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.
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.
BACKGROUND: As of 2023, 25.5% of live births in France are from mothers who were born abroad. Women born in sub-Saharan Africa are especially at risk of maternal and neonatal morbidity and mortality. Intermediate explanatory factors probably include access to and quality of care. The BiP multidisciplinary mixed-methods project sought to explore implicit racial biases among prenatal practitioners as one of the first approaches to this issue in France. The qualitative component we present here aimed to explore the clinical relationship between women from different migration backgrounds and healthcare providers as well as possible racial-based differential care in the setting of prenatal care. METHODS: A sociological qualitative study was conducted in three public maternity units in the Paris area among 6 obstetrician-gynaecologists, 6 midwives, 6 anaesthesiologists, and 148 pregnant women. The study was based on audio-recorded prenatal consultations and self-confrontation interviews with practitioners. Consultations and interviews were analysed thematically. RESULTS: The countries of birth and social positions of the participating women were globally similar to those of the pregnant women seen in each maternity unit. The content of care was globally controlled by healthcare providers and consultations were slightly longer for immigrant than native women; the explanations they provided were appropriate to women’s level of understanding. The prenatal follow-up, when standardised, left little room for differential care. Nonetheless, the tone of voice and the type of jokes showed the salience of the social relations of race and class, beyond the strict framework of the care relationship. A few instances of racism in care were identified and analysed, but their consideration by the institution was non-existent. CONCLUSIONS: French research is beginning to produce data on racial discrimination in healthcare, and this qualitative study provides an in-depth understanding of mechanisms leading to less adequate care, which was not an everyday occurrence. Despite the inclusion bias inherent in this type of approach, this study produced original results about the differential care of women who are immigrant during hospital prenatal care.
The 2025 Ebola outbreak that ravaged the Bulape Health District (HD) in Kasai, Democratic Republic of Congo (DRC), was tackled using the incident management system (IMS) model. The Bulape HD is located in the Mweka territory, which has experienced two Ebola epidemics: one in 2007 and another in 2008. The IMS comprises seven strategies recommended for an effective response to an Ebola outbreak: (i) thorough investigation, (ii) strengthening infection prevention and control measures in the community, (iii) ensuring that medical care is provided by experienced professionals, (iv) strengthening risk communication and community engagement (RCCE), (v) ring vaccination, (vi) operational research, and (vii) anchoring interventions in the existing health system. We share our experience implementing these seven strategies and compare them with those utilized during three previous Ebola outbreaks. This paper describes our achievements, the resulting benefits, and the factors that facilitated the implementation of the aforementioned strategies. A literature review and interviews were conducted. The atlas.ti 22 software was used for data analysis. Implementing these seven strategies contributed to an effective response, largely due to the experience and expertise of those involved but also thanks to the support of technical and financial partners (TFPs) and the engagement of the local community. Challenges such as geographical accessibility, the fragile health system, the community's strong attachment to traditional practices, and negative reactions to healthcare-which was widely discredited, with many of those involved expressing a lack of faith in its effectiveness-were major obstacles. To overcome these challenges, an integrated approach was utilized, combining a rapid comprehensive response with deep and respectful community engagement. The support and alignment of TFPs were invaluable during this process. The RCCE pillar proved key to successful IMS implementation. Our experiences will be useful during the next Ebola outbreak in the DRC; additionally, they may also help to inform the response to similar outbreaks in other countries.
