Well-being Outcomes Research Articles

Strategies for Promoting Positive Childbirth Experiences: Delphi Approach

Background:: The experiences that women gain during childbirth remain with them throughout life. This study aimed to provide strategies to promote positive childbirth experiences. Method:: This Delphi study was conducted in three rounds from September to November 2019. A purposively selected 17 national experts, including obstetricians, reproductive health professionals, and midwives, participated in this study. Results:: Most of the 52 initial strategies in the first round (50 strategies) were approved with a few corrections in the first and second rounds, and 23 strategies were presented in the third-round questionnaire; most panelists agreed upon them. Finally, they approved 73 strategies with five categories: promoting professional support, enhancing control skills, encouraging empowerment, promoting spouse and other important support, and improving childbirth preparation. Conclusion:: The Delphi approach allows for developing a consensus that will serve as a template for education, practice, and future research in maternity care units. Hence, multidimensional approaches are required to promote positive childbirth experiences that can potentially improve mothers’ well-being outcomes.

Strengthening the pain care ecosystem to support equitable, person-centered, high-value musculoskeletal pain care

Abstract Improving health and wellbeing outcomes for people experiencing chronic musculoskeletal pain requires collective efforts across multiple levels of a healthcare ecosystem. System-wide barriers to care equity must however be addressed (eg, lack of co-designed services; overuse of low value care/underuse of high value care; inadequate health workforce; inappropriate funding models; inequitable access to medicines and technologies; inadequate research and innovation). In this narrative review, utilizing a systems’ thinking framework, we synthesize novel insights on chronic musculoskeletal pain research contextualized through the lens of this complex, interconnected system, the “pain care ecosystem.” We examine the application of systems strengthening research to build capacity across this ecosystem to support equitable person-centred care and healthy ageing across the lifespan. This dynamic ecosystem is characterized by three interconnected levels. At its centre is the person experiencing chronic musculoskeletal pain (micro-level). This level is connected with health services and health workforce operating to co-design and deliver person-centred care (meso-level), underpinned further upstream by contemporary health and social care systems (macro-level context). We provide emerging evidence for how we, and others, are working towards building ecosystem resilience to support quality musculoskeletal pain care: at the macro-level (eg, informing musculoskeletal policy and health strategy priorities); at the meso-level (eg, service co-design across care settings; health workforce capacity); and downstream, at the micro-level (eg, person-centred care). We outline the mechanisms and methodologies utilized and explain the outcomes, insights and impact of this research, supported by real world examples extending from Australian to global settings.

The Influence of Loneliness on Pain Outcomes for Adolescents: A Cross-Sectional Survey

ABSTRACT Background Loneliness, the perception that one’s social relationships do not meet the desire for social connection, is a risk factor for poor mental and physical health. Adolescents with chronic pain experience higher rates of peer loneliness which persists over time. Previous studies used a single loneliness measure, limiting our understanding of the nature of their loneliness. This study describes the types of peer loneliness (intimate, relational, and collective) experienced by these adolescents and the impact that peer loneliness has on pain-related outcomes. Methods A cross-sectional online survey was completed by 128 Canadian adolescents aged 12–18 years who experienced pain for at least 3 months. Validated measures captured demographics, pain-related characteristics, types of peer-related loneliness, measures of social well-being, and mental and physical health outcomes. Results Friedman’s tests of z-scores indicate that participants equally experienced dyadic, relational, and collective peer loneliness. MANCOVA revealed that those who identify as Black were lonelier after controlling for socioeconomic status. Multiple regression showed that loneliness was a robust predicter of worse scores on social well-being and mental health outcomes with males and females equally impacted by loneliness. Despite moderate correlations between loneliness and pain interference and pain intensity, loneliness did not predict school absences, suggesting that loneliness’ influence on physical pain outcomes may be temporally earlier (e.g. contribute to pain chronification). Conclusions Peer loneliness among adolescents with chronic pain negatively impacts their social well-being and mental health outcomes. Interventions addressing loneliness to target all three types of peer loneliness may be key to improving pain-related outcomes.

