Medical invalidation, medical gaslighting, and related constructs have gained visibility in public discourse but remain inconsistently defined in scientific literature. Despite growing research—often focused on specific diseases— to date, no single review has comprehensively synthesized their definitions, causes, consequences, or methods of measurement. This scoping review addresses this gap by examining medical invalidation and related constructs. Using a preregistered protocol, we systematically searched PubMed, CINAHL, Web of Science, Google Scholar, and ProQuest (dissertations) without year restrictions. Eligible sources included peer-reviewed empirical, theoretical, and conceptual work in English addressing invalidation, gaslighting, or closely related notions within healthcare. A total of 158 studies were identified through database searches and citation tracking. Data extraction followed a standardized schema, and findings were synthesized descriptively and through thematic analysis to clarify terminology, map determinants and outcomes, and identify existing measurement approaches. The results showed substantial inconsistency in how “invalidation,” “not being taken seriously,” and “gaslighting” were defined. Medical invalidation emerged as a multifactorial phenomenon driven by diagnostic challenges, structural and societal factors, provider and patient characteristics, stigma, misattribution, interactional dynamics, academic knowledge gaps, and disease-related complexity. Invalidation was associated with wide-ranging behavioural, emotional, cognitive, physical, relational, and systemic harms, while validation had consistently beneficial effects. Proposed solutions in the summarized studies included communication improvements, clinician training, patient support, targeted research, and structural and systemic changes. Medical invalidation represents a complex, systemic issue with significant implications for patient safety. The discussion highlights its multifactorial origins, its potential to cause both psychological and physical harm, and the need for clearer conceptualisation within the field. Advancing research requires validated instruments and longitudinal designs to examine underlying mechanisms and consequences. Addressing medical invalidation will demand multi-level interventions to improve communication, reduce structural barriers, and promote equitable, patient-centred care. https://doi.org/10.17605/OSF.IO/MPE6U
Primary health care (PHC) plays a central role in promoting equitable access to health services in Vietnam. However, workforce shortages and unequal distribution of physicians, particularly in remote and disadvantaged areas, remain major challenges. To address this, the Ministry of Health implemented the 585 Policy, deploying young doctors with postgraduate training to underserved regions. Understanding medical students’ perceptions of PHC and related workforce policies is crucial for sustaining such initiatives. An online cross-sectional survey was conducted among 215 medical students from 16 universities across Vietnam between March 2019 and February 2020. A structured questionnaire was used to assess (1) students’ perceptions of PHC and the 585 Policy, (2) key motivators influencing their willingness to participate in the 585 Policy, and (3) factors associated with students’ perceptions of PHC and the 585 Policy. Among 215 participants, most were Doctor of Medicine students (77.7
Migration has increased population diversity and created challenges for safe medication use. Evidence remains limited regarding factors influencing medication-related problems among migrants and the support needed to optimise medication use in the home. No studies have addressed support for medication use in the home among migrants or proposed models for such support. The aim was to identify the support needed and to develop a model for support to promote safe medication use in the home and prevent medication errors among foreign-born persons with language difficulties. A co-creation participatory action research design involved end-users—foreign-born persons and relatives, and staff in healthcare and pharmacies. Focus group discussions, based on previous studies, were analysed using qualitative content analysis and interpreted through Pawson’s framework across four contextual dimensions: individual, interpersonal, institutional, and infrastructural. The analysis identified seven areas where support was required: routines to support safe medication use; continuity and risk assessment; support for language understanding; resources; information for patients and relatives to understand medication treatment and the prescribing system; staff training; and national measures. Support was needed across all contexts, particularly at the institutional and infrastructural levels through organisational development and clearer guidelines and regulations, but also at the interpersonal level in everyday interactions with healthcare and pharmacy staff. The findings informed the development of a support model anchored in primary healthcare includingan extended interdisciplinary team involving relatives and pharmacists, coordinated by an accessible contact person. In conclusion, promoting safe medication use in the home for foreign-born persons with limited language proficiency requires placing a well-informed patient at the centre of care; care planning based on individual needs; and coordinated support across individual, interpersonal, institutional, and infrastructural levels. Everyday practice should be critically reviewed to organise teamwork, allow time for risk assessment, and improve patient and relative education. Strengthening continuity, communication, and shared responsibility across a seamless healthcare chain may reduce medication-related risks and support patients and relatives in managing medications safely in the home. Implementation of the developed model should be accompanied by organisational and policy-level changes to enable sustainable, person-centred medication safety.
