Aged care in Australia is under scrutiny. In 2021, the Royal Commission into Aged Care Quality and Safety highlighted the need for increased informed choice. Occupational therapists working within residential and community aged care have a responsibility to provide informed choice to their clients. Knowing more about the perspectives of occupational therapists about informed choice with older people will provide insights into practice that may direct future training needs and best practice recommendations. This study therefore aimed to explore perspectives of Australian occupational therapists about informed choice when working with older people. A qualitative descriptive research design was employed. Through purposive and snowball sampling, 10 Australian occupational therapists who work in the aged care sector were recruited. They worked in both residential and community aged care. Data were collected face-to-face and via tele-conferencing using semi-structured interviews; data were analysed using reflexive thematic analysis. Consumers of occupational therapy services were not involved, but this is a recommendation for future research. The findings reflected tensions reported in the literature of managing multiple decision-makers and fluctuating decision-making capacity alongside professional responsibilities. Theme 1 described methods for raising client awareness of options, negotiating choices, exercising caution, and supporting dignity or risk. Theme 2 described the communication skills employed for promoting informed choice, and Theme 3 described the need for collaborative decision-making. The final theme outlined the value of workplace policies, procedures, and documents for informed choice. Occupational therapists in aged care approach their practice using a person and family centred lens. They employ skilful communication, negotiation, and problem solving. However, tensions exist between managing professional responsibilities around risk and supporting informed choice. Aged care is complex, with ongoing need for training and supervision, and a community of practice for idea sharing and collective problem-solving. Informed choice in aged care means older people know enough about their health and care options to make their own decisions. This includes the legal right to accept or refuse services. Autonomy happens when people can decide for themselves without pressure from others. When aged care supports autonomy and choice, older people may have improved lives. In 2021, the Royal Commission into Aged Care Quality and Safety called for greater emphasis on informed choice in aged care. However, occupational therapists' perspectives about informed choice when working with older people are largely unknown. Researchers interviewed 10 occupational therapists who worked in both residential and community aged care to learn their views about informed choice. Four themes were developed about informed choice, including building trust, communicating clearly, and involving families in decisions. They also refer to and use policies and procedures, such as staying up‐to‐date, risk reduction, and meeting documentation requirements. The study found that occupational therapists need time and resources to communicate and collaborate, so they can maximise informed choice. It also showed the value of professional networks and shared learning to solve problems and generate ideas.
With ageing populations and increasing demand for aged care, quality of life (QoL) has become a central focus of recent policy reforms in Australia and other countries. The Quality of Life-Aged Care Consumer (QOL-ACC), a preference-based measure, was introduced as a mandatory national quality indicator across Australia in 2023 to support assessment and public reporting of variation in QoL across long term aged care facilities (LTCFs). While its national implementation is a significant step forward, further guidance is needed to support the interpretation of QOL-ACC scores in practice. Therefore, this study aimed to identify an empirical reference point on the QOL-ACC to aid interpretation of scores in LTCFs. Data were collected through self-reports from LTCFs residents and proxy reports from informal carers. An anchor-based method was used, comparing QOL-ACC summative scores (range: 0 to 24; higher scores indicate better QoL) against two global items of health and QoL. Receiver Operating Characteristic (ROC) curve analysis assessed the discriminative ability of different QOL-ACC scores in identifying residents who rated their global health or quality of life as "good" or better. Sensitivity, specificity, and area under the curve (AUC) were calculated. Of the total 316 care recipients included (200 [62.5%] self-reports and 116 [37.5%] proxy-reports), the majority were female (64.2%) with a mean age of 84 ± 8.2 years. A QOL-ACC summative score of ≥ 18 was identified as the optimal reference threshold for indicating good quality of life, with a sensitivity of 76%, specificity of 78%, and an AUC of 0.83 (95% CI 0.78-0.87), indicating good discriminative ability. This study provides a practical and evidence-based interpretive reference point for QOL-ACC scores in long-term care facilities. The identified cut-off may support interpretation of QOL-ACC outcomes in routine quality monitoring and inform care planning, service evaluation, and quality improvement interventions. As the population ages, improving quality of life (QoL) in aged care has become a major priority in Australia and other countries. The QOL-ACC is a national quality indicator introduced in 2023 to measure the quality of life of people living in aged care facilities. However, staff and policymakers need clearer guidance on how to understand and use these scores in practice. This study aimed to identify a practical reference point on the QOL-ACC scale. We analysed survey data from 316 long-term care residents and compared QOL-ACC scores with residents’ overall ratings of their health and quality of life. We found that a score of 18 provides a practical reference threshold for interpreting QOL-ACC results. Scores above this level may reflect a good standard of quality of life, while lower scores may indicate poorer QoL. This reference point may help aged care providers and policymakers better understand quality of life outcomes and support improvements in care. This threshold should be used with caution and alongside other quality of life information.
