South Asia faces a critical deficit in surgical, obstetric, trauma, and anaesthesia (SOTA) care, with over 1.6 billion people lacking access to safe and affordable surgical services. Addressing this inequity requires urgent workforce capacity building beyond traditional specialization. This study, conducted by the G4 Alliance Asia Working Group, employs a Multiple-Case Study design utilizing Cross-Case Synthesis to present six initiatives from Nepal, Bhutan, Pakistan, and India, mapped against a SOTA care workforce capacity building framework. We describe initiatives by training type (programmatic vs. non-programmatic), intent (upskilling vs. reskilling), and workforce outcomes such as task-shifting (delegating tasks to less specialized cadres), task-sharing (multi-cadre collaborative care), and task-creation (developing new cadre roles). Cross-case synthesis revealed distinct pathways for addressing workforce shortage and maldistribution. First, programmatic reskilling initiatives in Nepal, Bhutan, and Pakistan demonstrate how formalizing task shifting to mid-level providers and generalist doctors creates sustainable rural cadres recognized by national health systems. Second, non-programmatic models in India highlight the utility of upskilling existing surgeons to facilitate task sharing, thereby rapidly increasing the functional density of the workforce in resource-limited settings. Crucially, the analysis introduces task creation as a distinct workforce outcome to fill a specific "task-cadre gap" by establishing novel community engagement roles for SOTA care that do not exist in standard hierarchies. The synthesis indicates that while programmatic models support long-term retention through state absorption, non-programmatic interventions offer vital flexibility for immediate service delivery. Indigenously initiated, state-integrated models, providing secure career paths, achieved better sustainability, whereas foreign donor-dependent and non-programmatic models faced challenges. These initiatives underscore that locally driven, context-specific solutions can effectively bridge healthcare disparities. Facilitating cross-learning on the successes and limitations of these diverse models is essential to scale effective interventions and integrate them into national and regional policy plans, thereby ensuring equitable access to SOTA care across South Asia.
This study investigates the key determinants influencing the utilization of preventive health services among insured individuals in the United States following the implementation of the Affordable Care Act (ACA). Leveraging nationally representative data from the 2024 Financial Inclusion Survey, the research employs weighted logistic regression and Structural Equation Modeling (SEM) to analyze how perceived insurance coverage quality, access to a primary care physician, financial knowledge, and experiences with healthcare costs are associated with the uptake of no-cost preventive care. The findings reveal that individuals who report higher satisfaction with their insurance coverage, maintain ongoing relationships with primary care providers, and demonstrate greater financial literacy are more likely to engage in preventive health behaviors. Notably, while cost-related barriers are initially associated with increased utilization, their direct influence diminishes when financial knowledge is accounted for, highlighting the mitigating role of financial literacy. The SEM approach further clarifies the complex interplay between latent constructs such as perceived coverage quality and cost experiences, showing that these factors interact with each other and with other determinants to shape preventive care decisions. Importantly, once these structural and informational dimensions are considered, traditional demographic variables - such as race and gender - lose statistical significance, underscoring the greater impact of systemic and educational factors. These results suggest that policies aimed solely at eliminating financial barriers may be insufficient to maximize preventive care participation. Instead, fostering trust in insurance coverage, strengthening primary care relationships, and enhancing financial literacy are critical strategies for increasing preventive service utilization. By addressing the informational, relational, and economic dimensions of healthcare access, policymakers and stakeholders can more effectively promote preventive health engagement and advance population health outcomes.
Research in Aboriginal communities starts where the community is at and works collaboratively and culturally responsively to the priorities and rhythms of the communities. The See Treat Prevent (SToP) Trial is the first clinical study to incorporate a holistic approach to reducing skin infections. This approach enabled the worldviews of Aboriginal people at the local community level to govern the empowerment approach underpinning the co-design of healthy skin resources and an evaluation framework. This manuscript reports the process of working on Country with Aboriginal communities to facilitate the restoration of Indigenous knowledge systems that have historically been excluded from health research, programs and policies. Yarning methodology was a approach for embedding Aboriginal worldviews within the Person, Provider, Practice and Policy (P4) evaluation framework showing the bi-directional interrelationships between community members, providers, and policies that affect health and wellbeing of Aboriginal people at the local community level. Importantly, the P4 model is a practical framework for considering the impact of policy and distance in real-world circumstances. Addressing the high prevalence of skin infections in Aboriginal children living in Kimberley communities requires empowerment approaches to include the voices of Aboriginal people living on Country. Doing so should not be a universal approach but a specific approach embedding local community culture and context to enable self-determination for Aboriginal communities. Health interventions that do not allow for transparency between community interrelationships will be difficult to implement or capture the important system inequities that often go unnoticed. It is anticipated that P4 can provide real opportunities for understanding health behaviours, not only at the Person level but also at the Provider, Practice and Policy levels to influence change.
