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BackgroundChinese students are extremely vulnerable to developing mental illness. The stigma associated with mental illness presents a barrier to seeking help for their mental health. ObjectiveThe Linking Hearts—Linking Youth and ‘Xin’ (hearts) project is an implementation science project that seeks to reduce mental illness stigma and promote the mental health of university students in Jinan, China. The Linking Hearts project consists of 3 components. In this paper, we outline the protocol for the first component, that is, the contextual assessment and analysis of the mental health needs of university students as the first step to inform the adaptation of an evidence-based intervention to be implemented in Jinan, China. MethodsSix local universities will participate in the Linking Hearts project. A total of 100 students from each university (n=600) will engage in the contextual assessment through self-report surveys on depression, anxiety, stress, mental health knowledge, and mental health stigma. Quantitative data will be analyzed using several descriptive and inferential analyses via SPSS. A small number of participants (144 students and 144 service providers) will also be engaged in focus groups to assess the socio-environmental contexts of university students’ health and availability of mental health resources. Qualitative data will be transcribed verbatim and NVivo will be used for data management. Social network analysis will also be performed using EgoNet. ResultsLinking Hearts was funded in January 2018 for 5 years. The protocol of Linking Hearts and its 3 components was approved by the research ethics boards of all participating institutions in China in November 2018. Canadian institutions that gave approval were Ryerson University (REB2018-455) in January 2019, University of Alberta (Pro00089364), York University (e2019-162) in May 2019, and University of Toronto (RIS37724) in August 2019. Data collection took place upon ethics approval and was completed in January 2020. A total of 600 students were surveyed. An additional 147 students and 138 service providers took part in focus groups. Data analysis is ongoing. Results will be published in 2021. ConclusionsFindings from this contextual assessment and analysis will generate new knowledge on university students’ mental health status, mental health knowledge, and resources available for them. These findings will be used to adapt and refine the Acceptance and Commitment to Empowerment-Linking Youth N’ Xin intervention model. The results of this contextual assessment will be used to inform the adaptation and refinement of the mental health intervention to promote the mental health of Chinese university students in Jinan. International Registered Report Identifier (IRRID)RR1-10.2196/25009

This paper recounts the development and implementation of the "Peer Leader Training Manual" for the Story-Sharing for Sexual Health Research (SSSH) Study conducted in Toronto, Canada. In the disciplinary integration of health and adult education, the community-engaged health research reported here reflects the successful partnership of a team of academic researchers with a community-based organization. Eight community-based South Asian women peer leaders were collectively recruited and trained as research associates to explore how stories (relative to fact sheets) can be used to promote dialogue and knowledge about sexual health and reduce HIV stigma among South Asian women. This paper is about the adult education tool used to orient them to the SSSH Study and train them for related field work: recruit SSSH Study participants, arrange intervention site and logistics, deliver intervention, administer pre and post surveys, conduct focus groups, and ensure data security. The manual played a significant role in training the peer leaders who are now prepared to further engage in future community health partnerships. This tool will also be helpful for other community-engaged health research involving sexual health initiatives in marginalized communities.

Story-based learning is well recognized as an effective strategy for adult health education. However, there is a scarcity of research on story-based health education among women in South Asian diasporic communities. To address this gap, we undertook a pilot study in Toronto to explore how South Asian women respond to the use of fact-based and story-based materials for HIV/STI prevention. A total of 78 women were recruited from across the city. We engaged nearly half of the women (n=40) using fact sheets on HIV/STIs, and the remainder (n=38) using stories written by South Asian women on HIV/STIs. Surveys and focus groups were used to explore participants' responses in terms of knowledge, attitudes and perspectives. Results indicated that both approaches were effective in increasing participants' knowledge of HIV/STIs. Participants in the fact-based sessions tended to distance themselves from the idea of personal HIV/STI risks. Participants in the story-based groups were emotionally engaged, expressing personal commitments to take a stand against HIV stigma. In summary, within-culture stories are potentially effective tools that enable women to make sense of their own life situations and contextual vulnerabilities. Story-based materials are useful for breaking the silence of taboo topics, addressing stigma and discrimination and raising awareness about collective empowerment.

According to the Center for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program, the cervical cancer screening rate dropped by 84% soon after the declaration of the COVID-19 pandemic. The challenges facing cervical cancer screening were largely attributed to the required in-person nature of the screening process and the measures implemented to control the spread of the virus. While the impact of the COVID-19 pandemic on cancer screening is well-documented in high-income countries, less is known about the low- and middle-income countries that bear 90% of the global burden of cervical cancer deaths. In this paper, we aim to offer a comprehensive view of the impact of COVID-19 on cervical cancer screening in LMICs. Using our study, "Prevention of Cervical Cancer in India through Self-Sampling" (PCCIS), as a case example, we present the challenges COVID-19 has exerted on patients, healthcare practitioners, and health systems, as well as potential opportunities to mitigate these challenges. [ABSTRACT FROM AUTHOR]

Objective: To test whether the format in which women receive probabilistic information about breast cancer and mammography affects their comprehension. Methods: A convenience sample of 180 women received pre-assembled randomized packages containing a breast health information brochure, with probabilities presented in either verbal or numeric format, and four questionnaires. Enclosed questionnaires assessed women's knowledge of breast health, socio-demographic/ clinical characteristics, comprehension of breast health information brochure and format preference. Results: Nearly two-thirds of the study participants reported a preference for the numeric format. However, the study results showed that comprehension was significantly higher among women who received probabilistic information in verbal format than those who received the information in numeric format. This higher degree of comprehension was sustained even if the verbal format was inconsistent with the respondents' format preference, and even if the respondents' educational background were relatively limited. Women's comprehension was strongly associated with the interaction between received format and their format preferences as well as their education level and their perceived benefit of early detection of breast cancer. Conclusion: The study demonstrates that comprehension of information depends on: (1) women's readiness to receive information; and (2) their education and numeracy skills in processing and interpreting probabilistic information, particularly, when presented in quantitative format. Attention must be paid to these factors when designing or communicating breast health information in order to ensure full comprehension of information, and to avoid any potential discrimination which people may face relating to their poor education or numeracy skills. Systematic investigation into the relationships among readiness, numeracy problems, and format preferences could help build effective guidelines for providing women with appropriate and comprehensible information. (Contains 4 tables and 1 figure.)

Objective: To assess young women's breast health knowledge and explore its relation to the use of screening mammography. Methods: A convenience sample of 180 women aged 25-45 residing in Toronto, Canada, with no history of breast cancer and mammography received an information brochure and four questionnaires which assessed their knowledge of breast health, sociodemographic/clinical characteristics, and intended decision to use screening mammography. Results: Women's overall baseline knowledge score ranged from 0-18 with a mean of 10 and SD of 3.9. About half of the participants had a low score (0-9), 31 per cent did not know that the risk of breast cancer increases with age, 43 per cent did not know what was the appropriate age to start breast self examination (BSE), and 48 per cent did not know how frequently BSE should be performed. The overall knowledge score was significantly higher for those women who intended to use screening than those who did not (10.8 vs. 8.4, p less than 0.001). The intended use of screening was associated with women's knowledge (p less than 0.001), self-perceived health (p = 0.02), perceived susceptibility to breast cancer (p = 0.04) and perceived usefulness of information (p = 0.001). Conclusion: The study demonstrates that breast health knowledge is limited even among highly educated young women. This finding suggests the need for providing breast health education to women at earlier stage in their life when they have ample time to go through a logical series of decision stages on their way to adopting a new behaviour. (Contains 4 tables.)