Family or friend caregivers of older adults are critical in helping older adults navigate fragmented health and social systems, but they face significant challenges in doing so. Their needs for support, information, and resources are often unmet or remain largely invisible to health and social systems and public policy. In Ontario, Canada, Ontario Health Teams (OHTs) were established to integrate and streamline health care services. However, emerging evidence suggests that despite the requirement to integrate patient and caregiver advisors in these activities, caregivers still face substantial navigation barriers. This study aimed to systematically evaluate the amount, nature, and accessibility of information provided on each of the 58 OHT websites. Specifically, we focused on information on services and supports for older adults and their caregivers. Between November 2024 and May 2025, we conducted an environmental scan of all 58 OHT websites. Using a 5-point Likert scale, 2 team members independently rated how easy or difficult it was to identify services and supports for older adults and their caregivers. They also documented each service and support listed on each website and provided additional details on the experience of navigating the website in an open-text comment. The ratings were discussed in team meetings, and discrepancies were resolved through team consensus. Data analysis included thematic analysis of the services identified and of open-text responses (positive and negative experiences of navigating the websites, rationales for the ratings), as well as descriptive statistics of the ease of access ratings and of the types of services listed on OHT websites. Almost 60% of the websites were rated as difficult or very difficult to navigate, and 33% provided insufficient information on services and supports. However, information quality and accessibility varied significantly between websites. While some featured clear, well-organized resources, others were poorly designed, lacked a well-functioning search function, or provided vague or incomplete descriptions of services and supports. Design features that improved the accessibility and usefulness of websites included user-friendly, simple navigation and direct links to relevant services. In contrast, poorly designed websites often require multiple steps to access essential information, risking exacerbating caregiver burden. Our findings highlight significant barriers for caregivers to access and navigate health and social service information, despite the intended goals of OHTs to improve system navigation. Health care system reforms focusing on integrated care need to include older adults and their caregivers as priority populations. Older adults and caregivers need to be engaged systematically and comprehensively, including in the development, design, and evaluation of health care system websites. Further, standards of public reporting need to be developed, and integrated care networks need to be required to follow these standards. This will help to improve transparency and accountability.
Bullying has been considered a substantial risk factor toward various psychological disorders such as dissatisfaction with body image and body dysmorphic symptoms. This meta-analysis examines the strength and the nature of association between these aforementioned variables and its mental health consequences. A systematic review and meta-analysis were conducted on examining association between bullying and body dysmorphic symptoms, body image dissatisfaction, psychological distress, and self-esteem. Effect sizes were calculated using Hedges' g and pooled odds ratios (OR) under a random-effects model. Moderators and heterogeneity were explored using moderator analysis and meta-regression. The subgroup analyses (Cross-sectional versus Longitudinal Study Design) were carried out to determine the difference between study types. The meta-essentials excel workbook dichotomous (binary) was used to estimate Ors conduct meta-analysis. The forest and funnel plots were plotted to determine the statistical significance. The review of 38 Studies that explore the relationship between these variables at different time points to illustrate the effects on overall body dissatisfaction, low self-esteem, psychological distress, anxiety, depression, and suicidal ideation. Gender differences demonstrated that female participants were found more vulnerable to body dissatisfaction and eating disorders than male who were more likely to have anxiety regarding muscularity and strength. Five studies assessing body dysmorphic disorder (BDD) revealed a pooled OR of 6.30 (95% CI [2.25, 17.62], I2 = 55.35% p < 0.001), indicating a significantly increased likelihood of body dysmorphic symptoms among bullied adolescents, but significant heterogeneity among studies (cross-sectional studies I2 = 0.00%; longitudinal studies I2 = 86.17%). The high heterogeneity in longitudinal studies is due to differential diagnosis methods and small number of studies (k = 2). Furthermore, body image dissatisfaction also showed a significant negative association with bullying exposure (g = -1.38, 95% CI [-1.54, -1.23], p < 0.001). Similar patterns were observed with secondary outcomes with bullying attributing to psychological distress (g = -1.24) and lower self-esteem (g = -1.12). Considerable moderators were the study design, setting, and type of bullying, with cyberbullying and appearance-specific bullying having the greatest effects. Younger age of adolescent was found to be predictive of large effect sizes by meta-regression, as well as high quality of study. The sensitivity analysis supported the strength of the results, and the adjusted estimates showed that no publication bias (Egger regression test estimate = 4.96, p = 0.471; Trim and Fill method, p-value = 0 missing study; Begg and Mazumdar test, p-value = 1.00). Physical appearance and cyberbullying impact the body dysmorphic symptoms development negatively, body image dissatisfaction, psychological distress, and self-esteem. Bullying and body dysmorphic disorder are also found associated. The absence of publication bias suggests the results were valid and reliable, but meta-analysis findings are based on inclusion of a small number of longitudinal studies and majorly from cross-sectional studies. To maintain diagnosis consistency and methodological robustness in evidence synthesis, future researchers should undertake more longitudinal cohort studies utilizing standardized or validated BDD diagnosis scales. Although qualitative (systematic) synthesis shows a temporal relationship between bullying and BDD, but cross-sectional research-based evidence unable to determine the causal relationship. Future longitudinal or randomized controlled studies are encouraged to confirm and generalize findings.