Women with disabilities face significant barriers in accessing perinatal healthcare, often leading to poor maternal and neonatal outcomes. This narrative review, conducted using a PRISMA-informed systematic search strategy, aims to identify and synthesize the global literature on barriers to perinatal healthcare among women with disabilities, with a contextual sub-analysis of studies relevant to the Kashmir region. A total of 61 studies, published between 1967 and 2024, were identified through a PRISMA-informed systematic search process across four academic databases: Psycinfo, Jstor, Medline, and Google Scholar. Studies were appraised using the Mixed Methods Appraisal Tool (MMAT). Given substantial heterogeneity in study designs, disability types, outcomes, and regional contexts, findings were synthesized using an interpretive narrative thematic approach rather than statistical aggregation. The review synthesized findings from both qualitative (n = 36) and quantitative (n = 25) studies, including 10 studies focused on Kashmir, highlighting a significant regional research gap. Thematic synthesis identified three major themes: (1) barriers related to perinatal healthcare, (2) support systems during the perinatal period, and (3) healthcare system policy response and gaps. Barriers comprised physical inaccessibility, attitudinal stigma, knowledge and information barriers and socio-cultural barriers. Among the 61 studies reviewed, physical and attitudinal barriers were the most frequently reported (in 42 studies), followed by knowledge and information barriers, (in 28 studies) and socio-cultural barriers (in 25 studies). Support systems particularly emotional, familial and peer networks, were identified as important facilitators of perinatal healthcare access. In the Kashmir context, these barriers are intensified due to political instability, under-resourced health infrastructure, and sociocultural stigma. These findings underscore the importance of disability-inclusive perinatal healthcare strategies and context-sensitive policy approaches.
Household decisions shape health outcomes in subsistence farming communities in sub-Saharan Africa (SSA) where human wellbeing is closely linked to livestock productivity. We conducted a systematic review, guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), of 135 primary studies from Embase, Scopus, PubMed, Web of Science and Google Scholar. Using the Household Production of Health (HPH) framework, we structured research questions, extracted and synthesised evidence and identified health interventions in human and livestock health in SSA. We coded decision loci (sole vs joint decision-making) and characterised their prevalence, context and determinants of household health outcomes. Sole decisions dominated (40 % of human studies, 42 % of livestock studies) with men making the majority of the decisions, especially in livestock health, while joint decisions were less common (27 %, 32 % respectively) and focused on maternal, neonatal and child health. Women's decision-making power tended to increase with education, income and urban residence, while male authority was greater in rural areas where fewer income-earning opportunities for women prevail. The two HPH frameworks are tightly linked as behaviours that improve livestock health and productivity benefit nutrition, income and access to care for household members. We recommend gender-responsive, One Health policies that support women's control in areas of existing responsibility and engage men as active partners in shared decision-making within households to reduce inequalities. These efforts should be supported by progress towards universal health coverage, functioning health insurance schemes and accessible veterinary services to reduce inequalities and within-household trade-offs, and to improve health and livelihood resilience in SSA.
