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Primary Care and Global Community Health

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 58073

Special Issue Editor

Prof. Dr. Jon Øyvind Odland

E-Mail Website
Guest Editor
Department of Public Health and Nursing, UiT The Arctic University of Norway, 9037 Tromso, Norway
Interests: public health; epidemiology; environmental health; reproductive health; pregnancy care; climate change
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue has a focus on health within a global setting. Using data and research from populations and communities worldwide, the journal will accept submissions on global health problems concerning their development, investigation, and interventions or solutions. This information will give readers an understanding of the reciprocal nature of anthropogenic effects on the environment and the negative or hazardous effects that the environment can have on humans. For example, climate change can be discussed, focusing on areas where humans contribute to climate change and how humans are equally affected; additionally, solutions will be discussed with a final goal to provide a comprehensive view on the issue. Ultimately, the potential impact on human health that occurs around the world can be explored and further understood.

Prof. Dr. Jon Øyvind Odland
Guest Editor

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Keywords

  • global health
  • population health
  • adverse health
  • community health
  • environment

Published Papers (18 papers)

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15 pages, 2182 KiB  
Article
Patients’ Perspectives on the Use of a Newly Developed “Patients’ Guide for Doctor’s Visit”: DocVISITguide
by Rebecca Jaks, Elena Guggiari, Saskia Maria De Gani and Dunja Nicca
Int. J. Environ. Res. Public Health 2023, 20(14), 6414; https://doi.org/10.3390/ijerph20146414 - 20 Jul 2023
Viewed by 1165
Abstract
During doctor’s visits, fundamental decisions regarding a patient’s diagnosis and therapy are taken. However, consultations often take place within a limited time frame and are characterized by an asymmetric interaction. Therefore, patients’ questions can remain unanswered and concerns unspoken. A "Patients’ Guide for [...] Read more.
During doctor’s visits, fundamental decisions regarding a patient’s diagnosis and therapy are taken. However, consultations often take place within a limited time frame and are characterized by an asymmetric interaction. Therefore, patients’ questions can remain unanswered and concerns unspoken. A "Patients’ Guide for Doctor’s Visit" (DocVISITguide) was developed to prepare patients for their visits, supporting them to take an active role in the communication and leave the consultation well-informed. This paper describes the development of the DocVISITguide and its first small-scale evaluation based on a sequential explanatory mixed methods design from the patients’ perspective. For this purpose, a small sample of patients completed a pre- and post-questionnaire, and two in-depth interviews were conducted. Most participants found the DocVISITguide easy to understand. The guide helped them to take a closer look at their own health situation and be better prepared for the visit. More than three-quarters (82%) of the participants would probably use the guide again, and all (100%) would recommend it to family and friends. However, some patients felt unsure about using the guide within the consultation and showing it to their physician. To counteract this uncertainty, physicians should be actively involved in the use of such guides in the future. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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13 pages, 330 KiB  
Article
Travelling from Perspective of Persons with Disability: Results of an International Survey
by Urszula Załuska, Dorota Kwiatkowska-Ciotucha and Alicja Grześkowiak
Int. J. Environ. Res. Public Health 2022, 19(17), 10575; https://doi.org/10.3390/ijerph191710575 - 25 Aug 2022
Cited by 10 | Viewed by 2098
Abstract
Full inclusion of people with disabilities means their full participation in community life and the same opportunities to work and spend their free time that other members of the community have. This also applies to travel and tourism. Offers available to people with [...] Read more.
Full inclusion of people with disabilities means their full participation in community life and the same opportunities to work and spend their free time that other members of the community have. This also applies to travel and tourism. Offers available to people with various types of disabilities are seldom adapted to their needs. They face numerous barriers and obstacles when travelling or at their destination. The article presents selected results from an international comparative study concerning travel of people with sensory disabilities. The study was carried out in the first quarter of 2022 using the PAPI method on a group of 131 respondents from Poland, Greece, Cyprus and Portugal. To analyse the results, we relied on statistical inference using an independent two-sample t-test and one-way analysis of variance. Tests of the equality of two means were preceded by Levene’s test for homogeneity of variances. According to the study, people with sensory disabilities can see many barriers to travel that pose a significant constraint on their activity. These barriers vary depending on the type of disability, gender or the country of origin of the respondent, but the list of indications often includes the need to train service staff in the specific needs of people with different types of disabilities. Taking into account development opportunities that people with disabilities create for the tourism industry, including people with sensory disabilities who are frequently overlooked, it is worth considering measures aimed at improving knowledge and skills in this area in the future. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
16 pages, 368 KiB  
Article
Why Do We Not Follow Lifesaving Rules? Factors Affecting Nonadherence to COVID-19 Prevention Guidelines in Indonesia: Healthcare Professionals’ Perspectives
by Nelsensius Klau Fauk, Alfonsa Liquory Seran, Christopher Raymond, Maria Silvia Merry, Roheena Tahir, Gregorius Abanit Asa and Paul Russell Ward
Int. J. Environ. Res. Public Health 2022, 19(14), 8502; https://doi.org/10.3390/ijerph19148502 - 12 Jul 2022
Cited by 9 | Viewed by 2646
Abstract
This study aimed to understand Indonesian healthcare professionals’ (HCPs) perceptions and experiences regarding barriers to both HCP and community adherence to COVID-19 prevention guidelines in their social life. This methodologically qualitative study employed in-depth interviewing as its method for primary data collection. Twenty-three [...] Read more.