Intimate partner violence (IPV) has harmful effects on women's physical, mental, and reproductive health. This study investigates the relationship between experiencing IPV and unmet need for family planning in two provinces of the Democratic Republic of the Congo (DRC), emphasizing the potential mediating effect of reproductive coercion. To our knowledge, this is the first examination of the connection between IPV and unmet need for family planning in the DRC, particularly regarding the underlying mechanisms of this association. This research utilized secondary data from the third wave of the Performance Monitoring for Action (PMA) surveys carried out in two provinces of the DRC during the period from 2021 to 2022. The analysis focused on a sample comprising 1,387 women in unions aged between 15 and 49 years. To investigate the relationship between IPV and unmet need for family planning, linear probability models were employed and various factors were controlled. Additionally, we explored the moderating influence of reproductive coercion in this context. The linear probability model indicated that experiencing sexual IPV within the past 12 months was linked to an unmet need for family planning [aCoef = 0.12, CI95% = 0.04-0.21]. When sexual IPV occurred alongside reproductive coercion, a stronger correlation with unmet need was detected [aCoef = 0.24, CI95% = 0.03-0.44]. We showed that sexual IPV is associated with an unmet need for family planning in the DRC. While IPV should be considered a policy target, these results emphasize the importance of responding appropriately to IPV when sexual and reproductive health services are provided to women. This was the first study on the DRC and, more generally, on sub-Saharan Africa (SSA) to illuminate the underlying mechanisms of the association, revealing the moderating role of reproductive coercion.
BackgroundAlthough perceived distance is a key factor in deciding and reaching healthcare, its impact on antenatal care (ANC) utilisation remains underexplored.ObjectiveThis study aims to examine the effect of perceived distance on ANC uptake, stratified by key maternal characteristics.DesignCross-sectional analysis based on demographic and health survey data (DHS).MethodsThis study analysed the demographic and health survey data of 26 sub-Saharan African countries, comprising 186,873 women who had given birth within the five years preceding the surveys. The exposure variable was perceived distance to a healthcare facility, categorised as "a big problem" or "not a big problem." Whereas the outcome variable was the number of ANC contacts, classified as no, one to three, four to seven and eight or more contacts. A Generalised Structural Equation Model (GSEM) with a multinomial logit link was employed to examine the association. Analyses were further stratified by socio-demographic characteristics.ResultsThe analysis revealed that women who perceived the distance as a major problem had 15% higher odds of receiving only 1-3 contacts (aOR = 1.15, 95% CI: 1.05, 1.25, p = 0.002), and 51% higher odds of receiving no ANC (aOR = 1.51, 95% CI: 1.35, 1.66, p < 0.001), compared to those receiving eight or more contacts. These associations were particularly pronounced among women with lower educational status (aOR=1.48, 95%CI: 1.29, 1.64), rural residents (aOR=1.55, 95%CI: 1.37, 1.74), low household income (aOR=1.47, 95%CI: 1.27,1.68), and younger age (aOR=1.55, 95%CI: 1.31, 1.80).ConclusionPerceived distance remains a significant barrier to the utilisation of antenatal care services in resource-limited settings. Strengthening health system responsiveness and addressing structural barriers, such as transportation infrastructures, through innovations like mobile antenatal care is vital to improving maternal health outcomes and advancing global health equity. Ensuring access to high-quality antenatal care (ANC) is essential for improving maternal and newborn health outcomes. However, evidence on the effect of geographical distance on ANC use in sub-Saharan Africa remains limited and inconclusive. This study examined the relationship between perceived distance to a health facility and ANC utilisation across 26 sub-Saharan African countries. We analysed the Demographic and Health Survey (DHS) data from 186,873 women who had given birth in the five years preceding the survey. Women who reported that distance to a health facility was a major problem had 15% higher odds of attending only 1-3 ANC contacts and 51% higher odds of receiving no ANC, compared with women who attended at least eight contacts. These associations were stronger among women with lower levels of education, those living in rural areas, women from low-income households, and younger women. These findings underscore the importance of addressing perceived distance-related barriers to improve uptake of the WHO-recommended number of ANC contacts and to promote equitable access to maternal health services in sub-Saharan Africa.
