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A smartphone application (app) from the company Monsenso was developed to monitor anxiety symptoms in the treatment of anxiety disorders as an alternative to paper registrations. The aim of the study was to explore patient and therapist experiences of using the app in conjunction with standard treatment for anxiety disorder in a developmental and implementation phase. The study design was qualitative. Semi-structured interviews were conducted with three therapists and seven patients from an outpatient clinic. The interviews were analysed using thematic analysis. Three main themes emerged for both patients and therapists. The patient themes were usability (it was easier to use the app and remember daily mood registrations), insight in own disorder (awareness of symptom progress), and support to use the app (support from the therapist was wanted). The therapist themes were therapeutic quality (app registrations made it easier to prepare sessions), the role of the therapist (enthusiasm and technical assistance affected the patient), and implementation challenges (time allocation is important). The anxiety monitoring app is recommended in standard treatment as an alternative to paper registrations. However, a successful development and implementation process include ready available technical support, time allocation, and therapist effort and enthusiasm. [ABSTRACT FROM AUTHOR]

Criterion measures vary greatly in terms of their psychometric quality and ease of use. This paper serves two purposes. First, it provides a general summary of different approaches to criterion measurement in a military context. Second, it provides an extensive review of 16 specific types of criterion measurement methods (e.g., job performance rating scales, self-report questionnaires, job knowledge tests) on nine psychometric and ease-of-use evaluation factors. Eight criterion measurement experts read a summary of extant research and made ratings to evaluate each measurement method on the evaluation factors. Rater intra-class correlations (ICCs) were high, ranging from.75 to.95 across the evaluation dimensions with a median of.91. Data showed a quality-feasibility tradeoff, where criterion data that are easy to obtain often have technical flaws. Recommendations for military services and future directions in criterion measurement (e.g., applications of machine learning) are discussed. [ABSTRACT FROM AUTHOR]

This is a perspective, about the future climate policy of Pakistan, to improve the harvest of Green Climate Funds (GCF). This paper takes upon the calculation of climate financing potential in the context of the energy sector of Pakistan by estimating the potential of becoming a net-zero sector in Pakistan's Economy. The study has identified several options for the government to reallocate the energy mix and tie the energy demand targets with climate targets for a green future of Pakistan. The study has used basic excel tools to calculate facts from the available data sets in Pakistan. The study found that, if Pakistan chooses to shift from dirty sources of energy production to the use of cleaner inputs for energy production, Pakistan can generate a significant amount of climate finance by reducing the emissions from energy production, which are recordable, traceable, and can be evaluated by any of the third-party evaluating organization. The initial cost for Pakistan will cause some discrepancies in some of the macroeconomic indicators and may also cause budget imbalances it will surely help the economy to achieve the targets of becoming a net-zero economy and be able to harvest Green Climate Funds in long term with much faster rate, which can overpass the investments made or being made in this sector and will create a significant amount jobs in the economy, which will be green jobs, promoting environmental friendly output and sustainable growth. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents qualitative research findings from the evaluation of a Parkinson's Dance well-being venture in the UK. Methods: Qualitative data was gathered to see how bespoke dancing sessions helped people with Parkinson's (PwP) to manage their conditions and improve their lives and prospects. Principles of a participatory approach were incorporated and methods included semi-structured interviewing, researchers participant observation and an elicitation-based activity. Nineteen PwP, six carers, four dance artists and seven helpers participated in the study. Results: Participating in Parkinson's Dance sessions meant that PwP could experience the possibilities to dance, develop a "can do" attitude, experience fun, enjoyment, social connection, exercise, movement to music, improvement and/or maintenance of their balance, suppleness, coordination and confidence with movement, symptoms being pushed back and ability to learn new things. Conclusions: Our findings add to the evidence-base about the benefits of dance for people experiencing Parkinson's and through novel application of the Life-world based well-being framework of K. T. Galvin and Todres (2011) we propose a theoretical basis for Parkinson's Dance as a resource for well-being. There is scope to consider application of the well-being framework to other arts activities and as the basis of an arts and well-being evaluation tool. [ABSTRACT FROM AUTHOR]

Under what life conditions do individuals turn to perfectionistic striving and ideals as a solution? The present paper examines how people with perfectionism narrate their relationship to our shared existential vulnerability; that we are vulnerable as human beings, and that the ways we relate to this vulnerability have consequences for psychological health. In the present qualitative study, we explored the life narratives told by nine students with perfectionism, drawing on semi-structured life-story interviews. We conducted an explorativereflexive thematic analysis and identified five themes: 1) Outside--Feeling Alienated, 2) Relating to Chaos, 3) Trying to Control the Painful and Uncontrollable, 4) Islands of Just Being and Positive Contact, and 5) Heading Toward a Balance Between Doing and Being. Their perfectionism can be seen as a way of handling existential vulnerability at a point in their lives where relational resources needed to stay firm in a vulnerable state are lacking. Perfectionistic themes influence their personal identity in the domain of narrative constructions, values, belongingness, and embodiment. Accomplishments were dominant themes in the plots of their narrative self-constructions and values. They felt their "self-made" identities kept others at a distance. However, we also found strivings for a more fulfilling life with broader self-definitions. [ABSTRACT FROM AUTHOR]

Purpose: This research examines the implementation of the Icelandic Prevention Model (IPM) in Canada to identify opportunities revealed by the COVID-19 pandemic to re-design our social eco-system to promote wellbeing. This paper has two objectives: 1) to provide a conceptual review of research that applies the bioecological model to youth substance use prevention with a focus on the concepts of time and physical space use and 2) to describe a case study that examines the implementation of the IPM in Canada within the context of the COVID-19 pandemic. Method: Study data were collected through semistructured qualitative interviews with key stakeholders involved in implementing the IPM. Results: Findings are organized within three over-arching themes derived from a thematic analysis: 1) Issues that influence time and space use patterns and youth substance use, 2) Family and community cohesion and influences on developmental context and time use and 3) Opportunities presented by the pandemic that can promote youth wellbeing. Conclusion: We apply the findings to research on the IPM as well as the pandemic to examine opportunities that may support primary prevention and overall youth wellbeing. We use the concepts of time and space as a foundation to discuss implications for policy and practice going forward. [ABSTRACT FROM AUTHOR]

Qualitative research provides an in-depth understanding of lived experiences. However, these experiences can be hard to apprehend by using just one method of data analysis. A good example is the experience of resilience. In this paper, the authors describe the chain of the decision-making process in the research of the construct of "resilience". s The authors justify the implications of a multi-method, pluralistic approach, and show how the triangulation of two or more qualitative methods and integration of several qualitative data analysis methods can improve a deeper understanding of the resilience among people with chronic pain. By combining the thematic analysis, narrative analysis, and critical incident technique, lived experiences can be seen from different perspectives.Therefore, the thematic analysis describes the content and answers to "what" regarding resilience, the narrative analysis describes the dynamics of resilience, and answers to "how", while the critical incident technique clarifies the most significant experience and the answers to "why" changes happen. This integrative approach could be used in the analysis of other psychological constructs and can serve as an example of how the rigour of qualitative research could be provided. [ABSTRACT FROM AUTHOR]