Loneliness and Social Isolation: qualitative study among youth in vulnerable situations

Abstract Background Loneliness and social isolation are increasing among young people, particularly those in vulnerable NEET (Not in Education, Employment or Training) situations, potentially leading to poor health and well-being outcomes. We aim to explore these challenges from the perspective of NEET youngsters and link workers who support them in co-creating individual action plans for their social and economic integration. Methods Data were collected through in-depth and semi-structured interviews with 15 young people in NEET situations, aged 18-34, and 7 link workers from several social organisations in rural and urban areas in Portugal. The young participants were selected based on their age, educational level, mental health needs, and urban/rural regions. Thematic analysis was used to analyse the interviews. Results The results showed a convergence between the perspectives of young people and link workers on the factors that influence social isolation and loneliness, including social and emotional skill deficits, excessive use of social media platforms, and mental health problems. Young people reported to being heavily involved in social media platforms, which often did not translate into meaningful relationships in real life. Youngsters also highlighted the lack of local support and community resources in rural areas. Link workers identified specific challenges young migrants face in community integration, including language barriers (for the youth with a migrant origin) and lack of familiarity with local resources. Conclusions This study highlights social media platforms, mental health and social and emotional skill deficits as main factors contributing to the social isolation and loneliness of young people in a NEET situation. This emphasizes the importance of integrated proximity-based interventions that incorporate community resource mapping and local support networks, including mental health support services, and promote multi-sector collaboration. Key messages • Social media platforms, mental health needs, and social and emotional skill deficits drive social isolation in NEET youth, stressing integrated, community-focused interventions. • Proximity-based strategies with community mapping and mental health support enhance NEET youths’ social integration, urging cross-sector collaboration.

Validity of the Multigroup Ethnic Identity Measure for Māori, Pacific, Asian & European adolescents

Abstract Background Ethnic identity is important for positive health and wellbeing outcomes, especially for Indigenous youth and adolescents from minoritised ethnic groups. The Multigroup Ethnic Identity Measure (MEIM) is widely used to examine ethnic identity as a general phenomenon across ethnic groups. However, evidence regarding its validity for adolescents from different ethnic backgrounds is mainly limited to the US context. This study investigated psychometric properties of the MEIM, for the first time, within a large ethnically diverse population-based sample in New Zealand. Methods We used data from the Growing Up in New Zealand study. Participants were 4500 12-year-olds and included 22.4% Māori (the Indigenous people of New Zealand), 16.7% Pacific, 14.8% Asian and 51.9% European young people. 45.7% were cisgender boy, 37.4% were cisgender girl, and 16.4% were non-binary, trans or unsure. We conducted factor analysis for the 12-item MEIM. Results Confirmatory factor analysis model fit tended to be best for a solution with two factors representing two ethnic identity subcomponents of Exploration and Affirmation/Belonging. A single ‘ethnic identity’ factor showed a slightly weaker model fit. Exploratory factor analysis revealed a 2-factor structure with a slightly different item composition as compared to the original MEIM subscales. The findings were largely comparable across ethnic groups. Conclusions The MEIM appears to be a valid measure for Māori, Pacific, Asian and European young people. However, nuances may exist due to unique contexts including structural factors, societal norms and challenges, opportunities and access to cultural engagement. Ethnic identity is strongly linked to health and wellbeing including quality of life, self-esteem and life satisfaction. Therefore, we recommend acknowledging nuances of ethnic identity during an important time of development within diverse cultural contexts, by applying subscales and subgroup analyses where possible. Key messages • The Multigroup Ethnic Identity Measure is valid and appropriate to use at age 12-years among diverse ethnic groups including Māori, Pacific, Asian and European. • Nuances of ethnic identity should be acknowledged as an important factor for health and wellbeing, especially during critical times of transition for adolescents within diverse cultural contexts.

