Implementation and evaluation of a rural community-based pediatric hearing screening program integrating in-person and tele-diagnostic auditory brainstem response (ABR)

Technology acceptance and use among nursing staff in Latin American hospitals: A mixed methods study

Background

Digital health technologies can improve health outcomes and the efficiency of healthcare delivery when used appropriately. Nevertheless, the human-computer interaction is a concern in compassionate patient care and nurses' professional well-being.

Objective

To analyze the degree of technological acceptance and use within nurses in two Latin American university hospitals.

Design

A mixed methods study design.

Settings

Two Latin American university hospitals, one in Chile and the other in Colombia.

Participants

A total of 53 nurses participated in the study. In phase 1, 31 nurses took part, with 15 from a Chilean hospital and 16 from a Colombian hospital. In phase 2, 22 nurses participated, with 14 in Chile and 8 in Colombia.

Methods

: A mixed methods sequential study was conducted in inpatient services. It was developed in three phases. First, a quantitative one with a call to all nurses in two institutions, in Chile and Colombia. A scale of the unified theory of acceptance and use of technology, adapted to nursing in Spanish, was employed following expert validation both facial and content aspects. Second, a qualitative one with four focus groups with service coordinator nurses and in-depth interviews with nursing managers or supervisors. These sessions were recorded and transcribed verbatim. Quantitative data were analyzed using descriptive statistics and hypothesis testing for mean differences, while qualitative data underwent content analysis. Finally in the third phase, both qualitative and quantitative data were integrated to establish the acceptability and use of the technology.

Results

Quantitative analysis revealed a statistically significant positive correlation between behavioural intention to use the system and facilitating conditions ( r ( 31 ) = 0.50 , p < . 01 ). Also, there is a positive correlation between behavioural intention to use the system and effort expectancy in Chile ( r ( 13 ) = 0.60 , p < . 05 ). Additionally, a statistically significant difference ( p < . 05 ) exists between the two institutions regarding social influence and facilitating conditions. Qualitative data confirmed these findings. Integration made it possible to specify the factors such as the performance expectancy, facilitating conditions, and anxiety determine the acceptability and use of technology by nurses in the studied institutions.

Conclusions

The degree of technological adoption among nursing staff in two Latin American university hospitals is currently 3.7 ± 0.4 (scale from 1 to 5). Understanding the aspects that affect the acceptance and use of technologies paves the way for achieving their best use in support of nursing care.

Registration

ING-256-2020, January 16, 2023.

Tweetable abstract

Nurses in Latin American show mixed tech acceptance. Understanding barriers is crucial for better care delivery #DigitalHealth #NurseTech.

Targeting mental health and wellbeing in women who have experienced gender-based violence through moderate-vigorous physical activity: a systematic review

BACKGROUND

Gender-based violence (GBV) is associated with high rates of psychopathology (i.e., depression, anxiety, post-traumatic stress disorder) in victim-survivors. Existing research has demonstrated that physical activity is beneficial for mental health and wellbeing across various populations. However, it is currently unclear whether moderate-vigorous physical activity (MVPA) is efficacious for victim-survivors of GBV. Therefore, this systematic review aims to understand 1) the acceptability and feasibility of leisure-time MVPA interventions for victim-survivors of GBV, 2) the efficacy of leisure-time MVPA interventions for mental health and wellbeing in this cohort, and 3) the implementation strategies used in the development of such interventions.

METHODS

Four databases were searched from inception to January 2024. Leisure-time MVPA intervention studies that reported on at least one measure of mental health or wellbeing for self-identified/biological women who had lived experience of GBV were eligible.

RESULTS

Eleven studies met inclusion criteria, and analysis revealed a range of different types of MVPA (n = 5) and mental health/wellbeing outcomes measured (n = 9). The main findings include: 1) feasibility and acceptability of MVPA for victim-survivors was enhanced where trauma and violence-informed (TVI) practices were used in the development and delivery of interventions. 2) There was a lack of clarity and consistency around TVI practice in physical activity intervention research. 3) Leisure-time MVPA may be positively associated with mental health and wellbeing.

CONCLUSIONS

Limited evidence exists regarding the impact of MVPA on mental health and wellbeing for this important population group. Future studies should embed TVI strategy within the design, delivery, and implementation of interventions.

Unveiling trends in urinary tract cancer mortality among older adults in the United States (1999-2022): a CDC WONDER perspective

BACKGROUND

Urinary tract cancers (UTCs), including bladder cancer, remain a significant public health challenge, particularly among individuals aged 75 and older. Despite declining bladder cancer-specific mortality rates between 2015 and 2020, the broader trends in UTC mortality and associated demographic disparities remain underexplored.

METHODS

We analyzed mortality data from 1999 to 2022 using the CDC WONDER database. UTC deaths were identified using ICD- 10 codes C64 to C68. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, stratified by sex, race/ethnicity, and census regions. Joinpoint regression identified annual percent changes (APCs) to assess temporal trends.

RESULTS

From 1999 to 2022, 477,157 UTC deaths were recorded, 66% of which occurred among individuals aged 75 and older. The AAMR increased from 97.1 in 1999 to 103.5 in 2022, with a rise between 1999 and 2007 (APC: 0.63%), a decline from 2007 to 2019 (APC: - 0.33%), and a resurgence from 2019 to 2022 (APC: 2.42%). Older males exhibited higher AAMRs than females (178.7 vs. 53.6 in 2022), and Whites had the highest AAMR (108.5) among racial groups. The Western region recorded the highest AAMR (84.3) during the study period.

CONCLUSION

The resurgence in UTC mortality post- 2019 highlights emerging challenges, particularly among older males, Whites, and residents of the Western region. Targeted interventions, including improved screening and equitable healthcare access, are essential to mitigate these disparities and improve outcomes.

Assessment of the person-centered maternity care scale: a global systematic review

Background

Person-centered maternity care (PCMC) refers to respectful, responsive, and compassionate childbirth care. The PCMC scale enables quantitative measurement of PCMC. Despite the widespread use of the PCMC scale, no global synthesis exists. We, therefore, conducted a global systematic review of studies using the PCMC scale to quantitatively assess women's childbirth experiences, evaluate the scale's psychometric properties, and identify predictors of PCMC.

Methods

We searched PubMed, Web of Science, and Embase from inception to September 3, 2024. Included studies used the PCMC scale by Afulani et al. to examine the facility-based childbirth experiences of women in any setting, with no time or language restrictions. Three reviewers independently assessed titles, abstracts, and full texts. We assessed study quality using Joanna Briggs Institute critical appraisal tools. We utilized a standardized extraction template to extract full PCMC and sub-scale scores (standardizing scores to a 0-100 range for easier comparison), predictors, and psychometric properties. The primary outcome is the mean PCMC score.

Findings

Our initial search yielded 415 articles, of which 41 publications from 32 independent samples were included. Most studies were conducted in Africa (63%). Mean PCMC scores were generally lower in studies from Africa (under 75), moderate in Asia (60 to over 90), and higher in North America (over 80). The lowest score reported was 38.2/100 (SD = 15.8) in an observational study conducted in Sierra Leone, while the highest was 97.1/100 (SD = 2.9) following an intervention in India. The lowest scoring domain across countries was communication and autonomy, with the lowest score at 18.1/100 in a study in Ethiopia. Positive predictors of PCMC included higher wealth, education, early antenatal care, and birth in lower-level and private health facilities. Inconsistent predictors included age, marital status, and obstetric complications.

Interpretation

PCMC is sub-optimal globally, particularly in the domain of communication and autonomy. There are also inequities in PCMC driven by various sociodemographic and health systems-related factors. Interventions to improve women's experiences and to address the inequities are therefore needed.

Funding

None.

Group-Learning Activities and Nurses Internalization of Evidence-Based Practices: Secondary Analysis of a Cross-Sectional Study in Hospital Wards

Aim: This study is a secondary analysis aimed at verifying the relationship between organizational learning activities for evidence-based practices (EBPs) in hospital wards and nurses' internalization of those EBPs and analyzing the contextual effects. Methods: This study used data from a previous study which was conducted to develop the group organizational learning activity inventory and used the same sampling method. The participants were asked about the extent of their internalization of EBPs, the organizational learning activities in their ward, and individual and ward characteristics. This study employed two-level hierarchical linear modeling with nurses' internalization of EBPs as the objective variable, eight factors of the Group Organizational Learning Activity (GOLA) Inventory as the explanatory variable, and individual and ward characteristics as control variables. Nurses' individual scores for the eight factors of the GOLA Inventory were analyzed by centering within clusters, and the wards' mean GOLA Inventory scores were also examined. To show the effectiveness of concrete activities for the internalization of EBPs, we calculated the contextual effects of the wards' organizational learning activities on the internalization of EBPs. Results: As in the primary analysis, a total of 422 nurses from 56 wards in 12 hospitals responded to the survey and 360 nurses from 48 departments were included in this secondary analysis. Although the mean scores of all eight factors of the GOLA Inventory (ward level) were significantly positively associated with the internalization of EBPs, the contextual effect of each factor differed. Conclusion: Rather than creating an EBP team, specific ward-level activities, such as those designed to ensure that the staff can understand why EBPs are implemented and encourage them to take ownership of EBPs, are necessary for nurses' internalization of EBPs. Based on the results of this research, hospital or ward managers, as well as staff involved in introducing new practices, can implement efforts to promote nurses' internalization of EBPs.

