Trust In Healthcare Providers Research Articles

'Let him die in peace': understanding caregiver's refusal of medical oxygen treatment for children in Nigeria.

Efforts to improve oxygen access have focused mainly on the supply side, but it is important to understand demand barriers, such as oxygen refusal among caregivers. We therefore aimed to understand caregiver, community and healthcare provider (HCP) perspectives and experiences of medical oxygen treatments and how these shape oxygen acceptance among caregivers of sick children in Lagos and Jigawa states, which are two contrasting settings in Nigeria. Between April 2022 and January 2023, we conducted an exploratory qualitative study using reflexive thematic analysis, involving semistructured interviews with caregivers (Jigawa=18 and Lagos=7), HCPs (Jigawa=7 and Lagos=6) and community group discussions (Jigawa=4 and Lagos=5). We used an inductive-deductive approach to identify codes and themes through an iterative process using the theoretical framework of acceptability and the normalisation process theory as the analytic lens. Medical oxygen prescription was associated with tension, characterised by fear of death, hopelessness about a child's survival and financial distress. These were driven by community narratives around oxygen, past negative experiences and contextual differences between both settings. Caregiver acceptance of medical oxygen was a sense-making process from apprehension and scepticism about their child's survival chances to positioning prescribed oxygen as an 'appropriate' or 'needed' intervention. Achieving this transition occurred through various means, such as trust in HCPs, a perceived sense of urgency for care, previous positive experience of oxygen use and a symbolic perception of oxygen as a technology. Misconceptions and pervasive negative narratives were acknowledged in Jigawa, while in Lagos, the cost was a major reason for oxygen refusal. Non-acceptance of medical oxygen treatment for sick children is modifiable in the Nigerian context, with the root causes of refusal being contextually specific. Therefore, a one-size-fits-all policy is unlikely to work. Financial constraints and community attitudes should be addressed in addition to improving client-provider interactions.

211 A Machine Learning Approach to Reduce Disparities in Compliance with Public Health Interventions

OBJECTIVES/GOALS: To establish the root causes of vaccine hesitancy in populations who have less equitable access to health and healthcare services, and experience healthcare inequities, related to the environmental and social determinants of health, through community engagement and conversations, collaboration, circulation, and communication. METHODS/STUDY POPULATION: Existing data from a cross-sectional survey, vaccine hesitancy (VH) parent study, entitled 'Western New York (WNY) COVID-19 Collaborative to Promote Vaccine Acceptance,' conducted July to November 2022, after IRB approval, will be qualitatively analyzed. In the parent study, surveys were administered in WNY community congregations and community centers to individuals that historically have less equitable access to healthcare resources and may encounter health and healthcare disparities. Minorities, in urban and rural areas, age eighteen and older were identified through the NYS Department of Health’s Immunization Information System for daily vaccination rates. A qualitative analysis, promoting fact base HL, and building an inferential statical machine learning tool are the next steps. RESULTS/ANTICIPATED RESULTS: We anticipate the results to show an interplay of multiple factors, including personal, cultural, historical, social, and political, and varies depending on circumstances of time, place, and the type of vaccine being offered. Additionally, a lack of awareness or understanding of vulnerabilities and seriousness of vaccine-preventable diseases, lack of trust in health care providers, social norms, distrust of the healthcare system, biomedical research, and government policy, limited knowledge and understanding of vaccine safety and efficacy, and fear/uncomfortable with needles, as well as the less addressed environmental and social determinants of health associated with racial/ethnic minorities in communities with limited resources may also contribute to VH and less favorable health outcomes. DISCUSSION/SIGNIFICANCE: Identifying people who historically have less equitable access to healthcare resources and may be more likely to resist healthcare services, due to distrust in the system is important. Creating and evaluating an innovative tool to predict refusal of public health interventions is essential to avoid spreading preventable diseases.

Unveiling Patient Trust in Physicians Across China: Insights from a Nationwide Cross-Sectional Study.