BACKGROUND: By the end of 2023, it was estimated that over 473 million children were living in areas affected by armed conflict globally. In these settings, adolescents are at heightened risk of experiencing multiple forms of violence. While parenting interventions are a promising strategy that can equip parents with skills and practices to prevent violence against children, little is known about desired content of parenting interventions for caregivers of adolescents in conflict settings. This qualitative study aims to address this gap through participatory methods with adolescents and parents in a setting of co-occurring conflict and displacement. The study is situated in the development phase of the Medical Research Council (MRC) framework for developing and evaluating complex intervention. METHODS: Same-sex participatory workshops were conducted with n = 73 participants: n = 37 parents, n = 16 adolescent boys and n = 20 adolescent girls living in Ituri province of the Democratic Republic of Congo. Workshops explored perception of the burden of violence among adolescents, the experience of parents living in a conflict setting, associated changes in parenting practices, and proposals on content for parenting interventions to reduce violence against adolescents. The study applied reflexive data analysis and grouped themes corresponding to the research question. RESULTS: Parents and adolescents perceive parenting interventions as a strategy that may contribute to reducing different forms of violence experienced by adolescents. Majority of content in existing parenting interventions were nominated by adolescents and by caregivers. Nine components/themes were identified by participants as important for inclusion in a parenting intervention. Three themes related to experiences of violence, three themes related to healthy relationships and three themes related to strategies for parents to manage their conduct, skills, and their mental health. While the parenting content proposed as relevant for participants in a conflict setting mirrors content from non-conflict settings, the findings illustrate the necessity to tailor interventions to strengthen the adolescent-parent relationship and address family violence. CONCLUSION: The findings can inform researchers, policy makers and practitioners working with adolescents and parents in conflict settings on what content to adapt, newly develop or replicate to evaluate and implement evidence-based parenting interventions.
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.
BACKGROUND: Adolescents and young people living with HIV (AYPLHIV) in sub-Saharan Africa (SSA) face intersecting structural and psychosocial challenges that compromise their wellbeing, yet these realities are poorly captured by generic wellbeing measures used in economic evaluations. This overview of reviews synthesised evidence from SSA to identify key determinants of social wellbeing to inform the co-development of a contextually relevant wellbeing scale suitable for economic evaluations in the region. METHODS: We searched reviews published between January 2000 and September 2023 across ten databases on EBSCOhost, Ovid, and Web of Science. The conduct and reporting of this overview followed the Preferred Reporting Items for Overviews of Reviews guidelines. Eligible reviews included quantitative, qualitative, and mixed-methods studies examining wellbeing or mental health among AYPLHIV aged 10–24 years in SSA. Review quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Data were synthesised thematically, mapped onto Keyes Social Wellbeing framework, and study selection presented with a PRISMA flow diagram. RESULTS: Sixteen medium-to-high quality reviews were included. South Africa (n = 15) and Uganda (n = 14) were the most represented countries. Most reviews focused on adolescents aged 10–19 years (n = 11). Our analysis identified five recurring themes central to the social wellbeing of AYPLHIV: social support, acceptance and belonging, self-acceptance, aspirations and goals, and coping. These themes aligned with Keyes’ Social Wellbeing model, with social support and acceptance and belonging reflecting social integration, and aspirations and goals reflecting social contribution. Key psychological wellbeing constructs identified included positive relationships, self-acceptance, purpose in life, and environmental mastery. CONCLUSIONS: These domains reflect both personal experiences and structural realities yet remain underrepresented in commonly used wellbeing measures. This is a critical limitation, as economic evaluations often rely on generic instruments that fail to capture what matters most to AYPLHIV in SSA. Future research should develop a wellbeing scale that incorporates these domains, is sensitive to socioeconomic context, and can be collected alongside socioeconomic status indicators. Embedding such a measure into evaluation systems would improve the accuracy, equity, and policy relevance of economic evaluations and ensure that investments reflect AYPLHIV’s lived realities.
