Global Public Health最新文献

An intersectional analysis of social constraints and agency among sex workers in Tunisia during the COVID-19 pandemic; the community-based qualitative study EPIC-MENA. COVID-19大流行期间突尼斯性工作者的社会约束和机构交叉分析基于社区的定性研究EPIC-MENA。

IF 2.3 3区医学

Global Public Health Pub Date : 2025-12-01 Epub Date: 2025-04-03 DOI: 10.1080/17441692.2025.2486436

Marion Di Ciaccio, Elisa Adami, Nassima Boulahdour, Othmane Bourhaba, Juliana Castro Avila, Nicolas Lorente, Khawla Beldi Chouikha, Montassar Nabli, Sonia Torkhani, Mehdi Karkouri, Daniela Rojas Castro

{"title":"An intersectional analysis of social constraints and agency among sex workers in Tunisia during the COVID-19 pandemic; the community-based qualitative study EPIC-MENA.","authors":"Marion Di Ciaccio, Elisa Adami, Nassima Boulahdour, Othmane Bourhaba, Juliana Castro Avila, Nicolas Lorente, Khawla Beldi Chouikha, Montassar Nabli, Sonia Torkhani, Mehdi Karkouri, Daniela Rojas Castro","doi":"10.1080/17441692.2025.2486436","DOIUrl":"https://doi.org/10.1080/17441692.2025.2486436","url":null,"abstract":"The economic, social and health impacts of the COVID-19 pandemic varied across population groups. This study aimed to provide a comprehensive view of the effects of socioeconomic constraints on sex workers' agency during the COVID-19 pandemic in Tunisia, using the analytical framework of intersectionality. We performed a thematic content analysis of semi-structured interviews conducted with sex workers (n = 19). Results highlighted the heavy burden of socioeconomic constraints on their agency, and specifically on their decision to continue sex work or not during the pandemic. The fact that there were fewer clients during the pandemic led to greater economic precarity, especially among mothers. Furthermore, interviewees - mostly cisgender male sex workers with same-sex practices - reported increased violence and discrimination by clients and the police. Participants also experienced difficulties accessing health care for themselves and for their children, including access to COVID-19 vaccination. This was especially true for women with a low educational level. Finally, sex workers' mental health was also strongly affected by the pandemic. Findings highlights the role of various intersecting socioeconomic conditions and structural vulnerabilities on sex workers' experience of the COVID-19 pandemic in Tunisia, in terms of health and their capacity to negotiate agency.","PeriodicalId":12735,"journal":{"name":"Global Public Health","volume":"20 1","pages":"2486436"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Social capital as an instrument for health literacy promotion among community-dwelling older adults in Hong Kong. 社会资本作为促进香港社区长者健康知识普及的工具。

IF 2.3 3区医学

Global Public Health Pub Date : 2025-12-01 Epub Date: 2025-04-07 DOI: 10.1080/17441692.2025.2486433

Padmore Adusei Amoah, Vera Mun Yu Tang, Moses Adjei

{"title":"Social capital as an instrument for health literacy promotion among community-dwelling older adults in Hong Kong.","authors":"Padmore Adusei Amoah, Vera Mun Yu Tang, Moses Adjei","doi":"10.1080/17441692.2025.2486433","DOIUrl":"https://doi.org/10.1080/17441692.2025.2486433","url":null,"abstract":"This study investigates how different forms of social capital influence the health literacy of community-dwelling older adults. Semi-structured interviews were conducted with 24 older adults aged 65 and above living in Hong Kong. Thematic analysis technique was employed to analyse the data. The findings showed that both structural and cognitive forms of social capital were available to most of the older adults. However, some struggled to access common forms of social capital, such as bonding and expressed distrust in their neighbours. Some respondents demonstrated sufficient health literacy (e.g. seeking a second medical opinion), while others had limited health literacy (e.g. difficulties seeking advice during medical consultations). The influence of social capital on older adults' health literacy was evident in four areas: (1) social capital and access to health information; (2) managing infodemic and evaluating healthcare information; (3) social capital and quality of healthcare; and (4) adverse influence of social capital for health literacy and health-related outcomes. Health literacy can impel older adults towards healthy ageing, and its reinforcement can be strengthened by incorporating various forms of social capital. This is because the health literacy of older adults is fundamentally tied to social interactions.","PeriodicalId":12735,"journal":{"name":"Global Public Health","volume":"20 1","pages":"2486433"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Barriers and enablers towards integrated care for survivors of sexual violence in humanitarian settings: A real-time qualitative Delphi study. 人道主义环境中性暴力幸存者综合护理的障碍和推动因素：一项实时定性德尔菲研究。

