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IntroductionDigital interventions for 24-hour movement patterns (i.e., physical activity, sedentary behavior, sleep) show promise for cancer prevention, particularly among Black and Hispanic women, who experience worse cancer outcomes and lower adherence to sleep and physical activity guidelines. This study examined whether neighborhood characteristics influence digital health use and attitudes among Black and Hispanic women and explored whether individual sociodemographic factors moderate these relationships.MethodsIn a secondary analysis of a cross-sectional study, a total of 992 Black and Hispanic women aged 18-49 completed an online survey assessing demographic factors, sleep quality, physical activity levels, digital health use, and attitudes towards digital health interventions for sleep and physical activity. Neighborhood-level data on socioeconomic status, racial composition, and access to health services were extracted from geocoded addresses. Multivariable binary logistic regression models tested associations between neighborhood characteristics and digital health outcomes. Moderation by age, race, and education was assessed.ResultsBlack and Hispanic women living in neighborhoods with low or moderate-to-high socioeconomic risk were more likely to own wearable devices than those in high-risk neighborhoods. Health app use was more common among Black and Hispanic women in neighborhoods with higher rates of adults having personal doctors and greater out-of-pocket medical expenses. Among women in medically underserviced neighborhoods, Black women were more likely to use a health app, while Hispanic women were less likely. Race, age, and education moderated the influence of access to health services and racial structures on interest in digital health interventions for physical activity and sleep.ConclusionNeighborhood characteristics such as socioeconomic status, healthcare access, and racial structures play a vital role in shaping digital health use and attitudes among Black and Hispanic women. Tailored digital interventions that consider neighborhood-level factors may improve adoption, engagement, and effectiveness, and ultimately reduce cancer risk in these populations.

Women in Sudan face significant challenges in access to healthcare due to financial hardship, male decision-making influence and geographic limitations, contributing to delayed care-seeking barriers to maternal and reproductive healthcare, and persistent health inequities. A community-based cross-sectional study was conducted among 760 Sudanese women aged 18 years and above using a structured interviewer-administered questionnaire. Data were collected through face-to-face interviews across urban and rural areas, and associations with healthcare accessibility were examined using binary logistic regression analysis. Financial limitations were a major barrier, with 24.8% of women reporting rare or no financial ability to access healthcare. Additionally, 32.1% always required male permission to seek care and 7.6% experienced healthcare delays due to male family members' decisions. Women living more than 10 km from a healthcare facility were 7.1 times more likely to report inadequate access. Nearly half of the participants 49.6% strongly disagreed that male family members understood the importance of timely healthcare. Women's access to healthcare in Sudan remains constrained by interconnected economic, sociocultural, and geographic barriers. The findings highlight that urgent policy reforms are needed to expand affordable and geographically accessible healthcare services, strengthen women's financial and decision-making autonomy, and promote community-based interventions that engage men in supportive healthcare practices. Not applicable.

Somaliland faces persistently high burdens of maternal and perinatal mortality, with limited population-based data on pregnancy complications, sociocultural influence on maternal and perinatal health, and women's reproductive health needs across the continuum of pregnancy, childbirth, and postpartum. Also, available health materials, such as for assessing maternal near misses (MNM) or strengthening healthcare literacy, often appear unfit in the contextual realities. In response, the objective of this study is to unfold the physical, cultural, and psychosocial strengths and challenges experienced by women in Somaliland during pregnancy, childbirth, and the postpartum period; to examine how these factors as well as the woman's health-seeking behaviour influence pregnancy outcomes and women's ability to achieve future reproductive health goals; and to pilot how these insights can inform the co-creation of context-appropriate health materials. The PROMISE study is a community-based longitudinal pregnancy cohort in Hargeisa, Somaliland, including approximately 800 pregnant women&#x2009;<28&#x2009;weeks of gestation recruited from randomly selected sub-districts. Women will be followed up at three time points (<28&#x2009;weeks of gestation, >36 and one-three months postpartum) using questionnaires and clinical measurements. An MNM tool will be adapted through a Delphi process, and its validity will be tested using the cohort. The cohort findings will inform a co-creation process to develop postpartum contraceptive counselling materials to be pilot-tested for feasibility, acceptability, and preliminary effects. This protocol responds to major evidence gaps in fragile and low-resource settings, and aims to generate contextually grounded evidence and co-created interventions to strengthen maternal health agency in Somaliland and beyond. Main findings: This study will generate the first longitudinal, community-based pregnancy cohort in Somaliland capturing the physical, mental, and sociocultural determinants of maternal health across pregnancy, birth, and postpartum periods.Added knowledge: By embedding multiple sub-studies within a single community-based pregnancy cohort, this study will link clinical and epidemiological findings to sociocultural determinants, such as social support, self-care, and collective decision-making.Global health impact for policy and action: Findings can inform context-sensitive policies and co-created interventions, including postpartum contraception counselling, to strengthen reproductive health services and agency.