Central Java, Indonesia, experienced a 40.9 % COVID-19 positivity rate in 2022, exceeding the WHO benchmark. This study examines the association between changes in sociodemographic, environmental, and healthcare factors and the rise in COVID-19 prevalence, focusing on regional disparities across Central Java. Variables from public datasets were chosen based on the Social Determinants of Health (SDOH) framework. Data analysis begins with variable identification via Pearson correlation, followed by an Ordinary Least Squares (OLS) regression employing Stepwise Backward Elimination, and subsequent assumption tests including Jarque-Bera, Breusch-Pagan, Moran's I, and multicollinearity checks. Upon identifying spatial autocorrelation and heteroscedasticity, Geographically Weighted Regression (GWR) was applied to address spatial heterogeneity. Ordinary Least Squares (OLS) analysis identified Change in tourist arrival ratio per population, environmental health workforce ratio per land area, and community healthcare workforce ratio per land area as associated factors with change in COVID-19 prevalence. The Geographically Weighted Regression (GWR) model, with a higher R2 value of 0.66, better accounted for regional variations, especially in central and eastern regions. The findings indicate that traveler mobility and the spatial distribution of community health workers are linked to increased COVID-19 prevalence, whereas environmental health workers are associated with a protective result, but these are associations at the aggregate (district/city) level and may be influenced by confounding or reverse causation. Structural factors such as unequal access to resources, healthcare, and sanitation, driven by tourism-induced social inequality, contribute to the disproportionate impact of COVID-19 on vulnerable communities, making it essential for policymakers to address these disparities to protect both local populations and visitors. The study recommends regulating risk-based tourist activities, expanding the environmental health workforce, and enhancing spatial monitoring systems to inform evidence-based health policy.
Assess the impact of a change in a philanthropic funding strategy toward focusing on the inclusion of responses to the social determinants of health (SDOH) in diabetes care. Retrospective analysis of routinely collected clinical and social determinants of health data. Federally Qualified Health Centers Across the United States who were selected to receive funding after applying. People living with diabetes who received care support that was partially or wholly supported from philanthropic funding provided by Direct Relief. The primary intervention was the injection of funding from Direct Relief to support the integration of interventions responsive to the SDOH. Example interventions include referral to SDOH support, home based monitoring, inclusion of community health workers, virtual care, and community-based care. The primary outcome measure was the change in HbA1c from baseline to two to four months for all patients contributing data. Participants in the HBHC program demonstrated a reduction in glycosylated hemoglobin of -1.25 points ([95 % CI, -1.45 - -1.06], p < 0.01) after 60-to-119-days. Participants with family and housing needs, nutrition needs, and social and emotional health needs had statistically significantly higher baseline HbA1c's than patients without these needs. Future philanthropically supported efforts should encourage integration of SDOH interventions into clinical services for under-resourced patients living with diabetes. Additional prospective, controlled studies should be completed to more definitively determine the impact of investment on specific interventions designed to respond to the most frequently encountered SDOH needs.
West Africa faces recurring public health outbreaks, including Ebola, COVID-19, and Mpox, underscoring the need for strong Global Health Security (GHS) core capacities. This study uses Joint External Evaluation (JEE) scores and After-Action Review (AAR) findings to assess public health emergency preparedness across 15 West African countries and identify gaps between theoretical assessments and operational response capacity. A mixed-methods approach compared JEE scores (2016-2023) with thematic analysis of AAR findings from major outbreaks. Consistency between JEE-predicted capacities and AAR-reported challenges was assessed using a three-level rating system (High/Moderate/Low) and the Kappa statistic. In 68 of 105 technical area comparisons (65%) of cases, JEE scores accurately predicted weaknesses in laboratory systems and workforce development. However, in 37 comparisons (35%) of cases, JEE scores overestimated preparedness, particularly in risk communication(all15 countries,100%), real-time surveillance(13 of 15 countries, 87%), and cross-border coordination, where countries with high scores faced operational failures during outbreaks. AARs revealed logistical bottlenecks, supply chain disruptions, and coordination failures not captured by JEEs. Alignment with SDG 3.d (health security), SDG 10 (inequalities), SDG 17 (partnerships), and SDG 9 (infrastructure) underscores broader development implications. While JEE is valuable for baseline assessment, it incompletely predicts real-world outbreak response performance. Integrating AAR findings into national planning and refining JEE indicators to include operational metrics will enhance health security evaluations. Regionally coordinated action through WAHO is essential for addressing gaps and building resilient systems aligned with sustainable development goals.