The number of immunocompromised patients (ICPs) is increasing, and these patients are vulnerable to infection and therefore eligible for additional vaccinations. Current guidelines therefore advise vaccination against pneumococcal disease, herpes zoster, and human papillomavirus. However, uptake of these medically indicated vaccines is low, partly due to logistical barriers and limited vaccination facilities. We studied the implementation of a vaccination care pathway for medically indicated vaccines for ICPs, a collaborative initiative between hospitals and municipal public health services (MPHS). The aims were to facilitate vaccine uptake, evaluate collaboration, identify implementation challenges, and determine requirements. A mixed-methods study with a convergent design was conducted, including adult patients with inflammatory bowel disease recruited from two hospitals. Healthcare providers participated in semi-structured interviews, and patients and healthcare professionals completed questionnaires. Vaccination uptake and the quality of consultations were assessed using a predefined scoring checklist. 100 patients were included. Vaccine uptake was high, with 238 of 243 recommended vaccinations administered (97.9
Globally, about 81 million people per year are driven to financial catastrophe from the costs of surgery and other related nonmedical costs, with low- and middle-income countries (LMICs) bearing the greatest burden. This study determined the catastrophic out-of-pocket (OOP) health expenditure and the socioeconomic burden associated with accessing paediatric surgery at the highest tertiary health facility in Zambia. A cross-sectional study was conducted at the University Teaching Hospital (UTH) in Lusaka District, Zambia, involving 380 parents or guardians of paediatric patients recruited over three months using consecutive sampling. The primary outcome was catastrophic health expenditure (CHE), determined using the budget share approach. The secondary outcome was the socioeconomic burden of surgery, assessed using the reported adopted socioeconomic coping mechanisms. Data were collected using a 36-item electronic questionnaire and analysed in R version 4.5.1 with appropriate descriptive and inferential statistics. Overall, 127 (33.4
Wheelchair users with physical disabilities frequently encounter barriers to healthcare access that contribute to poorer health outcomes compared with the general population. Although tertiary referral hospitals provide the highest level of specialized medical care, their complex organizational structures and standardized clinical processes may unintentionally create additional accessibility challenges. Despite increasing attention to healthcare access among people with disabilities, little is known about how wheelchair users experience barriers within tertiary referral hospitals. This study aimed to explore the experiences of wheelchair users with physical disabilities when accessing healthcare services at tertiary referral hospitals in South Korea. A descriptive qualitative design was employed. Semi-structured, in-depth interviews were conducted with 11 wheelchair users aged 19 years or older who had experience receiving outpatient care at tertiary referral hospitals in South Korea. Participants were recruited through purposive and snowball sampling. Interview data were analyzed using thematic analysis. Three main themes were identified: (1) structural barriers within tertiary referral hospitals, including transportation barriers, inaccessible diagnostic equipment, and limited access to rehabilitation services; (2) clinical encounters influenced by disability-centered assumptions, characterized by diminished autonomy, disability overshadowing, and limited attention to quality-of-life concerns; and (3) adaptation to inaccessible healthcare environments, including both coping strategies and gradual disengagement from healthcare services. The findings reveal a functional accessibility gap, where formal accessibility provisions do not necessarily translate into practically usable healthcare settings. Wheelchair users encounter persistent structural and relational barriers when accessing tertiary referral hospitals. The findings highlight an advanced-care paradox, in which highly specialized medical systems may unintentionally reproduce accessibility inequities. Improving healthcare access requires not only physical accessibility improvements but also disability-competent care practices, coordinated navigation support, and healthcare systems responsive to diverse physical needs.
