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BackgroundSeveral studies have focused on family stress processes, examining the association between various sources of stress and the mental health and well-being of parents and adolescents. The majority of these studies take the individual as the unit of analysis. Multi-actor panel data make it possible to examine the dynamics of the family context over time and the differentiating effects of individual roles within the same family. Accurate information about family processes allows practitioners to provide support that enhances family resilience and minimizes the risk of mental health problems. ObjectiveOur study contributes to the research on family stress processes by focusing on families with different income levels, and by collecting panel data from mothers, fathers, and adolescents within the same family. MethodsThe relationship between mothers, fathers, and children (RMFC) study is an ongoing Flemish multi-actor panel study that aims to enhance our understanding of family processes that protect the mental health and well-being of two-parent families with a target adolescent between 11 and 17 years old. Mothers, fathers, and children provide information about various aspects of family life, including finances, sources of stress, health, mental health, parenting, and coping strategies. Measures have been chosen whenever possible that have sound conceptual underpinnings and robust psychometric properties. The study posed two challenges. First, economically disadvantaged families are difficult to reach. Second, the collection of multi-actor data is often plagued by high nonresponse. To ensure that the families were targeted as successfully as possible, the study employed a purposive nonprobability sampling method. ResultsThe RMFC study is one of the largest triadic panel studies of its kind. The first wave of quantitative data collection was conducted between February 2012 and January 2013. A total of 2566 individuals of 880 families participated in our study. The second wave of data collection will be undertaken 6-12 months later. ConclusionsThe strength of the RMFC study is its multi-actor panel approach of data collection among families with different income levels. Strategies that were followed to address the empirical issues involved with the sampling design are discussed, together with theoretical and practical implications.

Research on stimulant misuse among students has been rising. These medicines are generally prescribed to treat ADHD, but they are also used by students to enhance their academic performance. To date, qualitative research on the topic is limited, specifically in understanding the "process" of misuse, i.e. the motivations embedded in a particular academic and social context driving students' decision to use. The aim of this research was to develop subtypes by disentangling patterns in the process of stimulant misuse. We conducted a focus group (n = 5) and semi-structured interviews (n = 28) with Flemish university students who had misused stimulants during their academic career. We employed abductive analysis principles, in which we build on Conrad's medicalization and enhancement theory and Cox and Klinger's motivational model of alcohol use. Two dimensions were key in differentiating theoretically meaningful subtypes: (1) perception of academic need and (2) frequency of use. The "normalization subtype" indicates having concentration problems and structurally uses stimulants to deal with these problems; the "rescue subtype" is able to study without stimulants, but occasionally uses them to cope with academic demands and/or personal stressors; the "experimental subtype" does not have an academic need to use stimulants, but temporarily uses them out of curiosity; the "performance subtype" does not need the medication, but perceives it as a convenient tool to structurally facilitate academic life, e.g. to shorten the study process. Our study shows a nuanced story of students' stimulant misuse and helps inform the development of tailored preventive measures.

First-year university students encounter considerable academic stress, possibly resulting in mental health problems. Although studies have illustrated the academic and health benefits of sense of belonging, few studies have focused on its role in the relationship between academic stress and mental health complaints. The current study used structural equation modeling to examine this role among first-year students (N = 363) at two Flemish universities. Sense of belonging was considered to consist of perceptions of social match and personal interaction. Personal interaction partially mediated the relationship between academic stress and anxiety-related complaints. For depression-related complaints, a full mediation was found. Policy initiatives were formulated, aimed at encouraging students to learn and work together, which may promote a smooth transition to the university environment.

Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.

BackgroundMany health conditions perceived to be contagious, dangerous or incurable, or resulting in clearly visible signs, share a common attribute - an association with stigma and discrimination. While the etiology of stigma may differ between conditions and, sometimes, cultural settings, the manifestations and psychosocial consequences of stigma and discrimination are remarkably similar. However, the vast majority of studies measuring stigma or addressing stigma through interventions employ a disease-specific approach.Main bodyThe current paper opposes this siloed approach and advocates a generic concept of 'health-related stigma' in both stigma measurement and stigma interventions. Employing a conceptual model adapted from Weiss, the current paper demonstrates the commonalities among several major stigmatized conditions by examining how several stigma measurement instruments, such as the Social Distance Scale, Explanatory Model Interview Catalogue, Internalized Stigma of Mental Illness, and Berger stigma scale, and stigma reduction interventions, such as information-based approaches, contact with affected persons, (peer) counselling, and skills building and empowerment, were used successfully across a variety of conditions to measure or address stigma. The results demonstrate that 'health-related stigma' is a viable concept with clearly identifiable characteristics that are similar across a variety of stigmatized health conditions in very diverse cultures.ConclusionA more generic approach to the study of health-related stigma opens up important practical opportunities - cross-cutting measurement and intervention tools are resource saving and easier to use for personnel working with multiple conditions, allow for comparison between conditions, and recognize the intersectionality of many types of stigma. Further research is needed to build additional evidence demonstrating the advantages and effectiveness of cross-condition approaches to stigma measurement and interventions.