Recovery-oriented mental health care approach is gaining acceptance in Asian countries, including Singapore. Following Western countries, Singapore started hiring peer support specialists (PSS) as part of mental healthcare services. The aim of this paper was to explore and understand how individual peer support specialists in Singapore perceive and make sense of their role given their unique perspective as both recipients and providers of mental healthcare treatment. Six PSS in Singapore were interviewed utilizing a semi-structured interview schedule. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. Four superordinate themes were generated illustrating how PSS viewed their role: embracing and embodying recovery, balancing on a bridge, impossible without support, and helping to end stigma. Findings also illustrated participants' awareness of the nature of the job and the role of PSS as still in the infancy stage. They embraced a recovery-oriented mindset despite experiencing stigma from professionals and/or their social support. The need to understand familial attitudes towards the PSS role is discussed. The limitations, contributions to the research, and several areas for future research are also outlined. [ABSTRACT FROM AUTHOR]

The article focuses on increased use of thematic analysis (TA) and particularly the TA approach developed in qualitative and mixed methods research published in IJTH as the editors of the journal have invited to provide a commentary on good practice and common problems in TA research. Topics include examines the aim of this commentary is to guide researchers in producing and reporting methodologically coherent TA.

Rapid reviews involve a streamlined approach to knowledge synthesis. They are used to identify high-quality evidence for the purpose of informing decisions and initiatives, completed over relatively short timeframes, and have been found to reach conclusions that do not differ extensively from full systematic reviews. Although common in the health sector, rapid reviews are not as widespread in education. This paper reflects on the experiences of conducting a rapid review that applied review guidance from the health sector to a topic situated within education: effective Professional Learning (PL) for school-based educators. Our purpose is not to share the rapid review's findings: rather, our interest lies in exploring the process of undertaking the review. We sought to investigate the methodological decisions we made for the education context as we carried out the review. As part of a large-scale investigation focusing on practitioner use of research evidence in education, we undertook a rapid review to understand what is known about effective PL. Drawing on methodological literature from the health and education sectors, we documented the procedure involved in conducting our rapid review in education. At each step, we reflected on methodological issues encountered, decisions taken and the procedural adjustments we made to align the process to the education context. Our reflections identify the key adaptations we made to ensure that review guidance was carefully attuned to the context of the education field and the wider purpose of the review: in our case, to inform an initiative in education. Considerations highlighted by our procedure also included the role of reviewer judgement in quality appraisal and attending to collaborative review team processes. These reflections support the notion that the use of research to inform decisions in education needs to be a dynamic, contextualised, and collaborative process. Rapid reviews have a crucial part to play in efforts to strengthen evidence-informed practice in the education sector. Our methodological exploration offers insights for those conducting, using, and commissioning rapid reviews to provide systematic and transparent evidence-based guidance for initiatives in education. [ABSTRACT FROM AUTHOR]

Background: Immigrant Latinx transgender people often migrate to the United States because of a desire for increased safety and more opportunities. However, after migrating to the United States, immigrant Latinx transgender people often struggle to access basic needs, including health care, jobs, and stable finances. These struggles are exacerbated for undocumented immigrant Latinx transgender people. There is a gap in the literature regarding needed resources for immigrant Latinx transgender community members living in the United States. Aims: Utilizing a critical intersectionality framework, the aim of the present study was to investigate the resource needs of immigrant Latinx transgender community members living in the United States. Methods: A community sample of 18 immigrant Latinx transgender people living in a large metropolitan city in Florida participated in individual semi-structured interviews to explore their community resource needs. Results: Thematic analysis revealed five themes related to resources that participants needed including: 1) Transgender healthcare/resources, 2) Public education, 3) Financial aid resources, 4) Homelessness resources, and 5) Addictions care. Two resource need-related themes were identified that pertain specifically to undocumented immigrant Latinx transgender people, including: 1) Documentation papers for access, and 2) Legal aid. Conclusions: Findings suggest that immigrant Latinx transgender community members in this study provided guidance about broad resources needed to enhance their wellness and safety, and promote liberation of community members. Participants' resource needs suggest the importance of policy and structural level changes from institutions with power that consider and enhance the wellness of immigrant Latinx transgender people. Findings also suggest the need for more tailored interventions and case work to better support immigrant Latinx transgender people. [ABSTRACT FROM AUTHOR]

Large pulsation and impact occur during the working process of hydraulic rock drill, which has a negative influence on the system. Aiming at this phenomenon, the related characteristics of hydraulic fluid inertia are studied in this paper. The dynamic model of impact and reversing mechanism of rock drill is established. Through the parameter analysis of the model, the concepts of hard parameter quantity and soft parameter quantity are proposed. The influence coefficient C of the initial section of crevice flow including the influence of fluid inertia is deduced, and the comprehensive factors such as hydraulic oil velocity, unstable flow and friction resistance are analyzed, The value of soft parameter quantity ζ is (ξ+1) ~ (ξ+ 1.5)。The pressure test of the working chamber is designed and 7 groups of data are obtained. Through data analysis, the influence of C on the simulation results is obtained, which has a great influence on the reversing valve. The deviation of simulation data of left and right valve chamber pressure is increased from ± 8% to ± 3%. It has a certain impact on the impact piston. The deviation of simulation data increases from ± 5% to ± 3%, and has little impact on the accumulator. The deviation of simulation data increases from ± 4% to ± 3%. [ABSTRACT FROM AUTHOR]

Complementary medicines (CMs) that are formulated to facilitate weight loss are a popular and widely available treatment option, particularly among women. There is limited research regarding their use in the South African context. The aim of this study was to gather information on the use and perceived effectiveness of CMs for weight loss among adult women. A quantitative, descriptive survey design was used. Johannesburg, South Africa. A purposive sample of women over the age of 18 years who had used CMs for weight loss within the past five years were recruited from health stores and a university campus healthcare centre. Data were obtained through a self-administered 29-item, paper-and-pen questionnaire. Responses were descriptively analysed using cross-tabulation, multiple response analysis and frequency tables. Data from 160 questionnaires were analysed and the results demonstrated that a wide variety of CM products are used for weight loss, with branded combination products, green tea, Garcinia cambogia and conjugated linoleic acid being the most popular. Most participants also adopted lifestyle interventions such as exercise and calorie restriction during their weight loss attempt. While minor side effects were experienced by over half of the participants, the majority were satisfied with their product choice as well as the amount of weight that they lost. Most participants perceived their CM weight loss product of choice to be effective. However, other concomitant weight-loss strategies that were employed may have been responsible for these results. Despite their popularity, there is only very limited research surrounding the safety and efficacy of these weight-loss products, with most studies being conducted on single constituents rather than whole formulations as sold on the market. Healthcare providers should encourage the disclosure of the use of CM weight-loss products to ensure safe and effective patient care and mitigate the potential risks associated with their inappropriate use. [ABSTRACT FROM AUTHOR]