This study aimed to understand Indonesian healthcare professionals’ (HCPs) perceptions and experiences regarding barriers to both HCP and community adherence to COVID-19 prevention guidelines in their social life. This methodologically qualitative study employed in-depth interviewing as its method for primary data collection. Twenty-three HCP participants were recruited using the snowball sampling technique. Data analysis was guided by the Five Steps of Qualitative Data Analysis introduced through Ritchie and Spencer’s Framework Analysis. The Theory of Planned Behaviour was used to guide study conceptualisation, data analysis and discussions of the findings. Results demonstrated that HCP adherence to COVID-19 prevention guidelines was influenced by subjective norms, such as social influence and disapproval towards preventive behaviours, and perceived behavioural control or external factors. Findings also demonstrated that HCPs perceived that community nonadherence to preventive guidelines was influenced by their behavioural intentions and attitudes, such as disbelief in COVID-19-related information provided by the government, distrust in HCPs, and belief in traditional ritual practices to ward off misfortune. Subjective norms, including negative social pressure and concerns of social rejection, and perceived behavioural control reflected in lack of personal protective equipment and poverty, were also barriers to community adherence. The findings indicate that policymakers in remote, multicultural locales in Indonesia such as East Nusa Tenggara (Nusa Tenggara Timur or NTT) must take into consideration that familial and traditional (social) ties and bonds override individual agency where personal action is strongly guided by long-held social norms. Thus, while agency-focused preventive policies which encourage individual actions (hand washing, mask wearing) are essential, in NTT they must be augmented by social change, advocating with trusted traditional (adat) and religious leaders to revise norms in the context of a highly transmissible pandemic virus. Future large-scale studies are recommended to explore the influence of socio-cultural barriers to HCP and community adherence to preventive guidelines, which can better inform health policy and practice. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
18 pages, 1889 KiB  
Article
Impact of Fortified Infant Cereals on the Burden of Iron Deficiency Anemia in 6- to 23-Month-Old Indonesian Infants and Young Children: A Health Economic Simulation Model
by Alberto Prieto-Patron, Patrick Detzel, Rita Ramayulis, Sudikno, Irene and Yulianti Wibowo
Int. J. Environ. Res. Public Health 2022, 19(9), 5416; https://doi.org/10.3390/ijerph19095416 - 29 Apr 2022
Cited by 2 | Viewed by 2712
Abstract
Iron deficiency and iron deficiency anemia (IDA) are highly prevalent among Indonesian infants and young children (IYC). Severe IDA hampers mental development in young children and is linked to lower quality of life and lower productivity as adults. The consumption of fortified infant [...] Read more.
Iron deficiency and iron deficiency anemia (IDA) are highly prevalent among Indonesian infants and young children (IYC). Severe IDA hampers mental development in young children and is linked to lower quality of life and lower productivity as adults. The consumption of fortified infant cereals (FIC) increases iron intake during the weaning period, thus reducing the social burden of IDA. In this manuscript, we aimed to assess the impact of FIC on the burden of IDA on IYC in Indonesia. We analyzed data for IYC aged 6–23 months from the fifth wave (2014–2015) of the Indonesia Family Life Survey (IFLS) and the Indonesia Demographic and Health Survey 2017 (IDHS-17). We adapted a health economic simulation model to estimate the impact of FIC that accounted for lifetime health and cost consequences in terms of reduced future income and DALYs. The mean Hb level was 10.5 ± 1.4 g/dL. Consumers of FIC had a reduced burden of disease (43,000 DALYs; USD 171 million) compared with non-consumers. The consumption of fortified infant cereals plays an important role in reducing the burden of IDA, and it might complement the available strategy of nutritional interventions to address this problem in Indonesian IYC. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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11 pages, 323 KiB  
Article
Associations between Allergic and Autoimmune Diseases with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder within Families: A Population-Based Cohort Study
by Dian-Jeng Li, Ching-Shu Tsai, Ray C. Hsiao, Yi-Lung Chen and Cheng-Fang Yen
Int. J. Environ. Res. Public Health 2022, 19(8), 4503; https://doi.org/10.3390/ijerph19084503 - 08 Apr 2022
Cited by 13 | Viewed by 2786
Abstract
Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are commonly comorbid with allergic and autoimmune diseases in children. The aim of the current study was to investigate the association between children’s and first-degree relatives’ (i.e., mother, father, and full sibling) allergic and autoimmune [...] Read more.
Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are commonly comorbid with allergic and autoimmune diseases in children. The aim of the current study was to investigate the association between children’s and first-degree relatives’ (i.e., mother, father, and full sibling) allergic and autoimmune diseases and children’s ASD and ADHD. We enrolled participants from Taiwan’s Maternal and Child Health Database. We used the Cox regression model to examine the associations of familial, siblings’ and children’s allergic and autoimmune diseases with children’s ASD and/or ADHD. In total, we included 1,386,260 children in the current study. We found the significant association between familial allergic or autoimmune disease and development of ASD or ADHD among children. We also identified the predominant impact of familial aggregation on the above associations. The associations between some parental diagnoses of autoimmune or allergic diseases in children’s ASD and/or ADHD were stronger in mothers than those in fathers. Early assessment of the possibility of ASD and ADHD is required for children who have a parent with an allergic or autoimmune disease. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
8 pages, 642 KiB  
Article
Acute Alcohol Intake Impairs the Velocity Storage Mechanism and Affects Both High-Frequency Vestibular-Ocular Reflex and Postural Control
by Hyo Geun Choi, Sung Kwang Hong, Su Kyoung Park, Hyo-Jeong Lee and Jiwon Chang
Int. J. Environ. Res. Public Health 2022, 19(7), 3911; https://doi.org/10.3390/ijerph19073911 - 25 Mar 2022
Viewed by 1868
Abstract
Background: Acute alcohol intake is known to cause gait instability, dizziness, and lack of psychomotor coordination. Previous studies demonstrated the positive effects of alcohol on the oculomotor system and the low-frequency vestibulo-ocular reflex (VOR). However, the low-frequency VORs is a rather un-physiologic stimulation, [...] Read more.
Background: Acute alcohol intake is known to cause gait instability, dizziness, and lack of psychomotor coordination. Previous studies demonstrated the positive effects of alcohol on the oculomotor system and the low-frequency vestibulo-ocular reflex (VOR). However, the low-frequency VORs is a rather un-physiologic stimulation, and the reported explanations regarding the relations between the alcohol-induced VOR changes and posture control are inconsistent. OBJECTIVE: The present study evaluates how acute alcohol intake affects more physiologic mid- to high-frequency VORs, postural control, and elucidates the connection between the VOR and posture control after alcohol intake. Methods: A total of 31 healthy volunteers participated. Each participant received calculated amounts of alcohol drinks according to their body weight and genders with the targeted blood alcohol content (BAC) level of 0.05% using the Widmark formula. A vestibular test battery composed of posturography, video head impulse test, rotatory chair test (slow harmonic acceleration (SHA) and step velocity), and subjective visual vertical/horizontal tests (SVV/SVH) were conducted twice in alcohol-free condition (no alcohol intake within 24 h) and acute alcohol condition. Results: Acute alcohol intake decreased stability scores in all NS/EO (normal stability-eyes open), NS/EC (normal stability- eyes closed), PS/EO (perturbed stability-eyes open), and PS/EC (perturbed stability-eyes closed) conditions. High-frequency VOR gains decreased, but mid-frequency VOR gains were not significantly affected by alcohol intake. In addition, time constants were reduced significantly after alcohol ingestion in both clockwise and counter-clockwise rotation. Phase lead in SHA test and SVV/SVH was not affected by alcohol intake. Conclusion: Acute alcohol intake affected postural stability, high-acceleration head impulses, and the velocity storage mechanism. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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17 pages, 380 KiB  
Article
A Survey on Knowledge, Prevention, and Occurrence of Sexually Transmitted Infections among Freshmen from Four Italian Universities
by Luca Cegolon, Melania Bortolotto, Saverio Bellizzi, Andrea Cegolon, Luciano Bubbico, Giuseppe Pichierri, Giuseppe Mastrangelo and Carla Xodo
Int. J. Environ. Res. Public Health 2022, 19(2), 897; https://doi.org/10.3390/ijerph19020897 - 14 Jan 2022
Cited by 8 | Viewed by 3158
Abstract
Background. The peak of sexually transmitted infections (STI) among adolescents/young adults suggests a low level of prevention. In order to assess whether the level of sexual health education (SHE), received by several channels, was effective at improving sexual behaviors, we conducted a [...] Read more.
