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Abstract Background and aims The Lebanese healthcare system faces multiple challenges including limited capacities, shortage of skilled professionals, and inadequate supplies, in addition to hosting a significant number of refugees. While subsidized services are available for pregnant women, representing the majority of the refugee population in Lebanon, suboptimal access to antenatal care (ANC) and increased maternal mortality rates are still observed, especially among socioeconomically disadvantaged populations. This study aimed to review the maternal health outcomes of disadvantaged Lebanese and refugee pregnant women seeking ANC services at primary healthcare centers (PHCs) in Lebanon. Methods A retrospective chart review was conducted at twenty PHCs in Lebanon, including Ministry of Public Health (MOPH) and United Nations Relief and Works Agency for Palestine refugees (UNRWA) facilities. Data was collected from medical charts of pregnant women who visited the centers between August 2018 and August 2020. Statistical analysis was performed to explore outcomes such as the number of ANC visits, delivery type, and onset of delivery, using bivariate and multivariable logistic regression models. Results In the study, 3977 medical charts were analyzed. A multivariate logistic regression analysis, revealed that suboptimal ANC visits were more common in the Beqaa region and among women with current abortion or C-section. Syrians had reduced odds of C-sections, and Beqaa, Mount Lebanon, and South Lebanon regions had reduced odds of abortion. Suboptimal ANC visits and history of C-section increased the odds of C-section and abortion in the current pregnancy. As for preterm onset, the study showed an increased likelihood for it to occur when being Palestinian, having current C-section delivery, experiencing previous preterm onset, and enduring complications at the time of delivery. Conclusion This study suggests the need for low-cost interventions aiming at enhancing access to ANC services, especially among pregnant women in fragile settings.

Abstract Background Existing evidence marked a prevalent use of Complementary and Alternative Medicine (CAM) therapies in Lebanon that is concomitant with low rates of disclosure to health care providers and limited knowledge among the general public of safety and side effects of CAM use. Objectives To examine the perspectives of Lebanese CAM users, CAM providers, and health care providers (HCPs) regarding their understanding of CAM and of the Push and Pull factors that drive its use. Methods A qualitative research study was conducted using in-depth interviews, targeting Lebanese adults (CAM users; 18-65 years) (n=14), CAM providers such as yoga instructors, owners of CAM product outlets, herbalists, and religious figures (n=13); and HCPs including physicians, nurses, dietitians, and pharmacists (n=14). The topic guide covered, in addition to the understanding of CAM, the Push and Pull factors driving CAM use. The adults were recruited by convenient sampling, and CAM providers and HCPs using a purposive sampling approach. Interviews were audiotaped, transcribed, and translated into English. Analysis was performed using a qualitative thematic approach. Similarities and differences in the perceptions of the participants with regards to factors that influence CAM use were charted and contrasted, using a triangulated approach. Results The three study groups exhibited a similar understanding of CAM, referring to non-conventional therapies used to prevent/treat diseases or to enhance wellbeing. CAM users and CAM providers identified “distrust in HCPs”, “lack of patient-centered care in CM”, and “limitations and side effects of CM” as important Push factors. All study groups highlighted the limited CAM knowledge of HCPs as a main reason for the lack of patient-centered care. All three groups also underscored the affordability and the social and cultural support for CAM as main enablers of its prevalent use. Unlike HCPs who were skeptical about the safety and effectiveness of CAM, CAM users and CAM providers indicated that most of CAM therapies are safe and efficient. Conclusions The triangulation of perspectives (CAM users, CAM providers, and HCPs) in this study allowed a comprehensive appraisal of CAM use and its drivers. Improving the HCPs’ CAM-related knowledge, promoting patient-centered care and fostering an open dialogue between HCPs and CAM providers are among the recommendations of the study.

