BACKGROUND: Tuberculosis (TB) infectiousness decreases significantly with only a few days of treatment, but delayed diagnosis often leads to late treatment initiation. We conducted a sequential explanatory mixed methods study to understand the barriers and facilitators to prompt diagnosis among people with TB.
METHODS: We enrolled 100 adults who started TB treatment in the Carabayllo district of Lima, Peru, between November 2020 and February 2022 and administered a survey about their symptoms and healthcare encounters. We calculated total diagnostic delay as time from symptom onset to diagnosis. We conducted semi-structured interviews of 26 participants who had a range of delays investigating their experience navigating the health system. Interview transcripts were inductively coded for concepts related to diagnostic barriers and facilitators.
RESULTS: Overall, 38% of participants sought care first from public facilities and 42% from the private sector. Only 14% reported being diagnosed with TB on their first visit, and participants visited a median of 3 (interquartile range [IQR] health facilities before diagnosis. The median total diagnostic delay was 9 weeks (interquartile range [IQR] 4-22), with a median of 4 weeks (IQR 0-9) before contact with the health system and of 3 weeks (IQR 0-9) after. Barriers to prompt diagnosis included participants attributing their symptoms to an alternative cause or having misconceptions about TB, and leading them to postpone seeking care. Once connected to care, variations in clinical management, health facility resource limitations, and lack of formal referral processes contributed to the need for multiple healthcare visits before obtaining a diagnosis. Facilitators to prompt diagnosis included knowing someone with TB, supportive friends and family, referral documents, and seeing a pulmonologist.
CONCLUSIONS: Misinformation about TB among people with TB and providers, poor accessibility of health services, and the need for multiple encounters to obtain diagnostic tests were major factors leading to delays. Extending the hours of operation of public health facilities, improving community awareness and provider training, and creating a formal referral process between the public and private sectors should be priorities in the efforts to combat TB.

BACKGROUND: Measures of patient safety culture and patient experience are both commonly utilised to evaluate the quality of healthcare services, including hospitals, but the relationship between these two domains remains uncertain. In this study, we aimed to explore and synthesise published literature regarding the relationships between these topics in hospital settings.
METHODS: This study was performed using the five stages of Arksey and O\'Malley\'s Framework, refined by the Joanna Briggs Institute. Searches were conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, SciELO and Scopus databases. Further online search on the websites of pertinent organisations in Australia and globally was conducted. Data were extracted against predetermined criteria.
RESULTS: 4512 studies were initially identified; 15 studies met the inclusion criteria. Several positive statistical relationships between patient safety culture and patient experience domains were identified. Communication and teamwork were the most influential factors in the relationship between patient safety culture and patient experience. Managers and clinicians had a positive view of safety and a positive relationship with patient experience, but this was not the case when managers alone held such views. Qualitative methods offered further insights into patient safety culture from patients\' and families\' perspectives.
CONCLUSIONS: The findings indicate that the patient can recognise safety-related issues that the hospital team may miss. However, studies mostly measured staff perspectives on patient safety culture and did not always include patient experiences of patient safety culture. Further, the relationship between patient safety culture and patient experience is generally identified as a statistical relationship, using quantitative methods. Further research assessing patient safety culture alongside patient experience is essential for providing a more comprehensive picture of safety. This will help to uncover issues and other factors that may have an indirect effect on patient safety culture and patient experience.

BACKGROUND: Health tourism is an important component that may influence the direction of development in a region. Mazandarn, Iran, is recognized as a highly sustainable market in the region because of its abundant natural resources, temperate temperature, and strategic geographical location. Therefore, considering the importance of health tourism and its existing potential in Mazandaran, Iran, this study was conducted with the aim of exploring a comprehensive perspective on local drivers in community-based health tourism industry development and factors affecting the attraction of health tourism.
METHODS: We conducted this study in Mazandarn, Iran, using a qualitative approach. Participants included a sample of Iranian people, aged 34-54 years, with previous history of health tourism or expert in it. Participants were selected from three different categories of the community: academic professionals in health tourism, managers in health tourism, and health tourists. Data were obtained via semi-structured in-depth interviews and focus group discussions. Inductive qualitative content analysis was used to converge and compare themes through participant data. The interviews kept going until data saturation was achieved.
RESULTS: Based on our findings, we distilled local drivers in community-based health tourism industry development into five main categories and 30 subcategories: (Sharifabadi AM, Ardakani FA. A model for health tourism development using fuzzy TOPSIS and interpretive structural modeling in Yazd province. J Health Adm (JHA). 2014;17:55.) infrastructure and resources; (Hemmati F, Dabbaghi F, Mahmoudi G. Investigating the impact of Information Technology on the status of Health Tourism in Mashhad, Iran. Revista Publicando. 2018;5(15):54-65.) tourist attractions; (Sarabi Asiabar A, Rezapour A, Raei B, Tahernezhad A, Alipour V, Behzadifar M. Economic, Cultural, and Political Requirements for Medical Tourism Development in Iran: Insights from a Fuzzy Analytical Hierarchy Process Method. Med J Islamic Repub Iran. 2022;35:199.) socio-cultural contexts; (Mosadeghrad AM, Sadeghi M. Medical tourism: Reasons for choosing Iran. Payesh (Health Monitor). 2021;20(2):145-66.) economic-financial factors; and (Manna R, Cavallone M, Ciasullo MV, Palumbo R. Beyond the rhetoric of health tourism: shedding light on the reality of health tourism in Italy. Curr Issues Tourism. 2020;23(14):1805-19.) political-communicative factors. The findings of the study showed that, from the participants\' point of view, although there are several strategies, such as the development of public service and tourism infrastructure, increasing tourist attractions, and formulating appropriate policies and procedures for the development of health tourism, they are also faced with many challenges, especially political, economic, and cultural challenges.
CONCLUSIONS: This study showed that improving infrastructure and resources, promoting tourist attractions, informing socio-cultural contexts, improving economic and financial capacity, and developing political and communicative contexts might increase the attraction of health tourists. The suggested components are not contextually driven, although empirical outcomes may differ based on the level of service offerings in health tourism locations.