Background. The peak of sexually transmitted infections (STI) among adolescents/young adults suggests a low level of prevention. In order to assess whether the level of sexual health education (SHE), received by several channels, was effective at improving sexual behaviors, we conducted a survey among freshmen from four Italian universities. Methods. This observational cross-sectional study was carried out with an anonymous self-reported paper questionnaire, administered during teaching lectures to university freshmen of the northern (Padua, Bergamo, and Milan campuses) and southern (Palermo campus) parts of the country. Knowledge of STI (a linear numerical score), knowledge of STI prevention (dichotomous variable: yes vs. no) and previous STI occurrence (polytomous variable: “no”; “don’t know”; “yes”) were the outcomes in the statistical analysis. Results. The final number of freshmen surveyed was 4552 (97.9% response rate). The mean age of respondents was 21.4 ± 2.2 years and most of them (70.3%) were females. A total of 60% of students were in a stable romantic relationship. Only 28% respondents knew the most effective methods to prevent STI (i.e., condom and sexual abstinence), with a slightly higher prevalence of correct answers among females (31.3%) than males (25.8%). Students with history of STIs were 5.1%; they reported referring mostly to their general practitioner (GP) (38.1%) rather than discussing the problem with their partner (13.1%). At multivariable analysis, a significantly higher level of STI knowledge was observed in older students (25+ years of age), biomedical students, and those from a non-nuclear family; lower levels were found among students of the University of Palermo, and those who completed a vocational secondary school education. Those who had less knowledge about the most effective tools to prevent STIs included males, students from the University of Palermo, students registered with educational sciences, economics/political sciences, those of foreign nationality, and those whose fathers had lower educational levels. The risk of contracting a STI was significantly lower only in students not in a stable relationship (relative risk ratio, RRR = 0.67; 95% confidence interval, 95%CI = 0.48; 0.94), whereas such risk was significantly higher in students with higher STI knowledge (RRR = 1.15; 95%CI = 1.08; 1.22). Discussion and Conclusions. University freshmen investigated in this study had poor knowledge of STIs and their prevention. Unexpectedly, those with higher levels of knowledge had an increased risk of STIs. There have been no educational interventions—with good quality and long-term follow-ups—that increased the confidence that such SHE programs could have population level effects. A new high-quality study is therefore recommended to assess the effectiveness of an intervention generating behavioral changes; increasing only STI knowledge may not be sufficient. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
11 pages, 1082 KiB  
Article
Tonsillectomy in Adults over 40 Years of Age Does Not Increase the Risk of Pneumonia: A Three-Year Longitudinal Follow-Up Study
by Sung Joon Park, Chanyang Min, Dae Myoung Yoo, Sei Young Lee and Hyo Geun Choi
Int. J. Environ. Res. Public Health 2021, 18(24), 13059; https://doi.org/10.3390/ijerph182413059 - 10 Dec 2021
Cited by 1 | Viewed by 2120
Abstract
To evaluate the effect of tonsillectomy on the subsequent risk of pneumonia in an adult population, a longitudinal follow-up case control study was conducted using a national health screening cohort dataset between 2003 and 2012. A total of 1005 tonsillectomy participants were 1:4 [...] Read more.
To evaluate the effect of tonsillectomy on the subsequent risk of pneumonia in an adult population, a longitudinal follow-up case control study was conducted using a national health screening cohort dataset between 2003 and 2012. A total of 1005 tonsillectomy participants were 1:4 matched with 4020 control participants for age, sex, income, and region of residence. The number of pneumonia diagnoses were counted from the index date (ID) to the date after the first-year (post-ID 1y), second-year (post-ID 2y), and third-year (post-ID 3y) periods. Simple linear regression and multiple linear regression were conducted to calculate estimated values (EVs) and 95% confidence intervals for each post-ID pneumonia and compared between the two groups. Subgroup analyses were performed according to age, sex, and the number of pneumonia cases during the year prior to the ID (pre-ID 1y). In the simple linear regression model, post-ID pneumonia did not show a significant correlation with tonsillectomy (post-ID 1y: EV = 0.003; post-ID 2y: EV = 0.007; post-ID 3y: EV = 0.013; all p > 0.05). In the multiple regression model, post-ID pneumonia also did not show a significant correlation with tonsillectomy (post-ID 1y: EV = 0.001; post-ID 2y: EV = 0.006; post-ID 3y: EV = 0.011; all p > 0.05). In the subgroup analyses, tonsillectomy did not show a significant correlation with post-ID pneumonia in either the simple linear regression or multiple linear regression models (all p > 0.05). Tonsillectomy performed in the adult population did not show any effect in increasing the incidence of pneumonia during the first three postoperative years. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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14 pages, 351 KiB  
Article
When Pregnancy Coincides with Positive Diagnosis of HIV: Accounts of the Process of Acceptance of Self and Motherhood among Women in South Africa
by Sphiwe Madiba
Int. J. Environ. Res. Public Health 2021, 18(24), 13006; https://doi.org/10.3390/ijerph182413006 - 09 Dec 2021
Cited by 3 | Viewed by 2469
Abstract
Literature has highlighted the unique period of vulnerability following an HIV diagnosis during pregnancy. Despite the high burden of HIV among pregnant women in South Africa, the experiences of women diagnosed with HIV during pregnancy have rarely been explored in isolation from those [...] Read more.
