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Aim: The aim of the study was to identify barriers and benefits in establishing a model for integration of palliative care of cancer patients in daily clinical practice in tertiary health institutions. Methods: This was a qualitative design study using in‐depth interviews with four stakeholders and focus group discussions with 19 nurse managers using purposive sampling to select the participants, utilizing interpretive paradigm method. Need was ascertained for a model that would guide nursing care for cancer patients. Results: Barriers identified in relation to integrating palliative care in daily clinical practice included lack of hospital policies about palliative care activities, cultural influences, denial or rejection of diagnosis by patients, inappropriate attitude of health care workers, patients failing to keep check‐up appointments and financial implications of setting up a dedicated palliative care team. Benefits of the model were twofold: hospital outcomes and patients/family outcomes. Conclusions: Quality care for cancer patients/families calls for the adoption of clearly set out principles of palliative care as an integral component of daily practice. Challenges to implementation of palliative care services in hospitals can be overcome by establishing workable policies and allocating adequate funds for palliative care activities. SUMMARY STATEMENT: What is already known about this topic? There is high incidence rate of cancer globally and Nigeria is not an exception.Diagnosis of cancer brings about fear and psychological distress to patients and their families.There is absence of health policy in Nigeria on prevention, control or even care of conditions such as cancer. What this paper adds? Barriers to adapting a palliative care model can be overcome by instituting policies, guidelines and palliative care teams to monitor all patients diagnosed with cancer.General positive attitude of health care professional towards cancer patients and families.Barriers to palliative care model implementation can be overcome by proper follow‐up of patients on first diagnosis. The implications of this paper: Hospital management can develop and implement interventions based on patients identified needs.Nurses should be properly trained on palliative care principles.There should be medium of educating patients and families after diagnosis of cancer to avoid negative cultural influence. [ABSTRACT FROM AUTHOR]

This paper presents the challenges and barriers to accessing formal maternity care in South East Nigeria from women's perspectives. It is drawn from a study that explored the concept of safe motherhood. The study used a hermeneutic phenomenological approach guided by post-structural feminism. Data were collected through individual semi-structured interviews with 17 women who were attending a formal healthcare facility for antenatal care. Four aspects of the challenges and barriers encountered by women when accessing care in a formal healthcare setting as reported by the participants of the study are as follows: financial constraints, lack of autonomy, negative attitude of the healthcare providers, and healthcare worker strikes. Some participants linked the economic status of women to the lack of education which had an impact on their ability to make an independent decision as to whether to seek formal maternity healthcare or not. Negative attitudes, and frequent strikes of healthcare workers in many cases, discourage women from using the formal maternity healthcare facilities. It is evident that Nigeria did not achieve the Millennium Development Goal (MDG) 5, which is to improve maternal health. Achieving the Sustainable Development Goal (SDG) 3.1, which is to reduce the global maternal mortality ratio, requires more than technical approaches. Genuine political will is required if the health system is to be affordable for all women. There is the need to address the gender-related issues that sustain women's low socio-economic status. The government needs to pay the workers as and when due, and a performance appraisal should be in place to ensure improvement in the quality of care offered to women. [ABSTRACT FROM AUTHOR]