Mobility, access to transport and healthcare play a crucial part in healthy ageing. However, these often posechallenges for older adults in the global South. This study applies the three concepts of 'motility' (access, competence and appropriation), to explore transport inequalities and barriers to access healthcare services for older adults in Bengaluru, India. The paper draws on interviews with sixty adults, aged 50 years and over, residing in urban Bengaluru. A semi-structured in-depth interview guide was employed to explore the transport inequalities. Applying thematic analysis, we present the mobility and transport barriers to access healthcare. Restricted access to healthcare services due to unavailable and unaffordable transportation resulted in missed appointments, delayed care and deterioration of health conditions. To cope with the barriers, older adults often visited less specialised clinics for regular check-ups and those with financial constraints resorted to self-medication. These actions further deteriorated health and led to adverse health outcomes. Our findings suggest that integrated health and transport policies must be designed to ensure equitable access to transportation services. Enabling older adults to have more independent lives and improve access to preventive healthcare is essential for better health outcomes. [ABSTRACT FROM AUTHOR]

The health burden due to mental health has historically been underestimated with focus on communicable diseases and deaths and little consideration of disability and comorbidity effects of poor mental health. Recent data show increasing trends of mental health disorders as a share of global health burdens and vulnerability of adolescents. This paper aims to explore social determinants of mental health as experienced by adolescent girls, drawing attention to gendered risks during the COVID-19 pandemic. Semi-structured interviews with twenty-two adolescent girls in urban informal settlements in Kenya and Nigeria reveal unique environmental, socio-cultural, economic and educational factors that threatened their mental wellbeing. The pandemic exacerbated these determinants. An equitable recovery will require a consideration of not only disproportional mental health outcomes, but also social determinants that contribute to these outcomes. As more than half of the urban population in sub-Saharan Africa reside in informal settlements, this study has implications for youth-focused mental health interventions in these and similar settings. [ABSTRACT FROM AUTHOR]

In 2020, the New Zealand (NZ) Parliament voted to decriminalise abortion. Although NZ's abortion law formally opposes sex selective abortions, there is considerable complexity in the gender politics of 'choice' and 'agency' in multi-ethnic societies, and interpretations of reproductive rights for ethnic minority women and for the girl child, respectively. This paper explores these complexities through the perspectives of reproductive and maternity care practitioners who are situated at the interface of legal systems, health service provision, and delivery of culturally sensitive care. Thirteen practitioners were interviewed as part of this study. The analysis highlights strains in framings of 'reproductive choice' (underpinned by western liberal notions of rights) and 'gender equality' (abortion rights that acknowledge the complexity of cultural son-preference) for ethnic minority women. These tensions are played out in three aspects of the post-reform landscape: (a) everyday practice and accountability; (b) consumerism and choice; (c) custodianship and gender rights. The findings point to the limitations in operationalising choices for ethnic women in health systems wherein trust deficit prevails, and cultural dynamics render complex responses to abortion. They also highlight reconfigurations of client-expert relationships that may have implications for practitioners' abilities to advocate for ethnic women's rights against cultural influences. [ABSTRACT FROM AUTHOR]

Leadership by health professionals is key in any health system, but health leadership training programmes are varied in their conceptualisation, learning objectives, and design. This paper describes an undergraduate leadership and management module for health students at the University of Sierra Leone and provides lessons from the design process. Our methods included an initial scoping review and qualitative study, followed by a co-design process of 10 workshops and 17 consultation meetings. The result was a curriculum with learning outcomes emphasising leadership identity, proactiveness, management of people and of change, and the formation of peer relationships. Learning methods included group teaching, team quality improvement projects, mentoring, and reflective practice. Lessons from the design process included the importance of support from university leadership and extensive consultation. Virtual workshops enabled broader participation but limited relationship building. Integrating doctoral research into the process facilitated inclusion of evidence and theory but risked reducing ownership by faculty. The importance of interprofessionalism and management skills in leadership training emerged during the process, illustrating the effectiveness of a co-design approach. Our programme is broadly aligned with other health leadership frameworks and is distinctive due to its undergraduate focus, offering insights for leadership training design in other settings. [ABSTRACT FROM AUTHOR]

Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes. [ABSTRACT FROM AUTHOR]

In the recent literature, energy efficiency got the attention of scholars due to its discouraging impact on CO2 emissions, which is considered the most prevalent greenhouse gas that human activities produce. Data reports that China is the leading CO2 emitting country across the globe, and still the environmental degradation is in progress. Thus, the current paper empirically investigates the impact of energy efficiency (ENEF), financial inclusion (FD), GDP, export diversification (EXD), and human capital index (HCI) on the environmental degradation of China over the period from 1988 to 2018. This study uses various time-series tests to empirically investigate the determinant of CO2 emissions, including normality tests, unit root tests, and combined cointegration tests. Besides, the long-run coefficients are analyzed via the fully modified ordinary least square (FMOLS), dynamic OLS (DOLS), and the Canonical Cointegrating Regression (CCR) estimators. The empirical findings reveal that all the variables are cointegrated in the long run. However, the coefficient estimate shows that ENEF and HCI significantly promote environmental sustainability. While GDP, FD, and EXD significantly promote environmental degradation by enhancing the CO2 level in the atmosphere. This study recommends practical policy implications based on the empirical findings: energy-efficient products and energy sources could be promoted. [ABSTRACT FROM AUTHOR]

In 2019, the World Health Organization recognised diabetes as a clinically and pathophysiologically heterogeneous set of related diseases. Little is currently known about the diabetes phenotypes in the population of low- and middle-income countries (LMICs), yet identifying their different risks and aetiology has great potential to guide the development of more effective, tailored prevention and treatment. This study reviewed the scope of diabetes datasets, health information ecosystems, and human resource capacity in four countries to assess whether a diabetes phenotyping algorithm (developed under a companion study) could be successfully applied. The capacity assessment was undertaken with four countries: Trinidad, Malaysia, Kenya, and Rwanda. Diabetes programme staff completed a checklist of available diabetes data variables and then participated in semi-structured interviews about Health Information System (HIS) ecosystem conditions, diabetes programme context, and human resource needs. Descriptive analysis was undertaken. Only Malaysia collected the full set of the required diabetes data for the diabetes algorithm, although all countries did collect the required diabetes complication data. An HIS ecosystem existed in all settings, with variations in data hosting and sharing. All countries had access to HIS or ICT support, and epidemiologists or biostatisticians to support dataset preparation and algorithm application. Malaysia was found to be most ready to apply the phenotyping algorithm. A fundamental impediment in the other settings was the absence of several core diabetes data variables. Additionally, if countries digitise diabetes data collection and centralise diabetes data hosting, this will simplify dataset preparation for algorithm application. These issues reflect common LMIC health systems' weaknesses in relation to diabetes care, and specifically highlight the importance of investment in improving diabetes data, which can guide population-tailored prevention and management approaches. [ABSTRACT FROM AUTHOR]

