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Background: Given the worldwide reach of COVID-19, media coverage has amplified the psychological and social effects of this pandemic causing a widespread fear. Despite substantial research on the short-term psychological impact of COVID-19, its long-term consequences on mental health remain relatively unexplored. This research aims to develop and validate a Post-Pandemic Fear of Viral Disease (PPFVD) scale and to see its relationship with general anxiety disorder among the Pakistani population., Methods: A cross-sectional online-based survey was conducted with 457 respondents in August and September 2022. We adopted the modified fear of coronavirus scale (FCV-19 S) consisting of seven items and the Generalized Anxiety Disorder (GAD) questionnaire to measure anxiety disorder. Confirmatory factor analysis was applied using the maximum likelihood estimation method. Scale dimensions and item reliability were tested for their validity and goodness of fit. SPSS and AMOS were used for data management and analyses., Results: All inter-item correlations were found to be significant and ranged between 0.30 and 0.70. The value of Cronbach's alpha was 0.887, indicating good reliability. Corrected item-total correlations ranged between 0.632 and 0.754. Factor loadings ranged from 0.664 to 0.810, indicating a good internal consistency. Overall, these results clearly demonstrate that the one-factor solution model for PPFVD presents a good fit to the data. The composite reliability (CR = 0.747) was also good., Conclusions: The COVID-19 pandemic has negatively affected the mental health of people globally. This measurement scale can be trusted and used to test the PPFVD in the post-pandemic situation. Prospective research might validate this instrument in newly emerging scenarios and test it with diverse ethnic groups., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Ensuring safety and wellbeing of all the minority populations of Pakistan is essential for collective national growth. The Pakistani Hazara Shias are a marginalized non-combative migrant population who face targeted violence in Pakistan, and suffer from great challenges which compromise their life satisfaction and mental health. In this study, we aim to identify the determinants of life satisfaction and mental health disorders in Hazara Shias and ascertain which socio-demographic characteristics are associated with post-traumatic stress disorder (PTSD)., Methods: We used a cross-sectional quantitative survey, utilizing internationally standardized instruments; with an additional qualitative item. Seven constructs were measured, including household stability; job satisfaction; financial security; community support; life satisfaction; PTSD; and mental health. Factor analysis was performed showing satisfactory Cronbach alpha results. A total of 251 Hazara Shias from Quetta were sampled at community centers through convenience method based on their willingness to participate., Results: Comparison of mean scores shows significantly higher PTSD in women and unemployed participants. Regression results reveal that people who have low community support, especially from national and ethnic community, religious community, and other community groups, had higher risk of mental health disorders. Structural equation modeling identified that four study variables contribute to greater life satisfaction, including: household satisfaction (β = 0.25, p < 0.001); community satisfaction (β = 0.26, p < 0.001); financial security (β = 0.11, p < 0.05); and job satisfaction (β = 0.13, p < 0.05). Qualitative findings revealed three broad areas which create barriers to life satisfaction, including: fears of assault and discrimination; employment and education problems; and financial and food security issues., Conclusions: The Hazara Shias need immediate assistance from state and society to improve safety, life opportunities, and mental health. Interventions for poverty alleviation, mental health, and fair education and employment opportunities need to be planned in partnership with the primary security issue., Competing Interests: We have no conflict of interest to declare., (© 2023 The Author(s).)

