With the health and social care research trends shifting towards conception, development, delivery, and implementation of more evidence-based interventions, public partnerships have emerged as key foundational moral components to tailor best practices to conduct research with the patient, public, and community. This paper reflects on how public partnerships were established in the ongoing CONTROL research study to open, trustworthy, and mutually beneficial relationships with public partners. This paper presents a reflective case study that exemplifies collaborative research in action using the Public Involvement Impact Assessment Framework and the UK standard of Public Involvement. We reflected on our approaches to public involvement and engagement, establishing a public advisory group, its capacity development, and contribution to the main study and multilevel impact of relational community engagement. Our strategies can inform future public partnerships in funded projects, especially in lower- and middle-income countries. People affected by Tuberculosis and depression face stigma, poor treatment outcomes, and lack of access to healthcare, especially in low-income communities and refugee groups. The VoICE of CONTROL initiative was launched as part of the CONTROL research program to establish and strengthen the public partnership regarding tuberculosis and depression and shape the research from the start. We held community engagement sessions to learn about people’s experiences with TB, stigma, myths, mental health, and challenges they face in accessing health care. From these sessions, we invited individuals to join the advisory group and contribute regularly to the CONTROL study’s design, intervention development and refinement, materials, and outreach activities. To enhance capacity development, training sessions were arranged for team and advisory group members regarding patient and public involvement in research. The feedback from the community and advisory group helped shape a culturally sensitive mental health intervention and awareness campaign. This paper presents how meaningful public partnerships can lead to more relevant, respectful, and inclusive research with underserved communities.

OBJECTIVES Recruiting hard-to-reach and marginalized populations into health-related research studies can be challenging. This systematic review aimed to synthesize evidence on the identification and effectiveness of different recruitment and retention methods for marginalized communities. METHODOLOGY Seven databases (PubMed, MEDLINE, EMBASE, Web of Science, Scopus, PsycINFO, and Proquest (Including Google Scholar for grey literature) were searched from January 1950 to June 2022 for studies recruiting marginalized groups and detailing recruitment and retention methods. Study details, population, recruitment and retention methods, outcomes, and limitations were extracted. The frequency of recruitment and retention methods was tallied, and narrative synthesis was conducted. RESULTS Of the 101 studies included, thirty-one studies met the inclusion criteria, covering populations including lesbian, gay, bisexual, and transgender (LGBT), racial and ethnic minorities, immigrants, and low socioeconomic groups. The most common recruitment methods were respondent-driven sampling (n=9), social media/online advertising (n=8), snowball sampling (n=7), and community outreach (n=6). Recruitment rates ranged from 2% to 91%, where reported. CONCLUSION Engaging minority communities involved direct community outreach methods such as presentations, health fairs, and in-person contact. Common retention strategies included financial incentives, culturally competent staff, and active engagement, yet no single method consistently proved most effective. Utilising a combination of tailored sampling approaches can mitigate the limitations inherent in individual methods. Enhanced reporting on recruitment and retention rates is essential for future studies.

[This corrects the article DOI: 10.1371/journal.pgph.0003784.].

Background Cannabis use is associated with an increased risk of Cannabis Use Disorder (CUD). Cognitive Behavioral Therapy (CBT) has been shown as an effective intervention for CUD in High-Income Countries, but its implementation may be limited in Low- and Middle-Income Countries due to cultural differences. Cultural adaptation of CBT may enhance its appropriateness, acceptability, and feasibility in diverse populations where cannabis use is prevalent with limited treatment options. Methods and Analysis This study follows a multi-method approach. The first phase will involve focus group discussions and In-depth Interviews to explore cultural beliefs, treatment preferences, and contextual barriers. Findings will inform three co-adaptation workshops with patients, caregivers, clinicians, and community stakeholders. These workshops will guide the development of a culturally adapted CBT (CA-CBT) manual. The manual will be piloted in a pre-post feasibility study. The study will assess acceptability, appropriateness, and feasibility of the intervention using indicators such as recruitment, retention, adherence, and patient engagement. Preliminary outcomes on cannabis use frequency and dependence severity will also be examined. Qualitative data will be analyzed through framework and thematic analysis, whereas quantitative data will be evaluated using descriptive and inferential statistical methods. Ethical approval has been obtained from institutional review boards in Khyber Medical University, Pakistan and the Keele University, United Kingdom. Significance of the Study The study contributes to the literature by documenting a systematic process for adapting CBT for CUD in Pakistan, where access to structured psychological treatments is limited and treatment needs remain unmet. It explains how interviews, focus groups, stakeholder involvement, and feasibility testing will shape the adaptation. The study offers practical guidance for researchers and practitioners developing culturally relevant interventions for substance use in low-resource contexts.