Background: Anaemia in pregnancy causes a significant burden of maternal morbidity and mortality in sub-Saharan Africa, with prevalence ranging from 25 to 45% in Nigeria. The main treatment, daily oral iron, is associated with suboptimal adherence and effectiveness. Among pregnant women with iron deficiency, which is a leading cause of anaemia (IDA), intravenous (IV) iron is an alternative treatment in moderate or severe cases. This qualitative study explored the acceptability of IV iron in the states of Kano and Lagos in Nigeria. Methods: We purposively sampled various stakeholders, including pregnant women, domestic decision-makers, and healthcare providers (HCPs) during the pre-intervention phase of a hybrid clinical trial (IVON trial) in 10 healthcare facilities across three levels of the health system. Semi-structured topic guides guided 12 focus group discussions (140 participants) and 29 key informant interviews. We used the theoretical framework of acceptability to conduct qualitative content analysis. Results: We identified three main themes and eight sub-themes that reflected the prospective acceptability of IV iron therapy. Generally, all stakeholders had a positive affective attitude towards IV iron based on its comparative advantages to oral iron. The HCPs noted the effectiveness of IV iron in its ability to evoke an immediate response and capacity to reduce anaemia-related complications. It was perceived as a suitable alternative to blood transfusion for specific individuals based on ethicality. However, to pregnant women and the HCPs, IV iron could present a higher opportunity cost than oral iron for the users and providers as it necessitates additional time to receive and administer it. To all stakeholder groups, leveraging the existing infrastructure to facilitate IV iron treatment will stimulate coherence and self-efficacy while strengthening the existing trust between pregnant women and HCPs can avert misconceptions. Finally, even though high out-of-pocket costs might make IV iron out of reach for poor women, the HCPs felt it can potentially prevent higher treatment fees from complications of IDA. Conclusions: IV iron has a potential to become the preferred treatment for iron-deficiency anaemia in pregnancy in Nigeria if proven effective. HCP training, optimisation of information and clinical care delivery during antenatal visits, uninterrupted supply of IV iron, and subsidies to offset higher costs need to be considered to improve its acceptability. Trial registration ISRCTN registry ISRCT N6348 4804. Registered on 10 December 2020 Clinicaltrials.gov NCT04976179. Registered on 26 July 2021 Plain language summary: Low blood level in pregnancy is of public health importance and with common occurrence worldwide, but with a higher rate in low resource settings where its burden greatly affects both the mother and her baby. This low blood level is usually caused by poor intake of an iron-rich diet. It could lead to fatigue, decreased work capacity, and dizziness if not detected. Without treatment, this condition could affect the baby, possibly leading to its sudden demise in the womb, immediately after birth, or even the woman's death. The use of oral iron has been the primary treatment; however, it is associated with significant side effects, which have led to poor compliance. Fortunately, an alternative therapy in the form of a drip has been shown to overcome these challenges. However, it is not routinely used in countries like Nigeria. Moreover, being effective is different from being utilised. Therefore, this study was conducted to understand the factors that will make this treatment widely accepted. We interviewed pregnant women, family support and health care providers in 10 health facilities in Lagos and Kano States, Nigeria. Our findings revealed good attitudes to iron drip. However, its inclusion into routine antenatal health talk, training of health care providers, availability of space, drugs and health workers who will provide this care, and ensuring this drug is of low cost are some of the efforts needed for this treatment to be accepted. [ABSTRACT FROM AUTHOR]

Literature indicates a knowledge gap in the preparedness of teachers to deliver sexuality and human immunodeficiency virus (HIV) prevention education to learners with intellectual disabilities in Africa. This paper reports on teachers' opinions on sexuality of Nigerian learners with intellectual disabilities and awareness of their risk of HIV infection. The study utilized key informant interviews with 12 teachers to explore their views on the sexuality and risk of HIV exposure of learners with intellectual disabilities in special schools across Oyo State, Nigeria. Interview scripts were analyzed using interpretative phenomenological analysis. Teachers considered learners with intellectual disabilities as 'hypersexual' and incapable of intimate relationships. Learners with intellectual disabilities were reported to be at risk of exposure to HIV infection due to sexual abuse, transactional sex and lack of sexuality and HIV education. Teachers expressed confidence to deliver sexuality and HIV education but lacked skills to communicate relevant information to learners with intellectual disabilities in accessible formats. Teachers' negative attitudes, misconception and lack of skills to deliver sexuality education to learners with intellectual disabilities have to be addressed through training. Further studies are needed to provide baseline information for developing a tailored sexuality and HIV education for Nigerian learners with different types of disabilities. [ABSTRACT FROM AUTHOR]

