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Responding to the increasing challenges to mental health equity, Talk It Out Counseling Clinic (the Clinic), an innovative, public-facing counselling service, was established at the University of Toronto during the pandemic. Operating on the principles of anti-oppression and trauma-informed care, the Clinic trains Master of Social Work students to deliver mental health counselling to populations encountering multiple barriers to mental health equity through phone or video. Guided by a quality improvement framework, this study used chart reviews to examine the demographic characteristics, initial mental health status and service utilisation of clients (N  =   116) who completed services at the Clinic during its inaugural year. Three-quarters of the clients identified as Black or other racialised individuals, and over 70 per cent rated their general mental health as poor or fair. Nearly 80 per cent of clients referred to the Clinic proceeded to an intake, amongst whom 69.6 per cent successfully completed the services. Warm handoff was associated with service engagement, whilist men and older clients were more likely to terminate the services prematurely. The study underscores the mental health needs of communities confronting multiple challenges and illuminates the processes conducive to client engagement and service delivery within an innovative, school-run mental health clinic. [ABSTRACT FROM AUTHOR]

Gay men have higher rates of psychological distress and greater dissatisfaction with mental health services than heterosexual men. Emerging adulthood is a vulnerable period representing a crucial period of sexual identity formation. Understanding of experiences during engagement with professional mental health services by gay men remains limited, especially in emerging adulthood. This study explored emerging adult gay men's experiences during their engagement with professional mental health help-seeking. In-depth semi-structured interviews were conducted with seven gay-identifying cisgender men. Data were analysed using reflexive thematic analysis. An overarching theme of perseverance was identified, with two themes of navigating anticipatory heterosexism and renegotiating pathology. Navigating anticipatory heterosexism included subthemes of selective disclosure and seeking "safe" practitioners. In renegotiating pathology, interviewees described delineating distress, thereby separating sexual identity from their mental health presentation, as well as normalising distress resulting from experiences of prejudice and minority stress. These themes encapsulate how participants reported navigating sexual identity-based challenges during the help-seeking process, thereby persevering and continuing with help-seeking. Results highlight how mental healthcare can be navigated and underscore the need to: 1) enhance signalling safety to sexually diverse client groups, and 2) increase practitioner cultural competency to reduce stigma or heterosexism in experiences of healthcare. What is already known about this topic: Gay men have higher rates of psychological distress than their heterosexual counterparts. Emerging adulthood is a particularly vulnerable period for mental health amongst sexual minorities. Gay men report greater dissatisfaction with mental healthcare than heterosexual men and encounter challenges when seeking professional mental health help. What this topic adds: Challenges encountered during the help-seeking process were navigated through self-advocacy in the form of renegotiating pathology. Emerging adult gay men reported managing anticipated heterosexism through appraising practitioners for 'safety' and selectively disclosing sexual identity. Results underscore the value of practitioner cultural competence training, signalling safety and engaging in culturally affirming practices. [ABSTRACT FROM AUTHOR]

Workplace-related factors are associated with the risk of depression. Despite implementation of workplace health promotion (WHP) programmes in China to promote the physical and mental well-being of workers, the relationship between WHP and depression has received limited attention. This study investigated the association between WHP service utilisation and depressive symptoms among workers. This was a cross-sectional survey. A researcher-designed questionnaire was used to collect information on socio-demographic and occupational characteristics, WHP service utilisation, and mental health status. The Lasso method was used for variable selection to achieve dimension reduction, and logistic regression was used to assess the association between WHP service utilisation and depressive symptoms. The analysis included 11,710 workers, of whom 17.0% had depressive symptoms. Lasso regression resulted in 6 of 18 WHP services showing significant negative associations with depressive symptoms, including occupational safety training, mental health services, health check-ups, sports activities, fitness rooms, and healthy canteens. The logistic regression results showed that, after adjusting for sociodemographic and occupational factors, utilisation of these six services was associated with a decreased likelihood of depressive symptoms. The adjusted odds ratio (aOR) was 0.84 (95% confidence interval [CI]: 0.73–0.96) for occupational safety training, aOR: 0.82 (95% CI: 0.68–0.99) for mental health services, aOR: 0.80 (95% CI: 0.71–0.90) for health check-ups, aOR: 0.68 (95% CI: 0.57–0.80) for sports activities, aOR: 0.59 (95% CI: 0.47–0.74) for fitness rooms and aOR: 0.72 (95% CI: 0.59–0.87) for healthy canteens. Utilisation of WHP services was associated with a lower prevalence of depressive symptoms. Implementation of WHP services and the provision of a supportive workplace environment should be prioritised to benefit the mental health of workers. [ABSTRACT FROM AUTHOR]

Copyright of China Journal of Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Early pregnancy losses [EPL] are common, varied, and require different courses of management and care. In the UK, women who suspect or suffer a pregnancy loss are usually provided specialist care in early pregnancy assessment units [EPAUs]. Their configuration has recently been evaluated, but recommendations for change in-line with best practice for optimum outcomes were unable to be implemented due to the COVID-19 pandemic health system shock. To compare women's experiences of EPAUs during the pandemic to themes previously found in qualitative work undertaken with women who utilised EPAUs before the pandemic. We conducted semi-structured virtual interviews, with women (N = 32) who suffered an early pregnancy loss during the pandemic; analysing transcripts using Template Analysis, based on findings about women's (pre-pandemic) experiences of EPAU from The VESPA Study. We report on seven key themes: Barriers to Accessing Services; Communication & Information; Retention of Relational Care; Involvement in Care Decisions; Staffs' Attitude or Approach; Efficiency of Service Delivery; Sensitive Patient Management. Sensitive patient management and woman-staff interactions in EPAU settings remain a fundamental issue. Women also reported their experiences of EPAUs were comparatively worse during the pandemic. Women valued the care provided by EPAUs and found services to be efficient, despite pandemic-related restrictions. However, psychological recognition surrounding EPL and appropriate, sensitive, relational care and support continue to be areas in need of improvement. Our recommendation is to implement the improvements suggested by VESPA as a priority to ameliorate present sub-optimal experiences and prevent further deterioration. [ABSTRACT FROM AUTHOR]

Abstract Background Improving access to facility-based delivery care has the potential to reduce maternal and newborn deaths across settings. Yet, the access to a health facility for childbirth remains low especially in low-income settings. To inform evidence-based interventions, more evidence is needed especially accounting for demand- and supply-side factors influencing access to facility-based delivery care. We aimed to fill this knowledge gap using data from Tanzania. Methods We used data from a cross-sectional survey (conducted in January 2012) of 150 health facilities, 1494 patients and 2846 households with women who had given births in the last 12 months before the survey across 11 districts in three regions in Tanzania. The main outcome was the place of delivery (giving birth in a health facility or otherwise), while explanatory variables were measured at the individual woman and facility level. Given the hierarchical structure of the data and variance in demand across facilities, we used a multilevel mixed-effect logistic regression to explore the determinants of facility-based delivery care. Results Eighty-six percent of 2846 women gave birth in a health facility. Demand for facility-based delivery care was influenced more by demand-side factors (76%) than supply-side factors (24%). On demand-side factors, facility births were more common among women who were educated, Muslim, wealthier, with their first childbirth, and those who had at least four antenatal care visits. On supply-side factors, facility births were more common in facilities offering outreach services, longer consultation times and higher interpersonal quality. In contrast, facilities with longer average waiting times, longer travel times and higher chances of charging delivery fees had few facility births. Conclusions Policy responses should aim for strategies to improve demand like health education to raise awareness towards care seeking among less educated groups and those with higher parity, reduce financial barriers to access (including time costs to reach and access care), and policy interventions to enhance interpersonal quality in service provision.