Achieving universal health coverage is a key component of the Sustainable Development Goals, focusing on equitable access to quality health services and minimising financial hardship. While strategies often target the demand-side, supply-side barriers such as travel time and facility-level constraints are often overlooked. Accurately quantifying who is affected by these barriers and identifying their locations and specific barriers is critical to improving service delivery. This study examines these barriers in Mali, a country with significant health system challenges exacerbated by high fertility rates and political instability. Using the WHO's Health Resources and Services Availability Monitoring System, we conduct an analysis of the geographic accessibility of antiretroviral therapy (ART) services. Our aim is to estimate the number of people affected by supply-side barriers by using a geographic accessibility model that calculates travel time to facilities with ART services. The analysis applies a least-cost path algorithm to assess accessibility, where ART services are defined as accessible within 2&#x2009;hours travel time. People within this range with available services have access while those outside are geographically constrained. For those within 2&#x2009;hours but without ART access, we identified and quantified facility-specific barriers. The results show that nearly 2.7&#x2009;million Malians do not have timely access to ART within 2 hours. For about 70%, distance is the main barrier, while the rest face facility-level issues such as the fact that the service is not being planned in the facility, lack of medical supplies and lack of training. This study offers important insights for targeted interventions to scale up ART provision and provides a scalable model for other health services and contexts.

Little research has considered associations between walkability and multiple health outcomes and the moderating effect of social determinants of health. This study examined relationships between walkability and diverse health issues (depression, poor mental health, poor physical health, mobility disability, obesity) and no leisure-time physical activity and whether these relationships were moderated by social vulnerability. Then, we assessed whether these moderated effects varied between urbanicity. For 1089 census tracts in South Carolina, we compiled EPA National Walkability Index, 6 health metrics from the CDC-PLACES dataset, and the CDC Social Vulnerability Index. Multilevel regression models were employed to account for the nested structure of the data, with census tracts (level 1) nested within counties (level 2). Overall, tract walkability was significantly negatively associated with poor mental health, poor physical health, obesity, and no leisure-time physical activity. The interaction between National Walkability Index and Social Vulnerability Index suggested that the relationship between health metrics and walkability varied depending on the level of social vulnerability in the community. In addition, tract rural or urban classification significantly altered the relationship between walkability and some health metrics. This study's findings provide valuable insights for equitable urban planning and strategies to address walkability and public health issues.

Improving the quality of health services remains a significant challenge in Indonesia, particularly due to variations in workforce capacity, uneven adoption of digital health systems, and limited stakeholder engagement. Understanding how these factors influence service quality from the perspectives of key stakeholders is essential to inform effective and sustainable improvement strategies. This study employed a qualitative descriptive design across multiple healthcare settings in Indonesia, including primary health centers, clinics, and district hospitals. Data were collected through in-depth, semi-structured interviews with healthcare providers, facility managers, policymakers, and community representatives. Participants were selected purposively based on their involvement in service delivery and quality improvement activities. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. An inductive coding approach was applied to identify recurring patterns and themes. Analytical rigor was enhanced through peer debriefing, source triangulation, and member checking. The analysis identified several interconnected themes influencing health service quality. Workforce capacity emerged as a central challenge, characterized by limited access to continuous training, high workloads, and gaps in clinical and managerial competencies. Digital health implementation varied widely across facilities, with barriers including low digital literacy, poor infrastructure, and limited system integration. Participants also highlighted gaps in policy implementation at the facility level, often related to bureaucratic constraints and insufficient organizational support. Community engagement was generally limited, with few structured mechanisms for capturing and responding to patient feedback. Participants emphasized that effective quality improvement requires coordinated strategies addressing human resources, digital readiness, governance, and community participation. Health service quality improvement in Indonesia is shaped by complex interactions between workforce capacity, digital health readiness, organizational support, and community engagement. Sustainable improvement requires integrated, context-sensitive strategies that strengthen human resources, support effective use of digital systems, enhance local policy implementation, and promote patient-centered care. These findings provide practical insights for policymakers and health system leaders seeking to strengthen service quality in resource-constrained settings.