kwong e.w.-y., pang s.m.-c., choi p.-p. & wong t.k.-s. (2010) Influenza vaccine preference and uptake among older people in nine countries. Journal of Advanced Nursing 66(10), 2297–2308. Aim. This paper is a report of a study delineating factors that influence older people’s preferences and uptake of the influenza vaccine in nine countries. Background. Vaccination uptake for the aging population in many countries still remains below the World Health Organization recommended rate. Older people who perceive higher susceptibility to and severity of influenza, and more benefits from vaccination and action cues prompting vaccination, tend to accept the vaccine, but those with more perceived barriers to vaccination are less likely to accept it. Method. A total of 208 older people from China, Indonesia, Turkey, Korea, Greece, Canada, the United Kingdom, Brazil and Nigeria were recruited to 14 vaccinated and 12 unvaccinated focus groups. They shared their experiences of influenza, and influenza vaccination, and promotion of influenza vaccination in focus groups. The data were collected in 2007. Findings. We identified five themes and generated a hypothetical framework for in-depth understanding of vaccination behaviour among older people. Participants’ vaccine preferences were determined by their behavioural beliefs in vaccination, which were based on their probability calculation of susceptibility to and severity of influenza and vaccine effectiveness, and their utility calculation of vaccine, healthcare and social costs. Action cues prompting vaccination and vaccine access further affected the vaccine uptake of participants with vaccine preferences. Vaccination coverage was likely to be higher in the countries where normative beliefs in favour of vaccination had formed. Conclusion. The hypothetical framework can be used to guide healthcare providers in developing strategies to foster normative beliefs of older people in vaccination, provide effective action cues and promote vaccine access. [ABSTRACT FROM AUTHOR]

Religion and spirituality are central to everyday life in Nigeria. Social work educators recognize that learning cannot be separated from the influence of context, including religion and spirituality. This study presents the first empirical inquiry into religion and spirituality in social work education in Nigeria. The qualitative study explored the inclusion of religion and spirituality on Nigerian social work programs from the viewpoints of social work educators, adopting a phenomenological approach. Data from key informants' semi-structured interviews with 12 purposively sampled social work educators based at three Nigerian universities (University of Nigeria, Nsukka; University of Benin, and Nnamdi Azikiwe University) were analyzed thematically. The findings highlight the importance of religion and spirituality in social work education; yet point to coverage being limited and located within elective modules, and for social work educators to recognize the relevance of religious and spiritual aspects of their students' and service users' existence in developing educational curricula. The study calls for prioritizing the integration of religion and spirituality in social work degree programs. Strengthening the links between religion, spirituality, and social work will better prepare future practitioners to be cultural component and work with the profession's values of social justice. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore how cultural beliefs and traditions are integral to understanding indigenous mental health conditions (MHCs) and traditional healing (TH). However, Nigerian cultural beliefs about MHCs and TH are under-researched. Design/methodology/approach: This study adopted a qualitative design using critical realist and social constructionist perspectives to explore Nigerian mental health-care practitioners (MHCPs) and lay participants' (LPs) views regarding MHCs and TH. Purposive and snowball sampling techniques were used to select 53 participants (MHCPs = 26; LPs = 27; male = 32; female = 21) in four Nigerian cities (Ado-Ekiti, Enugu, Jos and Zaria). Data were collected using semi-structured interviews and analysed through thematic analyses. Findings: The data sets revealed three overarching themes, namely, existing cultural beliefs about MHCs as spiritual curse; description of TH as the first treatment modality for MHCs; and perceived stigma associated with MHCs and help-seeking behaviours. Originality/value: A study on Nigerian cultural beliefs and TH contributes meaningfully to mental health systems. Future research and policy initiatives could explore ways of optimising TH practices and community awareness programmes to increase access to mental health care in Nigeria. [ABSTRACT FROM AUTHOR]

Background Health workers are indispensable to service delivery especially in rural and remote communities where the burden of disease is high. Nigeria faces numerous human resources for health challenges, health workers are reluctant to take up rural postings, and the government is struggling to implement planned interventions due to staff shortages. This study explored the perspectives of policymakers and primary health care (PHC) managers on factors that hinder health workers from staying in rural and remote areas and strategies for improving retention. Methods We interviewed purposively selected 10 policymakers and 20 PHC managers in Bauchi and Cross River States, Nigeria. Results Respondents identified a lack of basic social amenities, the poor state of infrastructure, poor working conditions, remuneration and the barrier to career advancement as factors that impede health workers from taking up rural postings. Strategies for improving retention include enforcing bonding; paying salaries promptly, increase in rural allowances and prioritizing health workers in rural and remote areas for capacity building. Conclusion The results of the study indicate the importance of applying context-specific strategies aimed at ensuring the availability of social amenities such as roads, water, electricity, telecommunication, security, the status of infrastructure, working conditions and remunerations. [ABSTRACT FROM AUTHOR]