Background: Improving access to facility-based delivery care has the potential to reduce maternal and newborn deaths across settings. Yet, the access to a health facility for childbirth remains low especially in low-income settings. To inform evidence-based interventions, more evidence is needed especially accounting for demand- and supply-side factors influencing access to facility-based delivery care. We aimed to fill this knowledge gap using data from Tanzania. Methods: We used data from a cross-sectional survey (conducted in January 2012) of 150 health facilities, 1494 patients and 2846 households with women who had given births in the last 12 months before the survey across 11 districts in three regions in Tanzania. The main outcome was the place of delivery (giving birth in a health facility or otherwise), while explanatory variables were measured at the individual woman and facility level. Given the hierarchical structure of the data and variance in demand across facilities, we used a multilevel mixed-effect logistic regression to explore the determinants of facility-based delivery care. Results: Eighty-six percent of 2846 women gave birth in a health facility. Demand for facility-based delivery care was influenced more by demand-side factors (76%) than supply-side factors (24%). On demand-side factors, facility births were more common among women who were educated, Muslim, wealthier, with their first childbirth, and those who had at least four antenatal care visits. On supply-side factors, facility births were more common in facilities offering outreach services, longer consultation times and higher interpersonal quality. In contrast, facilities with longer average waiting times, longer travel times and higher chances of charging delivery fees had few facility births. Conclusions: Policy responses should aim for strategies to improve demand like health education to raise awareness towards care seeking among less educated groups and those with higher parity, reduce financial barriers to access (including time costs to reach and access care), and policy interventions to enhance interpersonal quality in service provision. [ABSTRACT FROM AUTHOR]

Abstract Background In Vietnam and many developing countries, private healthcare is increasingly being leveraged by governments to complement public services and increase health service access and utilisation. Extensive understanding of patterns of utilisation of private over public health services, and the rationale for such consumer decisions, is important to ensure and promote safe, affordable and patient-centred care in the two sectors. Few studies within the Southeast Asian Region have explored how private and public providers interact (via social networks, marketing, and direct contact) with consumers to affect their service choices. This study investigates providers’ views on social factors associated with the use of private over public health services in Vietnam. Method A thematic analysis was undertaken of 30 semi-structured interviews with experienced health system stakeholders from the Vietnam national assembly, government ministries, private health associations, health economic association, as well as public and private hospitals and clinics. Results Multiple social factors were found to influence the choice of private over public services, including word-of-mouth, the patient-doctor relationship and relationships between healthcare providers, healthcare staff attitudes and behaviour, and marketing. While private providers maximise their use of these social factors, most public providers seem to ignore or show only limited interest in using marketing and other forms of social interaction to improve services to meet patients’ needs, especially those needs beyond strictly medical intervention. However, private providers faced their own particular challenges related to over-advertisement, over-servicing, excessive focus on patients’ demands rather than medical needs, as well as the significant technical requirements for quality and safety. Conclusions This study has important implications for policy and practice in Vietnam. First, public providers must embrace social interaction with consumers as an effective strategy to improve their service quality. Second, appropriate regulations of private providers are required to protect patients from unnecessary treatments, costs and potential harm. Finally, the insights from this study have direct relevance to many developing countries facing a similar challenge of appropriately managing the growth of the private health sector.

Abstract Background Adolescents are vulnerable to sexual and reproductive health (SRH) risks yet, have poor utilisation of SRH services due to personal, social, and demographic influences. This study aimed to compare the experiences of adolescents that had received targeted adolescent SRH interventions and those that did not and evaluated the determinants of awareness, value perception, and societal support for SRH service utilisation among secondary school adolescents in eastern Nigeria. Methods We undertook a cross-sectional study of 515 adolescents in twelve randomly selected public secondary schools, grouped into schools that had received targeted adolescent SRH interventions and those that did not, across six local government areas in Ebonyi State, Nigeria. The intervention comprised training of schools’ teachers/counsellors and peer educators and community sensitisation and engagement of community gatekeepers for demand generation. A pre-tested structured questionnaire was administered to the students to assess their experiences with SRH services. Categorical variables were compared using the Chi-square test, and predictors were determined through multivariate logistic regression. The level of statistical significance was determined at p

Abstract Background The growing demands for multidisciplinary cancer survivorship care require new approaches to address the needs of people living after a cancer diagnosis. Good Life–Cancer Survivorship is a self-management support survivorship program delivered by community allied health (AH) services for people diagnosed with cancer. A pilot study established the benefits of Good Life–Cancer Survivorship to help survivors manage their health and wellbeing in the community health setting. This study expanded the program to four community health services and evaluated the implementation outcomes of the referral pathway to the survivorship program. Methods Eligible cancer survivors attending hospital oncology services were referred to the survivorship program. Data was collected between 19/02/2021-22/02/2022 and included allied health service utilisation, consumer surveys, and interviews to understand consumer experience with the referral pathway. Interviews and focus groups with hospital and community health professionals explored factors influencing the referral uptake. Implementation outcomes included Adoption, Acceptability, Appropriateness, Feasibility, and Sustainability. Results Of 35 eligible survivors (mean age 65.5 years, SD = 11.0; 56% women), 31 (89%) accepted the referral. Most survivors had two (n = 14/31; 45%) or more (n = 11/31; 35%) allied health needs. Of 162 AH appointments (median appointment per survivor = 4; range = 1–15; IQR:5), 142/162 (88%) were scheduled within the study period and 126/142 (89%) were attended. Consumers’ interviews (n = 5) discussed the referral pathway; continuation of survivorship care in community health settings; opportunities for improvement of the survivorship program. Interviews with community health professionals (n = 5) highlighted the impact of the survivorship program; cancer survivorship care in community health; sustainability of the survivorship program. Interviews (n = 3) and focus groups (n = 7) with hospital health professionals emphasised the importance of a trusted referral process; a holistic and complementary model of care; a person-driven process; the need for promoting the survivorship program. All evaluations favourably upheld the five implementation outcomes. Conclusions The referral pathway provided access to a survivorship program that supported survivors in self-management strategies through tailored community allied health services. The referral pathway was well adopted and demonstrated acceptability, appropriateness, and feasibility. This innovative care model supports cancer survivorship care delivery in community health settings, with clinicians recommending sustaining the referral pathway.

Aims: ADHD (attention‐deficit/hyperactivity disorder) affects 5% of children on average. Despite the high need to access services for ADHD treatment, not all children with ADHD utilise healthcare services equally. This study aims to systematically synthesise evidence of equity and equality in health service use/costs and health‐related quality of life (HRQoL)/wellbeing of children with ADHD across socioeconomic (SES) classes. Methods: The literature search was conducted across seven databases (Academic Search complete, MEDLINE Complete, PsycINFO, ERIC, Global Health, CINAHL and EconLit). The search was limited to peer‐reviewed articles published to 23rd January 2023 in English and focused on children. Study quality was assessed using the Critical Appraisal Skills Program (CASP), Joanna Briggs Institute (JBI) and Mixed Methods Appraisal Tool (MMAT) checklists. Results: 25 out of 1207 articles were eligible for inclusion. The results showed that SES was associated with different types of healthcare utilisation. Only three studies were found on HRQoL/well‐being. Children with ADHD from low SES families had lower HRQoL than children from high SES families. Conclusion: This study found that a social gradient exists in both healthcare service use and children's HRQoL among those with ADHD. [ABSTRACT FROM AUTHOR]

Background: In Vietnam and many developing countries, private healthcare is increasingly being leveraged by governments to complement public services and increase health service access and utilisation. Extensive understanding of patterns of utilisation of private over public health services, and the rationale for such consumer decisions, is important to ensure and promote safe, affordable and patient-centred care in the two sectors. Few studies within the Southeast Asian Region have explored how private and public providers interact (via social networks, marketing, and direct contact) with consumers to affect their service choices. This study investigates providers' views on social factors associated with the use of private over public health services in Vietnam. Method: A thematic analysis was undertaken of 30 semi-structured interviews with experienced health system stakeholders from the Vietnam national assembly, government ministries, private health associations, health economic association, as well as public and private hospitals and clinics. Results: Multiple social factors were found to influence the choice of private over public services, including word-of-mouth, the patient-doctor relationship and relationships between healthcare providers, healthcare staff attitudes and behaviour, and marketing. While private providers maximise their use of these social factors, most public providers seem to ignore or show only limited interest in using marketing and other forms of social interaction to improve services to meet patients' needs, especially those needs beyond strictly medical intervention. However, private providers faced their own particular challenges related to over-advertisement, over-servicing, excessive focus on patients' demands rather than medical needs, as well as the significant technical requirements for quality and safety. Conclusions: This study has important implications for policy and practice in Vietnam. First, public providers must embrace social interaction with consumers as an effective strategy to improve their service quality. Second, appropriate regulations of private providers are required to protect patients from unnecessary treatments, costs and potential harm. Finally, the insights from this study have direct relevance to many developing countries facing a similar challenge of appropriately managing the growth of the private health sector. [ABSTRACT FROM AUTHOR]

