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Meeting appropriate ethical standards for research involving human participants, mean ensuring confidentiality. It is assumed that the research participant will accept the safeguarding protocols necessary to ensure confidentiality. This assumption however oversimplifies the variation of motivations that goes into participants' decisions to participate in research. Drawing on reflections from my fieldwork experience in Ghana, I answer the questions: Why do research participants reject confidentiality? What ethical position can one take when the researcher and the researched have conflicting perspectives about confidentiality? I contend that participants with personal stake refuse confidentiality when they want to be acknowledged for their data. Rejecting confidentiality is however, embedded in the individual perspective, cultural, and political context of the study area. The ethical concerns of such refusal can be ameliorated if confidentiality is nuanced to include six categorically distinct but mutually non-exclusive stages: research-planning, ongoing-information, writing-up, reality-after-research, differential-disseminations, and no-confidentiality-clause. The paper further argues that whilst maintaining institutional allegiance in this matter is crucial, employing confidentiality should lie at the intersection of participants' motivation for taking part in the research, the socio-cultural-specific-context of the study location and the nature of the topic being explored.

Background: Ghana was one of the few countries commended to have halved extreme poverty after the MDG era yet the under-five mortality rate (U5MR) was dire. Ghana's U5MR is still above the national and global SDG target. As a result, the government has over the years implemented other complementary social and policy interventions to improve the socioeconomic status of households to ensure better child health outcomes. Yet key gaps exist and threaten child health outcome sustainability, and child health-related SDG targets. In this regard, we hypothesize that household wealth should therefore not influence under-five child deaths significantly. Methods: The paper first reports the under-five mortality trend over the past 30 years in Ghana. It uniquely analyses the levels and trends in wealth as measured by the Gross National Income per capita at purchasing power parity (ln GNI/p, ppp) as a proxy of the mean Comparative Wealth Index (CWI) against under-five child deaths in Ghana. Using data from the 2014 Ghana Demographic and Health Survey and employing the logistic regression estimation technique, the paper further estimates the effect of household wealth and other key covariates on under-five child deaths. Implemented government poverty-alleviating policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify risk gaps to child deaths. Results: The 30 year trend analysis from 1990 to 2020 shows that the under-five mortality rate in Ghana is still high, falling short of the rate of decline that is expected toward achieving the 2030 SDG target for U5MR of 25 deaths per 1000 live births. Our empirical estimations show that household wealth still has a negative and significant relationship with under-five child deaths despite the government's existing poverty-alleviating and pro-poor health policies. In addition, the results show that regional differences, maternal age, the number of children alive, and attendance to postnatal healthcare services are crucial for child survival. Conclusion: The results imply that the government should consolidate universal programmes with intensified targeted interventions toward improving household wealth, especially in the Northern Savannah regions. A new and dynamic child health policy is imminent to reflect strategies towards achieving the SDG target on U5MR. Additionally, intensive education on active maternal participation in postnatal care should be given critical consideration to improve child survival. [ABSTRACT FROM AUTHOR]

Purpose: Despite the increasing discourse on mixed methods (MM) in academic literature, less attention has been focused on its methodological development in the built environment in developing countries. This paper aims to examine the basis and challenges of the application of MM for health-care facilities management (FM) research in Ghana. Design/methodology/approach: This paper adopts autoethnography as its research method, coupled with a scholarly review of methodological literature to position a technical view on the application of mixed methods for health-care FM research in a developing country. Findings: This paper contributes and lends support to the methodological strength of MM as epistemologically coherent and useful for understanding the intricacies of health-care FM. This paper advances the proposition that the nascent stage of FM development in Ghana, paucity of literature, epistemological and axiological considerations underscore the choice of a sequential MM. The attitude of research participants, ethical challenges and time-lapse for data analysis were observed as practical challenges. Research limitations/implications: Discussion of data integration is excluded. Practical implications: This paper provides a nuanced understanding of the concept of MM in health-care FM and set forth practical recommendations worthy to enhance the application of MM research. Originality/value: This paper is among the few focusing on methodological discussion of health-care FM. This paper proposes a framework to guide researchers in the application of mixed methods. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to identify human rights violations of patients during the early periods of the COVID-19 pandemic in Ghana by investigating the experiences of people on how health-care professionals discharged their responsibilities during the time in question. Design/methodology/approach: Explanatory design of the mixed methods approach was adopted, with the intention of collecting both quantitative and qualitative data sequentially, and then integrating the results at the interpretation stage. The approach enriched the quality of data collected as it offered the advantage of shedding light on the primary motivations and reasons for attitudes and behaviours and helped to provide an in-depth understanding of how individuals interpret the happenings around them and their experiences. Thus, although some amount of quantitative method was used in the data collection, the core of this paper is based on the qualitative interpretations. Findings: The study reveals that health-care professionals, especially those in the Tema Metropolis, undermined certain fundamental human rights of patients during the early period of the COVID-19 pandemic. This includes failure to provide information to patients about treatment options and potential risks of medications; failure to seek the informed consent of patients before performing medical procedures; denial of access to medical files of patients for transfer; and inability or failure to provide medical ambulances services to patients on time. Originality/value: Although many publications on human rights dimensions and health protective issues on COVID-19 pandemic are available on a global scale, still little information pertaining to experiences of individuals with health-care professionals during the early days of the COVID-19 pandemic, especially in Ghana through the lens of patient's rights exists. This paper, therefore, fills an important gap in health-care management information, critical for policy decision-making processes regarding patient's rights in times of pandemic control. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine landlords' health support systems to tenants to control COVID-19 in selected informal settlement rental housing (ISRH) in Ghana, dwelling on landlords' views. Design/methodology/approach: The paper used the concurrent imbedded mixed-methods approach and grounded the findings in the socio-ecological theory. The authors collected both qualitative and quantitative data from 242 landlords in 13 informal settlements across Ghana using quotas. The authors undertook semi-structured face-to-face and telephone interviews. The authors conducted content and thematic qualitative data analysis and used simple descriptive statistical data analysis. Findings: The paper discovered that tenants had limited knowledge on the transmission of the pandemic, forcing landlords to regulate their building services usage, ventilation and thermal control, entertainment, common areas and rent advancement for tenants to control the pandemic. Also, tenants found it difficult to comply with the rules on ventilation for fear of criminal attacks, while high social connection and interaction among renters and inadequate enforcement caused the non-adherence by renters to social gathering. Again, landlords had difficulty in contract-tracing visitors suspected to be infected with the virus. Originality/value: The use of concurrent and imbedded mixed methods to investigate landlords' viewpoints on their support in health needs of their tenants to regulate COVID-19. The prescriptions from the study provide practical applications to formulate a mix of housing and health policies to formalize the support of landlords to their tenants in ISRH in Ghana. [ABSTRACT FROM AUTHOR]

On 11 March 2020, the World Health Organisation declared COVID‐19 a global pandemic. Subsequently, governments worldwide implemented strict regimes of lockdowns and school closures to contain the transmission of the virus. Ghana's government on 15 March 2020 also announced a lockdown and closure of schools, lasting up till January 2021. Against this backdrop, the paper examined the implications of school closures on child labour in Ghana. Qualitative data for the study were collected between October 2020 to February 2021 in a small rural community in northern Ghana. Findings from 16 semi‐structured interviews with schoolchildren aged 8–13 years show how school closures have meant that children from contexts of poverty: (a) are driven into child labour as they are either forced to accompany their parents to work on farms or sell foodstuff by the roadside; and thus, ultimately (b) engage in no learning during the lockdown period. [ABSTRACT FROM AUTHOR]