Pakistan, a lower-middle-income country of some 241 million people, faces a rising cancer burden — an estimated 185,748 new cancer cases and 118,631 cancer deaths in 2022 — that is served by a heterogeneous and largely uncoordinated mix of public, private for-profit, philanthropic, and Atomic Energy Commission cancer facilities. Nationally representative data on oncology infrastructure, diagnostic capacity, therapeutic access, and workforce conditions remain limited. We surveyed oncology professionals to describe, from their perspective, the capabilities of their institutions and their own working conditions. A cross-sectional survey was completed by 111 oncology professionals practising across ten cities in four provinces between July and September 2025. A structured questionnaire captured institutional infrastructure, diagnostic and molecular testing, multidisciplinary practice, therapeutic availability, supportive services, research activity, financial constraints, and workforce perspectives. Data were analysed descriptively with the individual respondent as the unit of analysis. Institutional sector (private, government, or Atomic Energy Cancer Hospital) was assigned post hoc from each respondent’s known institutional affiliation and compared using the χ² test with Freeman–Halton exact confirmation. Respondents comprised radiation/clinical (55.9
Internet-based testing services for sexually transmitted and blood-borne infections have increased in prevalence and altered the testing landscape and testing behaviours in many jurisdictions. Our objective was to understand how system partners perceived the possible benefits and drawbacks of adapting and implementing an online testing program like GetCheckedOnline which was already operating in British Columbia, Canada, into a new provincial context where it did not exist. We conducted in-depth interviews and focus groups with sexual healthcare providers, program managers and developers, and other public health professionals with expertise in sexually transmitted infections testing (N = 41) in Ontario, Canada. Our interview questions were part of a larger study focused on improving equitable access to sexually transmitted infections testing. Transcripts were transcribed verbatim and analysed using NVivo software following grounded theory. We created a conceptual figure to chart tensions from participant accounts onto a model of GetCheckedOnline. We describe five key tensions in the accounts of our participants to elucidate perspectives on the possible benefits and barriers/concerns of implementing a digital testing model like GetCheckedOnline in another province: (1) access, (2) privacy, (3) co-ordination/communication, (4) agency, and (5) health system impacts. We map these five tensions across the core elements of the online testing program (i.e., from creating an online account, completing an assessment, and submitting specimens to getting results and engaging in repeat testing). Our analysis elucidates the multiple advantages that online testing modalities may provide for service users as well as substantive barriers and concerns perceived by health system partners, including the potential (unintended) consequences and paradoxes of introducing digital sexually transmitted infections testing.
The COVID-19 pandemic raised ethical questions about how scarce medical resources should be defined and allocated. Existing debates have largely focused on triage criteria and distributive principles, with less attention to how different social and institutional actors understand the allocation problem itself. This study examined how healthcare providers and civil society advocates in South Korea understood the problem of pandemic resource allocation, and how their perspectives diverged across four dimensions: scarcity, fairness, survival, and preparedness. This qualitative study included 31 participants: 16 healthcare providers with direct experience treating patients during the COVID-19 pandemic and 15 civil society advocates supporting socially marginalized populations. Providers participated in semi-structured individual interviews, while advocates participated in focus group interviews. Both methods incorporated written vignettes based on ethically contested resource-allocation policies implemented in South Korea. Data were collected from August 2025 to March 2026 and analyzed primarily inductively using reflexive thematic analysis. Four interrelated themes were identified. First, providers understood scarcity mainly in terms of beds, personnel, and treatment capacity within clinical settings, while advocates emphasized barriers that prevented marginalized populations from entering or remaining connected to the healthcare system. Second, providers foregrounded clinical need and clinical judgment, whereas advocates explicitly incorporated structural vulnerability and unequal access into their understanding of fair allocation. Third, providers framed survival largely through mortality prevention and treatment capacity, while advocates emphasized social survival, including continuity of care, livelihood, and everyday support. Fourth, both groups stressed the need to establish ethical principles and institutional preparedness before future crises, with advocates calling for standing participatory bodies that include patients, civil society, and healthcare professionals. Pandemic resource allocation was shaped by differing understandings of what counted as a resource, who qualified as a legitimate subject of allocation, and what outcomes counted as survival. Equitable preparedness requires ethical principles, equity safeguards, and participatory governance to be institutionalized before a public health emergency occurs.
