Search

The burden of malnutrition experienced globally, coupled with the increasing rate of micronutrient deficiencies, compromises the health and well-being of women during their reproductive years. Obesity places young South African women at particular risk during pregnancy, and increases obesity risk for their offspring. To address these risks, the Bukhali trial is being implemented in Soweto, South Africa with 18–28-year-old women, as part of the Healthy Lifestyle Trajectory Initiative. A dietitian is part of the Bukhali intervention team (community health workers) to provide nutritional support for overweight/obese trial participants, making use of the International Federation of Gynaecology and Obstetrics (FIGO) Nutrition Checklist. This paper reflects on the experiences and lessons learned by the Bukhali dietitian, including the use of the FIGO Nutrition Checklist and Healthy Conversation Skills to facilitate conversations about making healthy dietary behaviour changes. Identified challenges that influence nutrition and behaviour are discussed, including lack of food affordability, cultural and social influences on healthy food choices, unsupportive environments and food insecurity. Strategies to optimise this nutritional support are also mentioned. The Bukhali trial is showing that introducing additional nutrition support by a dietitian for at-risk participants has the potential to encourage young women to prioritise nutrition and health, even in the midst of contextual challenges to both nutrition and health. [ABSTRACT FROM AUTHOR]

Cloud computing is a technology that holds great promise and has potential to revolutionize the healthcare sector. Many security and privacy issues are brought up by the cloud's centralization of data for both patients and healthcare professionals. There is a need for maintaining secrecy in communication in exchanging medical data between the sender and the receiver, which can be done by cryptography. This article presents a cryptographic algorithm (encryption and decryption) to have a secure communication of digital health care confidential data using DNA cryptography and Huffman coding. The interesting property is the cipher size obtained from our algorithm is equal to the size of the cipher obtained from the character set of given data. Security analysis is provided to show the security of data when stored and transmitted to the cloud. The cryptographic requirements, key space analysis, key and plain text sensitivity, sensitive score analysis, sensitivity and specificity, optimal threshold, randomness analysis, uniqueness of implementation, entropies of binary bits, DNA bases, DNA bases with Huffman code, Huffman encoded binary bits and cloud service provider's risk are analyzed. The method proposed is compared with other cryptographic methods and results that it is more secure and stronger than other methods. [ABSTRACT FROM AUTHOR]

Adherence to daily oral pre-exposure prophylaxis (PrEP) for HIV prevention has been challenging for adolescent girls and young women (AGYW). As part of The Community PrEP Study (CPS), AGYW were randomised to HIV-prevention empowerment counselling (intervention) or basic medication pick-up (control). In this qualitative sub-study, we interviewed AGYW participants (n = 39) to explore PrEP use and study experiences by study arm, and study staff (n = 7) to explore study implementation, site environment, and participant engagement. Data were thematically analysed using a constant comparison approach. Comparative matrices assessed similarities and differences in study experiences and PrEP support preferences. Friendly, non-judgmental, non-stigmatizing study staff were described as central to participant’s positive experiences. Participants highly valued CPS staff’s holistic health support (e.g. physical and psycho-social). Intervention participants described empowerment counselling as helpful in supporting PrEP disclosure. However, control participants also described disclosing PrEP use to trusted individuals. Participants and staff recommended public-sector PrEP services provide holistic, confidential, and integrated sexual and reproductive health services, and community sensitisation. An adolescent and youth-friendly environment was the primary factor motivating AGYW’s study engagement. While HIV-prevention empowerment counselling was well received, welcoming, respectful and non-judgmental staff may be the ‘secret sauce’ for implementing effective PrEP services to AGYW. [ABSTRACT FROM AUTHOR]

The aim of this study is to assess WHO/Eastern Mediterranean region (WHO/EMR) countries capacities, operations and outbreak response capabilities. Cross-sectional study was conducted targeting 22 WHO/EMR countries from May to June 2021. The survey covers 8 domains related to 15 milstones and key performance indicators (KPIs) for RRT. Responses were received from 14 countries. RRTs are adequately organised in 9 countries (64.3%). The mean retention rate of RRT members was 85.5% ± 22.6. Eight countries (57.1%) reported having standard operating procedures, but only three countries (21.4%) reported an established mechanism of operational fund allocation. In the last 6 months, 10,462 (81.9%) alerts were verified during the first 24 h. Outbreak response was completed by the submission of final RRT response reports in 75% of analysed outbreaks. Risk Communication and Community Engagement (RCCE) activities were part of the interventional response in 59.5% of recent outbreaks. Four countries (28.6%) reported an adequate system to assess RRTs operations. The baseline data highlights four areas to focus on: developing and maintaining the multidisciplinary nature of RRTs through training, adequate financing and timely release of funds, capacity and system building for implementing interventions, for instance, RCCE, and establishing national monitoring and evaluation systems for outbreak response. [ABSTRACT FROM AUTHOR]

This study aimed to determine the factors that promote and facilitate rehabilitation as well as challenges and possible barriers perceived by people with spinal cord injury (SCI). This study was part of a larger, mixed-method Finnish Spinal Cord Injury (FinSCI) study. We interviewed 45 persons with SCI representing participants from the FinSCI study and used a qualitative approach and a deductive-inductive content analysis to analyse the data. We identified 28 facilitators and 19 barriers in the rehabilitation process. The majority of the facilitators and barriers were related to the rehabilitation planning phase. There were more barriers than facilitators in applying for and accessing treatment or rehabilitation and during the implementation of rehabilitation. Facilitators consisted of successful, realized, or planned treatments or rehabilitation events; clear goals; multidisciplinary teamwork; support and monitoring in various changing situations; and the rehabilitees' own capabilities and activities, among other things. The barriers included delays, challenges and deficiencies in the planning and implementation of treatment or rehabilitation; the lack of different skills; and resources of rehabilitation professionals; and different personal factors, which made the rehabilitation process cumbersome. Good communication and interaction between stakeholders are crucial for the progress of rehabilitation. [ABSTRACT FROM AUTHOR]

Endometriosis, a chronic gynecological disease affecting approximately 10% of women of reproductive age, has a significant impact on physical and mental health. This cross-sectional study aimed to explore experiences of validating and invalidating communication in three contexts (with healthcare providers, employers, and family/friends), and whether this may predict health-related quality of life (HRQoL) in women with endometriosis. Data was collected through a digital survey distributed to women with self-reported endometriosis in Sweden. The survey included measures of validating and invalidating communication, depressive symptoms, anxiety, and HRQoL. A total of 427 women participated. The results indicated that women experienced varying levels of validating and invalidating communication in different contexts, with close family/friends providing the highest level of validation, and healthcare providers the lowest. Furthermore, a combined construct of high levels of validation and low levels of invalidation from healthcare providers and from close family and friends were significant predictors of HRQoL. These findings highlight the importance of supportive communication and understanding from healthcare providers and close social networks in promoting the well-being of women with endometriosis. Future research should further explore the impact of validating communication within healthcare settings and develop interventions to improve communication and support for women with endometriosis. [ABSTRACT FROM AUTHOR]