This paper provides insights from experiences in data gathering and recruitment from two research projects on disability/mental health in Ghana. The focus of the study explores stigma amongst individuals diagnosed with mental illness and their caregivers. The study investigates the positioning of the researcher in a superior light by participants which often wrests power from those who should be considered the true experts of their own circumstances. Inequality in the interview process thus carried the risk of impacting the quality of the data, as some participants did not consider themselves as 'experts' of their condition. The paper explores strategies for addressing these challenges of hierarchy and inequality in the research process in the Global South. Based on the study, we report on our experiences as follows: (1) ensuring that participants are empowered to engage with researchers; and (2) training local researchers to engage in culturally sensitive research processes. [ABSTRACT FROM AUTHOR]

The purpose of this paper is twofold: to explore the factors influencing the emergence and growth of informal e-waste activities and to examine workers' motivation for involvement in informal e-waste activities. Semi-structured interviews and observations among actors in the recently established Dagomba-Line e-waste site in Kumasi, Ghana were employed to gather relevant data. Emergence and growth of e-waste activities are largely influenced by spatial, political, socio-cultural and economic factors. The reuse and open disposal of e-waste are the common practices due to the cost of transportation to a final disposal site. Similar to findings at the well-established Agbogbloshie e-waste site, also in Ghana, scavengers are found at the bottom of the e-waste financial ladder. The major motivating factor for engaging in e-waste handling is poverty. Additionally, some respondents mentioned the lucrative nature of the activity, landlessness, and peer influence as a motivation. The results showed that younger workers (below 35 years) were more likely to be engaged in the activity for reasons of peer influence and poverty and major source of livelihood. The paper recommends that policy and planning should reflect ways of delivering and creating stable socio-economic conditions that promote an inclusive and sustainable development. [ABSTRACT FROM AUTHOR]

Many children continue to be sexually abused worldwide. In Ghana, relatively high figures of child sexual abuse (CSA) are reported by the police daily. Although there are laws that seek to protect children from sexual abuse, in reality, there is a wide gulf between legislation and practice. This paper explores why this is so by examining the measures adopted in sanctioning perpetrators of CSA in the Ga community in Ghana. The study uses a qualitative approach to collect data from parents and guardians through in‐depth interviews. The study revealed that, generally, traditional rather than legal sanctions are adopted in handling CSA cases. This paper thus interrogates the consequences of the obvious contraventions of the law as traditional interventions are resorted to. We posit that CSA can be minimised only when child protection laws are enforced by the police and victims are reoriented to appreciate the benefits of seeking legal redress. Key Practitioner Messages: Conscious efforts must be made to destigmatise child sexual abuse.Sensitisation programmes should be organised periodically by stakeholders to educate community members on child sexual abuse.The police in partnership with the media must also lead the campaign to educate the populace that choosing traditional options of redress and non‐disclosure of incestuous acts against children is a clear violation of the law and the rights of the child. [ABSTRACT FROM AUTHOR]

This study contributes to the literature on challenges and opportunities for social participation experienced by older adults in Ghana and provides useful lessons for theory and practice. The study explored this topic using a descriptive phenomenology approach. A purposive sample of 23 older adults aged 60 years and above participated in semi-structured interviews to provide data for the study. The interviews were audio-recorded and transcribed for analysis. Data were analyzed following descriptive phenomenology principles, such as paying attention to experiential detail and the personal and relational significance of experience as described, and using existing literature as heuristic to reformulate and gain insight into the general and unique characteristics of experience as described by participants. Two themes emerged from the data. Living at the margins emerged from the descriptions of challenges whose subthemes included health problems, isolation, and poverty. Elevated citizenship emerged from the descriptions of opportunities whose subthemes were acts of reciprocity, recognition, and preferential treatment. The paper discusses how these themes underlie both social exclusion and social participation among participants. [ABSTRACT FROM AUTHOR]

Although healthy life expectancy is projected to be increasing among older people in Ghana, a high proportion and number of older people will live with functional disability, warranting their need for long‐term care. We explored the expressions used by older people to describe their needs and preference of care and support. Using the descriptive qualitative approach, 14 older people were engaged via semi‐structured interviews, and the data were analysed thematically. The study found that older people desired a decent accommodation, preferential healthcare, adequate nutrition, and an opportunity to interact with their peers at social functions. A provision of sufficient financial assistance, adequate healthcare, the periodic organisation of social and group events for older people, and the availability of home care and support could help older people address these needs. The paper reveals the need for interventional research on how a model incorporating social, health and environmental factors even during a pandemic can address older people's varying needs. [ABSTRACT FROM AUTHOR]

Midwives and nurses play a critical role in safeguarding the lives of women in resource‐constrained African countries. Working within the context of scarce resources may undermine their moral agency and hinder their ability to care. The purpose of this paper is to understand the influence of resource scarcity on midwifery and nursing care and practice. A critical ethnography was conducted in the obstetric department of three tertiary‐level facilities in Ghana. Purposive sampling was used to recruit 30 midwives and nurses and semistructured interviews, field notes and documentary materials were used to generate in‐depth understanding. Ethical approval was granted from Canada and Ghana and written, and ongoing informed consent was obtained from the participants. Five conceptual themes depicting the impact of scarce resources on midwifery and nursing care were discovered: compromised care, constrained care, dehumanized care, missed care and disengaged care. Improving the maternal health of women and averting avoidable maternal morbidity and mortality require governments and institutions to invest in health infrastructure that will support the delivery of ethical and safe midwifery care for women in their most vulnerable period. [ABSTRACT FROM AUTHOR]

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted. [ABSTRACT FROM AUTHOR]

While mobile phones promise to be an important tool for bridging the healthcare gaps in resource-poor areas in developing countries, scalability and sustainability of mobile phones for health (mhealth) interventions still remain a major challenge. Meanwhile, health workers are already using their own mobile phones (referred to as 'informal mhealth') to facilitate healthcare delivery in diverse ways. Therefore, this paper explores some strategies for integrating 'informal mHealth' in the healthcare delivery of Ghana, by highlighting some opportunities and challenges. The study mainly employed a combination of literature review, focus group discussions and key informant interviews with community health nurses (CHNs) and other stakeholders, who were purposively selected from the three ecological zones in Ghana. The study found that, while scale-up of 'formal mhealth' remains challenging in Ghana, almost all CHNs in our study are using their personal mobile phones 'informally' to bridge healthcare gaps, thereby promoting universal health coverage. This provides opportunities for promoting (or formalising) 'informal' mhealth in Ghana, in spite of some practical challenges in the use of personal mobile phones that need to be addressed to ensure sustainable healthcare delivery in the country. [ABSTRACT FROM AUTHOR]

