Background:Mental health is a global concern. Because of Kashmir's sociopolitical environment and susceptibility to natural calamities, self-reported mental health problems increased. Due to social stigma, lack of awareness, and scarce mental health resources, this distress remains prevalent. Aim:This cross-sectional study aimed to estimate the prevalence and risk factors associated with self-perceived depression and anxiety among adults in a central district of Kashmir. Methods and Materials:Following a 2-day training session for the research team, a door-to-door survey of 488 adults was carried out in 13 randomly chosen locations in one of Kashmir's districts. After providing their informed consent and sociodemographic information, participants were asked to complete Kashmiri and Urdu-translated version of Hopkins Symptom Checklist for Anxiety and Depression (HSCL). Results:The prevalence of anxiety and depression symptoms was 31.76% and 28.28%, respectively, while 30.94% reported high overall psychological distress. Females had significantly higher odds of reporting anxiety (OR: 1.72, 95% CI: 1.10-2.71). Unemployment was strongly associated with both anxiety (OR: 1.89, 95% CI: 1.22-2.92) and depression (OR: 2.04, 95% CI: 1.31-3.19). Members of the Other Backward Classes/Scheduled Castes were more likely to report anxiety (OR: 1.58, 95% CI: 1.01-2.46) and emotional distress (OR: 1.67, 95% CI: 1.08-2.59). Younger, unemployed individuals showed particularly high levels of distress. Conclusions:High prevalence of self-perceived depression and anxiety was observed, particularly among women, the unemployed, and socially marginalized groups. These findings underscore the need for community-based mental health interventions, targeted outreach to high-risk groups, and stigma reduction strategies to improve access to care and promote mental wellbeing in conflict-affected regions.

Background: Menstrual restrictions remain widespread in Nepal, where approximately 90% of women and girls follow at least one restriction. One of the most harmful practices, chhaupadi (severe menstrual seclusion), requires women and girls to isolate in huts during menstruation and is associated with substantial physical and psychological risks, including injury, assault, smoke inhalation, and social exclusion. Although interventions have attempted to address chhaupadi, effectiveness has varied, and no comprehensive assessment has identified which components work, for whom, and under what conditions. Few prior efforts have meaningfully engaged communities in intervention design to ensure contextual relevance and sustainability. Objective: This protocol describes a three-aim study designed to (1) elucidate mechanisms underlying the success or failure of chhaupadi interventions; (2) co-design a culturally grounded, theory-and evidence-informed intervention in partnership with communities; and (3) pilot and evaluate the intervention using a controlled trial design. Methods: This multiphase study integrates realist synthesis, intervention mapping, human-centered design, and arts-based research. In aim 1, we will conduct a realist synthesis of published and gray literature, complemented by knowledge-sharing workshops and expert interviews to identify underlying mechanisms explaining chhaupadi intervention success or failure. In aim 2, synthesis findings will inform participatory intervention development. Using the intervention mapping framework, we will convene a co-design workshop incorporating human-centered design and arts-based research methods (eg, asset mapping, impact ladder, concept posters, and communal storytelling) with women, adolescents, and community collaborators to develop intervention components and implementation strategies. In aim 3, the co-designed intervention will be piloted in a controlled trial comparing intervention communities (full community-designed intervention) with control communities (menstrual health education only). Quantitative measures will assess knowledge, attitudes, and practices related to chhaupadi, self-efficacy, mental health, and reproductive health outcomes. Implementation indicators (eg, enrollment, acceptability, appropriateness, and feasibility) will also be assessed. Qualitative interviews and discussions will examine implementation processes, barriers, facilitators, and contextual influences. Results: The study was funded in September 2023. Aim 1 activities began in April 2024. To date, 69 materials met the inclusion criteria, and a workshop with 8 organizations and 44 interviews has been conducted. Analysis was completed in February 2026, with results expected in the summer of 2026. Aim 2 co-design workshops began in March 2025; eleven women participated in the workshop, and an additional 123 community members have been consulted. This has resulted in a draft intervention called "Our Voice: Transforming Lives through Ending Chhaupadi." Aim 2 results are expected in Fall 2026. Aim 3 data collection will begin in Winter 2027. Conclusions: By systematically identifying effective intervention mechanisms and embedding community leadership throughout design and implementation, this study aims to develop a sustainable strategy to reduce harms associated with chhaupadi and improve women's and girls health. This integrated framework may also inform interventions addressing other socially embedded health practices in low-resource settings. International Registered Report Identifier (IRRID): DERR1-10. 2196/89117