One in five child deaths under age 5 are a result of severe wasting. Malnutrition at early ages is linked to lifelong consequences, such as reduced cognitive skills, reduced earnings in adulthood and chronic health conditions. Countries worldwide have committed to addressing child undernutrition, and ending hunger is foundational to the Millennium Development Goals. In this paper, we study the intergenerational effect of providing free tuition in secondary school on future children’s nutrition. We combined a novel longitudinal dataset that captures educational policies for 40 African countries from 1990 to 2019 with the Demographic and Health Survey (DHS). We identified three countries that introduced free secondary education several years after implementing free primary education. Exploiting this variation in timing we estimate the additional impact of providing free secondary education over free primary education. Using a difference-in-difference approach, we find that introducing free secondary education significantly reduced wasting. Cohorts exposed to free secondary had an 18% relative decrease in wasting. The impact on cohorts exposed only to free primary was smaller and not statistically significant. Expanding free secondary education has long-term, intergenerational benefits and is an effective path to reducing malnutrition. Results are robust to different specifications. [ABSTRACT FROM AUTHOR]

Young people in Colombia present high rates of mental health problems, to which the country’s history of armed internal conflict contributes in complex ways. Mental health services in Colombia are fragmented, inadequate, and difficult to access for many. Young people’s help)seeking is often hindered by mental health stigma and/or poor experiences with services. This paper presents a thematic analysis of qualitative data from a mixed-methods study aimed at developing and testing a mental health intervention for Colombian youths. We draw upon theoretical lenses from scholarly work on stigma and Sen’s ‘capabilities approach’ to inform our analysis of interviews and group discussions with staff and young people involved in the state-funded human capital building programme ‘Jovenes en Acción’ (JeA). By illustrating how study participants talked about stigma, vulnerability, mental health services organisation, and the challenges of discussing mental health topics in a learning environment, we illuminate aspects of mental health support and anti-stigma interventions that might need enhancing. In particular, we suggest that more emphasis on ‘community competencies’ as complementary to and interrelated with individual competencies would strengthen young people’s individual and collective resources for mental wellbeing while being in line with the sociocritical principles of existing human capital-enhancing programmes. [ABSTRACT FROM AUTHOR]

Young mothers often encounter stigma and discrimination, affecting their lives and that of their children. This paper explores stigma management strategies and their effectiveness for young mothers in rural Nigeria. Ten key informants and 24 young mothers were recruited from Ife-East in South-Western Nigeria. Data from semi-structured interviews showed that societal disapproval of pregnant teenagers and young mothers were common experiences. Women used a range of strategies to actively cope with stigma including: belief in predestination, avoidance, concealment, and cohabitation. These strategies could be seen as tools to mitigate negative stereotypes and discrimination. However, they also had the unintended consequences of compounding many young women’s difficult circumstances and exposing them to adverse outcomes, including gender-based violence, repeat pregnancies, poor mental health, and low uptake of services. The results show the need for policy frameworks to actively combat stigma by addressing the negative framing of early pregnancy and motherhood and promoting supportive environments for young mothers. Health professionals need to be trained to offer de-stigmatising services to encourage young mothers to seek help and reduce pre-existing inequities in access to services, and policies need to include measures that address the rights of young mothers and protect them from violence and abuse. [ABSTRACT FROM AUTHOR]

The UN’s Zero Tolerance Policy, which bans all relationships between UN staff and locals, portrays all relationships as exploitative, fails to account for nuances in these relationships and does not acknowledge the agency of local women or communities. This study uses community-based qualitative data from eastern DRC that shares narratives on a wide variety of consensual relationships between peacekeepers and local women. Our paper uses a data-driven approach, including a post-colonial feminist lens, and ideas of structural agency to provide an expanded definition of agency that invites readers to re-examine their views of women in conflict settings. Finally, we provide clear recommendations for the UN and other international non-governmental agencies on policies related to sexual exploitation and abuse. [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]

Comprehensive sexuality education (CSE) seeks to improve young people's knowledge, attitudes and practices in relation to sexual and reproductive health, sexual and social relationships, and dignity and rights. In Ethiopia, young people with disabilities and young women involved in sex work are particularly vulnerable to sexual violence and poor sexual health, yet face stigma and accessibility challenges that continue to exclude them from information, support and services. Because they are often out of school, these groups are also often excluded from programmes that are largely delivered in school settings. This paper explores the challenges faced by these groups of young people in accessing inclusive and age-appropriate sexual and reproductive health knowledge and services in the Ethiopian context and the implications for delivering CSE. The research included literature review, mapping analysis and interviews with young people from those two groups and with service providers and programme implementers. Our findings indicate that young people with disabilities and young women involved in sex work face myriad barriers to accessing information and services that support positive and healthy sexuality, relationships and rights. However, changes over the past decade to national and regional governance structures and a political environment in which CSE has become increasingly contested have generated siloed approaches to the provision of sexual and reproductive health information and services, and poor linkages to complementary services including violence prevention and social protection. It is vital that efforts to implement comprehensive sexuality education are informed by these challenges in the wider policy environment. [ABSTRACT FROM AUTHOR]

In this study, we developed and validated a scale that measures the sense of community among Korean military personnel. We conducted the research in three stages. In the first preliminary stage, we administered an open-ended questionnaire to 47 military officers in order to develop the initial questions. Experts verified the content validity of the 60 preliminary questions, and the questions were modified based on the experts' input. In the second preliminary stage, we extracted preliminary scales for 20 items based on the responses of 457 Army soldiers. In the third stage, we provided the preliminary scale to 656 Korean military personnel, and their responses were used to extract a five-factor matrix with 20 items. The five factors were Needs Fulfillment, Influence, Shared Emotional Connection, Rule Compliance, and Membership; each factor consisted of four items. Finally, after four weeks, we administered the scale to 208 additional military personnel, and the stability of the scale was confirmed, with a test-retest reliability of .90. To conclude the paper, we describe the implications of the scale developed in this study as well as directions for future studies. [ABSTRACT FROM AUTHOR]