BACKGROUND: Mental health—defined as a state of well-being enabling people to realise their potential, cope with daily stress, perform productive work, and contribute positively to their communities—is still perceived by the majority of people in low-income countries, including primary school teachers, as mental ill-health. This study aimed to understand the perceptions and explanatory factors of primary school teachers’ commitment to promoting mental health in schools in the urban Democratic Republic of Congo (DRC). METHOD: This qualitative study was conducted in the urban DRC, especially in the city of Kinshasa. We collected data by conducting face-to-face, in-depth individual interviews with 24 primary school teachers from 12 schools (private, public and faith-based). We analysed the data according to Braun and Clarke’s reflexive thematic analysis approach. The results were organised around the following themes: teachers’ understanding of mental health, factors explaining teachers’ commitment to promoting mental health in schools, perceived obstacles, current practices, and mental health needs and expectations. RESULTS: Participants perceived mental health in school as a concept associated with “madness” or simply misinterpreted it. They stated that they perform mental health promotion activities based on their knowledge, including identifying pupils with mental health conditions, providing psychological first aid, and referring them to specialist services. Their commitment to promoting mental health in schools depended on their personal motivations and perceived institutional support. However, several factors, such as lack of training, lack of resources, and lack of sustained institutional support, were cited as perceived obstacles to their commitment. Participants highlighted the need for specific training in mental health promotion and advocated for integrating mental health into school curricula to strengthen its promotion. CONCLUSION: The findings reveal that primary school teachers in Kinshasa still perceive mental health more as the presence of mental disorders than as positive mental health. Mental health promotion is not being implemented optimally in primary schools, as several perceived obstacles affect teachers’ commitment. These findings point to the need to revitalise mental health promotion in primary schools, particularly by establishing psychological support structures in schools and training teachers in mental health promotion.
BACKGROUND: The measurement and valuation of quality of life for older people is critical for economic evaluation and for person-centred quality assessment across health and aged care sectors. However, most existing quality of life (QoL) measures were developed for younger populations and do not encapsulate what is important to older people’s QoL. The Quality of Life – Aged Care Consumers (QOL-ACC), a preference-based quality of life measure, co-designed with older Australians in aged care, addressed this gap and is now part of the National Aged Care Quality Indicator Program. Health and aged care systems for older people overlap as many individuals require a continuum of care that spans both sectors. In Australia, the health care system is predominantly occupied by older people, with subacute services the fastest growing area. Subacute care is a specialised multi-disciplinary care that supports recovery and functional optimisation where the main goal is maximisation of QoL. Building on our previous work in aged care, this study will develop and validate a QoL measure tailored to older people receiving subacute services, supporting improved care and informed policy making decisions. METHODS: This study consists of three stages. Qualitative interviews with older people in subacute care settings to assess the face validity and content validity of the QOL-ACC measure using a think-aloud approach. These findings will inform revisions to the QOL ACC, which will then be tested using an iterative interviewing process. The revised QOL-ACC measure will then be validated for older people in subacute settings through rigorous psychometric assessments. Finally, a preference-based scoring algorithm to enable the calculation of quality-adjusted life years (QALYs) will be developed. DISCUSSION: Quality improvements are needed across the health care system, particularly for older people, who may have complex health needs. However, their voices are often not heard, as no suitable preference-based QoL measure exists to monitor their QoL. This study will co-develop and validate the first preference-based QoL measure for older people in subacute settings, enabling the application of the QOL-ACC across both health and aged care systems leading to better informed decision-making and maximising QoL outcomes for older people.