Objective: Women living in Pakistan have complex health problems including infectious and non-communicable diseases, accident and injuries, and mental health problems. While a majority of these women rely on primary healthcare services for all of their healthcare needs, there has to date been no overview of the extent of their effectiveness. The objective of this review was to (1) synthesise the available evidence regarding the effectiveness of primary care based interventions aimed at improving women's mental and physical health and (2) identify the factors that promote effectiveness for women's health outcomes., Methods: Five academic databases were searched, including PubMed, BMC Medicine, Medline, CINAHL and the Cochrane Library. A search was also made of the grey literature. The quality of included studies was assessed using a standardised critical appraisal tool, and the findings summarised using a narrative synthesis., Results: In total, 18 studies were included in the review. Eight involved evaluations of counselling interventions, three health education and awareness interventions, two social and psychosocial interventions, and five were evaluations of combination interventions. Twelve of the included studies were randomised controlled trials. Of these 14 reported significant outcomes, and 4 further interventions showed partially favourable results. However, interventions mostly targeted women's mental or reproductive health., Conclusions: While the evidence is limited in terms of quality and what has been evaluated, a number of interventions appear to be effective in improving outcomes for women. The three key approaches include the adoption of an active door-to-door and group-based approach; utilisation of community peers who can deliver care cost-effectively and who are more accepted in the community; and the integration of financial vouchers to support uptake in poor populations., Prospero Registration Number: CRD42020203472., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The outbreak of the novel coronavirus disease (COVID-19) has posed multiple challenges to healthcare systems. Evidence suggests that mental well-being is badly affected due to compliance with preventative measures in containing the COVID-19 pandemic. This study aims to explore the role of positive mental health (subjective sense of wellbeing) to cope with fears related to COVID-19 and general anxiety disorder in the Pashtun community in Pakistan., Methods: A cross-sectional survey was conducted among 501 respondents from Khyber Pakhtunkhwa participating in an online-based study. We performed correlational analysis, hierarchical linear regression and structural equational modeling (SEM) to analyze the role of mental health in reducing fears and general anxiety disorder., Results: The results of the SEM show that positive mental health has direct effects in reducing the fear related to COVID-19 (β = - 0.244, p < 0.001) and general anxiety (β = - 0.210, p < 0.001). Fears of COVID-19 has a direct effect on increasing general anxiety (β = 0.480). In addition, positive mental health also has an indirect effect (β = - 0.117, p < 0.001) on general anxiety (R 2  = 0.32, p < 0.001) through reducing fear of coronavirus., Conclusion: Based on these findings, there is a need to develop community health policies emphasizing on promotive and preventive mental health strategies for people practicing social/physical distancing., (© 2022. The Author(s).)

Introduction: Home delivery is a predominant driver of maternal and neonatal deaths in developing countries. Despite the efforts of international organizations in Pakistan, home childbirth is common in the remote and rural areas of Khyber Pakhtunkhwa province. We studied women's position within the household (socio-economic dependence, maternal health decision making, and social mobility) and its association with the preference for home delivery., Methods: We conducted a cross-sectional household survey among 503 ever-married women of reproductive age (15-49 years), who have had childbirth in the last twelve months or were pregnant (more than 6 months) at the time of the interview. A two-stage cluster sampling technique has been used for recruitment. Descriptive and bivariate analyses have been conducted. A binary logistic regression model was calculated to present odds ratios and corresponding 95% confidence intervals for factor associated with home delivery., Results: An inferior status of women, restrictions in mobility and limited power in decision making related to household purchases, maternal health care, and outdoor socializing are contributing factors of home delivery. Furthermore, women having faced intimate partner violence were much more likely to deliver at home (OR = 2.66, 95% CI: 1.83.3.86, p < 0.001)., Discussion: We concluded that women are in a position with minimal authority in decision making to access and deliver the baby in any health facility. We recommend that the government should ensure the availability of health facilities in nearby locations to increase institutional deliveries in the study area., (© 2021. The Author(s).)

The COVID-19 pandemic has necessitated support for continued learning in frontline practitioners through online digital mediums that are convenient and fast to maintain physical distancing. Nurses are already neglected professionals for support in training for infection control, leadership, and communication in Pakistan and other developing countries. For that reason, we aimed to deliver a WhatsApp-based intervention for continued learning in nurses who are currently working in both private and public sector. A 12-week intervention was delivered to 208 nurses (102 in the control group and 106 in the intervention group) who had been employed in the clinical setting during data collection. The analysis reveals that nurses in the intervention group show significantly better results for learning in "infection prevention and control" and "leadership and communication." Results of a content analysis based on participant's feedback also confirm that the WhatsApp-based intervention is a valuable tool for education. This study highlights the effectiveness of online-based digital interventions as a convenient training tool for awareness and management of infectious diseases, leadership, and communication during COVID-19 and beyond. Furthermore, this study emphasizes that group interventions with other healthcare practitioners and the role of on-going longer WhatsApp-based interventions can become integral tools to support continued learning and patient safety practices., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jafree, Zakar, Rafiq, Javed, Durrani, Burhan, Hasnain Nadir, Ali, Shahid, Momina, Wrona, Mahmood and Fischer.)