Background: While research on trans People of Color's experiences has been increasing in recent years, this intersectional work has often not included a focus on the specificities of multiracial and multiethnic trans experiences. Aims: This study explores shifts in racial identity by multiracial/multiethnic trans people as they transition gender and the ways Whiteness and nationalist ideology shape their racialized gender experiences. Methods: This paper is based on six in-depth, semi-structured interviewswith self-identifiedmultiracial, multiethnic, andmulti-heritage trans people in the USA. Data collection centered participants' experiences of self-identification and interactionswith others (e.g., family, acquaintances, and strangers). Results: As participants transitioned gender and were acknowledged by others in their gender identity, shifts in their embodiment were used by others to ascribe a new racialized gender. This often resulted in participants reflecting on their sense of self and racialized gender identities in new ways. Discussion: Multiracial and multiethnic transgender people's experiences in transitioning race confirm the importance of intersectional analysis, reveal the intersectional fluidity of social categories, explicate how social understandings of one category (e.g., race) influence another category (e.g., gender), demonstrate that the meanings associated with racialized gender are based in relations of power, and show that, in transgender studies particularly, we must attend to the ways that the concept of transition implicates not only gender, but also other categories such as race and nationality. [ABSTRACT FROM AUTHOR]

This paper aims at describing the eating experience of people diagnosed with and treated for laryngeal cancer. Going beyond the mere conceptualization of "after-effect" or the quantification of the disease's impact on the basis of standardized questionnaires, we present a qualitative analysis of the narratives of such experiences. Ethnographic study. Data is obtained from conversations, semi-structured interviews, participant observation, and written documents. A discourse analysis of the narrative information was conducted, with process coding and using the constant comparative method, inductive content analysis, category analysis, units of meaning associated with each other, and triangulation. The impact of cancer on eating processes is not limited to nutrition, but also affects the social and cultural value of food, which is put into question. The symbolic and social values which accompany the traditional way of eating are modified, which is connected with impaired quality of life. The impact on the eating process and its relationship with quality-of-life impairment are clear and connect with the importance of eating ways in culture and social organization. Greater attention should be paid to these contexts in clinical practice, which can affect even more than the impact on communicative processes. [ABSTRACT FROM AUTHOR]

Purpose: Despite increased focus on parenting support internationally, there is a lack of agreement in what constitutes parenting support. This paper explores the experiences of parenting support activities from the perspective of stakeholders in Norwegian basic schools. Methods: Five focus group interviews were conducted with representatives from the schools' parent work committee, class teachers, health nurses, and social workers from nine schools. The data were interpreted using an inductive thematic analysis. Results: Three main themes emerged from the data: (1) A community for the best of the child, (2) uniting through relations, and (3) sharing knowledge and language. Parenting support was experienced as universal, relational, and multidimensional. It was related to everyday life interactions between the home, school, and the parenting community with the best interest of the child as a goal. Conclusion: To avoid reducing parents to passive recipients of expert advice, parenting support activities should be an integral part of everyday school-home-parenting community collaborations. Abbreviation: EU-The European Union; UN-The Unition Nations; CoE-The Council of Europe; NSD-The Norwegian Centre for Research Data; CTP-Class teachers in primary school; CTJS-Class teachers in junior secondary school; P-Parents; H-Health nurses; SW-Social workers [ABSTRACT FROM AUTHOR]

Purpose: Self-reliance and social participation are strongly promoted by social policy. Both concepts are linked to the concept of vulnerability, for people who do not meet these standards are labelled "vulnerable people". In this paper, the insider's perspective takes central stage by seeking to explore what it means to be labelled a "vulnerable person", and through this to further our insight into the meaning of the concept of vulnerability. Method: Thirty-three in-depth interviews were conducted with 16 allegedly vulnerable people. The data were subjected to thematic content analysis. Results: Our analysis revealed three main dimensions and eight sub-dimensions of perceived vulnerability, outlining an insider's concept of vulnerability. This concept includes manifestations of vulnerability, feelings coexisting with vulnerability, and the image of vulnerable people. Conclusion: The perception of vulnerability changes when interacting with others in society, especially with social policy implementers. In this interaction, the perceived vulnerability increases and becomes societal vulnerability. It concerns a dependency situation in which one's strength and self-determination are not recognized, and the help needed is not provided. By acknowledging the insider's perspective, social policy can fulfil a more empowering role towards "vulnerable people" and contribute to people's well-being. [ABSTRACT FROM AUTHOR]

Background: Appropriate supports and instructional practices contribute to the development of self-determination. Also, research shows that the promotion of skills related to self-determination has been linked to the achievement of desired outcomes over the different life stages. Advances in self-determination require the development of assessment instruments because there is a reciprocal relationship between assessment and instruction. The purpose of this paper is to provide a description of the AUTODDIS Scale, along with evidence of its reliability and external validity. Method: A sample of 541 people with intellectual disabilities aged from 11 to 40 was used to validate the scale. Results: The reliability results indicate that the AUTODDIS Scale shows high internal consistency. The total score and subscale scores indicate moderate inter-rater reliability. The scores were also moderately to highly associated with other related measures of self-determination and quality of life (QoL). Conclusion: Our results demonstrate that consistent and valid information can be obtained from the AUTODDIS Scale. [ABSTRACT FROM AUTHOR]

Birth registration is vital to provide legal identity and access to essential services. Worldwide, approximately 166 million children under five years (just under 25%) are unregistered, yet >80% of all births occur in health facilities in most low- and middle-income countries (LMIC). This study, conducted in association with UNICEF, aims to review facility-based birth registration initiatives, and provide recommendations to close the gap between facility birth and birth registration rates in LMIC. A literature review covering published and grey literature was conducted to identify facility-based initiatives to increase birth registration rates. Semi-structured in-depth interviews were conducted by audio-call with six key global stakeholders to identify additional initiatives, and further insights for barriers and enablers to close the gap. Academic databases and grey literature search yielded 21 studies meeting pre-specified inclusion criteria. Nine barriers preventing birth registration were identified and grouped into three themes: health system, governmental, and societal barriers. Facility-based birth registration initiatives resulted in an increase in birth registration rates. Importantly, health promotion within communities also increased demand for birth registration. In-depth interview respondents provided further detail and supported data found in literature review. Synthesis of the literature and stakeholder interviews noted enablers including inter-sectoral collaboration between health sector and civil registration ministries e.g., placing civil registration offices in health facilities or allowing medical doctors to act as registrars. Facility-based birth registration initiatives can increase birth registration rates in LMIC. Initiatives need to address both supply and demand side of birth registration to improve facility-based birth registration rates. A multi-sectoral approach within governments, and alignment with multiple stakeholders is vital. [ABSTRACT FROM AUTHOR]