Purpose: This qualitative study describes nurses' experiences and perceptions of how they develop the clinical gaze. Methods: This qualitative study used an inductive approach and content analysis to assess the experiences of newly graduated nurses, nurse managers, and nursing teachers. Nineteen interviews were conducted. To achieve credibility, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative research (COREQ). Results: Two themes emerged: nurses' personal abilities and the learning culture. Learning culture was considered the foundation of the development of the clinical gaze. The clinical gaze was found to be developed in relationships with patients and when learning together with colleagues, in which the opportunities for reflection are central. To develop the clinical gaze, structures for learning activities, such as reflection, communication exercises, and simulation, are needed so that they become a natural part of daily work. This can also be achieved through supervision and skills training both at university and in a care context. Conclusions: Prerequisites for the development of the clinical gaze include physical presence with the patient combined with learning activities such as conscious reflection with others in a safe learning culture. [ABSTRACT FROM AUTHOR]

Purpose: Differences of sex development (DSD) are congenital conditions that involve variations in individuals' sex chromosomes, genes, external and/or internal genitalia, hormones, and/or secondary sex characteristics. This study sought to elucidate the experiences of adolescents and young adults living with DSD by focusing on their experiences of intimacy and sexual health. Methods: An interpretative phenomenological research design was adopted. Semi-structured qualitative interviews were conducted with 11 Norwegian adolescents and young adults aged 16--26 years who had five different DSD conditions. The interview findings were analysed by means of a reflexive thematic analysis. Results: The participants reported feeling different, both in terms of how their body functioned and how their body looked. Lack of knowledge increased this feeling of differentness. Moreover, lack of everyday language with which to talk about intimacy and sexual concerns resulted in the participants feeling stigma. Anticipating stigmatization and lacking everyday language complicated the participants' communication regarding their DSD and sexual health. Conclusions: The sexual experiences of adolescents and young adults with DSD are diverse. Fear of stigmatization and lack of everyday language complicate communication with healthcare professionals and others. Understanding their unique needs is crucial to helping individuals achieve good sexual health. [ABSTRACT FROM AUTHOR]

Purpose: To describe the patient's experience of participation in their care when admitted for elective surgical procedures. Materials and methods: A purposive sample of 14 patients who had undergone elective surgery was included in semi-structured individual interviews at a university hospital. The data was analysed using qualitative content analysis. Results: One theme was identified: Creating a meaningful relationship to enable participation in the care, based on three categories; Abilities, willingness, and a lack of experience affect participation, A professional approach with an open communication and individualized information, and The importance of structural factors. Conclusions: To meet the patient's individual needs and wishes regarding participation, meaningful relationships need to be created between patient and healthcare personnel. The results also indicate that the patients have insufficient knowledge about their role regarding participation. To improve patient participation, its meaning needs to be clarified individually to the patient, emphasizing the importance to be active involved in his or her own care. [ABSTRACT FROM AUTHOR]

Purpose: Many municipalities today, together with other stakeholders, offer group exercises for the older population via municipal meeting places, focusing on promoting good health. During the Covid-19 pandemic, these group exercises either continued in a modified form or ceased. The aim of this study was to explore involved stakeholders' experiences of group exercises for older persons arranged via municipal meeting places during the Covid-19 pandemic. Methods: Six online focus group interviews were conducted with 25 stakeholders, such as decision-makers and representatives from the non-profit sector, from seven municipalities in Sweden. Data were analysed using thematic analysis. Findings: The collaboration around the group exercises was challenged due to affected communication and decision-making. The stakeholders described the importance of adapting and finding new ways to offer group exercise. Furthermore, the re-arranging of group exercises created concerns about the well-being of the older persons but also happiness with the older persons ability to act for their own well-being during the pandemic. Conclusions: This study highlights the importance of the municipalities exchanging experiences, making the older persons more involved in the decision-making process, enabling a personcentred encounter with the older persons when exercising in groups, and strengthening supportive environments by sharing the ownership of arranging the group exercises with the older persons. [ABSTRACT FROM AUTHOR]

Purpose: Although previous research indicates that care transitions differ between rural and urban areas, the knowledge of challenges related to care transitions in rural areas appears limited. This study aimed to provide a deeper understanding of what registered nurses' perceive as the main concerns in care transitions from hospital care to home healthcare in rural areas, and how they handle these during the care transition process. Methods: A Constructivist Grounded Theory method based on individual interviews with 21 registered nurses. Results: The main concern in the transition process was "Care coordination in a complex context". The complexity stemmed from several environmental and organizational factors, creating a messy and fragmented context for registered nurses to navigate. The core category "Actively communicating to reduce patient safety risks" was explained by the three categories-- "Collaborating on expected care needs", "Anticipating obstacles" and "Timing the departure". Conclusions: The study shows a very complex and stressed process that includes several organizations and actors. Reducing risks during the transition process can be facilitated by clear guidelines, tools for communication across organizations and sufficient staffing. [ABSTRACT FROM AUTHOR]

The purpose of this interpretative phenomenological analysis (IPA) is to explore how five professional South African violinists make sense of their lived experiences of performancerelated pain. The research problem this study investigates is multifaceted. It includes examining the career implications for violinists who play despite experiencing pain and are afraid to speak up because of the stigma associated with being injured. There is a lack of support and understanding from fellow musicians, doctors and other specialists when faced with diagnosing injuries and recommending treatment options. In South Africa, there is limited research on these aspects. In this IPA study, the data were collected through semi-structured interviews with five professional South African violinists with performance-related pain. The six subordinate themes that emerged from the data analysis were: (i) Playing through the pain; (ii) Lack of identity; (iii) Depression when unable to play because of pain; (iv) Growth through faith and spirituality; (v) Support and lack of support from family, friends, management, doctors and other experts; and (vi) Lack of awareness and understanding of performance- related injuries. Heightened awareness of musicians' lived experience of performancerelated pain could bring about much-needed change and support advocacy for pain-prevention initiatives and assistance for violinists. [ABSTRACT FROM AUTHOR]