The study aims to estimate the prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) in the Greater Kasai region of the Democratic Republic of the Congo (DRC) and to examine how demographic and socio-economic factors, such as displacement status and livelihood conditions, are associated with these mental health outcomes. A cross-sectional two-stage multi-cluster sampling survey. In 2016-2019, a violent conflict in the Greater Kasai region of the DRC led to widespread atrocities and massive displacement. The population not only has to cope with the aftermath of interpersonal violence, loss of loved ones and displacement but also faces severe food shortages and livelihood crises. Data were collected in 2022 from 4069 randomly selected heads of households (displaced and non-displaced) within 126 randomly selected localities in 27 health zones in the Greater Kasai. The study collected data from households with different displacement experiences: internally displaced people (IDPs), returned IDPs, repatriated refugees and members of the host community (those without a displacement history). The primary outcomes are mental health disorders. Anxiety, depression and PTSD were measured with the Generalised Anxiety Disorder-7, the Patient Health Questionnaire-9 and the Primary Care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. The prevalence of anxiety, depression and PTSD was 8.3%, 18.3% and 37.8%, respectively. Anxiety affected 10% of non-displaced respondents, with a similar prevalence among IDPs (9%) and returned IDPs (8%), compared with a substantially lower prevalence among repatriated refugees (4%). About 17% of non-displaced respondents have symptoms of depression; this number is considerably higher for IDPs (22%) and returned IDPs (22%) but lower for repatriated refugees (11%). Around 40% of the non-displaced individuals, IDPs and repatriated refugees are characterised by PTSD, while this share is lower for returned IDPs (31%). Overall, a one unit increase in food insecurity (on a 0-7 scale) is associated with higher levels of anxiety (0.33 on a 0-21 scale, p<0.001), depression (0.60 on a 0-27 scale, p<0.001) and PTSD (0.07 on a 0-5 scale, p<0.05); these associations exist for those with and without a displacement history. Food insecurity is associated with poor mental health in Greater Kasai. Further research needs to explore how to develop synergistic interventions to improve both mental health and livelihoods in conflict-affected populations.
Person-Centered Care (PCC) has become established as an essential model in geriatric care, promoting the dignity, autonomy, and well-being of residents. However, the COVID-19 pandemic posed an unprecedented challenge to its implementation in nursing homes (NH), affecting both the quality of care and human relationships. This study analyzes the perceptions of residents, relatives, professionals, and directors regarding PCC before, during, and after the pandemic in Catalonia (Spain). A multicenter cross-sectional study was conducted in 30 NH across the 10 healthcare regions of Catalonia. Validated PCC in Gerontology Services model questionnaires were administered to 335 participants, including residents, relatives, professionals, and directors. Each item was retrospectively assessed at three time points: before, during, and after the pandemic. Descriptive, staffing, and pandemic-related variables from the facilities were collected. Statistical analyses included descriptive statistics, nonparametric tests for group comparisons, and bivariate associations assessed using Spearman's rank correlation coefficients. During the COVID-19 pandemic, PCC scores dropped sharply-from 176 pre-pandemic to 136 during the crisis- before partially recovering to 171 post-pandemic, underscoring the substantial impact of the health emergency. Larger NHs and those with more months in "red code" experienced greater losses in PCC scores during the pandemic, while homes with a higher proportion of resident transfers showed smaller decreases. Additionally, NHs with a higher physician-to-resident ratio experienced larger decreases in PCC scores during the pandemic, while NHs that suffered greater losses in PCC scores tended to show greater post-pandemic recovery. This study confirms that PCC is particularly vulnerable during health crises such as the COVID-19 pandemic. The findings highlight the need for flexible organizational structures, adequate resources, and strong ethical guidance to ensure the sustainability of the PCC model and underscore the importance of contingency plans that maintain PCC without compromising residents' safety, dignity, or autonomy. Not applicable.
BACKGROUND: Hypertension remains a leading cause of cardiovascular diseases worldwide. Unfavorable working conditions may lead to detrimental effects on employees’ health and work well-being. Healthcare workers are often exposed to sustained high stress levels due to the demands of their occupation, making them more susceptible to burnout. Despite their commitment to caring for others, their health can also be compromised. This study aimed to investigate the prevalence of hypertension and its associated factors among healthcare workers in Kinshasa, focusing on occupational factors. METHODS: A cross-sectional study was conducted through a structured questionnaire based on the modified WHO STEPwise and Maslach Burnout Inventory - Human Services Survey for Medical Personnel among healthcare workers selected via multistage stratified random sampling in Kinshasa’s hospitals from December 2023 to January 2024. Weight, height, blood pressure, and fasting blood sugar were measured. The prevalence of hypertension was determined. All associated variables with hypertension were included in a multivariable logistic regression analysis at the 5% significance level. RESULTS: Of 566 healthcare workers enrolled in the study, 55.0% were female and 45.0% were male, with a mean age of 39.0 ± 10.4 years. The prevalence of hypertension was 23.3% (95% CI: 19.9–27.0), with 57.6% (95% CI: 48.7–66.1) of hypertensive participants unaware of their diagnosis at the time of data collection. In the multivariable analysis, the socio-demographic and lifestyle factors associated with hypertension were age ≥ 40 years (aOR = 3.48, 95% CI: 2.02–5.98), physical inactivity (aOR = 1.69, 95% CI: 1.02–2.80), being overweight (aOR = 1.79, 95% CI: 1.05–3.06), and being obese (aOR = 3.80, 95% CI: 2.06–7.01). Regarding occupational factors, seniority ≥ 10 years (aOR = 3.41, 95% CI: 1.94-6.00), night shift work (aOR = 5.00, 95% CI: 2.85–8.78), and burnout syndrome (aOR = 2.02, 95% CI: 1.23–3.31) were associated with hypertension. CONCLUSION: Beyond lifestyle, occupational conditions contribute to hypertension among HCWs. Addressing hypertension requires tackling both lifestyle behaviors and modifiable work-related factors. Integrating healthy practices such as regular physical activity, balanced nutrition, and routine blood pressure monitoring with structured shift schedules, stress management programs, and supportive workplace environments can protect cardiovascular health, prevent burnout, and strengthen HCWs’ efficiency and patient care quality.