Lived experience of affordability as a barrier to prescription medicines: A longitudinal qualitative study

Background

Lack of affordability is a major barrier to medicines access in many countries. It can result in ethnic and other inequities in medicines use and these have been documented in New Zealand. We aimed to understand the lived experience of barriers to accessing medicines faced by groups that are likely to encounter them, and to explore how they played out over time. This paper presents results related to affordability.

Methods

We carried out a longitudinal qualitative study, repeatedly interviewing 21 households about their lives and access to medicines, over a year. Participants were Māori, Pacific, former refugee, or Pākehā (New Zealand Europeans) with limited incomes.

Results

Many participants faced social disadvantage and many had physical and mental health problems. Often, they had busy and stressful lives, and this formed the backdrop to issues with medicines. Charges for GPs and medicines could directly prevent access, but also eroded relationships with healthcare providers, reducing acceptability of services. There could be confusion about charges, and when they were perceived as unreasonable participants felt aggrieved. At the time of the study, most (but not all) pharmacies had prescription charges, and limited financial resources drove some participants' choice of pharmacy. Some felt forced to choose between cost and physical accessibility or quality of care. Lack of affordability also interacted with other barriers to access, such as lack of transport, to prevent access to needed medications. Lack of affordability also made participants more vulnerable to the impact of small mistakes in prescribing and dispensing.

Discussion

Exploring lived experience provides insights into the multiple ways that lack of affordability prevents access to medicines: directly, through interaction with other barriers to access including transport, by damaging trust and reducing acceptability of services, and by making participants less able to deal with mistakes made by health professionals.

Outcome preferences in fidelity-adaptation scenarios across evidence-based parenting programs: A discrete choice experiment

BACKGROUND

Implementing evidence-based parenting programs often involves navigating fidelity-adaptation decisions. While research has explored various aspects of this dilemma, little is known about how practitioners' outcome preferences influence their decisions in real-world scenarios.

METHODS

This study employed a discrete choice experiment (DCE) to investigate the relative importance of five outcomes (Relationship Quality, Satisfaction, Workload Strain, Value Conflict, and Reach) in fidelity-adaptation decisions among 209 practitioners delivering evidence-based parenting programs in Sweden. The DCE presented 25 choice sets across five contextual scenarios, analyzed using Bayesian hierarchical logistic regression.

RESULTS

All five outcomes significantly influenced practitioners' choices, with Relationship Quality emerging as the most impactful (log-odds: 4.56, 95% CI [4.16, 4.91]). Satisfaction and minimizing Value Conflict showed similar importance (log odds: 2.45 and -2.40, respectively), while Workload Strain and Reach had slightly less impact (log odds: -2.10 and 1.96, respectively).

CONCLUSIONS

This study offers a novel perspective on the role of outcome preference in navigating fidelity-adaptation decisions. The strong preference for improving parent-child relationships aligns with core parenting program goals, while consideration of other outcomes reflects practitioners' holistic approach to implementation. These findings can inform the design of interventions and implementation strategies that balance effectiveness with real-world constraints, potentially enhancing parenting programs' adoption, sustainability, and impact.

Barriers and facilitators to maternal healthcare in East Africa: a systematic review and qualitative synthesis of perspectives from women, their families, healthcare providers, and key stakeholders

BACKGROUND

In East Africa, women face significant challenges accessing maternal healthcare during pregnancy, childbirth, and the postnatal period. While several studies have examined barriers and facilitators to maternal care, there is no comprehensive review reflecting the various perspectives of women, their families, healthcare providers, and key stakeholders. We systematically reviewed qualitative literature on maternal healthcare in East Africa, synthesizing insights from multiple perspectives and exploring barriers and facilitators across socioecological levels.

METHODS

A qualitative evidence synthesis focused on studies from East Africa published between January 2015 and June 2024. We searched electronic databases, including PubMed, Embase, Scopus, Cochrane, Web of Science, and ProQuest, and used citation tracking to find additional references. Eligible studies were critically appraised using the Critical Appraisal Skills Program, and a thematic synthesis was performed to identify barriers and facilitators.

RESULTS

Of the 3181 records identified, 81 studies (63 qualitative and 18 mixed method) met the inclusion criteria, representing 4816 individuals from six East African countries. This review identified barriers at various levels: individual barriers included a lack of awareness and knowledge, fear of being treated poorly, and financial constraints; interpersonal barriers comprised limited family support, communication challenges, and a lack of decision-making autonomy; health facility barriers included poor quality of healthcare, poor infrastructure, limited medical supplies, provider shortages, abusive behaviors from healthcare providers, lack of transportation, and high service costs; community-level barriers involved socio-cultural norms, societal stigma, and gender-based disparities; and policy-level barriers included poor focus on maternal health, a lack of male accompaniment policies, and conflicts. Key facilitators identified included improved healthcare understanding and women's self-efficacy at the individual level, family support and positive social influences at the interpersonal level, high-quality services, reliable transportation, compassionate care, and health education at the health facility level, community initiatives, gender equality, and maternity waiting homes at the community level, as well as free maternity services and health extension programs at the policy level.

CONCLUSION

The synthesis identified key barriers and facilitators to the maternal healthcare in East African countries, ranging from individual to policy levels. We recommend that future initiatives focus on addressing these barriers while enhancing facilitators across individual, interpersonal, health facility, community, and policy levels through woman-centered, evidence-based strategies. Moreover, fostering collaboration among governments, healthcare providers, and communities is essential for improving access to the maternal continuum of care.

Prohibiting Babel-A call for professional remote interpreting services in pre-operation anaesthesia information

INTRODUCTION

Language barriers within clinical settings pose a threat to patient safety. As a potential impediment to understanding, they hinder the process of obtaining informed consent and uptake of critical medical information. This study investigates the impact of the current use of interpreters, with a particular focus on of engaging laypersons as interpreters, rather than professional interpreters potentially affecting patient safety. A further objective is to explore the reliability of phone-based telemedicine in terms of the retention of important medical facts.

METHODS

In three groups (N per group = 30), we compared how using lay or professional interpreters affected non-German speaking patients' subjectively perceived understanding (understood vs. not understood) and recollection (recollected vs. not recollected) of information about general anaesthesia. Proficient German speaking patients served as the control group. Statistical analyses (χ2 tests and binomial) were calculated to show differences between and within the groups.

RESULTS

All three groups indicated similar, high self-reported levels of having understood the medical information provided. This was in stark contrast to the assessed objective recollection data. In the lay interpreter group, recollection of anaesthesia facts was low; only around half of participants recalled specific facts. For patients supported by professional interpreters, their recollection of facts about anaesthesia was significantly enhanced and elevated to the same level of the control group (fluent in German). Moreover, for these patients, providing information by means of phone-based telemedicine before anaesthesia yielded high levels of understanding and recollection of anaesthesia facts.

CONCLUSION

Phone-based telemedicine is a safe and reliable method of communication in the professional interpreter group and German speaking control group, but not in the lay interpreter group. Compared to lay interpreters, professional interpreters significantly improve patients' uptake of critical information about general anaesthesia, thus highlighting the importance of professional interpreters for patient safety and informed consent.

Perceptions and practices of imaging personnel and physicians regarding the use of brain MRI for dementia diagnosis in Uganda

INTRODUCTION

Diagnosing dementia remains challenging in low-income settings due to limited diagnostic options and the absence of definitive biomarkers. The use of brain MRI in the diagnosis of dementia is infrequent in Uganda, and even when it is used, subtle findings like mild regional atrophy are often overlooked, despite being crucial for imaging diagnosis.

OBJECTIVE

The purpose of this study was to explore the perceptions and practices of imaging personnel and physicians regarding the use of brain MRI as a diagnostic approach for dementia in Uganda.

METHODS

This was an exploratory qualitative study involving radiologists, technologists, senior house officers and psychiatrists. The participants were 25 in total. Data was collected through key informant interviews and focus group discussions and analyzed thematically using an inductive approach.

RESULTS

The study revealed three key themes: Brain MRI Practices for Diagnosing Dementia, Facilitators of Appropriate MRI Use, and Barriers to Appropriate Use of Brain MRI. Sub-themes under these themes included cost considerations, poor and good MRI practices, MRI as a standard operating procedure, positive attitudes towards brain MRI, and barriers such as structural, financial, operational, technical, and patient-related issues. Participants acknowledged the high accuracy and superiority of brain MRI for diagnosing dementia and recognized it as the standard of care. However, its use in Uganda is limited due to high costs, restricted access, mechanical failures, patient claustrophobia, myths and misconceptions, and interpretation difficulties by radiologists and inappropriate protocols by technologists.

CONCLUSION

The study identifies barriers to effective brain MRI use for dementia diagnosis in Uganda, including limited training, high costs, and uneven equipment distribution. Despite this, providers are positive about MRI adoption. Enhancing training, awareness, and phased rollouts can improve outcomes. Future research should focus on similar low-resource settings for validation.

Construction of a bundle for the safety of patients with mental disorders during hospitalization

OBJECTIVE

to develop a bundle for the safety of psychiatric patients during hospitalization.

METHODS

a methodological study conducted in two stages. In the first, a comprehensive literature review was developed through a scoping review and conducted to examine evidence on the safety of psychiatric patients during hospitalization. In the second, based on the evidence listed, a set of actions was developed for the safety of psychiatric patients during hospitalization.

RESULTS

twenty-six articles published between 2012 and 2022 were used, making it possible to categorize recommendations and build a bundle through four axes: safety culture; clinical decision-making; intervention planning; and interpersonal violence.

