Dialogues in health最新文献

{"title":"‘Beyond core business’: A qualitative review of activities supporting environmental health within remote Western Australian schools","authors":"Stephanie L. Enkel ,&nbsp;Rebecca Dalton ,&nbsp;Chicky Clements ,&nbsp;Hannah M.M. Thomas ,&nbsp;Tracy McRae ,&nbsp;Ingrid Amgarth-Duff ,&nbsp;Marianne Mullane ,&nbsp;Lisa Wiese ,&nbsp;Liam Bedford ,&nbsp;Nina Lansbury ,&nbsp;Jonathan R. Carapetis ,&nbsp;Edie Wright ,&nbsp;Asha C. Bowen","doi":"10.1016/j.dialog.2025.100215","DOIUrl":"10.1016/j.dialog.2025.100215","url":null,"abstract":"<div><h3>Background</h3><div>Aboriginal children and families contend with higher rates of preventable infectious diseases that can be attributed to their immediate living environment. The environments in which children spend most of their time are their homes and schools. We aimed to understand the opportunities in the school setting to support student skin health and wellbeing through environmental health activities, how these activities were completed, and the barriers to their implementation.</div></div><div><h3>Methods</h3><div>Recognising the importance of healthy skin for educational success, this work was embedded within a larger cluster randomised stepped-wedge Trial aimed at reducing the rate of skin infections among Aboriginal children living in the Kimberley region of Western Australia by 50 %. We used qualitative data collected via a culturally appropriate yarning methodology during trial evaluation interviews. The data from 35 yarns with 41 individuals were thematically analysed.</div></div><div><h3>Findings</h3><div>Data indicated that schools serve as a hub of health and hygiene support and maintenance, with school staff balancing teaching responsibilities while also meeting the basic health and wellbeing needs of students. Uncertainties regarding funding and policies governing these activities remained; ongoing exploration is required.</div></div><div><h3>Interpretation</h3><div>Staff in remote Kimberley schools devote substantial time and resources to supporting student hygiene needs, often stepping in when health infrastructure at home is inadequate. These activities are seen as necessary to support student wellbeing and participation in learning. While schools are well-positioned to respond in this way, these responsibilities extend beyond their core role and place additional pressure on staff and budgets. There is a need to better understand how such work is resourced and to consider how policy and funding frameworks might more formally support it.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"6 ","pages":"Article 100215"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848157","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":"Health disparity at the intersection of religion and caste: Evidence from India","authors":"Biplab Kumar Datta ,&nbsp;Shriya Thakkar","doi":"10.1016/j.dialog.2024.100186","DOIUrl":"10.1016/j.dialog.2024.100186","url":null,"abstract":"<div><h3>Objective</h3><p>The provisions and recognition of Schedule Castes (SCs), the constitutional term for the Dalits in India, have been exclusively extended to Hindus, Buddhists, and Sikhs (HBS). Omission of Dalit Muslims and Christians (MC) from the SC category stripped them of the affirmative action benefits tied with the SC status. This study aimed to explore how such differential treatment might play a role in differential health outcomes in Dalit women in India.</p></div><div><h3>Methods</h3><p>Drawing data on 177,346 Dalit women, aged 20 to 49 years, from two successive nationally representative surveys, we assessed the differential likelihood of hypertension and diabetes, between MC- and HBS- Dalit women. Accounting for birth cohort-, survey wave-, and state of residence- fixed effects, along with socioeconomic conditions and cardiometabolic risk factors, we obtained adjusted odds of having hypertension and diabetes in MC women. To check the validity of our results, we conducted similar analyses using data on 170,889 Scheduled Tribe (ST) women, another marginalized group, whose ST-status recognition were not tied to religion.</p></div><div><h3>Results</h3><p>We found that Dalit MC women were 1.13 (95% CI: 1.03–1.25) and 1.19 (95% CI: 1.05–1.36) times more likely to have hypertension and diabetes, respectively, compared to Dalit HBS women. Conversely, no statistically significant differential likelihood of these conditions was observed between MC and HBS women in the ST sample.