Time, Stigma and Fear: Main Barriers for STI Testing among Spouses in Meghalaya, India

Introduction Women attending termination of pregnancy (TOP) clinics are a risk group for STIs, and those with STIs are at increased risk of developing postabortal complications. We explored what STI care is provided in Dutch TOP clinics, and we compared these results with the United Kingdom (UK). Methods A qualitative study including 14 semi-structured interviews with health care professionals (HCPs) in TOP clinics (Netherlands: 9, UK: 5). Interviews were recorded, transcribed, and analysed by thematic content analysis. Results In the Netherlands, azithromycin prophylaxis is routinely prescribed after a surgical TOP, but not routinely after a medical TOP. STI tests are only offered by Dutch clinics if clients are considered at high STI risk based on the intake questionnaire. High costs of STI testing form the main barrier for clients not accepting STI testing, as costs are not covered by all health insurances. Alternatively, some clinics refer women to the Public Health Service (PHS), where STI testing is free for high-risk groups. This also involves barriers as not all women go for testing. HCPs in TOP clinics that collaborate with PHSs in the Sense program (sexual and reproductive health care) experience less barriers, as free STI testing is then offered on location of the TOP clinic. Sexual health counselling in TOP clinics is often limited to birth control conversations, also in the UK. The major difference between Dutch and UK TOP clinics is that UK clinics (who are not privately owned) offer free STI testing to all clients. Conclusion HCPs in Dutch TOP clinics consider STI testing an important part of their service, but financial barriers prevent STI testing on location. In the UK, free STI care is broadly implemented in TOP clinics. Collaboration with PHSs (in Sense program) could improve STI testing and sexual health counselling in Dutch TOP clinics. Disclosure of interest statement The study is funded by the RIVM. No pharmaceutical grants were received in the development of this study.

This study presents the first analyses of the mineral chemistry, geochemistry and petrogenesis of magnesio-carbonatite dykes from the recently identified Padu–Nongryngkoh region, Meghalaya (India). In the field, carbonatites occur as dykes emplaced in the intensely deformed and layered basement of gneissic rocks. Padu carbonatites consist primarily of calcites and dolomites along with varied proportions of apatite, forsterite, phlogopite, spinel, pyrochlore, ilmenite, magnetite and zircon. Apatites from these carbonatites show magmatic characteristics with marked enrichment of chlorine and heavy rare earth elements (REEs). However, these carbonatites display lower REE concentrations compared to the average REE abundances of global carbonatites, and are marked by extreme depletion of Ni, Ti, Rb, Nb, Ta, Zr and Hf. These carbonatites are associated with an episodic network of dykes and sills in the Padu–Nongryngkoh–Jarain area formed by possible upwelling of the Kerguelen Plume. Low REE concentrations in the Padu carbonatites may be due to either lack of REE replenishment in the magma source, or due to a differentiated alkaline hydrated melt as the source for these rocks.

Genetic testing (GT) for hereditary cancer risk enables early detection and prevention, yet many individuals who could benefit do not pursue testing. Limited genetic familiarity and lower genetic self-efficacy may act as barriers. This study examined relationships among patient-reported genetic familiarity, genetic self-efficacy, sociodemographic characteristics, and interest in GT. Data were drawn from the Early Detection of Genetic Risk (EDGE) baseline survey (n = 2,319), distributed to a random sample of patients aged ≥25 years from participating primary care clinics in Washington, Montana, and Wyoming. Patients were contacted via email and mailed letter in January 2021, prior to implementation of the EDGE intervention. Bivariate logistic regression assessed associations between sociodemographic factors and genetic familiarity and self-efficacy. Multivariable logistic regression examined independent associations between sociodemographic factors, genetic familiarity, genetic self-efficacy, and interest in GT. In multivariable analyses, higher genetic familiarity was strongly associated with interest in GT (adjusted odds ratio [aOR] = 2.67; 95% CI: 1.47-4.86). Higher income (aOR = 2.43; 95% CI: 1.43-4.13) and female sex compared with male (aOR = 1.80; 95% CI: 1.16-2.40) were also positively associated with interest in GT. Participants aged over 65 years were significantly less likely to express interest in GT (aOR = 0.28; 95% CI: 0.13-0.60). The strong association between genetic familiarity and interest in GT suggests that increasing basic genetic knowledge may be an effective starting point for educational interventions aimed at improving testing uptake. Understanding drivers of interest in GT can inform targeted strategies to enhance hereditary cancer prevention and early detection efforts.