Literature has highlighted the unique period of vulnerability following an HIV diagnosis during pregnancy. Despite the high burden of HIV among pregnant women in South Africa, the experiences of women diagnosed with HIV during pregnancy have rarely been explored in isolation from those diagnosed at different times. This paper explored the experiences of women who were diagnosed with HIV when pregnant and assessed their emotional recovery beyond diagnosis. The study used a qualitative descriptive phenomenological approach to conduct interviews with women recruited from ART clinics in a health district in South Africa. Participants included 19 women sampled purposively. The interviews were transcribed verbatim and analysed following the thematic approach. Testing positive during pregnancy and being free of symptoms increased the shock, disbelief, and strong emotions exhibited. For the women, the diagnosis of HIV coincided with pregnancy and transformed pregnancy from excitement to anxiety. Although the transition from being HIV negative to becoming HIV positive and pregnant was overwhelming, with the passage of time, the women transitioned to feelings of acceptance. However, the process of acceptance was slow and varied, with some experiencing non-acceptance for extended periods. Non-acceptance of HIV diagnosis has serious adverse public health consequences for the individual. Integrating continuous HIV counselling and culturally appropriate psychosocial care into practice could foster acceptance for pregnant women with HIV diagnosis. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
11 pages, 637 KiB  
Article
Role of Socio-Demographic and Environmental Determinants on Performance of Community Health Workers in Western Kenya
by Fletcher Njororai, Daniel Ganu, Kogutu Caleb Nyaranga and Cholo Wilberforce
Int. J. Environ. Res. Public Health 2021, 18(21), 11707; https://doi.org/10.3390/ijerph182111707 - 08 Nov 2021
Cited by 5 | Viewed by 2335
Abstract
Background: The performance of community health workers remains an area of significant global focus. The role of community health workers in sub-Saharan Africa has evolved over time in response to changing health priorities, disease burdens, and workforce demands. Recently, Kenya revised its [...] Read more.
Background: The performance of community health workers remains an area of significant global focus. The role of community health workers in sub-Saharan Africa has evolved over time in response to changing health priorities, disease burdens, and workforce demands. Recently, Kenya revised its community health strategy in response to challenges faced with the implementation of grassroots primary health care initiative. Implementation of community health programs is often inconsistent, and they vary widely in many attributes. The purpose of this study was to explore factors influencing performance of community health workers in Vihiga County, Western Kenya in light of the political devolution. Methods: The study was a cross-sectional study design that involved a quantitative method of data collection. A sample of 309 participants was selected through cluster and simple random sampling. A self-administered and -structured questionnaire was used to gather data, s, and those who were not able to respond individually were guided by the research assistants. Results: The community health workers were 75.2% females and 24.8% males. Performance was significantly associated with not being employed, (OR = 2.4; 95% CI, 1.4–4.4), secondary education (OR = 0.7; 95% CI, 0.5–1.1), lack of conflict resolution mechanism (OR = 2.2; p = 0.017), lack of support (OR = 1.5; p = 0.03), and community health work not seen as important (OR = 1.5; p = 0.041). Poor communication skills were also more likely to influence performance of community health workers (OR = 0.5; p = 0.050) and poor road network (OR = 0.361; p = 0.000). Conclusions: These findings offer a deeper understanding of the interaction between CHWs contextual situations, structural challenges, and performance. Addressing influential factors of CHWs performance in multi-task settings is important in preventing overtaxing their work capacity and to maintain quality performance as countries move towards universal health coverage. Strategies for incentivizing, attracting, and sustaining men in CHWs is important to broaden perspectives about this critical role in society. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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14 pages, 331 KiB  
Article
Understanding Barriers to the Access to Healthcare and Rehabilitation Services: A Qualitative Study with Mothers or Female Caregivers of Children with a Disability in Indonesia
by Gregorius Abanit Asa, Nelsensius Klau Fauk, Lillian Mwanri and Paul Russell Ward
Int. J. Environ. Res. Public Health 2021, 18(21), 11546; https://doi.org/10.3390/ijerph182111546 - 03 Nov 2021
Cited by 5 | Viewed by 3252
Abstract
Accessibility to healthcare and rehabilitation services for children with a disability (CWD) is essential to improving their health and wellbeing. However, access to the services, especially in many settings in developing countries with scarcity of resources, is still limited. As part of a [...] Read more.