Background: The evolving U.S. drug market has fueled a public health crisis with rising drug use-associated morbidity and mortality, revealing a mismatch between current abstinence-based addiction care and the needs of people who use drugs (PWUD) to access evidence-based harm reduction services (HRS). Co-locating HRS into outpatient clinics could reduce mortality and improve clinical outcomes. We investigated barriers and facilitators of HRS implementation through kit distribution at three heterogenous outpatient addiction clinics using pre- and post-implementation focus groups. Methods: We conducted qualitative description approach via 1-hour virtual focus groups and individual interviews with clinic staff and providers both pre- and post-implementation of kit distribution. Interview guides were based on the Consolidated Framework for Implementation Research to assess anticipated and actual implementation barriers and facilitators. Interviews were analyzed using thematic analysis. Results: Five providers and six staff participated in pre-implementation data collection. Dominant themes pre-implementation included participant enthusiasm for HRS integration and anticipated barriers of personal knowledge and external stigma against PWUD. Six providers and five staff participated post-implementation. Participants reported few actual barriers, of which external stigma and lack of funding for program sustainability were most prominent. Conclusions: Implementation of HRS in outpatient addiction clinics was well-received by providers and staff and supported by pre-implementation trainings, site champions, and favorable implementation environments. Further efforts are needed to reduce stigma in the greater community and achieve sustainable funding for HRS.

INTRODUCTION:Women living with a serious mental illness (SMI) can experience a myriad of challenges throughout their reproductive years including suboptimal contraceptive use and unintended pregnancy. Little is known about the contextual factors that influence the contraceptive use of women with SMI. To address this gap, we conducted qualitative interviews with women with SMI residing in Pennsylvania, to understand their pregnancy intentions, current contraceptive use, and factors that influence their contraceptive use behaviors and experiences. METHODS:We conducted twenty-eight semi-structured in-depth interviews with a convenience sample of women who were sexually active and between the ages of 18-45 with a diagnosis of bipolar disorder (n = 10), MDD (n = 12), and schizophrenia/schizoaffective disorder (n = 6). Two coders analyzed transcripts using Crabtree and Miller's editing approach to identify qualitative themes and subthemes. RESULTS:Most women (89%) reported wanting to avoid pregnancy; however, their contraceptive use did not always align with these intentions. SMI symptoms, contraceptive knowledge and attitudes, substance use, reproductive coercion, intimate partner violence, and sexual assault/abuse influenced participants' contraceptive use. Among this sample, a larger proportion of women with schizophrenia/schizoaffective disorder experienced reproductive coercion compared to women with MDD or bipolar disorder. DISCUSSION:Study findings underscore the critical need for contraceptive counseling that considers the complex and potentially unique challenges faced by women with SMI. Future research should focus on developing and evaluating integrated care models that effectively support their family planning and contraceptive needs.

Introduction The burden of HIV among Native American communities is significant and rising across Indian Country, yet little is known about the PrEP continuum of care or the factors that influence PrEP engagement among these resilient communities.Theory This review examines the determinants of health shaping the PrEP continuum of care among Native American communities through the lens of both Indigenous and Western frameworks. Barriers and facilitators emerging across the literature are organized within the five levels of the Socio-Ecological Model.Method A systematic search across six academic and two grey literature databases identified 2,949 studies, of which 31 were included; qualitative and quantitative associations between determinants of health and PrEP outcomes were synthesized descriptively, and barriers and facilitators were identified thematically.Results Only three studies had entirely Native American study populations; across the remaining 28, Native Americans were underrepresented or aggregated with other racial-ethnic groups, demonstrating evidence of data genocide. Findings revealed mixed or non-statistically significant associations between Western determinants of health and PrEP outcomes, while Indigenous determinants were rarely examined. Thirty-six barrier and 26 facilitator themes emerged across the five levels of the Socio-Ecological Model.Discussion Results underscore the limited understanding of the determinants of health influencing the PrEP continuum of care among Native American communities. Recognizing both Indigenous and Western determinants as integral to the PrEP continuum of care may transform how researchers, practitioners, and Native American communities collectively conceptualize and implement PrEP initiatives.

