搜索结果：Stigma and health

Black people with intellectual and developmental disabilities (IDD) report poor health and lower service use compared with their White counterparts. Structural racism, neighborhood segregation in particular, has been identified as a potential barrier to equitable service use, but empirical investigations remain limited. To examine the association between race/ethnicity and neighborhood-level segregation on the use of outpatient occupational therapy and physical therapy and home health services among people with IDD. A secondary data analysis, using weighted two-level logistic regression models, of the Medical Expenditure Panel Survey (2013-2020) and census tract data from the American Community Survey. Sixteen percent of individuals with IDD reported use of outpatient occupational therapy and physical therapy, and 23% reported use of home health services. Race and neighborhood segregation were not significantly associated with service use; however, age and Medicaid coverage showed significant associations with both occupational therapy and physical therapy and home health care use. Individuals ages 0 to 3 yr were more likely to receive services than older cohorts, highlighting age-related disparities. The findings suggest that although racial disparities were not evident in this data set, structural and age-related factors still shape service utilization. Occupational therapy scholars need larger and more nuanced data sets of people with IDD to better map associations between race and neighborhood segregation and its impact on service use along the health care pipeline. Plain-Language Summary: In this article, we introduce a novel application of neighborhood-level racial segregation measures to assess structural racism in health care access among people with intellectual and developmental disabilities (IDD). By integrating data from the Medical Expenditure Panel Survey and American Community Survey, we provide preliminary evidence on service utilization patterns for outpatient occupational therapy and physical therapy and home health care, highlighting age-related disparities and the need for more nuanced data sets. The findings underscore the importance of contextualizing service use within structural determinants and offer direction for occupational therapy practitioners and health services researchers to refine equity-driven methodologies and advocacy strategies, ensuring that all people with IDD can access the home and community-based supports they need to participate in daily life. Positionality Statement: The research team was led by Khalilah R. Johnson, an occupational scientist and occupational therapy practitioner who identifies as Black and female and has an extensive history working with Black people with IDD in participatory action research and practice. Izabela Annis, the team's statistician and programmer, uses European ethnic classification and identifies as Slavic. In her work, she uses rigorous and comprehensive statistical methods to measure and analyze the complex effects of structural racism on health and social outcomes. Kathleen C. Thomas is a White woman whose family experience of serious mental illness shapes her understanding of stigma and its structural impacts. This lens informs her commitment to research and mentoring that focuses on reducing disparities experienced by people with mental illness and by communities marginalized by disability, poverty, rurality, and racism.

Tuberculosis (TB) stigma continues to impede equitable access to prevention, diagnosis, treatment, and care, undermining efforts to end the epidemic. Despite commitments to eliminate TB stigma in the 2023 United Nations Political Declaration on TB, implementation of evidence-based stigma reduction interventions remains constrained by limited systematic and comparable data. This community-led paper describes findings from 17 national TB stigma assessments conducted using validated stigma measurement scales and guided by the World Health Organization social-ecological model to generate cross-country evidence for action. Across the 17 countries-representing 38% of the estimated global TB burden in 2024-a total of 26,040 individuals participated in the quantitative components. Participants included people with TB (56%, n = 14,685), family members (18%, n = 4,662), community members living in the same areas (16%, n = 4,206), and healthcare workers (10%, n = 2,487). The most frequently reported contexts where people with TB reported stigma inhibited access to services were observed in the community (25%) and self-stigma (23%). These were followed by stigma in health facilities (18%), homes and families (18%), and workplaces (16%). Common drivers included self-isolation among people with TB, concealment of TB status by families, community avoidance behaviours (e.g., reluctance to share food or drink), and healthcare workers' endorsement of forced isolation during treatment. Thirty percent (30%) of healthcare workers reported experiencing stigma, mainly from colleagues. Stigma occurred most often before presentation at health facilities-particularly during symptom recognition, disclosure, and treatment initiation and adherence-and disproportionately affected women and underserved populations. Although most countries reported protective laws and policies-generally embedded in broader health or constitutional frameworks rather than TB-specific legislation-implementation and enforcement were frequently inadequate, particularly regarding workplace protections, privacy, non-discrimination, and safeguards against involuntary isolation. These findings confirm that stigma remains a major barrier to TB care and highlight the need to scale up context-responsive stigma reduction strategies. Priorities include targeting critical settings and stages of the TB care continuum, addressing prevalent stigma drivers, strengthening enforcement of legal protections, prioritizing disproportionately affected populations, and promoting meaningful co-creation and leadership by people affected by TB.