Purpose: It can be challenging to research aspects of people's health behaviour, attitudes, and emotions due to the sensitive nature of these topics. We aimed to develop a novel methodology for discussing sensitive health topics, and explore the effectiveness in focus groups using prostate cancer and screening as an example. Method: We developed a fictitious case and employed it as a projective technique in focus groups on prostate cancer and screening. The participants were men and their partners who lived in Denmark. Results: The technique encouraged emotional and cognitive openness in focus group discussions about the risk of prostate cancer, the benefits and harms of screening, and decision-making about screening. It appeared that using the fictitious case allowed the participants to personally distance themselves from the topic, project emotions onto the case, and thereby openly talk about their emotions. Conclusion: This article presents a methodological contribution to communication about sensitive topics in focus groups, using prostate cancer screening as an example. Further refinement of the methodology is needed to enable participants to transfer improvements in knowledge to their own decision about screening. [ABSTRACT FROM AUTHOR]

Professional assertiveness can enable the healthcare provider to confidently share their expertise without seeming authoritarian to the patient. Professional assertiveness is an interpersonal communication skill that helps express opinions or knowledge while respecting similar competencies in others. For healthcare providers, this compares to sharing scientific or professional knowledge with their patients while respecting their person, ideas, and autonomy. Professional assertiveness also connects the patient's beliefs and values with actual scientific evidence and healthcare system constraints. The definition of professional assertiveness might be easy to understand, but it remains challenging to apply in clinical practice. In this essay, we hypothesize that the practical difficulties healthcare providers encounter with assertive communication stem from their misunderstanding of this style. [ABSTRACT FROM AUTHOR]

Training in healthcare team communication has largely focused on strategies to improve information transfer with less focus on interpersonal dynamics and emotional aspects of communication. The Operating Room (OR) may be one of the most emotionally charged hospital environments, and is one requiring excellent team communications. We aimed to identify literature reporting on the emotional aspects of OR team communication. Our research questions were: what are the triggers in the environment that provoke an emotional response affecting communication, and what are the emotional responses to communication between OR team members; and how do these emotional aspects of communication affect the function of the OR team? We undertook a Scoping Review of literature across relevant databases following published guidelines, and narrative synthesis of the identified studies. From the 10 included studies we identified three themes: (1) Emotional experiences in the OR and their contributors; (2) Effects of emotional experiences on team communication; and (3) Solutions to manage the emotional experiences in the OR. Theme 1 sub-themes were: (1) Range of emotions experienced in the OR; (2) Hierarchical culture and (3) Leadership expectations as contributors to negative emotions. The OR is an emotionally charged environment. The hierarchical culture can inhibit staff from speaking up, and failure of leaders to meet team expectations, e.g., through appropriate and timely communication, may cause frustration and stress. The consequences of emotions include poor team dynamics, ineffective communication and potential negative impact on patient care. Few studies described strategies to manage emotions in the OR. The studies reviewed describe an environment where emotions can run high, affecting interpersonal communications, team function and patient care. The few identified studies relevant to our research questions demonstrate a need to better understand the emotional aspects of OR team communication and the effectiveness of interventions to improve these. [ABSTRACT FROM AUTHOR]

Objectives: Sexual myths are exaggerated beliefs that have no scientific basis. Buying into these beliefs can lead to any number of sexual dysfunctions and decreased quality of life. Therefore, it is necessary to uncover the factors associated with sexual myths and to provide remedial services for anyone struggling with them. Methods: This study was conducted to determine the variables affecting sexual myths. Gender, demographic variables (family type, region of residence, and talking about sexuality with parents), religiosity, and childhood trauma were included as independent variables in the study. A total of 375 teacher candidates participated in the study. Data was collected using a personal information form, Sexual Myths Scale, Religiosity Scale, and Childhood Trauma Questionnaire. Results: Descriptive analyses and linear multiple regression analysis were used in the study, and both adherence to sexual myths and experienced childhood trauma were found to be high in the teacher candidates who did not talk about sexuality with their families. Conclusions: The results of the analysis showed that gender and religiosity were significant predictors of sexual myths. The findings were discussed in light of the literature. [ABSTRACT FROM AUTHOR]

Previous research has highlighted that youth gender dysphoria (GD) and gender diversity (GDI) are experienced in unique ways by different family members, with youth outcomes significantly influenced by family support and understanding. Few studies on a national level have explored individual family member experiences, specifically family, social and healthcare experiences, involving young people, parent/carers and siblings. Using an online survey incorporating circular questioning, this study sought to discover individual family member experiences of youth GD/GDI in Australia, within a family, healthcare, and social context. Young people experiencing GD/GDI, parents/carers and siblings were recruited through Facebook advertising and completed an online survey, exploring positive and negative experiences of youth GD/GDI, within and outside of the family. Survey questions predominantly used Likert scales, with free-text fields, enabling both quantitative and qualitative data analysis. Six hundred and sixty young people aged 12-17 years experiencing GD/GDI, 158 parents/carers ranging in age from under 30 years to more than 60 years (most common age band was 40-49 years; 62%), and 40 siblings aged 12-17 years completed at least part of the online survey. Participants reported mixed experiences of youth GD/GDI with varying levels of understanding and support provided by family members and others. Parents and siblings generally felt it important for healthcare professionals to ask everyone's experience in the family, although only one-third of young people felt this was important. Most parents and young people also highlighted the importance of sibling support. The majority of young people felt misunderstood by other family members. Most family members, particularly young people, reported different viewpoints within families and primarily negative experiences. The research findings support sibling inclusion in healthcare appointments in certain circumstances, depending on context, and a whole of family approach overall, if agreeable to the family and unlikely to cause harm. [ABSTRACT FROM AUTHOR]

The last twenty years have brought profound changes in communication and technology. World leaders have extended their communication into the digital space. In the Catholic world, we speak of a digital papacy, seeing the growth of a community following the Pope on social media. Our study looks at how the language of the Holy See is changing in media-related texts published annually for World Communications Day. The research corpus consists of the messages of the last three popes – from 1995, when the vatican.va domain was created, up to 2022. Using textual analysis, we show that, in addition to the normal change in terminology, the approach of the popes as the ecclesiastical authorities to the community is changing, and the community itself is also changing. For example, the word 'must,' which was widely used in messages until the rise of social networks, has completely disappeared from the texts in the last few years. Our study leads us to posit that not only is there a change in how the popes address the Catholic community, but there is also a paradigm shift in society and culture. [ABSTRACT FROM AUTHOR]

Traditional learning methods may not sufficiently engage students and many have studied VR and AR's impact on student learning. Many construction management (CM) students have difficulty visualizing a building structure and understanding the materials and methods used to build it. This research investigated the use of a physical hands-on construction exercise integrated with VR and AR as a way to improve student visualization ability and learning of the course material. In this study, students built a physical model of a wood frame structure using K'NEX viewing either 2D drawings, 3D drawings, VR or AR models. Students perceived the VR, AR, and hands-on activity, as beneficial for improving their visualization of building structures. They also noted improvement in their understanding of construction materials and sequencing compared to using 2D drawings. In addition, the use of VR and AR improved student communications skills. This research is significant because it adds information on integrating hands-on and VR or AR approaches, in the same activity, to further improve CM student visualization skills and their learning of the course material. The integrated hands-on and VR/AR activity could be used by other CM programs that are interested in applying an active, learning-by-doing, approach in their curriculum. [ABSTRACT FROM AUTHOR]

