SSM - Health Systems最新文献

{"title":"Household out-of-pocket expenditure for normal and caesarean childbirth in Bangladesh","authors":"Abdur Razzaque Sarker ,&nbsp;Anik Hasan,&nbsp;Sangida Akter","doi":"10.1016/j.ssmhs.2026.100180","DOIUrl":"10.1016/j.ssmhs.2026.100180","url":null,"abstract":"<div><h3>Background</h3><div>Institutional childbirth rates have been rising rapidly worldwide, including in Bangladesh. This study aims to examine out-of-pocket expenditure (OOPE), financial distress, and associated factors related to institutional childbirth in Bangladesh using nationally representative household data.</div></div><div><h3>Methods</h3><div>This study analysed secondary data from the Bangladesh Demographic and Health Survey 2022. A generalised linear model (GLM) with a log link and gamma (γ) distribution was used to assess the associations between explanatory variables (e.g., mother's age, education, place of delivery) and the OOPE of childbirth.</div></div><div><h3>Results</h3><div>The average self-reported OOPE per institutional childbirth was USD 201.64 (median USD 180.24). C-section deliveries incurred the highest average OOPE (USD 253.01; median USD 212.05), while normal deliveries averaged USD 83.71 (median USD 53.01). Access to electronic media, wealth status, and place of delivery were significant predictors of OOPE for normal deliveries, while maternal age, education, and delivery location influenced C-section costs. These results indicate that financial distress was more common among C-section deliveries (20 %) than among normal deliveries (12 %). The concentration index (-0.234) showed financial distress was more concentrated among poorer households.</div></div><div><h3>Conclusions</h3><div>To reduce the financial burden of institutional deliveries, it is essential to strengthen social protection mechanisms, expand health insurance coverage, and ensure equitable access to quality maternal healthcare—key steps toward achieving universal maternal health coverage and reducing preventable maternal and neonatal complications.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100180"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Housing affordability, cost-of-living and NHS workforce retention in a high-cost region of England: A multiphase study","authors":"Dillon Newton ,&nbsp;Mariam Zarjoo ,&nbsp;Philip Brown ,&nbsp;Tom Simcock ,&nbsp;Joanne Garside ,&nbsp;John Stephenson ,&nbsp;Sara Eastburn ,&nbsp;Charlene Pressley ,&nbsp;Ed Ferrari ,&nbsp;David Leather ,&nbsp;Tony Gore","doi":"10.1016/j.ssmhs.2026.100175","DOIUrl":"10.1016/j.ssmhs.2026.100175","url":null,"abstract":"<div><div>Rising living costs in high-cost areas of England are causing financial strain for NHS staff, particularly those in lower pay bands. Housing affordability has become a key issue for workforce retention and poses risks to the stability of healthcare services. This study examined financial pressures facing NHS staff in two Integrated Care Systems in South East England and identified policy options to support workforce sustainability. A mixed-methods design was used that combined a survey of healthcare staff with qualitative discussions with housing providers and local authorities to explore the impact of housing costs and financial stress on decisions about whether to remain in post. Findings show that lower-paid staff faced significant difficulties securing affordable housing near their workplaces, contributing to financial hardship and intentions to leave. Stakeholders highlighted barriers such as high land costs, funding constraints and limited collaboration between the NHS and housing sectors, and proposed practical approaches including partnerships with housing providers, repurposing vacant properties and targeted financial support for staff. Stakeholders tended to frame these solutions within existing welfare-based approaches, yet the findings also suggest that where staff can afford to live has direct implications for service continuity. Considering housing for NHS staff as part of the wider infrastructure that supports essential services therefore offers an important direction for future policy.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100175"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Situational analysis of health systems for ear and hearing care in the World Health Organization (WHO) Eastern Mediterranean Region: A systematic review and evidence synthesis to inform national policies and strategies","authors":"Dialechti Tsimpida ,&nbsp;Hala Sakr ,&nbsp;Abdelrahman Elwishahy ,&nbsp;Shelly Chadha ,&nbsp;Chander Chitra ,&nbsp;Saied Mahmoudian","doi":"10.1016/j.ssmhs.2026.100170","DOIUrl":"10.1016/j.ssmhs.2026.100170","url":null,"abstract":"<div><div>In the Eastern Mediterranean Region (EMR), 78.1 million people experience hearing loss of any degree, with 22.1 million having disabling hearing loss, projected to reach 51.7 million by 2050. Unless global action is taken, the worldwide burden could reach over 700 million people with disabling hearing loss by 2050. This systematic review presents the first comprehensive health systems analysis of ear and hearing care (EHC) in the region. Following PRISMA guidelines, we analysed 146 articles through the WHO health systems framework to identify systemic barriers to effective EHC integration. Our findings reveal significant health systems challenges: fragmented governance with limited cross-sectoral coordination; inadequate