BACKGROUND: A single multi-country study in sub-Saharan Africa (SSA) conducted nearly two decades ago reported that caesarean section (C-section) delivery was associated with reduced subsequent childbearing. To address the gap created by the lack of recent regionally representative evidence that reflects changes in access to surgical delivery, maternal health systems, and fertility-related attitudes, we assessed the association between having ever had a C-section and subsequent fertility outcomes. METHODS: The study used the most recent data from the Demographic and Health Surveys (DHS) of 30 countries in SSA conducted between 2013 and 2024 (n = 790,139). The study used two outcome variables: (i) the number of children ever born and (ii) the desire/preference for another child. The independent variable is whether the respondent has ever had a C-section birth. The first analysis applied a negative binomial regression to examine the association between C-section births and the number of children born. The second analysis applied multivariable binary logistic regression to analyse the association between C-section births and the desire to have more children. RESULTS: The mean number of children for each woman is 3.60 (95% CI:3.56–3.61). Chad had the highest mean number of children born (4.61, 95% CI:4.56–4.66) whereas Lesotho had the lowest mean number of children born (2.09, 95% CI:2.02–2.16). The results show that women who have ever had a C-section birth are 8% less likely to have more children compared to those who have not had a C-section birth (IRR = 0.92, 95% CI: 0.91–0.93). Also, higher levels of education are associated with a lower likelihood of having more children, particularly for those with higher education (IRR = 0.51, 95% CI: 0.50–0.52) compared to those with no education. CONCLUSION: These findings highlight the need for focused and practical interventions to offer counselling to mothers during perioperative, pre-operative, and post-operative periods to enhance understanding of C-section and their potential implications on future fertility. Providing women with clear and practical information during prenatal and antenatal visits can help them better understand the medical reasons for C-sections, as well as the potential risks associated with having many children.
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.
North Kivu, in eastern Democratic Republic of the Congo (DRC), was the epicenter of the second largest Ebola Virus Disease (EVD) outbreak in history and has been an active conflict zone for decades. The COVID-19 pandemic further exacerbated an already complex situation. This qualitative study, conducted as part of a broader investigation into Ebola vaccine hesitancy and at the onset of COVID-19 vaccination rollout in the DRC, assessed perceptions, beliefs, and attitudes toward the COVID-19 virus and vaccines among community members and healthcare workers who had experienced the 2018-2020 EVD outbreak, during which a novel vaccine was also administered. Between May and June 2021, thirty-three focus group discussions (FGDs) and fifteen key informant interviews were conducted across three health zones that had offered Ebola vaccination (rVSV-ZEBOV) during the 2018-2020 EVD outbreak. Participants included healthcare workers (HCWs) and community members, as well as leaders, administrative officials, and frontline workers who had supported outbreak response and vaccination services. Across all locations and groups, perceived risk of COVID-19 was low, with many participants doubting its existence and relevance, particularly when compared to other needs and endemic health conditions in their communities. COVID-19 was believed to primarily affect white, affluent individuals in urban areas, and not those residing in hot climates. Vaccine hesitancy was driven by perceived insufficient transparency and communication regarding COVID-19 vaccines, including questions about their composition, potential side effects, and rationale behind prioritizing certain groups. COVID-19 vaccine perceptions also reflected broader concerns, including mistrust of the government and rumors related to past Ebola outbreaks and vaccination efforts. To increase uptake, respondents recommended ensuring COVID-19 vaccination is voluntary and free of charge, working with non-traditional local demand generation and vaccination actors, strengthening local vaccine production capacity, and increasing the impact of interpersonal communication through social media messaging. These findings add to growing evidence on how prior exposure to another disease of international concern (Ebola) and the associated vaccine, as well as historical context, influence perceptions of novel vaccines. Community engagement and tailored communication to address community concerns and misinformation are essential to building trust. Policymakers and implementers should consider more innovative approaches for developing and implementing vaccination policies in collaboration with local actors.