BACKGROUND: The 2018 Nigeria Demographic and Health Survey shows poor maternal health in northern Nigeria. Contraceptive use remains low and maternal mortality high. Studies show that cultural norms related to men\'s decision-making role in the family significantly contribute to this phenomenon.
OBJECTIVE: The assessment was designed to identify barriers to service delivery and utilisation of maternal-health and family-planning services in three northern Nigerian states, focusing on aspects of service delivery affected by husband involvement.
METHODS: Qualitative design included 16 focus group discussions and 12 in-depth interviews with facility clients, and 16 in-depth interviews with healthcare providers, in each of the three states.
METHODS: Primary healthcare facilities in three northern Nigeria states: Bauchi, Kebbi and Sokoto.
METHODS: Women who came to the facility for family-planning services (n=233 in 24 focus groups); women who came for antenatal care (n=97 in 12 focus groups); men married to women who either received antenatal care or delivered in a facility (n=96 in 12 focus groups); mothers of newborns who delivered in a facility (n=36) and healthcare providers (n=48).
RESULTS: We found gender barriers to contraceptive use and to obtaining maternal healthcare, with some women requiring their husband\'s permission to use services, even in emergencies. Several supply-side barriers exacerbate the situation. Many healthcare providers would not provide women with a family-planning method without their husbands\' presence or approval; some male providers would not admit a woman to deliver in a facility if her husband objected to her being treated by a man and there was no female provider present and some facilities do not have the infrastructure to accommodate men.
CONCLUSIONS: Despite years of programming, barriers to women\'s family-planning and maternal-health service utilisation persist. State governments in northern Nigeria should invest in additional provider training, improving infrastructure and hiring more female healthcare providers.

OBJECTIVE: Low birth weight (LBW) is an important indicator of newborn health and can have long-term implications for a child\'s development. Spatial exploratory analysis provides a toolkit to gain insight into inequalities in LBW. Few studies in Ghana have explored the spatial distribution of LBW to understand the extent of the problem geographically. This study explores individual and cluster-level distributions of LBW using spatial exploration components for common determinants from nationally representative survey data.
METHODS: We used data from the 2017 Ghana Maternal Health Survey and conducted individual-level and cluster-level analyses of LBW with place and zone of residence in both bivariate and multivariate analyses. By incorporating spatial and survey designs methodology, logistic and Poisson regression models were used to model LBW.
METHODS: Ghana.
METHODS: A total of 4127 women aged between 15 and 49 years were included in the individual-level analysis and 864 clusters corresponding to birth weight.
METHODS: Individual and cluster-level distribution for LBW using spatial components for common determinants.
RESULTS: In the individual-level analysis, place and zone of residence were significantly associated with LBW in the bivariate model but not in a multivariate model. Hotspot analysis indicated the presence of LBW clusters in the middle and northern zones of Ghana. Compared with rural areas, clusters in urban areas had significantly lower LBW (p=0.017). Clusters in the northern zone were significantly associated with higher LBW (p=0.018) compared with the coastal zones.
CONCLUSIONS: Our findings from choropleth hotspot maps suggest LBW clusters in Ghana\'s northern and middle zones. Disparities between the rural and urban continuum require specific attention to bridge the healthcare system gap for Ghana\'s northern and middle zones.

OBJECTIVE: The objectives of this study are to describe couples\' experiences and perceived barriers to participation in the CenteringPregnancy model in southeast of China and to understand whether smartphones could play a potential role in this model.
METHODS: This study employed a descriptive phenomenological qualitative study using semistructured dyadic interviews with women and their partners. The interviews were audiotaped, transcribed verbatim and subjected to thematic analysis.
METHODS: This study was conducted in two pilot prenatal clinics in southern China.
METHODS: A purposive sample of 13 couples who underwent smartphone-assisted CenteringPregnancy were recruited. Data were collected until saturation through semistructured dyadic interviews between December 2022 and March 2023.
RESULTS: The study yielded four primary themes: (1) motivation for participation, (2) acceptance of CenteringPregnancy, (3) barriers and suggestions and (4) support for smartphone use of CenteringPregnancy.
CONCLUSIONS: CenteringPregnancy was well received by couples. Couples can access additional medical care and engage in intensive social interactions assisted by smartphones. However, certain objective challenges need to be acknowledged, including inadequate activity space, high demand for knowledge by couples and inflexible time for employed partners. Moreover, the risk that smartphones can lead to false expectations among couples needs to be noted.