financing with heavy reliance on out-of-pocket payments; critical workforce shortages across the region; and inequitable service distribution between urban and rural areas. While progress has been made with initiatives such as neonatal screening programs and primary care integration, these achievements remain limited in scope. Socioeconomic factors create additional barriers, affecting both hearing loss development and healthcare access. Alternative service delivery models, including telemedicine and task-sharing, show potential but lack systematic implementation. The economic burden of unaddressed hearing loss in the EMR ($30 billion annually) contrasts with potential returns of up to $7 per dollar invested. We propose five key actions: integrating EHC into universal health coverage, establishing comprehensive services across care levels, implementing awareness campaigns, developing monitoring systems, and promoting implementation research. This analysis provides evidence-based recommendations for health system reforms to address hearing loss while optimising resource allocation in diverse EMR contexts.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technologies used for the quantification of essential medicines in health facilities in sub-Saharan Africa: A systematic review","authors":"William N.M. Reuben ,&nbsp;Goodluck G. Nyondo ,&nbsp;Raphael Z. Sangeda ,&nbsp;Selestin J. Ngoma","doi":"10.1016/j.ssmhs.2026.100183","DOIUrl":"10.1016/j.ssmhs.2026.100183","url":null,"abstract":"<div><h3>Background</h3><div>Accurate medicine quantification is essential in Sub-Saharan Africa (SSA), where supply chain inefficiencies and persistent stock-outs undermine treatment outcomes. Although Artificial Intelligence (AI) and Machine Learning (ML) offer promising solutions, their use in the region remains poorly documented.</div></div><div><h3>Methods</h3><div>This systematic review was prospectively registered with PROSPERO (CRD42024552735) and conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of PubMed, Embase, Web of Science, and Google Scholar were searched through May 2024. Eligible studies were peer-reviewed and assessed for technologies aimed at improving quantification of medicines in SSA. Screening was performed using Covidence software and study quality was assessed with Mixed Methods Appraisal Tool (MMAT).</div></div><div><h3>Results</h3><div>Seven studies met the inclusion criteria. Three evaluated AI/ML technologies: Random Forest showed strong predictive accuracy with Root Mean Square Error (RMSE) of Train: 1.137 | Test: 1.23 and R² of Train: 0.78 | Test: 0.71; Long Short-Term Memory (LSTM) showed excellent model fit with RMSE of Train: 2.0 | Test: 2.043 and R² of Train: 0.952 | Test: 0.912. Four evaluated non-AI technologies: SMS for Life, Forced Ordering Max–Min system, and E + TRA Health system, reported reduced stock-outs and improved supply visibility. Most studies were conducted in Rwanda, Tanzania, and Uganda and demonstrated moderate to high methodological quality.</div></div><div><h3>Conclusion</h3><div>AI/ML models demonstrate potential to improve medicine quantification accuracy in SSA, while non-AI digital tools effectively reduce stock-outs. Therefore, wider adoption of context-appropriate solutions is needed to strengthen supply chain in the region.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100183"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feminist political economy analysis of labor rights and protections of Nepal’s community health workers","authors":"Roosa Sofia Tikkanen ,&nbsp;Sushmita Pokhrel ,&nbsp;Usha Ghimire ,&nbsp;Biraj Neupane ,&nbsp;Svea Closser ,&nbsp;Bernadette Nirmal Kumar","doi":"10.1016/j.ssmhs.2025.100158","DOIUrl":"10.1016/j.ssmhs.2025.100158","url":null,"abstract":"<div><div>Community health workers are a feminized cadre often engaged informally with low pay and without labor law protections. Feminist political economy (FPE) argues that the undervaluation of health and care workers relates to gendered assumptions around skill and motivation. We examined the labor rights and protections of Nepal’s Female Community Health Volunteers (FCHVs) through an FPE lens to assess the valuation of their work by decision-makers and the opportunity costs of volunteering. Our case study design collected data from 165 documents, 26 semi-structured interviews and five focus groups from four districts in Bagmati province, analysed via thematic analysis using a two-pronged framework derived from the World Health Organization’s recommendations for CHW programs and health workforce labor rights: ‘remuneration fairness’ relative to cost of living, labor market and workload, and ‘social protection’ as insurance, retirement benefits and legal recognition. Remuneration was not considered ‘fair’ relative to living costs, labor market context or their workload, contributing to turnover among younger, higher-educated FCHVs. Social protection gaps persisted around health and life insurance, and retirement compensation was low relative to the longstanding experience of some FCHVs. Although informality impedes FCHVs’ labor rights, some municipalities have added incentives and expanded social protections, in part through female Deputy Mayors and FCHVs elected into local government. Gendered assumptions around time availability and skill persist among policymakers, contributing to the low valuation of FCHV labor.