The prosperity of inclusion of students with disabilities largely rest on the attitudes of mainstream teachers. Few studies explore the relationship among school climate, teachers' attitude on inclusion and teachers' efficacy in China. This study surveyed 266 general teachers in China to understand the role of teachers' efficacy on inclusive education between school climate and teachers' attitude. The results indicated that teachers hold positive attitudes towards inclusion on average, especially in the dimension of affection. Additionally, school climate, teachers' efficacy and teachers' attitude were significantly associated, and the mediating effect of teachers' efficacy between school climate and teachers' attitude were proved by mediation analyses. The findings suggested that creating more inclusive school climate and improving general teachers' knowledge and skills on inclusive education, especially the skills on collaboration with others, which could contribute to promote more positive attitude on inclusive education of general teachers. [ABSTRACT FROM AUTHOR]

The use of interactive technologies has been demonstrated to enhance verbal and non-verbal communication, as well as the social interaction tendencies of children with Autism Spectrum Disorder (ASD). We examined effects of using Virtual Voice Assistant (VVAs) in children with ASD with respect to two outcomes: speech skills and social interaction skills. A single-case study included three children with ASD (4–11 years old) that utilized VVAs for three months. Pre- and post-intervention questionnaires and semi-structured interviews were used to measure the communication and social interaction skills of the participating children. Participant One, Two and Three showed improvement in the number of correct words produced the VVA intervention. All participants showed increases in social interactions in the intervention phase. Overall, the results showed that the VVAs had positive effects on the speech and social interaction skills of autistic children. The findings demonstrate that children with ASD may benefit from VVAs to improve their communication skills. [ABSTRACT FROM AUTHOR]

This scoping review addresses peer-reviewed research on musical interaction with children and young people with severe/profound intellectual and multiple disabilities (S/PIMD). Twenty-five articles published between the years 2000 and 2020 met the inclusion criteria. A narrative synthesis was used to summarise and evaluate different features, including participant characteristics, study design and methods, type of musical interaction, the abilities and behaviours in focus, reported benefits, promising components of musical interaction, and quality appraisal of the studies. The results revealed a variation in participant characteristics and study designs, where small-sample descriptive case studies were most common. In terms of the type of musical interaction, active music therapy was the most commonly used approach, followed by technology-mediated and multisensory musical activities. In terms of abilities and behaviours, a large majority of the studies focused on social interaction and communication, followed by engagement, attention and affect. Six categories were identified as promising components of musical interaction: the responsivity of the interaction partner, singing songs, structure and predictability in the activities, long-term interventions, technology-mediated and multisensory musical activities, and a therapeutic alliance between interaction partners. Based on this review, we discuss future research and practical implications for musical interaction and music therapy for children and young people with S/PIMD. [ABSTRACT FROM AUTHOR]

The Internet and Information Communication Technologies (ICTs) in general have significantly transformed the world's economy and social landscape, enhancing the lives of individuals, promoting business growth, and stimulating economic development. Not having access to the Internet and the appropriate technology comes with a high probability of constrained prospects of quality education, social mobility, employment opportunities, and other factors related to quality of life. This research used a concurrent mixed-method inquiry to explore the effects of digitalization on learning outcomes with a digital learning management platform (Sakai). University of Ghana was selected purposively because the university has been employing the use of Sakai LMS as a tool for teaching and learning since 2014. Two hundred and thirty students (230) at Level 100 in the Adult Education program of the University were chosen as participants for the quantitative survey (n = 230) and 10 students were randomly selected from the 230 to participate in an in-depth interview (n = 10). The study utilized both questionnaires and interviews for data collection. Whereas the quantitative data were analysed using inferential statistics, the qualitative data were analysed via content and thematic approaches. The study found that Sakai as a learning tool enhanced students' participation in discussion forums and online chats that enhanced the learning process through the sharing of ideas and course resources with one another. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder (ASD) show great interest in technological devices, and especially in robots. Several studies in the field have suggested that socially assistive robotics (SARs) can help children with ASD in the enhancement of their social skills and communication, and in the reduction of their stereotypical behaviors. Few published research results are available regarding robot programming or coding in the context of STEM education (Science, Technology, Engineering and Mathematics) for these children. In this pilot study, the authors designed and implemented educational activities with the robot 'Codey Rocky', a ready-to-use robot designed for code learning and programming by primary school children. In this pilot study, the participation of two eight-year-old schoolchildren, a girl with ASD and intellectual deficit and a boy of typical development in triadic interactions with the robot, led to the enhancement of the social and communication skills of the girl with ASD. A decrease in her challenging behaviors was also observed although she manifested repetitive and stereotyped behaviors throughout the educational sessions. The benefits, risks, and implications of the use of SARs for children with ASD are discussed. [ABSTRACT FROM AUTHOR]

There is a recognized need for evidence to inform breast cancer screening guidelines and services for transgender people, who face barriers to accessing appropriate and inclusive health care. This review summarized evidence for breast cancer risk and screening guidelines in transgender individuals, including the potential impact of gender-affirming hormone therapy (GAHT); factors that may influence screening decision-making and behaviors; and considerations for providing culturally safe, high-quality screening services. A protocol was developed based on the Joanna Briggs Institute scoping review methodology. Searches were performed in Medline, Emcare, Embase, Scopus, and the Cochrane Library for articles reporting information on the provision of culturally safe, high-quality breast cancer screening services for transgender people. We identified 57 sources for inclusion: 13 cross-sectional studies, 6 case reports, 2 case series, 28 review or opinion articles, 6 systematic reviews, 1 qualitative study, and 1 book chapter. Evidence on rates of breast cancer screening among transgender people and the association between GAHT and breast cancer risk was inconclusive. Factors negatively associated with cancer screening behaviors included socioeconomic barriers, stigma, and lack of health provider awareness of transgender health issues. Breast cancer screening recommendations varied and were generally based on expert opinion due to the lack of clear evidence. Considerations for providing culturally safe care to transgender people were identified and mapped to the areas of workplace policies and procedures, patient information, clinic environment, professional conduct, communication, and knowledge and competency. Screening recommendations for transgender individuals are complicated by the lack of robust epidemiological data and clear understanding of the role GAHT may play in breast cancer pathogenesis. Guidelines have been developed based on expert opinion and are subsequently not uniform or evidence based. Further work is required to clarify and consolidate recommendations. [ABSTRACT FROM AUTHOR]