CONCLUSIONS

the scientific evidence provided clear guidance on actions to improve the safety of psychiatric patients during hospitalization. This evidence also highlighted gaps in research, indicating the need for future studies in this area.

Addressing Critical Mistakes in Administering Intravenous Medications at Omdurman Military Hospital, Khartoum, Sudan

Objective

Errors in the preparation and administration of intravenous medications are significant contributors to morbidity and mortality rates in medical practice. Early reporting and the implementation of preventive measures can mitigate these errors. This study aims to identify patterns and frequencies of errors in IV medication preparation and administration, along with associated factors, at Omdurman Military Hospital in Khartoum, Sudan.

Methods

This observational, descriptive, cross-sectional study was conducted in the emergency department of Omdurman Military Hospital from January to May 2022. We observed 60 nurses responsible for intravenous drug preparation and administration using a pretested questionnaire and checklist on multiple occasions. The data was analyzed by SPSS and the descriptive and inferential statistics were applied.

Results

Our findings reveal that 98% of the nurses reported a lack of formal training in IV drug preparation and administration. The observed preparation area was characterized as untidy in 59.6% of observations, and 52.5% were conducted in crowded environments. We identified six distinct types of errors during drug preparation, with the most common being the absence of aseptic techniques (63.2%) and the failure to check drug expiry dates before administration (99%). In contrast, five types of administration errors were reported, with the most prevalent being incorrect administration rates (68.7%) and the absence of post-administration side-effect assessments (84.8%). Additionally, 83.3% of nurses did not label the unused portion of a drug intended for the next dose.

Conclusion

This study identifies a total of 11 different types of errors in IV drug preparation and administration, some of which are associated with the hospital's work environment. The lack of formal training among 98% of the nurses stands out as a significant contributor to the increasing frequency of these errors.

Predictors of client satisfaction with family planning services in Ethiopia: a systematic review and meta-analysis

Background

The use of modern contraceptives by married Ethiopian women has increased over the past 15 years. Despite a few studies reporting different predictors of satisfaction with family planning services, there is a lack of nationwide data showing the determinants of client satisfaction with family planning services. Thus, this meta-analysis aimed to determine the predictors of client satisfaction with family planning services in Ethiopia.

Methods

From January 20 to March 10, 2024, a thorough search of the literature was conducted using PubMed, Web of Science, EMBASE, CINAHL, and Google Scholar. The quality of the included studies was assessed using the critical assessment checklist developed by the Joanna Briggs Institute (JBI). The statistical program Stata 11 was used to carry out the analysis. Using Cochran's Q-statistic, heterogeneity was statistically assessed and measured by the I 2 value. If significant heterogeneity was found across the included studies, a random effects model was used to assess the factors influencing client satisfaction with family planning services. Otherwise, a fixed-effects model was employed.

Results

Independent factors influencing clients' satisfaction with family planning services included waiting times of less than one hour (POR = 4.37; 95% CI: 2.05, 9.32), ensuring privacy (POR = 6.31; 95% CI: 2.78, 14.28), convenient opening hours (POR = 5.91; 95% CI: 1.61, 21.63), education level above primary school (AOR = 2.61; 95% CI: 1.02, 6.68), being informed about side effects (AOR = 3.08; 95% CI: 1.22, 7.74), and receiving adequate information (POR = 4.2; 95% CI: 1.87, 9.44).

Conclusion

The findings indicate that key factors significantly influencing client satisfaction with family planning services include reduced waiting times, privacy protection, convenient service hours, higher education levels, being informed about potential side effects, and receiving comprehensive information. These elements are critical for improving satisfaction and should be prioritized in family planning services. As a result, Ethiopian policymakers and decision-makers must devise plans to maximize client satisfaction with healthcare services through client-centered care.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=563937, PROSPERO (CRD42024563937).

An evaluation of the impact of a cancer support specialist service on families of children with cancer and the multidisciplinary team in a children's health service in Ireland

The onset of childhood cancer is sudden and unexpected, and the effect on the family unit can be enormous as they embark on a major life transition. Families of children with cancer have a high level of psychosocial needs due to the many challenges they may face during their child's cancer journey. Previous research indicates that the current healthcare system does not always meet these needs. This qualitative descriptive study aimed to explore the impact of a new Cancer Support Specialist Service from the perspective of the families and the multidisciplinary team. Data were collected using semi-structured one-to-one interviews. The impact on the family was increased emotional, practical, informational, and navigational support. The impact on the MDT included freeing up time for the clinical component of their work, decreasing worry that unmet needs for parents were not being addressed, and increasing access to timely flexible support for families. The knowledge advanced by this study can inform future planning of the Cancer Support Specialist Service.

Individualized Care Plans for High Utilizers

Frequently admitted patients (i.e., 'high utilizers') comprise a small percentage of all patients yet consume a relatively large proportion of hospital resources. This quality improvement project aimed to reduce hospital resource utilization by implementing individualized care plans (ICPs) for high utilizers. An electronic health record (EHR) report identified high utilizers. A hospitalist workgroup then selected patients who were relatively young with frequent low-risk admissions. The workgroup created and documented ICPs in the EHR, then linked to the ICPs from numerous locations. For the selected patients, total admissions per year were reduced from 125 to 41 (-67%) and days per year in hospital from 497 to 219 (-56%), while length of stay was increased from 4 to 5.4 (+26%) days. Implementation of ICPs can allow high utilizers to spend more time at home, while simultaneously freeing up valuable hospital resources for the community. Making ICPs easily accessible is key to success.

Nair A, Agrawal D, Zadey S, Surendran G, George Joseph R, Dayma G, Rafeekh L, Saha S, Sharma S, Prakash SS, Sankarapandian V, John P, Patel V. Barriers and facilitators for the use of telehealth by healthcare providers in India-A systematic review

It is widely assumed that telehealth tools like mHealth (mobile health), telemedicine, and tele-education can supplement the efficiency of Healthcare Providers (HCPs). We conducted a systematic review of evidence on the barriers and facilitators associated with the use of telehealth by HCPs in India. A systematic literature search following a pre-registered protocol (https://doi.org/10.17605/OSF.IO/KQ3U9 [PROTOCOL DOI]) was conducted on PubMed. The search strategy, inclusion, and exclusion criteria were based on the World Health Organization's action framework on Human Resources for Health (HRH) and Universal Health Coverage (UHC) in India with a specific focus on telehealth tools. Eligible articles published in English from 1st January 2001 to 17th February 2022 were included. One hundred and six studies were included in the review. Of these, 53 studies (50%) involved mHealth interventions, 25 (23.6%) involved telemedicine interventions whereas the remaining 28 (26.4%) involved the use of tele-education interventions by HCPs in India. In each category, most of the studies followed a quantitative study design and were mostly published in the last 5 years. The study sites were more commonly present in states in south India. The facilitators and barriers related to each type of intervention were analyzed under the following sub-headings- 1) Human resource related, 2) Application related 3) Technical, and 4) Others. The interventions were most commonly used for improving the management of mental health, non-communicable diseases, and maternal and child health. The use of telehealth has not been uniformly studied in India. The facilitators and barriers to telehealth use need to be kept in mind while designing the intervention. Future studies should focus on looking at region-specific, intervention-specific, and health cadre-specific barriers and facilitators for the use of telehealth.

Examining naloxone access and interest in secondary naloxone distribution on an American Indian Reservation in the Northern Midwest of the United States

Background

Indigenous communities in the United States experience disproportionate rates of overdose morbidity and mortality due to a range of historical traumas and ongoing oppression. Limited health and harm reduction service access on some Tribal lands exacerbate these challenges. To date, little is known about naloxone access on tribal reservation lands.

Methods

We used cross-sectional survey data from community members on the reservation lands of a northern Midwest Tribe in the United States. We explored the prevalence and correlates of recent (past 6-month) naloxone receipt and interest in secondary naloxone distribution among all participants and people who used drugs (PWUD) recently. Correlates included sociodemographics, cultural identity and spirituality, witnessing overdoses, stigma, and drug use characteristics.

Results

Among 227 Indigenous participants, the average age was 45, 62 % were women, 53 % were single, 29 % were not working, 29 % had experienced recent hunger, and 8 % considered themselves homeless. 91 % said that Indigenous spiritual values were important to them. Sixteen percent had witnessed a recent non-fatal overdose, and 6 % had witnessed a fatal one. Twenty-four percent of the overall sample had recently received naloxone, and 40 % of PWUD had received it. Witnessing both fatal (p<0.001) and nonfatal overdoses (p=0.001) were associated with receiving naloxone. Further, 63 % of participants were willing to distribute naloxone.

Conclusions

Innovative strategies to expand naloxone access that are culturally relevant and responsive are needed in Indigenous communities. Cultural connectedness and shared identity are key strengths of Indigenous communities that can potentially be leveraged to implement secondary naloxone distribution programs.

Bypassing primary antiretroviral therapy centres in Sub-Saharan Africa: An integrative review of the theoretical and empirical literature

The uptake of antiretroviral therapy (ART) is critical to meeting the global HIV treatment goal of 95-95-95 by 2025. Although a few Sub-Saharan African countries have already achieved this target, the prevalence of bypassing primary ART centres in many countries in the subregion has negative implications for ART uptake and use. This study used the access to health services framework to analyse the evidence and factors contributing to bypassing primary ART centres by individuals in the sub-region seeking HIV care and support. We found compelling evidence of the prevalence of ART clients bypassing their primary ART centres in search of specialised care in higher-tiered health facilities. Others use bypassing to conceal their HIV-positive status to avoid social stigma. We argue that introducing specialised and differentiated ART at the primary level of care can address this phenomenon. While we anticipate that this measure will satisfy clients' desire for specialised care, we recommend enhancing public awareness about the effectiveness of ART to reduce stigma towards ART clients. Legislation and strict enforcement of anti-HIV stigma laws, which outlaw and criminalise stigmatising people living with HIV (PLHIV), could potentially be an effective stigma-deterring measure. To complement this effort, PLHIV should be empowered to understand legislative instruments and steps to take when confidentiality and discriminatory issues arise. We recommend further research in Sub-Saharan Africa to investigate the relationship between bypassing primary ART centres and client adherence. The findings will help design appropriate strategies to increase ART uptake at primary ART centres.