While extant literature demonstrates that healthcare providers' stigmatizing attitudes negatively impact care for people who use drugs (PWUD) and people with HIV (PWH), limited research has explored how these stigmas are interrelated. This study examines the relationships between multiple dimensions of stigma-including cognitive, affective, and role-based attitudes-toward PWUD and PWH. We operationalized these dimensions using two validated instruments. The Drug and Drug Problems Perception Questionnaire (DDPPQ) assessed five role-based dimensions of provider attitudes toward PWUD: role adequacy, role support, job satisfaction, role-related self-esteem, and role legitimacy. The HIV/AIDS Provider Stigma Scale (HPASS) measured three dimensions of HIV-related stigma: cognitive (stereotypes), affective (prejudice), and behavioral (discrimination). Canonical correlation analysis was used to examine multivariate associations between these subscales. The analysis included 128 healthcare providers from HIV clinics in Birmingham, AL, and Pittsburgh, PA. Participants were predominantly White (52.4%), cisgender women (70.3%), aged 36-47, with less than five years of experience working with PWH (35.8%) and PWUD (29.6%). The overall CCA model was statistically significant (Wilks's lambda = 0.579, F [15, 281.97] = 4.103, p < 0.0001), explaining 42.1% of the shared variance. Function 1 (rc = 0.615) accounted for 37.8% of the variance. Role-related self-esteem had the highest loading among DDPPQ subscales (beta = 1.024), while prejudice (beta = 0.778) and stereotypes (beta = 0.546) were the strongest contributors from HPASS. Findings highlight the interconnection between stigmatizing attitudes toward PWUD and PWH. Subscale-level analyses suggests that providers with lower role-related self-esteem are more likely to hold prejudicial and stereotypical attitudes, reinforcing intersectional stigma. Addressing one form of stigma may help reduce the other, supporting more effective and targeted interventions in HIV care settings.

BACKGROUND:Utilizing iterative and collaborative tools, Human-centered Design (HCD) facilitates the creation of tailored solutions for multifaceted issues by fostering empathy and a deep understanding of human behaviors. This paper presents insights gleaned from employing HCD tools to center communities in global health intervention development. PURPOSE:The study team collaborated with community members in Dailekh, Nepal to co-design interventions to address harms associated with menstrual seclusion, known as chhaupadi. RESEARCH DESIGN AND STUDY SAMPLE:A Community Design Team, comprising 10 women representing various castes and ages convened for a four-day intervention co-design workshop in the community. A Community Validation Team, comprising 12 individuals from diverse occupational and caste backgrounds provided feedback on the interventions. Additionally, six village leaders participated in Key Informant Interviews to garner additional insights. DATA COLLECTION:In the study's initial "discovery" phase, the Community Design Team employed HCD tools to generate a nuanced understanding of the context, stakeholders, and community experiences. Subsequently, in the second "design" phase, the Community Design Team crafted interventions to address harms associated with chhaupadi. RESULTS:Invaluable lessons gained from this study underscore the necessity of crafting contextually suitable tools, checklists, and prompts for participants, allocating sufficient staff, time, and resources, and adapting to participants' literacy levels and engagement preferences, whether through group or individual activities. CONCLUSIONS:Reflecting on these insights, our experience suggests HCD offers promising tools to authentically and equitably involve participants with diverse backgrounds in articulating their own ideas for community-based solutions in Nepal. Health practitioners, researchers, and intervention development experts are encouraged to consider adopting HCD methodologies to prioritize community voices in devising solutions for complex health challenges.