To describe an evidence-informed, experience-based co-design process used to adapt metropolitan early palliative care referral models for implementation in a regional Australian health service. A scoping review of palliative care delivery and early referral models to inform evidence-informed, experience-based co-design workshops involving consumers, clinicians, and health service staff. Sequential mixed-methods development study comprising evidence synthesis to identify model components, followed by two iterative workshops to construct and refine a context-appropriate outpatient early referral model. A regional public health service in Victoria, Australia, seeking to establish an outpatient early referral palliative care clinic for people with advanced cancer. Purposefully sampled stakeholders (patients/carers, oncologists, palliative care clinicians, cancer care coordinators, Aboriginal health worker, managers, and researchers) took part in two online workshops. Co-designed model structure and components, perceived feasibility in a resource-constrained regional context, and agreed service scope and patient eligibility. The process generated a regionally tailored early referral pathway incorporating needs-based screening, prioritisation to manage limited capacity, and staged roll-out initially focused on selected cancer groups. These adaptations, while pragmatic, highlight the resourcing disparities faced by rural and regional services and the equity implications of resource-driven variation in care delivery. Evidence-informed co-design enabled pragmatic adaptation of metropolitan palliative care models to a regional setting and offers a transferable approach for other rural and regional services.

Arrhythmias such as atrial fibrillation and bradyarrhythmia impose a substantial public health burden. Although genetic predisposition contributes to arrhythmia risk, the extent to which modifiable lifestyle factors may mitigate this risk remains unclear. This study aimed to evaluate the association between a comprehensive healthy lifestyle and incident arrhythmias, and to assess whether these associations differ across levels of genetic susceptibility. A prospective cohort analysis was conducted using 341,736 UK Biobank participants after excluding individuals with baseline arrhythmias and incomplete lifestyle information. A healthy lifestyle score (HLS) incorporating smoking status, alcohol consumption, diet quality, and physical activity was constructed. Incident arrhythmias were identified through ICD-10 and procedure codes. Cox proportional hazards models were used to estimate hazard ratios (HRs) for overall arrhythmia, atrial fibrillation, and bradyarrhythmia, adjusting for demographic and clinical covariates. Genetic susceptibility was quantified using a polygenic risk score (PRS) for atrial fibrillation, and joint lifestyle-genetic risk categories were used to evaluate their combined associations with AF risk. Over a mean follow-up of 10.9 years, 37,990 participants developed an incident arrhythmia, comprising 34,491 atrial fibrillation/flutter (AF) events and 9,399 bradyarrhythmia events; the composite count is a deduplicated union, so the two subtype counts overlap by 5,900 dual-subtype cases (Supplementary Table S4). Higher HLS values were associated with lower risks of overall arrhythmia and AF, whereas the association with bradyarrhythmia appeared weaker and non-monotonic. Compared with participants in the unfavorable lifestyle category, those in the favorable category had lower risks of AF (HR, 0.89; 95% CI, 0.87-0.91), overall arrhythmia (HR, 0.91; 95% CI, 0.89-0.94), and bradyarrhythmia (HR, 0.92; 95% CI, 0.87-0.97). The intermediate lifestyle category was also associated with lower risks of AF (HR, 0.92; 95% CI, 0.90-0.94), overall arrhythmia (HR, 0.93; 95% CI, 0.90-0.95), and bradyarrhythmia (HR, 0.94; 95% CI, 0.90-0.99). In joint-category analyses using participants with high genetic risk and an unfavorable lifestyle as the common reference group, the lowest AF risk was observed among individuals with both low genetic susceptibility and a favorable lifestyle. A competing-risks sensitivity analysis with non-arrhythmia death treated as a competing event preserved the direction and approximate magnitude of the lifestyle association for AF and overall arrhythmia (Supplementary Table S10): 10-year cumulative incidence in the favorable versus unfavorable categories was 5.85% versus 6.61% for AF and 6.44% versus 7.14% for overall arrhythmia. For bradyarrhythmia, 10-year cumulative incidence was numerically similar across lifestyle strata (1.64-1.72%), consistent with a residual contribution of differential survival to the observed bradyarrhythmia pattern (Supplementary Figure S1). A sensitivity analysis substituting the diet subscore with an AHA Life's Essential 8-aligned cardiovascular-specific subscore produced directionally consistent estimates across all endpoints (Supplementary Table S8). In this large population-based cohort, adherence to a healthier lifestyle was associated with modestly lower risks of overall arrhythmia and atrial fibrillation. The association with bradyarrhythmia was weaker and appeared non-monotonic. These observational findings require confirmation in randomized lifestyle-intervention studies before causal inference.