Accessibility to healthcare and rehabilitation services for children with a disability (CWD) is essential to improving their health and wellbeing. However, access to the services, especially in many settings in developing countries with scarcity of resources, is still limited. As part of a qualitative study exploring impacts of caring for CWD on mothers or female caregivers and their coping strategies, this paper describes barriers for access to healthcare and rehabilitation services for CWD in Belu district, Indonesia. One-on-one, in-depth interviews were conducted with 22 mothers or female caregivers of CWD. Participants were recruited using a combination of purposive and snowball sampling techniques. These were supplemented with interviews with two staff of disability rehabilitation centers in Belu to understand any additional barriers. Data analysis was guided by a qualitative data analysis framework. Our analysis identified that lack of affordability of healthcare services (high costs and low financial capacity of mothers) was the key barrier for access to healthcare and rehabilitation services CWD. Religious or faith-based factors, such as being a non-Catholic (Belu is predominantly Catholic), converting from Catholic to other religions, and the belief in children’s disability condition as “God’s will”, were also influencing factors for lack of access to the services. Shortage of staff, distrust in the therapy skills of staff at rehabilitation centers, and unavailability of appropriately trained healthcare professionals were structural or system-related barriers. The findings indicate the need for government-owned and run disability rehabilitation centers (not faith-based), the provision of fully subsidised health insurance to provide free services, and the provision of qualified therapists and healthcare professionals (to build trust) in Belu and other similar settings in Indonesia. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
22 pages, 2589 KiB  
Article
Identifying and Addressing the Underlying Core Problems in Healthcare Environments: An Illustration Using an Emergency Department Game
by Gustavo M. Bacelar-Silva, James F. Cox, Humberto R. Baptista and Pedro Pereira Rodrigues
Int. J. Environ. Res. Public Health 2021, 18(19), 10083; https://doi.org/10.3390/ijerph181910083 - 25 Sep 2021
Viewed by 2145
Abstract
The emergency department (ED) crowding is a critical healthcare issue worldwide that leads to long waits and poorer healthcare outcomes. Goldratt’s theory of constraints (TOC) has been used effectively to improve such problematic environments for more than three decades. While most TOC solutions [...] Read more.
The emergency department (ED) crowding is a critical healthcare issue worldwide that leads to long waits and poorer healthcare outcomes. Goldratt’s theory of constraints (TOC) has been used effectively to improve such problematic environments for more than three decades. While most TOC solutions are simple, with many viewing them as purely common sense, they represent paradigm shifts in how to manage complex, uncertain, and silo environments. Goldratt used a simple dice game with a straight flow (I-shape) to illustrate the impact of dependent resources and statistical fluctuations in managing resources. Additionally, games help to overcome resistance to change and gain ownership by having participants develop their solutions. This new cooperative game illustrates an ED environment where patients may follow different care pathways according to their clinical needs, timeliness of care is measured in minutes, the demand is highly uncertain, and treatment must frequently start almost immediately. A Monte Carlo simulation validated the TOC solution to this ED game, achieving results similar to the real TOC’s implementations. Moreover, this article provides a thorough process to Socratically introduce TOC to healthcare professionals and others to recognize that the EDs’ (like other healthcare systems’) core problem is the traditional approach to managing them. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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21 pages, 404 KiB  
Article
Global Health in Swedish Nursing Curricula: Navigating the Desirable and the Necessary
by Monne Wihlborg and Helen Avery
Int. J. Environ. Res. Public Health 2021, 18(17), 9372; https://doi.org/10.3390/ijerph18179372 - 05 Sep 2021
Cited by 2 | Viewed by 1935
Abstract
Global health challenges are likely to be aggravated in the coming years by rapid climate change and environmental degradation. To address the resulting health inequities, nurses need an integrated understanding of environmental and social determinants of health. This study adopts an explorative inductive [...] Read more.