Despite increasing policy investment in smart home-based elderly care platforms, participation among older adults and care institutions remains limited. Existing studies have primarily examined participation-related factors from either the demand or supply side, but have paid limited attention to how these factors are interconnected within platform-based elderly care systems. Consequently, the structural relationships among participation-related factors and the factors occupying key positions within the broader care system remain insufficiently understood. To explore the interdependencies among factors related to participation in smart home-based elderly care platforms among older adults and care institutions in China. A three-stage exploratory study design was adopted. First, potential participation-related factors were identified through prior ethnographic research. Second, the identified factors were refined using expert ratings, coefficients of variation, and fuzzy set membership analysis. Third, an expert-informed directed and weighted factor network was constructed based on expert assessments of inter-factor relationships. Social network analysis was applied to examine network structure, brokerage positions, and structural prominence through network-level analysis, block modeling, and node- and edge-level metrics. Factors demonstrating high structural prominence were identified by integrating node-level indicators with block model positions, and robustness was assessed through sensitivity analyses. Initially, 21 elderly-related and 14 institution-related factors were identified. After refinement, 27 factors were retained, forming a fully interconnected expert-informed network with a clear core-periphery structure. Platform-, governance-, and institution-related factors occupied structurally central and intermediary positions, whereas older adult-related factors were more structurally dependent within the network. Twelve structurally prominent factors were identified, including trust in service provision, family support, payment power, inadequacy of existing care arrangements, care service quality, platform quality, service accessibility, service delivery costs, government subsidy support, payment and settlement mechanisms, revenue allocation arrangements, and performance incentive structures. Sensitivity analyses further supported the stability of the network structure and structurally prominent factors. Participation-related conditions in smart home-based elderly care platforms appear to be embedded in interdependent structural relationships rather than operating as isolated factors. The findings suggest that institutional arrangements, platform governance, and service delivery conditions may play central roles in shaping participation dynamics. These findings highlight the value of a system-oriented perspective and suggest that improving participation may require coordinated strategies across service delivery, platform governance, payment mechanisms, institutional incentives, and policy support.
Identifying and understanding implementation determinants is a critical step in the process of tailoring implementation strategies to local contexts. System Support Mapping (SSM) is a method rooted in systems thinking that offers a structured approach to exploring the responsibilities, needs, resources, and wishes of individuals within an implementation context. However, SSM has not yet been systematically described and applied as a methodology for identifying implementation determinants within multi-site implementation studies. This article introduces and illustrates the combined application of SSM and the Matrixed Multiple Case Study (MMCS) approach as a structured six-step methodology for identifying and analysing implementation determinants within and across sites, using data from the Neo-MILK project as an illustrative example. The project aimed to implement a structured lactation support programme for mothers of very low birth weight infants and establish human donor milk banks in German neonatal intensive care units (NICUs). To illustrate the six-step methodology, semi-structured interviews with key persons from five German NICUs, which were conducted during the early intervention phase, served as the empirical basis for demonstrating each methodological step. Transcripts were analysed using directed content analysis, with SSM elements serving as deductive categories and context-specific codes developed inductively. The MMCS approach was used to organise, compare, and synthesise findings within and across sites. Applying the six-step methodology, we demonstrate the type of output each step produces, ranging from individual System Support Maps per key person and NICU (steps 1–3) to a sortable cross-site matrix (steps 4–6). The within-site analysis (step 5) illustrates how the methodology surfaces context-dependent perceptions of the same determinant, showing that a given resource category could be perceived as facilitating, inhibiting, or both, depending on individual responsibilities, needs, and local context. The cross-site analysis (step 6) demonstrates how the matrix structure makes homogeneous and heterogeneous determinant patterns visible across sites, indicating different contextual manifestations of the same determinant. The combined application of SSM and the MMCS approach provides a structured methodology for identifying and analysing implementation determinants that accounts for the perspectives of individual interest-holders and enables systematic within-site and cross-site comparison. The distinction between homogeneous and heterogeneous determinant patterns offers a basis for differentiating between cross-site and site-specific implementation strategies. Further research is needed to evaluate the use of SSM across multiple evaluation timepoints and its integration into initial and ongoing tailoring of implementation strategies. DRKS00025058; registered 6 May 2021.