Abstract Background The COVID-19 pandemic compounded political and financial pressures on the nursing workforce in Lebanon. The government resigned in October 2019 in response to the popular uprising that called for an end to corruption and economic mismanagement 5 months before the first COVID-19 case appeared in the country. The continuing crises and the added stress of COVID-19 has increased the risk of occupational burnout and turnover in the nursing workforce. Therefore, valid and reliable measurement is imperative to determine burnout levels, prioritize intervention, and inform evidence-based workforce policy and practice. The primary aim of the study was to delineate burnout levels and cut-points in a national sample of nurses to inform workforce policies and prioritize interventions. Methods Multidimensional and unidimensional Rasch analyses of burnout data collected from a national convenience sample of 457 hospital nurses 9–12 months after Lebanon’s political and economic collapse began. The data were collected in July–October 2020. Results Multidimensional Rasch analysis confirmed that the Copenhagen Burnout Inventory has three highly correlated unidimensional scales that measure personal burnout, work-related burnout, and client-related burnout. Except for a ceiling effect of ~ 2%, the three scales have excellent measurement properties. For each scale, Rasch rating scale analysis confirmed five statistically different nurse burnout levels. The mean personal burnout scores and work-related burnout scores (50.24, 51.11 respectively) were not higher than those reported in the international literature. However, the mean client-related burnout score of 50.3 was higher than reported for other countries. Compared with a baseline study conducted at the beginning of Lebanon’s political and economic crises, only client-related burnout scores were higher p.

Abstract Background The COVID-19 pandemic impacted the practices and resilience of most healthcare workers, including dieticians. In addition to offering critical care to COVID-19 patients, dieticians play a major role in preventing and managing conditions known to affect COVID-19, such as obesity and metabolic disorders. The objective of this study was to examine the conditions and changes in the work environment as well as resilience and its correlates among dieticians during the COVID-19 pandemic in the United Arab Emirates (UAE). Methods A cross-sectional national survey was conducted among dieticians practicing in the UAE (n = 371), using a web-based questionnaire. The questionnaire addressed, in addition to the sociodemographic information, the practice-related characteristics and resilience of participants. For the latter the Connor–Davidson Resilience Scale© was used. Descriptive statistics as well as simple and multiple linear regressions were used in the statistical analysis. Results Of participants, 26.4% reported not having access to personal protective equipment and 50% indicated being concerned for their safety and health. Furthermore, considerable proportions of participants were not satisfied (45%) with the support nor with the appreciation (37.7%) they received during the pandemic. One in four dieticians considered quitting his/her job. While 65.8% of participants reported counseling COVID-19 patients, a third did not use any online platform for counseling. The most cited challenge to dietetic practice during the pandemic was ‘maintaining work-life balance’ (43.1%). The mean CD-RISC score was 72.0 ± 14.0. After adjustment, working in a hospital or public clinic (as opposed to private clinic), having a condition preventing face-to-face counseling, considering quitting job and feeling neutral or dissatisfied with the appreciation were associated with lower resilience scores, while counseling COVID-19 patients was associated with higher scores. Conclusions Despite the fairly high resilience among dieticians practicing in the UAE during the COVID-19 pandemic, the findings of this study highlighted a few challenges, mainly related to safe practice environment, support for online counseling, and maintaining work-life balance. Concerted efforts of policy and decision makers ought to develop targeted programs for dieticians to ensure their retention and wellbeing during the COVID-19 pandemic.

Abstract The August 2020 explosion in Lebanon resulted in casualties, injuries, and a great number of internally displaced persons. The blast occurred during an economically and politically complex time in the country. Given multiple and competing post-explosion reconstruction priorities, in ths editorial we briefly examine the requirements for a build back better scenario.