Although the sexual and reproductive health and rights (SRHR) of young people and migrants should be prioritised, young migrants' sexual and reproductive health (SRH) is rarely studied in Sweden. To explore young migrants' understanding and experiences of sexual rights and examine their perceptions and experiences in accessing SRH services. This is a mixed method study including a national survey that recruited 1773 newly arrived young migrants; a youth clinic survey that recruited 1089 youths after visiting youth clinics; and a qualitative study that included 13 interviews with newly arrived Arabic-speaking migrant men. The results are synthesised using a new ecological framework of access to understand the factors influencing young migrant access to health care based on the levels of the ecological model and the five steps of access: approachability, acceptability, adequacy, affordability, and quality. Young migrants understood SRH as both 'essential' and 'a right.' Their sexual rights were less fulfiled compared to other young people in Sweden, particularly for men, non-binary, LGBTQ+, those born in South Asia, without a residence permit, and those of low economic conditions. SRH services were largely unapproachable as almost half of those who needed them did not utilise them. Services were generally acceptable due to the 'open environment,' however, some young migrants faced cultural insensitivity, fear of exposure, low parental support, and long waiting times. SRH services' quality was perceived as good, however, negative experiences were reported, particularly in the domains of respect, equity, privacy, non-prejudice, and consultation quality. The access of young migrants to SRH services is facilitated by an 'open environment' and available and good quality services; however, they faced serious barriers such as limited access to information about the health system, comprehensive sexual education, lack of cultural sensitivity, and cultural racism. [ABSTRACT FROM AUTHOR]

Children with a significant cognitive and motor developmental delay (SDD) are vulnerable for the development of (future) behavioral and mental health problems. To support children within this target group, knowledge on their social-emotional development is necessary. Therefore, in this paper, an explorative assessment of the changes in the social-emotional functioning of children with SDD over a two-year period was done. Yearly semi-structured interviews with one or more primary caregiver(s) of 25 children were conducted and analyzed on 13 domains of social-emotional functioning, according to an adapted version of the Scale for Emotional Development - Revised (SED-R). This study showed a lot of variation in individual and group patterns of change across the two-year period. Charting the social-emotional development in this target group is challenging and requires further in-depth analysis of individual trajectories as well as more fine-grained and long-term data collection. [ABSTRACT FROM AUTHOR]

The increasing prevalence of non-communicable diseases and obesity is associated with excessive consumption of sugar. To address this concern the taxation of sugar-sweetened beverages (SSBs), known as the Health Promotion Levy (HPL), was implemented in South Africa in April 2018. A study was undertaken to investigate perspectives of dietitians and key industry role-players (KIRs) on the HPL. This was a cross-sectional, descriptive study. A national study was conducted in South Africa via a virtual platform. The participants were registered dietitians (n = 138) and key industry role-players (KIRs) (n = 39) who had expertise in nutrition, food science and/or sugar taxation legislation. Electronic surveys probed participants' awareness and opinions of the HPL, perceived SSB purchasing of consumers and barriers or facilitators for implementation of the HPL. Dietitians were positive regarding the HPL (75.8%; n = 94/124) but regarded the tax as too little to affect a reduction in obesity (71.8%, n = 89/124). They reported a 19.2% reduction in their perceived clients' daily purchasing of SSBs since implementation of the HPL. The KIRs regarded the HPL as insufficient to influence consumers' purchasing behaviour (64.9%, n = 24/37). Consumers' habitual purchasing was deemed a barrier (83.8%, n = 31/37) and consumer education an enabling factor (76,9%, n = 30/39) to successful implementation. Dietitians have a positive opinion on the HPL. They agree that the HPL alone will not influence the purchasing behaviour of consumers or reduce the prevalence of obesity. KIRs regard the HPL to be insufficient to affect consumers' purchasing behaviour. The HPL should form part of a multi-pronged approach to create a supportive environment to reduce sugar consumption. It is recommended that approaches should include fiscal measures, consumer education and controlled marketing of SSBs. Trained dietitians would be able to enhance the goal of the HPL to combat the obesity pandemic. [ABSTRACT FROM AUTHOR]

One of the core principles of providing care in general practice is giving more to those who need it most. We investigate some of the complexities of this ambition in the context of cancer care for patients defined as socially disadvantaged by their general practitioner (GP). We do this by exploring how care is sought, how it is offered, and what expectations patients and GPs carry with them when receiving and providing cancer care in the Danish welfare state. We carried out semi-structured interviews with eight GPs and seven socially disadvantaged cancer patients living with different types and stages of cancer. The interviews focused on needs and challenges in cancer follow-up in general practice and were thematically coded. Drawing on theoretical concepts of morality and Nordic individualism, we point to how one of the main challenges in cancer care and follow-up is to figure out how the doctor-patient relationship should be established, practiced, and maintained. Both GPs and patients stressed the importance of the relationship, but how it should be practiced amidst social norms about being a patient, a citizen and how care-seeking should unfold seems less clear. In conclusion we argue that giving more to those who need it the most is a difficult and ill-defined task that is shaped by the cultural, social, and political expectations of both GPs and patients. [ABSTRACT FROM AUTHOR]

Demographic changes, the evolvement of modern medicine and new treatments for severe diseases, increase the need for palliative care services. Palliative care includes all patients with life-limiting conditions, irrespective of diagnosis. In Norway, palliative care rests on a decentralised model where patient care can be delivered close to the patient's home, and the Norwegian guideline for palliative care describes a model of care resting on extensive collaboration. Previous research suggests that this guideline is not well implemented among general practitioners (GPs). In this study, we aim to investigate barriers to GPs' participation in palliative care and implementation of the guideline. We interviewed 25 GPs in four focus groups guided by a semi-structured interview guide. The interviews were recorded and transcribed verbatim. Data were analysed qualitatively with reflexive thematic analysis. We identified four main themes as barriers to GPs' participation in palliative care and to implementation of the guideline: (1) different established local cultures and practices of palliative care, (2) discontinuity of the GP–patient relationship, (3) unclear clinical handover and information gaps and (4) a mismatch between the guideline and everyday general practice. Significant structural and individual barriers to GPs' participation in palliative care exist, which hamper the implementation of the guideline. GPs should be involved as stakeholders when guidelines involving them are created. Introduction of new professionals in primary care needs to be actively managed to avoid inappropriate collaborative practices. Continuity of the GP–patient relationship must be maintained throughout severe illness and at end-of-life. According to the Norwegian guideline for palliative care, the GP should have a central position in providing primary palliative care. Recent research and public reports suggest that not all GPs have such a central role or adhere to the guidelines. This study highlights individual and structural barriers that could be addressed to increase GPs' participation in palliative care and aid the implementation of the guidelines for palliative care. [ABSTRACT FROM AUTHOR]

