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In response to the global call to upscale mental health services in low--income countries, mental health non-governmental organisations (MHNGOs) have sprung up in Kerala to address mental health needs by partnering with pre-existing locally grown, bottom-up, community-led pain and palliative clinics (PPCs) to increase access to mental health care through task-shifting. The MHNGOs mandate filtering only patients with 'severe mental disorders' from low socioeconomic backgrounds for their free services. This eligibility criterion mandated by the MHNGO is ruffling feathers within the palliative clinics that oppose such -classifications. They believe that suffering cuts across all divisions and should not be discriminated against based on economic background and severity of illnesses. When chronicity and suffering are held universal by the MHNGO and palliative care, respectively, it brings to the fore the enactment of two perspectives of care. Drawing on observations of clinical interactions between patients, MHNGO staff and mental health professionals and interviews with community volunteers of palliative care clinics in Kerala, this paper demonstrates how chronicity narrative promoted by MHNGOs based on biopsychiatric model gains hegemony, whereas the community care model loses traction progressively. The state, caught between these two narratives, frontstages development by submitting its health machinery to the MHNGOs flouting basic medical safety laws in its services to marginalised people like the tribal population. This paper argues that the rising dominance of chronicity narrative in community mental health clinics as well as in popular media discourses evolves out of power relations between the MHNGOs and the palliative clinics. [ABSTRACT FROM AUTHOR]

Community engagement is gaining prominence in global health research. But communities rarely have a say in the agendas or conduct of the very health research projects that aim to help them. This paper provides new evidence on how to share power in priority-setting in ways that seek to overcome structural constraints created by the funding environment. The five strategies were identified through case study research on the Participation for Local Action project in Karnataka, India. That project was carried out by researchers in partnership with the Zilla Budakattu Girijana Abhivrudhhi Sangha, an indigenous community development organisation representing the Solega people. The paper describes each identified strategy for sharing power in priority-setting, followed by a report of the pitfalls and challenges that arose when implementing it. Thus, the study also demonstrates that even where actions and strategies are used to address power imbalances, pitfalls will arise that need to be navigated. Given those challenges, considerations to reflect upon before employing the identified strategies are suggested. Ultimately, the paper aims to communicate strategies for sharing power during and after priority-setting and lessons on how to implement them effectively that can be used by global health researchers in the current funding environment. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to understand the maternal health vulnerabilities of migrant women in slums and explore their challenges during and after childbirth. Design/methodology/approach: The study used a qualitative approach, including in-depth interviews through purposive and snowball sampling techniques. Thematic analysis was used for analysing data. The consolidated criteria for reporting qualitative studies (COREQ)-32 items were followed for reporting this study. Findings: The study found that migrant women were highly susceptible to adverse birthing outcomes due to risks involved in birthing, lack of care and hygiene, lack of skilled care in dealing with complicated pregnancies and exposure to domestic and obstetric violence. Originality/value: The study intends to highlight the narratives of female migrants' birthing and maternal health challenges. The entire process of childbirth in slums with consequences can result in maternal and infant morbidities and mortalities. [ABSTRACT FROM AUTHOR]

Purpose: Migrants face some unique health-care challenges, which often remain unaddressed by the health system. The purpose of this study is to determine health-care access among migrants in Chhattisgarh, from a lens of health equity. Design/methodology/approach: This study was conducted in a government-built tenement under the Integrated Housing and Slum Development program in Bilaspur district of Chhattisgarh state of India. It is a mixed-methods study which used a survey method, focus group discussion, in depth-interviews, semi-structured interviews and non-participant observations of health facilities in the area. Respondents included residents (migrants) and other local stakeholders like the Chief Medical Officer of the district, elected representatives of the local government and frontline health workers. This paper focuses on the findings from the qualitative component of the study. Findings: The move to resettle the people living in the slums to the periphery of the city had a negative impact on their health-care access. They find it difficult to access public health services, given the services are concentrated in the city. Women, elderly people and disabled people grapple with additional challenges in being able to access basic reproductive health services and care for chronic illnesses. Equity in health-care access is linked to various social determinants of health including access to housing and social security. However, the authors found that the migrant community is being deprived of appropriate housing facilities and social security. Originality/value: This paper explores the health-care access of internal migrants in Chhattisgarh state of India in the larger context of urban development with a focus on health equity. [ABSTRACT FROM AUTHOR]

Covid-induced lockdowns have increased the importance of technology in education. Though access to technology as well as availability of the internet remain a major concern for a lot of children in the global south, children with intellectual disabilities are disadvantaged even more as most of the e-content is developed keeping in mind the average learner. Unstructured interviews were conducted with children with intellectual disabilities studying in government schools in Haryana as well as their teachers and parents. Thematic analysis of the interviews was conducted to understand the use-patterns of mobile phones by children with intellectual disabilities. Findings suggest that these children are learning to use mobile phones on their own or with some support and are able to navigate the complexities of these smartphones quite well. They use these devices mostly for their entertainment. This paper then reflects on the need and strategies to develop these technologies in ways that they can be used as effective tools for teaching children with intellectual disabilities, especially in the inclusive education system in developing countries. The paper reflects on the need to develop technology and tools using flexible and exploratory designs to enhance the learning processes for children with intellectual disabilities from the lower income strata. This study highlights the importance of being able to use mobile phones by children with intellectual disabilities belonging to low income families. Following this, the article argues for designing of mobile phones suitable for use by children with intellectual disabilities using playfulness and explorations, and Building e-content keeping the elements of playfulness and exploration which can enhance the learnings of this group of students which is often ignored. [ABSTRACT FROM AUTHOR]

Background: Given India's high patient load on the existing healthcare setup, as well as political, social, and organizational challenges, the nursing sector is facing various problems, therefore leading to substandard nursing experiences leading to poor patient care at the parallel healthcare setups, specifically homecare. This paper presents self-managed organizations (SMOs) characterized by a horizontal management structure as an effective alternative to existing hierarchical management structures overladen with bureaucracy. Therefore, we are exploring the strategies at self-managed homecare organizations that can make nursing a better and more productive experience. Method: This study utilized Constructivist Grounded Theory (CGT), employing semi-structured interviews to explore nursing dynamics in horizontal organizational structures. It delved into crucial aspects like finances, organizational structure, value systems, information flow, and conflict resolution within SMOs. The methodology involved theoretical sampling, prioritizing expert self-management knowledge over mere representativeness. Seven nurses, twelve management members, and fifteen patients from self-managed homecare organizations contributed to the examination of nursing experiences. Constant comparative analysis of data led to the identification of the Qualitative Success Enablers (QSEs), revealing three themes: Insightfulness, Enhancing Nursing Experience through Job Enrichment, and Autonomy-Enabled Intrapreneurship. Results: The findings indicate that the horizontal management structure represented by the studied organization in India has shown considerable success in times laden with uncertainties during the COVID-19 pandemic, especially during the delta wave, which revealed the frailty of existing healthcare infrastructure. The organization successfully maintained a better nursing experience and gained patient and employee satisfaction, as revealed by in-depth semi-structured interviews and constant comparative analysis. Conclusion: In a world of unique challenges, we stand on the brink of significant transformations. SMOs are vital in India's homecare sector for enhancing nursing experiences and overall organizational performance. Fostering a trust-based environment within SMOs is integral to delivering effective services. The autonomy to design nursing jobs, insightfulness, and innovativeness in the nursing job through suitable training activities, various job enrichment methods, and finding meaningfulness in a job through softer aspects of caregiving result in an enhanced nursing experience at SMOs. This groundbreaking approach can be extended to other homecare organizations in India, relieving the strain on the existing healthcare system. [ABSTRACT FROM AUTHOR]