The emergence of COVID-19 caused a significant global threat, affecting populations worldwide. Its impact extended beyond just physical health, as it inflicted severe damage and challenges to individuals' well-being, leading to a deterioration in mental health. The lived experiences of patients hold a paramount position to explore and understand their perception of care which can ultimately strengthen the health system’s delivery domain. This study explores the lived experiences of patients in the isolation ward, their recovery, and the quality of care being provided in the hospital and its effects on their mental health.Study DesignA phenomenological qualitative study using in-depth interviews.MethodsWe conducted 11 in-depth interviews of COVID-19 patients admitted to the isolation ward of the public hospitals of Peshawar, Pakistan. Participants who stayed for a minimum of 10 days in an isolation ward were included in this study. Interviews were transcribed and analyzed using NVivo 12 software and generated five themes through inductive analysis.ResultsFive themes emerged from the participants’ lived experiences: Heading towards the hospital, Health Care Quality, Impact on Mental Health, Recovering from COVID-19 and Back on one’s feet. These included all the positive and negative lived experiences. Socio-environmental factors along with their experiences of the disease itself and with the healthcare providers guided their reaction which was important conciliators in their experiences during the pandemic.ConclusionBased on the findings, the environment of isolation had a major influence on the mental well-being of the individuals involved. Considering the important role of the ward environment in shaping patient experiences and outcomes prompts a reevaluation of healthcare practices and policies. By addressing these factors healthcare systems can strive for greater effectiveness, resilience, and compassion in managing the pandemic's impact on patient care.

Most of the world’s 300 million smokeless tobacco (ST) users live in South Asia but ST policies for that region are poorly researched, developed and implemented. Longitudinal studies to understand the uptake and use of ST and smoking, and influences on these, such as health promotion strategies, are lacking. We planned to conduct longitudinal surveys among secondary school students in three countries with the highest ST burden: Bangladesh, India and Pakistan to explore ST and smoking uptake, use and health promoting strategies. Before running that longitudinal study, we assessed the feasibility of conducting such a multi country survey using a mixed-methods design. The survey (and feasibility study) was conducted in 24 secondary schools (eight per country, three classes per school). Three data sources, researcher records/fieldnotes, survey data of 1179 students, and interview/focus group discussion data from 24 headteachers, 64 teachers and 76 students, were used to understand the feasibility of three study tasks: 1) selecting, recruiting, and retaining schools and student participants; 2) survey administration; and 3) robustness of the data collection instruments. The datasets were analysed separately and triangulated. Overall, we could select and recruit schools and students using consistent methods across countries although recruitment was challenged by securing higher authority permissions and parental consent. Recommended improvements were for permission/consent processes. Survey administration was generally feasible and acceptable with recommendations for scheduling and researcher-student ratios. Questionnaire completion was 83%-100% across countries, with suggestions to improve readability and understanding, addressing students’ queries and questionnaire simplification. Due to COVID-19, we could not conduct follow-up surveys, so were unable to assess school or student retention. In conclusion, incorporating the lessons learnt from this study would improve the feasibility of conducting such a multi-country survey in the future. Reported benefits included increasing tobacco health risks’ knowledge with potential for increased tobacco control support.

Abstract Background Access of all people to the healthcare they need, without financial hardship is the goal of Universal Health Coverage (UHC). As UHC initiatives expand, assessing the needs of vulnerable populations can reveal gaps in the system which may be covered by relevant policies. In this study we (i) identify the met and unmet primary healthcare needs of the poorest population of Khyber Pakhtunkhwa province (KP), Pakistan, and (ii) explore why the gaps exist. Methods We used Leveque’s Framework of Patient-centred Access to Healthcare to examine unmet primary healthcare (PHC) needs and their underlying causes for the poorest population in four districts of Khyber Pakhtunkhwa province, Pakistan. Using a triangulation mixed methods design, we analysed data from a quantitative household survey of744 households, 17 focus group discussions with household members and, 11 interviews with healthcare providers. Results Our results show that indicate that despite service utilization, PHC needs were not met, primarily due to prohibitively high costs at each stage of access. Furthermore, gaps in outreach and information (approachability), and varying availability of medicines and diagnostics at facilities (appropriateness) the supply side as well as difficulties in navigating the system (inability to perceive) and adhering to prescriptions (inability to engage) on the demand side, also led to unmet PHC needs. Going beyond utilization, our findings highlight that engagement with care is an important determinant of met needs for vulnerable populations. Conclusion Social health protection policies can contribute to advancing UHC for primary care. However, in our setting, enhancing communication and outreach, addressing gender and age disparities, and improving quality of care and health infrastructure are necessary to fully meet the needs of the poorest populations.