Background Public stigma and fear are heightened in cases of extreme violence perpetrated by persons with serious mental illness (SMI). Prevention efforts require understanding of illness patterns and treatment needs prior to these events unfolding. Aims To examine mental health service utilisation by persons who committed homicide and entered into forensic care, to investigate the adequacy of mental healthcare preceding these offences. Method Forensic patients across two mental health hospitals in Ontario with an admitting offence of homicide between 2011 and 2021 were identified (n = 112). Sociodemographic, clinical and offence-related variables were coded from the health record and reports prepared for the forensic tribunal. Results Most patients (75.7%) had mental health contacts preceding the homicide, with 28.4% having a psychiatric in-patient admission in the year prior. For those with service contacts in the year preceding, 50.9% had had only sporadic contact and 70.7% were non-adherent with prescribed medications. Victims were commonly known to the individual (35.7%) and were often family members in care-providing roles (55.4%). Examination of age at onset of illness and offending patterns suggested that most persons admitted to forensic care for homicide act in the context of illness and exhibit a low frequency of pre-homicide offending. Conclusions Many individuals admitted to forensic care for homicide have had inadequate mental healthcare leading up to this point. Effective responses to reduce and manage risk should encompass services that proactively address illness-related (e.g. earlier access and better maintenance in care) and criminogenic (e.g. substance use treatment, employment and psychosocial supports) domains.

Objective: In 2014, the Primary Care Plus (PC+) model was introduced in the Netherlands to shift low-complex specialised care from the hospital to the primary care setting. While positive effects of PC+ have been documented at individual patient level concerning health-related quality of life, perceived quality of care and care costs, its impacts on service use at the population level remain uncertain. Methods: In this observational study, we used retrospective health insurance reimbursement claims data from the largest health insurer in the intervention region to determine service use. We assessed PC+ and secondary care insurance claims (i.e. claims of the regional hospital and claims of other secondary care settings in and outside the region visited by patients from the intervention region) from 2015 to 2018 and compared these to the national level. Results: The total number of claims related to low-complex specialised care in the intervention region showed an increase over time. The increase in claims was related to PC+. The number of claims related to the regional hospital and other secondary care settings decreased over time. During the same period, a declining trend in claims at the national level was observed. Conclusion: The introduction of the PC+ model in one region in the Netherlands was associated with an increase in the use of low-complex specialised care. This suggests that the ability of the PC+ model to substitute for specialist care at population level may be limited. Going forward, it will be important to continue monitoring and evaluating service use as substitution effects may materialise only over a longer timeframe. [ABSTRACT FROM AUTHOR]

Background: Adolescents are vulnerable to sexual and reproductive health (SRH) risks yet, have poor utilisation of SRH services due to personal, social, and demographic influences. This study aimed to compare the experiences of adolescents that had received targeted adolescent SRH interventions and those that did not and evaluated the determinants of awareness, value perception, and societal support for SRH service utilisation among secondary school adolescents in eastern Nigeria. Methods: We undertook a cross-sectional study of 515 adolescents in twelve randomly selected public secondary schools, grouped into schools that had received targeted adolescent SRH interventions and those that did not, across six local government areas in Ebonyi State, Nigeria. The intervention comprised training of schools' teachers/counsellors and peer educators and community sensitisation and engagement of community gatekeepers for demand generation. A pre-tested structured questionnaire was administered to the students to assess their experiences with SRH services. Categorical variables were compared using the Chi-square test, and predictors were determined through multivariate logistic regression. The level of statistical significance was determined at p < 0.05 and a 95% confidence limit. Results: A higher proportion of adolescents in the intervention group, 126(48%), than in the non-intervention group, 35(16.1%), were aware of SRH services available at the health facility (p-value < 0.001). More adolescents in the intervention than the non-intervention group perceived SRH services as valuable– 257(94.7%) Vs 217(87.5%), p-value = 0.004. Parental/community support for SRH service utilisation was reported by more adolescents in the intervention group than in the non-intervention group- 212 (79.7%) Vs 173 (69.7%), p-value = 0.009. The predictors are (i) awareness-intervention group (β = 0.384, CI = 0.290–0.478), urban residence (β=-0.141, CI=-0.240-0.041), older age (β-0.040, CI = 0.003–0.077) (ii) value perception - intervention group (β = 0.197, 0.141–0.253), senior educational class (β = 0.089, CI = 0.019–0.160), work-for-pay (β=-0.079, CI=-0.156–0.002), awareness (β = 0.192, CI = 0.425–0.721) (iii) parental/community support - work-for-pay (β = 0.095, CI = 0.003–0.185). Conclusions: Adolescents' awareness, value perception, and societal support for sexual and reproductive health services were influenced by the availability of SRH interventions and socio-economic factors. Relevant authorities should ensure the institutionalisation of sex education in schools and communities, targeting various categories of adolescents, to reduce disparity in the utilisation of sexual and reproductive health services and promote adolescents' health. [ABSTRACT FROM AUTHOR]

Background: The growing demands for multidisciplinary cancer survivorship care require new approaches to address the needs of people living after a cancer diagnosis. Good Life–Cancer Survivorship is a self-management support survivorship program delivered by community allied health (AH) services for people diagnosed with cancer. A pilot study established the benefits of Good Life–Cancer Survivorship to help survivors manage their health and wellbeing in the community health setting. This study expanded the program to four community health services and evaluated the implementation outcomes of the referral pathway to the survivorship program. Methods: Eligible cancer survivors attending hospital oncology services were referred to the survivorship program. Data was collected between 19/02/2021-22/02/2022 and included allied health service utilisation, consumer surveys, and interviews to understand consumer experience with the referral pathway. Interviews and focus groups with hospital and community health professionals explored factors influencing the referral uptake. Implementation outcomes included Adoption, Acceptability, Appropriateness, Feasibility, and Sustainability. Results: Of 35 eligible survivors (mean age 65.5 years, SD = 11.0; 56% women), 31 (89%) accepted the referral. Most survivors had two (n = 14/31; 45%) or more (n = 11/31; 35%) allied health needs. Of 162 AH appointments (median appointment per survivor = 4; range = 1–15; IQR:5), 142/162 (88%) were scheduled within the study period and 126/142 (89%) were attended. Consumers' interviews (n = 5) discussed the referral pathway; continuation of survivorship care in community health settings; opportunities for improvement of the survivorship program. Interviews with community health professionals (n = 5) highlighted the impact of the survivorship program; cancer survivorship care in community health; sustainability of the survivorship program. Interviews (n = 3) and focus groups (n = 7) with hospital health professionals emphasised the importance of a trusted referral process; a holistic and complementary model of care; a person-driven process; the need for promoting the survivorship program. All evaluations favourably upheld the five implementation outcomes. Conclusions: The referral pathway provided access to a survivorship program that supported survivors in self-management strategies through tailored community allied health services. The referral pathway was well adopted and demonstrated acceptability, appropriateness, and feasibility. This innovative care model supports cancer survivorship care delivery in community health settings, with clinicians recommending sustaining the referral pathway. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Adolescents are reported to be the fastest growing population at risk for intimate partner violence, and yet very few seek help, and those who do are more likely to turn to friends and family before, if at all, professional sources such as the police, mental health practitioners, social workers, health professionals and teachers. Research on refugee-background adolescents is scant despite their growing presence in migration flows to Australia and other western resettlement countries. This article reports on a qualitative investigation of help-seeking among young women from refugee backgrounds who had experienced partner violence during adolescence. Interview and focus group data were obtained from 17 cisgender young women and five helping professionals. Very few participants voluntarily sought professional help during or after a violent relationship due to a range of individual, interpersonal and sociocultural influences. Prevention and intervention efforts should be anchored in a nuanced understanding of the contexts of partner violence for this population group as well as sensitivity to how disclosure and help-seeking may be influenced by age and developmental stage, cultural background, acculturation, and access to support services. What is already known about this topic: Adolescent partner violence is an important public health problem with significant physical, psychological, and social consequences for adolescents. Preliminary research, mainly from the US, reports that very few adolescents seek professional help when violence occurs. Although adolescents consistently account for a large proportion of the humanitarian intake in Australia, the US and other western resettlement countries, they are underrepresented in research. What this topic adds: This study sheds light on the individual, interpersonal and sociocultural contexts of help-seeking for partner violence in an under-researched population group. Very few participants voluntarily sought professional help during or after a violent relationship. Barriers corresponded with, and diverged from, those reported for adolescents in the general adolescent population. Recommendations are made to enhance the developmental and cultural fit of interventions designed for adolescents. [ABSTRACT FROM AUTHOR]