IF 2.3 3区医学

Global Public Health Pub Date : 2025-12-01 Epub Date: 2025-02-04 DOI: 10.1080/17441692.2025.2460016

Engy Sawah, Karina Kielmann, Joris Michielsen

{"title":"Barriers and enablers towards integrated care for survivors of sexual violence in humanitarian settings: A real-time qualitative Delphi study.","authors":"Engy Sawah, Karina Kielmann, Joris Michielsen","doi":"10.1080/17441692.2025.2460016","DOIUrl":"https://doi.org/10.1080/17441692.2025.2460016","url":null,"abstract":"In humanitarian settings with high levels of sexual violence (SV), care is often offered through fragmented silos, exacerbating the burden on the health workforce and survivors. We aimed to identify contextual and health systems barriers and enablers to providing integrated medical and mental health & psychosocial support (MHPSS) in the care for SV survivors in humanitarian settings. Using Valentijn's framework, a qualitative, real-time Delphi study (RTD) approach was conducted with 17 experts representing seven geographical subregions. Challenges and enablers identified across the participants' contexts were consistent. Contextual challenges included volatile contexts, collapsed health systems, and insufficient basic infrastructure. Professional-related challenges included lacking expertise among healthcare professionals (HCPs), high staff attrition rates, and compassion fatigue. Health systems-related challenges included poor referral and coordination mechanisms, lack of funding and resources, misaligned donor priorities and low prioritisation of SV comprehensive care. Effective networking, community engagement, capacity building, co-locating services, participatory management, promoting employees' sense of ownership, establishing a digital information system, and a unified joint patient file were key identified enablers. Further research should be conducted to assess HCPs' and SV survivors' perceptions and experiences of how best to integrate MHPSS services, and understand the challenges and opportunities in delivering integrated services.","PeriodicalId":12735,"journal":{"name":"Global Public Health","volume":"20 1","pages":"2460016"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Research in compulsory drug detention centres in China: Characteristics and ethical considerations. 中国强制戒毒拘留中心研究：特点与伦理思考。

IF 2.3 3区医学

Global Public Health Pub Date : 2025-12-01 Epub Date: 2025-01-10 DOI: 10.1080/17441692.2024.2447795

Yazid Barhoush, Joseph J Amon

{"title":"Research in compulsory drug detention centres in China: Characteristics and ethical considerations.","authors":"Yazid Barhoush, Joseph J Amon","doi":"10.1080/17441692.2024.2447795","DOIUrl":"10.1080/17441692.2024.2447795","url":null,"abstract":"More than 500 centres in China hold over 300,000 individuals in what has been described by the United Nations as unethical and ineffective compulsory treatment and rehabilitation centres. Individuals in these centres face widespread human rights abuses, including lack of due process, forced labour, physical and sexual violence, and denial of healthcare. Because of the vulnerability of individuals in detention settings to abuse in research trials, ethical guidelines have required research to pose no more than minimal risk, to address the process of incarceration, and the health or well-being of detained individuals. To understand the scope and ethical protections of research conducted in Chinese drug detention centres, we conducted a literature review by searching the China Academic Journals Database for Chinese language research articles published between 2012-2021. We identified 68 articles of drug detention detainees that examined physical and psychosocial health; infectious disease prevalence; past drug use; and other topics. The majority of studies (56%) did not provide any information on the consent of research participants. Only ten (15%) studies reported receiving ethics approval. No studies examined the process or conditions of detention. Journal editors, in China and globally, should increase scrutiny of research conducted in compulsory drug detention settings.","PeriodicalId":12735,"journal":{"name":"Global Public Health","volume":"20 1","pages":"2447795"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The effectiveness of coercive measures in motivating vaccination: Evidence from China during the COVID-19 pandemic. 强制措施在推动疫苗接种方面的有效性：来自COVID-19大流行期间中国的证据

IF 2.3 3区医学

Global Public Health Pub Date : 2025-12-01 Epub Date: 2025-01-07 DOI: 10.1080/17441692.2024.2445827