Background: The United Nations through its Sustainable Development Goals (SDG) 3 and 5 has championed Women empowerment for exclusive breastfeeding through various action plans and expected the concept to be decentralized through locally mandatory implementation of various institutional policies and programs in member Countries. Using Kabeer's empowerment concept, the authors in this paper assessed availability and implementation of breastfeeding policies and programs in three public universities in Ghana. Methods: The study design was an exploratory-descriptive-case study involving university employees and student mothers from three public universities in Ghana. The universities were selected via simple random approach whilst selection of participants was purposive. Data were collected between April and July 2018 using an unstructured interview guide developed by the authors, audio recordings, field notes and desktop review of documents. Manual thematic analysis of data was done to present results descriptively. The University of Cape-Coast Ethics Review Board approved the study. Results: Thirty-six respondents participated in the study. Three main themes (Breastfeeding policy and programs, Institutional support, and views on Breastfeeding/Childcare support) emerged. Despite being gender/child friendly, none of the universities in this study has a formal breastfeeding/childcare policy/program and there are no immediate policy plans for on-campus facilities to enhance breastfeeding. Financial cost emerged as a major challenge hindering the universities from implementing a policy/program in this regard. On the part of student mothers, lack of legal protection, lack of breastfeeding-friendly university policies, inadequate availability of breastfeeding facilities, and insufficient awareness of the importance of breastfeeding among nursing mothers has been a major setback for breastfeeding on campus, hence nursing mothers continue to make personal but challenging arrangements for breastfeeding on university campuses. Conclusions: The study findings reflect negative implications for childcare as it affects optimal child nutrition, hence impacting on achieving the SDGs 3 and 5 in Ghana. The authors recommend introducing formal breastfeeding-friendly policies/programs as one of the criteria for accreditation of universities in Ghana to enhance optimal childcare and sound maternal mind for studies and/or work once there is an assurance of child safety and proximity to breastfeed on demand. [ABSTRACT FROM AUTHOR]

This paper presents findings of a study that explored the challenges and coping strategies of parents of children with mental disorders. In-depth interviews were conducted with 35 parents of children with mental disorders at the Psychiatric Unit of the Komfo Anokye Teaching Hospital in Kumasi. Data were analyzed using thematic content analysis. Findings indicated that financial constraints, inability to secure permanent employment, and stigma were the challenges of the parents. Having faith in God and accepting their children's condition were the coping strategies adopted by the parents. However, lack of effective support system makes coping difficult for the parents. [ABSTRACT FROM AUTHOR]

Integrating consumers' experiences into quality mental health service assessment is relevant to improve service outcomes. Despite this, limited studies have attempted to explore consumers' experiences, particularly in developing countries, such as Ghana. This paper aims to explore consumers' subjective experiences of the quality of mental health services. A qualitative method involving in-depth interviews was used to collect data from 21 consumers of mental health services. Thematic analysis was used to analyse the data, which is discussed using a realistic evaluation approach. The study identifies four themes, 33 inductive codes and 594 references. The themes used to interpret the verbatim narratives are the available mental health services, therapeutic interaction with the professionals, competency and skills of the professionals, and the changes experienced in the consumers' lives. The study indicates that the mental health services aim to provide a range of treatments and medications as well as recovery-oriented services, using mechanisms such as ensuring an effective therapeutic relationship and improving technical competency and skills. The contextual factors and the mechanisms have helped to achieve some changes in the lives of consumers (increased satisfaction, reduced symptoms, improved functionality, feeling normal, improved living skills and self-care, work and capabilities, and social inclusion). The study concludes that policymakers and clinicians should integrate evidence-based recovery services, principles and values into the existing mental health services. The mechanisms used to promote quality of mental health services should be strengthened, through periodic monitoring and evaluation, using approaches such as sensor data capturing, to ensure good coordination and continuity. [ABSTRACT FROM AUTHOR]

Background: Homelessness among people with mental illness has grown to become a common phenomenon in many developed and developing countries. Just like in any other country, the living conditions of homeless people with mental illness in Ghana are unwholesome. Despite the increased population of these vulnerable individuals on the streets, not much is known about the perspectives of the general public towards this phenomenon in Ghana. Aim: This research was conducted to explore the perspectives of community members on homeless people with mental illness. The main study objectives were (a) to find out the impacts of the presence of persons with mental illness on the streets and (b) to ascertain the reasons accounting for homelessness among persons with mental illness. Method: Utilizing a qualitative research design, twenty community members were sampled from selected suburbs in Nsawam and interviewed with the use of a semi-structured interview guide. The audio data gathered from the interviews were transcribed verbatim and analysed thematically. Results: Majority of the participants asserted that homeless people with mental illness had no access to good food, shelter, and health care. They further stated that some homeless people with mental illness perpetrated physical and sexual violence against the residents. Moreover, the participants believed that persons with mental illness remained on the streets due to neglect by their family members, and limited access to psychiatric services. Conclusion: This paper concludes by recommending to government to make mental health services accessible and affordable to homeless persons with mental illness nationwide. [ABSTRACT FROM AUTHOR]

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The World Health Disability Assessment Scale (WHODAS‐2.0) has widely been accepted as the standard measure of disability. However, psychometric testing is mostly performed in developed countries. This paper aims to assess the psychometric properties (reliability, validity) of the WHODAS‐2.0 among consumers of mental health services in Ghana. Two translators (expert in English language and Akan language) performed forward and backward translation of the WHODAS‐2.0 from English language to Ghanaian language (Twi). A total of 510 consumers of mental health services were recruited consecutively to complete the WHODAS‐2.0 using RedCAP. Confirmatory factor analysis was used to analyse the data. All domains in the 6‐factor solutions had excellent internal consistency (ω = 0.90–0.98), sufficient convergent validity and had satisfactory discriminant validity except for domain on participation. The CFA model confirmed that the data had a good model fit, CFI = 0.97, TLI = 0.96, RMESA = 0.05, RMR = 0.03; NFI = 0.94; χ2 = 1243.8, df = 529, P < 0.001. Although the WHODAS 2.0 had satisfactory psychometric properties and was thus considered to be a reliable and valid measure for assessing disability and level of functioning in consumers of mental health services, researchers and clinicians should re‐consider items within the participation domain. Also, practitioners are encouraged to integrate the WHODAS‐2.0 into the collection of data on clinical outcomes, as well as, collecting data on government social protection intervention programmes for consumers. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to explore the perceived benefits and challenges of online distance education and computer‐based testing (CBT) among registered nurses and midwives in a sample of government‐owned health facilities and health training institutions in Ghana. Design: Exploratory descriptive qualitative design. Methods: Individual semi‐structured interviews were conducted with 45 participants (i.e. 25 nurses and 20 midwives). The data were manually processed and analysed using Braun and Clarke's thematic analysis approach (November 2019‐February 2020). Results: Nurses and midwives prefer online distance education for three reasons: convenience, cost‐effectiveness and learning centre proximity to the workplace. The course schedule's flexibility allowed participants to work and study simultaneously. Others acknowledged online distance education as a viable option for overcoming the challenges of obtaining study leave. However, the lack of recognition of certificates by some employers, poor Internet connectivity and perceived excessive course load were noted as deterrents. Regarding the CBT, many of the participants said that it was useful. Among the advantages of CBT are: (1) a decrease in examination malpractices, (2) a decrease in examination costs and (3) a rise in students' interest in information, communication and technology (ICT). This finding emphasizes the necessity of integrating ICT into nursing and midwifery education and examinations, as well as maximizing its benefits. [ABSTRACT FROM AUTHOR]

Background: Collaborative clinical facilitation converges key players to guide students individually and within groups towards achieving clinical nursing competence. However, experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and nursing and midwifery students are often fragmented and have been largely unexplored in Ghana. Aim: To describe the experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and final year nursing and midwifery students in Northern Ghana. Setting: The study was conducted at two nursing and midwifery colleges and an academic hospital in Northern Ghana. Methods: A qualitative, descriptive, exploratory design was utilized. Forty-six participants comprising 16 nurse educators, 10 clinical preceptors, 10 nursing students and 10 midwifery students were purposively sampled. Focus groups and in-depth interviews were used to gather data and analysed thematically. Results: Three themes revealed facilitative experiences of collaborative clinical facilitation: team-based clinical mentorship and supervision, personalised preceptorship, and clinical conferences. Two themes emerged inhibitory to collaborative clinical facilitation: staff shortages and lack of timely communication. Conclusion: This study found that team mentorship, preceptorship and conferences fostered collaborative clinical partnerships for students' clinical learning. However, failure to engage in timeous communication in the midst of staff shortages hampered its smooth practice. Orientation workshops need to be organised for key players to share relevant updates and explore ways to navigate the challenges often experienced within the clinical training environment. Contribution: This paper provides insight into the collaborative nature of clinical facilitation; and highlights the need for coordinated clinical placements to enhance students' clinical learning. [ABSTRACT FROM AUTHOR]