Background: Quality of childcare can predict a child's emotional and behavioural adjustment throughout the life span. Furthermore, this has major implications for child development and mental health in the long-term. Parents often face major challenges while providing childcare especially during the early years of a child. Aim: This paper describes specific parental concerns in raising a toddler from a mental health developmental perspective. Methods: The study was conducted in urban Bengaluru, India under an exploratory research design using semi-structured interviews. Ten parents participated in the study. Data was analysed using thematic analysis. Results: Four major themes emerged. The first theme was related to the formation of parental beliefs about parenting which identified several sources such as parenting practices witnessed during childhood, childhood experiences and influence of culture, mass or social media. The second theme to emerge was on concerns related to toddlers which parents had difficulties in understanding as well as managing, specially navigating through sleep and feed pattern, identifying developmental needs and making a meaning of toddlers' communication styles and content. The third theme showed parental concerns which consisted of areas such as parental stress, physical exhaustion, lack of time for each other or toddler, lack of information about handling toddlers and absence of validation of parental efforts. The final theme was on their current parenting practices with their toddlers which showcased controlling styles, play time but low on quality, inappropriate responses to toddlers' emotions or behaviours and several culturally practiced measures which were not validated scientifically. Conclusion: The pre-existing belief among parents about parenting and toddlers' specific behaviours influence parenting practices. The understanding of the parental challenges is beneficial in developing an appropriate parenting programme focussing on strengthening psychological capacities of toddlers. [ABSTRACT FROM AUTHOR]

In this paper, we contend that urban middle-class older Indians engaged in "serious leisure" as a way to reimagine and reconfigure the structure of everyday life during the pandemic-led epochal downtime. In particular, we heuristically show that leisure activity patterns and constraint negotiation strategies among older Indians followed conceptual semblances with the dominant leisure-based typology of Serious Leisure Perspective. By thematically analysing household surveys (n = 71), time-use diaries and in-depth interviews (n = 15) of middle to upper middle-class individuals (55–80 years), we show how both men and women distinguished between serious leisure that is marked by motivation, agency and perseverance with that of unstructured, routinized free-time (or causal leisure). Time-use diaries suggested that despite the changed realities of heightened domestic time available to both genders due to the pandemic, women recorded higher proportion of their daily hours in household management and caregiving. Although women were governed by moral-cultural self-descriptions in their engagement with leisure, it was often associated with an enhanced sense of self-actualisation, self-management and identity. Overall, we show how the social codes of age and gender were inextricably linked with the practice of leisure during the pandemic. [ABSTRACT FROM AUTHOR]

Background: "CoviSainik Program" was implemented in collaboration with the Ambuja Cement Foundation and Community Medicine Department in rural districts of eight states of India from May to December 2021 to create a cadre of volunteers. The aim of the present paper is to describe the program and evaluate it so that the findings can be the guiding tool for policymakers to replicate a similar program. Material and Method: A cross-sectional, mixed-method – concurrent study design was adopted to evaluate the program for its short-term outcomes such as gain in the basic knowledge of COVID-19 amongst master trainers and their feedback and program output viz – the proportion of volunteers trained and their profile by census sampling. Motivational factors, experiences of volunteers, and outcomes of COVID-19 work in their villages were explored by purposive with maximum diversity sampling with 62 online in-depth interviews and 8 online focus group discussions (FGDs). Results: There was a statistically significant difference in the pre-test (12.8 ± 5.6) and post-test (25.9 ± 9.3) scores of the Master Training Program evaluation test. Out of 6534 trained volunteers, 5901 worked as volunteers, and amongst those, 47.1%, 35.1%, and 17.8% worked for ≤3 months, 3 to 6 months, and ≥6 months, respectively, in their villages. The major themes generated for motivational factors to join the program were altruism, savior nature, generating awareness, and concern for others. The major outcomes generated by trained volunteers COVID-19 vaccination were in raising awareness on COVID-19 appropriate behavior and early identification of COVID-19 cases in their villages. Conclusion: The "CoviSainik Program" was successful in creating cadres of trained volunteers. [ABSTRACT FROM AUTHOR]

Since the onset of COVID-19, the provision of psychotherapy services has shifted online. Thus, telepsychotherapy has been the focus of much research to document therapists' experiences; however, it has been mainly quantitative. In the Indian context, no known empirical research has focused on the implications of this transition on psychotherapists. Therefore, the present paper presents an in-depth idiographic study exploring psychotherapists' experiences in India, who had to transition to telepsychotherapy rapidly. Ten novice psychotherapists providing clinical services virtually were individually interviewed. The transcripts were analysed using interpretative phenomenological analysis. The main themes that emerged from the analysis were: negative impact on therapeutic process, detrimental effect on personal and professional self, positive impact of telepsychotherapy for therapist and, strategies for helping the adjustment to telepsychotherapy practice. The idiographic and psychological focus enabled a detailed exploration of the profound impact the sudden transition had on novice psychotherapists' work with clients and their self-efficacy. Despite contextual constraints faced by the psychotherapy profession in India, the participants demonstrated creative ways of working around the challenges encountered during telepsychotherapy. Nonetheless, their experiences highlight the need to initiate training programs in telepsychotherapy. [ABSTRACT FROM AUTHOR]

The feminisation of ageing observed across the world is a significant challenge in many societies. Women's greater longevity is associated with the increased likelihood of age-related disability and morbidity. Furthermore, gendered disadvantage and poverty can make access to health care increasingly problematic in later years. Among the Indian states, Kerala has the highest number of residents above the age of 60 and many are older widows. Given this context, this paper explores what promotes access to health care for older widows living alone in the south Indian state of Kerala. Thirty-two in-depth interviews, eight focus group discussions and eight units of participant observation were carried out among widows, health-care providers and key informants. Applying a reflexive inductive approach to our analysis, the main barriers to access that emerged were altered family structures and loneliness, whilst enablers included good social networks and access to neighbourhood clinics. Our participants' social networks were drawn from three levels: family, neighbourhood and the wider community. The ability to form a personal community from their social networks and the quality of relationships within this community strongly predicted the capacity to access health care. Efforts to improve access to health care for older widows requires a response that is rooted in the socio-cultural context of the community. Comprehensive social protection policies that promote initiatives to engender social capital among the older population, decentralised primary health-care services, and the training and sensitisation of health service staff would be key to promote equitable access for older widows. [ABSTRACT FROM AUTHOR]

This paper critically reviews and reflects on the processes for providing Assistive Technology (AT) services to Persons with Disabilities (PWD) in Bangladesh, India and Nepal. The aim is to investigate the AT service delivery systems in these countries and suggest improvements where weaknesses are identified. We carried out a descriptive qualitative exploratory study in Bangladesh, India and Nepal by conducting key informant interviews with policymakers (5), AT service providers (22) and mobility and hearing related AT service users (21). We used a directed content analysis approach guided by a seven-point AT service delivery process model to thematically analyse the existing processes for AT service delivery, from first contact through to follow-up and maintenance. AT service delivery processes are sub-optimal in all three countries, and improvements are needed. No common AT service delivery process was found, although there are common features. In general, it is easier for PWDs in India and Nepal to access AT than for those in Bangladesh, but all three countries are failing to live up to their commitments to uphold the human rights of PWDs. Although good elements of AT service delivery processes can be identified, the systems in all three countries are fragmented and generally weak. A more holistic approach of looking at the process of AT service delivery, from first contact right through to follow-up and device maintenance, with a single door service delivery system, free of cost at the point of service is recommended in these countries. Although we found significant weaknesses in AT delivery in all three countries, there are some good AT service delivery practices and opportunities for these countries to learn from one another. A systematic and stepwise approach to assessing current AT service delivery processes in the three countries – examining the delivery system as a whole, from initiation to repair and management – can help identify opportunities to improve the process for (prospective) AT users. A more coherent single door system of AT service delivery will increase the quality and efficiency of the fragmented AT service delivery practices in Bangladesh, India and Nepal. [ABSTRACT FROM AUTHOR]