Global health challenges are likely to be aggravated in the coming years by rapid climate change and environmental degradation. To address the resulting health inequities, nurses need an integrated understanding of environmental and social determinants of health. This study adopts an explorative inductive approach to examine how global health and sustainability are expressed the course syllabi of undergraduate nursing programmes (n = 24) in Sweden. After excluding biomedical and other unrelated content, 67 syllabi were selected for a thematic analysis. Results indicate that global health, the social determinants of health and sustainability tend to appear in a fragmented manner in the syllabi. Global health content is often limited, relegated to elective courses, or altogether missing. A theoretical framework is lacking, and focus lies on an individual rather than structural perspective. Based on international policy, earlier studies on undergraduate nursing education and theoretical work, suggestions are made for how global health and sustainability content could be integrated into nursing education, notably by using a structural competency approach. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
16 pages, 1558 KiB  
Article
Assessment of Knowledge, Attitude, and Practice of Antibiotic Use among the Population of Boyolali, Indonesia: A Cross-Sectional Study
by Hidayah Karuniawati, Mohamed Azmi Ahmad Hassali, Sri Suryawati, Wan Ismahanisa Ismail, Taufik Taufik and Md. Sanower Hossain
Int. J. Environ. Res. Public Health 2021, 18(16), 8258; https://doi.org/10.3390/ijerph18168258 - 04 Aug 2021
Cited by 37 | Viewed by 9578
Abstract
Misuse and overuse of antibiotics are potential causes of the increasing prevalence of antibiotic resistance (ABR). Having information about the knowledge, attitude, and practices concerning antibiotics use by the public might help control ABR growth. Therefore, this cross-sectional study aimed to investigate the [...] Read more.
Misuse and overuse of antibiotics are potential causes of the increasing prevalence of antibiotic resistance (ABR). Having information about the knowledge, attitude, and practices concerning antibiotics use by the public might help control ABR growth. Therefore, this cross-sectional study aimed to investigate the levels and associated factors of knowledge, attitude, and practice (KAP) of antibiotics use among the public. A questionnaire was designed and validated, which consisted of a total of 51 questions with four sections: demographics (6), knowledge (20), attitude (12), and practice (13) to measure KAP. Univariate analysis (using Mann–Whitney U and Kruskal–Wallis analysis) was applied to assess the differences in the mean scores of KAP. Linear regression analysis was performed to identify factors associated with KAP. Finally, using Spearman analysis we have examined the correlation between responses to the KAP. The sample size of this study was 575, with a 99.96% response rate. Regarding knowledge, 73.12% of respondents stated that antibiotics could be used to treat viral infections, and 63.35% of respondents answered that antibiotics could reduce fever. Concerning attitude, 50% of respondents had considered stopping taking antibiotics as soon as symptoms had disappeared. In analyzing practice, we found 40% of respondents obtained antibiotics from a pharmacy without a prescription from a physician, a nurse, or a midwife. Statistical analysis revealed that KAP about antibiotic use was significantly associated with gender, area of residence, level of education, and monthly income (p < 0.05). Our findings concluded that men, respondents with low income, those with low-level education, and those living in rural areas are more prone to excessive use of antibiotics without knowing the adverse effects of improper use and how it can contribute to high ABR. So it is urgently necessary to strengthen policies on antibiotics use, including drug provision, distribution, and sales. In addition, people with low KAP should be a priority consideration in education outreach initiatives. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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Review

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37 pages, 788 KiB  
Review
Designing a Logic Model for Mobile Maternal Health e-Voucher Programs in Low- and Middle-Income Countries: An Interpretive Review
by Seohyun Lee and Abdul-jabiru Adam
Int. J. Environ. Res. Public Health 2022, 19(1), 295; https://doi.org/10.3390/ijerph19010295 - 28 Dec 2021
Cited by 2 | Viewed by 2415
Abstract
Despite the increasing transition from paper vouchers to mobile e-vouchers for maternal health in low- and middle-income countries, few studies have reviewed key elements for program planning, implementation, and evaluation. To bridge this gap, this study conducted an interpretive review and developed a [...] Read more.
Despite the increasing transition from paper vouchers to mobile e-vouchers for maternal health in low- and middle-income countries, few studies have reviewed key elements for program planning, implementation, and evaluation. To bridge this gap, this study conducted an interpretive review and developed a logic model for mobile maternal health e-voucher programs. Pubmed, EMBASE, and Cochrane databases were searched to retrieve relevant studies; 27 maternal health voucher programs from 84 studies were identified, and key elements for the logic model were retrieved and organized systematically. Some of the elements identified have the potential to be improved greatly by shifting to mobile e-vouchers, such as payment via mobile money or electronic claims processing and data entry for registration. The advantages of transitioning to mobile e-voucher identified from the logic model can be summarized as scalability, transparency, and flexibility. The present study contributes to the literature by providing insights into program planning, implementation, and evaluation for mobile maternal health e-voucher programs. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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13 pages, 461 KiB  
Review
Examining Opportunities, Challenges and Quality of Life in International Retirement Migration
by Yuan Tang and Tara Rava Zolnikov
Int. J. Environ. Res. Public Health 2021, 18(22), 12093; https://doi.org/10.3390/ijerph182212093 - 18 Nov 2021
Cited by 3 | Viewed by 2354
Abstract
As the world has become more interconnected due to the invention and innovation of communication and transportation technologies, more individuals than ever before have been able to travel long distances. In recent years, a growing number of physically able adults in late adulthood [...] Read more.