Background. Nurse emigration, often termed "brain drain," poses significant challenges to Ghana's healthcare sector. Aim. This study explores nurse managers' perspectives on determinants and strategies for mitigating nurse emigration in Northern Ghana. Methods. Sixteen nurse managers were interviewed using semistructured interviews between October and December 2023. Purposive sampling was used to select the participants. QDA Miner Lite version 6 was used for systematic coding and thematic data analysis, following the conventional content analysis approach. Results. Following data encoding and classification, the study identified three primary categories: determinants of brain drain, impact of brain drain on the healthcare system, and mitigating factors of brain drain. Conclusion. The study reveals that various factors, including inadequate pay, limited opportunities for career growth, and lack of access to technology, drive the brain drain among Ghanaian nurses. These lead to negative impacts on the healthcare system, such as increased workload, reduced patient satisfaction, and a shortage of skilled nurses. To tackle this issue, solutions including offering career advancement opportunities and improving salaries and working conditions among others have been highlighted to mitigate the brain drain among Ghanaian nurses. [ABSTRACT FROM AUTHOR]

Background: COVID-19 vaccine hesitancy is a major public health challenge with the potential to prevent communities from achieving the coverage level necessary for herd immunity against the COVID-19 virus. Objective/aim: The study determined COVID-19 vaccine acceptance and associated factors among residents of the Afadzato South District of Ghana. Methods: A descriptive cross-sectional study was conducted among 422 respondents aged 18 years and above using a self-administered and interviewer administered structured questionnaires for persons who could read and with no formal education respectively. The study was conducted and reported in line with the Strobe statement for cross sectional studies. Data analysis was done using the Stata-17.0 software. The association between the dependent and independent variables was examined using a logistic regression analysis, with a p-value of < 0.05 considered statistically significant. Results: More than half of the respondents (n = 291, 68.96%) were below 25 years old. Majority of the respondents were females (n = 218, 51.66%) and had attained secondary education (n = 291, 68.96%). Less than half of the respondents 35.5% (151) indicated acceptance of the COVID-19 vaccine and more than half (n = 271, 64.22%) indicated non-acceptance of the COVID-19 vaccine. The results showed that education level, information source, overall knowledge of COVID-19 vaccine, and misconception of COVID-19 vaccine were significantly associated with acceptance of the COVID-19 vaccine. Conclusion: The study found high vaccine hesitancy among the respondents. Important significant predictors of COVID-19 vaccine hesitancy were education level, information source, overall knowledge of COVID-19 vaccine, and misconception of COVID-19 vaccine. In the attempt to address vaccine hesitancy by health agencies, it is important to take into consideration the varying educational backgrounds of the population in context and their diversified sources of information. This may ensure that everyone in the community is reached with important information on COVID-19 and its vaccines to reduce misconceptions and misinformation. [ABSTRACT FROM AUTHOR]

Introduction: Terminal illness is an irreversible illness that, without life-sustaining procedures, usually results in death or permanent disability from which recovery is unlikely. When involved, family caregivers are believed to improve health outcomes, such as reduced hospitalization, and establishing a patient's initial access to professional treatment services. However, caring for a patient with a terminal illness is viewed as one of the most difficult aspects of providing care. This study aimed to identify the challenges, and coping strategies developed by family caregivers to cope with the care of the terminally ill person. Methods: An exploratory descriptive qualitative approach was used. Twenty (20) family caregivers voluntarily participated in the study from the Korle-Bu Teaching Hospital. Semi-structured interviews were conducted with the participants. The transcribed interviews were then analysed using thematic analysis. Results: From the analysis, three main themes emerged: challenges, coping strategies, and social support. These themes encompassed sixteen subthemes including financial burden, bad health conditions, faith and prayer, and support from health professionals. From the study, both male and female family caregivers narrated that providing care for sick relatives undergoing terminal disease is characterized as a daily duty demanding one's time and fraught with emotional strain. In addition, even though it was a difficult job, family members who provided care for ailing relatives never gave up, citing responsibility, the importance of family, and religious beliefs as the primary motivations for doing so. Conclusion: The difficulties and demands of family caregiving roles for terminally ill relatives are complex and multifactorial. The findings call for multidisciplinary professional attention for family caregivers and policies that will support their lives holistically. [ABSTRACT FROM AUTHOR]

Background: This study assessed knowledge, behaviors, and perceptions towards hypertension following community dissemination on cardiovascular disease (CVD) risk within the Navrongo Health and Demographic Surveillance Site in Northern Ghana. Methods: A cross-sectional mixed methods study was conducted among middle aged men and women following education on CVD and their risk factors. Knowledge and attitudes of participants regarding hypertension were measured in 310 participants using a survey tool and the resultant data was analyzed with descriptive statistics. Focus group discussions (FDG) were used to assess perceptions of 40 study participants on their lived experiences with hypertension. Recorded interviews were transcribed verbatim and coded into themes using Nvivo 12 software before thematic analysis. Results: Of the 310 surveyed participants, 54% were women and the mean age was 50 ± 6 years. The results showed that 84% of participants had heard about hypertension, 70% knew it was an increase in blood pressure and could be caused by excess salt intake, poor diet and physical inactivity. About 22.3% of participants were aware of the had hypertension. In terms of management, majority of the participants were aware that hypertension could be treated with antihypertensive medication and that untreated or uncontrolled hypertension could result in adverse health consequences. Few participants had ever had their blood pressure measured and did not access screening or healthcare care services and rather perceived the health system as inadequate to screen, and manage hypertension. Conclusion: Though, knowledge on hypertension was high, awareness of hypertension status and access to screening and healthcare services was low. Community beliefs and perceptions strongly influence treatment, and control of hypertension. Effective sustained community dissemination efforts addressing misperceptions could improve hypertension treatment and control. [ABSTRACT FROM AUTHOR]

Background: Adolescents in Ghana are vulnerable to unequal power relations at the personal, community and structural levels which in turn limits their opportunities in access to critical sexual and reproductive health information and services. There is therefore high unmet need for sexual and reproductive health (SRH) information and services and the Bono East region typifies this situation, recording some of the poorest SRHR outcomes among adolescents. We, therefore, aimed to investigate the SRH needs (unmet), behaviors and utilization of SRH services among adolescents in the Bono East region. Methods: Using a maximum variation sampling approach, this qualitative study conducted in-depth interviews and focused group discussions with adolescent boys and girls, parents, community leaders, and healthcare providers. Results: Our findings are presented under two broad categories: major SRHR concerns of adolescents, and perspectives about that influences adolescents' utilization of SRHR services. Under the major SRHR need of adolescents, the following themes emerged: information and services on pregnancy prevention, menstrual hygiene management, availability of comprehensive abortion care services, and attitudes towards adolescent pregnancy. The perspectives about the factors that influence adolescent children were discussed at multiple levels: individual/personal. interpersonal and community/societal. At the individual level, limited understanding of adolescence/puberty, desire of adolescents to belong and misperceptions about contraceptives. At the interpersonal level, issues relating to technical capacity needs of service providers, disrespect exhibited by service providers, and parental failure were identified as influential factors. Then at the community/societal level, we identified structural constraints and compromised social safety concerns in accessing contraceptives and services. Conclusion: In conclusion, the findings from this study offer valuable insights into the complex landscape of adolescent sexual and reproductive health in the Bono East region. The implications for policy and practice are manifold, ranging from comprehensive education to addressing menstrual hygiene, involving parents, training healthcare providers, and promoting respectful care. [ABSTRACT FROM AUTHOR]