Adolescents and young people (AYP) experience a disproportionate burden of both mental health conditions and HIV, particularly in low- and middle-income countries (LMICs)-nations classified by the World Bank as having lower or middle economies. Mental health problems such as depression, anxiety, and substance use increase HIV (Human Immunodeficiency Virus that attacks the human immune system and leads to various illnesses when untreated) risk, and negatively affect treatment adherence and outcomes. However, mental health remains insufficiently integrated into HIV research and programming. Evidence on how mental health services are operationally integrated into HIV prevention and treatment for this population is limited and fragmented. This scoping review mapped existing evidence on the integration of mental health services into HIV treatment programs for AYP in LMICs, guided by PRISMA-ScR (a guideline used for reporting scoping reviews in research) and the Person-Concept-Context framework, a framework used to define specific research question in research. In this case, the population was adolescents and young people (10-24 years) receiving HIV prevention or treatment services, the concept referring to the integration of mental health interventions such as screening, assessment and counseling within HIV services, and the context focused on low- and middle-income countries (LMICs). PubMed, MEDLINE, Scopus and PsycINFO databases were searched for studies published between 2014 and 2024. Eligible studies reported mental health screening, assessment, treatment, or referral within HIV services for AYP in LMICs. Two reviewers independently screened studies, assessed full texts, and extracted data. Of 634 records identified, ten (10) studies met the inclusion criteria. All were conducted in Sub-Saharan Africa and primarily used qualitative or pilot designs. Four integration approaches were identified: routine mental health screening within HIV services, task-shifting to trained lay providers, peer-led and community-based psychosocial support, and culturally adapted, youth-centered psychological interventions. Common barriers included stigma, low mental health literacy, limited training and supervision, staffing constraints, and weak referral systems. Existing evidence is limited, remains exploratory, preliminary, and largely focused on feasibility and implementation experiences, suggesting that integrating mental health services within adolescent HIV care in LMICs may be feasible and acceptable when approaches are contextually adapted and participatory.

Chemsex, sexual activity under the influence of psychoactive substances, remains a major public health concern for men who have sex with men (MSM) globally. In Malaysia's conservative context, the convergence of chemsex and HIV transmission presents complex challenges. This narrative review examines how the Covid-19 pandemic and extended lockdown disrupted HIV services and intensified psychosocial stressors, amplifying chemsex, HIV, and mental health issues among Malaysian MSM. A systematic search of international databases (2018-2025) identified relevant studies through keyword screening of articles, abstracts, and full texts. The Covid-19 lockdown exacerbated psychosocial stressors such as isolation and minority stress, altered chemsex patterns, and increased drug use. Disruption of HIV testing and treatment delayed diagnoses and potentially heightened transmission, while PrEP uptake remained low (18.3%) despite awareness. The pandemic intensified syndemic interactions concerning chemsex, HIV, and mental health. Urgent, integrated, person-centered intervention is needed to address this multifaceted crisis. The Synergistic Impact of Covid-19 Lockdown on Sexualized Drug Use and HIV on Malaysian Men Who Have Sex with Men: A ReviewPlain Language SummaryChemsex is sexual activity under the influence of drugs such as methamphetamine. This behaviour, common among men who have sex with men (MSM), increases the risk of HIV infection and mental health issues. In Malaysia, where strict laws and social stigmas exist around homosexuality and drug use, makes it difficult for MSM to access support and healthcare.This review explores how the Covid-19 pandemic and Malaysia's lockdowns affected chemsex practices and HIV trends among Malaysian MSM. The Lockdown limited social contact and increased social isolation, which amplified pre-existing issues that caused many MSM to turn to chemsex as a way to cope. These heightened feelings of stress led to increased drug use and riskier sexual practices (including injecting methamphetamine). Younger Malaysian MSM are affected by these trends that potentially carry lasting effects, and many do not surface until advanced stages of addiction and/or HIV.HIV testing and treatment services were disrupted during the Covid-19 lockdown, resulting in late diagnoses and potentially higher chances of HIV transmission. Only 18% of Malaysian MSM used pre-exposure prophylaxis (PrEP) as HIV prevention despite increased awareness.The overlapping health issues of Covid-19, chemsex, mental health, and HIV form a complex synergy that worsened during the pandemic. The findings highlight an urgent need for integrated health services that combine addiction intervention, mental health support, and HIV prevention strategies that are tailored to the MSM community. More comprehensive programs that integrate harm reduction, recovery, and prevention methods are needed to mitigate the issues concerning chemsex. Educating healthcare providers on MSM-specific issues is essential to reducing stigma and supporting them effectively.