Implementation of an intervention can result in a discrepancy between what was planned and what is delivered, affecting outcomes for recipients. The aim was to explore, from the perspective of hospital foodservice staff, their experiences delivering a nutrition intervention and the barriers and enablers to its implementation. A process evaluation of a pilot study was undertaken using qualitative description. A purposive sample (n = 15) of hospital foodservice supervisors and foodservice assistants responsible for delivering a higher energy menu to hospital patients participated in focus groups and semistructured interviews. Theoretical frameworks of behaviour underpinned the method. Content analysis elicited factors (sub-themes) influencing foodservice staff's capability, opportunity and motivation to provide the nutrition intervention. Thematic analysis (by two independent researchers) further explored factors (themes) related to the process of the intervention's implementation. Five key themes (and 15 sub-themes) explained factors effecting implementation of the nutrition intervention. Aspects of the foodservice environment and patients' resistance were barriers to implementation and perceived sustainability. Teamwork, problem solving, leadership and job satisfaction were enablers. There was an opportunity to optimise training and feedback. Characteristics of foodservice staff, including their: knowledge, beliefs and perceptions of diet, health and their job role, had the potential to influence their behaviours and decision making. A number of interacting factors influenced foodservice staff's delivery of a higher energy menu as planned. Addressing the challenges of time, foodservice structure, patients' resistance, gaps in knowledge and misconceptions among foodservice staff may enhance similar nutrition interventions in the future.

BackgroundDespite advanced nursing roles having a research competency, participation in research is low. There are many barriers to participation in research and few interventions have been developed to address these. This paper aims to describe the implementation of an intervention to increase research participation in advanced clinical nursing roles and evaluate its effectiveness.MethodsThe implementation of the intervention was carried out within one hospital site. The evaluation utilised a mixed methods design and a implementation science framework. All staff in advanced nursing roles were invited to take part, all those who were interested and had a project in mind could volunteer to participate in the intervention. The intervention consisted of the development of small research groups working on projects developed by the nurse participant/s and supported by an academic and a research fellow. The main evaluation was through focus groups. Output was analysed using thematic analysis. In addition, a survey questionnaire was circulated to all participants to ascertain their self-reported research skills before and after the intervention. The results of the survey were analysed using descriptive statistics. Finally an inventory of research outputs was collated.ResultsIn the first year, twelve new clinical nurse-led research projects were conducted and reported in six peer reviewed papers, two non-peer reviewed papers and 20 conference presentations. The main strengths of the intervention were its promptness to complete research, to publish and to showcase clinical innovations. Main barriers identified were time, appropriate support from academics and from peers. The majority of participants had increased experience at scientific writing and data analysis.ConclusionThis study shows that an intervention, with minor financial resources; a top down approach; support of a hands on research fellow; peer collaboration with academics; strong clinical ownership by the clinical nurse researcher; experiential learning opportunities; focused and with needs based educational sessions, is an intervention that can both increase research outputs and capacity of clinically based nurses. Interventions to further enhance nursing research and their evaluation are crucial if we are to address the deficit of nurse-led patient-centred research in the literature.

Stage fright, also known as stage fright or fear of public speaking, is a recognized phenomenon that affects many people in different contexts. This research focuses on analyzing how stage fright becomes a communication barrier in the educational field, specifically in the classroom. The methodology used is mixed research under the Quantitative and Qualitative approach, data collection was carried out through interviews and survey. The results indicate that stage fright has a significant impact on students’ communication in the classroom. Those who experience stage fright tend to avoid actively participating in discussions, oral presentations, and other activities that require speaking in front of their peers. This negatively affects their learning by missing opportunities to express ideas, ask questions and participate in discussions. Factors that contribute to stage fright in the educational context are identified, such as fear of judgment and negative evaluation, lack of confidence in communication skills, and peer pressure. These factors create anxiety and stress, further hindering students’ ability to communicate effectively. As a result of the research, strategies are proposed to address stage fright and promote effective communication in the classroom. These include relaxation techniques and stress management, creating a supportive and trusting environment, designing activities that promote active participation by all students, and training teachers in managing stage fright.