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From legacy systems to real-time response: VPD-SMART implementation and its impact on public health surveillance in Paraguay and the Americas","authors":"Claudia Ortiz ,&nbsp;Felipe A. Millacura ,&nbsp;Christian Atavillos ,&nbsp;Pamela Bravo-Alcántara ,&nbsp;Juan Espinoza ,&nbsp;Victor Osorio ,&nbsp;Carolina Baeza ,&nbsp;Paola Ojeda ,&nbsp;Fernando Revilla ,&nbsp;Carmelita Pacis ,&nbsp;Susana Bobadilla ,&nbsp;Faviola Araceli ,&nbsp;Pablo Del Medico ,&nbsp;Carlos Tejo ,&nbsp;Enzo Rossi ,&nbsp;Fabian Ordoñez ,&nbsp;Silvana Zapata-Bedoya ,&nbsp;Emilia Cain ,&nbsp;Pilar Tavera ,&nbsp;Mirta Magarinos ,&nbsp;Martha Velandia-Gonzalez","doi":"10.1016/j.ssmhs.2025.100166","DOIUrl":"10.1016/j.ssmhs.2025.100166","url":null,"abstract":"<div><div>In the Americas, traditional public health surveillance systems often face a significant data-use gap, hindering a timely response to vaccine-preventable diseases (VPDs). This manuscript details the implementation of VPD-SMART, a novel DHIS2-based system, as a digital transformation initiative to enhance VPD surveillance and bridge this gap. We analyze Paraguay's transition from the legacy Integrated Surveillance Information System (ISIS) to VPD-SMART, focusing on how its functionalities, including real-time decentralized data collection and enhanced analysis, improve the performance of health information systems. We find that the transition to VPD-SMART significantly improved data quality, consistency, and timeliness. A quantitative analysis showed a notable increase in data completeness and a rise in consistency for key variables from 54 % to 97 %. The average time for data entry also decreased, shifting from a weekly to a daily basis. Qualitative findings confirm that the system empowers health authorities with real-time, data-driven insights. By examining these challenges and opportunities, we provide empirical evidence on how leveraging DHIS2 can enhance public health surveillance and inform similar digital transformation efforts in other low- and middle-income countries.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and opportunities for policy development on digital health equity in four Canadian jurisdictions","authors":"James Shaw ,&nbsp;Caroline Tait ,&nbsp;Ubaka Ogbogu ,&nbsp;Lorian Hardcastle ,&nbsp;Ewan Affleck ,&nbsp;Ivar Mendez ,&nbsp;Ambreen Sayani ,&nbsp;Sheryl Spithoff ,&nbsp;Simone Shahid ,&nbsp;Sumaya Mehelay ,&nbsp;Heather Ross ,&nbsp;Janine Badr ,&nbsp;Amy Ma ,&nbsp;Jean-Louis Denis","doi":"10.1016/j.ssmhs.2025.100164","DOIUrl":"10.1016/j.ssmhs.2025.100164","url":null,"abstract":"<div><div>Digital health equity is an increasingly important topic, understood here as an aspirational state where everyone has access to the health-related digital technologies that support them in meeting their health-related needs. Despite strong emerging evidence regarding policy options to promote digital health equity, little policy action has been taken internationally to implement these options. The purpose of this paper is to report on a qualitative research project that explores the challenges and opportunities for policy development and implementation on digital health equity in four Canadian jurisdictions: Alberta, Saskatchewan, Ontario, and Quebec. We completed an Intersectionality-Based Policy Analysis, involving in-depth qualitative interviews with 23 participants, including both policy actors (i.e., those in positions to develop and/or implement digital health equity policy) and community leaders (i.e., those in positions advocating for the needs of structurally marginalized communities). Our findings illustrate a set of foundational policy options and more tailored policy programs for digital health equity, including the development of equity-focused accountability processes in new funding for digital health innovation. We also found challenges related to the political structure of Canada as a federation, and novel challenges related to the development of policy for digital health equity specifically. In our discussion, we explore three policy development challenges in detail: conflicting views on the priority status of health equity, challenges in building long-term partnerships with community for policy development, and conflicting views on the role of technology vendors in public policy for health care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A mixed-methods study of expanding later abortion care at two U.S. facilities","authors":"Tracy A. Weitz ,&nbsp;Adrian Davis ,&nbsp;Malcolm Wilson Schwartz ,&nbsp;Julia E. Kohn","doi":"10.1016/j.ssmhs.2025.100161","DOIUrl":"10.1016/j.ssmhs.2025.100161","url":null,"abstract":"<div><div>After the U.S. Supreme Court overturned the federal right to abortion in 2022, many state laws continued to define abortion in relation to the “viability” standard established in <em>Roe v. Wade</em> (1973) and <em>Planned Parenthood v. Casey</em> (1992). Providers often operationalized this concept as an ultrasound reading of 24 weeks’ pregnancy duration, despite broad discretion to determine viability. This study examines how two Illinois facilities expanded abortion services from the commonly accepted 24-week threshold to 28 weeks. We employed a mixed-methods design including an anonymous online staff survey, qualitative interviews with a purposive sample of clinical and non-clinical staff, and analysis of administrative patient data. We aimed to identify