Oral self-management of palbociclib using mobile technology: Findings from a nurse-led randomized controlled trial

Objective

Test the feasibility and effectiveness of a text message reminder intervention for the self-management of oral anticancer medication in patients with metastatic breast cancer.

Methods

Forty-three females initiating treatment with palbociclib participated in a two-armed prospective randomized clinical trial. Participants were randomized into the control (n = 21) and intervention groups (n = 22) from January 2020 to January 2023. Survey responses were collected at three-time points; (1) at consent, (2) end of treatment cycles, and (3) at a follow-up clinic visit. Surveys included a demographic questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, post-study assessment, and the R-15 Participant Satisfaction Questionnaire. Nurse providers completed the Adaptation of Stamps Nurse Workload questionnaire.

Results

The COVID-19 pandemic and regulatory decisions supporting other CDK4/6 medications negatively influence recruitment; thus, a small sample for each arm only detected large differences between the two arms regarding effectiveness. Feasibility analysis was not conducted due to insufficient data, but the participants frequently used their smartphones for text messaging. Although the survey data were limited, participants provided anecdotal information supporting the use of text messaging as a positive method to remind them to take their medication, have their labs drawn, and attend MD visits. Participants would have liked text messages at the exact time they took their medications as a simple reminder.

Conclusions

Given the importance of cancer treatments and the difficulties patients experience during these treatments, text messages using smartphones can actively improve patients' engagement and their ability to manage their treatment regimens.

Trial registration

ClinicalTrials.gov; ID: NCT04216576.

The Effectiveness and Cost Analysis of a Pilot Newborn Hearing Screening Program at a Hospital in a Low- to Middle-Income Country

Background

When a universal newborn hearing screening program is not feasible, particularly in the early stages of its establishment when it requires a great deal of effort and resources, a smaller scale in screening, such as a specific geographical subset or targeted group, is suggested rather than doing nothing. This study aims to pilot a newborn hearing screening program at a hospital in a low- to middle-income country and determine its effectiveness and costs in the context of a lack of qualified audiologists.

Methods

All high-risk births at Hatyai Hospital were recruited for newborn hearing screening between January and December 2021. Newborns who failed 2 stages of transient evoked otoacoustic emissions screening were referred for diagnostic assessment and subsequent interventions. The program's effectiveness was assessed based on the standards of the American Academy of Pediatrics. All costs related to screening, diagnostic, and intervention stages were also evaluated.

Results

Out of 883 newborns, 792 newborns were screened, resulting in a 95.1% screening coverage. The referral rate regarding the diagnostic stage was 3.9%. Also, 28.3% and 12.9% lost-to-follow-up rates were observed in the secondscreening and diagnostic assessment stages, respectively. Ten children were confirmed as having permanent hearing loss, with a prevalence of 1.3%. The total cost was US$13 611, and the cost (for the screening stage) per case screened was US$4.

Conclusion

The program was considered effective with 2 out of 3 benchmarks achieved.

Funding and compliance to Test-Before-Treat recommendation in management of uncomplicated malaria among primary health care workers in Anambra State, Nigeria - a cross-sectional comparative study

Introduction

in 2010, Nigeria adopted the Test-Before-Treat recommendation in her "national guideline for diagnosis and treatment of malaria." Across Nigeria, donor agencies including the Global Fund to Fight AIDS, Tuberculosis and Malaria, support states in malaria control, particularly at the Primary Healthcare level. This study aims to compare compliance to Test-Before-Treat recommendations in managing uncomplicated malaria among health workers in global fund-supported and government-supported Primary Healthcare Centers (PHCs) in Anambra State.

Methods

a cross-sectional comparative study involving 32 PHCs across Anambra State. Using multi-stage sampling, the facilities were selected from four local government areas in two of the three senatorial zones. Data were collected using 1536 proforma for retrospective audit of case records, 82 health worker questionnaires, 32 facility assessment questionnaires, and 32 observational checklists for health facility inventory; and analyzed using IBM SPSS Statistics version 20. The Chi-square test of independence and Fisher's exact test was used to determine the association between categorical variables. Statistical significance (p) was set at 0.05.

Results

compliance with Test-Before-Treat recommendations in global fund-supported PHCs was 99% (760/768) versus 84% (645/768) in the government-supported (p=0.00). Comparatively, global fund-supported PHCs had higher availability of free malaria rapid diagnostic test kits (mRDT), job aids, copies of national guidelines in consulting rooms, staff with recent training on mRDT, and staff recently exposed to supervision.

Conclusion

donor fund supports enhanced compliance to Test-Before-Treat recommendations by increasing the availability of free mRDT kits, job aids, National Guidelines, and frequency of staff exposure to supervision and training on mRDT.

Burden of infant group B Streptococcus disease and impact of maternal screening and antibiotic prophylaxis in Ontario, Canada: a population-based cohort study

Background

Group B Streptococcus (GBS) significantly contributes to neonatal sepsis and meningitis, with varying disease rates reported globally and limited population-based data. We estimated infant GBS disease burden in Ontario, Canada and assessed the association of maternal GBS screening (35-37 weeks' gestation) and intrapartum antibiotic prophylaxis (IAP) provision with infant disease rates.

Methods

Our population-based cohort study included pregnant individuals and their offspring from April 2012 to March 2018, utilising the provincial birth registry linked to health administrative data. GBS cases were ascertained through culture results and diagnostic codes. We calculated incidence rates for early-onset disease (EOD: 0-6 days), late-onset disease (LOD: 7-89 days), and ultra-LOD (ULOD: 90-365 days). Adjusted incidence rate ratios (aIRR) were derived via log-binomial regression to compare infant GBS rates according to screening and IAP-receipt.

Findings

Among 776,148 liveborn infants, we identified 803 with GBS, with multiples exhibiting a threefold incidence increase. Incidence rates of EOD, LOD and ULOD were 0.49, 0.46 and 0.07 per 1000 livebirths, respectively. Of eligible pregnancies, 94% were screened; 23% screened positive, and 81% of them received IAP. Nearly 12% of term EOD infants had mothers who missed IAP despite screening positive. Maternal screening was associated with lower rates of any infant GBS disease (aIRR: 0.60; 95% CI: 0.45, 0.80). Among screen-positive births, IAP-receipt was associated with reduced rates of EOD (aIRR: 0.72, 95% CI: 0.48, 1.29) and LOD/ULOD (aIRR: 0.69; 95% CI: 0.46, 1.05), but confidence intervals included 1.0.

Interpretation

Our study, the largest Canadian investigation into infant GBS disease, highlights both widespread adoption and ongoing challenges of the current prevention strategy.

Funding

Canadian Institutes of Health Research.

Supporting psychosis research, implementation, and training through an academic intermediary-purveyor organization

Intermediary-purveyor organizations (IPOs) are a type of dissemination support system that are intended to enhance the adoption and sustainment of empirically supported treatments (ESTs) by deploying empirically supported strategies to remediate implementation challenges. Despite the recent proliferation of government-funded IPOs for other psychiatric populations, IPOs that can redress the substantial science-to-practice gap among clients who experience psychotic disorders are not well documented. This article provides an overview of an IPO in an R1 academic medical center whose mission is to enhance access to evidence-based interventions for individuals who have or are at risk for a psychotic disorder. The article spotlights the functions of an IPO and illustrates these functions with a use case, cognitive behavioral therapy for psychosis. We highlight IPO-led activities related to cognitive behavioral therapy for psychosis purveyance, professional development, quality improvement, public awareness education and training, research and evaluation, as well as program and policy development. Finally, we address the advantages and disadvantages of establishing IPOs of this nature in academic medical centers, the importance of academic-community partnerships in advancing EST implementation, and present considerations for replication. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Strategies to Bridge the Theory-Practice Gap in Nursing Education in Iran: A Participatory Action Research

Background

Nursing is a scientific profession that focuses on the art of care. However, its theory-practice gap has led to problems in teaching nursing students. Therefore, this paper aims to present the effects of the implementation of theory-practice gap strategies in training nursing students in the emergency department.

Materials and Methods

This study included the implementation and reflection phases of participatory action research in both the School of Nursing and Midwifery of the Isfahan University of Medical Sciences, Iran, and the emergency ward of Alzahra Educational Hospital, Iran, from 2016 to 2019. First, 10 strategies were implemented with the help of stakeholders. In the reflection phase, 15 semi-structured, in-depth interviews, focus groups, observations, and field notes were analyzed using the conventional content analysis approach.

Results

The data were obtained from 15 participants, most of whom were women. Data analysis revealed three themes and seven main categories, including leaving the comfort zone (understanding the necessity for changes, individual and organizational perception, and response to change), bringing about change (strengthening of patterns and preparation of processes), and unstable deployment of change (perceived promotion and planning to reinforce the change).