Trust is a major factor affecting patient-physician relationship and healthcare quality. However, there has been a lack of comprehensive study on the extent of and major factors affecting patient trust in healthcare providers of China, the world's largest developing country. The objective of this study is to elucidate the current status of outpatient trust in physicians in China and its influencing factors, providing empirical evidence to enhance doctor-patient trust and improve doctor-patient relationships. Between December 2017 and January 2018, 28,760 patients seeking care at the outpatient departments of 136 tertiary hospitals were interviewed, where they were asked to rate their trust in physicians. We applied a multilevel logistic regression model to explore the association between patients trust and characteristics of hospitals, physicians and patient characteristics. We conducted a series of sensitivity analysis to check the robustness of our findings. Among 28,760 participants included in this study, 91.54% expressed trust in their physicians, while 7.52% showed moderate trust. Only 0.94% expressly distrusted or strongly distrusted their physicians. Outpatients of hospitals with convenient payment, volunteer guidance and enough seats available in the rest and waiting area showed higher levels of trust. Physicians who had a senior title, showed patience and protection of the patient's privacy were more likely to be trusted by their patients in the outpatient setting. Compared to their female counterparts, male outpatients showed a higher degree of trust. While this study highlights an overall high level of Trust in physicians (TIP) among patients in China's tertiary hospitals, it is found to vary with patient demographic factors as well as provider's attributes. Hospitals with a more keen sense of protecting patients privacy and better meeting patients' need for efficient and caring service provision process appeared to yield a higher level of trust.

Consequences of receiving weight-related advice from a healthcare provider: Understanding the varied experiences of people with higher weight

Healthcare providers regularly give weight-related advice (e.g., behavioral weight loss counseling) to patients with higher weight (BMI ≥30 kg/m2). The U.S. Preventive Services Task Force recommends this practice on the basis that behavioral weight-related advice can motivate patients to attempt weight loss; however, it is also possible that this advice has adverse consequences (e.g., negative psychological reactions). In this study, we examined people's reported reactions to a recent experience of receiving weight-related advice from a healthcare provider. U.S. adults (N = 189) with higher weight who reported having received weight-related advice completed an online survey via Prolific. They answered questions about their most recent experience of receiving weight-related advice, including the purpose of the visit, characteristics of their provider, and characteristics of the advice itself. They also provided demographic information and indicated their trust in healthcare providers and the healthcare system. 90.5% of participants (n = 171) reported having one of three types of reactions to their provider's weight-related advice. Participants (1) felt motivated to change their behaviors and weight; (2) felt bad or guilty about their behaviors and weight; or (3) felt both motivated to change and bad or guilty. Using chi-square tests of independence and one-way ANOVAs, we examined how various participant characteristics and characteristics of the visit, provider, and advice itself differed across these three groups. We found significant demographic differences across the groups and found that a disproportionate amount of people in the “motivated” group reported having requested the weight-related advice and having had a two-way discussion about weight with their provider. Whereas some people feel motivated after receiving weight-related advice from a healthcare provider, others are left feeling bad about themselves or ambivalent. Understanding these varied reactions may provide insights into how healthcare providers can deliver advice that is motivating without eliciting negative psychological reactions.

Data Governance in AI - Enabled Healthcare Systems: A Case of the Project Nightingale

The study investigates data governance challenges within AI-enabled healthcare systems, focusing on Project Nightingale as a case study to elucidate the complexities of balancing technological advancements with patient privacy and trust. Utilizing a survey methodology, data were collected from 843 healthcare service users employing a structured questionnaire designed to measure perceptions of AI in healthcare, trust in healthcare providers, concerns about data privacy, and the impact of regulatory frameworks on the adoption of AI technologies. The reliability of the survey instrument was confirmed with a Cronbach's Alpha of 0.81, indicating high internal consistency. The multiple regression analysis revealed significant findings: a positive relationship between the awareness of technological projects and trust in healthcare providers, countered by a negative impact of privacy concerns on trust. Additionally, familiarity with and perceived effectiveness of regulatory frameworks were positively correlated with trust in data, while perceptions of regulatory constraints and data governance issues were identified as significant barriers to the effective adoption of AI technologies in healthcare. The study highlights the critical need for enhanced transparency, public awareness, and robust data governance frameworks to navigate the ethical and privacy concerns associated with AI in healthcare. The study recommends adopting flexible, principle-based regulatory approaches and fostering multi-stakeholder collaboration to ensure the ethical deployment of AI technologies that prioritize patient welfare and trust.