A global goal for early childhood education and care is to ensure universal, "quality" provision that reaches all children. Achieving this goal requires a well-prepared workforce that is equipped to adapt to and deliver early childhood programs across the vastly diverse contexts and communities where children are growing up around the world. Yet currently there is a severe shortage of early childhood workers, particularly in "low resource" and complex communities. Evidence to support appropriate training for such workers is also lacking. In response, this paper presents findings from a case study of a large-scale training program for community-based early childhood workers in central-east India. A total of 650 community-based Village Communicators were trained to deliver a responsive caregiving package to parents of young children. Data collected over 3 months highlight how the unique contextually grounded, caring and reflexive approach to training resulted in profound personal and professional change among training participants. The findings are of significance in informing policy and practice associated with global goals for early childhood. First, they challenge the technical, programmatic approaches to training that are commonly adopted for preparing this workforce. Second, they evidence the potentially transformative, long-term impact of person-centered approaches to training that facilitate knowledge-sharing to understand local needs and attitudes. Third, they provide insight into ways in which training programs can support enhanced local relevance and effectiveness of early childhood services implemented for children and families across diverse contexts. Highlights: Caring, consultative approaches to training support transformative changes in knowledge and practice among community-based early childhood workers. Community-based workers comprise a crucial yet under-researched workforce globally. Active contribution to adapting early childhood interventions for greater local relevance empowers community-based workers as well as enhancing program content. Training for community-based workers in early childhood needs to shift away from overly programmatic, technical approaches. Meeting global goals for early childhood development requires localized responses. [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]

Dissociative/conversion disorders affect almost 31% of children and adolescents in a clinical setting. These children experience significant impairments in their academics, and daily functioning, with high chances of developing other psychiatric comorbidities such as anxiety and depression. However, there are no studies that explore the experiences of suffering from dissociative/conversion disorders from perspective of the sufferer. Therefore, the paper has aimed at exploring the subjective experiences of dissociative and conversion disorders among adolescents in the Indian context by examining their understanding about the illness and the reason they ascribe to the cause of their illness. The study used a qualitative semi-structured interview to understand their illness. In total, 10 adolescents of age group between 12 and 16 years participated. Eight out of the 10 participants were female and the mean age was 12 years. All of them were in-patients in the department of Child and Adolescent Psychiatry, NIMHANS, which is the tertiary mental health care Institute India and pioneer Institute of mental health in Asia. All participants have had at least one or more consultation history either with a traditional healer or/and physician. Thematic analysis identified vital themes such as (1) Adolescents' attributing factors of the illness, (2) Cognitive and emotional appraisal of stressful situation/s, (3) Adolescents' appraisal of different explanatory model, (4) Living with the Impact of the illness. This analysis about dissociative/conversion disorders from adolescents' perspective has a major contribution in enhancing the clinical knowledge and practice in planning and managing children/adolescents diagnosed with dissociative/conversion disorders. [ABSTRACT FROM AUTHOR]

Research and practice in the area of mental health has been conventionally predominated by the deficit-based approach, which attempts to improve lives by fixing symptoms. However, the growing impact of the positive psychology movement in the last two decades has resulted in incorporation of the strength-based approach into mental health work. The objective of this article is to (i) emphasize the efficacy of strength-based approach in the area of mental health (ii) identify shortcomings in the Indian Mental Health System (MHS) (iii) recognize micro-level initiatives in the MHS and (iv) provide recommendations for the future. These objectives are accomplished via reflections obtained from an ethnographic research with participants reporting mental health symptoms. Additionally, opinions gathered from mental health professionals, and government and non-government organizations working in the area were also considered. This work has shed light on the recent micro-level transformations in the system including contextualization of mental illness and treatment, valuing patient's input in the treatment process, and the creation and effective functioning of mental health task-forces. This paper concludes with a four-point recommendation that can help to incorporate the strength-based approach in MHSs for better outcomes. [ABSTRACT FROM AUTHOR]

India’s experience with the National Rural Health Mission (NRHM) is notable on account of nationally formalising – at scale – community action in service delivery,monitoring, and planning of health services. A study was undertaken to document and create a historical record of NRHM’s ‘communitization’ processes. The oral history method of the Witness Seminar was adopted and two virtual seminars with five and nine participants, respectively, were conducted, and supplemented with 4 in depth interviews. Analysis of transcripts was done using ATLAS.ti 22 with the broad themes of emergence, evolution, and evaluation and impact of ‘communitization’ under NRHM. This paper engages with the theme of ‘emergence’ and adopts the Multiple Streams Framework (MSF) conceptualised by John Kingdon for analysis. Key findings include the pioneering role of boundary spanning decision makers and the Jan Swasthya Abhiyan (JSA) in advocacy and design of ‘communitization’ structures, and the legacy of rights based social mobilizations and state-civil society partnerships in health during the 1990s influencing the ethos underlying ‘communitization’. Democracy, leadership from the civil society in policy design and implementation, and state-civil society partnerships are linked to the positive results witnessed as part of ‘communitization’ in NRHM. [ABSTRACT FROM AUTHOR]

The paper examines the multi-dimensional nature of Internet Addiction (IA) and its influence on Well-Being (WB) amongst a representative sample of 320 young urban Indian internet users. Nine hypotheses are proposed through a conceptual model to assess the multi-dimensional nature of IA and its relationship with WB. Partial Least Squares – Structure Equation Modelling (PLS-SEM) was conducted to assess the hypothesised relationships. Of the proposed nine hypotheses, seven were accepted. The result indicated IA as a four-dimensional construct – Internet Control Disorder (ICD), Internet Craving (IC), Internet Obsession (IO), and Addictive Behaviour (AB). The findings supported that ICD positively and significantly influences IC. IC and AB both have a significant impact on IO. ICD and IC have a significant impact on the individual's AB. ICD and IO significantly influence WB. With respect to the dimensions IC, AB, and IO, the model is successful in explaining around 26%, 45%, and 33% of the variation. IA as a multi-dimensional phenomenon and its relationship with WB in a young-demographic nation like India has immense academic and societal value. The study provides critical actionable insights for users, educators, health counsellors, parents, and policymakers regarding interventions for controlling internet addiction. [ABSTRACT FROM AUTHOR]

This paper explores how religious beliefs influence meaning-making and prosocial action among community responders. Fourteen non-professional rescue and relief volunteers were interviewed post the 2018-19 floods in Kerala, India. The study adopts Braun and Clarke's Thematic Analysis with a critical realist approach. Several participants viewed the disaster as an act of God but simultaneously engaged in scientific sense-making; religious meaning-making offers a means of coming to terms, while rational causal attributions promote mitigation measures. Suffering was seen as a test of faith. Many volunteers experienced the disaster as a reminder that re-oriented them to piety and iterated human vulnerability. Although the disaster evoked a lack of control, they found meaning in the service of others and viewed their actions with humility and gratitude. Service was often both intrinsically meaningful and religiously motivated. The findings underscore the role of religious meaning-making in promoting prosocial action and community resilience post disasters. [ABSTRACT FROM AUTHOR]

Therapy process research focuses on understanding how therapy is conducted by professionals in the field. It is a nascent field of psychotherapy enquiry in India. This paper explores how novice therapists in India perceive their clients, and how this influences the process of therapy. In depth interviews were conducted with ten novice therapists, with less than six years of practice experience, from Mumbai, India. The data was thematically analysed. The data revealed that therapists' perceptions of their clients were defined by socio‐demographic features of age and gender, along with presenting complaints and personal attributes. Participants had defined beliefs about good clients as contrasted with difficult ones. Distinct preferences for particular client types were identified. The antecedents to these beliefs were attributed to the therapist's worldview, their training and the supervision received. These views, and the conceptualisation of the client, influenced the choice of client, the process of therapy and how they proceeded with sessions, and their methods of referral. The data from the study has implications for therapist training, supervision and further research. [ABSTRACT FROM AUTHOR]