Conclusions

Using participatory action research to reduce the theory-practice gap in nursing education is of grave importance. During the change process, stakeholders defined new educational processes or reinforced the previous applicable patterns. Also, they started to plan for more control over educational processes as well as considering new promotions. This is valuable knowledge for use in bridging the theory-practice gap in nursing education.

Assessment of Cardiopulmonary Resuscitation Knowledge Among Physicians in the Pediatrics Department of an Urban Tertiary Referral Hospital in Ethiopia: A Cross-Sectional Study

Background: Early recognition of cardiac arrest and prompt start of cardiopulmonary resuscitation (CPR) boost survival rates and reduce postarrest consequences. Little information is available about the fundamental CPR knowledge of healthcare workers who work with children in Ethiopia. Methods: All physicians, regardless of seniority, participated in this cross-sectional survey from June to August 2022. They received a structured survey that was modified from the American Heart Association (AHA) Basic Life Support (BLS) test which was made up of 10 questions about participants' job experience and 25 multiple-choice CPR knowledge questions. Data analysis was done using a multinomial logistic regression test with a p value of 0.05. Result: One hundred sixty-eight doctors with various levels of seniority participated in this study. The participants included a male-to-female ratio of 1.3:1, a median age of 28 years, 92 (57.9%) male participants, and 124 (78%) participants with less than 5 years of clinical experience. Ninety-seven participants, or 61%, had scored less than 75% whereas 13 (8.2%), participants, had good knowledge that is scoring above 75%. Participants who had training in CPR within the previous year showed significantly higher levels of knowledge than those who hadn't. Even though 90% of the participants claimed to have CPR knowledge, the majority of participants were found not to have below 75%. Conclusion: The study concludes that while many doctors believe they have adequate CPR knowledge, actual knowledge levels are insufficient. Staff should undergo regular certification and assessments to ensure they retain their resuscitation knowledge. This ongoing evaluation is crucial for maintaining high standards of care and preparedness in emergencies.

Assessment of magnitude of medicines wastage and the contributing factors in selected public health facilities of Hadiya Zone, Central Ethiopia Regional State

BACKGROUND

Medicine wastage occurs when medicines are damaged, obsolete, or expired and become unsafe for use. In Ethiopia, although there are reports that reveal the presence of wasted medicines in the country, there is limited objective evidence on the type and extent of medicine wastage as well as its contributing factors.

OBJECTIVE

The study aimed to assess the medicine wastage rate and identify its contributing factors in the sampled public health facilities (HFs) in Hadiya Zone, Central Ethiopia Regional State.

METHOD

A facility-based cross-sectional study complemented by a qualitative study was conducted in selected public HFs in Hadiya Zone, Central Ethiopia Regional State, from November 1 to 31, 2022. All the hospitals were selected intentionally, and health centers were selected using simple random sampling techniques. For the qualitative study, the chief clinical officers and pharmacy department heads of HFs were purposefully selected as key informants because they were supposed to be more information-rich than other health professionals. The quantitative data were entered and analyzed using the Statistical Package for Social Sciences version 20.

RESULT

The total monetary value of wasted medicines in the assessed HFs in the Ethiopian Fiscal Year (EFY) 2011-2013 was 652,479.45 ETB (5.24%). The three-year trend showed that, in the 2011-2012-2013 EFY, medicine wastage was 7.57%, 6.44%, and 3.1%, respectively. Expiration solely accounted for 97.3% of this total value. The alleged explanations for the waste of such medicines were a lack of accurate data available for medicine quantifications, the presence of overstocked medicines due to improper forecasting, a lack of electronic stock management, an abrupt change in the treatment regimen, and improper use of stock management. Whether the perceived causes had an impact on the medicine wastage was assessed, and the results confirmed that a significant association between medicine wastage and overstock (p-value = 0.006, AOR = 8.57, 95% CI = 1.87-39.26), accurate data (p-value = 0.013, AOR = 5.43, 95% CI = 1.42-20.76), and electronic stock management (p-value = 0.05, AOR = 0.311, 95% CI = 0.094-1.03) was observed.

CONCLUSION

The identified medicine wastage rate is significant for a nation that struggles to allocate limited resources fairly. It may negatively affect the initiatives taken by the government to increase public engagement in the healthcare system through insurance contributions. It is a glance for HFs to take immediate corrective action.

Curcumin loaded hydrogel with double ROS-scavenging effect regulates microglia polarization to promote poststroke rehabilitation

Cyclodextrins are used to include curcumin to form complex, which is subsequently loaded into a reactive oxygen species (ROS) responsive hydrogel (Cur gel). This gel exhibits a dual ROS scavenging effect. The gel can neutralize extracellular ROS to lead to a ROS-sensitive curcumin release. The released curcumin complex can eliminate intracellular ROS. Furthermore, the Cur gel effectively downregulates the expression of CD16 and IL-1β while upregulating CD206 and TGF-β in oxygen and glucose-deprived (OGD) BV2 cells. Additionally, it restores the expression of synaptophysin and PSD95 in OGD N2a cells. Upon injection into the stroke cavity, the Cur gel reduces CD16 expression and increases CD206 expression in the peri-infarct area of stroke mice, indicating an in vivo anti-inflammatory polarization of microglia. Colocalization studies using PSD95 and VGlut-1 stains, along with Golgi staining, reveal enhanced neuroplasticity. As a result, stroke mice treated with the Cur gel exhibit the most significant motor function recovery. Mechanistic investigations demonstrate that the released curcumin complex scavenges ROS and suppresses the activation of the ROS-NF-κB signaling pathway by inhibiting the translocation of p47-phox and p67-phox to lead to anti-inflammatory microglia polarization. Consequently, the Cur gel exhibits promising potential for promoting post-stroke rehabilitation in clinics.

Impact of in-service training on the knowledge, attitude, and practice of pharmacovigilance in Malawi: a cross-sectional mixed methods study

Background

Spontaneous reporting of adverse drug reaction (ADRs) is low in Malawi. We assessed the impact of training intervention on knowledge, attitudes, and practices of health care professionals (HCPs) in pharmacovigilance (PV).

Methods

We employed a mixed-methods study design. A questionnaire was administered among HCPs who were trained in PV, followed by face-face interviews. We further extracted individual case safety reports which were submitted to the local databasewithin a period of six months prior and after the PV training. Quantitative data was analyzed using STATA 14.1. Paired t-test was used to assess the differences in PV knowledge among HCPs before and after the training. For qualitative data, we manually derived key themes from the participant's responses.

Results

Overall, the mean knowledge score was significantly improved across all the participants from a mean of 56% (95% CI 53% to 58%) to 66% (95% CI 64% to 69%) after the training, p< 0.001. There was a 2.8-fold increase in the number of participants who were able to detect an ADR after the training and a 1.8-fold increase in the percentage of reporting the detected ADRs after the training. Participants expressed preference of a paper-based reporting system to other reporting tools. However, they outlined several challenges to the system which discourages HCPs from reporting ADRs, such as lack of feedback, unavailability of reporting forms and delay to transmit data to the national centre.

Conclusion

The survey found that in-service training for HCPs improves KAP of PV and reporting rates of ADRs. We recommend widening of the training and introducing PV courses in undergraduate programs for health care workers in Malawi.

The correlation between children's health literacy level and healthy eating self-efficacy

Background

The school environment provides an important opportunity for children and educators to develop health education and health literacy the ability to make rational health decisions and identify and determine factors that affect health. The aim of this study is to determine the correlation between health literacy and eating self-efficacy levels of primary school students and the affecting factors.

Methods

The study was conducted with 486 fourth graders studying in a primary school located in eastern Turkey between September 2021 and June 2022. The data were collected through face-to-face interviews using the Personal Information Form, the Health Literacy for School-Age Children Scale (HLSAQ, and the Healthy Eating Self-Efficacy Scale for Children (HESES-C). Data were analyzed by number, percentage, mean, independent samples t-test, non-parametric Mann-Whitney U and Kruskal-Wallis tests, and Pearson's correlation tests.

Results

The gender of the students and the education level of their mothers had a statistically significant correlation with their mean HESES-C and HLSAC scores scores (p<0.05). There was a significant negative correlation between the students' HLSAC and their HESES-C mean scores.

Conclusions

According to the findings of the study, the students had a moderate level of health literacy and a low level of healthy eating self-efficacy. There was a negative relationship between health literacy levels and healthy eating self-efficacy.

Household financial burden associated with out-of-pocket payments for healthcare in Iran: insights from a cross-sectional survey

BACKGROUND

One of the key functions and ultimate goals of health systems is to provide financial protection for individuals when using health services. This study sought to evaluate the level of financial protection and its inequality among individuals covered by the Social Security Organization (SSO) health insurance between September and December 2023 in Iran.

METHODS

We collected data on 1691 households in five provinces using multistage sampling to examine the prevalence of catastrophic healthcare expenditure (CHE) at four different thresholds (10%, 20%, 30%, and 40%) of the household's capacity to pay (CTP). Additionally, we explored the prevalence of impoverishment due to health costs and assessed socioeconomic-related inequality in OOP payments for healthcare using the concentration index and concentration curve. To measure equity in out-of-pocket (OOP) payments for healthcare, we utilized the Kakwani progressivity index (KPI). Furthermore, we employed multiple logistic regression to identify the main factors contributing to households experiencing CHE.