There is no doubt that lack of a common language is the main obstacle to communication between people from different backgrounds. However, the cultural aspect also plays a very important role, since even two people with a common language may not understand each other in certain situations, that is, when extra-linguistic factors intervene. We hypothesize that religion and religious beliefs and customs are part of one's culture and may also pose communication barriers and lead to misinterpretation by society and more specifically by the public services that receive these people. To confirm our hypothesis, we intend to analyse the case of Germany, a society in which, statistically, Catholics and Muslims make up the two largest demographic groups, in order to find out whether the differences between the followers of these religions could lead to misunderstandings. In conclusion, we recommend intervention by properly trained linguistic-cultural mediators in order to avoid these barriers, and suggest for this purpose the implementation of Service-learning activities at the university level to foster translation and mediation competence among these future professionals. [ABSTRACT FROM AUTHOR]

Atherosclerosis screening with ultrasound is non-invasive and can be used as part of risk communication. The potential of personalised and pictorial-based risk communication is assessed in VIPVIZA, a population-based randomised controlled trial that aims at optimising cardiovascular disease (CVD) prevention by investigating the impact of visualisation of subclinical atherosclerosis. The present aim was to explore cognitive and emotional reactions evoked by the intervention as well as attitudes to any implemented life style changes in VIPVIZA participants in the intervention group with improved health status and furthermore to study possible interactions between these factors. Understanding mechanisms of action was central since non-adherence to preventive guidelines are often faced in clinical practice. In-depth interviews with 14 individuals were analysed with qualitative content analysis. Cognitive and emotional processes were highly interlinked and described by the main theme Cognitive and emotional reactions in strong interplay for orchestration of health oriented behavioural change. The informants' descriptions revealed two distinctly different psychological processes which constituted the two subthemes, Problem-focused coping and Encouragement-driven process. The results highlight that an interaction between emotional reactions and efficacy beliefs is important in facilitating behavioural change. Furthermore, the results underscore the importance of the risk message being perceived as clear, accurate, reliable and also emotionally engaging and thereby show why atherosclerosis screening and pictorial-based risk communication have the potential to contribute to effective CVD prevention strategies and shared decision making in primary care. Trial registration: ClinicalTrials.gov identifier: NCT01849575, registration 8 May 2013. Atherosclerosis screening and pictorial-based risk communication have the potential to contribute to more effective CVD prevention strategies. Risk messages on atherosclerosis status were perceived as clear, accurate, reliable and emotionally engaging. An interplay between efficacy beliefs and emotional reactions facilitated behavioural change. Patients' understanding of CVD risk is important for shared decision-making and of relevance for non-adherence to preventive guidelines. [ABSTRACT FROM AUTHOR]

To explore how cancer survivors have experienced their contacts with primary care after being diagnosed with cancer, focusing on the integration between cancer specialist and primary care, and participants' views on what could make primary care services better at catering to the needs of cancer survivors. A qualitative study in which data was collected through semi-structured digital focus group interviews and analyzed using a template analysis approach. Adult residents of Skåne, Sweden, who had been diagnosed with and initiated treatment for either of five common cancer forms, recruited through patient advocacy groups. A qualitative description of participants' experiences and perceptions as expressed in focus group interview data. Most participants felt that primary care services had not played a significant role for them, despite patterns of both increased and unmet health needs. Insufficient coordination and communication with specialist cancer care, low availability, lacking personal continuity, low cancer competence and lacking commitment to cancer-related needs were presented as barriers to satisfactory primary care. A strengthened bond between cancer and primary care services, privileged access, and holistic perspectives were all suggested as measures to make primary care more suitable to cancer survivors' needs. The study suggests that cancer survivors experience a range of issues that hinders primary care services from playing a productive role in the cancer care process. The results speak for a need for interventions to remove barriers to satisfactory primary care contacts in this group of patients. The growing number of cancer survivors highlights the role of primary care services in the cancer care continuum. Despite the presence of unmet needs, few cancer survivors felt that primary care services had been significant to their care. Survivors identified a number of barriers to satisfactory primary care, including lacking coordination and communication between cancer and primary care. Strengthened links between healthcare services, privileged access, and holistic perspectives were suggested to improve primary care delivery for cancer survivors. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus pandemic has swept across the United Kingdom (UK). Given the ever-evolving situation, little is known about the repercussions of coronavirus and the subsequent lockdowns for children diagnosed with Autism Spectrum Disorder (ASD). Therefore, this study explores the social-communicative impact of the first lockdown (March 2020 – July 2020) in the UK and the return to school period (September 2020 – October 2020), following prolonged disruption to routine, in children diagnosed with ASD. Methods: Parents of autistic children completed 2 separate online surveys following the first lockdown in the UK (n = 176) and also when children returned to school following the summer break (n = 54). Results: The results suggested that self-regulation skills (p <.05) and co-operation skills (p <.05) were most affected over the course of the lockdown. Children's physical activity levels were perceived to significantly increase during the return to school (p <.0001), which was associated with better social-communication outcomes (p <.05). Conclusion: Future work is needed to confirm and explore the findings. Such work could be implemented to protect and improve the social-communicative outcomes of autistic children. [ABSTRACT FROM AUTHOR]

This article provides an agenda for future research on brand communication in social media. Based on an overview of the current state of research, a discussion of the theoretical and conceptual challenges of brand communication in social media, and a survey about the expectations of the media and advertising industry, I present six key directions for future research. These six key directions include research on (1) social media influencers, (2) personalized brand content in social media, (3) ethical concerns about the nature of social media content and consumer empowerment, (4) platform characteristics rather than on Facebook, (5) the integration of social media in the media mix and the consumer journey, and (6) using real social media data. Together these six key directions help to shape the social media research agenda. [ABSTRACT FROM AUTHOR]

Research over the years has delved into the role of culture in advertising from various perspectives using both cross-country comparisons and within-country investigations. An assessment of recent research offers observations for scholars to consider for future work in this area: continue to expand theories, sample outside of the usual cultures, assess comparability, identify obstacles to publishing, consider changes in data collection and related issues, and connect the dots by providing periodic state-of-the-knowledge reviews and analyses. At the same time, it would be worthwhile for future work to respond to changes in the environment and new communication needs by studying consumer ethnocentrism during a period of heightened trade tensions and a slowdown in globalization, and by looking into philanthropy and corporate social responsibility communication for initiatives to help solve local, regional, and global problems. [ABSTRACT FROM AUTHOR]