This study rests on two important considerations: the rapid increase of COVID-19 cases in Pakistan and also the marginalization of the people of the KPK province, which would make them more vulnerable in fearing COVID-19. We aim to translate and validate FCV-19S into the Urdu language and to identify the socio-demographic associations with fear in the people of the KPK. Using an online Google survey, we were able to sample 501 respondents from the KPK. The Cronbach alpha α value for the Urdu FCV-19S displayed good internal reliability at .846. The unidimensional structure of the FCV-19S in Urdu was confirmed, and all of the items were found to be statistically significant, ranging from 0.59 to 0.80. The results of the confirmatory factor analysis show that fit indices are all within an acceptable limit. The FCV-19S was also significantly and positively correlated with preventive behavior ( r  = .328, p  < .01) and general anxiety ( r  = .458, p  < .01). The results of independent sample t tests show that women ( t  = 4.086, p  < 0.001), married people ( t  = - 2.709, p  < .001), and unemployed people ( t  = - 3.199, p  < 0.001) of the KPK experienced great fear of COVID-19. We conclude that that the Urdu version of the FCV-19S is a valid and reliable tool and must be used by healthcare practitioners, government bodies, and researchers, to identify the prevalence of fear and to subsequently plan improved social and health policies to reduce anxiety in the public., Competing Interests: Conflict of InterestThe authors do not have any conflict of interest., (© Springer Science+Business Media, LLC, part of Springer Nature 2020.)

The ongoing COVID-19 pandemic is the most significant public health crisis of this century, and the world has been facing multiple challenges for the last two years, including a high death toll, the imposition of various forms of lockdown and the unavailability of vaccines. Globally, people have faced fearful situations and sought information from social media in order to understand the severity of the situation as well as to protect themselves and others. In comparison to traditional media (electronic and print), social media provides quick and easy access to information, making its impact timely and powerful. The cross-sectional data reflects social media use and its associations with self-efficacy, perceived threat, and preventive behavior in the time of COVID-19 among the people of Pakistan. An online-based cross-sectional survey has been conducted to obtain data from the respondents. These respondents were reached out by sharing a hyperlink through various social media platforms. A total number of 310 respondents furnished their responses. The survey was completed in April 2020. This data may be of great interest to researchers, policymakers, research organizations, and social and mental health practitioners who wish to explore other dimensions of mental health issues caused by the ongoing COVID-19 pandemic., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s). Published by Elsevier Inc.)

The Coronavirus pandemic (COVID-19) originated in China at the end of 2019, the virus festered there for four months before spreading globally. Impacting the developed and developing world including Indonesia. It has transformed social, economic and political practices social life, everyday habits and government policies, with multi-dimensional consequences on human life. The present study endeavours to explore the relationship between religiosity, social capital, and psychological well-being of the general public, particularly in terms of coping with the pandemic. In addition to this, the study aims to highlight the importance of public awareness regarding social distancing, use of religion as a coping mechanism, and living a healthy lifestyle during pandemic. For knowing the perception of the masses, an online survey by using a self-administered questionnaire was carried out among coronavirus patients, the general public, social media activists, students, and professionals across Indonesia. The findings indicate that the pandemic has altered the lifestyle of the masses in different ways and that people have varied perceptions towards this virus regarding its spread and preventive measures. The study also reveals that, social capital (β = .418, p < .001), psychological well-being (β = .343, p < .001), and religious coping (β = .145, p <. 01) have a significant amount of the variance of coronavirus situational stress (F =  69.77, p < .001, R2 = 0.485). Lastly, the study suggests that, adopting preventative measures, standard operating procedures that are sustainable and healthy forms of coping with the pandemic will be equally as important as medical care in order to contain and eventually eradicate the virus., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Although the role of social media in infectious disease outbreaks is receiving increasing attention, little is known about the mechanisms by which social media use affects risk perception and preventive behaviors during such outbreaks. This study aims to determine whether there are any relationships between social media use, preventive behavior, perceived threat of coronavirus, self-efficacy, and socio-demographic characteristics. The data were collected from 310 respondents across Pakistan using an online cross-sectional survey. Reliability analyses were performed for all scales and structural equational modeling was used to identify the relationships between study variables. We found that: (i) social media use predicts self-efficacy (β = 0.25, p < 0.05) and perceived threat of coronavirus (β = 0.54, p < 0.05, R 2 = 0.06), and (ii) preventive behavior is predicted by self-efficacy and perceived threat of coronavirus ( R = 0.10, p < 0.05). Therefore, these results indicate the importance of social media's influence on health-related behaviors. These findings are valuable for health administrators, governments, policymakers, and social scientists, specifically for individuals whose situations are similar to those in Pakistan., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Mahmood, Jafree, Mukhtar and Fischer.)