In response to inherent occupational and operational stress in public safety personnel (PSP), multiple policies and interventions have been implemented, often with sparse or low-quality research. The National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard) is a comprehensive framework aimed at promoting mental health and preventing psychological harm in Canadian workplaces. This longitudinal multiple-cohort implementation science project describes mental health strategies implemented and associated organizational outcomes across five PSP organizations implementing change within the standard framework. Data were collected at two levels over a three-year span from the five public safety organizations that identified priority areas for improvement within the Standard based on local data and consultations. The organization selected and implemented a range of proactive mental health interventions, including resiliency training. Individual pre-post surveys assessed a variety of mental health disorders and work-related items. Annual organizational data included sick leave hours and extended health benefits for psychological services. Survey responses were aggregated at the organizational level. Rank-based correlation analyses (Kendall's tau) described associations among occupational stress, work engagement, stigma, and organizational indicators. Organizations demonstrated multiple indicators of progress in meeting the Standard. Post-mental health symptom scores were positively correlated with extended health costs. Higher organizational stress scores were associated with higher extended health costs (psychological) (τ = 1.0 at pre-intervention; 0.67 post-intervention). Positive changes in organizational stress scores and higher engagement scores over the implementation process were both associated with lower average extended health costs (τ = 1.0/-1.0 respectively). Resilience scores were inversely related to health costs (τ = -0.67), consistent with the protective role of resilience. The Standard can serve as a framework for improving workplace health and safety when integrated with multi-modal action plans and structured resilience programs.

Epidemics and disease outbreaks continue to threaten public health security in sub-Saharan Africa (SSA), disproportionately impacting impoverished and hard-to-reach populations. Although many country-specific studies exist, few syntheses have examined short-term health system responses to epidemics in hard-to-reach areas of SSA and their effects on health equity and resilience. This scoping review consolidates regional evidence on structural and policy-relevant lessons for enhancing health system preparedness and epidemic management in resource-limited settings. A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Four electronic databases (PubMed, Cochrane Library, CAB Direct, and Google scholar) and grey literature sources for studies published between 2012 and 2022. Eligible studies reported short-term (immediate or early-phase) health system responses to epidemic-prone infectious diseases in SSA. Data were extracted thematically using Excel and analysed using a modified Donabedian framework encompassing structures, processes, and outcomes. Fifteen studies met the inclusion criteria and examined responses to Coronavirus 2019 (COVID-19), Ebola Virus Disease (EVD), and other epidemic-prone infections. Common weaknesses identified included shortages of trained healthcare workers, limited financial resources, poor leadership and coordination, and weak information systems. However, countries such as Rwanda, Ethiopia, Nigeria, and Uganda demonstrated adaptive governance, decentralised coordination, and the use of digital tools to improve surveillance, communication, and service delivery. Strong community engagement helped reduce stigma and increased adherence to control measures, especially in rural and underserved areas. Countries that incorporated epidemic response into existing primary healthcare and routine services achieved better equity and system resilience. The scoping review underscores strong evidence for incorporating epidemic preparedness into the broader health system. Policy focus areas include enhancing leadership and governance, establishing swift response mechanisms at subnational levels, and utilising technology for real-time data and coordination. Regional collaborations like those facilitated by the Africa CDC can improve collective resilience. Going forward, policies should prioritise not just emergency response but also ongoing investment in flexible, learning health systems that can withstand shocks while consistently providing essential services.