While there has been growing interest in comprehensive models of treatment and care for individuals living with HIV/AIDS, little attention has been given to the potential role that supervised injecting programs could play in increasing access to prevention and care services for HIV-positive injection drug users (IDU). We conducted 22 semi-structured interviews with HIV-positive IDU regarding a supervised injection program integrated in an HIV focused care facility known as the Dr. Peter Centre (DPC). We also interviewed seven staff members who supervise injections within the facility. All interviews were audio recorded, transcribed verbatim, and a thematic analysis was conducted. Participant and staff reports indicated that the integrated supervised injection program influenced IDUs’ access to care by building more open and trusting relationships with staff, facilitating engagement in safer injection education and improving the management of injection-related infections. Participants and staff viewed the program as facilitating the delivery of care through mediating overdose risks, reducing the need to punitively manage drug use onsite and reducing the risks of encountering used syringes on the premises. For some participants, however, feelings of shame and fear of judgment in relation to their drug use limited initial uptake of the program. Our findings identify mechanisms through which integrated supervised injection programs may serve to better facilitate access and delivery of comprehensive care for HIV-positive IDU and highlight the benefits of addressing HIV-positive IDUs’ drug use in the context of comprehensive models of healthcare.

Gay men's health typically relies on traditional forms of qualitative analysis, such as thematic analysis, and would benefit from a diversity of analytic approaches. Such diversity offers public health researchers a breadth of tools to address different kinds of research questions and, thus, substantiate different types of social phenomenon relevant to the health and wellbeing of gay men. In this article, I compare and contrast three qualitative analytic approaches: thematic, critical discourse, and conversation analysis. I demonstrate and distinguish their key analytic assumptions by applying each approach to a single data excerpt taken from a public health interview conducted for a broader study on gay men's health. I engage in a discussion of each approach in relation to three themes: its utility for gay men's health, its approach to dilemmas of voice, and its capacity for reflexivity. I advocate that qualitative researchers should capitalise on the full range of qualitative analytic approaches to achieve the goals of gay men's health. However, I specifically encourage qualitative researchers to engage with conversation analysis, not only because of its capacity to resolve dilemmas of voice and to achieve reflexivity, but also for its ability to capture forms of social life hitherto undocumented through thematic and critical discourse analysis.

BackgroundUnderstanding stakeholders’ perceptions is crucial to the development and implementation of any intervention. However, a structured approach to eliciting stakeholder insights into complex, multisector issues of food security, household environment and health is lacking in many low and middle-income countries. This qualitative, workshop-based participatory study explores stakeholders’ experiences of developing and implementing multisector interventions to provide transdisciplinary lessons for future developments in low and middle-income countries.MethodsParticipants were purposely selected based on their involvement in, or exposure to, the multisector intervention. Participants with interests in agriculture, nutrition, household air-quality, drinking water-quality and health from academic institutes, government and developmental organisations were brought together at a one-day workshop to participate in a series of discussions on issues relating to food security, nutrition, household environment and health in Nepal. All group discussions were audio-recorded and transcribed, and a thematic qualitative analysis performed to identify relevant themes.ResultsThe government’s ongoing Multisector Nutrition Plan, stakeholders’ willingness to work together, availability of local infrastructure for cross-institutional inputs and increasing global movement towards transdisciplinary approaches were identified by the 33 workshop participants, representing 23 organisations as key factors determining success of transdisciplinary work. Fragmentation, lack of research-based and practice-based evidence, limited transdisciplinary knowledge amongst sectoral stakeholders, short-term funding and lack of knowledge-sharing mechanisms were identified as barriers, often creating systematic problems for successful implementation. Stakeholders suggested methods to bring about success included: improved knowledge, both amongst policy-makers and implementers, of food security and its linkage with nutrition, household environments, health and hygiene; investment in collaborative practice-based research and evidence-based practice; and strengthened transdisciplinary collaboration between multi-stakeholders, such as researchers, implementers and beneficiaries, throughout the intervention development and implementation process.ConclusionsThis study suggests that multisector approach needs to adapt to take into account the experiences and views of the stakeholders concerned. The paper offers recommendations for successful development and implementation of future multisector interventions in Nepal that can be extrapolated to other low and middle-income countries, and lays foundations for future transdisciplinary working to support realisation of the recommendations.