Background: The uniqueness of the physician–patient relationship and the latter's lack of medical experience and knowledge necessitate providing patients with accurate and timely information necessary to engage them in treatment decision-making. Without detailed information from their physicians, patients cannot understand their medical condition, assess treatment options, and participate meaningfully in their care. Objectives: The present research determines the main factors influencing physicians' attitudes toward health information exchange with patients in Jordanian hospitals. The fundamental question addressed by this paper is why Jordanian physicians are reluctant to provide their patients with detailed health information about the potential risks, complications, and benefits of proposed treatments and other recognised alternative therapies. Method: This study is qualitative in nature, adopting face-to-face interviews as the key instrument of data collection in two hospitals in Jordan. The chief consideration of the sampling process was to select direct informants whose input would generate accurate results that might be generalised or translated to other contexts or settings. Thematic analysis was then used, and all participants' opinions, answers, and interactions were transcribed and then reduced into themes and patterns for research, as per similarities and relationships, through coding and representing the data. Key findings: The findings show that most patients in government hospitals, especially those elderly, poorly educated, or inexperienced, choose practitioners based solely on medical service fees and costs rather than quality and convenience. On the other hand, the large number of patients attending public hospitals and the insufficiency of physicians' financial incentives in such hospitals may discourage physicians from providing patients with detailed health information. Matters, however, take a different turn in private hospitals, in which many physicians improve the patient experience to keep him and attract others by sharing information with patients about their health and treatment. However, it was noted that some physicians at such hospitals still rely heavily on their relations with health insurance companies to attract patients rather than on meaningful communication with their patients. Finally, the present findings reveal that the absence of a clear legal duty of medical disclosure negatively influences the amount of information received during the clinic visit. Conclusions: The fact that the level of communication in Jordanian healthcare settings has not been determined in detail opens the door to unnecessary healthcare expenditure and creates uncertainty concerning the amount of information that patients need to know in order to be involved in their treatment decision-making. The lack of proper control and quality monitoring may also negatively affect the interests of patients and their rights to receive adequate information about their health status. [ABSTRACT FROM AUTHOR]

Background: Several research capacity strengthening (RCS) initiatives have been established in Africa over the past decade. One such initiative is the Consortium for Advanced Research Training in Africa (CARTA) that has gained traction over the years and has been proven as an effective multidisciplinary approach to strengthen research capacity to address public and population health in Africa. Objectives: In this article, we document the experiences and management-related interventions that cushioned the CARTA programme and enabled it to remain resilient during the COVID pandemic. We further make recommendations on the enablers of resilience and optimal performance of such RCS initiatives during crises and beyond. Methods: We used routine information gathered by the CARTA secretariat from consortium correspondence, meeting minutes, reports and other related documents produced in the year 2020 in order to consolidate the experiences and interventions taken by the programme at programmatic, institutional and fellowship levels. Results: We identified a series of management-related cyclic phases that CARTA went through during the pandemic period, which included immobilisation, reflection, brainstorming, decision-making, intervening and recovery. We further identified strategic management-related interventions that contributed to the resilience of the programme during the pandemic including assessment and monitoring, communication management, policy and resource management, making investments and execution. Moreover, we observed that the strength of the leadership and management of CARTA, coupled with the consortium´s culture of collaboration, mutual trust, respect, openness, transparency, equitability, ownership, commitment and accountability, all contributed to its success during the pandemic period. Conclusion: We conclude that RCS initiatives undergo a series of phases during crises and that they need to promptly adopt and adapt appropriate management-related strategic interventions in order to remain resilient during such periods. This can be significantly realised if RCS initiatives build a culture of trust, commitment and joint ownership, and if they invest in strong management capacity. [ABSTRACT FROM AUTHOR]

Long Covid, or Post-Covid Conditions, is a global health problem. Yet we know strikingly little about the different experiences of Long Covid patients cross-nationally. To address this shortcoming, we conducted an online survey of Long Covid patients active on social media in the U.S. (n = 334, October to December 2021) and Brazil (n = 144, January to April 2022). Our analysis of short answer responses indicates patient dissatisfaction with medical care provided for Long Covid in both the U.S. and Brazil. For Long Covid patients in Brazil, there were additional concerns raised about the lack of local expertise about their condition. Based on these results, we urge policymakers to expand the education of medical professionals in order to raise awareness of Long Covid. Experts in the Global North should also be encouraged to engage in dialogue with patient groups and experts in the Global South, in order to better understand how local contexts shape the experience of Long Covid. [ABSTRACT FROM AUTHOR]

The Framework Convention on Tobacco Control (FCTC) requires countries to develop and implement multi-sectoral tobacco control strategies, including policies and legislation. Zambia, potentially faced by a rising problem of tobacco smoking, signed the FCTC in 2008 but has been unable to enact a tobacco policy for over a decade. This study explores the role of 'principled engagement', a key element of the theoretical framework for collaborative governance, in Zambia's delayed success to develop a comprehensive tobacco control policy. This was a qualitative case study of key stakeholders in the collaborative process of trying to develop a tobacco policy in Zambia. Participan-ts were sampled from across various sectors, including government departments and civil society, comprising anti-tobacco activists and researchers. A total of 27 key informant interviews were undertaken. We supplemented the interview data with a document review of relevant policies and legislation. Data were analysed using thematic analysis. Several factors hindered efforts to attain principled engagement, including the adverse legal and socioeconomic environment in which the collaborative regime evolves; poor planning of meetings and frequent changes in tobacco focal point persons; lack of active and meaningful participation; and communication challenges among the key stakeholders. These collaborative dynamics, coupled with the opposition to tobacco control efforts from within some government departments, revealed the inadequacy of the current collaborative governance regime to facilitate enactment of a comprehensive tobacco control policy in Zambia. Efforts to develop a comprehensive tobacco control policy in Zambia will require addressing challenges such as disagreements, communication, and leadership at engagement level across interested sectors. We further argue that principled engagement has a greater role to play in unlocking these efforts and should therefore be embraced by those entrusted to lead the process to develop tobacco policy in Zambia. [ABSTRACT FROM AUTHOR]

Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. In this paper, we offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions. The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary healthcare in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior healthcare experience. We describe here the progression of the partnership between these institutions to carry out the project and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health. [ABSTRACT FROM AUTHOR]

Cervical cancer is a significant public health concern globally, with low and middle-income countries bearing the highest burden, specifically the South Asian region. Therefore, the current scoping review aimed to highlight the factors influencing the implementation of human papillomavirus (HPV) vaccination in South Asia. Adopting the 'Arksey and O'Malley and Levac et al.' methodology, multiple electronic databases were searched to identify relevant records. The results were narratively synthesised and discussed, adopting the Consolidated Framework for Implementation Research (CFIR) model. We identified 527 records, which were assessed for eligibility based on title, abstract, and full text by three reviewers, followed by data extraction of 29 studies included for analysis in the review. Implementing HPV vaccination programs in South Asia faces various challenges, such as economic, health system, financial, health literacy, and sociocultural factors that hinder their successful implementation. To successfully implement the vaccine, a tailored risk communication strategy is necessary for these countries. Knowledge gained from the experience of South Asian nations in implementing the HPV vaccine can assist in policymaking in similar healthcare for advancing the implementation of HPV vaccination. [ABSTRACT FROM AUTHOR]