Care at Doorstep (CAD) is a home care service that includes medical and social care by skilled professionals. The purpose of this paper is to explore the need for CAD among users of the district mental health programme (DMHP) in Ramanagaram, Karnataka, India who have severe mental illness. The design of this study was descriptive where a qualitative inductive methodology was adopted. Data was collected from interviews of 20 caregivers and 7 mental health service providers linked to the DMHP. Socio demographic information was collected from participants and a semi-structured interview guides were used to explore needs and challenges in delivering care at home by the professionals. The themes that emerged from the manually transcribed and coded data were categorized as needs and challenges and used for developing a CAD model. [ABSTRACT FROM AUTHOR]

Introduction: The Transplantation of Human Organs Act (THOA) provided legal status to brain death as a form of death in 1994. However, even after three decades, the deceased organ donation rate in India stands at a mere 0.52 per million population, crucially due to a lack of brain death awareness, and an absence of institutionalized protocols for deceased donations. Objectives: By taking the case of the state of Haryana, this article seeks to understand the existing state of brain death awareness among professionals working in the medical community, and identify the implementation challenges that would be involved in instituting a state‑level policy for donations from deceased persons. Materials and Methods: This paper adopts a qualitative approach, utilizing in-depth interviews with doctors in the districts of Rohtak and Charkhi Dadri in Haryana, and transplant coordinators across the state to gather a nuanced understanding of the issue. Results: The research finds that brain death awareness is lacking among doctors, along with the necessary resources for brain death declarations to become practice. There is also an evident district-wise variation in the responses of doctors when it comes to the potential challenges of instituting a brain death declaration standard operating procedure. It offers recommendations for improved implementation of organ transplant policies and scaling up of deceased donations. Conclusion: To unearth the potential that deceased organ donation holds, some immediate measures that can be taken include mapping all the functional organ retrieval facilities across the state and their closest civil hospitals or postgraduate medical institutions with trauma centres, and focusing on the sensitization of the medical functionaries with respect to brain death and its identification. [ABSTRACT FROM AUTHOR]

Introduction: Poor medical information transfer across healthcare visits and providers poses a potential threat to patient safety. Patient‐held health records (PHRs) may be used to facilitate informational continuity, handover communication and patient self‐management. However, there are conflicting opinions on the effectiveness of PHRs, other than in maternal and child care. Moreover, the experiences of users of PHRs in low‐ and middle‐income countries are critical in policy decisions but have rarely been researched. Aim: This study aimed to explore similarities and differences in the perspectives of patients, carers and healthcare providers (HCPs) on the current PHRs for diabetes and hypertension in Kerala. Methods: A qualitative design was used comprising semistructured interviews with patients with diabetes/hypertension (n = 20), carers (n = 15) and HCPs (n = 17) in Kerala, India. Data were analysed using thematic analysis. Results: Themes generated regarding the experiences with PHRs from each user group were compared and contrasted. The themes that arose were organized under three headings: use of PHRs in everyday practice; the perceived value of PHR and where practice and value conflict. We found that in the use of PHRs in everyday practice, multiple PHRs posed challenges for patients carrying records and for HCPs locating relevant information. Most carers carried all patients' past PHRs, while patients made decisions on which PHR to take along based on the purpose of the healthcare visit. HCPs appreciated having PHRs but documented limited details in them. The perceived value of PHRs by each group for themselves was different. While HCPs placed value on PHRs for enabling better clinical decision‐making, preventing errors and patient safety, patients perceived them as transactional tools for diabetes and hypertension medications; carers highlighted their value during emergencies. Conclusion: Our findings suggest that users find a variety of values for PHRs. However, these perceived values are different for each user group, suggesting minimal functioning of PHRs for informational continuity, handover communication and self‐management. Patient and Public Involvement: Patients and carers were involved during the pilot testing of topic guides, consent and study information sheets. Patients and carers gave their feedback on the materials to ensure clarity and appropriateness within the context. [ABSTRACT FROM AUTHOR]

India and the global community are facing a critical crisis of antimicrobial resistance (AMR), significantly contributed to by on-going and increasing antimicrobial misuse. Information as to what drives misuse of antimicrobials within India is essential to inform strategies to address the crisis. This papers aims to identify perceived influences on antimicrobial use in Hyderabad, India. We conducted semi-structured qualitative interviews conducted with thirty participants (15 doctors, 15 pharmacists) around their experiences of antimicrobials in Hyderabad, India. Thematic analysis was performed and four themes identified around (1) Perceptions of the problem of resistance and antimicrobial use; (2) Social pressures to prescribe/dispense; (3) Financial pressures driving antimicrobial over-use; and (4) Lack of regulation around training and qualifications. We conclude that antimicrobial use within India is embedded with, and occurs as a result of, complex social and economic factors including issues of resource limitation, structural/governance limitations and social relationships. Strategies to address misuse without acknowledging and addressing the critical driving forces of use will be unlikely to induce significant change. [ABSTRACT FROM AUTHOR]

Purpose: The current literature on attention-deficit/hyperactivity disorder (ADHD) shows a tangled picture of its etiology and diagnosis. It directs at over-medicalization in ADHD cases due to the pharmaceutical-based models surrounding its treatment. Further, the authors observed the negligible reporting of India's ADHD scenario in the reviewed literature. Thus, this study aims to explore the status of ADHD in India's urban setting through a pilot study. Design/methodology/approach: Social constructivist viewpoint guided this study. The authors conducted the pilot in two phases: face-to-face semi-structured qualitative interviews with 11 mental health professionals in the first phase, and, in the second phase, five mental health professionals responded to an online survey with same questions. After qualitative analysis, four major themes were identified: participants' opinions on ADHD etiology, issues in diagnosis, social context of ADHD and alternatives to medication. Findings: The findings highlight the need to re-visit the ADHD narrative in the Indian context. These findings also emphasize future investigation on the medicalization of ADHD in India. Research limitations/implications: A countrywide epidemiological survey is required to explore the distribution of the disorder to standardize diagnosis and treatment procedures pan-India. This paper is an attempt to iron out the ADHD-related information that needs further exploration and research. Originality/value: With in-depth interviews of mental health professionals, the study explores the state of ADHD in an urban setting in India. Future research must build on the current findings to establish the etiological and diagnostic framework of ADHD. [ABSTRACT FROM AUTHOR]

Acid attack refers to the act of hurling acid or any other corrosive substance on a person with the intention of injuring, harming, maiming, disfiguring or killing. Despite the fact that the number of acid attack cases in India have been rising, a separate section for acid attacks was not included in the Indian Penal Code until the year 2013. Even after the inclusion of this crime in the Indian Penal Code, the discourse about the crime and the condition of victims in the aftermath of the crime remains largely incomplete due to the selective focus on the medical treatment of the victims and punishment for the offenders. Therefore, the present paper attempts to explore social isolation as a consequence of the crime and the role of social support in the psychological rehabilitation of acid attack victims. The present research involved narrative interviews of a homogenous purposive sample of 30 female acid attack victims which were analysed using thematic content analysis. The findings suggest that victims of acid attack experience non‐social support in the form of social isolation social exclusion as a consequence of acid attack in addition to the lack of informational and instrumental social support. Results also suggest that social support plays a crucial role in the coping process of the acid attack victims. The insights of the present research will help in improving the understanding of the psychosocial correlates of acid attack victims and the recovery process of the acid attack victims. [ABSTRACT FROM AUTHOR]