FINDINGS

The study revealed that households in our sample allocated approximately 11% of their budgets to healthcare services. The prevalence of CHE at the thresholds of 10%, 20%, 30%, and 40% was found to be 47.1%, 30.1%, 20.1%, and 15.7%, respectively. Additionally, we observed that about 7.9% of the households experienced impoverishment due to health costs. Multiple logistic regression analysis indicated that the age of the head of the household, place of residence, socioeconomic status, utilization of dental services, utilization of medicine, and province of residence were the main factors influencing CHE. Furthermore, the study demonstrated that while wealthy households spend more money on healthcare, poorer households spend a larger proportion of their total income to healthcare costs. The KPI showed that households with lower total expenditures had higher OOP payments relative to their CTP.

CONCLUSION

The study findings underscore the need for targeted interventions to improve financial protection in healthcare and mitigate inequalities among individuals covered by SSO. It is recommended that these interventions prioritize the expansion of coverage for dental services and medication expenses, particularly for lower socioeconomic status household.

Healthcare professionals' willingness to utilize a mobile health application for adverse drug reaction reporting in a limited resource setting: An input for digital health, 2023

Background

Adverse drug reactions (ADRs) are a significant public health concern, particularly in limited resource settings where underreporting is prevalent due to various challenges. Mobile health applications (mHealth apps) offer a promising solution to enhance pharmacovigilance by facilitating easier and more efficient ADR reporting. However, despite the increasing availability and use of mHealth apps, there is a lack of evidence on healthcare professionals' willingness to adopt them for ADR reporting in resource-constrained environments. Therefore, this study aimed to assess the willingness of healthcare professionals in Ethiopia to utilize mobile health applications for adverse drug reaction reporting and identify associated factors.

Methods

We carried out a cross-sectional study involving 422 healthcare professionals working in institutional settings. We gathered data through a pretested questionnaire that participants completed themselves. We inputted the data using Epi Data V.4.6 and analyzed it using SPSS V.26. Our analysis involved conducting multivariable logistic regression to identify the factors influencing the likelihood of healthcare professionals using mobile applications to report adverse drug reactions.

Results

The study involved 389 healthcare professionals. Approximately 301 (77.4 %) of them expressed willingness to utilize mobile applications for reporting adverse drug reactions. The willingness to utilize mobile applications was significantly associated with the type of mobile phone (smart: AOR 3.56; 95 % CI 2.15-5.67), basic computer training (AOR 4.43; 95 % CI 2.27-8.64), mobile health-related training (AOR 1.96; 95 % CI 1.01-3.79), attitude (AOR 4.01; 95 % CI 2.19-7.35), perceived ease of use (AOR 2.91; 95 % CI 1.59-5.23), and perceived usefulness (AOR 2.10; 95 % CI 1.15-3.85).

Conclusions

Overall, there was a high proportion of healthcare professionals willing to use mobile devices for reporting drug adverse reactions. Their willingness correlated with factors such as the type of mobile phone, perceived ease of use, attitude, training, and perceived usefulness of mobile applications. With the increasing use of smartphones, motivation among healthcare professionals is rising. Basic computer and mHealth-related training are crucial for enhancing the acceptability of such applications and should be incorporated into future implementations. Taking these factors into account could offer insights into the design and implementation of mobile applications for adverse drug reactions in Ethiopia.

Evidence on the effectiveness of value-based payment schemes implemented in a hospital setting: A systematic review

Value-based payment is among payment models rewarding health care providers for achieving pre-defined targets of quality or efficiency measures of care. This paper aims to identify the evidence of the effectiveness of value-based payment schemes implemented in hospital settings. A systematic review of databases for studies published from 2000 to 2022 that evaluated VBP programs was conducted. We searched four databases including PubMed, Scopus, Embase, and Web of Sciences in July 2023. Studies were screened and assessed for eligibility. A thematic analysis approach was used to synthesize and summarize the findings. Overall, 29 articles looking into the VBP programs have been included. Most articles describe the effects on the outcome of care (n = 18). The findings of a great deal of evidence in this field show that VBP is not correlated with some outcome measures including hospital-acquired conditions, 30-day mortality, mortality trends, as well as mortality among patients with acute myocardial infarction or heart failure. Only three of 12 studies have revealed a positive relationship between a P4P program and efficiency. Seven studies from the United States (US) found no evidence or mixed findings on the effects of P4P on efficiency. The magnitude of the effects of VBP on healthcare quality, patient experience, and costs has often been small and non-significant. The unintended negative impact of incentives in value-based payment on hospitals should be tackled when adopting policies and decisions.

Barriers Experienced by Community-Dwelling Older Adults Navigating Formal Care: Evidence From an Australian Population-Based National Survey

OBJECTIVES

This study aims to identify the relationship between psychosocial factors and unmet needs among community-dwelling older adults who have received or who expect to receive formal home-based aged care services.

METHODS

A subsample of the national Survey of Disability, Ageing and Carers was used to examine the prevalence of having any unmet needs among older adults navigating care. We also examined associations between older adults' psychosocial factors and their unmet needs using logistic regression.

RESULTS

Regression analyses highlighted that perceived social isolation (OR = 1.62, 95% CI: 1.30-2.01), high/very high psychological distress (OR = 2.11, 95% CI: 1.52-2.93), and occasional assistance from informal support (OR = 1.92, 95% CI: 1.22-3.05) were associated with increased odds of having unmet needs, after adjusting for other covariates.

DISCUSSION

Our study suggests that older adults facing psychosocial difficulties or lacking informal support are more likely to encounter barriers in accessing formal care. Future policy should address the psychosocial needs and support networks of older adults.

Determinants of HIV/AIDS treatment and care service quality in Woliso Town, Oromia, Ethiopia: in the case of HIV prevention and control project

In Ethiopia, even though there is an effort to increase ART services, different challenges remain in the provision of HIV/AIDS treatment and care services, and little has been done to evaluate patient satisfaction levels. The purpose of this study is to assess the determinants of HIV/AIDS treatment and care service quality. A facility-based cross-sectional study was conducted during from October 2023 to November 2023 in Woliso Town. The total sample size was generated using a systematic random sampling method from the source population. The results of the study showed that client satisfaction with HIV/AIDS treatment and care service quality was 272 (81.4%) with 95% CI: 76.9-85.3%. Government employees were 67% less likely to be satisfied with HIV/AIDS treatment and care service quality (AOR = 0.33 95% CI: 0.11, 0.99) when compared to unemployed clients. The odds of client satisfaction were 6.72 times higher among study participants who do not have health insurance membership cards (AOR = 6.72 95% CI: 3.42, 13.91) compared to those who have health insurance membership cards. The odds of client satisfaction were 2.77 times higher among study participants who reported the availability of community referral for any social support (AOR = 2.77 95% CI: 1.12, 6.84) when compared to those who did not report. Those study participants for whom privacy was kept during the examination were 8.67 times higher to be satisfied (AOR = 8.67 95% CI: 2.53, 29.68) compared to those for whom privacy was not kept during the examination. In conclusion, the client satisfaction on HIV/AIDS treatment and care service quality was relatively high in the study area. Occupational status, health insurance membership cards, availability of community referral for any social support and keeping privacy during examination have significant associations with HIV/AIDS treatment and care service quality in terms of client satisfaction.

Discriminatory, racist and xenophobic policies and practice against child refugees, asylum seekers and undocumented migrants in European health systems

Child refugees, asylum seekers and undocumented migrants who have been forcibly displaced from their countries of origin have heightened health needs as a consequence of their migration experiences. Host countries have a duty to respond to these needs, yet across Europe we are seeing a rise in potentially harmful discriminative, hostile and restrictive migration policies and practices. Research exploring the role racism, xenophobia and discrimination in European health systems may play in child migrant health inequities is lacking. This Personal View seeks to highlight this knowledge gap and stimulate discourse on how discrimination in health information systems, data sharing practices, national health policy, healthcare entitlements, service access, quality of care, and healthcare workers attitudes and behaviours may infringe upon the rights of, and impact the health of child refugees, asylum-seekers and undocumented migrants. It calls for action to prevent and mitigate against potentially harmful policies and practices.

One Health research ethics review processes in African countries: Challenges and opportunities

One Health research has gained attention over the past few decades due to its potential to improve health challenges across the globe. However, obtaining ethics approvals for timely implementation of One Health research is a challenge in some contexts. Our study was undertaken to describe various challenges faced by researchers, research ethics committees (RECs) and members of regulatory bodies in Africa. An online survey was conducted between March and June 2021. The effect of predictors, including respondents' role (e.g., REC member, regulator and/or One Health researcher), sex, education, age, and country, on the perception of challenges and opportunities when conducting and reviewing One Health research, was investigated using multivariable linear regression models. Participants with different roles did not perceive any of the examined challenges differently during review of One Health-related research; but female participants (p = 0.026) and those with ten or more years of experience (p = 0.0325) perceived insufficient One Health knowledge as less of a challenge. Professional role was an important predictor (p = 0.025) for the perception of the establishment of a mandatory One Health review system. Respondents with multiple roles perceived the creation of ad hoc committees for review of One Health research under emergency situations to be less important (p = 0.02); and REC members perceived the creation of such committees to be less feasible (p = 0.0697). Our study showed that perceptions of the importance and feasibility of opportunities for improvement of One Health research ethics review under emergency and non-emergency situations varied across professional roles. This emphasizes the need to consider such improvement strategies; and the need for continuous and timely evaluation for improvement of ethics review of One Health and emergency research in Africa.

Leading from the bottom: The clinical leaders roles in an HIV primary care facility in Eldoret, Kenya

BACKGROUND

Clinical leaders in health systems play critical roles in making decisions that impact patient care and health system performance. Current literature has focused on the importance of clinical leaders' roles in healthcare settings and has not addressed the leadership aspect that clinical leaders engage in day-to-day decision-making in HIV facilities while providing HIV patient care. Therefore, identifying the leadership roles that wclinical leaders perform at HIV primary facilities is of critical importance.