Early sexual debut among young women in Kinshasa, Democratic Republic of Congo (DRC), represents a complex and multifaceted issue that carries significant implications for a range of factors including individual health and social dynamics. This research seeks to illuminate the factors influencing early sexual debut among young women in Kinshasa. The analysis involved 1,352 young women using a chi-square test at p < 0.05 and 95% CI for categorical variables. A mixed-effects multilevel binary logistic regression identified determinants of early sexual debut, showing adjusted odds ratios (AOR) and related factors, with 95% CI. The prevalence of early sexual debut among respondents aged 15-24 years was 16.3% with an average current age of 16.6 years. Being aged 20-24 years [AOR = 1.40, CI;1-1.97], cohabiting with a partner [AOR = 0.46, CI;0.31-0.69] or being married [AOR = 0.43, CI; 0.25-0.76], tertiary education [AOR = 7.91, CI; 3.11-20.08], high wealth index [AOR = 1.78, CI; 1.18-2.2], were significantly associated with early sexual debut. The analysis showed minimal differences across clusters, suggesting that individual factors predominantly shape attitudes towards sexual debut, while community-level attributes play a lesser role in predicting these attitudes. The analysis showed minimal differences across clusters, suggesting that individual factors predominantly shape attitudes towards sexual debut, while community-level attributes play a lesser role in predicting these attitudes. Furthermore, reinforcing the legal marriage and providing resources to support single and cohabiting women in delaying sexual commitments can significantly mitigate early initiation. This study explores the factors influencing early sexual debut (first sexual experience before age 15) among young women in Kinshasa, Democratic Republic of Congo. This research aims to inform policies and programs that can improve the health and well-being of young women in Kinshasa by addressing the factors associated with early sexual debut. The survey of 1,352 women indicated that among women aged 15–24 years, the prevalence of early sexual debut was 16.3%. The mean current age of respondents was 20.6 years (SD = 2.4). The mean age at sexual debut was 16.6 years (SD = 2.1). The youngest reported age at sexual debut was 10 years.Key findings show that older young women (20–24 years) were more likely to have early sexual debut compared to younger ones (15–19 years). Surprisingly, those with higher education (university level) were significantly more likely to start sexual activity early, possibly due to peer influence or urban exposure. Wealthier young women also had higher rates of early sexual debut, likely linked to greater independence or access to social networks. On the other hand, married or cohabiting women were less likely to have early sexual initiation, possibly because they waited for stable relationships.The study highlights that individual factor like age, education, and wealth play a bigger role in early sexual debut than community influences. To address this issue, the researchers suggest strengthening laws that protect young women, promoting sexual health education, and supporting economic opportunities to help delay early sexual activity. RéSUMé: CONTEXTE: Les premières relations sexuelles précoces chez les jeunes femmes à Kinshasa, en République démocratique du Congo (RDC), constituent un enjeu complexe et multidimensionnel avec de répercussions significatives sur divers aspects, notamment la santé individuelle et les dynamiques sociales. OBJECTIF: Cette recherche vise à identifier et analyser les facteurs déterminants des débuts sexuels précoces chez les jeunes femmes à Kinshasa. MéTHODE: L’étude a été réalisée sur un échantillon de 1 352 jeunes femmes, en utilisant un test du chi carré à p < 0,05 et un intervalle de confiance (IC) à 95% pour les variables catégorielles. Une régression logistique binaire à plusieurs niveaux a permis d’identifier les déterminants des premiers rapports sexuels, fournissant des rapports de cotes ajustés (AOR) et les facteurs connexes, avec un IC à 95%. RéSULTATS: La prévalence des premiers rapports sexuels précoces parmi les enquêtées âgées de 15 à 24 ans s’élevait à 16,3%, avec un âge moyen de toutes les enquêtées estimé à 16,6 ans. Les résultats ont révélé que les jeunes femmes âgées de 20 à 24 ans [OR = 1,40, IC ; 1–1,97], vivant avec un partenaire [AOR = 0,46, IC ; 0,31 − 0,69] ou mariées [AOR = 0,43, IC ; 0,25 − 0,76], ayant un niveau d’éducation tertiaire [AOR = 7,91, IC ; 3,11–20,08] et appartenant à un index de richesse élevé [AOR = 1,78, IC ; 1,18 − 2,2] étaient significativement associés à des débuts sexuels précoces. L’analyse a révélé des variations minimales entre les groupes, indiquant que les facteurs individuels influencent principalement les attitudes vis-à-vis des débuts sexuels, tandis que les caractéristiques communautaires jouent un rôle marginal. CONCLUSION: Les variations limitées entre les groupes suggèrent que les attitudes concernant les débuts sexuels sont principalement façonnées par des facteurs individuels, tandis que les attributs communautaires ont une influence réduite. De plus, renforcer la loi sur l’âge légal du mariage et fournir des ressources d’accompagnement pour aider les femmes célibataires et cohabitantes à reporter leurs engagements sexuels pourrait réduire significativement l’initiation précoce.