Purpose: A number of initiatives have been developed to ensure easy access to mental health services for Black and Asian Minority Ethnic (BAME) communities. Improving Access to Psychological Therapies (IAPT) is a service that delivers first line interventions for South Asian women; however, little is known about what makes IAPT accessible for this population. This paper aims to explore South Asian women's experiences of accessing psychological therapy and whether therapy within IAPT helps individuals to re-frame their experiences within their own cultural context. Design/methodology/approach: A qualitative approach was used. Semi-structured interviews were carried out with South Asian women who accessed an IAPT service. Ten participants took part in the study and interviews were analysed using thematic analysis. Findings: Six themes were identified; access, experience, cultural framework, therapist characteristics, expectations and "sticking with it". Having a good therapeutic relationship with the therapist was key. While cognitive behavioural therapy (CBT) enabled clients to manage their symptoms, manualised CBT led to a sense of dissatisfaction for some. Clients spoke of having to make a forced choice to either deny their culture or leave their culture at the door to access therapy. Cultural and religious exclusion had a negative impact on therapy particularly for those whose difficulties were related to their cultural or religious context. Practical implications: Culture and religion continues to be excluded from psychological therapy for South Asian Women. A cultural shift is required from within IAPT services to maintain engagement for this group. Further clinical implications are discussed. Originality/value: While the experiences of Black and Asian ethnic minority groups accessing secondary mental health services has been explored, this study explores and highlights the experiences of South Asian Women accessing therapy in primary care, and uniquely identifies the processes that enable women to engage in therapy. [ABSTRACT FROM AUTHOR]

Purpose: This paper discusses the need for government and healthcare organization to implement mobile phone-based solutions for healthcare during the Coronavirus (Covid-19) pandemic. It also highlights the challenges and/or barriers to the rapid introduction, implementation and management of these and other innovative solutions to health service delivery during the current situation Design/methodology/approach: The data include both qualitative and quantitative, collected from the primary interview-based case study and questionnaire survey. It also uses insights from the general populations, healthcare professionals and health information technology developers to understand the role of a mobile health intervention in the COVID-19 pandemic outbreak. Findings: Healthcare professionals and health information technology developers are confident that the use of mobile health technology and applications has the ability to assist in monitoring and controlling the COVID-19 outbreak. The key advantages of using mobile phone technology are: increased awareness, improved assistance in tracking and testing casualties, improved assistance in seeking and scheduling health information and medical appointments, increased social distancing, improved overall productivity and quality of life. However, data demonstrated that lack of awareness and accessibility or unwillingness to use the technology, complex healthcare needs, application infrastructure, policies and a dearth of training and support are all barriers to successful implementation of this useful tool. Practical implications: This research has the potential to make a significant impact on government and healthcare policy through presenting a coherent argument for the importance of designing and deploying mobile health technology and applications for the general population. Originality/value: prior literature in this domain is inadequate in explaining the importance of mobile phone-based healthcare solutions for health service and during serious disease outbreaks and, in particular, within the Indian context. The findings of this study can be used by government and healthcare organizations to improve health governance during the current global pandemic. [ABSTRACT FROM AUTHOR]

While the topic of women and water, sanitation and hygiene is a widely accepted concern among academics and activists, it continues to be an issue in developing countries with serious consequences. Based on a qualitative research conducted in rural Uttar Pradesh, India, the paper affirms that sanitation issues for women and girls are compounded by inequitable gender norms that put them at greater risk of experiencing violence and multiple health vulnerabilities. Women, despite having a high demand for safe toilet facilities, continue to practise unsafe sanitation. The findings highlight the role of three structural constraints as the key factors influencing toilet construction and use: poverty, inadequate sanitation policy and its implementation and gender-based power dynamics at the household level. The paper concludes by emphasising the relevance of engendering sanitation programmes and policies by involving women and girls in the planning process to ensure that dignified and gender-sensitive sanitation solutions are developed. The paper also stresses the need to have measures for strengthening and effectively implementing a sanitation policy for the poor and for programmes to work with both men and women to address gender power relations which influence toilet adoption and use. [ABSTRACT FROM AUTHOR]

Background: Pneumonia contributes to about 15% of child deaths globally, with 20% of the overall deaths occurring in India. Although WHO recommends the use of pulse oximeters (PO) in first-level facilities for early detection of child pneumonia in low- and middle-income countries (LMICs), this has not yet been implemented in India. We aimed to assess the feasibility and acceptability of introducing PO in integrated management of neonatal and childhood illnesses (IMNCI) services at primary health centres (PHC) in the rural Pune district. Methods: We identified medical officers (MO) and auxiliary nurse midwives (ANM) from six PHCs as study participants due to their involvement in the treatment of children. We developed in-depth interview (IDI) guides for both groups to explore their IMNCI knowledge and attitude towards the program through a qualitative study. We conducted interviews with MOs (n = 6) and ANMs (n = 6) from each PHC. The PO module was added to explore perceptions about its usefulness in diagnosing pneumonia. After baseline assessment, we conducted training sessions on adapted IMNCI services (including PO use) for MOs and ANMs. PO devices were provided at the study PHCs. Results: At baseline, no PO devices were being used at study PHCs; PHC staff demonstrated satisfactory knowledge about paediatric pneumonia management and demanded refresher IMNCI training. They also felt the need to reiterate the PO use for early diagnosis of pneumonia in children and highlighted the challenges encountered in managing pneumonia at PHCs, such as health system-related challenges and parents' attitudes towards care seeking. There was positive acceptance of training and PO started to be used immediately in PHCs. There was increased confidence in using PO at endline. PO use in examining symptomatic children increased from 26 to 85%. Conclusions: Paediatric PO implementation could be integrated successfully at PHC levels; we found pre-implementation training and provision of PO to PHCs to be helpful in achieving this goal. This intervention demonstrated that an algorithm to diagnose pneumonia in children that included PO could improve case management. [ABSTRACT FROM AUTHOR]

Background The obstetric transition model suggests that, as countries economically develop, the primary causes of maternal mortality change. Countries are assigned to one of five stages based on their maternal mortality ratio to identify priorities for reducing maternal deaths based on predominant determinants of mortality at each stage. We aim to validate the obstetric transition model using data from six diverse low- and middle-income countries representing self-identified priorities for improving maternal health and measurement compiled in a multi-stakeholder process. Methods We used multiple data sources from Bangladesh, Cote d'Ivoire, India, Mexico, Nigeria, and Pakistan, which included secondary data on country context and primary data derived from two sources: the content of multi-stakeholder meetings, called National Dialogues, which were organised around the 11 key themes identified in the World Health Organization's "Strategies toward ending preventable maternal mortality" (EPMM) and follow-up key informant interviews conducted in five of the seven countries. We conducted the analysis in four phases examining, the country's contextual profile, mapping the key themes and indicators to the model, exploring stakeholder prioritisation, and examining reasons for divergence from the model. Results Our results suggest that the stages of the obstetric transition generally align with the social, epidemiological, and health systems characteristics that the model predicts to be associated with countries at each stage, with some deviation related to health system deficiencies and barriers to access. Stakeholder priorities in maternal health generally align with those predicted by the model. Equity and women's rights emerged as a priority throughout all stages, not only within countries that are more advanced in the transition, as predicted by the model. Deviations between the model's predictions and country-level prioritisation were often explained by context-specific challenges. Conclusions This study is one of the first to validate the obstetric transition model using real data. Our findings support the validity of the obstetric transition model as a useful guide to aid decisionmakers in prioritising attention towards addressing maternal mortality. Country context, including equity, remains important to further inform priority-setting. [ABSTRACT FROM AUTHOR]

To explore themes regarding work-related barriers to access to health care, we conducted 32 interviews, 16 with third gender people and 16 with cisgender women, all of whom were all living with HIV in Hyderabad, India. Most respondents were members of Dalit castes and had been living with HIV for several years at the time of the interview. Using thematic content analysis, interviews were coded by two researchers using a social determinants of health conceptual framework. Themes highlighted in this study include the burden of taking time off from work, the loss of pay associated with missing work, and the interruption of gendered care work responsibilities that respondents faced when seeking treatment. Findings from this study support the claim that equitable work policies and practices for marginalized laborers can increase access to medical care for people living with HIV. [ABSTRACT FROM AUTHOR]