In the middle of 2020, with its borders tightly closed to the rest of the world, Australia almost achieved the local elimination of COVID-19 and subsequently maintained 'COVID-zero' in most parts of the country for the following year. Australia has since faced the relatively unique challenge of deliberately 'undoing' these achievements by progressively easing restrictions and reopening. Exploring the role of mathematical modelling in navigating a course through the pandemic through qualitative interviews with modellers and others working closely with modelling, we argue that each of these two significant phases of Australia's COVID-19 experience can be understood as distinct forms of 'model society'. This refers at once to the society enacted through the governance of risk, and to the visions of societal outcomes – whether to be sought or to be avoided – that are offered up by models. Each of the two model societies came about through a reflexive engagement with risk facilitated by models, and the iterative relationship between the representations of society enacted within models and the possibilities that these representations generate in the material world beyond them. [ABSTRACT FROM AUTHOR]

In 2019, the Doña Ana Wellness Institute (DAWI), Doña Ana County, New Mexico's health council, sponsored two trainings in structural competency by the Structural Competency Working Group. One focused on health care professionals and learners; the other focused on government, non-profit organisations, and elected officials. DAWI and New Mexico Human Services Department (HSD) representatives attended the trainings and identified the structural competency model as useful for the health equity work both groups were already engaging. These trainings provided the foundation for DAWI and HSD to develop additional trainings, programmes, and curricula founded on structural competency and focused on supporting health equity work. This article describes how DAWI and HSD used the structural competency framework to deepen our work, including how we have expanded the concept beyond its original orientation to support strategic planning, improve communication, and build structurally competent communities. We illustrate how the framework strengthened our existing community and state work and how we adapted the model to better fit our work. Adaptations included changes in language, the use of the lived experiences of organisation members as a foundation for structural competency education, and a recognition that policy work happens at multiple levels and in multiple ways for organisations. [ABSTRACT FROM AUTHOR]

When health systems are overwhelmed during a public health crisis regular care is often delayed and deaths result from lapses in routine care. Indigenous primary healthcare (PHC) can include a range of programmes that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health (SDoH) and a focus on redressing health inequities. We examined how Indigenous PHC mobilises and innovates during a public health crisis to address patient needs and the broader SDoH. A rapid review methodology conducted from January 2021 – March 2021 was purposefully chosen given the urgency with COVID-19, to understand the role of Indigenous PHC during a public health crisis. Our review identified five main themes that highlight the role of Indigenous PHC during a public health crisis: (1) development of culturally appropriate communication and education materials about vaccinations, infection prevention, and safety; (2) Indigenous-led approaches for the prevention of infection and promotion of health; (3) strengthening intergovernmental and interagency collaboration; (4) maintaining care continuity; and (5) addressing the SDoH. The findings highlight important considerations for mobilising Indigenous PHC services to meet the needs of Indigenous patients during a public health crisis such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: The voice signals a tremendous amount of gender cues. Transfeminine individuals report debilitating quality-of-life deficits as a result of their vocal gender dysphoria.Aims: We aimed to quantify the potential impact of this dysphoria experienced with quality-adjusted life years (QALYs), as well as associated treatments, through validated health utility measures. Methods: Peri-operative phonometric audio recordings of a consented transfeminine patient volunteer with a history of vocal gender dysphoria aided in the description of two transfeminine health states, pre- and post-vocal feminization gender dysphoria; monocular and binocular blindness were health state controls. Survey responses from general population adults rate these four health states via visual analogue scale (VAS), standard gamble (SG), and time tradeoff (TTO). Results: Survey respondents totaled 206 with a mean age of 35.8 years. Through VAS measures, these general adult respondents on average perceived a year of life with transfeminine vocal gender dysphoria as approximately three-quarters of a life-year of perfect health. Respondents also on average would have risked a 15%–20% chance of death on SG analysis and would have sacrificed 10 years of their remaining life on TTO measures to cure the condition. The QALY scores for the post-gender affirming treatments for vocal gender dysphoria (+0.09 VAS, p < 0.01) were significantly higher compared to the pretreatment state. There were no differences in the severity of these QALY scores by survey respondent's political affiliation or gender identity. Conclusions: To our knowledge, this study is the first to quantify how the general population perceives the health burden of vocal gender dysphoria experienced by transfeminine patients. Feminization treatments including voice therapy with feminization laryngoplasty appear to significantly increase health utility scores. [ABSTRACT FROM AUTHOR]

Our objective was to develop a series of short educational videos for teens and parents to watch before pediatric ADHD visits to motivate teens to be more actively involved during their visits. The development of the videos was theoretically guided by Social Cognitive Theory. First, we conducted two focus groups with teens (ages 11 to 17) with ADHD, two focus groups with teens' parents, and two focus groups with providers. The research team analyzed the focus group data to create the initial video script. Feedback was obtained from two teen advisory boards and the scripts were revised, then the videos were produced. Based on focus group results, an animated teen newscaster narrates six one- to two- minute videos with different themes: (a) talking to your doctor about your ADHD, (b) controlling ADHD without medication, (c) ADHD medications, (d) ADHD and school, (e) ADHD and relationships; and (f) talking to your parents about ADHD. Each theme includes three key messages and emphasizes how teens should discuss these messages with their providers. Teens, parents, and providers provided excellent insight into developing videos to increase teen involvement during ADHD visits. The developed video(s) are on Vimeo and on a website titled "Information for the Evolving Teenager" (iuveo.org). [ABSTRACT FROM AUTHOR]

This study aims to understand the impact of perceived values of digital content marketing (DCM) on consumer's experiential evaluations. It also explores the impact of consumer's experiential evaluations on brand loyalty, and the mediating impact of prior brand attitude on the relationship between customer's experiential evaluations and brand loyalty. This study utilizes a quantitative method, surveying 290 respondents in the context of Vietnam. The initial phase of this investigation is tested with a pilot study. Several statistical tools are applied to analyze the data, including exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation model (SEM). The findings show that three out of four dimensions of DCM's value perception, such as informative value, entertainment value, and social value, have a significantly positive impact on experiential evaluations. Experiential evaluations also significantly and positively affect brand loyalty, while brand attitude does not mediate the association between experiential evaluations and brand loyalty. These findings will strengthen current knowledge on this DCM issue by providing contextual insights from Vietnam. The practical implications are also provided. [ABSTRACT FROM AUTHOR]