Mass incarceration in the United States is a social-structural driver of health for sexual and gender minoritized adults (SGMA). The aim of this study was to develop a conceptual framework for post-release healthcare to use in adapting a mobile health unit (MHU) for SGMA returning from jail. We used concept mapping to answer a focal prompt regarding health-related needs for SGMA post-release. We recruited SGMA with recent incarceration experience and relevant community partners to participate in 4 concept mapping sessions. Multidimensional scaling produced a two-dimensional point map of all statements and their relative relationships and hierarchical cluster analysis illustrated clusters of needs. SGMA community members (n = 16) and community partners (n = 13) generated 109 unique statements describing post-release healthcare-related needs for SGMA. Participants sorted and rated these items, creating a map of 10 clusters of needs: Physical Health, LGBTQ-Affirming Mental Health Care, Release Planning, Release Aftercare, Peer Support, Immediate Needs, Stabilizing Needs, Resources to Thrive, Access to Education, and Structural Healthcare Advantages. While HIV prevention and treatment were identified as the most important and the best fitting, the vast majority of post-release healthcare needs identified by SGMA related to other social and structural drivers of health to reduce stigma and risk, increase access to important health services like harm reduction and gender-affirming care, improve their economic conditions, and provide social support and safety. This participant-led conceptual framework provides insight regarding important components to include in development and adaptation of interventions to address HIV and other health inequities for SGMA produced and exacerbated by the CLS.

Background:Multiple challenges, including limited technical knowledge, privacy concerns, or financial constraints to afford a smartphone, limit the introduction and implementation of a mobile application-based intervention aimed at supporting medication adherence for people with schizophrenia (SZ) in a low-resource setting. Recognising these barriers, this study aimed to explore the perceived acceptability of a mobile application specifically designed to improve medication adherence among individuals with SZ and their caregivers (CG). Methods:A total of 64 individuals diagnosed with SZ, who had been in remission for the past six months, and 36 CG, attending the outpatient psychiatry department of a tertiary care teaching institution, were recruited based on predefined selection criteria. The SZ and CG participants were interviewed separately using an adapted version of the Treatment Acceptability and Preference Scale (TAPS), which assessed their perceptions of the appropriateness, suitability, effectiveness, and willingness to use a mobile application. TAPS was administered immediately after describing the proposed features and potential utility of the mobile application designed to improve medication adherence. Results:There were no significant differences in demographic characteristics between SZ and CG, except that CG were significantly more likely to be employed than individuals with SZ (p = .02). Comparison of TAPS scores between the two groups revealed no significant difference in perceptions regarding the acceptability of the mobile application. However, a greater proportion of CG (63.9%) compared to individuals with SZ (56.25%) considered the mobile application to be appropriate. Correlation analysis indicated that younger age (p = .004) and higher levels of education (p = .01) were significantly associated with higher TAPS scores. Conclusion:The mobile application was generally acceptable to patients and CG, with younger and more educated participants showing higher acceptability.

This JAMA Insights explores how clinicians can use the harm reduction communication framework to engage with patients who have opioid use disorder, which could help prevent overdose and other substance use–related harms.

Background:Negative attitudes toward people who use drugs (PWUD) can hinder their engagement in healthcare and contribute to poor clinical outcomes. While harm reduction-informed care may improve healthcare worker attitudes and patient experiences, limited research has examined its acceptability within HIV clinical settings. Objectives:This study aimed to assess healthcare workers' attitudes toward PWUD and their acceptance of harm reduction principles within HIV care clinics and to examine associated sociodemographic and work-related factors. Design:Cross-sectional quantitative study. Design:In 2022, 128 healthcare workers from three HIV care clinics in Birmingham, AL and Pittsburgh, PA, completed a self-administered electronic survey via REDCap. Multivariable linear regression was used to examine associations between attitudes toward PWUD and acceptance of harm reduction practices, adjusting for relevant covariates. Methods:Overall, healthcare workers reported generally positive attitudes toward PWUD, though variations by location, race, and years of experience were observed. More negative attitudes toward PWUD were associated with lower harm reduction principles acceptance (b = -0.29, p = .001). Independent predictors of lower harm reduction acceptance included working in Birmingham versus Pittsburgh (b = -0.34, p = 0.001) and being identified as Black or African American versus White (b = -0.45, p = 0.001). Healthcare workers with 6-10 years and > 20 years of experience working with people with HIV reported higher harm arm reduction acceptance (b = 0.45, p = 0.003 and b = 0.62, p = 0.02, respectively), compared to those with ⩽5 years of experience. Results:These findings underscore the need for targeted interventions that improve harm reduction acceptability among HIV care workers, particularly those shaped by location, race, healthcare worker experience, and attitudes toward PWUD, to support the integration of harm reduction into HIV clinical practice.