International students from high cultural-distance backgrounds face unique adaptation challenges, yet research has predominantly examined these challenges using variable-centered approaches that assume population homogeneity. This study adopts a person-centered approach to identify distinct latent profiles among African international students in China based on identity recognition, social avoidance, cultural intelligence, and perceived discrimination, and examines how these profiles differ in cross-cultural adaptation outcomes. A mixed-methods research design was employed. Quantitative data were collected from 524 African international students at universities in four Chinese cities (Beijing, Guangzhou, Wuhan, and Wuxi) through questionnaire surveys. Latent profile analysis (LPA) was conducted to identify distinct subgroups, followed by auxiliary analyses comparing profiles on cross-cultural adaptation outcomes. Semi-structured in-depth interviews were conducted with a subsample of 18 participants, with qualitative insights extracted using thematic analysis to contextualize the quantitative findings. A three-profile solution provided the best fit to the data (entropy = .86, BIC = 5389.78). Profile 1, "Resilient Integrators" (35.5%), was characterized by high identity recognition and cultural intelligence, low social avoidance, and low to moderate perceived discrimination. Profile 2, "Anxious Withdrawers" (21.4%), exhibited low identity recognition and cultural intelligence, high social avoidance and perceived discrimination. Profile 3, "Cautious Navigators" (43.1%), showed moderate levels across all indicators but with notable within-profile variability. The three profiles differed significantly in cross-cultural adaptation (χ2 = 156.82, p < .001), with Resilient Integrators reporting the highest adaptation and Anxious Withdrawers the lowest. However, the difference between Resilient Integrators and Cautious Navigators was smaller than expected, suggesting that moderate resources can yield reasonable adaptation in structured contexts. Chinese language proficiency (OR = 1.74, p < .001) and social support (OR = 1.58, p < .001) were significantly associated with membership in the Resilient Integrators profile. Qualitative interviews (N = 18) largely corroborated the quantitative profiles but also revealed important within-profile heterogeneity, particularly among Cautious Navigators, some of whom described experiences overlapping with the Anxious Withdrawers pattern. African international students in China form qualitatively distinct subgroups with different configurations of psychological and behavioral characteristics. Findings provide preliminary evidence that support services tailored to the characteristics of distinct subgroups, such as intensive language training and structured social opportunities, may warrant further investigation as alternatives to uniform support programs.
The 2018-2020 Ebola Virus Disease (EVD) outbreak in Eastern Democratic Republic of the Congo (DRC) occurred amid armed conflict, institutional mistrust, and fragile health systems. The Ebola vaccine was deployed under emergency pre-licensure use, and concerns about it persisted. This study explored community and healthcare worker (HCW) perceptions of the Ebola vaccine to better understand the sociocultural and structural drivers of vaccine acceptance. We conducted a qualitative study in three heavily affected health zones in North Kivu province (Beni, Butembo, and Mabalako) in 2021. Data were collected through thirty-three focus group discussions and 15 key informant interviews with EVD survivors, community members, HCWs, and local leaders, purposively sampled to capture diverse perspectives. Transcripts were analyzed using thematic and content analysis. Participants reported concerns about the safety of the vaccine, mistrust in the institutions delivering it, and confusion due to rumors and inconsistent communication from the Ebola response. HCWs reported feeling coerced into vaccination rather than making a voluntary choice. Misinformation, logistical barriers, and perceptions of favoritism and stigmatization linked to ring vaccination were cited as preventing acceptance. Religion played a dual role, both fostering skepticism and encouraging acceptance depending on the stance of local faith leaders. Participants emphasized the need for transparent and balanced communication, equitable access, and greater involvement of trusted and competent community figures in vaccination efforts. Ebola vaccine decision-making in Eastern DRC was shaped by complex interactions between institutional mistrust, perceived risk, religion, and access constraints within a broader context of sociopolitical instability. This study provides a critical baseline of perceptions during the vaccine's pre-licensure phase and highlights the importance of locally grounded engagement strategies. As vaccines become licensed, understanding local perceptions as well as leveraging the influence of trusted religious and community leaders will be essential for improving vaccine uptake.