Effective healthcare delivery depends not only on clinical expertise but also on the quality of communication and interpersonal relationships between healthcare providers and patients. Despite the recognized importance of these human-centered factors, limited research has explored their impact on patient satisfaction and service quality within the Ghanaian context. This study aims to examine the influence of communication competence and interpersonal relationships on patient satisfaction. This study examines how healthcare providers' communication competence and interpersonal relationships influence their perceived patient satisfaction with service delivery, thereby shifting attention from technical skills to the relational aspects of care. A sequential mixed-methods design was employed. The quantitative phase involved a survey of 250 healthcare professionals. The qualitative phase comprised in-depth interviews with 20 participants,10 patients, and 10 healthcare staff. Data was analyzed using multiple regression techniques for the quantitative component and thematic analysis for the qualitative component. Verbal communication emerged as the most used method (70.4 %), followed by a combination of verbal and non-verbal strategies (19.6 %). Regression analysis revealed that both communication competence and interpersonal relationships had a significant impact on service quality and patient satisfaction. While interpersonal relationships displayed a negative coefficient in the regression model (B = -0.098) due to overlap with communication competence, qualitative findings confirmed that positive interpersonal interactions enhanced patient satisfaction. While technical skills contributed a smaller increase of 0.029. The Qualitative findings revealed that patients highly value empathetic communication, timely interactions, and non-verbal cues, such as physical touch and facial expressions, which enhance trust and satisfaction. The findings highlight the importance of integrating communication and interpersonal skills development into healthcare training and professional practice in Ghana. Strengthening these competencies can enhance patient experiences, improve health outcomes, and contribute to the overall quality of care delivery.
As a critical social determinant of health, occupational fatigue can be a key indicator for tracking mental health inequalities in working populations. A systematic assessment of fatigue and its impact on safety performance indicators is essential for developing effective preventive strategies in industrial settings. This study aimed to investigate the correlation between occupational fatigue and safety and health performance within an industrial sector in Gonabad, Iran. A descriptive-analytical, cross-sectional study was conducted among industrial workers. Data were collected using a demographic questionnaire, the Swedish Occupational Fatigue Inventory (SOFI) to quantify fatigue, and the ELMERI index to assess safety and health performance levels. Kolmogorov-Smirnov, t-test, Mann-Whitney, and Spearman's rank correlation coefficient tests were used for statistical analysis between variables. The study included participants with a mean work experience of 8.49 (±4.63) years. The mean SOFI score for occupational fatigue was 52.75, indicating a significant burden of fatigue. The mean ELMERI index score was 59.50, reflecting a moderate level of safety and health performance. A significant inverse correlation was found between occupational fatigue and safety performance (r = -0.40, p < 0.05), suggesting that higher levels of fatigue were associated with poorer safety and health outcomes. The findings demonstrate a significant negative relationship between occupational fatigue and safety performance, highlighting the detrimental impact of fatigue on workplace safety. These results underscore the need for implementing fatigue risk management systems and ergonomic interventions in the workplace. Future longitudinal research is recommended to elucidate further the causal mechanisms underlying this relationship.
One of the regions in Indonesia that has the highest prevalence of stunting cases is West Nusa Tenggara, with a percentage of cases almost reaching 12.7 %, even though this province is a priority target for stunting reduction by 2022. Specifically in the East Lombok region, this study took this location point because of the high number of stunting cases in West Nusa Tenggara. Puskesmas Denggen was the target of the study, covering six working areas namely Denggen, East Dengen, Majidi, Rakam, Sekarteja, and Pancor, with a total of 3416 under-five data. The data were obtained through two measurements: the initial in February 2024 and the final in August 2024. This research integrates a multidisciplinary approach, encompassing health and nutrition science, psychology, education, and religion, to create comprehensive interventions for stunting prevention and employs machine learning models to predict future cases. The interventions include Motivation, Hygiene, Nutrition, Mental Health, and Infant Health, which are designed to cover all the essential needs of children in the growth and development process. The results of the six villages measured showed that significant changes in data were obtained in Denggen Village when compared before and after the intervention. The results of measuring the effectiveness of the anti-stunting educational interventions were also found to be effective across the five key aspects, with several showing dominant and statistically significant improvements. The machine learning algorithms used also achieved very high accuracy using Decision Tree and Gaussian Naive Bayes. This anti-stunting education model can be applied to the same case in a wider scope by paying attention to several aspects as an evaluation.