</p></div><div><h3>Conclusion</h3><p>Our investigation thus, indicated a potential link at the crossroads of religion and caste that may contribute to the health disparities among marginalized women in India.</p></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"5 ","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772653324000224/pdfft?md5=1a72cad904fb9b30a72822d49d7d4d12&pid=1-s2.0-S2772653324000224-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fishing with skis, digging with noodles: Resolving task-and-tool mismatches in efforts to advance health equity","authors":"Katrina Plamondon ,&nbsp;Sana Z. Shahram","doi":"10.1016/j.dialog.2024.100200","DOIUrl":"10.1016/j.dialog.2024.100200","url":null,"abstract":"<div><div>When it comes to advancing equity, across the health sciences, efforts repeatedly target interventions on those most burdened by inequities rather than the systems or structures that give rise to inequities. This mismatch, in and of itself, is an important determinant of equity. While many conceptual models draw collective attention to deeper, structural causes (e.g., social, political, and commercial determinants of health) as the 'what', inattention to questions of 'how'–or the collective practices that serve to connect what is known with what is done–are like a wedge holding this gap in place. In this article, we use an exaggerated metaphor of mismatched task-and-tool to provoke critically reflective dialogue about collective attachment to scholarship and practices incoherent with our own body of knowledge. We offer a set of five practices easily integrated in any aspect of work related to advancing equity, through everyday actions anyone (anywhere) can take to purposefully act from an evidence and equity-informed position.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"5 ","pages":"Article 100200"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic analysis of the SARS-CoV-2 variants circulated in the Philippines, 2020–2024","authors":"Arnie Dimaano ,&nbsp;Kiana Dominique Carreon ,&nbsp;Giselle Sophia Camaya ,&nbsp;Irvin Rondolo ,&nbsp;Jarel Elgin Tolentino","doi":"10.1016/j.dialog.2024.100193","DOIUrl":"10.1016/j.dialog.2024.100193","url":null,"abstract":"<div><h3>Purpose</h3><p>Genomic sequencing has been an invaluable tool to determine the evolution of SARS-CoV-2. In the present study, we provided a comprehensive description of the SARS-CoV-2 variants circulated in the Philippines.</p></div><div><h3>Methods</h3><p>The dataset from the human COVID-19 infections was acquired by downloading the sequences and their associated metadata spanning from March 2020 to April 2024. Then, we executed several filtering criteria to acquire the final dataset for the Philippine samples and performed spatial distribution analysis and phylogenetic tree construction of the reported SARS-CoV-2 sequences.</p></div><div><h3>Results</h3><p>A total of 16,679,203 SARS-CoV sequences were obtained, of which 17,393 (0.10 %) were sampled in the Philippines. Western Visayas reported the highest SARS-CoV-2 sequences (21.33 %), while the Bangsamoro Autonomous Region in Muslim Mindanao reported the least (0.48 %). The phylogenetic tree revealed the evolution of the detected SARS-CoV-2 variants circulating in the Philippines with 19 A as the first reported case (based on the GISAID submission), and 24 A (JN.1) as the currently circulating variant. Omicron variants have dominated the Philippines with 21 L (Omicron, BA.2) having 5102 cases (29.33 %), followed by 22B (BA.5) having 2184 cases (12.57 %). Using Pearson's Chi-square test of independence, we showed that there is a significant association between the age-groups and gender with the detection years.</p></div><div><h3>Conclusion</h3><p>Altogether, this analysis showed the updated epidemiological trends of the reported SARS-CoV-2 variants in the Philippines. This increases the importance of conducting surveillance on viral infectious diseases such as COVID-19 to provide the scope and trajectory of viral spread in a country.