While most people desire acceptance and approval from their peers, previous research have shown that for anxious individuals often peers show a reduced willingness to pursue further interactions with them after initial interactions. To gain a deeper understanding of the factors influencing the process of likability, we conducted two studies. Using a zero-acquaintance paradigm and a quasi-experimental design, we aimed to investigate whether the likability of socially anxious and non-anxious individuals is primarily influenced by first impressions or the extent of their self-disclosure. The second study explored how evaluators' characteristics - such as personality traits, social anxiety, need for affiliation - influence the way they rate the likability levels of the (non)anxious individuals. We observed differences in evaluators' perceptions of speakers with respect to likeability and their desire for future interactions. Moreover, evaluator characteristics, such as social anxiety and the need for affiliation, were found to significantly influence their assessments of the likeability of socially anxious speakers.
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.
In China, the number of left-behind children (LBC) was more than 61 million, accounting for 21.88% of the child population. Due to a lack of parental care and insufficient family support, these children were more susceptible to stressful life events, such as interpersonal relationship (e.g., conflicts with classmates or friends) and study pressure (e.g., failures in the exam). Empathy, as an important protective factor, played a significant role in promoting the socialization and coping with stressful life events of LBC. Prior studies confirmed the relationship between stressful life events and empathy but not the underlying mechanisms for LBC and whether there were gender differences in the relationship. With a sample of 702 LBC (Mage = 12.61, SD = 1.60; 55.27% girls, 44.73% boys), we studied the relationship between stressful life events, self-esteem, and empathy. The results showed that stressful life events were directly and positively associated with empathy, that is, LBC who experienced more stressful events exhibited higher empathy. Furthermore, self-esteem mediated the relationship between stressful life events and empathy, with higher scores on stressful life events indirectly lowered empathy scores by negatively impacting self-esteem. Moreover, gender moderated the relationship between stressful life events and self-esteem, with higher stressful life events associated with lower self-esteem in girls than in boys. The present study revealed the role of self-esteem and gender in the relationship between stressful life events and empathy, which has important theoretical and practical significance for the prevention and intervention of social adaptation ability in LBC.
Hostile co-parenting can escalate during separation and divorce with significant ramifications on family relationships. The relational and private nature of this behavior can make it hard to document, study, and understand. The purpose of the present study was to determine how relational aggression targeting the co-parent (and former romantic partner), is associated with relational aggression targeting the parent-child bond. The sample consisted of 103 divorced/separated parents (45% fathers) who were co-parenting at least one child with their former partner (Mage years = 43.66, SD = 9.39). Parents completed measures assessing their engagement in different forms of relational aggression (toward their former partner and the child(ren)), relational abuse (from their romantic partner and their child(ren)), maladaptive personality traits, and vignettes assessing perceptions of loyalty/betrayal. Results suggest that parents who reported elevated levels of romantic relational abuse and who had stronger beliefs about betrayal (rating it as morally unacceptable) also reported more frequent engagement in both forms of relational aggression. Maladaptive personality traits (both psychopathic and narcissistic traits) were linked with romantic relational aggression. Perceptions of loyalty moderated the link between parental narcissistic traits and romantic relational aggression; and the link between parental psychopathic traits and excluding the co-parent, with parents more strongly opposed, engaging in these behaviors. The positive association among the two forms of relational aggression suggest that parent-child bond-breaking behaviors are best understood in the context of wider engagement in relational aggression, however each form of relational aggression has its unique nuances which need to be considered when developing prevention and intervention programs.