Abstract Background Shared decision-making (SDM) is an integral part of patient-centered delivery of care. Maximizing the opportunity of patients to participate in decisions related to their health is an expectation in care delivery nowadays. The purpose of this study is to explore the perceptions of physicians in regard to SDM in a large private hospital network in Dubai, United Arab Emirates. Methods This study utilized a cross-sectional design, where a survey questionnaire was assembled to capture quantitative and qualitative data on the perception of physicians in relation to SDM. The survey instrument included three sections: the first solicited physicians’ personal and professional information, the second entailed a 9-item SDM Questionnaire (SDM-Q-9), and the third included an open-ended section. Statistical analysis assessed whether the average SDM-Q-9 score differed significantly by gender, age, years of experience, professional status—generalist versus specialist, and work location—hospitals versus polyclinics. Non-parametric analysis (two independent variables) with the Mann-Whitney test was utilized. The qualitative data was thematically analyzed. Results Fifty physicians from various specialties participated in this study (25 of each gender—85% response rate). Although the quantitative data analysis revealed that most physicians (80%) rated themselves quite highly when it comes to SDM, qualitative analysis underscored a number of barriers that limited the opportunity for SDM. Analysis identified four themes that influence the acceptability of SDM, namely physician-specific (where the physicians’ extent of adopting SDM is related to their own belief system and their perception that the presence of evidence negates the need for SDM), patient-related (e.g., patients’ unwillingness to be involved in decisions concerning their health), contextual/environmental (e.g., sociocultural impediments), and relational (the information asymmetry and the power gradient that influence how the physician and patient relate to one another). Conclusions SDM and evidence-based management (EBM) are not mutually exclusive. Professional learning and development programs targeting caregivers should focus on the consolidation of the two perspectives. We encourage healthcare managers and leaders to translate declared policies into actionable initiatives supporting patient-centered care. This could be achieved through the dedication of the necessary resources that would enable SDM, and the development of interventions that are designed both to improve health literacy and to educate patients on their rights.

Abstract Background Gender equity remains a challenge across various labor markets with the health market being no exception. Despite the increased influx of women into health professions, horizontal and vertical occupational gender inequities persist. Main body The objective of this scoping review is to map the studies on gender equity in healthcare systems in terms of workforce planning, development, and management, as well as to identify the barriers and facilitators for integrating gender equity into healthcare systems. We reviewed the literature on the topic using nine electronic and two grey literature databases with the search strategy combining medical subheadings and keywords for each of the following four concepts of interest: “gender equity,” “human resources for health,” “healthcare setting,” and “management processes.” The scoping review included studies focusing on the examination of gender equity at the level of the health workforce. Out of 20,242 studies identified through the database search, the full text of 367 articles was assessed for eligibility and 110 were included in the qualitative analysis. The data of those studies was abstracted and analyzed into themes. Results do not only reveal a global dearth of studies focused on this important topic, but also the concentration of such studies in a few countries around the globe, mainly in North America and Europe. Four out of each five studies included in this review focused on physicians, followed by nurses (14%). In terms of design, an overwhelming majority of studies utilized quantitative designs (75%), followed by qualitative designs and database analyses. Studies were categorized into four pre-determined main themes: facilitators and barriers, workforce planning, HRH management, and HRH development. Conclusion Future research is needed to better understand poorly covered sub-themes such as mentorship, professional development, and training, as well as recruitment and retention among others. It is also equally needed to fill in the gaps in professional groups, study type, methodology, and region. While the review unearthed a number of well-studied themes, significant aspects of the topic remain untapped especially in developing countries and at the level of health professionals other than physicians.

Abstract Background The critical role pharmacists play in the healthcare system necessitates close monitoring of their supply, distribution, and competencies. This is especially relevant considering the global increase in the demand for pharmacists. In Lebanon, the pharmacy profession is facing several challenges related to the unplanned supply of pharmacists. The aim of the study is to analyze the Order of Pharmacists registration database and generate workforce distribution over the last six decades. Methods This study entailed a detailed database analysis of a deidentified subset of the Order of Pharmacists in Lebanon registration records for years 1954–2018. The analysis generated workforce distribution in terms of growth in number, distribution by gender, age distribution, geographic location, workforce status, sector of employment, and employment position. A descriptive analysis was carried out with cross-tabulations to identify distribution across selected variables. Results The pharmacy profession in Lebanon witnessed significant growth over the period of analysis. The “Community” was the most common employment sector (63%), followed by “Pharmaceutical Sector” (24%) and “Hospitals” (5%). The high ratio of pharmacists to 10 000 population (20.3) was contrasted by a low ratio of hospital pharmacist per hospital and per 100 hospital beds (1.9 and 1.7, respectively). The high pharmacist to population ratio is indicative of an oversupply of pharmacists precipitated by poor workforce planning. While oversupply did not result in high unemployment, it may have negatively affected the income of pharmacists and their adherence to the professional and ethical requirements of their job. Despite the large number of pharmacists in Lebanon, findings elicit concerns over the adequacy and safety of pharmacists’ services in hospitals with a low ratio of hospital pharmacists to 100 hospital beds. Conclusion This study unearthed several opportunities and concerns related to planning the supply, distribution, regulation, and the professional scope of practice of pharmacists in Lebanon. A concerted multi-stakeholder effort to address some of the identified challenges will not only improve the professional status of pharmacists but will also enhance the safety and efficiency of pharmaceutical care in the country.