Patient Perspective on Informed Consent In Surgery: A Qualitative Investigation

Background: Informed consent is a fundamental ethical principle in healthcare, representing mutual understanding and agreement between healthcare providers and patients, particularly crucial in surgical contexts. However, the patient's perspective on this process remains underexplored, especially in resource-constrained regions like Muzaffarpur and Bihar. Materials and Methods: This qualitative investigation employed a phenomenological research design to explore the experiences of 23 adult patients who underwent surgical procedures in Muzaffarpur. Semi-structured interviews, conducted in Hindi, were used to gather data, which were subsequently analyzed thematically. Results: The study revealed several key themes: (1) Limited Information Disclosure, (2) Short Timeframes for Decision-Making, (3) Varied Communication Styles, (4) Trust in Healthcare Providers, (5) Sociocultural Factors, and (6) Desire for More Information. These findings highlight the need for improved patient-centered communication, transparent information disclosure, trust-building, cultural sensitivity, and time allocation in the informed consent process. Conclusion: The patient's perspective on informed consent in surgical settings in Muzaffarpur, Bihar, underscores the importance of tailoring practices to local contexts. Enhancing communication, trust, and information accessibility can promote patient autonomy and improve the informed consent experience. These insights are vital for advancing ethical healthcare in resource-constrained regions.

Building Perspectives for Resilient Health System: Lessons Learned from the Experience of Patients and Health Professionals during COVID-19

The study seeks to explore experiences and perceived needs of patients in source isolation and healthcare professionals’ management of COVID-19 patients to inform practice in the event of emerging health disaster. Participants were recruited through snowball and purposive sampling strategy. We conducted semi-structured telephone interviews to understand their subjective evaluations of these events. We applied inductive thematic analysis, which yielded six themes. The health events resulting from COVID-19 varied and shaped patient perspectives. Response to care received and trust in healthcare providers was encouraging, including expressions of gratitude and resilience towards discomfort brought on by isolation. Processing COVID-19 in isolation describes how patients cognitively and psychologically dealt with the illness. Clinicians’ experiences of working in isolation centred around workflow management, maintaining safety, focus on patient-centric approach and expanding roles of health workers, even as complacency towards COVID-19 was on the rise. Effective deployment of resources, efforts of experienced clinicians and staff, along with cooperation and resilience of patients, paves the way for the system to endure through the crisis. These lessons can be preserved for practice as global health entities are pushing for pandemic response, preparedness and prevention through measures such as the pandemic treaty.

Examining Race-Based and Gender-Based Discrimination, Trust in Providers, and Mental Well-Being Among Black Women.

To examine experiences of discrimination among Black women, and to determine if experiencing race- and gender-based discrimination is associated with mental well-being and trust. Data from the TRUST study were used to examine experiences of discrimination among 559 Black women with hypertension receiving healthcare at a safety-net hospital in Birmingham, Alabama. A three-level variable was constructed to combine the race-based and gender-based measures of the Experiences of Discrimination scale. Linear regression was used to examine the association between experiences of discrimination with mental well-being and trust. Women who reported no experiences of race- or gender-based discrimination were older and reported higher mental well-being scores and greater trust. Fifty-three percent of study participants reported experiencing discrimination. Compared to participants who did not experience race- or gender-based discrimination, participants reporting experiences of race- or gender-based discrimination and those reporting experiencing both race- and gender-based discrimination were more likely to report poorer mental health. Reported experiences of gender- and/or race-based discrimination in this study were associated with lower mental health scores and less trust in health care providers. Our findings highlight the importance of examining experiences of discrimination among Black women, and the role of discrimination as a stressor and in reducing trust for providers. Incorporating an understanding and acknowledgement of experiences of discrimination into interventions, programs, and during clinical encounters may foster more trusting relationships between providers and patients.