Background: In addition to structural interventions such as syringe services and naloxone distribution, harm reduction (HR) is also a relational approach to care encompassing principles such as patient autonomy and pragmatism that can be implemented in healthcare teams to improve outcomes for people with HIV (PWH) who use drugs. Evidence suggests that using a relational HR framework to operationalize care for PWH who use drugs may improve the patient-provider relationship, thus positively impacting HIV outcomes. We previously found that negative attitudes toward people who use drugs are negatively associated with acceptance of HR; however, little is known about how HIV providers conceptualize the patient-provider relationship with PWH who use drugs. Objectives: The aim of this study was to describe the ways healthcare workers (HCWs) characterize interactions with PWH who use drugs and if these characterizations reflect relational HR or missed opportunities to improve the patient-provider relationship. Design: We used a qualitative descriptive design to characterize HCWs’ descriptions of their interactions with PWH who use drugs. Methods: We interviewed providers ( n = 23) working at three HIV clinics in the United States to assess their interactions with patients. Providers included anyone who had worked at their respective clinic for ⩾1 year and who had face-to-face contact with patients (e.g., front desk staff, nurses, physicians, and social workers). Data were coded thematically via Dedoose. Results: We discovered that HCWs characterize positive patient-provider interactions that both reflect HR principles and may not align with the principles of HR. Examples include when patients appear comfortable with and trusting of their provider, when patients feel heard by their provider, and when providers feel they are responsive to patient needs. However, other HCWs described positive interactions as counter to relational HR. Conclusion: HCW descriptions of positive interactions in line with relational HR in their conceptualization of patient-provider interactions with PWH who use drugs have the potential to guide efforts in increasing the acceptability of HR in HIV care. Given evidence showing HR improves outcomes for those who use substances, findings suggest missed opportunities to incorporate relational HR into the patient-provider relationship in HIV primary care settings. Registration: NCT05404750.

Objectives: To explore the perceptions of pregnant patients who use substances regarding positive or negative clinician communication during obstetrical care. Methods: We analyzed qualitative data from 85 semi-structured interviews with pregnant patients who reported or tested positive for substance use, which explored their interaction with obstetric providers during their first prenatal visit. This analysis focuses on patients' perceptions of negative versus positive clinician communication behaviors. Results: Eighty-five participants described clinician communication behaviors they felt affected their feelings about the clinician and their willingness to talk about prenatal substance use and other sensitive topics. Negative behaviors included clinicians (1) expressing judgment, (2) rushing through the consultation and providing limited information to patients, and (3) using statements or behaviors that made patients feel dehumanized. Positive behaviors included clinicians (1) explicitly expressing care for the patient, (2) creating rapport by soliciting patient stories and building relationships, and (3) demonstrating attentive listening. Innovation: To our knowledge, our study is the first to explore clinician communication behavior with a focus on prenatal substance use from the perspective of pregnant people using substances. Conclusion: Our findings highlight pregnant patients' perspectives on communication patterns that could improve patient-clinician interactions and, in turn, maternal health care and outcomes.