Young women diagnosed with breast cancer (BC) face considerable psychological and emotional distress, impacting their interactions with themselves, their families, and the wider community. This study sought to explore the interaction patterns of young Omani BC survivors following their diagnosis and during treatment. Semi-structured individual interviews were conducted with 11 Omani women diagnosed with BC, recruited from the Sultan Qaboos Comprehensive Cancer Care and Research Centre in Muscat, Oman. Participants were selected using purposive sampling to target Omani BC survivors aged under 45 years, with one to five years of survivorship post-diagnosis. Framework analysis was employed to analyse the qualitative data. Six key types of interactions with various groups were identified: self, children, spouses, family, friends, and society. While many BC survivors demonstrated resilience through their strong faith, viewing the illness as part of a divine plan, others experienced diminished confidence and social withdrawal due to body image issues. Interactions with children centred on maintaining normalcy, while spouses typically provided emotional support despite challenges with intimacy. Family and friends offered crucial support, although concerns regarding societal stigma led some women to conceal their diagnosis. Participants in this study demonstrated a strong sense of acceptance of their cancer diagnosis as a result of their faith, viewing it as part of a divine plan. Their belief in divine guidance, paired with optimism about the available treatments, fostered resilience, allowing them to maintain a calm and hopeful outlook during their journey of treatment and recovery. However, some participants experienced a decline in self-confidence, particularly after treatment. This affected their willingness to socialise and interact with others, leading to introversion and a marked withdrawal from social interactions, often related to changed self-perception or fear of judgment following changes in appearance.

**Background**: Facial nerve palsy (FNP) leads to a combination of aesthetic and functional deficits with profound psychosocial consequences. Significant advances have been made in restoring dynamic function through a range of facial reanimation solutions. Patient-reported severity scales are predetermined metrics that provide limited insight into patient values and perceptions. A qualitative study was conducted to elicit the experiences of patients with FNP and explore their views and motivations for seeking therapy. **Methods**: Participants were sourced from the Sydney Head and Neck Cancer Institute Database, Australia. Eligibility for the study included age over 18 years and a diagnosis of complete FNP. Semi-structured interviews were conducted and the transcripts were subjected to thematic text analysis.**Results**: Nineteen patients consented to participate in the study. One was excluded due to an isolated marginal mandibular nerve palsy. Five main themes emerged: eye symptoms, fear of judgement and social withdrawal, aversion to further invasive surgeries, the need for multidisciplinary streamlined care and lack of public awareness.**Conclusion**: Eye symptoms and the social consequences of FNP carry significant impact on both patients’ personal and professional lives. There is a paucity of services that can support patients across the complex spectrum of problems seen in FNP.

BackgroundHospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention.MethodsThe process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach.ResultsThemes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity.ConclusionsThis provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.

BackgroundCombination prevention interventions, when integrated with community-based support, have been shown to be particularly beneficial to adolescent and young peoples’ sexual and reproductive health. Between 2020 and 2022, the Africa Health Research Institute in rural South Africa conducted a 2 × 2 randomised factorial trial among young people aged 16–29 years old (Isisekelo Sempilo) to evaluate whether integrated HIV and sexual and reproductive health (HIV/SRH) with or without peer support will optimise delivery of HIV prevention and care. Using mixed methods, we conducted a process evaluation to provide insights to and describe the implementation of a community-based peer-led HIV care and prevention intervention targeting adolescents and young people.MethodsThe process evaluation was conducted in accordance with the Medical Research Council guidelines using quantitative and qualitative approaches. Self-completed surveys and clinic and programmatic data were used to quantify the uptake of each component of the intervention and to understand intervention fidelity and reach. In-depth individual interviews were used to understand intervention experiences. Baseline sociodemographic factors were summarised for each trial arm, and proportions of participants who accepted and actively engaged in various components of the intervention as well as those who successfully linked to care were calculated. Qualitative data were thematically analysed.ResultsThe intervention was feasible and acceptable to young people and intervention implementing teams. In particular, the STI testing and SRH components of the intervention were popular. The main challenges with the peer support implementation were due to fidelity, mainly because of the COVID-19 pandemic. The study found that it was important to incorporate familial support into interventions for young people’s sexual health. Moreover, it was found that psychological and social support was an essential component to combination HIV prevention packages for young people.ConclusionThe results demonstrated that peer-led community-based care that integrates SRH services with HIV is a versatile model to decentralise health and social care. The family could be a platform to target restrictive gender and sexual norms, by challenging not only attitudes and behaviours related to gender among young people but also the gendered structures that surround them.