Malaria remains a major cause of illness and death among children under five in Senegal, particularly in remote areas inhabited by transhumant herders who have limited access to health services. To address these gaps, the National Malaria Control Program implemented a community-based home management (CBHM) strategy in the Ferlo region of Matam, integrating One Health principles to engage animal and environmental health actors. A cross-sectional study was carried out describing the said CBHM-Ferlo strategy. Data were collected by document review and activity report exploitation on the DHIS2 platform. It focused on the IMCI target group (children under five) living in a mobile (transhumance) mode. The community-based home care providers (CBHCPs) were selected within and by their own transhumant herder's community to early detect and care of childhood illness (diarrhea, respiratory infection, malaria, etc.) on the one hand; and to reinforce vitamin A supplementation, deworming and immunization coverage on the other hand. The strategy's principle was "Making the home, the first 'hospital' of communities" with a total of 2307 cases seen by CBHCPs including 1464 cases of fever. The malaria testing rate of 98.9 % with a positivity rate of 21.1 %, 96.4 % of which were on artemisinin-based combination therapies. Regarding diarrhea, 209 cases were detected with 67.9 % of treatment rate based on oral rehydration solution and zinc. In terms of respiratory infections, cough/cold occurred in 96.5 % of cases, and pneumonia cases were treated 55.6 % of cases with amoxicillin. Finally, 1156 children were supplemented with vitamin A, while 443 children were dewormed, and 129 children were raised awareness and referred for immunization. Thus, CBHM-Ferlo strategy improved the care of childhood illness in Matam in 2024, and above all highlights the added value of One Health and transdisciplinary approaches.
Climate change is increasing morbidity and mortality, exacerbating the imbalance between care needs and available resources. Peer-reviewed literature and international frameworks have emphasized the importance of health system resilience in the face of this growing stressor. Because effective action plans must be tailored to specific national, regional, or local contexts, this study focuses on Switzerland-a Central European country with a high-performing acute care system that is notably energy-intensive and heavily reliant on fossil fuels and imported supplies. Given that temperatures in Switzerland are rising faster than the Northern Hemisphere average, adapting the healthcare system and reducing its energy consumption are critical challenges. The study provides a systematic overview of the anticipated impacts of climate change on the Swiss healthcare institutions and explores their adaptation and mitigation needs. Employing a Delphi approach with ten international climate experts across three phases-semi-structured interviews with thematic analysis, prioritization, and final consensus-we developed a concise conceptual model comprising seven dimensions: (1) Health problems related to climate change, (2) Changing care needs and expectations, (3) Impacts on the functioning of healthcare institutions, (4) Vulnerability of healthcare institutions to the physical impacts of climate change, (5) Contextual factors, (6) Adaptation measures, and (7) Mitigation measures. A typology of items was created for each dimension. Of the 114 final items, 102 were deemed important with strong consensus. The findings complement existing evidence and aim to support healthcare institutions in assessing their external and internal environments to enhance resilience.
Background the Saudi Arabian healthcare system is undergoing transformation towards 2030 vision, with increase recognition of Population Health Management (PHM) as a critical approach to enhance health system efficiency, health outcome, and preventing the burden of chronic diseases. Despite the implementation, integration, and policies intentions of PHM in Saudi Arabia, there is a need to inform ongoing transformation through consolidated and contextual understanding of PHM Methods This narrative review synthesis published literature examining PHM in the context of Saudi Arabia. relevant studies were identified through multiple databases and search engine including PubMed, Web of Science, and Google Scholar. Thematic analysis was conducted to analyze the content and generate themes across the included studies Results Five emerging themes were reported in terms of Healthcare services, policies and regulations, economics, e-health, and health insurance across 34 studies. The healthcare services in Saudi Arabia are reported to be facing many obstacles that have to be addressed to provide the population with optimal services that can follow the revolutionary vision of Saudi Arabia. Among these challenges, insufficient population education and engagement were consistently identified as major barriers to effective PHM implementation. Conclusion The transformation plan of Saudi Arabia is promising, yet the success of these reforms depends on the population. Hence, more focus is mandated on strengthening population engagement, system integration, and governance capacity. This narrative review underscores the need to focus on population-centered strategies and to translate structural reforms into measurable health gains and sustainable system performance.