Tuberculosis (TB) stigma is a critical barrier to timely diagnosis and treatment, yet few studies have quantified community-level TB stigma or its variability across geographic contexts. This study describes methods for capturing community-level TB stigma and examines stigma variability and correlations with community-level sociodemographic and TB-related factors across urban, periurban and rural communities. Ecological study. 93 demarcated study communities in Buffalo City Metropolitan Health District, Eastern Cape, South Africa. 3869 heads of household, age ≥18 years, were surveyed in a geographically clustered random sample of households across the 93 study communities. Validated scales were used to measure perceived TB stigma. Community levels of TB stigma were generated by aggregating individual responses within each study community. Median community TB stigma scores varied significantly by community location: compared with urban communities, rural communities had lower TB stigma scores (beta=-0.235; 95% CI -0.362 to -0.108) while periurban communities had higher scores (beta=0.136; 95% CI 0.017 to 0.254). Community TB stigma was positively associated with community HIV stigma, with the strongest associations in urban (beta=0.977 (95% CI 0.634 to 1.321) and rural (beta=0.816 (95% CI 0.186 to 1.446) communities. No associations were observed between TB stigma and TB prevalence, TB knowledge or household demographics after adjusting for community location. TB stigma varied meaningfully across communities and was associated with urbanicity and HIV stigma. Stigma is a complex social process and there may be many other factors shaping TB stigma at the community level. Future research and stigma-reduction interventions should consider local contexts and community-level determinants beyond individual demographics, TB knowledge or community TB burden.

LGBTQ+ (lesbian, gay, bisexual, transgender, and queer) adults often face multilayered discrimination, structural barriers, and cultural exclusion in health care settings that limit their access to care and adversely affect their health outcomes. However, comprehensive syntheses of their health care experiences remain limited. This study was designed to systematically synthesize the health care experiences of LGBTQ+ adults in formal care settings using the Joanna Briggs Institute's meta-synthesis approach, with a focus on their stressors, care-related challenges, and identity negotiations. These experiences were then interpreted through the lens of the Minority Stress Model to deepen the understanding of health care providers of the primary structural stressors and their implications in health care. A qualitative systematic review and meta-aggregation were conducted following the Joanna Briggs Institute (JBI) methodology. Chinese and English databases were searched, and studies were screened, appraised, and synthesized using standard JBI procedures and a ConQual confidence assessment. Twenty-three qualitative studies were included, yielding 70 findings, 15 categories, and 7 synthesized findings. Key themes identified included heteronormative assumptions, internalized stigma, identity concealment, structural inaccessibility, health care alienation, and care withdrawal. Conversely, affirming care environments and formal/informal social support were identified as enhancing patient trust and identity empowerment. LGBTQ+ patient experiences reflect structural stress and intersectional inequities in the health care they receive. Structural reforms in clinical practice, health policies, and professional education are needed to promote culturally sensitive, equity-oriented care for LGBTQ+ populations.

Mental health continues to be a neglected issue globally, and it is particularly disregarded in low- and middle-income countries (LMICs), where access to care is shaped by structural inequalities, pervasive stigma, and limited policy implementation. Here, we leverage data from the Global Mental Health Countdown 2030 to assess Pakistan's mental health landscape with respect to 48 core indicators grouped into four domains: (A) social and environmental determinants, (B) demand and need for treatment, (C) quality of services provision, (D) wellbeing. Comparison groups were provided as medians for South Asia and the larger LMICs. In relation to LMICs, Pakistan ranks in the bottom quartile for inclusiveness and displacement, and possesses increased concentrations of exposure to school bullying and pandemic-related anxiety. Psychological disorders are common and the treatment gap is over 90%, with much of care delivered by non-specialist or untrained providers. Moreover, decreased capacity levels in the system perpetuates mental health stigma. Although mental, neurological, and substance-use related disorders account for 6% of total DALYs, government spending on mental health is 0.4% of the budget in health. As a result, health outcomes are also reflected in low happiness scores and increasing rates of suicide. Psychosocial services are entirely absent at the primary care level, and systematic surveillance is nonexistent. This cross-sectional benchmark analysis underscores the urgent need for structural reforms, including primary care integration, investment in digital and community-delivered interventions, gender-responsive policies, and robust data systems to enable accountability and targeted policy action.