</p></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"5 ","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772653324000297/pdfft?md5=c2d3976b5c454541656dc2dae68e0f59&pid=1-s2.0-S2772653324000297-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking barriers: A gender-based quota system in nursing school admission in Bangladesh","authors":"Shimpi Akter ,&nbsp;Masuda Akter ,&nbsp;Sopon Akter ,&nbsp;Humayun Kabir","doi":"10.1016/j.dialog.2024.100196","DOIUrl":"10.1016/j.dialog.2024.100196","url":null,"abstract":"","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"5 ","pages":"Article 100196"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of education level and socioeconomic status on the association between depressive symptoms and memory in an older population in Latin America: An exploratory analysis from the Brazilian Longitudinal Study of Aging (ELSI-BRAZIL)","authors":"Karla Loss ,&nbsp;Wilson Fandino ,&nbsp;Bassel Almarie ,&nbsp;Blanca Bazan-Perkins ,&nbsp;Julia Minetto ,&nbsp;Nadine Aranis ,&nbsp;Thiago Monaco ,&nbsp;Aisha Aladab ,&nbsp;Kevin Pacheco-Barrios ,&nbsp;Felipe Fregni","doi":"10.1016/j.dialog.2024.100183","DOIUrl":"https://doi.org/10.1016/j.dialog.2024.100183","url":null,"abstract":"<div><h3>Purpose</h3><p>The globally increasing older population raises concerns about age-related conditions, including cognitive impairment and depressive symptoms. In Latin America, nearly one-third of the population is affected by either of these conditions. However, data investigating the association between cognitive impairment and depressive symptoms, particularly in Brazil, are limited to small-scale studies that have not carefully examined the critical effects of variables such as education level and socioeconomic status on this relationship. We aimed at exploring this association in a representative population-based cohort.</p></div><div><h3>Methods</h3><p>We used the Brazilian Longitudinal Study of Aging (ELSI-BRAZIL) database to examine the relationship between depressive symptoms and cognitive impairment in Brazilian older adults, adjusted for potential confounders. Direct acyclic graphs and multivariable linear regression were used to build our model. Depressive symptoms were measured using a short version of the Center for Epidemiologic Studies Scale (CES D-8), and combined memory recall test as a surrogate of cognitive impairment.</p></div><div><h3>Results</h3><p>The study included 8280 participants. Only education level was identified as a confounder for the relationship between memory loss and depressive symptoms. After adjusting for age, sex, and education level, there was strong evidence for a negative association between depressive symptoms and memory performance. For every 5-unit increase in the CES D-8 score, there was a reduction in memory capacity, translating to a loss of approximately one word in the combined words recall test (mean − 0.18, 95% CI -0.22; −0.15, <em>P</em> &lt; 0.001). In addition, we found strong evidence for an interaction between socioeconomic status and depressive symptoms. Subjects belonging to medium socioeconomic status (SES) showed more pronounced memory decline, when compared to those with lower SES (mean − 0.28, 95% CI -0.42 to −0.14, <em>P</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>In adults aged over 50, after adjusting for sex, age, and educational level, a 5-unit increase in CES D-8 score is associated with loss of one point in the combined memory recall test. This association seems to be confounded by educational level and significantly modified by socioeconomic status.</p></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"5 ","pages":"Article 100183"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772653324000194/pdfft?md5=21de359521041bee9f35146287736e7e&pid=1-s2.0-S2772653324000194-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141322660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The hierarchy of needs for laboratory medicine requires a foundational care delivery model","authors":"Melody Boudreaux Nelson ,&nbsp;Michelle F. Lamendola-Essel ,&nbsp;Aaron Odegard ,&nbsp;Stephanie Whitehead ,&nbsp;Dana Powell Baker ,&nbsp;Joy Nakitandwe","doi":"10.1016/j.dialog.2024.100187","DOIUrl":"10.1016/j.dialog.2024.100187","url":null,"abstract":"<div><p>Under the collective weight of growing test volume, staffing constraints, and Medicare reimbursements cuts, an enhancement-based, alternative payment structure focused on rewarding the laboratory's care delivery efforts via benchmarking is appealing. However, achieving a value-based payment model requires the development of an inclusive laboratory care delivery model (LCDM) framework. Today, a holistic, practical LCDM framework for laboratory medicine does not exist. However, such creation is essential for establishing