The World Health Organization's (WHO) guidance to the Middle East and North Africa (MENA) region, alongside post-Arab Spring legal reforms, has prompted many countries to prioritize Universal Health Coverage (UHC). Despite these efforts, progress remains uneven, and reforms have not consistently translated into improved population health outcomes. While global monitoring data reveal wide variation in UHC advancement, academic analysis of the factors behind these differences-particularly across countries with varying performance levels-remains limited. This paper addresses this gap through two objectives: first, to identify general enablers and barriers to UHC and assess the usefulness of these categories; and second, to examine how these factors operate in the MENA context. A scoping review, guided by PRISMA-ScR, was conducted using a six-dimension analytical framework. MENA countries were classified as low, middle, and high UHC performers based on the WHO Service Coverage Index (SCI), with one representative country from each category selected for in-depth review. Findings highlight six dimensions shaping UHC progress-social infrastructure, economic infrastructure, service delivery, governance, health resources, and financing-revealing both shared and context-specific influences. While financial inputs remain critical, strong governance and political commitment are equally essential for advancing coverage, equity, and quality. The study provides a nuanced understanding of UHC progress in the MENA region and offers actionable guidance for designing context-sensitive and sustainable health reforms.
Animal bite injuries are a serious public health concern due to the risk of rabies infection. In March 2024, the Department of Health (DOH) reported 84 rabies cases with six fatalities from Iloilo City. The most crucial management of animal bite injuries includes immediate wound care and rabies post-exposure prophylaxis (PEP), typically administered at an Animal Bite Treatment Center (ABTC). In 2007, the Philippines established the Republic Act No. 9482, also known as the Anti-Rabies Act, which created the National Rabies Prevention and Control Program (NRPCP) to control and eliminate rabies. This study aimed to describe the functions and challenges faced by one of these government-run ABTCs in Iloilo City, specifically a) provision of rabies PEP for animal bite cases, b) instructions for proper wound care, c) documentation of animal bite cases, and d) conduct of health promotion activities. This mixed-methods study was conducted at an ABTC in Iloilo City between January and March 2024. The first phase of the study collected secondary data from the official registry from January 1, 2018, to December 31, 2023. In the second phase, data were collected through direct observation of practices during a site visit in February 2024. A validated checklist based on the DOH Manual of Operations and WHO health system framework was developed and used for objective points of observation. Descriptive analyses of frequencies and percentages were conducted using Microsoft Excel and compared with the NRPCP guidelines. Also, Mann-Kendall test was conducted to evaluate the temporal trends in bite incidence proportions. The non-hospital-based government ABTC operated under the Iloilo City Health Office provided a.) rabies PEP and wound care for animal bite cases, b.) documentation of animal bite cases, and c.) awareness campaigns. A total of 20,134 animal bite cases were documented from 2018 to 2023. Three types of vaccines were delivered to the center: Purified Vero Cell Rabies (PVRV) and Purified Chicken Embryo Cell (PCEC) for active immunization, and Equine Rabies Immunoglobulin (ERIG) for passive immunization. In 2023, the lowest number of category III ERIG recipients was 42.65 % (n = 534). Despite COVID-19 restrictions from 2020 to the middle of 2022, all patients completed their TCV vaccination between 2020 and 2023. Challenges, such as vaccine shortages, record inconsistencies, and referral issues, persist. The non-hospital-based government-run ABTC has maintained rabies PEP services in Iloilo City from 2018 to 2023, despite challenges. Collaboration with the Local Government Unit (LGU) and DOH, increased campaigns, and lay lectures on the prevention of animal bites and rabies infection, along with increased healthcare funding, are needed for sustainable solutions.
Indian media has frequently highlighted the plight of vulnerable low-income groups who over-volunteer in clinical trials to make ends meet, often at the cost of their health. Despite these revelations, the lived experiences of these individuals remain insufficiently documented in academic literature. This study seeks to address this gap by exploring how clinical trial volunteers construct their world around their experiences of having taken part in multiple trials over a span of time. Additionally, the study aims to shed light on the current circumstances and challenges faced by these individuals and their families. Using Interpretative Phenomenological Analysis, this study analyses in-depth interviews conducted using respondent-driven sampling. Participants include three ex-serial volunteers who discontinued clinical trial participation and three key informants of deceased serial trial volunteers, from a remote mandal in the state of Telengana, South India. Three superordinate themes emerged: A journey of strain and stain, Transcending all turmoil to remain acceptable to system and society, and Agony of the family, each with five subthemes. The personal narratives highlight how financial desperation coerced them into serial participation. Over time, repeated enrolment led to physical and emotional deterioration, concealment, stigma, and family distress. Families discovered trial involvement only after adverse events or death, highlighting systemic gaps in transparency and post-trial care. Despite existing government regulations, the underground nature of recruitment networks and the persistent demand for willing participants enable these practices to thrive. Findings underscore the urgent need for a national registry, stronger oversight, and community-level awareness to ensure ethical, scientifically sound, and socially responsible clinical research in India.