Introduction: Mother-to-child transmission of hepatitis B infection is one of the major routes of hepatitis B virus (HBV) infection in Africa. Amusingly, Africa is the only region yet to meet the World Health Organization's target of reducing the prevalence of HBV infection to less than 1% among children under 5 years of age by 2020. In Ghana, little has been documented about midwives' views on the factors impacting the successful implementation of mother-to-child transmission via HBV prevention programs. Objective: This study explored midwives' views on the challenges associated with the prevention of mother-to-child transmission of HBV infection in the La-Nkwantanang municipality. Methods: The study adopted an exploratory descriptive qualitative design and involved 14 midwives who were purposively recruited from a primary-level health facility in the La-Nkwantanang Municipality, Accra. Individual face-to-face interviews were conducted using an in-depth interview guide. The data were content analyzed using the six steps recommended by Braun and Clark. Results: Three main themes, namely, health professional or midwife factors and patient and health facility factors, negatively impacted the prevention of maternal-to-child transmission program. The five subthemes identified in this study included lack of awareness, financial constraints, and unavailability of logistics and protocols. The study recognized that midwives face many challenges even though they have a strong desire to prevent vertical transmission of HBV. Conclusion: The implementation of a mother-to-child transmission program is negatively impacted by many intrinsic, client, and health facility factors. Midwives who act as major stakeholders need to be periodically trained on the components and protocols for managing pregnant women living with HBV. The necessary logistics and management protocols need to be urgently provided. The skills and education obtained from the training will empower midwives to be knowledgeable about how to deliver quality care and provide education and support for HBV-infected pregnant women. The provision of logistics needed for the successful implementation of the program could avert delays associated with the administration of the hepatitis B birth dose vaccine and immunoglobulin to exposed newborns. [ABSTRACT FROM AUTHOR]

Rehabilitative care for burn patients in developing countries is often wrought with several issues. Post-discharge support is equally challenging as there is often limited rehabilitative care as the burn survivors and their families transition. To inform practice, this study sought to explore the perspectives of adult burn survivors and burn care staff regarding transitioning from the burn unit and the development of a transitional rehabilitation programme. We employed interpretive description for this study. Semi-structured face-to-face interviews were conducted with adult burn survivors and burn care staff across two tertiary healthcare facilities in Lanzhou, Gansu Province of China, and Ghana. The thematic analytical approach was employed to analyse the data. Forty-six participants comprising 26 adult burn survivors and 20 burn care staff participated in this study. Two themes and five subthemes emerged from the data. Transitioning from the burn unit to the home was described as complex with varied biopsychosocial needs emerging. However, available support was not comprehensive to resolve these needs. Existing pre-discharge support is limited across both settings. Burn survivors expressed interest in taking on an active role in the rehabilitation process and being able to self-manage their post-burn symptoms following discharge. Transitional rehabilitative support should include an active follow-up system, ensure patient- and family-centred support, and offer a bundle of comprehensive rehabilitative services using locally available items which do not financially burden burn survivors and their families. In conclusion, transitioning from the burn unit is filled with varied health needs. Transitional rehabilitative care is required to bridge the pre-discharge and post-discharge periods. [ABSTRACT FROM AUTHOR]

Refugees and asylum seekers bring with them a plurality of cultures, traditions, and values that could prove crucial in influencing perceived health needs, requests for intervention, or willingness to undergo specific health treatments. Although studies have focused on the health consequences of forced migration, in recent years, there has been a lack of information on how refugees and asylum seekers represent their experiences of perceived health needs and elements that influence well-being, in a community context. This study aims to explore the experience of refugees and asylum seekers in an Italian multicultural community about perceived health needs. A qualitative phenomenological study was conducted with an interpretive approach. The data were collected using a semi-structured face-to-face interview. The interviews were transcribed, read thoroughly, and analyzed. Nineteen refugees and asylum seekers were interviewed. Three main themes were extracted: (1) the centrality of the family to feel healthy; (2) feeling part of a community; and (3) stability and security. The results confirm that health needs, experiences, and different cultural representations of health and illness should be read and addressed with a culturally competent vision. This study was not registered. [ABSTRACT FROM AUTHOR]

Introduction: People with disabilities (PwDs) constitute a large and diverse group within the global population, however, their sexual and reproductive health (SRH) needs are often neglected, particularly in low-and middle-income countries. This may result in adverse outcomes, such as sexually transmitted infections (STIs), unintended pregnancies, and experience of interpersonal violence (IV). This study aimed to assess the factors that influence the sexual lives of PwDs in two districts of Ghana. Methods: A sequential explanatory mixed-methods study design was used to collect data from PwDs. Quantitative data were obtained from 402 respondents using a pretested questionnaire, and qualitative data gathered from 37 participants using in-depth interviews. The quantitative data were analysed using descriptive and inferential statistics, while the qualitative data were analysed using inductive thematic analysis. Results: Most PwDs (91%) reported that they have ever had sex, which was associated with age, disability severity, and household size. The prevalence of poor SRH status, STIs, unintended pregnancy, pregnancy termination, and unsafe abortion were 10.5%, 5.7%, 6.4%, 21.6%, and 36.9% respectively. These outcomes were influenced by education, income, health insurance subscription, and proximity to a health facility. The prevalence of IV was 65%, which was related to disability type and severity. The qualitative data revealed five main themes: curiosity to engage in sexual activities, feelings of despair and insecurity with abled partners, preference for sexual relationships with other PwDs, IV and its perpetrators, and adverse SRH outcomes. Conclusion: The study findings indicate that most adult PwDs have ever had sex and they face various challenges in their sexual lives. They experience multiple forms of abuse and neglect from different perpetrators at different levels of society, which have negative impacts on their well-being. There is a need for comprehensive and inclusive interventions that address the SRH needs of PwDs, as well as the underlying social and structural factors that contribute to their vulnerability. Further research is recommended to explore the perspectives of stakeholders on how to improve the SRH outcomes of PwDs. Plain Language summary: People with disabilities make up 16 percent of the world population, but their sexual and reproductive health (SRH) needs are often unmet, especially in poorer countries, contributing to adverse outcomes. This study assessed factors influencing the sex lives of PwDs in two districts of Ghana. Quantitative data were collected from 402 respondents, while qualitative data were collected from 37 participants. The results showed that age, severity of disability, and household size influence sexual activity. Many respondents also reported adverse SRH issues including STIs and unintended pregnancies. Sixty-five percent reported experiencing violence or abuse, which is related to their disability type and severity. The study also found that PwDs encounter many challenges in their sexual lives, including abuse and neglect. The findings suggest the need to pay attention to the sexual health needs and the social issues that make PwDs vulnerable to various abuses. [ABSTRACT FROM AUTHOR]