Social prescribing for healthy ageing: insights from older people referral and uptake in Portugal

Abstract The population ageing presents multifaceted challenges for health systems, with implications for healthcare delivery and health and well-being outcomes. Innovative integrated-care approaches are needed to promote healthy aging and the quality of life of older people. Social Prescribing (SP) has emerged as a promising strategy to address the complex health and social needs of populations, including those older, offering non-medical interventions that encompass social, cultural, and community-based activities. SP has been implemented in Portugal since 2018 and currently target different subgroups, including elderly. This study aims to examine referral and uptake of older people to SP in Portugal. This cross-sectional study analysed sociodemographic, health condition, referral and uptake-related data from older patients (≥65 years) engaged in SP, collected through a survey and registries at primary healthcare units in Lisbon between 2018-2023. Of the 1060 patients referred to SP, 43.9% (n = 465) were aged 65 years or older. Within this age group, 38.1% were 71-80 years old and 36.1% were 81-90 years old; 67.5% were female. Around 48% were referred to SP for social isolation, 40% for social and financial support, and 32.5% for functional dependency. Two thirds had two or more chronic conditions, with cardiovascular disease (59,1%), mental health disorders (29,2%), and obesity (27,1%) being the most frequent. The SP consultations uptake rate was 59.1%, and patients were referred to a range of activities provided by third-sector organisations, as psychosocial support, home care, senior university classes, arts activities, and support in medicine management. The elderly population accounts for a large proportion of SP referrals. Further efforts are needed to identify the factors that influence patients’ acceptability and adherence and to promote the sustainability of SP and the well-being of the population. Key messages • Older people referred to SP initiative in Portugal have complex health-social needs, which reinforces the relevance of adopting a holistic centred-care approach to respond to the aging challenges. • Through SP older people have been integrated in community-based activities that promote their health and wellbeing, thus it is needed to develop tailored strategies to improve patient uptake.

Pleasure-inclusive sex education, sexual agency and sexual wellbeing in youth: A scoping review

Abstract Background A recent review study showed that pleasure-inclusive sex education can contribute to reducing sexual health risks such as unwanted pregnancy and STIs (Zaneva et al., 2022). Pleasure-inclusive sex education could also contribute to other measures of sexual wellbeing. In this study, we review the literature on associations between pleasure-incorporating sex education and sexual agency (including related concepts such as autonomy) and sexual wellbeing (part 1), and between sexual agency and sexual wellbeing (part 2). Methods We searched in 5 scientific databases using a wide scope of variables related to pleasure inclusive sex education, sexual agency, and various outcomes of sexual wellbeing, focusing on the last 2 decades. Forty-six articles were selected. Results In part 1 of the review we found that all studies reported associations between pleasure-based sex education and sexual agency or sexual wellbeing, but the literature is characterized by limitations and did not permit conclusions about the role of an added benefit of the pleasure component. In part 2 of the review study, we found positive associations between sexual agency (and related variables) and sexual wellbeing (including decreased levels of (re-)victimization). Conclusions Sexual agency may be related to increased sexual wellbeing, but it is still largely unclear whether pleasure-inclusive sex education can significantly contribute to this. There is a great need for high quality research, using innovative evaluation designs, taking into account the role of other important sources of sex education and other contextual factors. Key messages • A lot of work has been done, but the evidence that pleasure in sex ed ‘works’ for sexual wellbeing, is limited and indirect. • Great need for high quality research using novel and more realistic evaluation approaches.