IntroductionCervical cancer prevalence and incidence are high in sub-Saharan Africa, especially in Uganda, where screening rates are low, despite government policy recommending screening for all women aged 25-49 every three years. Most prior research focuses on client-related barriers to screening, including women's fears about the screening procedure, lack of partner support, and community-level stigma. Fewer studies elaborate on inner context factors related to health care systems, facilities, and providers. The aim of this study was to use qualitative methods to explore inner context factors that may affect cervical cancer screening in Uganda.MethodsWe recruited 20 health care facility administrators, 6 providers of cervical cancer screening, 2 district health officers, 2 division medical officers, and one government health official for key informant interviews, and 69 women (31 screened and 38 not screened for cervical cancer) for focus group discussions. Participants were recruited from four health care facilities that varied by urbanicity and funding source: one urban public facility, one urban private non-profit facility, one rural public facility, and one rural private non-profit facility.ResultsInner context themes emerged around infrastructure needs (insufficient space, equipment, and supplies) and staffing issues (inadequate staff quantity and training), which contributed to lower quality of care (e.g., long wait-times; painful, rushed exams). Women described privacy concerns as well as discomfort with male and young providers. Women with HIV were prioritized for screening based on funding streams and inability to serve all women given infrastructure and staffing issues. Despite barriers, many stakeholders were committed to providing cervical cancer screening services, and many women saw the value of screening.ConclusionThis study identified inner context barriers related to resource shortfalls, which affected quality of care. Low cost solutions are needed to improve health care readiness and increase reach of cervical cancer screening in Uganda.

IntroductionPublic health departments (HDs) are central to HIV prevention and care, yet client perspectives remain understudied. Before implementing a social network strategy within a HD, we examined how prior experiences with HDs influence engagement.MethodsWe conducted 17 in-depth interviews with Black sexual and gender minority individuals in Charlotte, North Carolina, to explore experiences with HDs.ResultsParticipants described emotional and navigational support during critical health encounters, including compassionate linkage to care and HIV/STI testing. Identity-affirming interactions and shared cultural backgrounds fostered trust and comfort. However, stigma, concerns about privacy, and intrusive exposure notifications created barriers and, in some cases, distrust of HDs.ConclusionsFindings underscore the importance of identity-concordant care and transparent communication. Tailoring partner services to address confidentiality and affirm identity is essential for public health approaches that build trust, reduce stigma, and meet the needs of underserved communities, ultimately improving engagement in HIV prevention and care. Experiences of Black Sexual and Gender Minority People Engaging With Health Department HIV and Sexual Health ServicesBlack sexual and gender minority (SGM) people are among the groups most affected by HIV in the United States, facing higher rates of new diagnoses and more barriers to care compared with other populations. Because local health departments often provide HIV testing, partner services, and help linking people to clinical care, understanding how Black SGM individuals have experienced these services is important. We interviewed 17 Black SGM adults in the Charlotte, North Carolina metropolitan area who had engaged in at least one HIV/STI-related healthcare service in the last year. Many described supportive health department staff who provided clear information and helped them access treatment. Others reported negative or intrusive interactions that reduced trust. Improving communication, privacy, and cultural respect could make health department services more welcoming and support national efforts to end the HIV epidemic.

Tuberculosis (TB) remains a major public health problem in Indonesia, and strengthening active case finding (ACF) is essential to improve early detection and interrupt transmission in high-burden settings. This study aimed to analyze the implementation of TB ACF at Depok II Primary Health Center, Sleman, Indonesia, using the Donabedian framework consisting of input, process and output components, with a focus on implementation processes, challenges, and strategies from a health promotion perspective. A qualitative case study design was employed. Data were collected through in-depth interviews, field observations, and document reviews involving 14 informants, including primary health center staff, district health office representatives, community health cadres, TB patients, a community leader, and a representative from a non-governmental organization. Data were analyzed thematically using the Miles and Huberman framework with support from NVivo version 12. The findings showed that the input component was generally well established, supported by policy commitment, multidisciplinary human resources, adequate basic logistics, program financing, and strong multisectoral partnerships, although challenges remained in village-level budget execution, limited cadre incentives, and dependence on external diagnostic services such as mobile chest X-ray. The process component was generally effective, characterized by structured service delivery, adaptive outreach strategies, strong health education, and patient-centered implementation. However, variation in community responsiveness, internalized stigma, and referral delays remained important barriers. The outcome component was reflected not only in case detection, but also in improved community awareness, acceptance of diagnosis, treatment adherence, and recognition of TB symptoms. Overall, TB ACF at Depok II Primary Health Center was generally effective and supported by strong system readiness and community engagement; however, its sustainability requires strengthened financing, referral access, and health promotion capacity to address remaining operational, behavioral, and social challenges.