Yue Guan

{"title":"The effectiveness of coercive measures in motivating vaccination: Evidence from China during the COVID-19 pandemic.","authors":"Yue Guan","doi":"10.1080/17441692.2024.2445827","DOIUrl":"https://doi.org/10.1080/17441692.2024.2445827","url":null,"abstract":"Governments worldwide have implemented mandates, restrictions, and other coercive measures to secure adequate vaccine coverage, with the COVID-19 pandemic providing numerous examples. While the ethics and public reception of such measures are matters of heated discussion, their effectiveness in motivating individuals to get vaccinated remains incompletely understood. This study addresses that gap by analyzing data from a 2022 nationwide online survey conducted in China. Respondents recruited through proportional quota sampling to reflect key demographic characteristics of the population were asked to specify their COVID-19 vaccination status and the reason behind their decision. Results reveal that while most respondents reported getting vaccinated voluntarily, 14.6% attributed their vaccination to the government's coercive mobilisation efforts. Moreover, members of the ruling Chinese Communist Party, as well as individuals favouring Western vaccines unavailable in China, were more likely to cite coercive mobilisation as the reason for their vaccination. These findings suggest that coercive measures can motivate a substantial proportion of the population to get vaccinated, especially those closely connected to the political system and those with unmet vaccination preferences. Given the controversy surrounding such measures, this enhanced understanding of their effectiveness could help with formulating targeted policies to combat infectious diseases and safeguard public health.","PeriodicalId":12735,"journal":{"name":"Global Public Health","volume":"20 1","pages":"2445827"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Parallel systems in healthcare: Addressing Indigenous health equity in Canada. 医疗保健平行系统：解决加拿大土著居民健康公平问题。

IF 2.3 3区医学

Global Public Health Pub Date : 2025-12-01 Epub Date: 2025-01-20 DOI: 10.1080/17441692.2025.2452195

Anika Sehgal, Andrea Kennedy, Katharine McGowan, Lynden Lindsay Crowshoe

{"title":"Parallel systems in healthcare: Addressing Indigenous health equity in Canada.","authors":"Anika Sehgal, Andrea Kennedy, Katharine McGowan, Lynden Lindsay Crowshoe","doi":"10.1080/17441692.2025.2452195","DOIUrl":"https://doi.org/10.1080/17441692.2025.2452195","url":null,"abstract":"The Canadian public healthcare system faces significant challenges in performance. While the formal healthcare system addresses funding, access and policy, there is a critical need to prioritise the informal system of community-oriented networks. This integration aligns with the World Health Organization's primary health care approach, emphasising a whole-of-society strategy for health equity. Canada's healthcare, harmonised through the Canada Health Act of 1984, focuses on need over ability to pay. Despite successes, the system struggles with social determinants of health and widening health inequities, especially among Indigenous peoples. Historical policies of forced assimilation have led to poor health outcomes and lower life expectancies for Indigenous populations. The Truth and Reconciliation Commission's Calls to Action stress removing barriers at multiple levels to improve Indigenous health. Indigenous perspectives on health, emphasising holistic wellness, contrast with Western healthcare's acute-illness focus. The emergence of parallel systems, informal networks within healthcare, reflects dissatisfaction with traditional approaches. Recognising the parallel system within Indigenous health, as proposed, can transform healthcare to better meet population needs. Systems mapping of Indigenous PHC in Alberta revealed numerous entities providing healthcare access, highlighting the importance of adequately funding and integrating these parallel systems to advance health equity.","PeriodicalId":12735,"journal":{"name":"Global Public Health","volume":"20 1","pages":"2452195"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mapping care pathways: Clinical providers' perspectives on process maps of HIV service delivery in Uganda. 绘制护理路径：临床提供者对乌干达艾滋病毒服务提供过程图的看法。

IF 2.3 3区医学

Global Public Health Pub Date : 2025-12-01 Epub Date: 2025-03-20 DOI: 10.1080/17441692.2025.2479660

Monica Jordan, Elizabeth Ekirapa Kiracho, Tozoe Marton, Gerald Karegyeya, Thomas Maina, Anthony Ssebagereka, Richard Ssempala, Rebecca Ross, Steven Forsythe, Allyala Nandakumar, Ryan McBain