Self-rated health in preadolescents as a predictor for prescription redemption and hospital contacts

Abstract Background The decline in self-rated health among children and adolescents raises concerns for their overall well-being and future health outcomes. We examined whether self-rated health in preadolescence predicts both psychiatric and somatic prescription redemption and hospital contacts in later adolescence. Methods This cohort study is part of the Danish National Birth Cohort and focuses on children born between 1996 and 2003. A survey was distributed to 96,382 preadolescents aged 11, who were then followed from 2010 to 2018 (average follow-up of 6.9 years). Data on prescriptions and hospital contacts were obtained from Danish registries. Negative binomial regression was employed to calculate the incidence rate ratio (IRR), comparing preadolescent children who rated their health as poor (‘Not So Good’/’Poor’) to those who rated it as good (‘Excellent’/’Good’). Results Of the 47,365 (49.1%) 11-year-old preadolescents who participated in this study, 5.3% reported experiencing poor self-rated health. Overall, adjusted analyses revealed higher rates of prescription redemptions (IRR 1.63 [95% CI: 1.53; 1.73]) and hospital contacts (IRR 1.86 [95% CI: 1.74; 1.99]) in these children. Poor self-rated health in preadolescence was associated with more somatic (IRR 1.51 [95% CI: 1.40; 1.62]) and psychiatric (IRR 3.04 [95% CI: 2.59; 3.57]) prescriptions, as well as somatic (IRR 1.61 [95% CI: 1.51; 1.72]) and psychiatric (IRR 2.80 [95% CI: 2.42; 3.25]) hospital contacts in adolescence, with similar associations across sexes. Conclusions Poor self-rated health in preadolescence is associated with higher rates of prescription redemption and hospital visits in adolescence, suggesting that perceptions of health in early life influence long-term well-being, especially regarding psychiatric health. This straightforward self-rated health measure offers healthcare professionals valuable insights for identifying children who may require support and early intervention. Key messages • Poor self-rated health in preadolescence predicts higher prescription redemption and hospital visits in adolescence, especially regarding psychiatric health. • Simple self-assessment of health in childhood may have the potential to help identify those needing support and early intervention for long-term well-being.

Predictors of adolescent well-being around the globe: are students from Confucian East Asia different?

PurposeUsing rich data from nearly 400,000 15-year-olds across 70 middle- and high-income countries and economies participating in PISA 2018, this study investigates (1) global predictors of adolescent subjective well-being (SWB), and (2) differences in adolescent life satisfaction, its predictors and endowments with predictors across world regions and cultures. A particular focus lies on comparing Confucian East Asia (CEA) with other world regions.MethodsData were analyzed using multiple linear regressions and Blinder-Oaxaca decomposition. As measures of adolescent well-being, this study employs life satisfaction, affective well-being, and meaning in life.ResultsGlobally, adolescent well-being outcomes are found to be most strongly linked to gender, personality, relative SES, relationship quality, peer SWB, autonomy and the learning environment, as well as local cultural factors. Estimations by world region reveal several culture-specific explanations for interregional well-being gaps. In particular, notoriously low levels of life satisfaction among students from CEA countries are found to be associated with low self-efficacy, low peer well-being, as well as with high emotional interdependence compared to other world regions. Emotional interdependence is more strongly experienced among CEA adolescents compared to adolescents from any other world region. Moreover, it is found to be more strongly associated with life satisfaction in the CEA region than in any other region. In line with the former, CEA students show stronger links between other relational factors (parents’ emotional support; sense of belonging at school) and life satisfaction compared to most other regions.ImplicationsThis study suggests that among the environmental factors that shape the experience of adolescent lives, relationship and cultural factors play key roles and are closely intertwined. Parents, educators and policymakers around the world should focus on creating a positive school environment that promotes well-being, student self-efficacy, a sense of belonging, and a safe space in which failure is accepted as part of the learning process. This is particularly needed in Confucian East Asian countries.

Social inequalities in the mental well-being of adolescents in Barcelona (2016-2021)