BACKGROUND: Sexual violence is a significant public health concern with severe physical, social and psychological consequences, which can be mitigated by health service utilisation. However, in Uganda and much of sub-Saharan Africa, these services are significantly underused, with 9 out of 10 survivors not seeking care due to a range of psychological, cultural, economic and logistical factors. Thus, there is a strong need for research to improve health service utilisation for survivors of sexual violence.
METHODS: The proposed study seeks to address the underutilization of health services for female survivors of sexual violence using a discrete choice experiment (DCE). The study will be conducted in the greater Masaka region of southwestern Uganda and target adult female survivors of sexual violence. We will first undertake qualitative interviews with 56 survivors of sexual violence to identify the key attributes and levels of the DCE. In order to ensure a sufficiently powered sample, 312 women who meet inclusion criteria will be interviewed. Our primary analysis will employ a mixed (random parameters) logit model. We will also model the role of individual-specific characteristics through latent class models.
BACKGROUND: The study protocol was reviewed and approved by the following ethics review boards in Uganda and the USA: the Uganda Virus Research Institute (UVRI), the Uganda National Council for Science and Technology (HS2364ES), Washington University in St Louis and the University of Michigan. Our methods conform to established guidelines for the protection of human subjects involved in research. Our dissemination plan targets a broad audience, ranging from policymakers and government agencies to healthcare providers, academic communities and survivors themselves.

OBJECTIVE: To study nurses\' perceptions of patient handoffs in tertiary care hospitals in Kelantan, Malaysia, and to identify predictors of these perceptions.
METHODS: Cross-sectional study.
METHODS: Three tertiary care hospitals in Kelantan, Malaysia, February-March 2023.
METHODS: The study\'s inclusion criteria were nurses who were Malaysian citizens, working in shifts and possessing a minimum of 6 months of work experience. Nurses holding administrative positions and those unavailable during the study period were excluded from participation. A stratified proportionate random sampling method was employed, and a 100% response rate was achieved, with all 418 selected nurses participating in the study.
METHODS: Nurses\' perceptions of patient handoffs were assessed using the validated Hospital Patient Handoff Questionnaire. Predictors of these perceptions were identified through multiple linear regression analysis.
RESULTS: The study revealed an overall positive perception of handoffs, with a mean score of 3.5 on a 1-5 scale. Receiving formal in-service training on handoff practices (regression coefficient 0.089, 95% CI: 0.016 to 0.161) and expressing satisfaction with the handoff process (regression coefficient 0.330, 95% CI: 0.234 to 0.425) were positively associated with nurses\' perceptions. Working in the paediatric department was associated with a lower perception of handoffs (regression coefficient -0.124, 95% CI: -0.195 to -0.053).
CONCLUSIONS: Formal in-service training, satisfaction and working in the paediatric department were significantly associated with nurses\' perceptions of patient handoffs in Kelantan. These findings suggest the need for tailored interventions to improve handoff processes and enhance patient safety. Further research could explore the effectiveness of specific training programmes targeting these identified predictors.

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BACKGROUND: Patient navigation, a complex health intervention meant to address widespread fragmentation across the healthcare landscape, has been widely adopted internationally. This rapid uptake in patient navigation has led to a broadening of the service\'s reach to include those of different social positions and different health conditions. Despite the popularity and prevalence of patient navigation programmes, the extent of patient involvement and/or partnership in their construction has yet to be articulated. This scoping review will explore and describe the extent to which patients have been engaged in the development and/or implementation of patient navigation programmes to date.
METHODS: This scoping review will adhere to the Arksey and O\'Malley framework for conducting scoping reviews. The electronic databases MEDLINE, CINAHL, EMBASE, PsycINFO, SocINDEX and Scopus were searched in September 2023 using terms related to patient navigation and programme implementation. Inclusion criteria stipulate that the studies must: (1) include an intervention labelled as \'navigation\' in a healthcare setting and (2) describe patient engagement in the design, development and/or implementation process of said patient navigation programme. To assess study eligibility, two reviewers will independently read through the titles and abstracts, followed by the full texts, of each study identified from the search strategy to determine whether they meet inclusion criteria. Reviewers will then extract data from the included studies, present descriptive study characteristics in tables, and perform qualitative content analysis.
BACKGROUND: This review does not require ethics approval as data will be collated exclusively from peer-reviewed articles and thesis dissertations. A manuscript summarising the results of the review will be written and submitted to a peer-reviewed journal for publication. The review will map aspects of programme development that have repeatedly utilised patient perspectives and areas where engagement has lagged. This review will also depict how patient engagement varies across programme characteristics.