Investigating the role of religiosity in coping with health anxiety during the outbreak of COVID-19 assumes significance given the continued onslaught of the pandemic and the importance of religion in many societies of the world. The aim of this study is to test the relationship between religious coping and health anxiety in Pakistani Muslims. The online survey method was used to collect data from 408 respondents. Structural equational modeling was performed, with results indicating that people who are suffering with health anxiety opt for religious coping (β = .54, R 2  = .29, p < .001). We conclude that it is important to consider the role of religion and spirituality during pandemic-induced anxiety. There are implications for counselors, physicians and researchers to integrate religious coping methods when planning mental health interventions during pandemics and otherwise.

Introduction: The lack of universal health coverage and high poverty rates among the majority of women in Pakistan makes it essential to understand the quality and effectiveness of primary healthcare services. The aim of this project is to systematically review the available literature for interventions for primary healthcare services for women in order to provide the basis for future healthcare policy. The primary objective is to identify the effectiveness of the intervention in terms of how successful it was in improving health of women; whereas the secondary aim is to identify barriers and facilitators for delivery of primary healthcare services., Methods and Analysis: A systematic review using a narrative synthesis will be undertaken, including qualitative, quantitative and mixed methods studies from January to June 2021. Electronic databases will be used including PubMed, BMC, Medline, CINAHL and Cochrane Library. The search will be conducted in English and no date restrictions will be applied. A thematic synthesis method will be used for data synthesis involving three steps: (1) the identification, coding and initial theme generation for effectiveness of primary healthcare interventions in Pakistan for women, (2) identification and grouping of overarching themes, and related subthemes, to develop descriptive themes for barriers and facilitators for primary healthcare delivery, and (3) generation of general analytical themes in order to present recommendations in terms of improved health outcomes for women., Ethics and Dissemination: Ethics approval for this study was obtained from the Institutional Review Board, Forman Christian College University. Results will be disseminated via publications in international peer-reviewed journals. In addition, conference proceedings will be used to inform the government, researchers, donors, non-governmental organisations and other stakeholders. This study will result in a systematic identification and synthesis of barriers and facilitators for women's health outcomes that will help inform future primary health policies., Prospero Registration Number: CRD42020203472., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Ensuring safety and wellbeing of healthcare providers is crucial, particularly during times of a pandemic. In this study, we aim to identify the determinants of anxiety in physicians on duty in coronavirus wards or quarantine centers., Methods: We conducted a cross-sectional quantitative survey with an additional qualitative item. Five constructs of workload, exhaustion, family strain, feeling of protection, and anxiety were measured using items from two validated tools. Modifications were made for regional relevance. Factor analysis was performed showing satisfactory Cronbach alpha results. Overall, 103 physicians completed the questionnaire., Results: T-test results revealed significant associations between gender and anxiety. Structural equation modeling identified that high workload contributed to greater exhaustion (β = 0.41, R 2  = 0.17, p < 0.001) and greater family strain (β = 0.47, R 2  = 0.22, p < 0.001). Exhaustion (β = 0.17, p < 0.005), family strain (β = 0.34, p < 0.001), and feelings of protection (β = - 0.30, p < 0.001) significantly explained anxiety (R 2  = 0.28). Qualitative findings further identified specific needs of physicians with regard to protective equipment, compensation, quarantine management, resource allocation, security and public support, governance improvement, and health sector development., Conclusions: It is imperative to improve governmental and social support for physicians and other healthcare providers during the corona pandemic. Immediate attention is needed to reduce anxiety, workload, and family strain in frontline practitioners treating coronavirus patients, and to improve their (perceptions of) protection. This is a precondition for patient safety.