Children with a significant cognitive and motor developmental delay (SDD) are vulnerable for the development of (future) behavioral and mental health problems. This paper aims to assess the social-emotional functioning of these children, both globally and in various domains. Semi-structured interviews with one or more primary caregiver(s) of 45 children were conducted and analyzed on 13 domains of social-emotional functioning, according to the Scale for Emotional Development - Revised (SED-R). The SED-R scoring system was slightly adapted in the current study in order to elucidate more subtle differences between children. A general delayed social-emotional development was found, with children functioning within different phases across domains and certain domains generally showing higher or lower scores. To capture the emotional needs of children with SDD, a more disaggregated scoring system seems valuable so that both the global level and the level per domain can be taken in consideration in designing interventions. [ABSTRACT FROM AUTHOR]

Adolescents experience significant barriers, including stigma and discrimination, to accessing voluntary family planning and reproductive health (FP/RH) services in Rwanda. Self-care interventions have been shown to reduce social barriers to FP/RH care, but little is known about the effectiveness of digital self-care for adolescents, particularly in low-resource settings. This paper presents findings from a pilot study of CyberRwanda, a digital self-care intervention providing comprehensive sexuality education and confidential online ordering of contraceptives for school-aged youth in Rwanda through a rights-based approach. A mixed-methods pilot study was conducted from November 2019 to February 2020 to assess feasibility, acceptability, and engagement and to inform a future impact evaluation. Surveys were administered to a random sample of 158 students aged 12–19 years in three secondary schools. In-depth interviews were conducted with students, parents, teachers, pharmacists, district-level administrators, and youth centre staff. Descriptive statistics were calculated and qualitative data were analyzed using a thematic coding approach. One hundred and fifty-eight surveys and 28 interviews were conducted. Results revealed high demand for CyberRwanda in schools. Students were interested in engaging with the program and found the FP/RH content relevant to their needs. However, few purchased contraceptive products through the online ordering system. There are preliminary indications that CyberRwanda may improve access to FP/RH information. An extended implementation period and further research are needed to measure the long-term impacts of the program and evaluate whether this digital self-care intervention can increase uptake of contraceptive methods and reduce adolescent pregnancy among school-aged youth. [ABSTRACT FROM AUTHOR]

The introduction of progesterone vaginal ring (PVR) in sub-Saharan Africa calls for insights on the product's role in promoting women's autonomy regarding their reproductive decision-making and behaviour. Such insights could inform the positioning of the method within family planning programmes in the region. In this paper, we explore husbands' experiences with PVR as perceived by their wives and as reported by husbands of a subset of women users in Kenya, Nigeria, and Senegal. We discuss how such experiences might influence women's rights and autonomy regarding their reproductive decisions and contraceptive behaviour. We use a mixed-methods approach drawing on data from quantitative interviews with 174 women and qualitative in-depth interviews with 10 husbands of a subset of the women in the three countries. The findings show that husbands appreciated PVR's attributes relating to user-control (women could insert and remove the method themselves), ease of use, and non-interference with sex and flow of breast milk. Wives' perceptions of their husbands' experiences regarding PVR's non-interference with sex were consistent with the husbands' own reports. In addition, health care providers played important roles in supporting sustainable use of the method through giving information, counselling, and assisting women who experienced ring slippage to manage those challenges. The findings suggest that self-managed health technologies such as PVR could expand women's choices and control over their reproductive decisions. The findings further suggest that sustainable use of such products could require linkages with appropriate health systems structures to address challenges with use if and when they arise. [ABSTRACT FROM AUTHOR]

Internally displaced women are underserved by health schemes and policies, even as they may face greater risk of violence and unplanned pregnancies, among other burdens. There are an estimated 450,000 internally displaced persons in India, but they are not formally recognised as a group. Displacement has been a common feature in India's northeast region. This paper examines reproductive and maternal health (RMH) care-seeking among Bru displaced women in India. The study employed qualitative methodology: four focus group discussions (FGDs) were held with 49 displaced Bru women aged 18–45 between June and July 2018; three follow-up interviews with FGD participants and five in-depth interviews with community health workers (Accredited Social Health Activists – ASHAs) in camps for Bru displaced people in the Indian state of Tripura. All interviewees gave written or verbal informed consent; discussions were conducted in the local dialect, recorded, and transcribed. Data were indexed deductively from a dataset coded using grounded approaches. Most women were unaware of many of the RMH services provided by health facilities; very few accessed such care. ASHAs had helped increase institutional deliveries over the years. Women were aware of temporary contraceptive methods as well as medical abortion, but lacked awareness of the full range of contraceptive options. Challenges in accessing RMH services included distance of facilities from camps, and multiple costs (for transport, medicines, and informal payments to facility staff). The study highlighted a need for comprehensive intervention to improve RMH knowledge, attitudes, and practices among displaced women and to reduce access barriers. [ABSTRACT FROM AUTHOR]

Indigenous research methods centralises the importance of Indigenous ways of researching, validating and interpreting knowledge. In Māori kin-community (kāinga) contexts this methodology is called whakapapa. It is an ethical approach to research. Through three kāinga case studies, our article explores whakapapa methodology as an expression of Kaupapa Māori research. We explore the importance of co-productive relationships or whanaungatanga; co-design and co-development, or kotahitanga; ethics procedures or tikanga; accountability to community or utu; and kin narratives or kōrero as a genealogically-ordered methodology of engaging kāinga and hearing their stories or views, compared to formal interviews. In relation to the research teams and kāinga, we also discuss two intersecting values, which we call the mana/manaakitanga dynamic. It is a widely accepted dualism in Māori society. Mana concerns ancestrally-framed authority based on descent, providing specialist views and perspectives, while manaakitanga concerns service through kinship, not least respect and consideration of others' interests. Given their centrality to shaping genealogically-prescribed behaviours, we show how they apply in research contexts amongst researchers, who are not just 'included', but who also become engaged participants in overall kāinga-led and kāinga-owned outcomes. We conclude by discussing how whakapapa methodology can help shape institutional ethics and help address grand challenges. [ABSTRACT FROM AUTHOR]

To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses. Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data. Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality. The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience. The Norwegian Infection Control Act gave comprehensive responsibility and authority for local COVID-19 pandemic management to the municipalities and the Municipality Chief Medical Officers (MCMOs). The MCMOs highlighted several challenges and shortcomings of the municipal crisis preparedness, of which lack of detailed organizational plans was the most prominent. Teamwork, digital networking and collective sensemaking seemed to enhance pandemic collaboration and resilience within and across municipalities. Most MCMOs gained a leading role at a higher organizational level within the municipality through the COVID-19 pandemic. To strengthen future crisis management, arrangements must be made, both organizationally and financially, for preparedness to remain on the agenda even between epidemics and pandemics. [ABSTRACT FROM AUTHOR]

