INTRODUCTION:Older people's experiences with access to primary healthcare are overlooked in LMICs, leading to inequitable access and limited delivery of person-centred care. In Lebanon, the economic crisis has increased older people's vulnerabilities and reliance on services provided through primary healthcare centres (PHCCs). This study explores (1) factors shaping decisions of using PHCCs; (2) experiences of older people accessing PHCCs from three perspectives: the older people themselves, family members and service providers; (3) family members' experiences with accessing PHCCs; and (4) service providers' experiences with providing care for older people within PHCCs in a Northern Lebanese district. METHODS:This study adopts a qualitative descriptive design with an inductive content analysis approach. Data were collected through seven focus group discussions and 15 individual interviews (n = 57 older people, family members, and service providers). RESULTS:Factors shaping decisions of using PHCCs' services include socio-economic status, knowledge of services, influences of family members, perceived service quality and proximity, age-related changes, and providers' attitudes and behaviours. Older people reported varied access experiences shaped by factors at individual, organisational, communal, governmental and global levels. Positive experiences included enhanced autonomy, gratitude for receiving needed services, perceived care quality and socialising opportunities. However, negative experiences included humiliation and discomfort, anxiety, dependency, perceived status regression, perceived poor quality and a sense of being a burden. While some family members reported relief from getting affordable care, others reported discomfort, perceived status regression, blame for neglect and challenges with coordinating care across multiple providers. Service providers' experiences included pride in supporting older people, but resentment due to unfair remuneration. CONCLUSION:Findings reveal aspects of care that older people and family members appreciate and others that contribute to negative experiences. Experiences of older people, family members and service providers are interconnected. Quality improvement requires comprehensive approaches addressing their needs. Findings inform practitioners and policymakers to design multidimensional and people-centred approaches to maximise healthcare access. PATIENT AND PUBIC CONTRIBUTION:No PPI engagement methods were applied in this study or analysis. However, the findings informed discussions with older people and facilitated partnerships to co-design a follow-up study focused on developing solutions.

INTRODUCTION:Older people in low- and middle-income countries face significant challenges when accessing primary care services. In Lebanon, most older people (75%) living with at least one chronic disease previously accessed private health services for care. However, the economic crisis substantially increased their reliance on primary healthcare centers (PHCCs), while factors shaping access to public services were unknown. This study explores the barriers and enablers influencing access to PHCCs' services. METHODS:This descriptive qualitative study involved 57 people including older adults (aged 60-92 years), informal caregivers, and service providers, recruited using maximum variation sampling. Data were collected through seven focus groups and fifteen interviews. The Framework Method was adopted for thematic analysis. The Patient-centered Access to Healthcare Framework facilitated mapping of barriers and enablers across five access opportunities. RESULTS:Findings are presented under five themes: 1) perception of healthcare needs, enabled by acute symptoms, free services, literacy, and familial support but hindered by lack of information on services; 2) healthcare seeking, supported by respectful providers, familial support, available quality services, and positive leadership, but constrained by providers' attitudes, poor service organization, limited finances, and negative perceptions; 3) healthcare reaching, enabled by proximity of PHCCs and home care, but limited by transport issues, mobility restrictions, staff and resource shortages, and service delivery challenges; 4) healthcare utilization, facilitated by low fees and economic recession, but hindered by lack of funds and financial resources; and 5) healthcare consequences, facilitated through positive relationships, literacy, and personal abilities, but constrained by cognitive and sensory limitations, poor relationships, and lack of care continuity, coordination, comprehensiveness, and patient-centeredness. CONCLUSIONS:This study highlights the challenges for older people, indicating factors to be strengthened and barriers requiring action at the PHCC and multi-sectoral levels. Ensuring adequate funding, information, and health coverage is primordial to improve older people's access to PHCCs.