PURPOSE

The study explored the views of healthcare providers working in AMPATH-MTRH HIV facility on what they perceived as the roles of clinical leaders at the HIV primary care facility.

METHODS

We conducted a qualitative exploratory study between December 2019 to May 2020, involving in-depth interviews with (n = 22) healthcare providers working in AMPATH-MTRH HIV facility, who were purposively and conveniently sampled to participate in in-depth interviews to explore perceptions regarding the leadership roles of clinical leaders. The collected data were analyzed thematically and Nvivo vs.12 software was used for data management.

RESULTS

The following themes were identified from the analysis regarding perceived clinical leaders' roles in an HIV primary care facility: 1) Strategic roles: providing direction and guidance, ensuring goals and objectives of the department are achieved within the set timelines, planning, and budgeting for adequate resources to support patient HIV care 2) Interconnecting health systems levels and supervisory oversight roles: a link between management, staff, and patients, solving problems, organizing and attending departmental meetings, facilitate staff training, accountable, collaborating with other departments and leaders, defines and assigns responsibilities, ensure quality patient service, coordination, and management of daily activities 3) Research roles: data collation, analysis, generation, review and reporting to the management.

CONCLUSION

Clinical leaders in the HIV care system perform leadership roles that are characterized by strategic, middle-level, supervisorial and research which reflects the model of the leadership and management style of the HIV care system. The understanding of these roles contributes valuable insights to HIV leaders and managers to recognize the important contribution of clinical leaders and consider reviewing Standard Operating Procedures to include these leadership roles and strengthen their capacity to maximize clinicians' contribution to improve HIV care and enhance responsive health systems.

Supporting health and social care professionals in serious illness conversations: Development, validation, and preliminary evaluation of an educational booklet

Serious illness conversations aim to align the care process with the goals and preferences of adult patients suffering from any advanced disease. They represent a challenge for healthcare professionals and require specific skills. Conversation guides consistent with task-centered instructional strategies may be particularly helpful to improve the quality of communication. This study aims to develop, validate, and preliminarily evaluate an educational booklet to support Italian social and healthcare professionals in serious illness conversations. A three-step approach, including development, validation, and evaluation, was followed. A co-creation process with meaningful stakeholders led to the development of the booklet, validated by 15 experts on clarity, completeness, coherence, and relevance. It underwent testing on readability (Gulpease index, 0 = lowest-100 = maximum) and design (Baker Able Leaflet Design criteria, 0 = worst to 32 = best). Twenty-two professionals with different scope of practice and care settings evaluated acceptability (acceptable if score ≥30), usefulness, feasibility to use (1 = not at all to 10 = extremely), and perceived acquired knowledge (1 = not at all to 5 = extremely). After four rounds of adjustments, the booklet scored 97% for relevance, 60 for readability, and 25/32 for design. In all, 18 (81.8%), 19 (86.4%) and 17 (77.3%) professionals deemed the booklet acceptable, moderate to highly useful, and feasible to use, respectively; 18/22 perceived gain in knowledge and all would recommend it to colleagues. The booklet has good readability, excellent design, high content validity, and a high degree of perceived usefulness and acquired knowledge. The booklet is tailored to users' priorities, mirrors their most frequent daily practice challenges, and offers 1-minute, 2-minute and 5-minute solutions for each scenario. The co-creation process ensured the development of an educational resource that could be useful regardless of the scope of practice and the care setting to support professionals in serious illness conversations.

Inpatient Psychiatric Care in the United States: Former Patients' Perspectives on Opportunities for Quality Improvement

Patient-centered care is a salient value expressed by stakeholders, but a commitment to implementing patient-centered care environments lags in the context of inpatient psychiatry. The current study aimed to describe patients' suggestions for improving the quality of inpatient psychiatry. We fielded a national survey online in 2021, in which we asked participants to report their recommendations for care improvement through a free-response box. We used an inductive qualitative approach to synthesize responses into themes. Most responses described negative experiences, with suggested improvements implied as the inverse or absence of the respondent's negative experience. Among 510 participants, we identified 10 themes: personalized care, empathetic connection, communication, whole health approach, humane care, physical safety, respecting patients' rights and autonomy, structural environment, equitable treatment, and continuity of care and systems. To implement the value of patient-centered care, we suggest that those in positions of power prioritize improvement initiatives around these aspects of care that patients find most in need of improvement.

Provider attitudes toward evidence-based practice in autism: a mini-review

There are many established evidence-based practices (EBPs) for autistic youth which facilitate wellbeing and skill development across a range of domains. However, individuals on the autism spectrum are consistently underserved in mental health settings, limiting their access to these EBPs. Positive provider attitudes toward EBPs may increase their uptake or use. The current mini-review seeks to synthesize the literature regarding attitudes toward EBPs among providers working with autistic youth across a variety of settings (i.e., school, early intervention, and general mental health). Fifteen quantitative studies were included. The majority of studies (n = 13, 87%) utilized the Evidence Based Practice Attitudes Scale (EBPAS) or a variation of this scale. Attitudes toward EBPs were primarily used as a correlate or covariate, although some studies reported descriptive statistics of provider attitudes. When available, the reported results suggest that attitudes toward EBPs are moderately positive at baseline, although they vary between provider types. Two studies (13%) examined change in attitudes toward EBPs and suggested that they may be responsive to intervention. However, findings were mixed as to whether attitudes toward EBPs are predictive of EBP use/uptake. Implications and future directions are discussed.

Using Voice-to-Voice Machine Translation to Overcome Language Barriers in Clinical Communication: An Exploratory Study

BACKGROUND

Machine translation (MT) apps are used informally by healthcare professionals in many settings, especially where interpreters are not readily available. As MT becomes more accurate and accessible, it may be tempting to use MT more widely. Institutions and healthcare professionals need guidance on when and how these applications might be used safely and how to manage potential risks to communication.

OBJECTIVES

Explore factors that may hinder or facilitate communication when using voice-to-voice MT.

DESIGN

Health professionals volunteered to use a voice-to-voice MT app in routine encounters with their patients. Both health professionals and patients provided brief feedback on the experience, and a subset of consultations were observed.

PARTICIPANTS

Doctors, nurses, and allied health professionals working in the Primary Care Division of the Geneva University Hospitals, Switzerland.

MAIN MEASURES

Achievement of consultation goals; understanding and satisfaction; willingness to use MT again; difficulties encountered; factors affecting communication when using MT.

KEY RESULTS

Fourteen health professionals conducted 60 consultations in 18 languages, using one of two voice-to-voice MT apps. Fifteen consultations were observed. Professionals achieved their consultation goals in 82.7% of consultations but were satisfied with MT communication in only 53.8%. Reasons for dissatisfaction included lack of practice with the app and difficulty understanding patients. Eighty-six percent of patients thought MT-facilitated communication was easy, and most participants were willing to use MT in the future (73% professionals, 84% patients). Experiences were more positive with European languages. Several conditions and speech practices were identified that appear to affect communication when using MT.

CONCLUSION

While professional interpreters remain the gold standard for overcoming language barriers, voice-to-voice MT may be acceptable in some clinical situations. Healthcare institutions and professionals must be attentive to potential sources of MT errors and ensure the conditions necessary for safe and effective communication. More research in natural settings is needed to inform guidelines and training on using MT in clinical communication.

Prolonged grief disorder in an inpatient psychiatric sample: psychometric properties of a new clinical interview and preliminary prevalence

BACKGROUND

Prolonged Grief Disorder (PGD) was newly included in the ICD-11 and DSM-5-TR. It is not yet part of the standard assessments in many healthcare systems, including psychiatric wards. Because disordered grief is associated with suicidality, sleep problems and substance use disorders, an investigation into PGD in psychiatric inpatients is warranted.

METHOD

We interviewed N = 101 psychiatric inpatients who were admitted to the open psychiatric wards and the day hospital of a German psychiatric hospital and who had lost a person close to them. Assessments comprised clinical interviews and self-report instruments covering PGD and other mental disorders. We specifically developed the International Interview for Prolonged Grief Disorder according to ICD-11 (I-PGD-11) for the study and examined its psychometric properties.

RESULTS

The prevalence rate of PGD among bereaved patients according to ICD-11 was 16.83% and according to DSM-5-TR 10.89%. The I-PGD-11 showed good psychometric properties (Mc Donald's ω = 0.89, ICC = 0.985). Being female, having lost a child or spouse, and unnatural or surprising circumstances of the death were associated with higher PGD scores.

TRIAL REGISTRATION

Approval was obtained by the ethics committee of the of the Goethe University Frankfurt (2021-62, 2023-17) and the Chamber of Hessian Physicians (2021-2730-evBO). The study was preregistered ( https://doi.org/10.17605/OSF.IO/K98MF ).

LIMITATIONS

We only assessed inpatients of one psychiatric clinic in Germany, limiting the generalizability of our findings.

CONCLUSION

The present study underlines the importance of exploring loss and grief in psychiatric inpatients and including PGD in the assessments. Given that a significant minority of psychiatric inpatients has prolonged grief symptoms, more research into inpatient treatment programs is needed.