Despite the benefits promised by mobile health, the introduction of these solutions is often met with resistance from various stakeholders. This article adopts a shared mental model approach to unearth the current perceptions, concerns, and mentalities of key stakeholders engaged in the provision of healthcare in Nigeria. These include policy makers, academics, healthcare professionals, and health information systems developers. Interviews and focus groups were used to examine stakeholders' views across three mental models: (1) the technology, (2) processes, and (3) the team. Our investigations reveal disparities in stakeholders' existing mental models and their perceptions of the proposed mobile health solution. We argue that fostering a common understanding of mobile health, as well as elucidating an improved understanding of processes and team behaviours, will mitigate the risk of resistance among stakeholders involved in the design and delivery of community healthcare services and culminate in a positive attitude towards new mobile health solutions among these stakeholders. We highlight the need to enhance communication and training from national to rural levels to promote complementary mental models and positively influence team performance. [ABSTRACT FROM AUTHOR]

We examined the scope of collaborative care for persons with mental illness as implemented by traditional healers, faith healers, and biomedical care providers. We conducted semistructured focus group discussions in Ghana, Kenya, and Nigeria with traditional healers, faith healers, biomedical care providers, patients, and their caregivers. Transcribed data were thematically analyzed. A barrier to collaboration was distrust, influenced by factionalism, charlatanism, perceptions of superiority, limited roles, and responsibilities. Pathways to better collaboration were education, formal policy recognition and regulation, and acceptance of mutual responsibility. This study provides a novel cross-national insight into the perspectives of collaboration from four stakeholder groups. Collaboration was viewed as a means to reach their own goals, rooted in a deep sense of distrust and superiority. In the absence of openness, understanding, and respect for each other, efficient collaboration remains remote. The strongest foundation for mutual collaboration is a shared sense of responsibility for patient well-being. [ABSTRACT FROM AUTHOR]

Background: Global efforts have increased facility-based childbirth, but substantial barriers remain in some settings. In Nigeria, women report that poor provider attitudes influence their use of maternal health services. Evidence also suggests that women in Nigeria may experience mistreatment during childbirth; however, there is limited understanding of how and why mistreatment this occurs. This study uses qualitative methods to explore women and providers' experiences and perceptions of mistreatment during childbirth in two health facilities and catchment areas in Abuja, Nigeria. Methods: In-depth interviews (IDIs) and focus group discussions (FGDs) were used with a purposive sample of women of reproductive age, midwives, doctors and facility administrators. Instruments were semi-structured discussion guides. Participants were asked about their experiences and perceptions of, and perceived factors influencing mistreatment during childbirth. Thematic analysis was used to synthesize findings into meaningful sub-themes, narrative text and illustrative quotations, which were interpreted within the context of this study and an existing typology of mistreatment during childbirth. Results: Women and providers reported experiencing or witnessing physical abuse including slapping, physical restraint to a delivery bed, and detainment in the hospital and verbal abuse, such as shouting and threatening women with physical abuse. Women sometimes overcame tremendous barriers to reach a hospital, only to give birth on the floor, unattended by a provider. Participants identified three main factors contributing to mistreatment: poor provider attitudes, women's behavior, and health systems constraints. Conclusions: Moving forward, findings from this study must be communicated to key stakeholders at the study facilities. Measurement tools to assess how often mistreatment occurs and in what manner must be developed for monitoring and evaluation. Any intervention to prevent mistreatment will need to be multifaceted, and implementers should consider lessons learned from related interventions, such as increasing audit and feedback including from women, promoting labor companionship and encouraging stress-coping training for providers. [ABSTRACT FROM AUTHOR]

The article offers information on breastfeeding practices in Southwest Nigeria. It states that 19 percent of the nursing mothers practiced exclusive breastfeeding. The survey showed the major constraints to exclusive breastfeeding due to reasons including babies continued to be hungry after breastfeeding, fear of babies becoming addicted to breast milk, and the need to return to work.The desire to practice exclusive breastfeeding was often compromised shortly after child delivery.

Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries - the United States, Nigeria, Pakistan, Peru and Mexico - to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations. [ABSTRACT FROM AUTHOR]