Purpose: Healthcare innovations are one of the drivers of healthcare sector growth in India. Innovation policies are challenging because of the uncertainty regarding the outcome of the innovations. Hence, there is a need to understand the interface between policies and healthcare innovations to identify gaps and propose timely recommendations. Accordingly, this study uses the Indian healthcare start-up sector as a case study to analyse the above linkages, gaps and propose recommendations. Methodology: Quantitative data from the Start-up India portal along with qualitative data from key informant interviews have been analysed to draw insights. Findings: Healthcare start-ups have made significant contributions to the economy and healthcare sector, but there are gaps and room for improvement especially in the areas of awareness, funding and mentoring. Conclusions: Based on the study findings a conceptual framework has been created for understanding the nature of gaps and their linkages in the healthcare innovation lifecycle. [ABSTRACT FROM AUTHOR]

Background: In March 2018, the Government of India launched a direct benefit transfer (DBT) scheme to provide nutritional support for all tuberculosis (TB) patients in line with END TB strategy. Here, the money (@INR 500 [~8 USD] per month) is deposited electronically into the bank accounts of beneficiaries. To avail the benefit, patients are to be notified in NIKSHAY (web-based notification portal of India's national TB programme) and provide bank account details. Once these details are entered into NIKSHAY, checked and approved by the TB programme officials, it is sent to the public financial management system (PFMS) portal for further processing and payment. Objectives: To assess the coverage and implementation barriers of DBT among TB patients notified during April–June 2018 and residing in Dakshina Kannada, a district in South India. Methods: This was a convergent mixed-methods study involving cohort analysis of patient data from NIKSHAY and thematic analysis of in-depth interviews of providers and patients. Results: Of 417 patients, 208 (49.9%) received approvals for payment by PFMS and 119 (28.7%) got paid by 1 December 2018 (censor date). Reasons for not receiving DBT included (i) not having a bank account especially among migrant labourers in urban areas, (ii) refusal to avail DBT by rich patients and those with confidentiality concerns, (iii) lack of knowledge and (iv) perception that money was too little to meet the needs. The median (IQR) delay from diagnosis to payment was 101 (67–173) days. Delays were related to the complexity of processes requiring multiple layers of approval and paper-based documentation which overburdened the staff, bulk processing once-a-month and technological challenges (poor connectivity and issues related to NIKSHAY and PFMS portals). Conclusion: DBT coverage was low and there were substantial delays. Implementation barriers need to be addressed urgently to improve uptake and efficiency. The TB programme has begun to take action. [ABSTRACT FROM AUTHOR]

This paper examines the relationship of empowerment to women's self-reported general health status and women's self-reported health during pregnancy in low-income communities in Mumbai. The data on which this paper is based were collected in three study communities located in a marginalised area of Mumbai. We draw on two data sources: in-depth qualitative interviews conducted with 66 married women and a survey sample of 260 married women. Our analysis shows that empowerment functions differently in relation to women's reproductive status. Non-pregnant women with higher levels of empowerment experience greater general health problems, while pregnant women with higher levels of empowerment are less likely to experience pregnancy-related health problems. We explain this non-intuitive finding and suggest that a globally defined empowerment measure for women may be less useful that one that is contextually and situationally defined. [ABSTRACT FROM AUTHOR]

Purpose In India, women feel unsafe particularly in public spaces and single women feel threatened in almost every context (Nag, 2016). The purpose of this paper is to examine women’s safety in the metropolitan city of Mumbai and argue that we need to address this issue and respond to the dearth of firsthand knowledge about women’s safety in India which is investigated in light of the social and cultural milieu. The study makes several recommendations based on the research findings.Design/methodology/approach The data collection was done in three separate stages. In the first phase, a structured questionnaire was administered orally to around 300 working women all over the city of Mumbai and its suburbs. The second stage adopted an exploratory qualitative approach using in-depth interviews and reflections. In the third stage, the authors audited busy areas on various parameters that might hamper women’s safety.Findings All the raw data obtained were analyzed using qualitative data coding and categorized to generate themes. Six clear themes emerged which include: perception of safety; safety in transportation; actual violation of personal or physical safety; negligible reaction by the victims; experience with the police; and firsthand recommendations and strategies. This study brings to light the disturbing fact that 91 percent of women worry about their safety all the time or most of the time when they are outside their homes. On the streets of the city almost all had experienced some tangible threats to their safety at some point of time.Originality/value Hypocrisy in the treatment of women is precisely what makes India unsafe for women. Although Mumbai ranks as the safest city in India, the study portrays that it is unsafe and fearsome for women. The recent much publicized crimes against women especially rape cases have made women’s safety an important topic for research. Not much primary research exists in this area. [ABSTRACT FROM AUTHOR]

Objectives:The population of India is aging rapidly. This demographic shift brings with it a host of challenges to the health and well-being of older adults, including the increased prevalence of non-communicable diseases, among them depressive disorders. In this paper, we report on qualitative research intended to inform the development of a locally acceptable and appropriate intervention to improve the well-being of older adults in Goa, India and, specifically, to prevent late-life depression. Method:Semi-structured interviews with 20 individuals, aged 60 years and older, attending two primary care clinics in Goa, India. Transcripts were reviewed to identify emerging themes, a coding scheme was developed and thematic analyses were conducted. Results:Analyses of the interview transcripts revealed the following key themes: (1) notions of old age tended to be negative and there were widespread fears of becoming widowed or incapacitated; (2) the most frequently reported health conditions were joint pain, diabetes and heart disease; (3) emotional distress was described using the terms ‘tension’, ‘stress’, ‘worry’ and ‘thinking’; (4) family issues often involved financial matters, difficult relationships with daughters-in-law and conflicted feelings about living with the family or independently; (5) other than a pension scheme, participants did not know of community resources available to older adults. Conclusions:Our findings are in general agreement with those of previous research, and with our experiences of working with older adults in Pittsburgh and the Netherlands.This research will inform the development of an intervention to prevent depression in older adults in Goa. [ABSTRACT FROM PUBLISHER]

Purpose: This paper explores the effect of inherent social inequalities on disability rights movements and their political activities in India and Nepal. The situation for persons with disabilities is similar in both countries. Many social and cultural phenomena coincide, and laws and policies are currently being formulated in line with the human rights agenda. In order to understand the current situation and the envisioned future for persons with disabilities, it is important to probe how, and under what circumstances, the disability issue is framed. Method: Purposive sampling was used to access outspoken activists in Kolkata in India and Kathmandu in Nepal. Semi-structured interviews were conducted, coded according to recurring themes, and analysed with Nancy Fraser's theory on misrepresentation of social movements along with literature on framing. Though only 7 interviews were conducted (a limitation of the paper), together with informal discussions and previous knowledge they provided a sufficient overview of the social movements in the two countries. Results: This paper increases the knowledge on the two social movements, and provides interesting case studies on how persons with disabilities engage in political activities in the Global South. The rights-based approach has a strong influence within both movements, and appears to be the main strategy adopted by them. Conclusions and Implications: The Indian and Nepalese disability rights movements are affected by social inequalities. It seems as though the urban middle-class and their needs colour the movements and its framing. Further research is needed to probe what implications these inequalities have for the situation of persons with disabilities. [ABSTRACT FROM AUTHOR]