Breastfeeding counseling is a key intervention to promote optimal infant feeding, particularly when delivered individually and in person. Its effectiveness depends on the quality of healthcare training, which remains variable. In Ecuador, public services primarily rely on group-based strategies with limited access to individualized support, reinforcing inequalities given the high cost of private services. This study describes an intervention co-developed with the local health system to strengthen provider capacity and implement an individualized counseling model in a rural setting. This practice-based case study was conducted in two phases between 2023 and 2024. In Phase I, 32 primary-level healthcare professionals participated in an 80-hour training program combining theoretical and practical components focused on technical skills, communication, and supportive counseling. Focus group discussions informed curriculum adjustments and explored changes in perceptions and competencies. In Phase II, a breastfeeding counseling room was established and staffed by ten trained healthcare professionals. Standardized digital records were used to document user characteristics and consultation topics. Data were analyzed descriptively using Stata and thematically using MAXQDA. Ten of 32 providers (31%) completed the training. A total of 305 counseling sessions were conducted with 247 women, most of whom were lactating (76.5%), aged 18-29 years (68%), and residing in the local catchment area (87.9%). The most frequent consultation topics included breastfeeding technique, nipple pain, perceived low milk supply, and milk expression and storage. Sessions averaged 36&#xa0;min. Users included adolescents and women with varying levels of maternal experience, highlighting diverse counseling needs. The intervention emphasized individualized, empathetic, and context-sensitive support. The intervention was feasible within a public primary healthcare setting and addressed key gaps in access to individualized breastfeeding support. It demonstrated the relevance of combining technical and relational competencies in counseling and the importance of integrating such services within existing health systems. These findings provide practical insights for the implementation of similar models in resource-constrained settings. Not applicable.

The health system has been identified as a key lever for increasing access to birth registration (BR) directly after birth. BR is critical for upholding human rights and accessing essential services, yet many low- and middle-income countries struggle with low BR rates. In this realist synthesis, we reviewed literature on two separate interventions that are designed to increase access to BR services. This included (1) embedding or appointing an official to register births in health facilities and (2) incorporating education on BR in routine perinatal care programmes. This study aimed to support the knowledge base on how these interventions work, why, and for whom, within health facility contexts. We followed the RAMESES I publication guidelines for realist syntheses. Iterative searches were carried out in PubMed, Scopus and Web of Science. The search also included grey literature, policy documents and insights from a key informant in South Africa. We adopted an iterative cycle of searches guided by review team exchanges, stakeholders' insights and sequential snowballing searches for theory and background information. We developed two initial programme theories, presented as ICAMO configurations, that were then refined against empirical evidence from 17 included studies, with publication dates ranging from 1992 to 2021. Our review findings highlight that the interventions improved BR rates by lowering logistical barriers, raising awareness and supporting BR staff, (i.e., personnel responsible for conducting BR within health facilities). Literature from LMICs suggest that the effectiveness of facility-level BR interventions is often affected by access to care, travel distances, transportation costs, as well as by the availability of resources, BR infrastructure, and staff motivation within healthcare facilities. These factors may, in turn, affect BR demand, parents' self-efficacy, and the extent to which BR initiatives align with parents' real-life contexts.

This study examines the factors influencing the Not in My Backyard (NIMBY) attitude toward Mental Health Welfare Centers (MHWCs) in South Korea, integrating individual and regional determinants. Using data from the 2022 Mental Health Perception Survey and Korean Statistical Information Service, we apply a Markov Chain Monte Carlo generalized linear multilevel model to assess predictors of NIMBY attitudes. Regional analysis indicates that a higher proportion of old housing is associated with stronger NIMBY attitudes, whereas higher mortality rates are linked to lower opposition, suggesting that neighborhood conditions and community-level health vulnerability shape public acceptance of mental health services. At the individual level, older age, poor physical health, negative perceptions of mental illness, and exposure to MHWC advertisements were associated with higher NIMBY attitudes, while internet-based information and personal recommendations were linked to lower opposition. The study highlights the limitations of traditional public awareness campaigns and underscores the importance of tailored, trust-based communication strategies that consider local context. These findings provide policy-relevant insights for promoting community-based mental health care.