Factors influencing knowledge sharing between scientific specialists in knowledge networks and communities of practice: A systematic literature review

Knowledge sharing is a competitive advantage and necessity for the success of any organization. Meanwhile, knowledge networks have been introduced as a way to enhance knowledge sharing between individuals and as an effective tool to facilitate knowledge exchange in clinical, educational, and commercial fields. The purpose of this paper is to identify the factors that can affect the level of knowledge sharing and exchange between academic and scientific specialists in knowledge networks and Communities of Practice (COP). A systematic literature review was conducted using the PRISMA guidelines. Four databases were searched, including Scopus, Web of Science, PubMed, and ProQuest. Google Scholar search was conducted to complete the search and ensure the tracking of the gray literature. Also, relevant sources, references, and reference lists of the related articles were reviewed. The studies were searched from April until August 2022 and finally the content analysis of the findings was done. Two reviewers independently assessed the quality of included studies. Data were extracted using the Joanna Briggs Institute (JBI) checklist tool. Of the 1439 records, 13 studies met the inclusion criteria. This study identified three main categories of factors affecting knowledge sharing in knowledge networks and COPs as individual factors, organizational, and structural. The results showed that knowledge networks provide opportunities to overcome professional barriers and complex systemic challenges and lead to knowledge sharing and exchange among scientific specialists. This article has important implications for managers, health policymakers, and academics who wish to expand knowledge sharing of scientific specialists through knowledge networks and CoPs in knowledge-based organizations.

Breaking Sound Barriers: Exploring Tele-Audiology's Impact on Hearing Healthcare

Hearing impairment is a global issue, affecting billions of people; however, there is a gap between the population affected by hearing loss and those able to access hearing healthcare. Tele-audiology, the application of telemedicine in audiology, serves as a new form of technology which aims to provide synchronous or asynchronous hearing healthcare. In this article, we reviewed some recent studies of tele-audiology-related topics to have a glimpse of the current development, associated challenges, and future advancement. Through the utilization of tele-audiology, patients can conveniently access hearing healthcare, and thus save travel costs and time. Recent studies indicate that remote hearing screening and intervention are non-inferior to the performance of traditional clinical pathways. However, despite its potential benefits, the implementation of tele-audiology faces numerous challenges, and audiologists have varying attitudes on this technology. Overcoming obstacles such as high infrastructure costs, limited reimbursement, and the lack of quality standards calls for concerted efforts to develop effective strategies. Ethical concerns, reimbursement, and patient privacy are all crucial aspects requiring in-depth discussion. Enhancing the education and training of students and healthcare workers, along with providing relevant resources, will contribute to a more efficient, systematic hearing healthcare. Future research will aim to develop integrated models with evidence-based protocols and incorporating AI to enhance the affordability and accessibility of hearing healthcare.

The implementation of embedded researchers in policy, public services, and commercial settings: a systematic evidence and gap map

BACKGROUND

Embedding researchers into policy and other settings may enhance research capacity within organisations to enable them to become more research active. We aimed to generate an evidence map on evaluations of embedded researcher interventions to (i) identify where systematic reviews and primary research are needed and (ii) develop conceptual understandings of 'embedded researchers'. We define 'embedded researchers' through a set of principles that incorporate elements such as the aim of activities, the types of relationships and learning involved, and the affiliations and identities adopted.

METHODS

We included studies published across all sectors, searching fourteen databases, other web sources and two journals for evaluations published between 1991 and spring 2021. Data were extracted using a coding tool developed for this study. We identified new typologies of embedded researcher interventions through undertaking Latent Class Analysis.

RESULTS

The map describes 229 evaluations spanning a variety of contexts. Our set of principles allowed us to move beyond a narrow focus on embedded researchers in name alone, towards consideration of the wide range of roles, activities, identities, and affiliations related to embedded researchers. We identified 108 different allied terms describing an embedded researcher. Embedded researcher activity spanned a continuum across lines of physical, cultural, institutional, and procedural embeddedness (from weaker to more intense forms of embeddedness) and took a range of forms that bridge or blur boundaries between academia and policy/practice.

CONCLUSIONS

We developed a broad map of international embedded researcher activity in a wide range of sectors. The map suggests that embedded researcher interventions occupy a broader suite of models than previously acknowledged and our findings also offer insight on the type and nature of this literature. Given the clear policy interest in this area, a better understanding of the processes involved with becoming embedded within an organisation is needed. Further work is also necessary to address the challenges of evaluating the work of embedded researchers, including consideration for which outcome measures are most appropriate, to better understand their influence.

Health-related quality of life and associated factors among health care providers in the northwest of Ethiopia: a multicenter cross-sectional study, 2023

Background

The diminished quality of life among healthcare providers (HCPs) could impact both their personal well-being and their ability to effectively fulfill healthcare needs and provide necessary facilities to the public. Furthermore, this decline in quality of life may also significantly influence the overall health of HCPs, regardless of their professional training and duties.

Objectives

The aim of this study was to assess the health-related quality of life (HRQoL) and associated factors among healthcare providers at comprehensive specialized hospitals in the Northwest Ethiopia.

Method

A cross-sectional study was conducted among 412 healthcare providers at comprehensive specialized hospitals in Northwest Ethiopia from June to July 2023. Study participants were enrolled using simple random sampling. Health-related quality of life (HRQoL) was measured using the World Health Organization Quality of Life Scale-Bref Version. Data entry and analysis were performed using Epi-data version 4.6.1 and SPSS version 24, respectively. Binary logistic regression was employed to assess the association between quality of life and independent variables. Variables with a p-value <0.05 at a 95% confidence interval were considered statistically significant.

Result

Out of the 422 study participants approached, 412 respondents were included in the final analysis. Poor quality of life was observed in 54.6% of participants. Factors such as working hours per day (AOR = 1.85, 95% CI: 1.12; 3.05), working experience (AOR = 1.95, 95% CI: 1.04; 3.65), and the presence of chronic disease (AOR = 2.11, 95% CI: 1.18; 3.75) were significantly associated with poor quality of life.

Conclusion

This study revealed that more than half of the participants experienced poor quality of life. Specific attention is needed for healthcare providers working for more than 8 h per day, those with less work experience, and those with chronic illnesses in order to improve their quality of life.

Exploring Foreign Domestic Workers' Perceived Contextual Factors That Influence Their Participation in Medical Consultations: An Ecological Lens

Foreign domestic workers have reported various health problems after moving to Hong Kong, which suggests the need for them to seek medical attention. Yet, much uncertainty exists about their perception of healthcare experiences as patients, particularly how they perceive their communication with ethnic-discordant healthcare providers. Drawing on foreign domestic workers' perspectives, we extracted non-interpersonal factors from Street's ecological model and its extension proposed by Head and Bute (2018) and examined how foreign domestic workers perceived these contextual factors affected their communication with healthcare providers. Thematic analysis was conducted on thirty Filipina and Indonesian domestic workers' narratives. Our findings confirmed that the context of digital media (characterized by Internet use and the adoption of a telemedicine approach) and the context of social ties (characterized by employers' involvement and everyday communication with friends and peers) were both potential contextual factors that domestic workers reported accounted for their participation in medical encounters. Theoretical and practical implications are discussed. Future research building on these findings is proposed.

Healthcare Professionals' Perceptions about the Implementation of Shared Decision-Making in Primary Care: A Qualitative Study from a Virtual Community of Practice

Background

The incorporation of shared decision making (SDM) is a central part of empowerment processes, as it facilitates greater activation on the part of patients, increasing the likelihood of them gaining control over their healthcare and developing skills to solve their health problems. Despite these benefits, there are still difficulties in the implementation of SDM among healthcare professionals due to internal and external factors related to the context and health systems.

Aim

To explore primary care professionals (PCPs)' perceptions of the SDM model, based on their preconceptions and experience in clinical practice.

Methods

A framework analysis was conducted on qualitative data derived from a virtual community practice forum, within a cluster-randomized clinical trial developed in the e-MPODERA project.

Results

The most important points in the opinions of the PCPs were: exploring the patients' values, preferences and expectations, providing them with and checking their understanding of up-to-date and evidence-based health information. The analysis revealed three themes: determinants of the implementation process of SDM, lack of consistency and dilemmas and benefits of PCP active listening, motivation and positive expectations of SDM.

Discussion

In our initial analysis, we examined the connections between the categories of the TDC model and its application in the primary care context. The categories related to the model reflect the theoretical understanding of professionals, while those related to perceptions of its application and use show certain discrepancies. These discrepancies could indicate a lack of understanding of the model and its real-world implications or insufficient commitment on the part of professionals or the organization to ensure its effective implementation.

Conclusions

Specific targeted training that addresses knowledge, attitudes and practice may resolve the aforementioned findings.

Communication Matters: The Role of Patient-Centered Communication in Improving Old Adults' Health Competence and Health Outcomes

Research has demonstrated links between patient-centered communication (PCC) and patients' health outcomes. However, little is known about the underlying processes that may mediate the relationship. This study is one of the first to examine the influence of PCC on older adults' health outcomes, as well as the mediation role of health competence, from a longitudinal perspective. With a general basis of Street et al.'s pathway model, we proposed and tested mediation pathways linking patient-centered communication to the older population's general and mental health, mediated by health competence. Data from 2011, 2017 and 2020 iterations of the Health Information National Trends Survey (HINTS) were used for this study. This study focused on older adults aged 60 and above. Results indicated that after controlling participants' age, gender, education, income and race, PCC is related to the older people's health outcomes either directly or indirectly, irrespective of time series. Specifically, health competence was found to significantly mediate the associations between PCC and the older adults' general health or mental health over the three iterations. Noteworthily, findings from this study also revealed that different dimensions of PCC might exert different influences on older patients' health competence and health outcomes.