Impact of disability-based discrimination in healthcare on parents of children with medical complexity.

To qualitatively assess the impact of disability-based discrimination in healthcare on the parents of children with medical complexity (CMC). In this qualitative study, we conducted in-depth, semi-structured interviews with the parents of CMC. Data collection and analysis occurred iteratively; constant comparison methods were used to identify themes describing the impact of disability-based discrimination in pediatric healthcare on the parents of CMC. Thirty participants from 15 US states were interviewed. Four themes were developed regarding the impact of disability-based discrimination in healthcare on parents. The themes were: (1) discrimination leads to a loss of trust in healthcare providers; (2) discrimination increases the burden of caregiving; (3) discrimination impacts parental well-being; and (4) racism and poverty-based discrimination amplifies disability-based discrimination. The experience of discrimination toward their child results in loss of trust and therapeutic relationship between provider and parent, causes increased burden to the family, and contributes to decreased parental well-being. These experiences are magnified in minoritized families and in families perceived to have a lower socioeconomic status based on insurance type.

Understanding attitudes and beliefs regarding COVID-19 vaccines among transitional-aged youth with mental health concerns: a youth-led qualitative study

BackgroundTransitional-aged youth (16–29 years) with mental health concerns have experienced a disproportionate burden of the COVID-19 pandemic. Vaccination is limited in this population; however, determinants of its vaccine hesitancy are...

Understanding COVID-19 vaccination decisions during pregnancy and while breastfeeding in a Canadian province

ABSTRACTBackgroundVaccination in pregnancy is important for preventing illness for mothers and babies; however, vaccine uptake in pregnant individuals is lower than non-pregnant females of fertile age. Given the devastating effects of COVID-19 and the increased morbidity and mortality risk for pregnant individuals, it is important to understand the determinants of vaccine hesitancy in pregnancy. The focus of our study was to explore COVID-19 vaccination among pregnant and breastfeeding individuals and its association with their reasons (psychological factors) for vaccination using the 5C scale and other factors.MethodsAn online survey investigating prior vaccinations, level of trust in healthcare providers, demographic information, and the 5C scale was used for, pregnant and breastfeeding individuals in a Canadian province.ResultsPrior vaccinations, higher levels of trust in medical professionals, education, confidence, and collective responsibility predicted increased vaccine uptake pregnant and breastfeeding individuals.ConclusionsThere are specific psychological and socio-demographic determinants that affect COVID-19 vaccine uptake in pregnant populations. Implications of these findings include targeting these determinants when informing and developing intervention and educational programs for both pregnant and breastfeeding individuals, as well as healthcare professionals who are making vaccine recommendations to patients. Study limitations include a small sample and lack of ethnic and socioeconomic diversity.

Australian Sexual Health Service Users’ Perspectives on Reducing the Oral Transmission of Bacterial STIs: A Qualitative Study

ABSTRACT Growing rates of bacterial sexually transmitted infections (STIs) demand new approaches to STI prevention. Sexual practices involving saliva or direct contact with the mouth increase the risk of STI transmission, but community awareness remains largely unexplored in the literature. The Community Awareness and Surveillance of STI Transmission study sought to explore sexual health clinic attendees’ awareness of oral STIs; experiences when seeking testing and treatment; and acceptable educational and clinical interventions. Twenty-one semi-structured interviews were conducted with a diverse group of Melbourne Sexual Health Center attendees’. Reflective thematic analysis was undertaken, revealing key themes across people of different genders, sexual identities, ages, and nationalities. All participants emphasized the importance of understanding how their sexual practices might put them at risk of an oral STI. They also sought care from specialist sexual health services with the expectation that health-care providers (HCPs) in these settings had more understanding of diverse sexual practices. Participants’ decisions to protect themselves against oral STIs were primarily driven by the effect the decision had on pleasure and intimacy. Comfort during the health-care encounter and trust in HCPs facilitated better understanding of individual STI risk. Differences in awareness and risk reduction strategies were noted based on past experience with oral testing and STIs. These findings highlight the importance of HCPs and public health interventions providing solutions that recognize the central role of pleasure and intimacy in our sexual lives.