Public universities play a pivotal role in society as they offer access to higher education to a broader range of the population. This has greater impetus for institutions in societies that have histories of political oppression or large economic disparities, such as South Africa. How these organizations define "leadership" and the organizations' roles as "leaders", and how that is portrayed to the public is therefore of great importance. This study conducts a textual analysis approach, using qualitative content analysis, of a purposeful (non-random) sample of the five top-ranked universities in South Africa to determine the leadership styles, definitions and narratives employed in their strategic plans to better understand how these universities position themselves in this regard. The research shows that while the strategic plans share similar core values such as a desire to be inclusive and foster transformation in society, the use of the two key research concepts differs as to how they are defined and to whom they refer. Better discussion and explanation of the responsibilities that university leaders have in achieving strategic goals, and the leadership role these organizations could and wish to play, could facilitate greater understanding and impact in the public sphere. [ABSTRACT FROM AUTHOR]

Dynamic communication within adipose tissue depends on highly vascularized structural characteristics to maintain systemic metabolic homoeostasis. Recently, it has been noted that adipose endothelial cells (AdECs) act as essential bridges for biological information transmission between adipose-resident cells. Hence, paracrine regulators that mediate crosstalk between AdECs and adipose stromal cells were summarized. We also highlight the importance of AdECs to maintain adipocytes metabolic homoeostasis by regulating insulin sensitivity, lipid turnover and plasticity. The differential regulation of AdECs in adipose plasticity often depends on vascular density and metabolic states. Although choosing pro-angiogenic or anti-angiogenic therapies for obesity is still a matter of debate in clinical settings, the growing numbers of drugs have been confirmed to play an anti-obesity effect by affecting vascularization. Pharmacologic angiogenesis intervention has great potential as therapeutic strategies for obesity. [ABSTRACT FROM AUTHOR]

Deconstructing current definitions of "health literacy (HL)" and "eHealth literacy (eHL)", into the core notion of "understanding health information (HI)", this study provides insights into what promotes and inhibits the understanding of HI for breast cancer patients during cancer patient pathways (CCP) in Norway. Seven well-educated women were interviewed. Through a stepwise deductive-inductive analysis of the transcribed interviews, the following topics were identified: 1) explanations accompanied by drawings, 2) individualized knowledge-based information, 3) information processing capacity, and 4) ambiguity in medical information. The women's understanding of HI increased when spoken communication was accompanied by visual illustrations, which served as roadmaps throughout the CPP. Even if HI should be targeted to the patients' individual needs, some HI can be generalized if it refers to established knowledge about the health phenomena. The women described their changing mental and physical status during the CPP and how these changes influenced their understanding of HI. The results challenge the idea that HL and eHL are fixed, stable, personal characteristics. On the contrary, HL/eHL, in this case particularly the understanding of HI, depends on the individual (temporary) physical and cognitive capacity of the patient and adaptation in the institutional and private contexts. [ABSTRACT FROM AUTHOR]

Adverse life experiences increase the risk of health problems. Little is known about General Practitioners' (GPs') thoughts, clinical concepts, and work patterns related to eliciting, including, or excluding their patients' stories of painful and adverse life experiences. We wanted to explore GPs' perceptions of the medical relevance of stories of painful and adverse life experiences, and to focus on what hinders or facilitates working with such stories. Eighteen Norwegian GPs participated in three focus group interviews. The interviews were analysed using reflexive thematic analysis. The participating GPs' views on the clinical relevance of patients' painful and adverse experiences varied considerably. Our analysis revealed two distinct stances: a confident-accepting stance, and an ambivalent-conditional stance. GPs encountered barriers to exploring such stories: scepticism on behalf of the medical discipline; scepticism on behalf of the patients; and, uncertainty regarding how to address stories of painful and adverse experiences in consultations. Work with painful stories was best facilitated when GPs manifested personal openness and prepared availability, within the context of a doctor-patient relationship based on trust. Clearer processes for handling biographical information and life experiences that affect patients' health are needed to facilitate the work of primary care physicians. [ABSTRACT FROM AUTHOR]

Families arriving in Sweden after being forced to flee their home need health care. Communication is a key component to establishing good care relations and becomes difficult when there are language barriers between families and healthcare professionals. In the context of neonatal care, communication is carried out with parents. The aim of the study was to describe parents' experiences of communication with neonatal healthcare professionals and using pictorial support when language barriers exist. The study takes a qualitative approach based on seventeen interviews with parents who had experienced neonatal ward. Qualitative content analysis was used. The parents needed to communicate through supports, which caused distress and misunderstanding. The relationship between parents and the healthcare professionals affected the communication. Pictorial support was used to different degrees. Four categories were identified from the data analysis: Communicating through supports, Facing barriers in communication, Facing external influences and The need for a good healthcare relationship. The present study is the first to describe parents' experience with using the pictorial support developed in the project KomHIT Refugee and therefore fulfils the function of being a first evaluation of the pictures from parents' perspective. [ABSTRACT FROM AUTHOR]

To examine stroke inpatients' real-life wayfinding behaviour and how the built environment of rehabilitation clinics might influence their behaviour and experiences. Stroke inpatients in seven rehabilitation clinics were observed (n = 70), each over the course of 12 consecutive hours. Their paths through the clinic and the locations of encountered wayfinding-related events were mapped on the floor plans and described in the written notes. The observations were supplemented by a survey asking patients about their wayfinding experiences. For a third of observed patients, at least one wayfinding-related event was observed on the observation day, and 50% of patients reported getting lost in their clinic at least once. Most wayfinding-related events occurred between patient rooms and therapy rooms, and patients frequently relied on backtracking or the help of the staff to find their way. Clinics' layout organization was found to play a role in the wayfinding behaviour of patients. Wayfinding is a common challenge that stroke inpatients encounter in rehabilitation clinics. Avoiding multiple decision nodes on the paths between patient rooms and therapy rooms and creating distinct identities for corridor segments in the decision nodes and the areas in front of elevators would likely improve wayfinding performance. [ABSTRACT FROM AUTHOR]

Navigating a health system which differs considerably from one's own can be a challenging process. Navigating this in seeking maternal health care can be additionally daunting. This article explores how immigrant women from diverse countries and ethnic backgrounds experienced and navigated the Norwegian maternal health service during pregnancy and childbirth. Eleven semi-structured interviews collected between 2019 to 2020 and analysed thematically informed this analysis. Principles of universalism underpinning all social and health policy in Norway, expect equality of service provision and access. These principles result in less individual choice. The women in this study found these contrary to their expectations of care but responded differently, with some experiencing the health provision as liberating while others distrusted that they were receiving the best care. A focus of concern was the expectation of more medicalized services. While some of these women used their own resources to circumvent the Norwegian health provisions, the implications for the health system extend beyond these women's experiences. The analysis suggests a need to encourage those whose expectations of care differ to build trust in institutions providing care. This article contributes to knowledge on the implications of diversity on Norway's universal health system. [ABSTRACT FROM AUTHOR]