Limited access of older people to primary health care is a pressing issue in resource-constrained countries, particularly in Lebanon, amid the ongoing crisis. The co-design research approach is instrumental in addressing this problem, as it draws on people's experiences to generate practical and sustainable solutions. Using the design thinking framework, this co-design study involved 13 older people, family members, and primary healthcare service providers in co-designing solutions to maximize older people's access to primary healthcare centers in Lebanon. The design thinking process was implemented through seven in-person workshops, complemented by three individual interviews with older people involved as advisors. Co-designers identified the lack of preventive strategies for mental health and cognitive abilities as a key access barrier and a co-design challenge. The process resulted in two solution prototypes: (i) a plan to implement screenings for depression and cognitive problems, as a new service to be delivered at the primary health care center, and (ii) a creative brief for a social media campaign to raise awareness about the importance of preventive strategies to promote mental health and abilities among older people. This study suggests that enhancing preventive care to promote mental health and cognitive abilities can improve access by fostering the approachability, acceptability, appropriateness, and availability of services, as well as individuals' ability to perceive the need for care, seek, pay, and engage with care. Further research is needed to support the implementation of suggested solutions, to replicate this work in different settings across regions, and to address other identified challenges.

A cross-sectional exploratory study was conducted to assess nurses and midwives' attitudes and beliefs towards addressing patients' sexual health. A convenient sample of 305 nurses and midwives (professionals and students) were recruited from University Hospitals in Lebanon. The Sexuality Attitude and Belief Survey (SABS) was used and data about barriers to sexual assessment, sexual education and sociodemographic characteristics were collected. The sample included nursing students, 30.1%, staff nurses, 61.2%, and midwives, 8.6%. The mean age was 26.8 years, and 83.7% were females. Only 28.4% of the total sample received sexual health education, and 12.5% reported taking patients' sexual history. The total SABS score was 48.4, which is relatively high. Most nurses and midwives (72.2%) stated that they do not spend time discussing patients' sexual concerns, viewing sexuality as 'too private an issue to discuss' (68.9%). In parallel, a minority had the belief that patients expect nurses to ask about their sexual concerns (32.7%) and felt confident in their abilities to address patients' sexual issues (30.3%). SABS score was significantly associated with the participants' gender, status, care unit, sexual health education and history taking. This study provided a preliminary appraisal of Lebanese nurses' and midwives' approaches towards patients' sexual health assessment and highlighted the obstacles that hinder appropriate sexual health practice. Based on the findings, there is a need for initiatives at the level of education and practice to develop nurses and midwives' competence and improve patient outcomes.

BACKGROUND:Nurses and midwives role in sexual healthcare is essential to help patients, particularly women, ensure a satisfactory sexual wellbeing. Yet, these professionals often overlook this aspect of patients' health. Little is known regarding nurses and midwives' attitudes, views and experiences concerning sexual healthcare. Using a naturalistic inquiry approach, this qualitative study was conducted to overcome this limitation and gain insights into nurses and midwives' role in the delivery of sexual healthcare.METHODS:A purposive sample of nurses and midwives was chosen from different clinical sites. Data generated by focus group discussions were were analysed using the Framework Analysis while adopting different strategies to ensure rigour. The study aligns with the consolidated criteria for reporting qualitative research checklist.RESULTS:Five themes illustrated the participants' views and experiences. These are: 'Perceptions of sexuality', 'Appreciating the discussion around the individuals' sexual issues', 'Muting the discussion around the individuals' sexual issues, 'Coping with embarrassment', and 'Promoting nurses' and midwives' roles sexual healthcare'. Nurses and midwives discussed the importance of sexuality in the couple's life. They reported controversial views and highlighted many challenges that make them reluctant in playing an efficient role in sexual healthcare. They discussed many suggestions, mainly getting a solid sexual health education to become better equipped to meet patients' sexual health needs.CONCLUSION:Findings are critical to empower nurses and midwives, break the barriers in discussing sexual healthcare and integrate this aspects of care more actively and confidently in daily practice.

This qualitative study explored the way middle-aged Lebanese women address their sexual difficulties. Data analysis revealed three overarching themes and subthemes. From these we developed a help-seeking behavior framework for sexual difficulties. The framework focuses on: the perception of the problem, the beliefs about help-seeking and the sources of help. This framework can be used to facilitate access to personalized sexuality-related care based on a better understanding of the complex interplay of personal, socio-cultural and service-related factors that influence help-seeking behavior for sexual problems.