Purpose – This paper seeks to discuss the attitudes and beliefs of the Pakistani/Kashmiri community in Birmingham towards the cultural practice of consanguineous (cousin) marriage and health, and how an understanding of Pakistani/Kashmiri community views may help institute good practice for health care professionals. Design/methodology/approach – A qualitative research study using eight gender- and age-specific focus group discussions and eight in-depth one-to-one interviews with participants who were in consanguineous relationships. All participants were from the Pakistani/Kashmiri community and residents of Springfield ward in Birmingham. Findings – The findings illustrate Pakistani/Kashmiri attitudes towards consanguinity and health. There was awareness of still births and genetic conditions but a poor understanding of genetics; respondents were reluctant to accept the link between cousin marriages and birth issues and explanations for still births and impairments were largely attributed to the "will of God". Female respondents were in favour of screening for genetic conditions but would not terminate pregnancies as this was contrary to Islamic ideas about pre-destiny and all respondents wanted more medical and Islamic scholarly information on cousin marriage and how it is linked to disabilities. Clearly there is a need to improve healthcare outcomes and reduce infant mortality in the Pakistani/Kashmiri community. Research limitations/implications – Research findings correspond with previous studies that have explored ethnic minority knowledge and attitudes to health and healthcare services and the need for culturally competent services. Originality/value – This paper presents some suggestions on effecting behaviour change in this important area. [ABSTRACT FROM AUTHOR]

Psychotherapeutic practices in India observes a paradigm shift with the current focus on the indigenous movement which has hit the discipline of Psychology like any other stream in Social Sciences and Humanities. The professional challenges and issues faced by the mental health professionals in this country has always revolved around on the 'uncanny' realm of myths, beliefs and religions as far as mental illness is concerned (Prasadarao & Sudhir, 2001). Efforts have been initiated in exploring the cultural and social roots of the health-illness constructs as well as debating on the possibility of 'integration' of these different philosophies. This paper is designed to understand the various therapeutic forms and processes in indigenous healing practices and to analyse the negotiation between indigenous healing practices and psychotherapy with special reference to Karnataka, one of the States situated in the Southern part of India. The study approaches the cultural landscape of Karnataka state based on a qualitative research design wherein in-depth unstructured interview of healers and mental health practitioners and systematic observation of some indigenous healing forms are adopted as methods of data collection. The paper concludes by looking at the challenges of constructing ethnospecific interventions in psychotherapy and the need to develop more cultural-specific theories taking into account the cultural history of the community. [ABSTRACT FROM AUTHOR]

This paper is a contribution to the growing literature on how best to design and support community health worker (CHW) programmes to maximise their positive impact. CHWs are laypeople trained to promote health among their peers. To do so they are commonly tasked with providing basic curative services, promoting the use of existing health services, facilitating cultural mediation between communities and healthcare providers and encouraging critical reflection and dialogue on social health issues. This paper presents a case study of a CHW project in rural Uttarakhand, north India, called the Accredited Social Health Activist (ASHA) programme. While the ASHA programme is not specifically targeting HIV/AIDS, CHW programmes have been flagged as a key means of addressing health resource shortages in poor countries, especially in relation to HIV/AIDS. This study of the ASHA programme provides insights into how best to support CHW programmes in general, including those focused on HIV/AIDS. The research involved 25 interviews and five focus groups with ASHAs, health professionals and community members as well as over 100 hours of non-participant observation at public health centres. The research investigated contextual features of the programme that are hindering the ASHAs' capacity to increase quantitative health outcomes and act as cultural mediators and agents of social change. Research found that ASHAs were institutionally limited by: (1) the outcome-based remuneration structure; (2) poor institutional support; (3) the rigid hierarchical structure of the health system; and (4) a dearth of participation at the community level. The conclusion suggests that progressive policy on CHW programmes must be backed up by concrete institutional support structures to enable CHWs to fulfil their role. [ABSTRACT FROM PUBLISHER]

Purpose The current Indian secondary school curriculum has been criticised for its failure to deliver relevant skills-based food and nutrition education for adolescents. The purpose of this paper is to understand the views of adolescents, their parents, teachers and school principals on the present food and nutrition curriculum and the role of the schools in developing food skills.Design/methodology/approach Semi-structured interviews were held with 15 students aged 14-15 years, 15 parents, 12 teachers and ten principals in ten private schools in Kolkata, India. The interview questions were primarily based on the content, merits and demerits of the curriculum. The digitally recorded data were transcribed verbatim and analysed thematically.Findings All the 52 interviewees observed that the food and nutrition curriculum created awareness in students about the importance of healthy eating. However, they also described certain weaknesses of the curriculum. These included lack of practical assignments, an out-dated and a limited curriculum, which failed to initiate critical thinking and was contradicted by sales practices in the school food environment. The interviewees prioritised the inclusion of food skills in the curriculum.Practical implications The emerging evidence suggests the need for the development of a skills-focussed food and nutrition curriculum to encourage healthy eating behaviours among adolescents.Originality/value Most of the work on food and nutrition education has come from developed nations – this is the first study in the Indian context of the secondary school food and nutrition curriculum. [ABSTRACT FROM AUTHOR]

Purpose:Very little is known about how older people from black and minority ethnic (BME) groups caring for someone after a stroke access and engage with social care services. This paper explores both the experiences of carers whose relative was receiving social care services in their own home and the value of a theory of humanising care to understand and explain these experiences. Method:Semi-structured interviews were undertaken with 50 carers from five different ethnic groups: Asian Indian, Asian Pakistani, Black African, Black Caribbean and White British. Data were thematically analysed within a phenomenological framework. Results:Five interacting themes emerged: communication and bureaucracy; time and timing; communication and rapport building; trust and safety; humanity and the human dimensions of care. Many of the experiences could be interpreted within a conceptual framework of humanising care underpinned by eight interacting dimensions of what it means to be treated as an individual and a human. Conclusions:Carers from BME and White British groups share many experiences of homecare although language and cultural difference may exacerbate common pressures and stresses. The framework for humanising care is a useful tool to evaluate aspects of homecare that are responsive to dignity and diversity.Implications for RehabilitationExplicitly identifying, describing and valuing the human dimensions of care may support services in responding appropriately to homecare users from black minority ethnic communities as well as those from white majority groups.Unresponsive services and poor communication may lead to loss of trust with care agencies and undermine BME carers’ sense of entitlement and competence in engaging with homecare services.Care worker continuity investing time in building relationships and care worker familiarity is important to many families who access social care services. [ABSTRACT FROM AUTHOR]

Background: Adolescents are vulnerable to stressors because of the rapid physical and mental changes that they go through during this life period. Young people residing in slum communities experience additional stressors due to living conditions, financial stress, and limited access to healthcare and social support services. The Adolescents' Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) study, is testing an intervention intended to improve mental health outcomes for adolescents living in urban slums in India combining an anti-stigma campaign with a digital health intervention to identify and manage depression, self-harm/suicide risk or other significant emotional complaints. Methods: In the formative phase, we developed tools and processes for the ARTEMIS intervention. The two intervention components (anti-stigma and digital health) were implemented in purposively selected slums from the two study sites of New Delhi and Vijayawada. A mixed methods formative evaluation was undertaken to improve the understanding of site-specific context, assess feasibility and acceptability of the two components and identify required improvements to be made in the intervention. In-depth interviews and focus groups with key stakeholders (adolescents, parents, community health workers, doctors, and peer leaders), along with quantitative data from the digital health platform, were analysed. Results: The anti-stigma campaign methods and materials were found to be acceptable and received overall positive feedback from adolescents. A total of 2752 adolescents were screened using the PHQ9 embedded into a digital application, 133 (4.8%) of whom were identified as at high-risk of depression and/or suicide. 57% (n = 75) of those at high risk were diagnosed and treated by primary health care (PHC) doctors, who were guided by an electronic decision support tool based on WHO's mhGAP algorithm, built into the digital health application. Conclusion: The formative evaluation of the intervention strategy led to enhanced understanding of the context, acceptability, and feasibility of the intervention. Feedback from stakeholders helped to identify key areas for improvement in the intervention; strategies to improve implementation included engaging with parents, organising health camps in the sites and formation of peer groups. Trial Registration: The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries, Reference number: CTRI/2022/02/040307. Registered 18 February 2022. [ABSTRACT FROM AUTHOR]