{"title":"Mapping care pathways: Clinical providers' perspectives on process maps of HIV service delivery in Uganda.","authors":"Monica Jordan, Elizabeth Ekirapa Kiracho, Tozoe Marton, Gerald Karegyeya, Thomas Maina, Anthony Ssebagereka, Richard Ssempala, Rebecca Ross, Steven Forsythe, Allyala Nandakumar, Ryan McBain","doi":"10.1080/17441692.2025.2479660","DOIUrl":"https://doi.org/10.1080/17441692.2025.2479660","url":null,"abstract":"In Uganda, where HIV prevalence remains high, innovative strategies are sought to achieve 95-95-95 targets in combating the epidemic. In 2020, Uganda joined the Activity-Based Costing and Management (ABC/M) Initiative, a multi-country effort to monitor resource allocation and funding for HIV services. As part of this Initiative, data collectors generated process maps, specific to each facility, from the data collected by observing patients as they navigated the healthcare system. This study assessed clinical providers' perceptions of process maps used in the ABC/M Initiative in Uganda to identify the benefits and limitations in informing service delivery. Clinical providers from 14 purposively selected facilities participated in key informant (KI) interviews to review and discuss process map impressions. Thematic content analysis revealed: (1) KIs were enthusiastic about process maps, recognising their value in quality and efficiency; (2) KIs perceived opportunities for improvements, including revising how process maps depicted the staff and infrastructure; and (3) KIs expressed confusion in interpreting specific facets of process maps. Our study highlights the nuanced perspectives of clinical providers regarding process maps' functions within their facilities. These findings underscore the importance of ongoing review and analysis of process maps within the ABC/M initiative, facilitating a culture of continuous quality improvement and enhanced resource allocation.","PeriodicalId":12735,"journal":{"name":"Global Public Health","volume":"20 1","pages":"2479660"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Attitudes and behaviours associated with HIV transmission in men who have sex with men in Portugal - a qualitative study. 葡萄牙男男性行为者中与艾滋病毒传播相关的态度和行为——一项定性研究。

IF 2.3 3区医学

Global Public Health Pub Date : 2025-12-01 Epub Date: 2025-03-24 DOI: 10.1080/17441692.2025.2480645

Filipa Correia, Kenneth Camargo, Paulo Nossa, Ana Aboim Horta, Margarida Correia-Neves, Alice Delerue-Matos

{"title":"Attitudes and behaviours associated with HIV transmission in men who have sex with men in Portugal - a qualitative study.","authors":"Filipa Correia, Kenneth Camargo, Paulo Nossa, Ana Aboim Horta, Margarida Correia-Neves, Alice Delerue-Matos","doi":"10.1080/17441692.2025.2480645","DOIUrl":"https://doi.org/10.1080/17441692.2025.2480645","url":null,"abstract":"HIV pandemic continues to affect key populations more than the general population, namely young men who have sex with men (MSM) [UNAIDS. (2023). The path that ends AIDS: UNAIDS global AIDS update 2023. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/sites/default/files/media_asset/2023-unaids-global-aids-update_en.pdf]. This study aimed to identify and better understand the attitudes and behaviours associated with HIV transmission in young MSM, and their awareness and motivation to use pre-exposure prophylaxis (PrEP). In 2022 and 2023, we interviewed 23 MSM between 20 and 30 years old. A hybrid methodology - inductive and deductive - was used for content analysis. Trust in partners, drug use, fetishisation regarding condomless sex and yielding to a partner's desire due to lack of assertiveness were highlighted as motivations for unprotected sex. Shame and fear of stigma were identified as potential inhibitory factors for HIV testing. Some concerns and lack of awareness regarding PrEP were noted, along with barriers to access, due to long waiting times for consultations and lack of knowledge or judgment by healthcare professionals. This study reinforces the need to invest in sex education and empowerment strategies, through a sexual orientation-sensitive approach, in the context of health education and care provision, as well as the need for training and streamlining PrEP fast-track protocols.","PeriodicalId":12735,"journal":{"name":"Global Public Health","volume":"20 1","pages":"2480645"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Engage less, provide more: Community health workers' perspectives on how to overcome opposition to polio vaccination in Pakistan. 少参与，多提供：巴基斯坦社区卫生工作者对如何克服反对脊髓灰质炎疫苗接种的看法。

IF 2.3 3区医学

Global Public Health Pub Date : 2025-12-01 Epub Date: 2025-02-11 DOI: 10.1080/17441692.2025.2465645