Background: Frontline professionals in health, social care, and emergency response settings are routinely exposed to traumatic events. Trauma-informed practice (TIP) frameworks emphasise organisational readiness, including leadership, systems, and culture, alongside organisational preparedness, referring to the practical capacity to recognise, respond to, and support trauma exposure. Despite increasing policy attention, there is limited empirical evidence that describes how frontline workers experience these organisational factors in practice and how they influence psychological safety, help-seeking, perceptions of workplace support and longer-term staff wellbeing following traumatic or distressing occupational experiences.Objective: This study explored frontline staff experiences of TIP across UK services, focusing on organisational readiness and preparedness and identifying strengths, gaps and priorities for improvement.Methods: A cross-sectional online survey was completed by 325 frontline workers across the NHS, social care and emergency response sectors. The survey assessed four domains: organisational structures and systems, workplace culture and psychological safety, leadership and workforce capability and wellbeing and access to support. Quantitative data were analysed descriptively. Free-text responses from 198 participants were analysed using reflexive thematic analysis and integrated with quantitative findings.Results: Participants described partial organisational readiness, including access to Employee Assistance Programmes, informal peer support and leadership endorsement of staff wellbeing. However, organisational preparedness to respond to trauma exposure was inconsistent. Psychological safety was limited, with many participants uncertain where to seek support and expressing concerns about confidentiality, stigma and professional consequences. Leadership training in trauma-informed approaches was limited, and communication about support pathways was often unclear.Conclusions: Frontline services demonstrate emerging strengths in trauma-informed readiness, but significant gaps remain in organisational preparedness. Key challenges relate to psychological safety, managerial capability, stigma and access to support. Strengthening leadership capability, improving communication, and creating safe, consistent pathways for help-seeking are essential to developing sustainable trauma-informed workplaces. The readiness of frontline services to embed TIP is uneven, with some foundational structures in place but many workers describing unclear systems, inconsistent organisational responses and uncertainty about how to access support following trauma exposure.Psychological safety is inconsistently embedded across organisations; fear of judgement, confidentiality concerns and perceived professional consequences continue to shape disclosure and help-seeking, despite the emotional intensity of frontline roles.These findings highlight the need for organisations to strengthen leadership capability, improve communication of support pathways and enhance practical preparedness, ensuring that existing structures can be enacted safely, consistently and confidently in everyday practice. Antecedentes: Los profesionales de primera línea en entornos de salud, atención social y respuesta a emergencias están expuestos rutinariamente a eventos traumáticos. Los marcos de práctica informada por trauma (TIP en su sigla en inglés) destacan dos elementos clave. La disposición organizacional se refiere a las condiciones estructurales, culturales y de liderazgo que apoyan enfoques informados sobre el trauma. La preparación organizacional refleja la capacidad práctica para reconocer la exposición al trauma, responder y apoyar al personal. A pesar de la creciente atención política, poca evidencia empírica describe cómo los trabajadores de primera línea experimentan estos factores en las organizaciones. Objetivo: Este estudio exploró las experiencias del personal de primera línea con TIP en los servicios del Reino Unido. Se centró en la disposición organizacional, incluyendo políticas, liderazgo, sistemas y capacidad de respuesta cultural, y preparación, incluyendo la seguridad psicológica, la confianza para buscar apoyo, la claridad de las vías de apoyo y el estigma. El objetivo era identificar fortalezas, carencias y prioridades de mejora. Método: Se completó una encuesta transversal en línea realizada por 325 trabajadores de primera línea de los sectores NHS, atención social y respuesta a emergencias. La encuesta evaluó la disposición y preparación organizacional en cuatro clústeres: estructuras y sistemas organizacionales, cultura laboral y seguridad psicológica, capacidad de liderazgo y plantilla, y bienestar y acceso al apoyo. Los datos cuantitativos se resumieron de forma descriptiva y las respuestas cualitativas de 198 participantes (61%) se analizaron mediante análisis temático reflexivo e integradas con los hallazgos cuantitativos. Resultados: Los participantes informaron una disposición organizacional parcial, incluyendo acceso a Programas de Asistencia al Empleado, apoyo informal entre pares y respaldo del bienestar del personal por parte del liderazgo. La disposición para responder a la exposición al trauma fue desigual. La seguridad psicológica fue limitada, ya que los participantes no estaban seguros de dónde buscar apoyo o reportar preocupaciones sobre la confidencialidad y las consecuencias. La formación en liderazgo en los principios de TIP fue limitada y la comunicación sobre las vías de apoyo y las expectativas organizacionales fue poco clara. Conclusiones: Los servicios de primera línea muestran algunas fortalezas en la disposición informada sobre el trauma, pero persisten carencias en la preparación organizacional. Estos se refieren especialmente a la seguridad psicológica, la capacidad de gestión, el estigma y el acceso al apoyo. Fortalecer la capacidad de liderazgo, mejorar la comunicación y crear vías seguras y consistentes para la búsqueda de ayuda son esenciales para entornos laborales sostenibles e informados sobre el trauma.