Objective: To investigate the Australian general public's perception of appropriate medical scenarios that warrants a call to an emergency ambulance. Methods: An online survey asked participants to identify the likely medical treatment pathway they would take for 17 hypothetical medical scenarios. The number and type of nonemergency scenarios (n = 8) participants incorrectly suggested were appropriate to place a call for an emergency ambulance were calculated. Participants included Australian residents (aged >18 years) who had never worked as an Australian registered medical doctor, nurse or paramedic. Results: From a sample of 5264 participants, 40% suggested calling an emergency ambulance for a woman in routine labour was appropriate. Other medical scenarios which were most suggested by participants to warrant an emergency ambulance call was 'Lego in ear canal' (11%), 'Older person bruising' (8%) and 'Flu' (7%). Women, people aged 56+ years, those without a university qualification, with lower household income and with lower emotional wellbeing were more likely to suggest calling an emergency ambulance was appropriate for nonemergency scenarios. Conclusions: Although emergency healthcare system (EHS) capacity not increasing at the same rate as demand is the biggest contributor to EHS burden, non-urgent medical situations for which other low-acuity healthcare pathways may be appropriate does play a small role in adding to the overburdening of the EHS. This present study outlines a series of complaints and demographic characteristics that would benefit from targeted educational interventions that may aid in alleviating ambulance service attendances to low-acuity callouts. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to assess the perception about palliative care and factors influencing the likelihood of palliative care service utilisation among adult cancer patients in Tikur Anbessa Specialized Hospital, Ethiopia, 2019. Methods: A facility‐based cross‐sectional study was conducted among 304 systematically selected adult cancer patients receiving palliative care service in Tikur Anbessa Specialized Hospital, Ethiopia. A multivariable binary logistic regression model was carried out to identify the independent factors associated with palliative care service utilisation, and P‐value < 0.05 was used to declare statistical significance. Results: One hundred thirty (42.8%) adult cancer patients utilise the available palliative care service in the hospital, and those who earn monthly income ≥$52.35 (AOR = 2.36, 95% CI 1.37,4.06) and those who have family members of more than two (AOR = 2.28, 95% CI 1.02,5.13) were associated with higher utilisation, but being a governmental employee and having formal schooling were the factors negatively associated with palliative care service utilisation with (AOR = 0.42, 95% CI 0.20, 0.87) and (AOR = 0.51, 95% CI 0.23, 0.94), respectively. Conclusions: A significant number of cancer patients were not utilising palliative care services, and higher monthly income and having more than two family members were the factors strongly associated with higher palliative care service utilisation. [ABSTRACT FROM AUTHOR]

Accessibility of health services outside metropolitan centres in Australia is sub‐optimal. Recognising the barriers and enablers of healthcare access in rural, remote and regional settings is necessary to improving health service access in these disadvantaged populations. Accordingly, this study aimed to examine the determinants of healthcare use in rural, remote and regional South Australia. Cross‐sectional survey data were collected from adults living outside metropolitan Adelaide in South Australia between April 2017 and March 2018. Using a multi‐modal recruitment campaign, eligible adults were invited to complete the 44‐item consumer utilisation, expectations and experiences of healthcare instrument. Independent predictors of health service utilisation (dependent variable) were determined using negative binomial regression. The questionnaire was completed by 3926 predominantly female (52.5%) adults aged ≥50 years (56.7%), residing in regional South Australia (84.5%). Fifteen independent variables were significantly associated with health service utilisation using univariate analyses. Using negative binomial regression analysis, two predisposing factors (sex, remoteness), three enabling factors (income, health literacy, employment), two need factors (health rating, multimorbidity) and two personal health practices (alcohol, diet) were independently and significantly associated with healthcare use. Female sex (OR = 1.436, p < 0.001), good/excellent health rating (OR = 0.589, p < 0.001) and high multimorbidity (OR = 1.408, p < 0.001) were the strongest predictors of health service use. These findings will help inform the development of targeted health promotion and service engagement strategies for regional populations, which in addition to addressing workforce shortages, may help address inequity in health outcomes, particularly for groups engaging with regional healthcare services infrequently. [ABSTRACT FROM AUTHOR]

Although mental health (MH) services and psychological support are tailored to fit the MH needs of those requiring these services in the UK, underutilisation persists. Current evidence suggests that ethnic minorities underutilise MH services with culture implicated in this trend. However, there is limited evidence from systematic reviews integrating the findings of primary studies on the role of culture in MH service utilisation among ethnic minorities. This review aims to synthesise and summarise evidence on the role of culture in MH service utilisation among ethnic minorities in the UK. Two reviewers searched CINAHL, APA PsycINFO and Medline databases using the Preferred Reporting Items for Systematic Review and Meta-Analysis. Two other reviewers screened the abstracts and full text, while three conducted data extraction and assessed study quality using the Critical Appraisal Skills Programme checklist for qualitative studies. One's culture was repeatedly identified to play a role in MH service utilisation among the ethnic minorities in the UK. The impact of cultural factors on service utilisation was through its effects on structure/institution, beliefs, stigma and perception of service. In addition, discrimination and other racism-related negative experiences during service use were found to inform perception and use of MH services. These findings suggest that MH services should be tailored to cultural differences to optimise service utilisation.

Objective Older adults are vulnerable to isolation and poor emotional wellbeing during COVID-19, however, their access to appropriate supports is unknown. The aim of this study was to explore older adults’ experiences accessing social and emotional support during the COVID-19 pandemic in Australia. Method Ten older adults from Western Australia (Australia) aged 68 to 78 years participated in individual semi-structured interviews between December 2020 and January 2021. Responses were investigated using thematic analysis. Results Three key themes emerged: adaptability and self-sufficiency; informal support-seeking; and digital and online technologies. Older adults were adaptable to COVID-19 restrictions; however, some were anxious about reconnecting with their social networks once restrictions had eased. Older adults relied on their informal support networks to maintain their social and emotional wellbeing during lockdown. Digital platforms (e.g., Zoom, social media) enabled older adults to stay connected with others, yet some older people were unable or reluctant to use technology, leaving them vulnerable to social isolation. Conclusions Older adults are resilient to the challenges of COVID-19. Informal supports and digital technologies are important to maintaining social and emotional wellbeing during lockdown. Local governments and community groups may benefit from increased funding to deliver services that promote social connectedness during times of crisis.

Women from a refugee background suffer higher psychological distress levels than men with a refugee background. Conceptualisation of mental health plays an important role in using mental health services for people from refugee groups. The purpose of this review is to synthesize literature describing how Middle Eastern refugee women perceive mental health and its influence on mental health service utilisation. The review is registered with Prospero, and we conducted an analysis that complies with PRISMA guidelines and identified 8 relevant documents, including 6 peer-reviewed papers, and two dissertations. The findings of four qualitative, three mixed-method, and one quantitative studies were synthesized through data extraction and thematic analysis. Based on the findings, cultural beliefs, values, and expressions play a critical role in understanding mental health. These included: (a) culturally influenced idioms of distress in conceptualising mental health (b) the role of stigma in mental health perception and service utilisation. (c) a preferred method such as professional services or lay techniques including prayer and social support for mental health treatment. The discussion section contextualizes and examines these key themes to consider how a better understanding of mental health can be used to support the development of programs and policies to increase the use of mental health services by individuals from a refugee background. This may, in the end, lead to reduced burdens of diseases related to mental health among those seeking asylum or seeking refugee status.