Calibration of Medical Devices: Method and Impact on Operation Quality

Medical devices play a pivotal role in modern healthcare, aiding in accurate diagnosis, monitoring, and treatment of patients. The reliability and accuracy of these devices are indispensable for ensuring patient safety and well-being. This project highlights the critical importance of calibrating medical devices to maintain their accuracy, precision, and performance, ultimately safeguarding the lives of patients. Calibration of medical devices is a systematic process that verifies and adjusts their measurements to a known standard. This process ensures that medical devices consistently provide accurate data and results. In the absence of proper calibration, there is a significant risk of incorrect readings, misdiagnoses, and inappropriate treatment plans, all of which can lead to patient harm. Regular calibration is essential not only for maintaining patient safety but also for meeting regulatory requirements and quality assurance standards. It helps identify and rectify deviations or drifts in device performance, preventing potential hazards in healthcare settings. Compliance with calibration protocols ensures that medical institutions and professionals can deliver reliable and effective care. Moreover, calibrated medical devices enhance the efficiency and cost-effectiveness of healthcare systems by minimizing the need for repeated tests and procedures due to inaccurate results. Patients can have confidence in the reliability of the devices used in their care, fostering trust in healthcare providers and institutions.

Colorectal Cancer (CRC) Screening Literacy and Facilitators Related to a Free Screening Program in Thailand.

This study aimed to evaluate CRC screening literacy and to determine the association between demographic characteristics and levels of CRC screening literacy and facilitators motivating participation. This cross-sectional study was carried out with 1,272 Thai citizens aged 50-70 years consenting to complete the screening protocol. Data were collected at the final visit by a self-reported questionnaire which was developed and validated using I-CVI=1. Difficulty of CRC screening knowledge dimension was tested by KR20, Cronbach's alpha 0.49. The majority of participants, 834 (65.6%) had sufficient CRC screening literacy and association between characteristics and levels of CRC screening literacy was not different. Comparing between characteristics and facilitators showed significant differences in trusting healthcare providers, perceiving harmless procedures, having constipation and time available. By married and own income participants exhibited lower trust in healthcare providers, 68% (OR 0.32, 95%CI 0.14 - 0.73) and 59% (OR 0.41, 95%CI 0.19 - 0.95), respectively. Married individuals perceived the procedures of screening involved higher harm, 32% (OR 0.68, 95%CI 0.45 - 0.99). Female and age over 60 with constipation constituted higher screening, 1.9 fold (OR 1.93, 95%CI 1.44 - 2.60) and 1.4 fold (OR 1.44, 95%CI 1.09 - 1.90). Though time available, age over 60 was lower screening 56% (OR 0.44, 95%CI 0.24 - 0.80), while own income and income more than 30,000 THB/month participants constituted higher screening 15 fold (OR 15.14, 95%CI 4.72 - 48.56) and 2.5 fold (OR 2.50, 95%CI 1.50 - 4.18), respectively. CRC screening literacy of participants was high. The association between characteristics and CRC screening literacy levels did not differ while characteristics and facilitators differed in some aspects. The free program promoted CRC screening equity; however, multilevel facilitators must be concerned, prioritized and intervened to motivate participation.

Patients' perspectives on informational needs surrounding gender-affirming vaginoplasty.