Abstract Crises have the potential to affect mental well-being (MWB), especially at vital stages of personal development such as adolescence. The objective of this study was to investigate the 2016-21 trends of social inequalities in the MWB of adolescents in Barcelona, stratifying by sex. Sequential, cross-sectional study based on the FRESC survey, held by the ASPB, representative of 8th and 10th grade adolescents (13-16 years old) schooled in Barcelona, in 2016 (N = 2,154) and 2021 (N = 2,299). MWB was examined using the validated WEMWBS, scoring from 14 (lowest) to 70 (highest) MWB. A temporal trend analysis of inequalities in MWB was carried out using the student socioeconomic status (SES) (low/average/high), measured with the validated FAS. For each group, the effect size of the WEMWBS means was measured with Cohen’s D. Linear regressions were performed, adjusting for academic grade, student country of origin, type of school and school index of vulnerable students. Adjusted β coefficients (aβ) and their statistical significance (p<.05) were estimated. In 2016, boys had higher MWB mean scores than girls (54.0 vs 50.8) (p<.01). In 2021, sex differences persisted, but with lower scores (51.7 vs 47.0) (p<.01) and still with a moderate effect size (0.52 in 2021 vs 0.40 in 2016). In multivariate regression models, boys in low SES showed the greatest MWB decrease in 2016 (low vs high SES: aβ= -3.44; p<.01). A significant temporal trend 2016-2021 of MWB worsening was observed in all groups, except for boys in low SES. The greatest deterioration in MWB was observed in girls, similarly in different SES (low SES: aβ= -3.52; p<.01). Boys in low SES showed the worst MWB in 2016 whereas all SES categories of girls had a significant trend of deterioration in MWB (2016-21). The latter could be attributed, among other factors, to a differential effect of the COVID-19 pandemic. These results underline the importance of addressing inequalities in the MWB, particularly among adolescent girls. Key messages • This study reveals a deterioration in mental well-being temporal trends (2016-2021) among adolescents in Barcelona, especially in girls. • Findings emphasize the need to address social inequalities for improving mental well-being outcomes in adolescent populations.

Public health effectiveness of cooling centres in adverse hot weather events: a systematic review

Abstract Background The 2022 heatwave in England highlighted the need for effective public health interventions like cooling centres in temperate climates where built-in air conditioning is uncommon. Aim To determine the impacts of cooling centres on heat-related health outcomes for users in temperate climates, assessing their effectiveness and identifying barriers to usage. Methods This systematic review analysed literature sourced from MEDLINE, Embase, Web of Science, CENTRAL, and Google Scholar from January 2010 to February 2023. Criteria for inclusion focused on studies evaluating health outcomes related to cooling centre use. Screening and quality assessments were independently conducted using the Mixed Methods Appraisal Tool. Results The review included six studies: three quantitative, three qualitative. Two were evidence synthesis of prior studies. No studies conclusively measured health and wellbeing outcomes directly after cooling centre use; instead, research emphasised user demographics, barriers, and facilitators. Common barriers included accessibility, operational hours, and public perceptions, which often misalign with user needs. Successful implementations were noted in centres integrated within community facilities like libraries or community centres. One modelling study suggested a number needed to treat to avoid one heat-related death of 1 million. The relevance of this is unclear as it was in a hotter climate with greater prevalence of air conditioning than in England. Conclusions While direct health benefits in cooler climates like England are poorly documented, cooling centres play an essential role in comprehensive heat response strategies. They offer potential social benefits and provide a cost-effective alternative to urban redesign. Future studies should aim to directly measure health outcomes and refine operational strategies to maximise benefits. Key messages • Cooling centres are crucial in comprehensive heat response strategies, yet direct evidence in cooler climates like England remains limited. • Integration with existing community services may significantly enhance cooling centre utilisation and effectiveness.

A Lifeline to Fill the Silence of Homelessness: Person-Centered Analysis of Digital Coping and Links to Mental and Physical Health.