This study aimed to explore the mediating role of stigma in the relationship between insight and medication adherence, as well as the moderating effect of social support in this mediation model, in order to provide a theoretical basis and intervention strategies for improving medication adherence in patients with stable schizophrenia. A cross-sectional study was conducted from August to December 2023, recruiting 350 patients with stable schizophrenia under the care of mental health centers in Changning and Huangpu Districts, Shanghai, using convenience sampling. Self-reported data were collected on sociodemographic characteristics, insight, stigma, perceived social support, and medication adherence. Statistical analyses included descriptive statistics, t-tests, ANOVA, Pearson correlation analysis, and bootstrap methods. Stigma was significantly negatively correlated with medication adherence (r&#xa0;=&#xa0;-0.295) and social support (r&#xa0;=&#xa0;-0.485), while insight showed significant positive correlations with medication adherence (r&#xa0;=&#xa0;0.179) and social support (r&#xa0;=&#xa0;0.265). Stigma partially mediated the relationship between insight and medication adherence (&#x3b2;&#xa0;=&#xa0;-0.077, p&#xa0;=&#xa0;0.009, 95% CI [-0.141, -0.025]). Perceived social support exerted significant moderating effects between insight and stigma (&#x3b2;&#xa0;=&#xa0;-0.060, p&#xa0;<&#xa0;0.01), as well as between stigma and medication adherence (&#x3b2;&#xa0;=&#xa0;0.503, p&#xa0;<&#xa0;0.01). This study revealed the partial mediating role of stigma in the relationship between insight and medication adherence, and demonstrated that perceived social support significantly moderates this mediation pathway. These findings suggest that while improving patients' insight, strengthening social support systems may effectively reduce stigma and enhance medication adherence.

Adolescents living with HIV (ALHIV) in sub-Saharan Africa (SSA) are a vulnerable population disproportionately affected by mental health disorders due to the combined burden of chronic illness, stigma and socioeconomic challenges. In response, numerous mental health interventions have been implemented to support ALHIV. However, the COVID-19 pandemic significantly disrupted health systems, particularly in-person services, potentially undermining the delivery and efficacy of these interventions. This protocol describes the methodology for a systematic review that will assess the impact of the COVID-19 pandemic on the implementation of mental health interventions for ALHIV in SSA and to explore the emergence or adaptation of interventions during this period. Data will be collected, analysed and reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will search PubMed, Web of Science, APA PsycINFO and Scopus for literature published from 2020 to 2025. Eligible studies will include both qualitative and quantitative designs that assess mental health interventions for ALHIV in SSA or explore pandemic-related implementation impacts. Both peer-reviewed and grey literature will be included. The primary outcomes of interest are implementation-related outcomes, including service disruptions, adaptations, feasibility, acceptability and barriers or facilitators influencing intervention delivery during the COVID-19 pandemic. Data, including study design, methodology and results, will be extracted and synthesised using an Excel spreadsheet. Specific inclusion and exclusion criteria will be used during literature screening and will include study type, location and language. This review uses only publicly accessible data from previously published studies and does not involve the collection of primary data or identifiable human subjects. Therefore, ethical approval is not required. The results of the review will be disseminated through publication in a peer-reviewed journal and shared with stakeholders working in adolescent HIV and mental health services in SSA. CRD420251147822.