factors that enabled or constrained service expansion and to document staff experiences. We used administrative data to assess patient characteristics. To address critiques that research on barriers and facilitators can be overly general, we triangulated findings across data sources with attention to the specific requirements of providing later abortion care. Findings highlight the importance of a supportive organizational culture—characterized by decisive leadership, tolerance for legal risk, commitment to later-care patients, and engagement with an enabling ecosystem. Equally critical was the ability to adapt service delivery, including staffing, clinical flow, pain management, and around-the-clock care. We find evidence that young people, people of color, and people from outside Illinois directly benefited from the expansion. This study contributes to understanding how health systems navigate change in contexts of high stigma, with implications for later abortion care and other contested services.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking cross-border health systems for contexts of mobility and forced displacement","authors":"Fouad Fouad ,&nbsp;Kyu Kyu Than ,&nbsp;Maria Paola Bertone ,&nbsp;Sophie Witter ,&nbsp;Nyi Nyi Kyaw ,&nbsp;Ibrahim R. Bou-Orm","doi":"10.1016/j.ssmhs.2026.100172","DOIUrl":"10.1016/j.ssmhs.2026.100172","url":null,"abstract":"<div><div>Health systems today are deeply affected by conflicts, forced displacement, and other stressors such as climate change. Traditional health system frameworks, while influential, often assume stable, territorially bounded national systems and do not fully capture the realities of mobility, contested authority, and health care seeking and delivery across borders. This paper explores how health systems operate in contexts where both internationally recognized borders and internal power lines shape the dynamics of health provision for displaced and mobile populations. Drawing on illustrative cases from Northwest Syria and Myanmar, we examine how health systems adapt across and beyond borders in the absence of formal national response. In Syria, humanitarian cross-border mechanisms, local governance bodies, and mobile referral networks have sustained care despite fragmented authority. In Myanmar, ethnic health organizations, diaspora networks, and transnational supply chains have long supported communities in border areas, with populations frequently moving across borders into Thailand, China, and Bangladesh to access essential care. We propose a new approach to cross-border health systems that includes recognizing the roles of non-state and humanitarian actors, enabling flexible financing and workforce recognition across jurisdictions, and developing interoperable data systems sensitive to mobility. By incorporating these dimensions, health systems can be better understood and supported in ways that reflect the realities of forced displacement and mobility in complex conflict-affected settings.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“They have my number, but they have not called to check up on me”: Exploring trust in the health care system among sex workers living with HIV in Kumasi, Ghana","authors":"Miesha Polintan ,&nbsp;Elijah Bisung ,&nbsp;Ebenezer Dassah","doi":"10.1016/j.ssmhs.2026.100177","DOIUrl":"10.1016/j.ssmhs.2026.100177","url":null,"abstract":"<div><div>Sex workers are disproportionately affected by the global HIV epidemic, yet distrust in the health system, driven by stigma and criminalization, hinders early testing and treatment. Despite significant progress, Ghana has fallen behind on the UNAIDS 95–95–95 targets. The unique intersectional experiences of sex workers living with HIV (SWLH) often go underreported, as studies primarily focus on sex work or HIV in isolation. This ethnographic study explores how the intersecting identities and care experiences of SWLH influence trust within the health system in Kumasi, Ghana. Semi-structured interviews were conducted with SWLH (n = 18) and key informants (n = 8). The data was analyzed thematically. Four key themes shaped SWLHs’ trust in the health care system: Communication, Confidentiality, Stigma, and Education. Transparent communication, regular check-ins, and provider attentiveness fostered trust, whereas inconsistent follow-ups and non-consensual testing created barriers. While confidentiality safeguards reassured patients, fears of unintentional disclosure by service providers remained. Stigma, both self-imposed and external, led some participants to avoid care or relocate to other communities. Education was critical to treatment adherence, yet misinformation about HIV persisted, underscoring the need for improved public health messaging. Strengthening trust requires patient-centered approaches, including transparent communication, strict confidentiality, stigma reduction, and comprehensive education. These could be achieved through tailored interventions, including enhanced provider training, peer-led programs, and community-centred awareness campaigns. While this research provides critical insights, further studies are needed to explore regional variations and structural influences on trust. Integrating SWLH voices in policy and program development is essential for creating sustainable, inclusive healthcare solutions.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100177"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}