To explore Norwegian GPs' experiences with and perceived suitability of issuing sickness certifications in remote consultations during the COVID-19 pandemic. We used a mixed methods research design. An online survey with 301 respondents was combined with qualitative interviews with ten GPs. Norwegian general practice. Most GPs agreed it was difficult to assess a patient's ability to work without physical attendance for a first-time certification in remote consultations. However, extending a certification was considered less problematic. If physical examinations were required, the GPs would ask the patient to come to the office. The most suitable diagnoses for remote certification were respiratory infections and COVID-19-related diagnoses, as well as known chronic and long-term diseases. The GPs emphasized the importance of knowing both the patient and the medical problem. The GP-patient relationship could be affected by remote consultations, and there were mixed views on the impact. Many GPs found it easier to deny a request for a sickness certification in remote consultations. The GPs expressed concern about the societal costs and an increased number of certifications if remote consultations were too easily accessible. The study was conducted during the COVID-19 pandemic, and the findings should be interpreted in that context. Our study shows that issuing sickness certifications in remote consultations were viewed to be suitable for COVID-19 related problems, for patients the GP has met before, for the follow-up of known medical problems, and the extension of sickness certifications. Not meeting the patient face-to-face may affect the GP-patient relationship as well as make the GPs' dual role more challenging. The GPs perceived issuing sickness certifications in remote consultations as suitable when patient and health problem are known, and when the certification is an extension. Issuing sickness certifications in remote consultations can both harm and strengthen the GP-patient relationship. The GPs were aware of their social responsibility and were concerned that issuing sickness certificates in remote consultations can change their sick-listing practice. [ABSTRACT FROM AUTHOR]

Objective: Subjective experience of people living with bipolar disorder is gaining attention in the field of research. Improving well-being could be as important as symptom remission, but this constitutes a vague concept. This study aimed at exploring the boundaries and the determinants of the well-being of people living with bipolar disorder in a French context. Methods: Individual semi-structured interviews were conducted with 16 patients by three professionals. Interviews were transcribed and analysed using the thematic analysis method. Results: Various dimensions emerged as contributing to well-being: daily routines, connectedness, regaining a positive identity, and self-awareness for self-management. Conclusions: In addition to those common to the general population, this study highlighted specific determinants of well-being: the construction of a positive identity through acceptance of the diagnosis, the importance of self-awareness and self-management. They are highly intertwined with those of personal recovery and could help caregivers design interventions that directly target these goals. This study aimed to identify specific components of well-being for people living with bipolar disorder. Understanding the determinants of wellbeing enable caregivers to design tailored interventions that directly target quality of life and help improve bipolar disorder outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Healthcare staff are on the frontline during disasters despite any personal adversity and vicarious trauma they may be experiencing. Wellness Warrior training is a post-disaster intervention developed in response to the 2019-2020 Australian bushfires to support staff in a rural hospital located on the South Coast of New South Wales, Australia. Method: This study explored the experiences and perspectives of 18 healthcare staff who were trained to provide emotional and peer support to their colleagues in the aftermath of a crisis. All the Wellness Warriors participated in semi-structured interviews between March and April 2020. Data were analysed using the reflexive thematic approach. Results: Healthcare staff reported developing interpersonal skills around deep listening and connecting with others which allowed for hearing the core of their colleagues' concerns. The training also helped staff to feel differently about work and restored their faith in healthcare leadership. Conclusion: Wellness Warrior training provided staff with knowledge and skills to support their colleagues in the aftermath of a natural disaster and later during the COVID-19 pandemic. As such, these findings suggest that peer support programs such as Wellness Warriors could be one way healthcare organisations can attempt to alleviate the psychological impact of natural disasters. [ABSTRACT FROM AUTHOR]

Background: Transition from paediatric to adult care is challenging for youths with a chronic condition. Most transition programmes place high value in autonomy and independence. We undertook a qualitative study to: (1) identify the needs and aspirations of youths and (2) better understand the well-being and flourishing of youths. Methods: Semi-structured interviews were conducted with youths, parents of youths and healthcare professionals recruited from four clinics. Thematic analysis focused on: (1) perceptions of transition; (2) key aspects of human flourishing during transition; and (3) salient concerns with respect to the transition and dimensions of human flourishing. Results: 54 interviews were conducted. Perceptions of transition clustered around: (1) apprehension about adult care; (2) lack of clarity about the transition process; (3) emotional attachment to paediatric healthcare professionals; (4) the significance of the coinciding transition into adulthood. Fourteen salient concerns (e.g., Knowledge and information about the transition, Parental involvement in healthcare) were identified with corresponding recommendations. Salient concerns related to important dimensions of human flourishing (e.g., environmental mastery, autonomy). Discussion and conclusion: The flourishing of youths is affected by suboptimal transition practices. We discuss the implications of our findings for environmental mastery, contextual autonomy, and the holistic and humanistic aspects of transition. [ABSTRACT FROM AUTHOR]

Elite athletes are continually subjected to a range of constraints specific to high performance, and these can have a negative impact on their health. Although many studies have explored the individual factors related to risky behaviours and disorders in elite sport contexts, few have focused on health promotion. Consequently, the interpersonal, institutional, and policy factors of the healthrelated behaviours of elite athletes are still poorly explored. Based on the socioecological model, this study aimed to identify the factors involved in the health-related lifestyle of elite athletes. Semistructured interviews were conducted with 45 participants: athletes (N = 32), their coaches (N = 6) and the managers of elite sport centres (N = 7). Both deductive and inductive thematic analyses were performed. Our results highlight the views of the actors. Regarding intrapersonal factors, resilience qualities and health literacy appeared as key factors in influencing the health-related lifestyle of elite athletes. At the interpersonal level, parents and coaches emerged as the main sources of educational support. Regarding institutional factors, the health policies of the elite sport centres were key factors in supporting the athletes' healthy lifestyle. These results encourage the development of health promotion programs at different levels of intervention. [ABSTRACT FROM AUTHOR]

Purpose: Despite suboptimal HIV outcomes among female sex workers (FSW), limited research has been conducted on factors that impact viral suppression among this population. Examining narratives of HIV management, we examined how experiences of diagnosis, treatment initiation, and ongoing care behaviours shaped viral suppression outcomes over time. Methods: We conducted 20 in-depth interviews with FSW in Santo Domingo, Dominican Republic. Using narrative and thematic qualitative approaches, we developed analytic summaries and matrices to compare trajectories of managing HIV between suppressed and unsuppressed participants. Results: Regardless of suppression status, participants described similar narratives of overcoming initial challenges to HIV management through personal resilience and social support. Unsuppressed participants identified more delays in initiating antiretroviral therapy and more lapses in adherence due to less active acceptance of their HIV status and more persistent experiences of economic hardship and HIV stigma. Conclusions: We found that individual, interpersonal and structural factors, including stigma and economic precarity, differentiated trajectories towards viral suppression among FSW indicating the importance of multilevel interventions. Improved access to mental health services and social support could promote greater early acceptance of HIV status and progress towards viral suppression among FSW. [ABSTRACT FROM AUTHOR]