Mental health is a major public health concern, with disproportionate burdens in sub-Saharan Africa (SSA), where access to care is limited and stigma remains high. Social and digital platforms, including social media, mobile health (mHealth) applications, and SMS-based messaging, provide opportunities for information sharing, peer engagement, and tailored interventions that may enhance literacy and normalize help-seeking. Yet, they pose risks, including misinformation, exposure to harmful content, and reinforcement of stigma in diverse contexts. Despite this potential, evidence from SSA on the effects of social and digital media messaging on mental health knowledge, attitudes, behaviors, and help-seeking is scarce. This systematic review will assess the effect of social and digital media mental health messaging on help-seeking behaviors in SSA. Electronic databases, including PubMed, Psychological Information Database (PsycINFO), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Communication and Mass Media Complete, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Educational Resource Information Centre (ERIC), ProQuest Sociology, Google Scholar and Embase will be systematically queried using predefined keywords without language restrictions to ensure comprehensive evidence capture. Eligible studies will include interventions delivering mental health messaging through social media, mHealth applications, SMS, web-based platforms, or hybrid approaches, analyzing behavioral and psychological outcomes, and any kind of intervention studies. Methodological quality and risk of bias will be assessed using validated tools appropriate to each study design, including the Cochrane Risk of Bias 2 (RoB 2) tool, Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I), and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Where appropriate, data will be synthesized with or without meta-analysis. This synthesis will clarify how social and digital media shape mental health outcomes, describe patterns across delivery channels, identify gaps, and inform culturally sensitive interventions to improve communication and promote mental health help-seeking in SSA.
Cognitive development is fundamental in building children's future learning and adaptive behaviours. Children's cognitive development may be influenced by an interplay of psychosocial factors, especially in settings such as sub-Saharan Africa, where resources are limited. Despite the significance of early cognitive stimulation on children, there is a paucity of research for understanding the complex interaction of psychosocial determinants of child cognitive development in Early Childhood Development centres, particularly in sub-Saharan Africa. This review aims to synthesise existing literature on the psychosocial determinants of child cognitive development in sub-Saharan African ECDs. This proposed systematic review will be conducted according to the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). We will search for primary studies conducted using qualitative, quantitative, and mixed methods approaches on global (PubMed, PsycINFO, ProQuest) and regional databases (Sabinet African Journals, Science Direct, African Index Medicus, and sub-Saharan African institutional repositories). The included studies should report on the psychosocial determinants of child cognitive development of children aged 0-6 years registered within sub-Saharan African ECDs and conducted in English between 2014 and 2024. The quality of studies will be assessed using the Mixed Method Appraisal tool, and the data will be analysed using the content analysis method. We envision that the systematic review will enrich discussions on child cognitive development and facilitate the development of interventions aimed at improving child cognitive development in sub-Saharan African ECDs.Systematic review registration PROSPERO CRD42023470844.