Despite being a natural physiological process, menstruation is often associated with health and safety challenges, stigma, and human rights concerns, especially in low-resource settings. In Nepal, menstrual restrictions are widespread; ninety percent of women and girls follow at least one menstrual restriction. One of these traditions, chhaupadi (severe menstrual seclusion), is a social-religious tradition in which women and girls isolate in menstrual huts or sheds during menstruation. Chhaupadi poses significant health and safety risks for women and families. Physical health risks include snake bites and animal attacks, hypothermia, suffocation from lighting fires in the sheds to keep warm, rape, and sometimes death. Women and girls are also psychologically affected during their stays in sheds. Isolation and limited security can leave women in perpetual states of fear, loneliness, stress, isolation, and low self-esteem. To date, numerous interventions have been implemented with varying degrees of rigorous evaluation and success. However, no known studies have comprehensively assessed which components of chhaupadi interventions hold promise. Further, no known prior interventions have fully engaged communities in the intervention design process to ensure suitability and sustainability that centers community values and voices. This paper describes a protocol for conducting participatory and creative menstrual health intervention research in Nepal that aims to fill gaps in understanding how to sustainably address harms associated with chhaupadi. This study is innovative and timely, as it is the first study to develop a comprehensive assessment of existing chhaupadi interventions and first to use a co-designed intervention approach to address the practice. This integrative three-pillar approach — drawing on Intervention Mapping (IM), Human-Centered Design (HCD), and Arts-based Research (ABR) — seeks to generate not only a co-created, theory- and evidence-based intervention, but also an innovative methodological framework adaptable to addressing multifaceted health issues in other LMIC contexts. In this three-phrase study we will apply a suite of innovative and tested research methods to address our study objectives. We will conduct a Realist Synthesis (Aim 1) to elucidate mechanisms of success or failure of chhaupadi interventions to date, which will inform community-led intervention development using principles of IM, as well as HCD and ABR tools (Aim 2). Next, we will pilot the community-designed chhaupadi intervention in a clinical trial, using a control group (Aim 3). Guided by community-engaged approaches at all stages of the study, we will collect qualitative, quantitative, and visual data (e.g., photographs, community maps, drawings) across multiple districts in Nepal where chhaupadi is practiced. This study was funded in September 2023. Data collection began in April 2024 and will continue until August 2028. Despite numerous efforts, a comprehensive understanding of the effects of chhaupadi interventions across Nepal remains absent. By embedding diverse community perspectives at every stage of the study, this approach ensures interventions are contextually grounded and culturally relevant. Beyond addressing a culturally situated menstrual health practice – chhaupadi - this community-centered model has the potential to inform strategies for reducing the harms associated with other harmful practices in diverse global settings.

Introduction:Peer recovery support services (PRSS), an expanding component in SUD treatment, are delivered by individuals with lived experience of substance use disorder (SUD). Despite the growing importance of these peers and the unique challenges they face in a developing health profession, limited research has focused on their workforce outcomes. This review aims to map the literature on (a) workforce outcomes among peers and (b) the individual and organizational contributors to these outcomes. Materials and methods:We conducted a scoping review of empirical literature from January 1, 1999 to January 26 2023 on APA PsycINFO®, Embase®, CINAHL®, Web of Science™, and Google Scholar. We also conducted a search of grey literature on institutional websites to locate additional articles. Search strategies targeted terms related to peers (e.g., peer specialist, people with lived experience), workforce outcomes (e.g., burnout, compassion fatigue), and organizational environments (e.g., workplace, volunteer). The review was preregistered with Open Science Framework (https://doi.org/10.17605/OSF.IO/C9YNR). Results:Of the 16,361 total articles retrieved, 20 were included after screening, consisting of 9 quantitative, 9 qualitative, and 2 mixed-methods studies. Cross-sectional survey was the most common study design (n = 9). Organizational factors, such as supervisory support and professional development opportunities, were linked to increased job satisfaction and retention while factors such as inadequate compensation and stigma were barriers to workforce sustainability. Individual challenges, including boundaries with clients and a lack of self-care, were associated with burnout and decreased job satisfaction. Conclusion:Results highlight challenges faced by peers in SUD services which limit their ability to sustain well-being and achieve career longevity. Research gaps include the need for longitudinal studies, a clearer understanding of work settings, and an exploration of mediating or moderating factors affecting workforce outcomes. Future efforts to foster a sustainable peer workforce should focus on improving peer workers' well-being through organizational support, professional development, and targeted interventions based on occupational health theories.