unifying tenants of practice for value-tracing by which standardized key performance and population health indicators can be derived. LAB-CARES is the first step in formulating an LCDM with the primary objective of defining and streamlining the processes and strategies necessary to deliver and articulate the value of diagnostic excellence across the healthcare system. The goal of LAB-CARES is to maximize efficiencies, enhance quality, disseminate clinical expertise, increase patient safety, and promote integrative practice. LAB-CARES is designed to improve an individual patient's quality of life (longitudinal laboratory results – beyond one test) and their surrounding communities (e.g., through surveillance and prevention – beyond one patient). Further professional conversation and efforts are paramount to integrate LAB-CARES as a formalized structure within the healthcare landscape.</p></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"5 ","pages":"Article 100187"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772653324000236/pdfft?md5=574c40e0129cadff23485b250e928653&pid=1-s2.0-S2772653324000236-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142075967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Indigenous-led buprenorphine-naloxone treatment program to address opioid use in remote Northern Canada","authors":"Aleksandra M. Zuk ,&nbsp;Fatima Ahmed ,&nbsp;Nadia A. Charania ,&nbsp;Celine Sutherland ,&nbsp;Gisele Kataquapit ,&nbsp;Robert J. Moriarity ,&nbsp;Nicholas D. Spence ,&nbsp;Leonard J.S. Tsuji ,&nbsp;Eric N. Liberda","doi":"10.1016/j.dialog.2024.100190","DOIUrl":"10.1016/j.dialog.2024.100190","url":null,"abstract":"<div><h3>Background/purpose</h3><p>In response to the opioid use challenges exacerbated from the COVID-19 pandemic, Fort Albany First Nation (FAFN), a remote Cree First Nation community situated in subarctic Ontario, Canada, implemented a buprenorphine-naloxone program. The newly initiated program was collaboratively developed by First Nations' nurses and community leaders, driven by the community's strengths, resilience, and forward-thinking approach. Using the First Nations Information Governance Centre strengths-based model, this article examines discussions with four community leaders to identify key strengths and challenges that emerged during the implementation of this program.</p></div><div><h3>Methods</h3><p>this qualitative study amplify the positive aspects and community strengths through the power of oral narratives. We conducted 20 semi-structured face-to-face interviews with community members who helped lead FAFN's COVID-19 pandemic response. Utilizing the Medicine Wheel framework, this work introduces a holistic model for the buprenorphine-naloxone program that addresses the cognitive, physical, spiritual, and emotional dimensions of well-being.</p></div><div><h3>Results</h3><p>Recommendations to support this initiative included the need for culturally competent staff, customized education programs, and the expanding of the program. Additionally, there is a pressing need for increased funding to support these initiatives effectively and sustainably. The development of this program, despite challenges, underscores the vital role of community leadership and cultural sensitivity to address the opioid crisis in a positive and culturally safe manner.</p></div><div><h3>Conclusion</h3><p>The study highlights the successes of the buprenorphine-naloxone program, which was developed in response to the needs arising from the pandemic, specifically addressing community members suffering from opioid addiction. The timely funding for this program came as the urgent needs of community members became apparent due to pandemic lockdowns and isolation. Holistic care, including mental health services and fostering community relations, is important. By centering conversations on community strengths and advocating for culturally sensitive mental health strategies that nurture well-being, resilience, and empowerment, these findings can be adapted and expanded to support other Indigenous communities contending with opioid addiction.