Abstract Background Literature reports a direct relation between nurses’ job satisfaction and their job retention (stickiness). The proper planning and management of the nursing labor market necessitates the understanding of job satisfaction and retention trends. The objectives of the study are to identify trends in, and the interrelation between, the job satisfaction and job stickiness of German nurses in the 1990–2013 period using a flexible specification for job satisfaction that includes different time periods and to also identify the main determinants of nurse job stickiness in Germany and test whether these determinants have changed over the last two decades. Methods The development of job stickiness in Germany is depicted by a subset of data from the German Socio-Economic Panel (1990–2013), with each survey respondent assigned a unique identifier used to calculate the year-to-year transition probability of remaining in the current position. The changing association between job satisfaction and job stickiness is measured using job satisfaction data and multivariate regressions assessing whether certain job stickiness determinants have changed over the study period. Results Between 1990 and 2013, the job stickiness of German nurses increased from 83 to 91%, while their job satisfaction underwent a steady and gradual decline, dropping by 7.5%. We attribute this paradoxical result to the changing association between job satisfaction and job stickiness; that is, for a given level of job (dis)satisfaction, nurses show a higher stickiness rate in more recent years than in the past, which might be partially explained by the rise in part-time employment during this period. The main determinants of stickiness, whose importance has not changed in the past two decades, are wages, tenure, personal health, and household structure. Conclusions The paradoxical relation between job satisfaction and job stickiness in the German nursing context could be explained by historical downsizing trends in hospitals, an East-West German nurse compensation gap, and an increase in the proportion of nurses employed on a part-time basis. A clearer analysis of each of these trends is thus essential for the development of evidence-based policies that enhance the job satisfaction and efficiency of the German nursing workforce.

Abstract Background eHealth can positively impact the efficiency and quality of healthcare services. Its potential benefits extend to the patient, healthcare provider, and organization. Primary healthcare (PHC) settings may particularly benefit from eHealth. In these settings, healthcare provider readiness is key to successful eHealth implementation. Accordingly, it is necessary to explore the potential readiness of providers to use eHealth tools. Therefore, the purpose of this study was to assess the readiness of healthcare providers working in PHC centers in Lebanon to use eHealth tools. Methods A self-administered questionnaire was used to assess participants’ socio-demographics, computer use, literacy, and access, and participants’ readiness for eHealth implementation (appropriateness, management support, change efficacy, personal beneficence). The study included primary healthcare providers (physicians, nurses, other providers) working in 22 PHC centers distributed across Lebanon. Descriptive and bivariate analyses (ANOVA, independent t-test, Kruskal Wallis, Tamhane’s T2) were used to compare participant characteristics to the level of readiness for the implementation of eHealth. Results Of the 541 questionnaires, 213 were completed (response rate: 39.4 %). The majority of participants were physicians (46.9 %), and nurses (26.8 %). Most physicians (54.0 %), nurses (61.4 %), and other providers (50.9 %) felt comfortable using computers, and had access to computers at their PHC center (physicians: 77.0 %, nurses: 87.7 %, others: 92.5 %). Frequency of computer use varied. The study found a significant difference for personal beneficence, management support, and change efficacy among different healthcare providers, and relative to participants’ level of comfort using computers. There was a significant difference by level of comfort using computers and appropriateness. A significant difference was also found between those with access to computers in relation to personal beneficence and change efficacy; and between frequency of computer use and change efficacy. Conclusion The implementation of eHealth cannot be achieved without the readiness of healthcare providers. This study demonstrates that the majority of healthcare providers at PHC centers across Lebanon are ready for eHealth implementation. The findings of this study can be considered by decision makers to enhance and scale-up the use of eHealth in PHC centers nationally. Efforts should be directed towards capacity building for healthcare providers.

An amendment to this paper has been published and can be accessed via the original article.