Individuals experiencing homelessness are among the most vulnerable population for mental and physical health disparities. Despite navigating numerous stressors on a day-to-day basis, they are vastly underrepresented within coping research. Using a person-centered approach, this study addresses ways in which technology is leveraged to manage ongoing stressors associated with the experience of homelessness. We employed a two-step and k-means cluster analysis within a sample of unhoused individuals (n = 66). Two distinct clusters emerged, revealing unique patterning of digital coping, stress, self-efficacy, and technology use. Resulting clusters were validated across numerous health outcomes, including mental and physical health problems, as well as digital service use and experience of homelessness. High digital engagement/low self-efficacy individuals (65% of sample) reported high levels of digital self-efficacy, yet lower levels of general self-efficacy. In contrast, low digital engagement/high self-efficacy individuals (35% of sample) engaged in relatively lower digital coping and technology use, with lower stress and higher general self-efficacy. High digital engagement/low self-efficacy individuals, in turn, reported more mental and physical health problems; whereas low digital engagement/high self-efficacy reported somewhat decreased digital access. Relatively few differences emerged between the clusters on experiences of homelessness. Due to the transient nature of unhoused people, reaching such vulnerable populations via technology to support their digital coping and subsequently enhance well-being outcomes represents a critical next step for digital equity. This population is poised to benefit from digital equity efforts, with critical implications for reduced health disparities.

The Welsh Health Equity Solutions Platform – a mechanism for health equity solutions

Abstract Health inequities are a longstanding issue in Wales, as they are across the globe. They disproportionately affect the health and wellbeing outcomes of disadvantaged groups, restricting opportunities to live full and prosperous lives. Post COVID-19 new groups are emerging with disproportionately higher risk of poor health and premature death and disease, especially those with unmet needs and vulnerabilities, with the rising cost of living amplifying health inequities. Despite their prevalence, health inequities are avoidable. Efforts to reduce health inequities require action on all the social determinants of health across the life course. Improved understanding of the key drivers of health gaps is needed to address the problem and provide support for solutions-driven action to break down the barriers to health equity. The Welsh Health Equity Solutions Platform (WHESP) launched on 22nd June 2023, a collaboration between Public Health Wales, Welsh Government and WHO European Office for Investment in Health and Development. The WHESP is an innovative digital tool developed around the WHO Health Equity Status Report initiative framework of the ‘five essential conditions’ for healthy, prosperous lives for all. It is a mechanism for health equity solutions and aims to inform and facilitate policy and decision making to improve population health and address the increasing health gap through an online gateway to data, health economics, policies, and innovative health equity tools. Emerging evidence is highlighted to identify solutions for achieving healthy equity, which informs evidence-based decision making to reduce the health gap, improve overall population health and wellbeing, and achieve inclusive and sustainable economic growth and prosperity for all. Collating and sharing health equity solutions, evidence, data and best practice both across Wales and globally supports equitable, long-term action to improve the health and wellbeing of the population. Key messages • Highlighting health equity solutions informs best practice on tackling health inequalities. • WHESP provides extensive evidence to facilitate cross-sectoral action and policy change.

Effectiveness of spiritual care interventions among patients in the intensive care unit: A systematic review and meta-analysis.

Spiritual care interventions can be an important source of emotional support for patients in the intensive care unit (ICU). However, there is wide variation in the literature and no quantitative assessment to synthesize the results of these studies. To examine the effectiveness of spiritual care interventions on disease-related physiological parameter and treatment outcomes and psychosocial well-being outcomes among patients in the ICU. A comprehensive search was conducted across 11 databases from inception to 27 May 2024. Studies involving the implementation of spiritual care interventions for patients in the ICU were included. Cochrane's bias risk tool and JBI Critical Appraisal Checklist were used to examine the methodological quality of included studies. Review Manager 5.3 was used to conduct meta-analyses. A total of 18 studies were included. Meta-analysis showed that spiritual care interventions could significantly reduce mean arterial pressure (MAP) (MD: -12.12, 95% CI: [-23.68, -0.56], p = .04), length of stay in the ICU (MD: -5.49, 95% CI: [-8.99, -2.00], p = .002), and improved consciousness (MD: 3.91, 95% CI: [1.42, 6.39], p = .002), anxiety (SMD: -1.78, 95% CI: [-3.06, -0.50], p = .006), spiritual well-being (SMD: 1.57, 95% CI: [0.05, 3.08], p = .04) and comfort (MD: 15.53, 95% CI: [10.81, 20.25], p < .01) among patients in the ICU, but had no significant effects on heart rate (HR), respiratory rate (RR), pulse rate (PR), blood pressure (BP), oxygen saturation (SpO2), duration of ventilator use and pain. Spiritual care interventions could reduce MAP and length of stay in the ICU; improve consciousness, anxiety, spiritual well-being and comfort among patients in the ICU; and are still inconclusive for HR, RR, PR, BP, SpO2, duration of ventilator use and pain. Urgent efforts are needed to better integrate spiritual care interventions into clinical care to enhance patient well-being. Spiritual care interventions could improve well-being of patients in the ICU.