Objectives: Exploring data on primary caregiver experiences of dealing with chronically ill children (CIC) strengthens the ability of paediatricians to improve the quality of care by detecting unmet needs in paediatric palliative care and understanding their original concerns instead of presumed needs. Hence, this study aims to identify and describe the primary concerns and challenges faced by caregivers of children with complex chronic conditions in a tertiary care hospital in Kerala. Materials and Methods: Primary caregivers of 25 children aged <13 years with non-malignant life-limiting illnesses, admitted to the paediatric department of a government medical college in Kerala between 1 July 2021 and 28 February 2022, underwent in-depth interviews to analyse their most worrisome issues. Thematic analysis was the method chosen for qualitative data analysis. Results: The main themes identified were medical issues, unmet needs, caregiver health issues, and social and financial issues. Among the medical issues, poor seizure control and infected bedsores, sleep deprivation in both patient as well as caregivers, and difficulty in maintaining the personal hygiene of patients were the major issues. Parents of almost all the CICs reported that they required diapers more than any other material or device. Maternal depression was the major caregiver health issue. The unavailability of antiepileptic drugs in peripheral health centres resulted in missing doses and undue expenses for travel to tertiary centres to obtain the same. Caregivers reported their dismay when they finally realised that they were given false hopes of a cure by different systems of medicine. Conclusion: The challenges faced by caregivers of children with complex chronic conditions are multifaceted. Their most problematic issues related to medical issues are the occurrence of breakthrough seizures and development of infected bedsores. The most important material hardship reported was diaper needs. Caregiver issues such as sleep deprivation and maternal depression must be identified and addressed while providing comprehensive palliative care. [ABSTRACT FROM AUTHOR]

Prolonged grief disorder (PGD) is a condition characterized by difficulty in coping effectively with the loss of loved ones. The proposed diagnostic criteria for PGD have been based predominantly on research from developed Western nations. The cultural variations associated with experience and expression of grief and associated mourning rituals have not been considered comprehensively. The current study aimed to understand the experience of prolonged grief in India through a qualitative enquiry with mental health professionals (focus group discussions) and affected individuals (key informant interviews). Several novel findings diverging from the current understanding of manifestation and narratives of PGD emerged from the study, including differences in the social contexts of bereavement and culture-specific magico-religious beliefs and idioms of distress. The findings point to limitations of existing diagnostic systems for PGD. The results of this study suggest that the assumption of content equivalence for psychiatric disorders across cultures may not be justified and that there is a need to develop culturally sensitive diagnostic criteria and assessment scales for PGD. [ABSTRACT FROM AUTHOR]

Objective: This paper explores use of narrative ideas in the context of occupational therapy practice while working with groups of children with handwriting difficulties. Method: 14 children in the age group of 7 to 10years who were part of an occupational therapy 'Handwriting Training Programme' at a Child Development Centre, Mumbai were interviewed by the author using narrative practices. The 13 week handwriting training program was structured to include 20 minutes of conversation time in each session which was facilitated by the author. The conversations were videotaped and transcribed to explore emerging themes. Results: Using the narrative practice of externalizing conversations, which focuses on separating the problem from the person, allowed the children to effectively identify the handwriting problem, describe effects of the problem on them, their lives at school, their families and friends. Conversing about the problem as a separate identity helped reduce feelings of guilt and blame, enabling them to take a stand against the problem and develop strategies to reduce the effect of the problem. Parent's reported a 'sense of responsibility and insight' in the children towards the need to change their handwriting. Conclusion: This paper highlights potential use of narrative ideas as a framework for a client centered practice within the context of occupational therapy. [ABSTRACT FROM AUTHOR]

Objectives: Many low- and middle-income countries have introduced State-funded health programmes for vulnerable groups as part of global efforts to universalise health coverage. Similarly, India introduced the Rashtriya Swasthya Bima Yojana (RSBY) in 2008, a publiclyfunded national health insurance scheme for people below the poverty line. The authors explore the RSBY's genesis and early development in order to understand its conceptualisation and design principles and thereby establish a baseline for assessing RSBY's performance in the future. Study design: Qualitative case study of the RSBY in Delhi. Methods: This paper presents results from documentary analysis and semi-structured interviews with senior-level policymakers including the former Labour Minister, central government officials and affiliates, and technical specialists from the World Bank and GIZ. Results: With national priorities focused on broader economic development goals, the RSBY was conceptualised as a social investment in worker productivity and future economic growth in India. Hence, efficiency, competition, and individual choice rather than human needs or egalitarian access were overriding concerns for RSBY designers. This measured approach was strongly reflected in RSBY's financing and benefit structure. Hence, the programme's focus on only the 'poorest' (BPL) among the poor. Similarly, only costlier forms of care, secondary treatments in hospitals, which policymakers felt were more likely to have catastrophic financial consequences for users were covered. Conclusions: This paper highlights the risks of a narrow approach driven by developmental considerations alone. Expanding access and improving financial protection in India and elsewhere requires a more balanced approach and evidence-informed health policies that are guided by local morbidity and health spending patterns. [ABSTRACT FROM AUTHOR]

Objective: Natural and man-made disasters are increasing in frequency. Recently, India has been victim of Phailin cyclone (Orrisa), floods (Uttarakhand), earthquakes, tsunami etc. Disaster situations generate significant personal loss, traumatic stress and environmental changes that directly disrupt occupational roles, habits and routines. Hence, the purpose of this concept paper is to endow with contributions that occupational therapy practitioners can provide to individuals and communities across the spectrum of disaster preparedness, response and recovery (DPRR). Further, to review and summarize authorities/organizations working for Disaster Management in India, to create awareness of Occupational Therapy role. Methodology: Phase I- Interviewed 11 Occupational Therapists working for Disaster Management in their countries, on: getting started (personal - professional preparedness), Getting connected, Accounting for OT performance strategies and contribution in DPRR contexts. Phase II-Search Strategy of Authorities/Organization. Thematic Analysis and Qualitative Data Analysis Minor 4.0 was used for data analysis. Results: Themes were generated that critically reflect on occupational therapy competencies and professional development needs for clinical/community practice, education, policy and research. 128 organizations have been identified and reported. Conclusion: This paper is a step towards expanding Occupation Therapy boundaries into the realm of disaster preparedness, response and recovery in India to make a difference. [ABSTRACT FROM AUTHOR]

Cognitive enhancement (CE) covers a broad spectrum of methods, including behavioral techniques, nootropic drugs, and neuromodulation interventions. However, research on their use in children has almost exclusively been carried out in high-income countries with limited understanding of how experts working with children view their use in low- and middle- income countries (LMICs). This study examines perceptions on cognitive enhancement, their techniques, neuroethical issues about their use from an LMICs perspective. Seven Indian experts were purposively sampled for their expertise in bioethics, child development and child education. In-depth interviews were conducted using a semi-structured topic guide to examine (1) understanding of CE, (2) which approaches were viewed as cognitive enhancers, (3) attitudes toward different CE techniques and (4) neuroethical issues related to CE use within the Indian context. All interviews were audio recorded and transcribed before thematic analysis. Findings indicate Indian experts view cognitive enhancement as a holistic positive impact on overall functioning and well-being, rather than improvement in specific cognitive abilities. Exogenous agents, and neuromodulation were viewed with skepticism, whereas behavioral approaches were viewed more favorably. Neuroethical concerns included equitable access to CE, limited scientific evidence and over-reliance on technology to address societal problems. This highlights the need for more contextually relevant neuroethics research in LMICs. [ABSTRACT FROM AUTHOR]