Conversational generative artificial intelligence agents (or genAI chatbots) could benefit youth mental health, yet young people's perspectives remain underexplored. We examined the Mental health Intelligence Agent (Mia), a genAI chatbot originally designed for professionals in Australian youth services. Following co-design, 32 young people participated in online workshops exploring their perceptions of genAI chatbots in youth mental health and to develop recommendations for reconceptualising Mia for consumers and integrating it into services. Four themes were developed using reflexive thematic analysis: (1) Humanising AI without dehumanising care, (2) I need to know what's under the hood, (3) Right tool, right place, right time?, and (4) Making it mine on safe ground. This study offers insights into young people's attitudes, needs, and requirements regarding genAI chatbots in youth mental health, with key implications for service integration. Additionally, by co-designing system requirements, this work informs the ethics, design, development, implementation, and governance of genAI chatbots in youth mental health contexts.

Food insecurity and child mental health difficulties frequently intersect, yet the mechanisms and pathways connecting them remain underexplored in resource-limited settings. This study developed a contextually grounded explanatory model to examine these relationships within a single rural Ugandan setting. We conducted 12 focus group discussions with 36 teachers across four schools in Masaka district, drawing on their sustained observations of children's food insecurity and mental health difficulties across a nine-month timeframe. Data were analysed using realist thematic analysis, supported by iterative coding, nine consensus meetings and member checking. Three interrelated pathways were identified. In the social causation pathway, food insecurity, manifested through hunger-related stress, food-related stigma and irregular or inadequate meals, preceded and contributed to mental health difficulties. In the social drift pathway, preexisting mental health difficulties among caregivers and/or children disrupted household functioning and food provision, increasing vulnerability to food insecurity. A bidirectional pathway captured recursive processes in which food insecurity and mental health difficulties co-evolved and reinforced one another over time. These pathways shaped children's mental health and educational engagement within school environments. The findings offer context-specific insights that may inform research in similar settings. They also highlight the potential value of integrated, multi-level interventions, while underscoring the need for longitudinal and intervention research.

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As South Korea faces growing population diversity, including aging, socioeconomic inequality, and migration, there is an urgent need to improve equity in healthcare communication and utilization. This study employs a photovoice methodology to explore how four marginalized groups (older adults, persons with disabilities, low-income public assistance recipients, and migrant women) experience barriers and facilitators to patient-doctor communication and healthcare utilization (n&#x2009;=&#x2009;20). Participants' photographs and narratives showed three cross-cutting structural barriers: long wait times and limited consultation time, financial constraints, and insufficient or unclear information. These barriers took different forms across groups, ranging from language barriers among migrant women to inaccessible transportation and kiosks for participants with disabilities. Facilitators included empathetic provider communication, trust-based relationships, visual aids, and family or peer support. Proactive patient strategies recurred across all four groups, though access to them was itself unequally distributed. These findings highlight the need for patient-centered communication, provider training in shared decision-making, and system-level reforms that address time pressure, cost uncertainty, interpreter access, and information asymmetry in healthcare encounters. Photovoice was useful in capturing the lived experiences of structurally marginalized groups and offers practical insights for designing inclusive healthcare practices and policies.

Patients with chronic diseases in Malaysia frequently return to public health facilities for their monthly medication supply, contributing to congestion and increased workload. At the same time, community pharmacists remain underutilized due to limited dispensing opportunities. This study explored community pharmacists' perspectives on participating in a public-private partnership model to supply repeat medicines to patients from public health facilities. A concurrent embedded mixed-methods design was employed, combining a nationwide quantitative survey of 433 community pharmacists with in-depth interviews involving 15 pharmacists from different states. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative interviews underwent thematic analysis. Most community pharmacists perceived community pharmacy-based repeat medicine supply as beneficial, citing patient convenience in terms of accessibility (96.3%), time saving (95.6%) and reduced travel costs (88.5%). They viewed community pharmacies as suitable service points (94.3%) and supported appropriate remuneration for their services (90.6%). Fewer pharmacists considered potential barriers such as increased workload (44.8%), operating costs (39.8%), or space constraints (43.0%). Strongly endorsed facilitators included timely reimbursement to the pharmacists, clear procedures and guidelines, and structured collaboration with public facilities. A high proportion (88.4%) expressed willingness to participate. Qualitative findings reinforced perceived benefits for patients, community pharmacists, and public health system. Participants highlighted the importance of a clear operational framework, efficient reimbursement systems, and avoidance of previous pitfalls in public-private collaborations. While challenges were noted, pharmacists believed these could be mitigated through proper systems including communication platforms, scheduling mechanisms, and defined formularies. Overall, community pharmacists demonstrated strong support for participating in repeat medicine supply services. Their motivation stems from patient benefits, professional fulfilment, and commercial sustainability. Realizing this model, however, requires system-level reforms, stakeholder engagement, and robust implementation mechanisms to ensure an effective and sustainable collaboration.