Overcoming Challenges and Promoting Positive Education in Inclusive Schools: A Multi-Country Study

Inclusive education faces significant challenges requiring deep understanding and comprehensive solutions. This study aims to establish a holistic framework for understanding the challenges in inclusive education, the core mission of inclusive schools, and the essential qualities of teachers. The methodology employed was qualitative, using the grounded theory method. A total of 59 experts from 13 countries participated in this study. Semi-structured asynchronous virtual interviews were conducted and analyzed using ATLAS.ti software (version 8). The results identified eight persistent challenges to inclusive education. In addition, positive education was highlighted as the fundamental core of inclusive schools, with emphasis on the development of learning, well-being, engagement, resilience, motivation, mental health, affective and social outcomes, creativity, and happiness. Finally, the integral profile of the inclusive teacher was defined based on a four-dimensional model. This groundbreaking study introduces a novel comprehensive framework that revolutionizes our understanding of the enduring challenges in inclusive education. Elucidating the core mission of inclusive schools and defining the essential qualities of inclusive teachers offers transformative insights. This study’s implications, future perspectives, and limitations provide a wealth of valuable information for policymakers, educators, and researchers, paving the way for innovative approaches and enhanced inclusive educational practices.

International and internal migration and the subjective wellbeing of wives left behind in Ghana

AbstractHusbands' labour migration has ramifications for significant family members, particularly wives left behind. However, limited studies have been conducted to examine the impacts of husbands' migration on women left behind married to international and internal migrants. Drawing on a purposive sampling survey of 298 Ghanaian women (international = 129 and internal = 169) in the Volta Region, we assessed their subjective wellbeing using three dimensions: self‐reported health, self‐reported satisfaction with life, and self‐reported happiness. The results from t‐tests show that on average, international women left behind have higher perceived health (3.72), perceived happiness (3.82) and satisfaction with life (3.19). Results from the multivariable binary logistic regression analyses reveal that while no variables predict self‐reported health for international women left behind, high frequency of communication is statistically associated with internal women left behind self‐assessed health. International women left behind who lived in nuclear households and internal women left behind who reported high wealth quintiles were both statistically associated with satisfaction with life, respectively. While demographic factors (age and duration of marriage) were significant predictors of happiness for international women left behind, neighbourhood type and frequency of communication predicted happiness for internal women left behind. The differences in variables predicting each of the subjective wellbeing dimensions demonstrate the concept's multidimensionality. It also highlights factors influencing subjective wellbeing outcomes of women left behind are not solely due to their husbands' migration. The policy implications of this study are highlighted.

Young carers in Ghana: caring activities, ways into care and the impacts of caregiving

ABSTRACT In Ghana, children often provide care and support to family members with disabilities, mental illnesses and other health conditions. Understanding the nature of their caring activities is essential for identifying stressors and promoting better health and wellbeing outcomes for this group of children, described in the wider literature as young carers. This qualitative study investigated the nature and impact of caring activities on young carers aged 11–17 years. The findings revealed that young carers provide domestic, financial, medical and personal care. Caring activities while beneficial, result in a double burden, as young carers often support both the care recipients and their dependents. Despite the challenges associated with caring activities, the study also reveals the myriad reasons young carers enter care work, suggesting that the work of young carers is not simply an obligation or a choice but a process and an integral part of Ghanian family structures. The study highlights the urgent need for formal mechanisms to identify and support young carers and their care recipients in Ghana.