The recognition of the need for Adolescent and Youth-Friendly Health Services (AYFHS) is growing. It is important to ensure the provision of high-quality sexual and reproductive health (SRH) services that cater to the unique needs of adolescents and young people (AYP). Adolescents and young people spend a significant amount of time in Higher and Tertiary Education Institutions (HTEIs) where adolescent friendly services are needed. However, there is limited evidence on the availability of sexual and reproductive health services for young people in HTEIs in Zambia. Using the Human Rights Based Approach to healthcare availability, accessibility, acceptability, and quality of care (AAAQ) framework, this study explores young people's perceptions of youth-friendly sexual and reproductive health services in selected HTEIs in Zambia. Between March and June 2021, a qualitative case study was conducted in 12 selected HTEIs located in Lusaka, Central, and Copperbelt provinces of Zambia. The study employed In-depth Interviews (IDIs) and Focus Group Discussions (FGDs) with AYPs, as well as Key-informant Interviews (KIIs) with healthcare providers. The healthcare providers at health facility, district and provincial levels were interviewed to provide insights about the services provided in the HTEIs. A total of 112 interviews were conducted. Data analysis was performed using thematic analysis in NVivo version 11. In the study, young people reported the availability of primary health services like malaria, HIV, and pregnancy testing, as well as screening for STIs. However, their awareness of SRH services was limited. Contraception, STI testing and treatment, and HIV and pregnancy screening and testing were the most accessed services. Equipment and commodity shortages were common, hindering care provision. Young people found healthcare services in educational institutions inaccessible, with limited comprehensive care and understanding from providers. Services lacked tailoring for key populations and privacy/confidentiality. Health care providers also reported inadequate youth-friendly spaces, equipment, medication and trained workers which compromised the quality of care. Peer educators and provider training were seen as essential for improving accessibility and acceptability of services. The findings indicate significant barriers to the accessibility, availability, and acceptability of SRH services for AYP in HTEIs in Zambia. There is a pressing need to enhance AYSRH programming by increasing awareness of services and ensuring their availability and accessibility for young people. Sufficient funding for AYFHS can address challenges related to service quality, including inconsistent availability of medical equipment and supplies. Building the capacity of service providers can potentially enhance the uptake of services by AYP. It is crucial to target services to address the specific vulnerabilities of students with disabilities and key populations, aligning with the goal of achieving universal health coverage and leaving no one behind.

Over the past half century, the landscape of life and aging with spinal cord injury (SCI) has changed drastically, in part due to medical advancements and the rapidly increasing aging population. With these changes comes a critical need for rehabilitation professionals to understand aging with SCI in relation to strategies that support health maintenance over time. The purpose of this study was to identify and describe the meaning of health maintenance and aging outlook from the perspectives of individuals living with SCI. A qualitative descriptive approach using focus group interviews and thematic analysis was used to generate a rich understanding of shared experiences with SCI by allowing for discussion among participants. Participants were 24 individuals ranging in age from 22 to 76years who were living with chronic SCI (>12months), with injury duration ranging from 3 to 47years. Health maintenance was connected to 3 themes: self-management routine to prevent secondary health conditions; importance of injury acceptance over time; and engagement with disability networks. Aging outlook was linked to fear of functional dependence and lack of evidence-based education on aging with SCI. These findings suggest that individuals living with SCI would benefit from clinical support that acknowledges psychological and social aspects of health beyond physical routines. These findings inform the development and implementation of SCI-related interventions to maximize healthy aging. It is crucial for clinicians and researchers to investigate issues beyond routine self-management and functional independence to support the emotional adjustment of life with SCI. Unique personal considerations based on life stage when injured warrant investigation. Education and advocacy for peer support is imperative at all life stages given its positive impact on health.