Over the past 40 years, successive Australian Governments have developed a comprehensive programme of settlement services (SS) designed to improve settlement outcomes for humanitarian migrants. Many humanitarian migrants do not arrive with the appropriate skills and abilities to fully benefit from available SS. "Settlement services literacy" (SSL) has been proposed as a framework to contextualise factors that may enable or constrain humanitarian migrants' utilisation of SS. The aim of this study was to investigate the provision of SS in relation to SSL, that is humanitarian migrants' ability to effectively access information and services, to critically assess services, and to politically mobilise and effect change. Qualitative interviews were conducted with 26 service providers representing 19 organisations in Greater Western Sydney (n = 8) and Melbourne (n = 11). The study found that SS programmes address many of the indicators that promote SSL acquisition. However, this is not achieved systematically, nor do the programmes reflect all indicators across the three SSL levels. This study provides new insights into various factors impacting the effectiveness of SS provision and SSL acquisition. These insights can inform future programme policy reforms and contribute to more effective and responsive service systems that meet the diverse and complex needs of humanitarian migrants. [ABSTRACT FROM AUTHOR]

Purpose: To identify parameters associated with the downward trend in the uptake of Low Vision Services (LVS) in the Netherlands. Methods: A retrospective cohort study was conducted based on a Dutch national health insurance claims database (Vektis CV) of all adults (≥18 years) who received LVS from 2015 until 2018. Descriptive statistics were used to assess socio‐demographic, clinical and contextual characteristics and other healthcare utilisation of the study population. General estimating equations trends in characteristics and healthcare utilisation were determined over time. Results: A total of 49,726 unique patients received LVS, but between 2015 and 2018, the number of patients decreased by 15%. The majority was aged 65 years or older (53%), female (54%), had a middle (38%) or low (24%) socio‐economic status and lived in urban areas (68%). Between 2015–2018, significant downward trends were found for treatment with intravitreal injections and lens‐related diseases for LVS patients. For physical comorbidity, utilisation of ophthalmic care, low vision aids and occupational therapy, a significant upward trend was found over time. Conclusion: The decrease of Dutch LVS patients by 15% between 2015 and 2018 might be explained by a reduced distribution of patients treated with intravitreal injections and patients with lens‐related diseases within the LVS. Compared to 2015, patients were more likely to have physical comorbidity, to see an ophthalmologist and to use low vision aids and occupational therapy in 2016, 2017 and 2018. This might indicate enhanced access to LVS when treated by ophthalmologists or within other medical specialties, or the opposite, i.e., less access when not treated within one of these medical specialties. Future research is needed to examine differences in patterns between LVS users and non‐users further. [ABSTRACT FROM AUTHOR]

Objective: Existing evidence on factors associated with community treatment order placement is largely restricted to administrative data. We utilised the data from a large nationally representative sample to compare the demographic, clinical, social functioning, substance use and service utilisation profiles of people living with psychosis under community treatment orders with those who were not. Methods: Participants were grouped based on whether they had been subject to a community treatment order in the past 12 months or not. We conducted logistic regressions to examine demographic, clinical, social functioning, substance use and service utilisation profiles associated with the two groups. Results: People who had recently been subject to community treatment orders were more likely to be treated with long-acting injectable antipsychotics and lacked insight but were less likely to report suicidal ideation. They also had higher psychiatric inpatient admission rates but a lower frequency of general practitioner visits. Conclusion: People on community treatment orders in Australia may differ from those who are not under a community treatment order in their treatment needs. Resources and care provision must match the needs of this particularly vulnerable group. [ABSTRACT FROM AUTHOR]

Summary: This detailed 11-year longitudinal analysis calculated the public health cost of managing refractures in people aged ≥ 50 years in Australia's most populous state. It provides current and projected statewide health system costs associated with managing osteoporosis and provides a foundation to evaluate a novel statewide model of fracture prevention. Purpose: The purpose of this longitudinal analysis was to calculate current and projected refracture rates and associated public hospital utilisation and costs in New South Wales (NSW), Australia. These results will be used to inform scaled implementation and evaluation of a statewide Osteoporotic Refracture Prevention (ORP) model of care. Methods: Linked administrative data (inpatient admissions, outpatient attendances, Emergency Department presentations, deaths, cost) were used to calculate annual refracture rates and refracture-related service utilisation between 2007 and 2018 and healthcare costs between 2008 and 2019. Projections for the next decade were made using 'business-as-usual' modelling. Results: Between 2007 and 2018, 388,743 people aged ≥ 50 years experienced an index fracture and 81,601 had a refracture. Refracture was more common in older people (rising from a cumulative refracture rate at 5 years of 14% in those aged 50–64 years, to 44% in those aged > 90 years), women with a major index fracture (5-year cumulative refracture rate of 26% in females, compared to 19% for males) or minimal trauma index fracture and those with an osteoporosis diagnosis (5-year cumulative refracture rate of 36% and 22%, respectively in those with and without an osteoporosis diagnosis). Refractures increased from 8774 in 2008 to 14,323 in 2018. The annual cost of refracture to NSW Health increased from AU$130 million in 2009 to AU$194 million in 2019. It is projected that, over the next decade, if nothing changes, 292,537 refracture-related hospital admissions and Emergency Department presentations and 570,000 outpatient attendances will occur, at an estimated total cost to NSW Health of AU$2.4 billion. Conclusion: This analysis provides a detailed picture of refractures and associated projected service utilisation and costs over the next decade in Australia's most populous state. Understanding the burden of refracture provides a foundation for evaluation of a novel statewide ORP model of care to prevent refractures in people aged ≥ 50 years. [ABSTRACT FROM AUTHOR]

This study examines whether routine, low‐cost service use changes in the transition from homelessness to permanent supportive housing (PSH) and explores whether housing model, neighbourhood and level of case management engagement affect utilisation of routine services. Data come from a prospective longitudinal study of adults experiencing homelessness who entered PSH in Los Angeles between 2014 and 2016 and participated in four interviews: pre‐housing (i.e., while experiencing homelessness), and 3, 6 and 12 months after move‐in. Mixed effects logistic regression assessed the effects of demographics, case management, housing model and neighbourhood location on service utilisation at each time point across five domains: basic needs, financial, educational, mental health and physical health. Longitudinal unmet need for services and onsite service use contextualised findings. Service utilisation significantly decreased at each time point in the domains of basic needs, financial and mental health. Neighbourhood was significantly associated with basic needs and mental health service use, while housing model was associated with financial service utilisation. Case management was associated with all service use outcomes with all relationships demonstrating more case management visits was associated with greater odds of routine service utilisation. Unmet service needs were consistent over time. Onsite service utilisation was low across all residents. Results indicate that routine service use declines with length of tenancy while unmet need for services remain prevalent. Case management appears to be critical in facilitating routine service use, while the housing environment should be considered to ensure residents have accessible and proximal routine care. [ABSTRACT FROM AUTHOR]

Older adults are vulnerable to isolation and poor emotional wellbeing during COVID-19, however, their access to appropriate supports is unknown. The aim of this study was to explore older adults' experiences accessing social and emotional support during the COVID-19 pandemic in Australia. Ten older adults from Western Australia (Australia) aged 68 to 78 years participated in individual semi-structured interviews between December 2020 and January 2021. Responses were investigated using thematic analysis. Three key themes emerged: adaptability and self-sufficiency; informal support-seeking; and digital and online technologies. Older adults were adaptable to COVID-19 restrictions; however, some were anxious about reconnecting with their social networks once restrictions had eased. Older adults relied on their informal support networks to maintain their social and emotional wellbeing during lockdown. Digital platforms (e.g., Zoom, social media) enabled older adults to stay connected with others, yet some older people were unable or reluctant to use technology, leaving them vulnerable to social isolation. Older adults are resilient to the challenges of COVID-19. Informal supports and digital technologies are important to maintaining social and emotional wellbeing during lockdown. Local governments and community groups may benefit from increased funding to deliver services that promote social connectedness during times of crisis. What is already known about this topic: (1) Older adults are vulnerable to social isolation and poor mental health during COVID-19. (2) Older adults are less likely to seek and receive help for their emotional and social health than younger age groups. (3) Barriers to accessing appropriate supports include physical health problems, stigma, negative attitudes towards help-seeking and system-level factors. What this topic adds: (1) Older adults were able to adapt well to COVID-19 restrictions and relied on informal supports to maintain their wellbeing. (2) Older adults with limited social networks and poor access to and/or knowledge of digital technologies are at the greatest risk of social and emotional declines. (3) Telephone "warm" lines, volunteering opportunities, and programs to improve digital literacy may help to protect older adults' social and emotional wellbeing during times of crises. [ABSTRACT FROM AUTHOR]

Abstract Background The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh. Methods This study was conducted from December 2017 to November 2018. Three intervention and three control CCs were selected from Chakaria, a rural sub-district of Bangladesh. CSC was introduced with the Community Groups and Community Support Groups in intervention CCs between January to October 2018. Data were collected through observation of CCs during operational hours, key informant interviews, focus group discussions, and from DHIS2. Utilisation of CC services was compared between intervention and control areas, pre and post CSC intervention. Results Post CSC intervention, community awareness about CC services, utilisation of clinic operational hours, and accountability of healthcare providers have increased in the intervention CCs. Utilisation of primary healthcare services including family planning services, antenatal care, postnatal care and basic health services have significantly improved in intervention CCs. Conclusion CSC is an effective tool to increase the service utilization provided by CCs by ensuring community awareness and participation, and service providers’ accountability. Policy makers and concerned authorities may take necessary steps to integrate community scorecard in the health system by incorporating it in CCs.