Background: The study explores women's perception and experience of sexual difficulties. The need to address the subject was triggered by the scarcity of research that reflects on women's subjective views on sexual difficulties. This is particularly crucial for middle-aged women who frequently experience hormonal and psychosocial changes that may affect their sexual life.Methods: Using in-depth individual and focus groups interviews, 52 Lebanese women aged 40-55 years discussed their thoughts, feelings and behaviours concerning sexual difficulties. Women were recruited purposefully from clinical and non-clinical settings to get maximum sampling variation that provided rich information and deep understanding of the subject. Recordings were transcribed verbatim and analysed about the framework analysis. Many strategies were adopted to ensure rigour.Results: Women's narratives led to four themes: women's inability to communicate sexual desires and concerns; male sexual difficulties; marital conflicts; and sexual difficulties as context-bound. Women's sexual difficulties are driven by double standards and inhibiting sexual socialisation. Once married, many women had very challenging sexual experiences. They were obliged to silently bear their husbands' poor sexual performance to protect their masculinity and thus their social image and identity. Women's narratives also showed that marital conflicts, daily life problems as well as physical and psychological burdens further challenged their sexual wellbeing and contributed to their sexual difficulties. Conclusion: The study makes a unique contribution to voicing women's views and concerns as sexuality is insufficiently researched and reported in Lebanon. It emphasises the multidimensional nature of female sexual difficulties, particularly the gender-based norms that inhibit their sexual selves and profoundly affect their sexual wellbeing and capacity to claim their sexual likes and dislikes. Findings have implications on research and practice to help women prevent and overcome their sexual difficulties.

Background Sexually transmitted infections (STIs) cause a major public health problem that affect both men and women in developing and developed countries. The aim of the study was to estimate the prevalence of 11 STIs among women who voluntarily participated in the study, while seeking gynecological checkup. The existence of an association between the presence of pathogens and symptoms and various sociodemographic risk factors was assessed. Methods A total of 505 vaginal and cervical specimens were collected from women above 18 years of age, with or without symptoms related to gynecological infections. Nucleic acid was extracted and samples were tested by real-time PCR for the following pathogens: C hlamydia trachomatis , Neisseria gonorrhoeae, Mycoplasma genitalium , Ureaplasma urealyticum , Urealplasma parvum , Trichomonas vaginalis , Mycoplasma hominis , Mycoplasma girerdii , Gardnerella vaginalis , Candida albicans and Human Papillomavirus ( HPV). Positive HPV samples underwent genotyping using a microarray system. Results Of the 505 samples, 312 (62%) were screened positive for at least one pathogen. Of these, 36% were positive for Gardnerella vaginalis, 35% for Ureaplasma parvum , 8% for Candida albicans , 6.7% for HPV, 4.6% for Ureaplasma urealyticum , 3.6% for Mycoplasma hominis, 2% for Trichomonas vaginalis , 0.8% for Chlamydia trachomatis , 0.4% for Mycoplasma girerdii , 0.2% for Mycoplasma genitalium and 0.2% for Neisseria gonorrhoeae . Lack of symptoms was reported in 187 women (37%), among whom 61% were infected. Thirty-four samples were HPV positive, with 17 high risk HPV genotypes (HR-HPV); the highest rates being recorded for types 16 (38%), 18 (21%) and 51 (18%). Out of the 34 HPV positives, 29 participants had HR-HPV. Association with various risk factors were reported. Conclusions This is the first study that presents data about the presence of STIs among women in Lebanon and the MENA region by simultaneous detection of 11 pathogens. In the absence of systematic STI surveillance in Lebanon, concurrent screening for HPV and PAP smear is warranted.

Objectives: This study explores the meanings middle-aged Lebanese women attribute to sexuality and sexual life and how these constructs are shaped socially, culturally, and politically.Study design: Using a qualitative design, data generation comprised semistructured individual interviews (n = 18) and one focus group (n = 5) with Lebanese women aged 40-55 years. Framework analysis was used for data analysis.Results: Inductive analysis identified four themes: Sexuality as imposed by sociocultural and gender norms; sexuality as a symbol of youthful femininity; sexual life as a fundamental human need; and sexual life as a marital unifier and family stabiliser. Findings show that women's sexual self is largely defined based on men's needs. Women sacrifice themselves to maintain family cohesiveness, which they regard as the core of society. However, some women challenged social norms and therefore bringing new meanings to their sexuality.Conclusion: This study offers new contextual information about the understanding of sexuality of middle-aged women within a Lebanese context, where the topic is not openly discussed. New insights are important to provide women with professional support that is culturally sensitive and appropriate. (C) 2016 Elsevier B.V. All rights reserved.