This study aimed to develop the Social Media Self-Presentation Discrepancy Scale (SMSDS) to assess individuals' tendencies to present themselves differently from their real selves in social media environments. The theoretical framework of the study was grounded in Goffman's theory of self-presentation, Higgins' self-discrepancy theory, and Leary's impression management model. Through exploratory (n = 243) and confirmatory (n = 409) factor analyses, the scale's structural integrity was established, revealing a three-factor structure comprising Reality Distortion and Exaggeration, Idealized Self-Presentation, and Strategic Impression Management. The scale demonstrated high internal consistency, and its construct validity and measurement invariance were supported through various statistical analyses. The SMSDS offers a functional assessment tool for evaluating psychological aspects of social media use, identifying risky digital behaviors among young users, and designing intervention programs targeting digital self-presentation. The findings contribute to a more comprehensive understanding of the multidimensional nature of self-presentation strategies on social media at both theoretical and applied levels.
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.
Adolescents living with HIV (ALHIV) face ongoing challenges with treatment adherence and engagement in care, resulting in lower viral suppression rates compared to adults. Peer navigation has shown promise in supporting psychosocial well-being and adherence among adults, but evidence specific to adolescents in sub-Saharan Africa (SSA) remains limited. This qualitative evidence synthesis (QES) describes and assesses the quality of qualitative and mixed-methods studies on peer navigation and support interventions for ALHIV receiving antiretroviral therapy in SSA. Eligible studies, published in English between January 2015 and October 2025, were identified through a comprehensive search strategy in PubMed, Scopus, CINAHL, and APA PsycArticles. Data were extracted and analyzed thematically using Atlas.ti, and aligned with the Context-Intervention-Mechanism-Outcome (CIMO) framework. PNs in the studies were young people living with HIV who provided education, counselling and adherence support to their peers who were ALHIV. Effective programmes featured structured training, supportive supervision, and flexible delivery models adapted to adolescents' preferences. Mechanisms of change included trust-building, emotional support, disclosure coaching and empowerment. Reported outcomes included improved adherence, clinic attendance and various psychosocial indicators. However, challenges such as stigma, role ambiguity, limited remuneration, and lack of policy guidance constrained the sustainability and scalability of PN programs. Overall, peer navigation interventions appear effective in strengthening adolescent HIV care when PNs are adequately trained, supervised and contextually adapted. The variation in how peer navigation and support interventions for ALHIV are delivered and designed, along with the lack of standardization of the interventions, may affect the generalizability of the findings and the rollout of PN programs across SSA.
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.
What do people say to socially reject someone, and is it what they would want to hear? We test whether rejectors use deflections - words to deflect the interpretation of the rejection as a negative judgment of the rejectee (e.g., "nothing personal") - and whether that has the desired effect. In two exploratory studies, participants spontaneously used deflections in video-recorded and written social rejections (N1 = 497, 19.1% deflections; N2 = 94, 35.1% deflections). In two preregistered studies (N3 = 1213; N4 = 933), participants imagined themselves as rejectors and as rejectees across multiple contexts (Study 3) and as rejectees in situations with acquaintances or close friends (Study 4). Participants preferred rejections with deflections compared to rejections without, and particularly preferred "nothing personal." The present research addresses the struggle to find the right words for social rejection and opens an avenue for investigation of when and how language may soften the blow.
There are many ways to feel isolated, including through interpersonal or existential experiences. The present research aims to clarify the causal psychological consequences of state existential isolation (i.e. feeling alone in one's subjective experiences) and to examine how these consequences overlap with, or diverge from, those elicited by other isolating experiences (i.e. social exclusion, being physically alone). Across three studies, we examined how experimentally induced existential isolation influences threat to fundamental social needs and emotional well-being, relative to neutral events and other forms of social disconnection. Results indicate that manipulations designed to elicit existential isolation reliably increase state existential isolation and threaten social needs (Studies 1-3), often comparably to manipulations of social exclusion (Study 2) and, in some cases, exceeding those associated with being physically alone (Study 3). Exploratory analyses of open-ended narratives suggest an overlap in the affective and contextual features of existential isolation, exclusion, and interpersonal isolation. Together, these findings underscore the importance of experimentally distinguishing existential isolation from related constructs to better understand the mechanisms through which social disconnection undermines psychological well-being.