This scoping review aimed to examine coping strategies and resilient behaviours for stress management among frontline healthcare workers as per the Sustainable Development Goal 3 (Ensure healthy lives and promote well-being for all). Five major databases (APA PsychInfo, Embase, MEDLINE, CINAHL, and Cochrane Library) were searched from their inception until December 2024, including peer-reviewed articles and the first three hundred results on Google Scholar. The review followed the JBI methodology for scoping reviews and PRISMA-ScR guidelines. The inclusion criteria were experimental and observational studies examining coping strategies and stress management interventions for frontline healthcare workers in any healthcare setting. Non-empirical studies, those without a clear methodology, and non-English-language studies were excluded. Data screening and selection were conducted using Rayyan software by two independent teams, with disagreements resolved through consensus with a third reviewer. Data extraction captured the study characteristics, population demographics, settings, and key findings. The cumulative sample size across all studies was 33,889 healthcare professionals, with significant gender disparity favouring female participants. This study spanned thirty countries across multiple continents, with the United States contributing the largest subset.
Digital health interventions are increasingly used to prevent non-communicable diseases (NCDs) by promoting healthy behaviors, yet evidence on which digital features are most effective remains fragmented. This systematic scoping review aimed to (1) identify the most commonly used types of digital interventions and their target populations for NCD prevention, (2) examine the primary objectives associated with each digital feature, and (3) assess their effectiveness in improving knowledge, attitudes, and behaviors. A comprehensive search was conducted across seven databases (PubMed, ScienceDirect, Scopus, JSTOR, Medline, CINAHL, and ProQuest). Following PRISMA guidelines, 20 peer-reviewed studies published between 2018 and 2024 met the inclusion criteria. Data were extracted on digital features, intervention objectives, and outcomes related to knowledge, attitudes, and behaviors. Messaging platforms were the most common (n = 7), followed by gamification, mobile applications, and wearables. Most interventions aimed to promote behavior change, especially those using mobile apps, messaging, and wearable tools. Similar digital features served different objectives depending on content design. Across studies, knowledge outcomes improved by 10-95 %, attitudinal outcomes by 2-40 %, and behavioral outcomes by 4-95 %. Messaging platforms showed the largest improvements in both knowledge and behavior, while gamification yielded moderate gains. Aligning digital tools with target users and intended outcomes enhanced overall impact. Messaging platforms and mobile applications emerged as the most frequently used and effective digital features for NCD prevention. Multi-feature interventions and platform-outcome alignment appear crucial to maximize effectiveness in digital health programs promoting healthy behavior.
To promote transparency and mutual accountability in global public health security among WHO States Parties, Article 54 of the International Health Regulations (2005) (IHR) obliges State Parties to regularly report capacities to prevent, protect against, control, and provide a public health response to the international spread of disease. Two prominent tools for assessing capacities, a mandatory State Parties Annual Self-Assessment (SPAR) and a voluntary Joint External Evaluation (JEE), cover similar concepts and structure, but agreement between the tools has not been assessed in a long term global analysis. This ecological study compared quantitative capacity scores from 1445 indicator-matched paired observations from 108 SPAR and JEE assessments completed in the same year, by 93 States Parties, between 2016 and 2023. Mixed effects methods were used to estimate mean agreement for each indicator, comparing tool editions/years, regions, and income groups. Overall, SPAR scores were higher than JEE scores, with the least agreement observed with indicators scoring near Level 3-4 capacity. However, consistency between SPAR and JEE evaluations improved recently, particularly in the latest 2022-2023 editions where 25 of the 28 matched indicator capacity scores were not significantly different on average. Three indicators with significant score disagreement pertained to infection prevention and control, health-care association infection surveillance, and national IHR focal point functions. Improved alignment between SPAR and JEE, particularly in recent editions, combined with the identification of remaining indicator disagreement, strengthens the evidence base for continued improvement in these essential assessment tools.