</p></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"5 ","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772653324000261/pdfft?md5=32eda085a6937338d6b85f85b39dfcf2&pid=1-s2.0-S2772653324000261-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142151553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An overlooked risk for skin health: Less availability and higher cost of sunscreen for people with melanated skin","authors":"Emerson D. Basch ,&nbsp;Grace C. Hillyer","doi":"10.1016/j.dialog.2024.100194","DOIUrl":"10.1016/j.dialog.2024.100194","url":null,"abstract":"<div><h3>Background</h3><div>Sunscreen with a skin protection factor (SPF) of 30 or greater is recommended to reduce the risk of skin cancer and improve skin health for all people regardless of skin tone. Traditional sunscreen that creates a white cast on the skin is incompatible with melanated skin.</div></div><div><h3>Methods</h3><div>The number of products on the shelf, SPF level, application, coloration, and cost were recorded at three beauty supply chain stores and three pharmacy, health, and wellness stores in or near Harlem in New York City in the Spring of 2023. The number of skin tones for tinted sunscreen was visually matched to the Fitzpatrick Skin Phototypes scale.</div></div><div><h3>Results</h3><div>A total of 385 sunscreen products were identified; 78.7 % were traditional white sunscreen, followed by sheer (15.3 %) and tinted (6.0 %) products. Beauty supply stores offered more tinted sunscreen options than did pharmacy, health, and wellness stores (<em>n</em> = 17,15.3 % vs. <em>n</em> = 6, 2.2 %, <em>p</em> &lt; 0.001). Of the tinted sunscreen products, 19 brands offered only a single tone. Tinted sunscreen was significantly more expensive with an average cost of $24.59 [SD $14.71] per ounce vs. $6.85 [SD 8.66] for traditional, and $9.38 [SD 8.92] for sheer suncreen.</div></div><div><h3>Conclusions</h3><div>Sunscreen that is tinted or sheer and compatible with melanated skin is less available and more costly than traditional white sunscreen in beauty and pharmacy chain stores in NYC. Availability and affordability of sunscreen matching the spectrum of skin tones are essential for optimal sun protection and skin health.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"5 ","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the preferences of traditional versus Western medicine in the Spiti Valley region of India: A qualitative approach","authors":"Annica Aguzzi ,&nbsp;Caren J. Frost ,&nbsp;Tejinder Singh ,&nbsp;L. Scott Benson ,&nbsp;Lisa H. Gren","doi":"10.1016/j.dialog.2024.100185","DOIUrl":"https://doi.org/10.1016/j.dialog.2024.100185","url":null,"abstract":"<div><h3>Background</h3><p>Traditional healing practices are prevalent in rural and mountainous areas of India where Western medicine is not accessible. WHO guidelines recommend integration of traditional and Western medicine to meet rural primary care needs. We explored three dimensions of rural patients' decision-making and satisfaction with their medical care: pregnancy-related concerns, pediatric care for children under five, and acute injuries.</p></div><div><h3>Methods</h3><p>We conducted a qualitative study using a phenomenological approach in India's Spiti Valley between August and October 2023. Sixteen individuals, age 18 years and older, participated in one-on-one interviews. The interviews were transcribed from Hindi into English, reviewed for accuracy by a native speaker, and imported into Dedoose software. Data were analyzed using inductive coding.</p></div><div><h3>Findings</h3><p>Multiparous women aged 35–44 were concerned about pregnancy complications, leading them to choose Western medicine despite access and cost barriers. Pediatric illness requiring urgent care at night was a concern for women with children under five. Those in the injuries group reported having to travel for care beyond basic first aid. Overall, concerns were about limited access to some services locally, as well as costs of travel, medical procedures, and medications when services were obtained beyond the local area.</p></div><div><h3>Interpretation</h3><p>All participants considered their traditional healer their first point of contact for medical care. A number of Western medical services were not available locally. These findings suggest a need to strengthen access to and integration of Western and traditional medical care in rural settings in India.</p></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"5 ","pages":"Article 100185"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772653324000212/pdfft?md5=a56af6d07c419646adb2f48ad3aef809&pid=1-s2.0-S2772653324000212-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141438543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}