This study aimed to investigate the informational preferences of patients undergoing gender-affirming vaginoplasty during their surgical journey. An anonymous survey was sent to 30 such patients who had the procedure between September 2018 and September 2020. The survey included Likert-scale questions about the importance of various topics and inquired about their preferred sources and formats for receiving this information. The responses of 17 individuals (56.7% response rate) were analyzed using descriptive statistics and qualitative thematic analysis. Key findings indicated that all topics in the survey were rated as moderately important or higher. Specifically, for 29 out of 30 pre-operative topics (96.7%), participants preferred written information, and for 27 topics (90.0%), they favored receiving information directly from their surgeon. Thematic analysis revealed five main themes: recovery process, satisfaction, trust in healthcare providers, information delivery, and neovaginal dilation and depth. In conclusion, individuals undergoing gender-affirming vaginoplasty have significant informational needs. They prefer to receive information from their surgical team, supplemented by written resources and verbal discussions. Notably, the importance of understanding neovaginal dilation and being aware of possible complications emerged as a key concern. The study also highlighted the importance of cultural competence and trust-building with healthcare providers, underscoring the need for more inclusive care practices.

Trust of patients and families in mental healthcare providers and institutions: a cross-cultural study in Chennai, India, and Montreal, Canada.

Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada, and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up. Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Nonparametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers. The study included 333 patients (Montreal = 165, Chennai = 168) and 324 family members (Montreal = 128, Chennai = 168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up. This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.

Navigating cultural diversity and conversation barriers in palliative care: a mini review

Navigating cultural diversity while providing palliative care is crucial to ensure that healthcare providers offer their patients the best possible care. Palliative care is increasingly confronted with cultural diversity. To achieve quality care, clinicians must be culturally competent and receive cross-cultural training. Culturally competent clinicians are those who adhere to organizational policies, undergo cross-culture training, and utilize the latest advances to enhance communication, improve health outcomes, and reduce racial and ethnic health disparities. Objective: The main aim of this review is to understand the complexities and challenges associated with navigating cultural diversity in palliative care. This entails recognizing and addressing religious beliefs, family roles, and other culturally rooted practices and perceptions that could influence the delivery of palliative care. Findings: Various cultural barriers have been identified that healthcare providers face, including communication barriers, religious beliefs, family roles, beliefs about suffering and pain, alternative medicines, trust in healthcare providers, radical and ethnic bias, and gender bias. Technological advances, organizational policies, and targeted education can mitigate these cultural and cross-cultural communication barriers. Enhanced training fosters understanding and ensures that diverse populations receive respectful end-of-life and palliative care. Such strategies promote trust, enhance patient-provider relationships, and lead to improved health outcomes. Conclusion: Navigating cultural diversity in palliative care is crucial. Despite the presence of various technological advancements, the ongoing necessity for healthcare providers to possess cultural competence and sensitivity remains evident. Continuous training, education, and heightened awareness are essential. The implementation of IA tools, revisions to organizational policies, and the enhancement of medical training can contribute to achieving cultural competence in healthcare. Looking ahead, we aspire to see improved personalized care that harmonizes medical expertise with cultural understanding, ultimately reducing disparities and elevating care standards universally.

Confidential Enquiry into Maternal Deaths in Namibia, 2018-2019: A Local Approach to Strengthen the Review Process and a Description of Review Findings and Recommendations.

First objective was to strengthen the national maternal death review, by addressing local challenges with each step of the review cycle. Second objective was to describe review findings and compare these with available findings of previous reviews. Confidential Enquiry into Maternal Deaths methodology was used to review maternal deaths. To improve reporting, the national committee focussed on addressing fear of blame among healthcare providers. Second focus was on dissemination of findings and acting on recommendations forthcoming the review. Reviewed were reported maternal deaths, that occurred between 1 April 2018 and 31 March 2019. Seventy maternal deaths were reported; for 69 (98.6%) medical records were available, compared to 80/119 (67.2%) in 2012-2015. Reported maternal mortality ratio increased with 48% (92/100,000 live births compared to 62/100,000 in 2012-2015). Obstetric haemorrhage was leading cause of death in the past three reviews. The "no name, no blame" policy, aiming to identify health system failures, rather than mistakes of individuals, was repeatedly explained to healthcare providers during facility visits. Recommendations based on findings of the review, such as retaining experienced staff, continuous in-service training and guidance, were shared with decision makers at regional and national levels. Healthcare providers received training based on review findings, which resulted in improved management of similar cases. Enhanced implementation of Confidential Enquiry into Maternal Deaths was possible after addressing local challenges. Focussing on obtaining trust of healthcare providers and feeding back findings, resulted in better reporting and prevention of potential maternal deaths.