Background: An Aboriginal-developed empowerment and social and emotional wellbeing program, known as Family Wellbeing (FWB), has been found to strengthen the protective factors that help Indigenous Australians to deal with the legacy of colonisation and intergenerational trauma. This article reviews the research that has accompanied the implementation of the program, over a 23 year period. The aim is to assess the long-term impact of FWB research and identify the key enablers of research impact and the limitations of the impact assessment exercise. This will inform more comprehensive monitoring of research impact into the future. Methods: To assess impact, the study took an implementation science approach, incorporating theory of change and service utilisation frameworks, to create a logic model underpinned by Indigenous research principles. A research impact narrative was developed based on mixed methods analysis of publicly available data on: 1) FWB program participation; 2) research program funding; 3) program outcome evaluation (nine studies); and 4) accounts of research utilisation (seven studies). Results: Starting from a need for research on empowerment identified by research users, an investment of $2.3 million in research activities over 23 years produced a range of research outputs that evidenced social and emotional wellbeing benefits arising from participation in the FWB program. Accounts of research utilisation confirmed the role of research outputs in educating participants about the program, and thus, facilitating more demand (and funding acquisition) for FWB. Overall research contributed to 5,405 recorded participants accessing the intervention. The key enablers of research impact were; 1) the research was user- and community-driven; 2) a long-term mutually beneficial partnership between research users and researchers; 3) the creation of a body of knowledge that demonstrated the impact of the FWB intervention via different research methods; 4) the universality of the FWB approach which led to widespread application. Conclusions: The FWB research impact exercise reinforced the view that assessing research impact is best approached as a "wicked problem" for which there are no easy fixes. It requires flexible, open-ended, collaborative learning-by-doing approaches to build the evidence base over time. Steps and approaches that research groups might take to build the research impact knowledge base within their disciplines are discussed. [ABSTRACT FROM AUTHOR]

Although mental health (MH) services and psychological support are tailored to fit the MH needs of those requiring these services in the UK, underutilisation persists. Current evidence suggests that ethnic minorities underutilise MH services with culture implicated in this trend. However, there is limited evidence from systematic reviews integrating the findings of primary studies on the role of culture in MH service utilisation among ethnic minorities. This review aims to synthesise and summarise evidence on the role of culture in MH service utilisation among ethnic minorities in the UK. Two reviewers searched CINAHL, APA PsycINFO and Medline databases using the Preferred Reporting Items for Systematic Review and Meta-Analysis. Two other reviewers screened the abstracts and full text, while three conducted data extraction and assessed study quality using the Critical Appraisal Skills Programme checklist for qualitative studies. One's culture was repeatedly identified to play a role in MH service utilisation among the ethnic minorities in the UK. The impact of cultural factors on service utilisation was through its effects on structure/institution, beliefs, stigma and perception of service. In addition, discrimination and other racism-related negative experiences during service use were found to inform perception and use of MH services. These findings suggest that MH services should be tailored to cultural differences to optimise service utilisation. [ABSTRACT FROM AUTHOR]

Older adults' mental health problems are a growing public health concern, especially because their rate of mental health service use is particularly low. Decades of mental health service utilisation models have been developed, yet key assumptions from these models focus primarily on factors that facilitate or inhibit access into the treatment system without taking into considering the dynamics of how individuals respond to their mental health problems and engage in service utilisation. More recently, dynamic models like the Network Episode Model (NEM-II) have been developed to challenge the underlying, rational choice assumption of traditional utilisation models. Given the multifaceted and complex nature of older adults' mental health problems, the objective of this study was to examine whether the NEM-II is a helpful and appropriate model for understanding the dynamic process of how older adults navigate the mental health system, including factors that advanced and delayed help-seeking. Our qualitative analyses from 15 interviews with older adults revealed that their backgrounds, social supports and treatment systems influence, and are influenced by, their illness careers. Factors that delayed help-seeking included: a lack of support, 'inappropriate' referrals/advice from treatment professionals and poor mental health literacy. This research suggests the NEM-II is a helpful and appropriate theory for understanding older adults' pathways to treatment, and has implications to enhance older adults' access to psychological services. [ABSTRACT FROM AUTHOR]

The present study is the first to investigate factors influencing professional mental health support seeking in Women of Refugee Background (WoRB) in Australia. WoRB are a vulnerable population with a range of complex mental health needs. Despite this, research has indicated that WoRB are an underrepresented population in the utilisation of mental health support services. This is a particular concern in Australia, due to an increasing number of WoRB being resettled. A multivariate logistical regression was conducted on a sample of 450 WoRB resettled in Australia from the Building a New Life in Australia (BNLA) data set to investigate factors associated with seeking professional mental health support. Several factors were identified as being significantly associated with professional mental health support seeking in WoRB resettled in Australia, including age, resettlement location, marital status, prearrival trauma involving violence against women, language barriers and health‐related variables, including mental distress and long‐term disability. The current study provides a unique insight into professional mental health support seeking from a gendered perspective in WoRB resettled in Australia. Insights into factors that influence seeking professional mental health support in this highly vulnerable population must inform mental health practice, service delivery and policies. [ABSTRACT FROM AUTHOR]

Abstract Background The Maternal and Child Health (MCH) handbook is an integrated home-based record (HBR) designed to record in a single document all the information regarding health services provided to a pregnant woman and her child. The MCH handbook has the potential to support continuity of care which is key to strengthening maternal, newborn and child health. However, there is a lack of an integrated system to manage the health of pregnant women and young children on an ongoing basis in Angola. Thus, the Angolan Ministry of Health is partnering with the Japan International Cooperation Agency to build the capacity of healthcare providers through trainings and implementation of the MCH handbook to improve service utilisation. In this study, we will estimate the impact of an intervention package including distribution of MCH handbook and its supplementary interventions to women, on the utilisation of services provided at healthcare facilities from pregnancy through the postnatal and early childhood period. Methods This study is a cluster randomised controlled trial involving public healthcare facilities across all the municipalities located in Benguela Province, Angola. All women who go to participating healthcare facilities and with confirmed pregnancy around the beginning of the trial period will be included in the study. Women will be randomised according to the municipality where their primary maternity and/or childcare services are located. The intervention package will consist of MCH handbook distribution at all public healthcare facilities, MCH handbook utilisation training for healthcare providers and community mobilisation for women on the use of the MCH handbook. The intervention will be administered to all women in the intervention arm while those in the control arm will continue the traditional use of two stand-alone HBRs. The primary outcome measure for this study is to compare the proportion of women who achieve a complete continuum of care in both study arms. Discussion The findings from the study are expected to form a basis for revising the current trial version of the Angola MCH handbook and provide a framework for policy guiding nationwide scale-up and distribution of the MCH handbook. Trial registration ISRCTN Registry ISRCTN20510127 . Registered on 4 June 2019

(1) Background: Lower socioeconomic status increases psychiatric service use, exacerbated during the COVID-19 pandemic by environmental stressors like air pollution and limited green spaces. This study aims to assess the influence of sociodemographic and environmental factors on mental health service utilisation. (2) Methods: This retrospective study uses an administrative database focusing on community mental health services in Northeast Italy. Spatial and temporal analyses were used to address space-time dependencies. (3) Results: Findings showed that sociodemographic factors like living in rented apartments and lower education levels predicted higher mental health service use. Environmental factors, such as elevated NO 2 levels and, before the pandemic, lower solar radiation and tree cover, correlated with increased service utilisation. COVID-19 reduced most of the pre-existing differences associated with these factors across census blocks with a different composition of sociodemographic and environmental factors. (4) Conclusions: These findings contribute to a better understanding of the impact of the environment on public mental health., Competing Interests: The authors declare no conflicts of interest.