Neonatal mortality remains a leading contributor to under-five mortality globally, particularly in low- and middle-income countries (LMICs). Kangaroo mother care (KMC) is an effective, low-cost intervention for improving outcomes among preterm and low birth weight infants; however, implementation remains inconsistent in resource-limited settings. We conducted a quality improvement study at a rural Kenyan hospital using three sequential six-week cycles. Interventions addressed key barriers to KMC, including provider knowledge, caregiver engagement, and environmental constraints. Primary outcomes were initiation of KMC within 24 h of delivery and mean daily duration of KMC. Secondary outcomes included the proportion of eligible hospital days during which neonates received ≥ 1 h of KMC and the proportion of eligible hospital days during which neonates received ≥ 8 h of KMC. A total of 45 neonates were enrolled. KMC initiation within 24 h increased from 8.3
Infertility is a critical public health issue that reduces the quality of life for many women and has become increasingly prevalent among Iranian couples in recent years. This study aimed to investigate the barriers that infertile women face in accessing and utilizing infertility treatment services. This is a quantitative cross-sectional study that was conducted on 450 infertile women with primary or secondary infertility in Tehran in 2023. The context included 5 large public and private centers providing Infertility treatment services. The data were gathered through interviews using a structured questionnaire developed mainly based on Saurman’s conceptual model and Hosseini Esfidarjani’s study questionnaire and then analyzed by descriptive statistics and also Spearman’s correlation, ANOVA and logistic regression model. Among the barriers to access, the highest average score is related to financial affordability barriers (8.66±15.22) and integration (81±11.45), and in the barriers to utilization, it is related to personal and cognitive issues (11.7±12.9) and service quality (5.5±6.9). According to Spearman’s correlation and ANOVA yesy, statistically significant associations was observed between access barriers and type of insurance, spouse’s employment status, ethnicity, place of residence, creating a break or gap between diagnosis and treatment, as well as the history of changing the treatment center. Also, a statistically significant associtions was observed between utilization barriers and type of insurance, employment status of the couple, creating a break or gap between diagnosis and treatment. In both dimensions, a negative correlation was observed between monthly income and barriers to access and utilization. However, according to the logistic regression analysis, only medical center where provided the ITSs was significantly related to the barriers to access and utilization of ITSs. Also an association was found between the place of residence (Cof = −2.26, p = 0.038) with access barriers, so that women living in rural areas faceed more access barriers. According to these findings, the access and use of infertility treatment services among infertile women is strongly influenced by affordability, factors related to the health system (accommodation and quality of services) and other cultural and socio-economic factors. Therefore, the development of policies and support mechanisms by the government, continuous education and support of the patient and providing a culturally safe environment can help in improving the access and utilization of infertility treatment services.
Artificial intelligence (AI) is increasingly promoted as a tool for strengthening health systems, but evidence on how it can be implemented in fragile, low-resource settings remains limited. This study examined AI-related practices and implementation readiness in one urban health zone in the Democratic Republic of Congo (DRC) and used African pilot experiences to contextualize the local findings. We conducted a secondary thematic analysis of semi-structured interviews with 11 purposively selected health professionals in the Ibanda Health Zone and integrated the findings with a critical narrative review of 56 scientific and grey-literature documents from the DRC, Rwanda, Kenya, and South Africa. The two evidence streams were coded against a common framework covering use cases, institutionalization, reported effects, and health-system prerequisites. No institutionally implemented clinical AI system was identified in Ibanda. Some professionals reported informal use of consumer generative AI, while Google Search, DHIS2, and routine laboratory automation formed part of the broader digital-readiness environment but were not classified as AI. Participants perceived potential benefits for diagnosis, laboratory turnaround, and data management, but reported major barriers related to training, connectivity, paper records, regulation, and governance. Individual African pilot studies reported promising results, but heterogeneous designs and settings precluded direct comparison or pooled conclusions. Ibanda illustrates a pre-emergent stage of AI readiness rather than established AI implementation. The combined evidence suggests that any future deployment should be gradual, locally validated, and preceded by investment in data systems, infrastructure, workforce capacity, and accountable governance. These exploratory findings are context-specific and should not be interpreted as evidence of AI effectiveness in the DRC.