Background: A sustainable point-of-care (POC) diagnostic testing implementation in low-resourced facilities enhances quick diagnostic investigation and halts unnecessary referrals. This study identified the barriers impeding the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana; as well as explored potential solutions that could enhance the accessibility and effectiveness of POC diagnostic testing, ultimately improving the quality of healthcare delivery. Methods: A total of twenty-eight participants were purposively selected from health facilities in low-resourced settings in the Bono Region for a descriptive qualitative study. Of the twenty-eight participants, seventeen including ten healthcare providers from CHPS facilities, six district health depot managers, and one regional depot manager were engaged in in-depth interviews. Additional eleven including nine healthcare providers and two district depot managers were also engaged in focus group discussions. NVivo version 12 software was employed for condensation, labelling, and grouping of themes. Data was analysed narratively. Results: Work overloads, limited POC testing services, stock-outs of POC tests at the facilities, and supply-related challenges of POC test kits were identified as major barriers to POC testing services. To solve these barriers, adequate funding, an effective delivery system, stakeholders' engagement and advocacy, and in-service and refresher training courses were suggested as potential solutions to POC diagnostic testing services implementation by the stakeholders. Conclusions: This study's findings emphasize the need to address the barriers hindering the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana. The suggested solutions provide a roadmap for improving the accessibility and effectiveness of POC testing, which has the potential to enhance the quality of healthcare delivery, reduce unnecessary referrals, and ultimately improve patient health outcomes in underserved settings. [ABSTRACT FROM AUTHOR]

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The COVID-19 pandemic has affected all aspects of professional disciplines including occupational therapy; however, little is known about how much of an impact the COVID-19 pandemic affected occupational therapy practice in Ghana. This study examined the impacts, coping strategies, and COVID-19 pandemic lessons for occupational therapy practices in the future. A descriptive qualitative design was employed with a purposive and convenience sampling methods to recruit occupational therapists from four practice settings in Ghana. Semi-structured interviews were conducted with seven participants. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Four major themes were identified from the analysis enlightening stakeholders on the impact and preparation for minimizing the impact of future pandemics on the workloads of an occupational therapist. The major themes are (1) impacts of the COVID-19 on occupational therapy practice and practitioners; (2) aspects or domains of work significantly affected by the pandemic; (3) the existing strategies employed to handle the challenges; and (4) strategies to minimize these challenges in the future. The current study has enlightened stakeholders on the need to make alternate preparations including telehealth, continuous support for telehealth infrastructures, training of practitioners, and research to adapt intervention strategies effectively. [ABSTRACT FROM AUTHOR]

Background: The need for primary care physicians to be heavily involved in the provision of palliative care is growing. International agencies and practice standards advocate for early palliative care and the use of specialized palliative care services for patients with life-threatening illnesses. This study was conducted to investigate physicians' referral practices and perceived barriers to timely referral at the Korle Bu Teaching Hospital. Methods: A cross-sectional study design was employed using a convenience sampling technique to recruit 153 physicians for the study. Data on socio-demography, referral practices, timing and perceived barriers were collected using a structured questionnaire. Binary Logistic regression using crude and adjusted odds was performed to determine the factors associated with late referral. Significance was set at p < 0.05. Results: The prevalence of late referral was reported to be 68.0%. There were poor referral practices among physicians to palliative care services, and the major barriers to late referral were attributed to the perception that referring to a palliative care specialist means that the physician has abandoned his patient and family members' decisions and physicians' personnel choices or opinions on palliative care. Conclusion: The healthcare system needs tailored interventions targeted at improving physicians' knowledge and communication strategies, as well as tackling systemic deficiencies to facilitate early and appropriate palliative care referrals. It is recommended that educational programs be implemented, palliative care training be integrated into medical curricula and culturally sensitive approaches be developed to address misconceptions surrounding end-of-life care. [ABSTRACT FROM AUTHOR]

Background: Children's initiation of early sex has several negative implications on their sexual and reproductive health, growth and development. In Ghana, few studies on early sexual debut have focused on adolescents. Therefore, this study examined the prevalence, causes, correlates and effects of early sexual debut among children aged 8 to 17 in Ghana using secondary data from the Department of Children of the Ministry of Gender, Children, and Social Protection. Methods: A convergent parallel mixed-method approach guided the study. Descriptive statistics and multivariable binary logistic regression were used to analyse the quantitative data, while thematic analysis was used to analyse the qualitative data. Results: The study found that the prevalence of early sexual debut among children was 13.2%, which is more predominant among female children. The main causes of early sexual debut include engaging in sex after watching pornography, self-desire to have sex, and being influenced by alcohol consumption. Also, age, sex, education, marital status, religion, ecological zone, living arrangements, and access to the Internet were significant correlates of early sexual debut. Early sexual debut increases children's risk of unwanted pregnancy, which leads to the termination of children's education or induced abortion. Also, early sexual debut had adverse impacts on the wellbeing of pregnant children and increased children's risk of multiple lifetime sexual partners. Conclusions: This study demonstrated that socio-demographic characteristics of children (e.g., age, sex, education, and marital status) were significant correlates of early sexual debut. Policymakers need to design appropriate interventions, considering the socio-demographic characteristics of children, to curb its occurrence in Ghana. [ABSTRACT FROM AUTHOR]

Background: Since its emergence, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused severe health, social and economic challenges. Mental healthcare has been significantly affected globally, and even worse in developing countries. An emerging economy like Ghana in West Africa was not spared its disruptive effects. This study aimed to elucidate the impact of the coronavirus disease 2019, the COVID-19 pandemic (caused by SARS-CoV-2), on Ghana's mental healthcare system. Methods: This is a mixed-method study using an emergent sequential exploratory design. A total of 15 front-line healthcare professionals were recruited from the three psychiatric hospitals, including the mental health department of a new teaching hospital in Ghana. Purposive sampling techniques and a semi-structured interview approach were used for recruitment and data collection. Quantitative data from hospital registries were collected and analysed to triangulate qualitative findings. Results: Fifteen mental health workers were enrolled in the study. The mean age of participants was (34.47 ± 4.07) years, average work experience of (6.23 ± 3.64) years and the majority as males (60%). This study found an average decline of 23% in hospital attendance and a 35% decline in admissions in all four facilities compared to the previous year, 2019. The lived experiences shared by mental healthcare providers were grouped under 3 main themes: Adjustments to workplace regulations, accessibility to mental healthcare, and psychological wellbeing of mental healthcare workers. The fear of contracting SARS-CoV-2 among healthcare workers, medication shortages, and logistical challenges were also reported to affect Mental Health services during the pandemic. Conclusion: This study highlights the challenges in mental healthcare during the COVID-19 pandemic in Ghana. The experiences encountered present an opportunity to gain insights into future pandemic preparedness and establish a framework for optimal mental healthcare delivery in Ghana. [ABSTRACT FROM AUTHOR]

This study used qualitative data from 30 women in three of Ghana's 16 administrative regions to explore motivations and barriers to help-seeking among victims of intimate partner violence. Results of the thematic analysis showed low reporting to formal support networks, such as the Domestic Violence and Victim Support Unit or the police, with higher preference for informal sources, such as family members and friends. Motivations to seek help included fatigue, severity of abuse, abusive partner's negligence in honoring marital obligations, and trust in family members. Barriers to help-seeking included: fear of divorce, stigmatization, lack of trust in formal support channels, sociocultural norms emphasizing gender role expectations, and family privacy. [ABSTRACT FROM AUTHOR]