The COVID‐19 pandemic is expected to have profound effects on healthcare systems, but little evidence exists on service provision, utilisation, or adaptations. This study aimed to (1) examine the changes to health and nutrition service delivery and utilisation in urban Bangladesh during and after enforcement of COVID‐19 restrictions and (2) identify adaptations and potential solutions to strengthen delivery and uptake. We conducted longitudinal surveys with health care providers (n = 45), pregnant women (n = 40), and mothers of children <2 years (n = 387) in February 2020 (in‐person) and September 2020 (by phone). We used Wilcoxon matched‐pairs signed‐rank tests to compare the changes before and during the pandemic. Services delivery for women and children which require proximity were severely affected; weight and height measurements fell by 20–29 percentage points (pp) for pregnant women and 37–57 pp for children, and child immunisations fell by 38 pp. Declines in service utilisation were large, including drops in facility visitations (35 pp among pregnant women and 67 pp among mothers), health and nutrition counselling (up to 73 pp), child weight measurements (50 pp), and immunisations (61 pp). The primary method of adaptation was provision of services over phone (37% for antenatal care services, 44%–49% for counselling). Despite adaptations to service provision, continued availability of routine maternal and child health services did not translate into service utilisation. Further investments are needed to provide timely and accurate information on COVID‐19 to the general public, improve COVID‐19 training and provide incentives for health care providers and ensure availability of personal protective equipment for providers and beneficiaries. [ABSTRACT FROM AUTHOR]

Introduction: sub-Saharan African countries contribute substantially to the global HIV disease burden. Despite this burden, and the promises that prevention could deliver, the implementation and uptake of HIV prevention programmes are still low. The study used the decision support system model to explore the potential impacts of prevention implementation on HIV burden (incidence) and service delivery. Methods: an operational research technique known as discrete event simulation model was used to capture an individual patient's pathways through the HIV care process from diagnosis to treatment and monitoring. The regular monitoring, over a 5-year period, including all the activities and resources utilized at each stage of the pathway were analysed, and the impact of increasing prevention measures for an HIV treatment service in a treatment centre in Nigeria was tested using the simulation model. Results: forty-three patients currently access the Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) annually, with a 20% and 80% split in the number of patients offered PrEP and PEP, respectively. Scenarios-based on increasing the number of people offered PrEP and PEP from 43 to 250 with a 50/50 split were tested. The outputs revealed improved preventive care by averting new HIV cases, reduction in service demand and utilization, but an increase in the required human resource as well as financial burden. In the next 5 years, the cumulative averted HIV cases are expected to increase from 2 and 5 people (baseline) to 24 and 20 people for PrEP and PEP, respectively. The potentially averted 2 cases per infected persons based on the basic reproductive number of HIV. Conclusion: the effective implementation of PrEP/PEP programme offers an additional safety measure to prevent HIV transmission in at-risk individuals and possibility of ending HIV epidemic. [ABSTRACT FROM AUTHOR]

Objective: To describe the immediate impact of the COVID‐19 pandemic on cervical screening, colposcopy and treatment volumes in Ontario, Canada. Design: Population‐based retrospective observational study. Setting: Ontario, Canada. Population: People with a cervix age of 21–69 years who completed at least one cervical screening cytology test, colposcopy or treatment procedure for cervical dysplasia between January 2019 and August 2020. Methods: Administrative databases were used to compare cervical screening cytology, colposcopy and treatment procedure volumes before (historical comparator) and during the first 6 months of the COVID‐19 pandemic (March–August 2020). Main outcome measures: Changes in cervical screening cytology, colposcopy and treatment volumes; individuals with high‐grade cytology awaiting colposcopy. Results: During the first 6 months of the COVID‐19 pandemic, the monthly average number of cervical screening cytology tests, colposcopies and treatments decreased by 63.8% (range: −92.3 to −41.0%), 39.7% (range: −75.1 to −14.3%) and 31.1% (range: −43.5 to −23.6%), respectively, when compared with the corresponding months in 2019. Between March and August 2020, on average 292 (−51.0%) fewer high‐grade cytological abnormalities were detected through screening each month. As of August 2020, 1159 (29.2%) individuals with high‐grade screening cytology were awaiting follow‐up colposcopy. Conclusions: The COVID‐19 pandemic has had a substantial impact on key cervical screening and follow‐up services in Ontario. As the pandemic continues, ongoing monitoring of service utilisation to inform system response and recovery is required. Future efforts to understand the impact of COVID‐19‐related disruptions on cervical cancer outcomes will be needed. COVID‐19 has had a substantial impact on cervical screening and follow‐up services in Ontario, Canada. COVID‐19 has had a substantial impact on cervical screening and follow‐up services in Ontario, Canada. [ABSTRACT FROM AUTHOR]

Abstract The COVID‐19 pandemic is expected to have profound effects on healthcare systems, but little evidence exists on service provision, utilisation, or adaptations. This study aimed to (1) examine the changes to health and nutrition service delivery and utilisation in urban Bangladesh during and after enforcement of COVID‐19 restrictions and (2) identify adaptations and potential solutions to strengthen delivery and uptake. We conducted longitudinal surveys with health care providers (n = 45), pregnant women (n = 40), and mothers of children

This study aimed to establish lifetime mental health service utilisation among the general population of Singapore. The sociodemographic correlates of those seeking help from different service provider groups and changes in lifetime mental health service utilisation between 2010 and 2016 among those with mental disorders were also explored. A population-based cross-sectional epidemiological household survey of the Singapore resident population aged 18 years and above was conducted from 2016 to 2018, using the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0. Data from two cross-sectional population-based studies were used for comparison of lifetime mental health service utilisation in 2010 (n = 6616) and 2016 (n = 6126). Chi square test and multiple logistic regression were used to analyse the data. A total of 6126 respondents completed the study in 2016. Overall 9.3% of the total sample, 32.0% of those with mental disorders, and 5.7% of those not meeting criteria for mental disorders, ever sought help for their mental health issues in their lifetime, from any treatment service sectors. Several sociodemographic characteristics were found to be correlated with different service provider groups. There was no change in mental health service utilisation between 2010 and 2016 for all mental disorders included in this study, with the exception of a significant increase in help sought from professionals in social services, among those with alcohol abuse. Even though the overall help-seeking rates are low, it is encouraging that those seeking help did so from mental health professionals and professionals working in the social services. [ABSTRACT FROM AUTHOR]

Objective: There is a dearth of longitudinal data on outcomes in prevalent cases of psychotic illness across a range of ages and levels of chronicity. Our aim was to describe changes over time in mental and physical health outcomes, as well as patterns of service utilisation that may have influenced outcomes, in a representative prevalence sample of 641 Western Australians with a psychotic illness who, at Wave 1, were part of the National Survey of High Impact Psychosis. Methods: In Wave 1 (2010, 2012), a two-phase design was employed to ensure representativeness: Phase 1 psychosis screening took place in public mental health and non-government organisation services, while, in Phase 2, a randomised sample was interviewed. In Wave 2, 380/641 (59%) of participants were re-interviewed, with interviews staggered between 2013 and 2016 (follow-up time: 2.3–5.6 years). Data collection covered mental and physical health, functioning, cognition, social circumstances and service utilisation. Mental health outcomes were categorised as symptomatic, functional and personal recovery. Physical health outcomes covered metabolic syndrome and its component criteria. Results: In mental health, there were encouraging improvements in symptom profiles, variable change in functional recovery and some positive findings for personal recovery, but not quality of life. Participants ranked physical health second among challenges. Metabolic syndrome had increased significantly. While treatment for underlying cardiovascular risk conditions had improved, rates of intervention were still very low. More people were accessing general practices and more frequently, but there were sharp and significant declines in access to community rehabilitation, psychosocial interventions and case management. Conclusion: Although we observed some positive outcomes over time, the sharp decline in access to evidence-based interventions such as community rehabilitation, psychosocial interventions and case management is of great concern and augurs poorly for recovery-oriented practice. Changes in service utilisation appear to have influenced the patterns found. [ABSTRACT FROM AUTHOR]