Mental health integration into primary health care (PHC) is widely advocated as the most feasible strategy to address the large treatment gap in low- and middle-income countries. However, baseline clinical decision-making skills of frontline primary healthcare workers (PHCWs) in the assessment, management, and referral of common mental, neurological, and substance use (MNS) disorders remain poorly documented, particularly in Northern Nigeria. This study assessed mental health knowledge, diagnostic accuracy, treatment, and referral skills among PHC workers in Kano, Nigeria. A cross-sectional study was conducted among 180 PHC workers selected through simple random sampling. Mental health knowledge was evaluated using the Mental Health Knowledge Questionnaire. Clinical decision-making skills were assessed with four culturally adapted clinical vignettes. Data were analysed using descriptive statistics, independent t-tests, ANOVA, and multivariable linear regression in IBM SPSS version 26, with statistical significance set at p < 0.05. The mean (SD) mental health knowledge score was 12.27 (2.62) out of 20 (61.35
This study aimed to assess the association between socioeconomic status (SES) and healthcare service utilisation in Spain, considering explanatory factors based on Andersen’s behavioural model and examining patterns across the 2017–2023 period, including the COVID-19 pandemic. Population-based cross-sectional study using data from national health surveys conducted in Spain in 2017, 2020, and 2023, including individuals aged ≥ 15 years. Dependent variables were general practitioner (GP) visits, specialist consultations, hospital admissions, and emergency department use across public and private sectors. SES (high, medium, low) was the main explanatory variable. Predisposing, need-related, and enabling factors were included. Generalised linear models with negative binomial distribution and robust standard errors were fitted. Models included interaction terms between SES and survey year. Analyses were stratified by gender. A total of 66,193 responses were analysed (22,038 in 2017; 22,077 in 2020; 22,078 in 2023). In primary care, lower SES was associated with higher use (IRR = 1.11; 95
Pharmaceutical residues resulting from patient excretion, incorrect disposal and manufacturing of medicines contribute to environmental pollution and related risks. Designing active pharmaceutical ingredients of inherently lower environmental risk (‘greener APIs’) is one potential solution to this issue. To assess the current level of preparedness to adopt potentially greener APIs as a part of more sustainable medical care, the perspectives of healthcare professionals on greener APIs were evaluated by investigating related opportunities, barriers and the needs to overcome these barriers. Semi-structured interviews were conducted with professionals working in the healthcare sector in European countries between February and April 2024 (n = 16). The interviewees included doctors (3), pharmacists (3), experts in procurement (3), reimbursement (1), market authorisation (2), healthcare provision (2) and industry’s sustainability reporting (1), as well as a professional working for an environmental NGO (1). Data was evaluated using qualitative content analysis. Interviewees’ answers showed that some strategies already exist to account for environmental aspects in decision-making, e.g. by adding environmental criteria to the tenders of procurement agencies. Criteria on environmental properties of APIs can be expected to play a more significant role in the decision-making of HC professionals in future. Balancing molecular properties related to patient benefit and risk against environmental properties could be product specific. Frequently expressed needs to enable this include: access to reliable scientific data and evidence of environmental impacts of APIs, legislative and regulatory frameworks and guidance to ensure environmental properties are assessed and weighed in a centralised and harmonised manner. The evident interest among HC professionals to consider environmental properties in their decision-making may stimulate data sharing by pharmaceutical companies in the short-term and efforts to design greener APIs in the long-term. The marketing authorisation process is viewed as the main intervention point in the life cycle of pharmaceuticals to strengthen considerations of environmental risks. The authors conclude that future research should target the identified barriers and their solutions. The study evaluates on the preparedness to adopt greener APIs into use. Qualitative interview study with 16 European healthcare (HC) professionals. Findings show interest by HC professionals to minimise environmental impacts. Barriers and needs to consider environmental criteria were identified.