Comparison of Understanding and Recall of Informed Consent Information in Written and Video Formats: A Focus on Retrograde Intrarenal Surgery

Objective: The aim of this study was to assess the impact of using video as an educational tool in the informed consent process for retrograde intrarenal surgery (RIRS) on patient understanding, satisfaction, and preferences compared to traditional written consent forms. Material and Methods: A total of 114 patients scheduled for RIRS participated in this study. After reading informed consent, participants completed a questionnaire assessing their baseline knowledge about the RIRS procedure. They then watched an educational video about the procedure and completed a post-video questionnaire to assess changes in knowledge and preferences between written and video-based informed consent. Results: The results demonstrated that incorporating a video into the informed consent process led to significant improvements in patients’ knowledge about the RIRS procedure (p<0.001). A majority of participants (94.5%) found the video presentation to be more helpful than the written consent form and preferred it over the traditional method. Additionally, the use of video was associated with increased confidence in making informed decisions about the procedure. The majority of participants found the video to be easily accessible and comprehensible, which contributed to their overall satisfaction. Conclusion: Video-enhanced informed consent process can be a valuable addition to the standard informed consent process in clinical practice. By providing easily accessible and comprehensible information, healthcare providers can better meet patients’ needs and improve the overall quality of care. This approach may lead to better patient outcomes, increased trust in healthcare providers, and a more patient-centered approach to medical care.

Reasons for non-disclosure of HIV-Positive status to healthcare providers: a mixed methods study in Mozambique

BackgroundNon-disclosure of known HIV status by people living with HIV but undergoing HIV testing leads to waste of HIV testing resources and distortion of estimates of HIV indicators. In Mozambique, an estimated one-third of persons who tested positive already knew their HIV-positive status. To our knowledge, this study is the first to assess the factors that prevent people living with HIV (PLHIV) from disclosing their HIV-positive status to healthcare providers during a provider-initiated counseling and testing (PICT) campaign.MethodsThis analysis was nested in a larger PICT cross-sectional study performed in the Manhiça District, Southern Mozambique from January to July 2019, in which healthcare providers actively asked patients about their HIV-status. Patients who tested positive for HIV were crosschecked with the hospital database to identify those who had previously tested positive and were currently or previously enrolled in care. PLHIV who did not disclose their HIV-positive status were invited to participate and provide consent, and were interviewed using a questionnaire designed to explore barriers, patterns of community/family disclosure, and stigma and discrimination.ResultsWe found that 16.1% of participants who tested positive during a PICT session already knew their HIV-positive status but did not disclose it to the healthcare provider. All the participants reported previous mistreatment by general healthcare providers as a reason for nondisclosure during PICT. Other reasons included the desire to know if they were cured (33.3%) or to re-engage in care (23.5%). Among respondents, 83.9% reported having disclosed their HIV-status within their close community, 48.1% reported being victims of verbal or physical discrimination following their HIV diagnosis, and 46.7% reported that their HIV status affected their daily activities.ConclusionPrevious mistreatment by healthcare workers was the main barrier to disclosing HIV-positive status. The high proportion of those disclosing their HIV status to their community but not to healthcare providers suggests that challenges with patient-provider relationships affect this care behavior rather than social stigma and discrimination. Improving patient-provider relationships could increase trust in healthcare providers, reduce non-disclosures, and help optimize resources and provide accurate estimates of the UNAIDS first 95 goal.