The trade of illicit pharmaceutical products and cosmetics (IPCs) poses a significant public health threat, particularly in Malaysia where evolving online-to-offline supply chains facilitate their influx. The Pharmacy Enforcement Branch participates in INTERPOL's Operation Pangea to curb this trade at logistical entry points. This study aimed to determine the prevalence, detection-seizure ratios, and categories of IPCs detected and seized at Sarawak's entry points during Operation Pangea from 2020 to 2023. This retrospective cross-sectional study analysed data extracted from Operation Pangea reports (2020-2023). Universal sampling was applied to all entry-point screening cases, while records with missing data, West Malaysia imports, and passenger luggage imports were excluded. IPCs were defined as products or cosmetics not registered or notified with the Ministry of Health. Prevalence and detection-to-seizure ratios were calculated using descriptive statistics, and chi-square tests were used to determine associations between variables and enforcement outcomes. A total of 301 consignments (1006 individual items) were screened, mainly through courier services and at the Southern Zone (Kuching). Screening detected 281 IPCs, corresponding to a 27.9% detection rate, of which only 67 (23.8%) were seized. Products containing scheduled poisons and supplements were the most frequently seized categories. Significant associations were found between consignment type and both detection and seizure outcomes, with courier consignments showing higher rates. The Seizure Detection Ratio declined markedly from 1.00 in 2021 to 0.05 in 2023. Most seized items were intended for treatment purposes, including chronic disease medications and analgesics. This study demonstrates a high prevalence of IPCs in imported consignments in Sarawak, highlighting ongoing risks associated with IPC supply chains. The decline in seizure detection ratio suggests the need to review enforcement consistency and prioritization to strengthen regulatory effectiveness.

TB cohort review is a structured clinical audit of case management and epidemiological data. In 2012, Wales (UK) implemented a national cohort review programme to improve clinical outcomes and enhance public health surveillance. Retrospective population-based cohort analysis of care quality outcomes for all notified TB cases in Wales (2012-2022). Adjusted regression modelling assessed temporal trends post-implementation and compared outcomes of cases presented at TB cohort review with those not presented. Of the 1,175 notified TB cases over the study period, 985 (83.1%) were presented at cohort review. Many case management outcomes achieved near-target thresholds. Adherence support was increasingly targeted at index cases with social complexity and higher transmission risk, alongside substantial improvements in the completeness of surveillance data. Persistent programmatic challenges in contact identification and assessment were identified. As countries approach pre-elimination thresholds, TB services must ensure rigorous surveillance data collection and targeting of limited resources to populations at greatest risk of transmission and non-completion of treatment. Since implementing a national TB cohort review in Wales, there have been significant post-implementation improvements in care outcomes. This provides a robust, resource-efficient framework for TB control that could be applied to other similarly resourced low-incidence countries.

Clinical ethical issues in paediatric practice are relatively common due to the nature of the doctor-parent-patient relationship, as these patients run the spectrum from newborns, infants, children and adolescents. The Clinical Ethics Consultation Service (CECS) was established at Hospital Al-Sultan Abdullah (HASA) in 2020. It has played a crucial role in addressing the ethical issues and dilemmas faced by healthcare professionals in their clinical practice. This study aimed to identify common ethical issues encountered in paediatric practice at HASA to provide recommendations on improving clinical ethics support. A qualitative approach employing key informant interviews (KIIs) was utilised. Five HASA paediatricians were interviewed. The results were divided into three sections. Section one focused on common ethical issues encountered by paediatricians. The issues were related to clinical decision-making, refusal of treatment by parents, end-of-life issues and resource allocation. Section two focused on the paediatrician's understanding and experience of clinical ethics which yielded mixed responses. Section three looked at input regarding the development of paediatric clinical ethics support. Recommendations include promoting the CECS and its services through awareness and educational programmes at HASA. It also recommends enhancing case consultations through participation during grand rounds, providing ethics education and training, as well as guidelines and policy development in paediatric practice at HASA. This study provided meaningful insights into common ethical issues faced by paediatricians at HASA and recommendations on how clinical ethics can support their practice. It also adds to the limited literature on clinical ethics in Malaysia.