AIM:To assess the relationship between disruptive/abusive situations and the 'intention to leave' nursing.BACKGROUND:While every nurse deserves to feel safe in his or her working environment, nurse abuse remains a common occurrence worldwide. Only when hospitals are safe, is retention enhanced and patient care improved.METHOD:A cross-sectional survey was conducted with 1053 nurses.RESULTS:Almost 70% of nurses experienced stressful disruptive/abusive situations that were mainly caused by patients/families. The majority felt skilled in dealing with these situations, yet around 40% considered leaving nursing because of disruption/abuse. Stress from disruption/abuse, the skill in dealing with abuse and the administrations' support were the best predictors for the 'intention to leave'.CONCLUSIONS:It may not be the amount of abuse per se that affects the nurses' intention to leave, but rather how the abuse is perceived, the skill in dealing with it and the support received from administration.IMPLICATIONS FOR NURSING MANAGEMENT:The support received from nursing administration may negate the effect of stress and the 'intention to leave' because of disruptive/abusive situations. This should behove nurse managers and administrators to have a system in place to provide support for nurses, which in turn could improve job satisfaction and retention.

AIMS AND OBJECTIVES To explore patterns of help-seeking in women who have sexual dysfunction and the implications for nursing practice. BACKGROUND Female sexual dysfunction is a common problem that is under-reported and untreated. Barriers to help-seeking reported in existing literature relate to the perception among many women that sexual dysfunction is: part of the normal ageing process; not bothersome or does not exist; an issue that health professionals are reluctant to address; a taboo subject. However, little is known about patterns of help-seeking in women with sexual problems. This leaves a potential gap in nursing knowledge regarding appropriate, supportive strategies. DESIGN Discursive inquiry framed theoretically by Vogel's model. METHODS A literature review was undertaken by searching relevant databases. A combination of keywords was used to identify peer-review papers relating to women's help-seeking behaviour for sexual dysfunction. Vogel's model was used as a framework to extract relevant information from the papers and structure the discussion. RESULTS Vogel's model comprises four steps: encoding and interpreting, generating options, decision-making and evaluation of behaviour. Using this stepwise approach helped elucidate the complex mechanisms associated with help-seeking in a structured manner. The key issues associated with help-seeking intention are concerned with women's personal awareness of and interaction with the environment. CONCLUSIONS Vogel's model offers a new approach to understanding the dynamics that underpin women's decisions to seek professional help when sexual concerns arise and also provides a useful framework for nurses to consider women's specific sexual concerns. RELEVANCE TO CLINICAL PRACTICE Implications for nursing practice are focused on public awareness, women's empowerment and the provision of effective sexual health care. Because sexual dysfunction is a global phenomenon, it is likely that the discussion in this paper will be relevant to an international, nursing readership.

This cross-sectional study was designed to assess the predictors of coping behaviors of 147 Lebanese parents (101 mothers and 46 fathers) with a child with intellectual disability. It assessed the contribution of child's and parent's characteristics, informal social support, and stress on the coping behaviors of fathers and mothers. Multiple regression analysis confirmed that the father's education, informal social support, and stress were the best predictors of coping. The child's age, severity of illness, and parental health did not significantly contribute to predicting coping behaviors. Contrary to expectations in a Middle Eastern culture, both fathers and mothers reported similar levels of stress, perceived informal social support, and coping. Although informal social support cannot be forced on parents, health professionals can mobilize resources that are culturally sensitive, such as home visitation by nurses or support from other parents. This may especially be beneficial in developing countries with limited resources.

In many Middle Eastern countries, including Lebanon, there is a stigma attached to families who have an intellectually impaired child. These families complain of isolation and lack of community resources that could help them cope with their circumstances to optimize the child's abilities. Health professionals and researchers should be cognizant of factors related to the process of stress adaptation to help families cope with their circumstances. The aim of this cross-sectional study was to identify factors that play a role in mothers' adaptation to the care of their intellectually impaired children. The results, based on a sample of 127 mothers from Lebanon, reveal that a high percentage of mothers had depressive symptoms. Multiple regression analysis demonstrates that by order of importance, the factors that determine maternal depression are family strain, parental stress, and family income. The conclusions about nursing implications from a cultural perspective are discussed and recommendations proposed.