Arman Majidulla, Marium A Sultan, Ayesha Zaman, Muhammad Shafique, Saeed Ahmed, Farah Naz, Sadaf Nayyab, Ali Sohail

{"title":"Engage less, provide more: Community health workers' perspectives on how to overcome opposition to polio vaccination in Pakistan.","authors":"Arman Majidulla, Marium A Sultan, Ayesha Zaman, Muhammad Shafique, Saeed Ahmed, Farah Naz, Sadaf Nayyab, Ali Sohail","doi":"10.1080/17441692.2025.2465645","DOIUrl":"https://doi.org/10.1080/17441692.2025.2465645","url":null,"abstract":"Pakistan has 40 Super High Risk Union Councils (SHRUCs) where polio has been persistently endemic, and community relationships have been a persistent challenge due to campaign fatigue and violent, organised resistance. This study aimed to gather perspectives from frontline workers in these areas to improve community engagement. We conducted participant observation, over 100 interviews, and held Human-centred Design inspired sessions with 171 teams of frontline polio staff from 2020 to 2022 in the SHRUCs of a major city in Pakistan. The results show that frontline polio workers repeatedly visited households broadly neglected by government services in SHRUCs, but some households refused the vaccine due to fatigue from multiple visits and fear of government surveillance. Others refused the vaccine to draw attention to their more pressing needs. Frontline polio workers suggested that decreasing touchpoints and providing additional services, such as food, medicines, primary health care, and sanitation services, would improve vaccine uptake. We discuss several implications for vaccine communications, including the importance of quality engagement, the legitimacy of rumours surrounding vaccination, the limited applicability of 'vaccine hesitancy', and the critical role of service provision in improving vaccine acceptability.","PeriodicalId":12735,"journal":{"name":"Global Public Health","volume":"20 1","pages":"2465645"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does a values clarification and attitudes transformation (VCAT) workshop influence provider attitudes, knowledge, and service provision related to abortion care?: Evidence from a mixed-methods longitudinal randomised controlled trial in Ethiopia. 价值观澄清和态度转变（VCAT）研讨会是否影响提供者对堕胎护理的态度、知识和服务提供？来自埃塞俄比亚一项混合方法纵向随机对照试验的证据。

IF 2.3 3区医学

Global Public Health Pub Date : 2025-12-01 Epub Date: 2025-02-21 DOI: 10.1080/17441692.2025.2465643

Alexandra Wollum, Katherine Key, Teshager Mersha, Martha Nicholson, Georgina Page, Kate Austen, Mamo Elias Endale, Heidi Moseson

{"title":"Does a values clarification and attitudes transformation (VCAT) workshop influence provider attitudes, knowledge, and service provision related to abortion care?: Evidence from a mixed-methods longitudinal randomised controlled trial in Ethiopia.","authors":"Alexandra Wollum, Katherine Key, Teshager Mersha, Martha Nicholson, Georgina Page, Kate Austen, Mamo Elias Endale, Heidi Moseson","doi":"10.1080/17441692.2025.2465643","DOIUrl":"https://doi.org/10.1080/17441692.2025.2465643","url":null,"abstract":"Despite being widely implemented, little information exists on the effect of Value Clarification and Attitude Transformation (VCAT) workshops on health care provider knowledge and attitudes and abortion provision. Between 2019 and 2021, we conducted a cluster-randomised controlled trial among 101 private abortion-providing healthcare facilities in Ethiopia. We surveyed 217 providers prior to a VCAT workshop and again at 2 weeks, 6 months, and one year following VCAT workshop participation to understand abortion knowledge and attitudes, examined service statistics to assess abortion client volumes, and conducted in-depth interviews with 30 providers. We found that a VCAT workshop for providers increased abortion service provision. In the year following the workshop, intervention facilities served 13% more abortion clients than expected based on the control group trend (95% CI: 6%-21%, p = .01). VCAT workshops moderately improved knowledge and supportive attitudes about abortion in the short-term. The VCAT workshop worked to change providers' attitudes by highlighting the importance of abortion in protecting clients from potential death and harm, but providers were less comfortable providing care to patients in situations deemed to be less socially justified (e.g. for married clients). Results support implementing ongoing VCAT refreshers with additional emphasis on client autonomy, cultural norms, and person-centred care.Trial registration: ClinicalTrials.gov identifier: NCT04181021.","PeriodicalId":12735,"journal":{"name":"Global Public Health","volume":"20 1","pages":"2465643"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0