Even if the effects of alcohol use on Intimate Partner Violence (IPV) are well documented, most of the research were from developed countries. Sub Saharan Africa is famous for higher rates of IPV, yet its relationship with partners alcohol consumption is rarely studied. This project focused on assessing the relationship between partners alcohol consumption and IPV against married women, using dual dataset for men and women. We used the recent 2021-2022 Demographic and Health Survey (DHS) dataset for five countries in Sub Saharan Africa. We accessed the dataset on February 13, 2024. The data was anonymous, and there was no any personal identifier. The dataset included 37,465 participants. We used women questionnaire to determine IPV and related factors, and partner's questionnaire for alcohol and related factors. STATA 18 was used for analysis. A generalized linear mixed model (GLMM) used to estimate the effect of partner alcohol consumption and other factors on IPV. We determined the level of significance at p-value of less than.05. The prevalence of IPV was 33.6% [32.9-34.2%]; and that of partner alcohol consumption accounted 25% [24.5-25.4%]. Partner alcohol consumption increased the odds of physical, emotional, sexual, and any form of IPV. Partner alcohol consumption increased the odds of IPV, which suggests that partner inclusive intervention packages might be effective in addressing IPV against women in SSA.
Adult Children of Alcoholics (ACOAs) face myriad challenges related to experiencing negative life events resulting from their parents' problematic drinking. ACOAs are at an elevated risk of developing alcohol-related problems and psychological distress, which may influence their overall well-being. The current, cross-sectional study examined the association of forgiveness with both ACOA-related problems and alcohol-related problems among college students raised by parents with a history of problematic drinking (N = 348), as mediated by psychological distress (i.e., depression, anxiety, and stress). Results indicated that higher levels of forgiveness of self and forgiveness of uncontrollable situations were each associated with lower levels of depression, which in turn were associated with fewer alcohol-related problems. Higher levels of forgiveness of self and forgiveness of uncontrollable situations were associated with lower levels of depression and stress, which in turn were associated with fewer ACOA-related problems. However, forgiveness of self and forgiveness of uncontrollable situations each operated through less anxiety in association with more ACOA-related problems. Neither depression, anxiety, nor stress operated as mediators of the association of forgiveness of parent(s) alcohol use with ACOA-related or alcohol-related problems. These findings suggest that certain dimensions of forgiveness, particularly self-forgiveness, may be crucial in mitigating psychological distress and related problems among ACOAs. The results highlight the potential importance of forgiveness-based interventions in addressing ACOA-related problems and problematic alcohol use among college students with a family history of alcohol problems.
Older adults living in residential aged care facilities (RACFs), particularly in regional and rural areas, experience a high burden of untreated dental caries, tooth sensitivity, and oral pain. Workforce shortages, limited access to dental services, and competing health priorities make the delivery of timely oral health care challenging in these settings. Poor oral health contributes to pain, impaired nutrition, reduced quality of life, and increased health service use. There is an urgent need for context-appropriate, accessible, and cost-effective interventions for RACF residents. Aqueous silver fluoride (AgF), a minimally invasive topical agent with caries-arresting and desensitizing properties, offers a pragmatic approach suitable for aged care settings. This protocol aims to test the effectiveness of an AgF intervention package in reducing tooth sensitivity and tooth pain, arresting caries, and improving oral health and well-being in older adults living in regional and rural RACFs. This study is a 2-arm, parallel-group cluster randomized controlled trial, with RACFs as the unit of randomization. The trial is conducted in public and private RACFs across regional and rural Queensland and New South Wales, Australia. Eligible participants are residents with at least 1 natural tooth. At baseline, calibrated examiners perform standardized oral examinations to assess dental caries status, lesion activity, and dentin hypersensitivity. AgF is applied to eligible carious lesions and sensitive tooth surfaces following a standardized clinical protocol. Follow-up assessments at 3 months include a repeat clinical examination to assess caries arrest and changes in hypersensitivity, along with resident-reported measures of oral pain and oral health-related quality of life collected using validated instruments. Outcomes include change in tooth sensitivity and oral pain at the 3-month follow-up, caries arrest rates, and change in oral health-related quality of life. Analyses will follow intention-to-treat principles and account for clustering using mixed-effects regression models with facility-level random effects. Models will adjust for baseline covariates and prespecified confounders. Sensitivity analyses will examine the robustness of the findings. The trial will also inform a planned economic evaluation embedded within the broader research program. This trial forms part of a broader program funded by the Medical Research Future Fund Dementia, Aging and Aged Care Grant (2024439). Recruitment and data collection commenced in May 2025 and are expected to conclude in June 2026. Recruitment is ongoing across participating RACFs. Data analysis is expected to commence in mid-2026, with primary findings anticipated for publication in early 2027. This protocol outlines a rigorous evaluation of a minimally invasive, scalable oral health intervention tailored to RACF settings. The findings will provide high-quality evidence on effectiveness to inform policy, service delivery, and economic evaluation aimed at improving oral health and well-being among older adults in residential aged care.