The outbreak of COVID-19 has raised numerous challenges to the present world. Due to the rapid spread of coronavirus, the high death toll, and enforcement of lock-down, people around the globe have faced fearful situations. Researches have also shown that a massive increase in psychological and mental health disorders is reported during the ongoing pandemic. The present cross-sectional data reflects the condition of the coronavirus fear, mental health, preventive behaviour, and anxiety disorder among the people of Khyber Pakhtunkhwa (KPK), Pakistan. At the time of data collection, the condition of lockdown and mobility restrictions were imposed by the provincial government due to which manual/physical collection of data was not possible. An online survey was designed using Google form facility to gather data from the respondents. After getting confirmation from pilot testing, the survey link was distributed through various online platforms including social media. Besides utilizing personal contact points in the KPK, social applications like Facebook, WhatsApp, and LinkedIn were also used for the dissemination of the survey. A total number of 501 respondents have furnished their responses and the survey was completed in a short period of time and the data were analyzed using SPSS. This data may be of great interest to researchers, policymakers, research organizations, social and mental health practitioners who wish to explore other dimensions of fear and anxiety among the masses caused by an ongoing pandemic (COVID-19)., Competing Interests: The authors earnestly declare that they do not have any competing interests which could impact the research work produced in this article., (© 2020 The Authors.)

Academics acknowledge religiosity, spirituality and social support as socio-behavioral factors that influence patients' ability to deal with chronic illness. This study has attempted to describe empirical reality of how these factors influence patients. The sample of this study was 500 chronically ill hepatitis patients and was selected through the multistage sampling techniques. Through structured interview schedule, data were collected during the period of September 2016 to March 2017 from five most populated cities of Punjab (Pakistan). Data were analyzed through descriptive (frequency and percentage) and inferential statistics (Cronbach's alpha, Pearson correlation, and structural equation modeling). The study suggests some recommendations and suggestions to policy makers regarding the significance of religiosity, spirituality and social support as coping strategies during chronic illness. The findings illustrate that social support has more association with coping than religiosity and spirituality of the patients.

Background: Professionalism is amongst the major dimensions determining the competence of medical doctors. Poor professionalism affects the overall outcome of healthcare services. This study explores the perspectives of young medical doctors on professionalism in Pakistan., Methods: A qualitative study based on in-depth interviews was conducted with 60 young medical doctors, aged less than 40 years, who had studied medicine in Pakistani universities, were Pakistani nationals, and were employed at various hierarchical levels, from house officer to consultant specialist, in public tertiary hospitals in Pakistan. The respondents were identified through a multistage maximum heterogeneity sampling strategy. A semi-structured interview guide was developed based on a previous extensive literature review. Written consent was obtained from the hospitals and study participants. Qualitative thematic analysis was applied to analyse the data., Results: The data analysis revealed that rigidity of opinions, unacceptability of contrasting perspectives, false pride, and perceived superiority over other professions and patients were major components of poor medical professionalism. Most of the young doctors believed that there is no need to include professionalism and humanity course modules in the medical curriculum, because topics related to social sciences are deemed irrelevant to medicine and judged to be common sense. The doctors recognised good professionalism in themselves, while reporting unprofessional behaviour demonstrated by their colleagues and paramedics. Other factors contributing to poor medical professionalism included the use of social media applications during duty hours, ridiculing patients, substance use such as smoking cigarettes in the office, referrals of complicated cases to other hospitals, freeing up beds before holidays, lack of cooperation from paramedical staff, and inadequate role models., Conclusions: Poor medical professionalism among young doctors needs to be addressed by policymakers. There is a need to revisit the medical curriculum to strengthen professionalism. It is essential to develop the qualities of tolerance, teachability, and acceptance in doctors in order to facilitate interprofessional collaborations and avoid medical errors.