Introduction: Breastfeeding has proven over the years to be one of the most effective means to ensure child survival. The advocators and myth busters of breastfeeding myths are supposed to be health professionals. However very little is known about myths surrounding breastfeeding as expressed by these health professionals (nurses and midwives). Hence this study. Objective: The study aimed at exploring the myths about breastfeeding as voiced by lactating nurses and midwives. Method: Qualitative exploratory descriptive design was used to investigate the subject matter. Twenty-five nurses and midwives were purposely selected to participate in the study after they had voluntarily opted to be part of the study. Data was audiotaped, transcribed verbatim and inductively analyzed. Results: It was evident that participants believed in myths about breastfeeding. The main themes discovered were breastfeeding myth beliefs and sociocultural myth influences. Six sub-themes identified were green stools/diarrhoea, childhood disease, teeth discoloration, child becoming stupid, culture and close relatives. Conclusion: Health professionals believe in unfounded myths about breastfeeding. Steps should be taken for them to get better lactation support. The outcomes of this study underscore the need for health professionals to address breastfeeding myths, understand the sociocultural context, and support evidence-based practice. Improving lactation support and education for nurses and midwives can lead to better clinical practice and, as a result, help to promote successful and healthy breastfeeding in Ghana. [ABSTRACT FROM AUTHOR]

Aim: To explore nurse managers' perceptions of patient‐centered care (PCC), its influence on quality nursing care, nurse job satisfaction, and to provide baseline data for a context‐driven PCC model. Design: The study utilized a qualitative, phenomenological design, employing individual in‐depth interviews to collect data on nurse managers' PCC perceptions until data saturation. Methods: Sampling involved purposive selection of Northern Ghana, random selection of the tertiary hospital cluster with the three participating hospitals, and purposive sampling of the nine nurse managers. Data analysis employed thematic analysis based on a six‐phase framework. Methodological trustworthiness was ensured through various strategies including prolonged engagement, supervisor discussions and crosschecking with interviewees. Results: Three main themes emerged from the study including nurse managers' conceptualization of PCC, perceived patient‐centred practices and its influence on nursing quality and job satisfaction. The findings emphasized the patient's individuality, cultural values, holistic care, the importance of strong nurse‐patient relationships and a patient‐centric environment. The nurse managers perceived PCC as positively influencing quality nursing care and nurse job satisfaction. The findings offer nuanced insights into nurse managers' perspectives on patient‐centeredness and highlight areas for improvement. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine the motivations and supports of stakeholders in the slum communities, Ghana. Design/methodology/approach: Two-stage methodologies were used for data collection. Published Google News articles about the phenomenon as well as exploratory qualitative in-depth interviews with 15 participants. Findings: The evidence shows that structured and unstructured are the two main categories of stakeholders operating in the space of slums in Ghana. It shows that stakeholders are motivated by their objectives and ethical or moral obligations to provide support in the form of consumables, housing and finance to the slums. Research limitations/implications: Because of the data collection regime used in this project, findings are specific to the Ghanaian context and not generalisable. However, the results could be beneficial in other contexts with similar slum phenomena. Practical implications: The conclusions drawn serve as a springboard for urban managers responsible for slum administration and management to develop policy packages to incentivise and enlist more non-slum stakeholders in the existing stakeholders. Originality/value: To the best of the authors' knowledge, this study is one of the few that expands the frontiers of the stakeholder model within context to discover specific slum stakeholders, their motivations and support for the slums in a consolidated manner. [ABSTRACT FROM AUTHOR]

While the understanding of child marriage in Ghana has improved in recent decades, scholarship on this important topic remains scant, especially research examining the reasons for child marriage across socio-cultural contexts. We apply the social-ecological model to explore the drivers of child marriage in the Bawku West District in Ghana. After purposive sampling, we conducted in-depth interviews with 15 women who married before the age of 18 and thematic content analysis to summarize the text. The findings reveal that child marriage is commonplace in the study area and has several drivers, including community/societal factors such as poverty and bride price payment. Other drivers include teenage pregnancy and low educational levels. The results corroborate the social-ecological model in which child marriage has multiple levels of influence. Findings suggest that addressing child marriage in Ghana requires practical solutions across all sectors and levels. Highlights: Female child marriage remains unacceptably high in Ghana. Research examining reasons for child marriage in Ghana is limited. This study examined reasons for child marriage in the Bawku West District of Ghana. Factors at multiple levels of the social-ecological system influence child marriage. Preventing child marriage requires practical solutions across all sectors and levels. [ABSTRACT FROM AUTHOR]

Given the importance Ghanaians attribute to spirituality and religiosity in terms of disease causation and management, this study explored the use of religious capital as a coping strategy by individuals with type 2 diabetes mellitus in self-care at the Techiman Holy Family Hospital Diabetes Clinic in the Bono East Region of Ghana. An exploratory descriptive qualitative research design was employed for the study. Semi-structured interviews were conducted with a convenience sample of twenty-seven (27) individuals recruited from the diabetes clinic. Content analysis was employed to find themes, which included: (1) Use of Prayer and Fasting for Courage from God, (2) Reliance on God as the Creator of Human Beings who Cures and Heals Diseases in the Body, (3) God as Source of life in times of Illness (Drawing life from God in times of illness), (4) Faith and Hope in God, and (5) Doctors and Nurses as Substitutes for God. The findings advocate the need to incorporate religiosity and spirituality into the provision of healthcare for individuals with diabetes to help them live productive lives. [ABSTRACT FROM AUTHOR]

Background: Globally, over 40 million lives have been claimed by HIV/AIDS. In Ghana, more than 350,000 people are living with HIV. Non-disclosure of HIV status is a major barrier to HIV/AIDS eradication; yet, little is known of the determinants of HIV status disclosure in resource limited settings in Africa like Ghana. Objective: Determine the predictors of HIV status disclosure among people living with HIV (PLHIV) and stimulate policy discourse on support systems for self-disclosure in Africa. Methods: This is a descriptive cross-sectional study among PLHIV (n = 181) in sub-Saharan Africa, specifically the Volta region of Ghana. Bivariate probit regression was run to determine factors associated with HIV status disclosure among PLHIV. Results: HIV status self-disclosure was reported by 50% of the respondents; nearly 65% disclosed their status to non-family members and non-partners. Significant correlates of HIV status disclosure either to partners or non-partners were marital status, monthly income, type of occupation, and being divorced due to HIV status (p < 0.05). Conclusions: HIV status disclosure remains low in Ghana like many African countries. There is the need for a renewed policy debate on tailored guidelines for HIV status self-disclosure and targeted support systems for PLHIV to ameliorate their predicaments and promote eradication of the epidemic in Africa. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent sexual and reproductive health continues to be a major public health issue in low-and middle-income countries. While many countries have policies aimed at reducing adolescent pregnancy, evidence of their impact is unclear. This study sought to explore the knowledge and awareness of policies and programmes aimed at reducing adolescent pregnancy among health and education professionals and grassroot workers in Ghana. Methods: We employed a cross-sectional, qualitative study design involving semi-structured interviews with 30 key informants (health and education professionals and grassroot workers) in the Central Region of Ghana. We also conducted a desktop review of policies aimed at reducing adolescent pregnancy in Ghana. We used content analysis to analyse the data. Results: Eight of the 30 participants demonstrated awareness of policies aimed at reducing adolescent pregnancy but only two could elaborate on this. By contrast, 19 of the 30 participants were aware of relevant programmes and provided detailed description of their implementation and activities carried out under each programme. Despite participants' low policy awareness and knowledge, their descriptions of the activities carried out under each programme aligned with the strategies and activities of the policies mentioned, as evident from the desktop review of the policies. Conclusion: Greater engagement of stakeholders in future policy development should increase policy awareness. Dissemination of policy content through community-based media channels and in local languages should promote and facilitate stakeholder engagement, which in turn should increase effective policy implementation with subsequent reduction of adolescent pregnancy. Plain Language Summary: Adolescent pregnancy is a major public health issue in low-and middle-income countries. Efforts to reduce adolescent pregnancy have become major health priorities globally. Several international organisations, including the United Nations, have adopted strategies such as those featured under the Sustainable Development Goal (SDG) 3.7. These strategies seek to ensure universal access to sexual and reproductive healthcare services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes by 2030. Many countries have policies and programmes with implementation strategies aimed at reducing adolescent pregnancy; however, evidence of their impact is unclear. We explored the knowledge and awareness of policies and programmes aimed at reducing adolescent pregnancy among health and education professionals and grassroot workers in Ghana. We conducted interviews among 30 key informants in Ghana. Few of the participants demonstrated awareness of policies aimed at reducing adolescent pregnancy and only two could elaborate on this. By contrast, most participants were aware of relevant programmes and provided detailed description of their implementation and activities carried out under them. Greater engagement of stakeholders in future policy development should increase policy awareness. Dissemination of policy content through community-based media channels and in local languages should promote and facilitate stakeholder engagement, which in turn should increase effective policy implementation with subsequent reduction of adolescent pregnancy. [ABSTRACT FROM AUTHOR]