Introduction Peer recovery support services are a promising approach for improving harm reduction, treatment, and recovery-related outcomes for people who have substance use disorders. However, unique difficulties associated with the role may place peer recovery support staff [i.e., peers] at high risk for negative workforce outcomes, including burnout, vicarious trauma, and compassion fatigue. Objective This scoping review protocol aims to describe a proposed effort to review the nature and extent of research evidence on peer workforce outcomes and how these outcomes might differ across service settings. Results of the review described in this protocol will help to answer the following research questions: 1) What is known about workforce-related outcomes for peers working in the substance use field?; 2) What is known about how the structure of work impacts these outcomes?; and 3) How do these outcomes differ by service setting type? Methods A scoping review will be conducted with literature searches conducted in PsycINFO®, [EBSCO],Embase® [EBSCO], CINAHL® [EBSCO], Web of Science™ [Clarivate], and Google Scholar databases for relevant articles discussing US-based research and published in English from 1 January 1999 to 1 August 2023. The proposed review will include peer-reviewed and grey-literature published materials describing the experiences of peers participating in recovery support services and harm reduction efforts across a variety of service settings. Two evaluators will independently review the abstracts and full-text articles. We will perform a narrative synthesis, summarizing and comparing the results across service settings. Expected outputs Publishing this protocol will help accelerate the identification of critical workforce issues, and bolster the transparency and reporting of the final review. The proposed review will assess the state of the literature on peer workforce-related outcomes and how outcomes might vary by service setting context. Results of the proposed review will be disseminated in peer-reviewed publications and conference presentations. Findings will inform the field regarding future directions to support the emerging peer workforce. Trial registration Systematic review registration Submitted to Open Science Framework, August 22nd, 2023.

Background The Pitt Public Health evaluation team used a mixed-methods, community-based participatory research method of concept mapping to evaluate factors affecting the Overdose Data to Action (OD2A) opioid overdose surveillance and prevention project outcomes for Allegheny County, Pennsylvania. Methods In June 2021 we developed the focal prompt: “What factors work to help or limit OD2A program outcomes at the individual, community, and or/system level?”Community partners participated in three phases: Brainstorming, Sorting and Rating, and Interpretation. Using concept mapping software, we applied multidimensional scaling to visualize a point map displaying factors and their relative relationships, and hierarchical cluster analysis to generate concept maps displaying clusters of factors. Results During the brainstorming phase community partners (N = 18) generated 69 unique statements describing factors impacting OD2A work and community partners (N = 16) sorted and rated statements using concept mapping software. In the interpretation community partners (N = 26) selected the 10-cluster map as the most salient cluster solution. Using this cluster map and cluster ratings, we identified Stigma, Criminalization and Marginalization, and Racial Equity as factors of highest importance to overdose prevention success but lowest in success thus far. Discussion Using concept mapping to evaluate factors affecting OD2A outcomes was a successful method of engaging community partners in considering opportunities to strengthen OD2A and future overdose prevention efforts.

In Nepal, menstrual practices, and particularly chhaupadi, impose restrictive norms affecting women's daily lives. Chhaupadi is a tradition that involves isolating women and girls during menstruation and after childbirth, along with following other restrictions, which have physical and mental health implications. To date, interventions have yet to fully and sustainably address harms associated with chhaupadi across the country. This two-phase study conducted in Dailekh, Nepal facilitated the development of community-created solutions to mitigate chhaupadi's adverse impacts on women's health. Using Human Centred Design and a community-engaged approach, the discovery phase identified key stakeholders and contextualised chhaupadi, while the subsequent design phase facilitated the development of five community-created interventions. These included leveraging female community health volunteers (FCHVs) for counselling and awareness, targeting mothers to drive behavioural change, engaging the wider community in behaviour change efforts, empowering fathers to catalyse change at home, and training youth for advocacy. The FCHV intervention concept was selected as the most promising intervention by the women co-design team, warranting broader exploration and testing. Additionally, while it is imperative for interventions to prioritise tackling deleterious aspects of chhaupadi, interventions must also acknowledge its deep-rooted cultural significance and history and recognise the positive aspects that some women may wish to preserve.