An examination of caregiver burden and contributing factors in cases of congenital microtia deformity.

This study aimed to assess the burden and influencing factors among primary caregivers of children with congenital microtia. A total of 153 primary caregivers of children with congenital microtia who underwent auricular reconstruction surgery at a tertiary A-grade hospital in Xi'an between October 2019 and August 2022, were recruited using convenience sampling. The Zarit Caregiver Burden Interview (ZBI) was employed to evaluate caregiver burden. While convenience sampling allowed for the practical recruitment of participants, its limitations include potential selection bias, which may affect the generalizability of the results. The mean total ZBI score was 30.07 ± 12.29. Among the participants, 26 caregivers (17.0%) reported no burden, 102 caregivers (66.7%) reported mild burden, 22 caregivers (14.4%) reported moderate burden, and 3 caregivers (2.0%) reported severe burden. Multivariate regression analysis identified several significant factors influencing caregiver burden, including the location and severity of the lesion, educational level, method of medical payment, monthly household income, communication with others about the child's condition, caregiver self-blame or guilt, and family support (all P < .05). Primary caregivers of children with congenital microtia face substantial burdens, emphasizing the need for targeted healthcare interventions. Strategic approaches are essential to address the psychological, social, and financial challenges they encounter. Future research should focus on longitudinal studies and interventions to enhance caregiver well-being and patient outcomes. However, caution is advised when generalizing these findings due to the sampling limitations.

The dynamic effects of becoming disabled on work, wages and wellbeing in the UK from 1991 to 2018

Abstract Over recent decades it has consistently been shown that disabled adults in the UK fare worse in the labour market and have lower levels of wellbeing than non-disabled adults. However, this is in part due to the selection into dis-ability of those with existing socio-economic disadvantages. In this article, we use panel data from the combined British Household Panel Survey and Understanding Society, covering the 27 years from 1991 to 2018, to distinguish between the effect of selection, the effect of dis-ability onset and the effect of dis-ability duration on a range of labour market and wellbeing outcomes. We show that there is important selection both into dis-ability and into longer experience of dis-ability on the basis of observable characteristics. We also show the importance of controlling for time-invariant unobservable individual characteristics that similarly affect selection into dis-ability and duration of dis-ability. Even after controlling for both forms of selection, we find significant negative effects of dis-ability onset and duration, and offer policy solutions to address them.

The Development and Piloting of an Early Youth-Engagement (EYE) Model to Improve Engagement of Young People in First Episode Psychosis Services: A Mixed Methods Study.

Psychosis is associated with significant health and societal costs. Early intervention in psychosis services (EIP) are highly effective in promoting recovery, yet substantial proportions of young people disengage. The current study aimed to develop and evaluate a novel engagement intervention in EIP services. A qualitative investigation of facilitators and barriers to engagement in 68 first episode psychosis patients, family members and young people, and a Delphi consultation with 27 regional and national youth and psychosis service leads informed the development of the intervention. A mixed-methods feasibility-pilot study then compared engagement outcomes in 298 EIP service users in two cohorts: standard EIP versus standard EIP plus the novel early youth-engagement (EYE) intervention. A qualitative study explored intervention experiences in 22 randomly selected service users, carers and clinicians. A process evaluation explored delivery. Disengagement was 24% in the standard EIP cohort compared to 14.5% in the standard EIP plus EYE intervention cohort. A 95% Bayesian credibility interval revealed a 95% probability that the true reduction in disengagement lay somewhere between 0% and 18%. The number needed to treat was 11, 95% CI [5, 242]. Use of the EYE resources was associated with engagement. Qualitiative feedback supported effects on communication, social network engagement, service user goals, mental health and well-being outcomes. The EYE intervention was designed from a service user, young person and carer perspective. Both qualitative and quantitative data support impacts on engagement. We now need to evaluate effectiveness, cost-effectiveness and implementation in a multi-site randomised controlled trial.