Introduction: Adolescents and young adults (AYA) face multiple barriers to accessing healthcare services, which can interact, creating complex needs that often impact health behaviours, leading to increased vulnerability to HIV. We aimed to identify distinct AYA subgroups based on patterns of barriers to HIV testing services and assess the association between these barrier patterns and sexual behaviour, socio-demographics, and HIV status. Methods: Data were from Nigeria's AIDS Indicator and Impact Survey (NAIIS, 2018) and included 18,612 sexually active AYA aged 15–24 years who had never been tested for HIV and reported barriers to accessing HIV testing services. A Latent class analysis (LCA) model was built from 12 self-reported barrier types to identify distinct subgroups of AYA based on barrier patterns. Latent class regressions (LCR) were conducted to compare the socio-demographics, sexual behaviour, and HIV status across identified AYA subgroups. Sex behaviour characteristics include intergenerational sex, transactional sex, multiple sex partners, condom use, and knowledge of partner's HIV status. Results: Our LCA model identified four distinct AYA subgroups termed 'low-risk perception' (n = 7,361; 39.5%), 'consent and proximity' (n = 5,163; 27.74%), 'testing site' (n = 4,996; 26.84%), and 'cost and logistics' (n = 1,092; 5.87%). Compared to adolescents and young adults (AYA) in the low-risk perception class, those in the consent and proximity class were more likely to report engaging in intergenerational sex (aOR 1.17, 95% CI 1.02–1.35), transactional sex (aOR 1.50, 95% CI 1.23–1.84), and have multiple sex partners (aOR 1.75, 95% CI 1.39–2.20), while being less likely to report condom use (aOR 0.79, 95% CI 0.63–0.99). AYA in the testing site class were more likely to report intergenerational sex (aOR 1.21, 95% CI 1.04–1.39) and transactional sex (aOR 1.53, 95% CI 1.26–1.85). AYA in the cost and logistics class were more likely to engage in transactional sex (aOR 2.12, 95% CI 1.58–2.84) and less likely to report condom use (aOR 0.58, 95% CI 0.34–0.98). There was no significant relationship between barrier subgroup membership and HIV status. However, being female, aged 15–24 years, married or cohabiting, residing in the Southsouth zone, and of Christian religion increased the likelihood of being HIV infected. Conclusions: Patterns of barriers to HIV testing are linked with differences in sexual behaviour and sociodemographic profiles among AYA, with the latter driving differences in HIV status. Findings can improve combination healthcare packages aimed at simultaneously addressing multiple barriers and determinants of vulnerability to HIV among AYA. [ABSTRACT FROM AUTHOR]

Background: Despite its overall good performance, the Belgium healthcare system scores less well in providing equal access to healthcare compared to other European countries. This increases the risk of people worse off to receive late diagnosis and to get complications of chronic diseases. Methods: This study aims to achieve a deeper understanding of how people with complications of a chronic disease – diabetes type 2 – experience care in the Belgium health system through semi-structured interviews with extreme case study sampling of people with advanced diabetes, and inductive analysis. Results: The results show that most respondents were diagnosed late in the course of their disease. There are variations in treatment and type of provider. People appreciate the personal and long-lasting contact with a medical doctor, while the contact with and role of paramedical providers was less recognized. Disease management has a significant impact on their financial budget and some respondents experienced barriers to obtain additional financial support. Discussion: Non-medical costs are not reimbursed, presenting a high burden to people. Self-management is tedious and hampered by other worries that people may have, such as financial constraints and coping with important life events. To conclude this study highlighted the need to improve diabetes screening. We suggest to enhance the role of paramedical professionals, integrate a social care worker, reduce financial constraints, and increase health literacy through more patient-centered, goal-oriented care. [ABSTRACT FROM AUTHOR]