Introduction: Previous evidence suggests the tobacco industry uses media to disseminate misleading narratives relating to illicit tobacco trade (ITT) as part of efforts to influence policy outcomes. Such evidence is largely high-income countries (HIC) focused, resulting in a literature gap for low- and middle-income countries (LMICs). Pakistan and its annual budget cycle are used as a case study for addressing this gap. Aims and Methods: Electronic English-language articles from newspapers in Pakistan (328) were sourced from LexisNexis and a sub-sample of Urdu-language electronic articles (12) were identified through internet searches. The articles were published between 2015 and 2020 and included claims/estimates relating to ITT, which were coded to identify cited data sources. Changes in media coverage before and after Pakistan's annual budget announcements were explored via Wilcoxon signed rank and Poisson regression tests. Results: Of the 357 claims/estimates analyzed, 66 (20%) were industry-funded. The most prevalent sources were national government bodies (36.6%) and tobacco companies or their representatives (15.1%). Wilcoxon signed-rank and Poisson regression tests on the frequency of English-language articles both created a p-value of < .05 for the frequency of relevant articles between the months of April and May, compared to the other months, indicating statistical significance. Conclusions: There was a statistically significant increase in the number of English-language articles featuring claims/estimates relating to Pakistan's ITT in the months leading up to the annual budget each year. The government should consider measures to improve transparency standards within media coverage and promote factcheck journalism to safeguard against industry tactics to manipulate public discourses. Implications This paper is, to the best of our knowledge, the largest exploration of the use of data sourced from the tobacco industry within a country's media that has been undertaken to date, utilizing a team of seven coders across the United Kingdom and Pakistan. Our findings reveal weaknesses within media coverage of ITT in Pakistan, both in English and Urdu language publications. We encourage the government to consider new standards to enhance transparency and promote factcheck journalism within media coverage in the country.

Pulmonary ethanol metabolism in the rabbit was investigated in vitro by examining oxidative (alcohol dehydrogenase) and non-oxidative (fatty acid ethyl ester synthase) pathways. Pulmonary alcohol dehydrogenase (ADH) activity was very low when measured at close to normal physiological conditions but increased at higher pH, although it was lower than that in the liver. Significant esterification of oleic acid was detected using rabbit lung homogenates, with the rate being intermediate to that of the other tissues examined. The results indicate that oxidative metabolism of ethanol (via ADH) by the rabbit lung is minimal compared to other tissues, but non-oxidative metabolism of ethanol leading to FAEE formation occurs at significant rates that may alter lipid metabolism or membrane composition.

Objective The implementation of smokeless tobacco control policies lags behind those for smoking. This scoping review summarizes the studies that evaluated public policies on smokeless tobacco regulation (SLT) and provides an overview of the jurisdictional level, target groups, and policy instruments. Methods Seven databases were systematically searched for studies reporting on public policies regulating SLT. Two reviewers independently screened all studies. Data extraction was performed using a predefined extraction form. Extraction was replicated for 10% of the identified studies for quality assurance. A narrative synthesis of the included studies was used to analyze and interpret the data. The protocol was published beforehand with the Open Science Foundation (OSF). Results Fourty articles comprising 41 studies were included. Most of the studies reported in the articles were conducted in the United States (n = 17) or India (n = 14). Most studies reported outcomes for students (n = 8), retailers/sellers (n = 8), and users/former users (n = 5). The impact of public policies on smokeless tobacco use, in general, was most frequently assessed (n = 9), followed by the impact of taxes (n = 7), product bans (n = 6), sales/advertising bans near educational institutions (n = 4), and health warnings (n = 3) on consumer behavior. Conclusions There are significant gaps in the evaluation of smokeless tobacco regulation studies that need to be filled by further research to understand the observed outcomes. WHO reporting on Framework Convention on Tobacco Control (FCTC) implementation should be linked to studies evaluating smokeless tobacco control measures at all levels of jurisdictions and in countries not members of the WHO FCTC or do not provide data. Implication Large gaps in the evaluation of SLT control policies exist. For some countries, WHO FCTC evaluations are available for different levels of jurisdictions. In countries with a strong federal structure, there is a lack of data beyond the national level to provide a more detailed look at compliance, indirect effects, or implementation gaps. More research is needed at all levels of jurisdictions, which add to the work of the WHO to understand what works for which target group, how the different levels of jurisdiction interact, how the real-world context can be incorporated, and what indirect effects may occur.

Objective:To compare the patient satisfaction attending accident and emergency (A&E) departments of the public and military hospitals of district Attock. Materials and Methods: This comparative study was conducted in the Combined Military Hospital and District Headquarter Hospital of District Attock from December 2019 to April 2020. Sample size of 390 was selected through convenient sampling technique. Data were collected using a self-administered questionnaire, consisting of three parts; demographic, satisfaction level of each service dimension and overall satisfaction regarding A&E. Data were analyzed using SPSS version 22.0. Results: The mean age of participants was 43.1 ± 14.5. Male participants were 305 (78.2%) and females were 85 (21.8%). Most of them were having the education up to Matric i.e., 174 (44.6%). Maximum number, 245 (62.8%) belonged to rural areas and government employees were 79 (20.3%). The satisfaction of participants was significantly associated with the education and monthly income of participants (p < 0.001). Furthermore, all the participants (100%) were satisfied with the services provided by A&E at CMH and 90% were satisfied with DHQ services. Conclusion: The satisfaction of participants was significantly associated with the Education and Monthly income of participants and not with the gender of patients, age, background, and occupation of participants. The overall satisfaction was higher in CMH in comparison to the DHQ hospital.