As the world has become more interconnected due to the invention and innovation of communication and transportation technologies, more individuals than ever before have been able to travel long distances. In recent years, a growing number of physically able adults in late adulthood have chosen to move across national borders to less costly countries in order to obtain better quality of life upon reaching retirement age. In light of this under-researched but increasingly popular retirement trajectory, this research aimed to provide more insight into the opportunities and challenges that international retired migrants have encountered while retiring abroad. Through the lens of humanistic theory, this research employed a systematic review of research literature, the majority of which were peer-reviewed studies published within the last five years. The reviewed studies (n = 22) conducted spanned four out of seven continents, with heavy emphasis on Europe, the Americas, and Asia. Research results indicated that many of the international retired migrants took advantage of the opportunities of pleasant weather, lower cost of living, and various amenities offered by their host countries to enhance their quality of life by engaging in an active and meaningful lifestyle. However, language barriers, lack of social support, rising healthcare costs, increases in the cost of living, uncertain political climate, and different healthcare practices in their host countries, presented considerable challenges to many international retirees. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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Other

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26 pages, 731 KiB  
Systematic Review
Community-Level Experiences, Understandings, and Responses to COVID-19 in Low- and Middle-Income Countries: A Systematic Review of Qualitative and Ethnographic Studies
by Christopher B. Raymond and Paul R. Ward
Int. J. Environ. Res. Public Health 2021, 18(22), 12063; https://doi.org/10.3390/ijerph182212063 - 17 Nov 2021
Cited by 9 | Viewed by 4021
Abstract
(1) Background: COVID-19 disruptions offer researchers insight into how pandemics are at once biological and social threats, as communities struggle to construct meaning from novel challenges to their ontological status quo. Multiple epistemes, in which public health imperatives confront and negotiate locally derived [...] Read more.
(1) Background: COVID-19 disruptions offer researchers insight into how pandemics are at once biological and social threats, as communities struggle to construct meaning from novel challenges to their ontological status quo. Multiple epistemes, in which public health imperatives confront and negotiate locally derived knowledge and traditions, vie for legitimacy and agency, resulting in new cultural forms. (2) Methods: To investigate the context and construction of community responses, a systematic review of qualitative literature was conducted with the aim of evaluating those insights provided by empirical, social field research in low- and middle-income countries since the onset of COVID-19. Six scholarly databases were searched for empirical, qualitative, field-based, or participatory research that was published in peer-reviewed journals between December 2019 and August 2021. (3) Results: Twenty-five studies were selected for data extraction, following critical appraisal for methodological rigor by two independent reviewers, and were then analyzed thematically. Faced with unprecedented social ruptures, restrictions in social and physical mobility, and ever-looming uncertainties of infection, financial insecurity, stigma, and loss, communities worldwide reacted in multiple and complex ways. Pervasive misinformation and fear of social rejection resulted in noncompliance with pandemic sanctions, resistance, and increased isolation, allowing the spread of the disease. The meaning of, and understandings about, COVID-19 were constructed using traditional, religious, and biomedical epistemologies, which were occasionally in conflict with each other. Innovations and adaptations, through syntheses of traditional and biomedical discourses and practice, illustrated community resilience and provided models for successful engagement to improve public health outcomes. (4) Conclusion: Local context and community engagement were indispensable considerations when enacting effective public health interventions to meet the challenges of the pandemic. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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9 pages, 310 KiB  
Commentary
Maternal Mortality from Induced Abortion in Malawi: What Does the Latest Evidence Suggest?
by Calum Miller
Int. J. Environ. Res. Public Health 2021, 18(19), 10506; https://doi.org/10.3390/ijerph181910506 - 07 Oct 2021
Cited by 8 | Viewed by 7554
Abstract
It is commonly claimed that thousands of women die every year from unsafe abortion in Malawi. This commentary critically assesses those claims, demonstrating that these estimates are not supported by the evidence. On the contrary, the latest evidence—itself from 15 to 20 years [...] Read more.
It is commonly claimed that thousands of women die every year from unsafe abortion in Malawi. This commentary critically assesses those claims, demonstrating that these estimates are not supported by the evidence. On the contrary, the latest evidence—itself from 15 to 20 years ago—suggests that 6–7% of maternal deaths in Malawi are attributable to induced and spontaneous abortion combined, totalling approximately 70–150 deaths per year. I then offer some evidence suggesting that a substantial proportion of these are attributable to spontaneous abortion. To reduce maternal mortality by large margins, emergency obstetric care should be prioritised, which will also save women from complications of induced and spontaneous abortion. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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