Anal cancer is a rare and under-researched malignancy, leading to limited understanding of patients' experiences and potentially insufficiently tailored care. This study explored the health-related quality of life (HRQoL) and healthcare interactions of people with anal cancer. Patients with confirmed diagnosis took part in semi-structured interviews, supplemented by two European Organisation for Research and Treatment of Cancer (EORTC) HRQoL questionnaires. Data were analysed using Interpretative Phenomenological Analysis and organized into themes. Twenty-one patients (71% female; mean age of 62 years) from five countries were included. HRQoL challenges were identified across four phases: illness onset, diagnosis, treatment, and life beyond treatment. Key themes included misdiagnosis, not being taken seriously, and emotional and social disruptions. Additional themes involved stigma, embarrassment, strain on loved ones, and healthcare experiences. Defecation problems were especially burdensome, beginning at onset, intensifying during treatment, and persisting as a chronic issue affecting well-being. Patients described coping strategies and sometimes reframed their experiences positively, expressing gratitude for support received. Questionnaire findings aligned with patients' reports of prominent physical symptoms. Anal cancer remains highly stigmatized, creating complex physical, emotional, and social challenges. Individualized care and extended psychosocial and practical support beyond treatment are essential to improve HRQoL and dignity in survivorship.

This qualitative study explores the perceptions of promoting sexual and reproductive health (SRH) as a priority in development and governance among youth in Nepal. Despite progressive national frameworks supporting gender equality and SRH, the SRH indicators and ground reality suggest a pressing need for improved commitment to ensuring safe and quality SRH services. Using a reproductive justice lens, the study engaged 105 diverse participants including youth leaders, former youth leaders, donors, and local government officials through in-depth interviews, key informant interviews, and focus group discussions conducted across all seven provinces of Nepal. While youth-led initiatives demonstrate promising efforts in policy advocacy, and digital engagement, they often encounter systemic and institutional hurdles like tokenism, policy exclusion, limited funding; and socio-cultural barriers such as deep-seated social stigma, and lack of inclusive programming. These barriers disproportionately impact marginalized groups, including sexual and gender minorities, persons with disabilities, and Dalit and Madheshi communities. To enable real progress in promoting SRH, this study identified a shift away from existing top-down approaches towards localized and decentralized strategies fostering youth agency, co-creation, and co-ownership of programs along with local governments, mainstreaming gender, and decentralizing resources and power for effective SRH promotion strategies.

To advance the long-term goal of a universal national school food program (SFP) in Canada, understanding the benefits of such programs is important. Through 2021-23, a universal curriculum-integrated school lunch pilot was introduced in two low-income and culturally diverse schools in Saskatoon, Saskatchewan, Canada. Case study research and interviews with 43 school staff were conducted over the course of the pilot to understand school and student-level benefits. Following an inductive-deductive analysis informed by a Health Promoting Schools (HPS) approach, it was found that the universal lunch enhanced the schools' social environment and supported teaching and learning. Results demonstrated that the pilot improved the well-being of students through creating welcoming and caring spaces in the school, supporting student achievement and attendance, enriching student food exposure and healthy eating, and enhancing opportunities for learning. Furthermore, the introduction of the universal lunch was reported to reduce the stigma of school lunch and support staff wellness. This research suggests freshly prepared, nutritious, and inclusive universal lunch programs can be an effective policy approach to support health promotion in schools. Recognizing the holistic benefits of universal lunch programs can help health and education sectors and other partners work together to advance lunch programs as school-wide, HPS interventions.

Weight stigma is prevalent in health care. Despite this, few studies have explored weight stigma in relation to cancer care. This study provides preliminary data on the frequency and types of weight stigma experienced by people with cancer in Australia. People who had a cancer diagnosis in the past 10&#xa0;years (n&#xa0;=&#xa0;150) completed an online survey to assess weight stigmatising experiences in cancer care. Experiences of weight stigma were assessed using an adapted version of the Stigmatising Situations in Healthcare measure. Descriptive, and multivariate analyses were conducted. Over half (n&#xa0;=&#xa0;79, 53%) of respondents reported experiencing weight stigma during their cancer care, including negative character judgements, accessibility issues, discrimination, unsolicited diet advice, and diagnostic overshadowing. The proportion of participants reporting at least one stigmatising experience ranged from 32% with a healthy BMI, to 70% amongst those whose weight was categorised as obese. Higher BMI, internalised weight bias, and healthcare avoidance were each independently associated with increased reports of weight stigma during cancer care. Participants who reported avoiding or delaying healthcare were more likely to report experiences of stigma. Higher ratings of physician empathy were associated with fewer reported experiences of weight stigma. As the first Australian quantitative investigation of experiences of weight stigma during cancer care, preliminary results reveal people with cancer may face a range of weight stigmatising experiences during their cancer care. Experiences of weight stigma increased with higher internalised weight bias and avoidance and/or delaying of health care utilisation.