Aim: Nurses' health advocacy (HA) role requires them to speak up for patients, clients, and communities in relation to healthcare. Various studies report the importance of the HA role of the nurse in healthcare. However, nurses' performance in this role is not clear yet. The present study aims to identify and explain how nurses perform their HA role in underserved populations. Design: Qualitative grounded theory by Strauss and Corbin. Methods: Data were gathered from three regional hospitals in Ghana with 24 registered nurses and midwives as participants through purposive and theoretical sampling techniques. Face‐to‐face in‐depth semi‐structured interviews were conducted from August 2019 to February 2020. The data were analysed using Strauss and Corbin's method and Nvivo software. The reporting follows Consolidated Criteria for Reporting Qualitative Research guidelines. Findings: The HA role performance theory emerged from data with role enquiry, role dimension, role context, role influence, role reforms and role performance as building blocks. Data analysis showed that the main concerns of the nurses during their daily practice were mediating, speaking up, and negotiating. Among others, the intervening conditions were clientele influence and interpersonal barriers, whereas the outcome was a balance between role reforms and role performance. Conclusion: Although some nurses proactively initiated biopsychosocial assessment and performed the HA role, most of them relied on clients' requests to perform the role. Stakeholders should prioritise critical thinking during training and intensify mentoring programmes in the clinical areas. Relevance for Clinical Practice: The present study explains the process by which nurses perform their roles as health advocates in their daily activities as nurses. The findings can be used to teach and guide clinical practice for the HA role in nursing and other health care fields. There was no patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to describe the knowledge and practice of simulation among health tutors with a view to promoting the use of simulation in health training institutions in the Northern and Upper East Regions of Ghana. Design: The study was quantitative research that utilized a descriptive cross‐sectional survey to describe the knowledge and practice of simulation in teaching. Methods: A structured questionnaire was used to collect data from 138 health tutors who were enumerated through the census for the study. The return rate was 87%, representing 120 health tutors who finally completed the study. The data were presented by means of descriptive statistics. Results: The findings of the study revealed that few participants had adequate knowledge of simulation. The study also found that a slight majority of the participants practiced simulation in teaching. The study further found that there was a positive correlation between health tutors' knowledge and the practice of simulation. Indicating that an increase in the health tutors' knowledge of simulation is associated with an increase in their practice of simulation. [ABSTRACT FROM AUTHOR]

Aim: This study explored the psychosocial experience of caregiving on the family caregiver of patients with prostate cancer in the Cape Coast metropolis of Ghana. Design: A descriptive phenomenological study was conducted through in‐depth face‐to‐face semi‐structured interviews. Twelve family caregivers of prostate cancer patients were selected through purposive sampling. Interviews were conducted until data saturation. All interviews were taped, transcribed verbatim and analysed thematically. Results: The family caregiver's psychosocial experience associated with caregiving uncovered two significant themes with 13 sub‐themes. 'Psychological impact' emerged as the first central theme, with anxiety, care as an obligation and feelings of inadequacy, hopelessness, uncertainty, denial and concealment as the sub‐themes. The second central theme was 'Social impact' with sexual concerns, role adjustment, loss of livelihood, turmoil and reduced leisure activities emerging as sub‐themes. Conclusion: The findings demonstrated that caring significantly impacts the psychological and social well‐being of the caregivers of prostate cancer patients. Therefore, there is a need for holistic assessment to include the psychosocial well‐being of family caregivers to improve quality of life. Therefore, psychiatric nurses support family caregivers through education and psychosocial interventions to improve their quality of life and enable them to care for their loved ones more effectively. [ABSTRACT FROM AUTHOR]

Background: Speaking up to safeguard patients is a crucial ethical and moral obligation for nurses, but it is also a difficult and potentially dangerous component of nursing work. Health advocacy is gaining impetus in the medical literature, despite being hampered by barriers resulting in many nurses in Ghana remaining mute when faced with advocacy-required situations. We explored situations that thwart nurses from performing their health advocacy role. Research question: What would cause nurses to take no action when they witness situations that require them to act as health advocates for their clients or communities? Research Design: An inductive, descriptive qualitative design was used to collect and analyse data on barriers that prevent nurses from practising their health advocacy role in Ghana. Individual one-on-one in-depth interviews were conducted using a semi-structured interview guide. The data were analysed using qualitative content analysis. Participants and research context: Twenty-four professional nurses and midwives registered with the Nursing and Midwifery Council were recruited from three regional hospitals in Ghana. These public hospitals were chosen from the upper, middle and coastal regions. Ethical considerations: The UKZN Ethics Review Committee in South Africa and the GHS Ethics Review Committee in Ghana both gave their approval for this study. Findings: Intrapersonal barriers, interpersonal barriers, and structural barriers emerged as major obstacles that nurses experience when performing their health advocacy role. Conclusions: Barriers to health advocacy have undermined nurses' ability to function as health advocates and are preventing them from utilising their health advocacy position in nursing practise. Giving nursing students positive role models in the classroom and in the clinic can help them become more effective health advocates. [ABSTRACT FROM AUTHOR]

Background: Patients suffering from chronic and life-threatening diseases receive inadequate palliative care in low-income countries, eventually leading to poor quality of life for these patients. Little is known about the experience of delivering palliative care in a low-resource country such as Ghana in comparison to higher-income countries. This study, therefore, aimed to assess the roles and challenges of nurses providing palliative care services for patients with cancer and life-limiting conditions at tertiary Hospitals in Ghana. Methods: Thirty oncology nurses at a tertiary Hospital in Ghana participated. All nurses were providing end-of-life care to patients with cancer. A qualitative exploratory-descriptive design and a semi-structured interview guide developed by the researchers were used. Interviews lasted on average forty minutes to 1 h were audio-recorded, and transcribed verbatim. Content analysis was carried out to generate themes and sub-themes. Findings: Participants were between the ages of 25 and 40 years. A higher percentage of females (n = 17, 57%) participated in the study than males (n = 13, 43%). Two main themes were generated which were the delivery of palliative care and the provision of home care services. The current roles of nurses were centered around pain management, home care services, spiritual needs, and psychological care. Challenges that hindered the implementation of palliative care included distress over expected and unexpected patient mortality, difficulty delivering bad news to patients and families, and frustration with health system resource shortages that negatively impacted patient care. Conclusion: Palliative care is one of the essential services provided for patients with life-limiting conditions, and nurses play an active role in the provision of this care. Further research is needed to determine the most effective ways to deliver this care, particularly in developing nations like Ghana. [ABSTRACT FROM AUTHOR]