Purpose: The postnatal period is a vulnerable time for parents and children but epidemiological and health care utilisation data for Germany on parental mental health during early childhood is scarce. This protocol describes the rationale, aim and study design of a population-based cohort study to assess the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use and cost of health care and social services in early childhood.Methods: As part of the collaborative SKKIPPI project, we will contact a random sample of 30,000 infants listed in the residents' registration offices of three German towns and we expect to include 6,000 mother-child pairs. Both parents are invited to fill out an online screening questionnaire. Mothers with indications of psychosocial stress will be interviewed to assess mental health disorders, regulatory problems of their children, as well as health care and social services utilisation, with a follow-up assessment after 6 months.Results: After description of sociodemographic and health data, we will analyse occurrences, patterns, and potential determinants (maternal age, social status, household factors, migration status etc.) of psychosocial stress and mental health disorders in the mothers and their children in early childhood.Conclusions: Our study will identify potential risk and protective factors for postnatal mental health and health care utilization of psychosocially burdened families. This will help to improve prevention and treatment strategies to strengthen the parent-child relationship, to reduce persisting vulnerability of children, and to improve health care and social services.Trial Registration: The study has been registered in the German Clinical Trial Registry on February 8th 2019 (DRKS-ID: DRKS00016653). [ABSTRACT FROM AUTHOR]

Athletes are vulnerable to a range of mental health symptoms, in part due to stressors within the sport environment. An early intervention framework suggests the benefits of routine screening and referral for mental health, however, greater understanding around athlete help-seeking is needed to support referral uptake. This review examined rates of formal help-seeking behaviour as well as barriers and facilitators to help-seeking in sport settings. Relevant studies were retrieved from SportDiscus, PubMed and PsycInfo, with unpublished studies identified through contacting authors. Help-seeking rates were meta-analysed and barriers and facilitators were meta-synthesised. Twenty-two studies were included. Help-seeking rates were reported in 11 studies (N = 3415) and the pooled proportion of help-seeking was 22.4 % (95 % CI 16.2–30.2, I2 = 95.7 %). Barriers were reported in 13 studies and facilitators in six, highlighting a range of sporting-specific factors, such as stigma in relation to athlete identity and sport culture, fear of deselection, and concerns around confidentiality in sport settings, in addition to lack of awareness, low mental health literacy, and negative attitudes to services. Normalising experiences of mental health in sport settings, including through role models, was a key facilitator to help-seeking. Results provide implications for sport organisations to promote help-seeking and athlete mental health, such as through the use of role models, ensuring clarity around confidentiality, stigma reduction interventions, and fostering team cultures that promote mental health. Findings also support the value of sport staff in facilitating help-seeking, and organisational culture changes to foster wellbeing. • This study provides a meta-analysis of formal mental health help-seeking behaviour of athletes. • The mental health help-seeking rate in athletes is 22.4 %, comparable with the general population. • Barriers to help seeking in athlete populations include team culture, and concerns around selection and confidentiality. • Facilitators of mental health help seeking suggest the value of athlete role models in normalising help-seeking for athletes. [ABSTRACT FROM AUTHOR]

Abstract Introduction Sub-Saharan Africa has the highest rate of adolescent pregnancy in the world. While pregnancy during adolescence poses higher risks for the mother and the baby, the utilisation of maternity care to mitigate the effects is low. This review aimed to synthesise evidence on adolescent mothers’ utilisation of maternity care in Sub-Saharan Africa and identify the key determinant factors that influence adolescent mothers’ engagement with maternity care. Method A systematic review of scholarly literature involving seven databases: ProQuest, PubMed, EMBASE/Elsevier, SCOPUS, PsycINFO, CINAHL and Infomit was conducted. Studies published in English between 1990 and 2017 that examined Sub-Saharan adolescent mothers’ experiences of utilising biomedical maternity care during pregnancy, delivery and the post-partum period were included. Results From 296 relevant articles 27 were identified that represent the experience of adolescent mothers’ maternal health service utilisation in Sub-Saharan Africa. The review indicates that maternal health service utilisation in the majority of Sub-Saharan African countries is still low. There is also a wide discrepancy in the use of maternity care services by adolescent mothers across countries in Sub-Saharan Africa. Conclusions The review reveals that a significant number of adolescents in Sub-Saharan Africa do not access and use maternity services during pregnancy. Several factors from individual to systemic levels contributed to low access and utilisation. This implies that interventions targeting the women, their partners, healthcare professionals, communities and the organisations (local to national) are necessary to improve adolescent mother’s engagement with maternity care in Sub-Saharan Africa.

Abstract Background Dien Bien Province in northwest Vietnam is predominantly populated with ethnic minority groups, who experience worse maternal and child health outcomes than the general population. Various factors are associated with maternal health care utilisation in Vietnam, including ethnic minority status, which is recognised as a key determinant of inequity in health outcomes. The aim of this study is to explore how and why ethnic minority women utilise maternal health services, and the factors that influence women and families’ decisions to access or not access facility-based care. Methods We used a qualitative approach, interviewing primary health care professionals (n = 22) and key informants (n = 2), and conducting focus groups with Thai and Hmong women (n = 42). A thematic analysis was performed. Results There were three main themes. 1. Prioritising treatment over prevention: women talked about accessing health services for health problems, such as unusual signs or symptoms during pregnancy, and often saw limited utility in accessing services when they felt well, or for a normal physiological event such as childbirth. Health professionals also saw their role as being mainly treatment-oriented, rather than prevention-focused. 2. Modernisation of traditional practices: health professionals and ethnic minority women discussed recent improvements in infrastructure, services, and economic circumstances that had increased access to health services. However, these improvements were less pronounced in Hmong communities, suggesting inequity. 3. Perceptions of quality influenced service utilisation: both health professionals and ethnic minority women perceived primary care facilities to be of lower quality compared to hospital, and some women made decisions about accessing services based on these perceptions, preferring to travel further and spend more to access higher quality services. Health professionals’ perceptions of low service quality appeared to influence their referral practices, with even uncomplicated cases referred to higher level services as a matter of course. Conclusions Primary health care facilities were technically available and accessible to ethnic minority women, however these services were likely to be underutilised if they were perceived to be of low quality. Some women had the means to access higher quality facilities, but others were limited to lower quality facilities, potentially reinforcing inequities in health outcomes.

Background There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. Aims This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. Method We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012–2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. Results The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14–68) and 24% were from primary care (median, 10; IQR, 5–20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. Conclusions The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.

Background: Indigenous Australians diagnosed with cancer have substantially higher cancer mortality rates compared with non-Indigenous Australians, yet there is a paucity of information about their end-of-life service utilisation and supportive care needs. Purpose: To describe the service utilisation and supportive care needs of Aboriginal and Torres Strait Islander people with cancer at end-of-life. Method: Hospital admission data were linked to self-reported data from a study of Indigenous cancer patients from Queensland, Australia during the last year of their life. Needs were assessed by the Supportive Care Needs Assessment Tool for Indigenous Cancer Patients which measures 26 need items across 4 domains (physical/psychological; hospital care; information/communication; practical/cultural). A descriptive analysis of health service utilisation and unmet needs was conducted. Results: In total, 58 Indigenous cancer patients were included in this analysis. All patients had at least one hospital admission within the last year of their life. Most hospital admissions occurred through emergency (38%) and outpatient (31%) departments and were for acute care (85%). Palliative care represented 14% of admissions and 78% died in hospital. Approximately half (48%) did not report any unmet needs. The most frequently reported moderate-to-high unmet need items were worry about the treatment results (17%), money worries (16%) and anxiety (16%). Conclusions: Utilisation of palliative care services that manage a full range of physical and psychosocial needs was low. Addressing worries about treatment results, finances and generalised anxiety are priorities in this population. [ABSTRACT FROM AUTHOR]