Service quality is an important aspect of customers’ experiences and behavioral intentions in community pharmacies. This study aimed to provide initial psychometric validation of a multidimensional service quality scale and examine its associations with customer satisfaction, loyalty, and word-of-mouth (WOM) intention in Da Nang, Vietnam. A cross-sectional survey was conducted from January to March 2024 with the participation of 409 customers. Service quality (six dimensions, 23 items), satisfaction (single item), loyalty (3 items), and WOM intention (2 items) were assessed using five-point Likert scales. Exploratory Factor Analysis and Confirmatory Factor Analysis were performed to evaluate the measurement model. Covariance-based Structural Equation Modeling was applied to test the hypothesized relationships. Additional regression and moderation analyses examined the associations of customer characteristics and pharmacy type with the three outcomes. The measurement model demonstrated good reliability and validity, with satisfactory factor loadings (> 0.65), composite reliability (> 0.78), and average variance extracted (> 0.53). The robust fit indices indicated adequate model fit (χ²/df = 1.722, CFI = 0.960, TLI = 0.952, RMSEA = 0.046, SRMR = 0.041). Customer satisfaction, loyalty, and WOM intention were generally favorable, with mean scores of 3.91 ± 0.75, 3.74 ± 0.77, and 3.63 ± 0.78, respectively; 80.2
Chronic diseases, including diabetes, are significant health challenges globally, particularly in low- and middle-income countries. Diabetes management is profoundly influenced by cultural beliefs and practices of providers and patients, necessitating culturally competent care by the providers to improve health outcomes. This qualitative phenomenological study explores healthcare providers’ perspectives on cultural competency in diabetes care at Tikur Anbesa Specialized Hospital in Ethiopia. A phenomenological qualitative design was employed, using in-depth individual interviews with 7 healthcare providers, including doctors, nurses, and pharmacists. The interview guide was based on Seeleman’s cultural competence model. The data were analyzed thematically, identifying key themes related to cultural competency of providers in diabetes care. Major thematic categories identified included: challenges in delivering culturally competent care due to cultural and religious influences; knowledge gaps in cultural competence; building trust and patient relationships; openness, respect, and curiosity toward patients’ beliefs; communication strategies and language barriers; shared decision-making; cultural competence training needs; and perceptions regarding outcomes. Providers emphasized the necessity of cultural competence training and formal guidelines to better understand and respect diverse cultural beliefs to enhance diabetes care outcomes. The lack of such training hindered effective communication and treatment adherence. Strategies employed by providers—including the use of interpreters and culturally adapted educational materials—highlighted the importance of building trust and fostering open communication. Despite systemic barriers, healthcare providers demonstrated attitudes of openness and respect toward patients’ cultural backgrounds, underscoring the critical need for comprehensive cultural competence training to improve patient engagement and health outcomes. Healthcare providers at Tikur Anbesa Specialized Hospital struggle to deliver culturally competent diabetes care due to inadequate training and resources. Effective communication and understanding of cultural beliefs are essential for improving patient outcomes. Structured cultural competence training programs integrated into healthcare curricula and professional development are crucial to enhance diabetes care and address the unique needs of diverse patient populations.
Exposure to tobacco smoke remain major public health concerns due to its’ association with multiple morbidities and increased health-services use. This cross-sectional study aimed to, (i) assess the prevalence of exposure to tobacco smoke (first-hand and second-hand) among students at a public university; (ii) assess the prevalence of tobacco smoke-related concurrent morbidities; (iii) assess the prevalence of health-services use (≥ 1 vs. none) during the past one-year; and (iv) evaluate the association between demographics, tobacco smoking, concurrent morbidities, and health-services use during the past year. A cross-sectional study was conducted in October 2022 among undergraduate students at Kuwait University using a structured electronic questionnaire. Participants were recruited as a sample of convenience. The prevalences (