Introduction: Provision of alternate livelihoods to smokeless tobacco (SLT) supply chain (SC) actors can help in curtailing SLT business and its consumption. We explored the reasons for SC actors' engagement in Naswar (SLT used in South Asia) business and their willingness to switch to other alternatives. Aims and Methods: We conducted an equal-status concurrent mixed-methods study in four districts of Khyber Pakhtunkhwa province of Pakistan. We surveyed 286 general points of sale (GPOS) and exclusive Naswar (EN) vendors through multistage cluster sampling. Additionally, we interviewed 15 tobacco farmers interpretively, being distinct from other SC actors. We assessed the association between vendors' willingness to switch and their awareness about tobacco-harms, profit margin, Naswar as a family business, length of business, education level, and shop type using logistic regression. Qualitative data assessed the farmer's viable alternatives to switch and were analyzed using deductive-inductive thematic analysis. Results: Product demand-77% and profit margins-75% were the main drivers for selling SLT by EN vendors. Half of the GPOS and 25% EN vendors expressed willingness to stop Naswar's sale. Vendors aware of tobacco-harms were more willing to switch, but less likely to switch if Naswar was perceived to bring "good profit." Farmers were mainly cultivating tobacco because of profitability, family-run farm, and perceived land-suitability for tobacco. Lack of government support was main constraint for farmers looking to switch. Conclusions: A considerable portion of Naswar SC actors in Pakistan are willing to switch to viable alternatives, with profitability of alternatives, support from authorities, and social obligations as key considerations in doing so.

Background: Smokeless tobacco (ST) use is common among youth in South Asia where 85% of the world’s 300 million ST users live and use the most lethal ST forms. Little is known about the impact of tobacco control policies on the youth ST uptake in those countries. We planned to conduct longitudinal surveys among school going adolescents to evaluate existing tobacco control policies on tobacco uptake and use, and a feasibility study for that prospective, observational cohort study. Study objectives: (1) To demonstrate the feasibility of selection, recruitment and retention of schools and of study participants; (2) To assess the feasibility and acceptability of the study procedure and study tool (questionnaire); (3) To evaluate if the questionnaire can assess tobacco uptake and use, and their potential predictors. Methods and analysis: The feasibility study will be conducted in two administrative areas within each of three South Asian countries: Bangladesh, India and Pakistan. We will use both quantitative and qualitative data collection methods. Eight eligible schools will be randomly selected within purposively selected sub-districts from each country. We plan to conduct one baseline and one follow up survey among students of grade 6-8, one year apart. At each time point, data on tobacco uptake and potential predictors will be collected from students via self-administered questionnaires that were designed for the longitudinal study. The qualitative component will be embedded into the study with each round of data collection to assess the acceptability of the study instrument (questionnaire) and data collection methods, via focus group discussions with students and semi-structured interviews with schoolteachers. Recruitment and retention rates, completeness of the questionnaires, frequencies and associations of tobacco use and explanatory variables will be reported. Data gathered from the focus group and interviews will be analysed using the framework approach.

Objective To obtain insights into the perceptions of barriers and facilitators to implementation of the WHO Framework Convention on Tobacco Control (FCTC) among smokeless tobacco (SLT) supply chain actors in the Khyber Pakhtunkhwa province of Pakistan. Methods We conducted a qualitative study to investigate the perceptions about SLT control policy formulation and implementation among exclusive Naswar sellers and point of sale vendors. We conducted five focus group discussions in three districts of Khyber Pakhtunkhwa using combined deductive-inductive thematic analyses. Results We identified three central themes that potentially impact policy formulation, its implementation and application. The first theme examines the role of children in the Naswar business: as potential customers, and as potential heirs to a Naswar-selling business. A second theme targets the ‘business of Naswar’, which includes a specific identity of Naswar sellers, its potential to generate profits and the special case of Naswar regulation as a socially accepted and culturally rooted product. The third theme addresses the unusual ingredients of Naswar and its production process, making Naswar a health risk for consumers and producers. We also report conflicting views regarding SLT control among the supply chain actors. Conclusions This study provides insights into the perceptions of important SLT supply-side stakeholders regarding various SLT control policy options based on the FCTC. While there is some opposition to policy approaches like taxation and switching of business, implementing a ban on selling SLT to minors may be a viable option for policymakers in the short term.