PLOS global public health最新文献

{"title":"Acceptability of self-sampling for high-risk HPV DNA testing for primary cervical cancer screening among women in Thyolo, Malawi: A qualitative study.","authors":"Hussein H Twabi, Wakumanya Sibande, Owen Mhango, Takondwa Charles Msosa, Chikumbutso Chipandwe, Madalo Mukoka, Moses Kumwenda, Vanitha Sivalingam, Dennis Solomon, Chisomo Msefula, David Lissauer, Marriott Nliwasa, Maria Lisa Odland","doi":"10.1371/journal.pgph.0004763","DOIUrl":"10.1371/journal.pgph.0004763","url":null,"abstract":"<p><p>Despite the roll-out of cervical cancer screening within routine health facilities, uptake of cervical cancer screening in Malawi remains low due to factors such as privacy concerns, stigma, and distance to health facility. Self-sampling for human papillomavirus (HPV) testing offers a viable alternative to provider-delivered sampling, resolving issues with accessibility and privacy related barriers. However, there is limited understanding of the acceptability of self-sampling among women in low-income settings. We aimed to assess women's perceptions, experiences, and acceptability of self-sampling for HPV testing for primary cervical cancer screening. We conducted a qualitative phenomenological study among ten purposively sampled women screening for cervical cancer at a rural hospital in Malawi. Data collection instruments and the thematic analytical approach were guided by the Theoretical Framework of Acceptability. Key constructs that were central to this analysis included affective attitude, burden, self-efficacy, intervention coherence, and perceived effectiveness. Self-sampling emerged as a culturally and socially acceptable diagnostic practice by the women, mediated by emic values of privacy, bodily autonomy, and convenience. Women valued the ability to autonomously collect samples, which allowed them to circumvent discomfort and perceived invasiveness linked to speculum use, especially by male clinicians. Sociocultural barriers such as limited literacy levels, poor access to transport, and a lack of spousal approval restricted broader acceptability. Facilitators of acceptability included comprehension of the intervention, confidence in the self-sampling process, and the potential of the intervention to increase screening uptake, reduce cervical cancer screening-related stigma and reduce healthcare worker burden. Self-sampling for cervical cancer screening is an acceptable and promising alternative for improving the uptake of screening among women in Malawi and similar low-income countries. Scale-up of this approach will require addressing socio-cultural barriers through optimising instructional materials, engaging male partners, and leveraging community health workers for scaled community implementation via task-sharing.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0004763"},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139740","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":"Patterns of utilization and determinants of maternal health services among women residing in low-income communities in Lagos State, Nigeria.","authors":"Tope Olubodun, Onikepe Owolabi, Oluseun Adejugbe, Olufunke Iroko, Chiamaka Uwalaka, Bosede Afolabi","doi":"10.1371/journal.pgph.0004862","DOIUrl":"10.1371/journal.pgph.0004862","url":null,"abstract":"<p><p>Maternal and perinatal morbidity and mortality can be significantly prevented when women utilize health facilities for antenatal care (ANC), delivery and postnatal care; particularly in low-income communities in sub-Saharan Africa, where facility-based maternal care is underutilized. This study assessed the pattern of utilization and determinants of uptake of maternal health services among women residing in low-income communities in Lagos State, Nigeria. This was a mixed methods cross-sectional study, among women of reproductive age 15 - 49 years. Quantitative data was collected from 3,651 women using interviewer-administered questionnaires. Twenty Focus Group Discussions were carried out among 172 women. Univariate, bivariate and multinomial regression was done to identify determinants of place of delivery.The mean age of respondents was 32 ± 6.4 years. Almost all the women (97.7%) had ANC during their last pregnancy regardless of provider. During ANC visits, 56.4% were attended to by a nurse/midwife, 24.2% by a doctor and 19.4% by a traditional birth attendant (TBA). Thirty-nine per cent of respondents had their last child delivered in a public health facility, 30.8% in a private health facility, and 30.2% at a TBA/religious centre/home. Determinants of facility delivery utilization include higher levels of education, higher household incomes, middle and rich wealth index, fewer number of children and higher level of satisfaction with healthcare facilities.. Reasons for choice of place of ANC and delivery from the qualitative inquiry included distance from homes, attitude of health workers and quality of care, affordability, choice of spouse, and belief in herbs/spiritual beliefs.A significant proportion of women delivered with TBA/religious centre/at home. To improve use of health facilities for maternal care, efforts must be steered at improving health worker attitudes, addressing geographical accessibility and affordability, promoting health insurance, and carrying along all relevant stakeholders including spouses, and religious and traditional leaders.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0004862"},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139719","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":"Perceived neighborhood safety, crime exposure, and chronic diseases among older Indians: The role of functional disabilities.","authors":"Manacy Pai, T Muhammad, Adedayo Adeagbo, Waad Ali","doi":"10.1371/journal.pgph.0005151","DOIUrl":"10.1371/journal.pgph.0005151","url":null,"abstract":"<p><p>We examined the associations between perceived neighborhood safety, crime exposure, and the prevalence of chronic conditions and multimorbidity among older adults in India. Moreover, we examined whether these associations varied by functional disabilities measured by difficulties in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Data came from the World Health Organization's Study on Global AGEing and Adult Health (SAGE), India Wave 2, conducted in 2015. Neighborhood safety was measured by perceptions of safety at home and while walking after dark, whereas crime exposure was assessed through reports of household victimization by violent crime in the past year. Chronic conditions were self-reported physician diagnoses of hypertension, diabetes, stroke, arthritis, angina, asthma, and lung disease, with multimorbidity defined as the presence of more than two chronic diseases. Multivariable regression analyses were used to examine the main associations and interaction terms to test the moderating role of ADL/IADL disabilities. The mean score of neighborhood safety (on a scale of 0-10) was 7.72 (SD: 2.05). Approximately 6% of the participants reported that they or someone in their household had been victims of violent crime in the previous year. Older adults with perceived neighborhood safety reported a lower number of chronic conditions (adjusted beta: -0.03, confidence interval [CI]: -0.04 to 0.01) and lower odds of multimorbidity (adjusted OR: 0.95, CI: 0.91 - 0.99). Those with crime exposure reported a higher number of chronic conditions (adjusted beta: 0.10, CI: 0.02 - 0.19). These associations were significantly more pronounced among those with ADL/IADL disabilities. Perceived neighborhood safety and crime exposure were significantly linked to chronic diseases and multimorbidity among older adults in India, particularly among those with functional disabilities. These findings underscore the need for targeted strategies to improve neighborhood safety and support among older Indians with functional disabilities.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0005151"},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139775","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":"Assessing the determinants of food choices among adolescents in India: A rainbow model using the socio-ecological framework.","authors":"Kanishka Upadhyay, Bhavika Singhvi, Reshma Nakte, Mokalla Thirupathi Reddy, Hrusikesh Panda, Preetu Mishra, SubbaRao M Gavaravarapu","doi":"10.1371/journal.pgph.0004776","DOIUrl":"10.1371/journal.pgph.0004776","url":null,"abstract":"<p><p>In India, the rising risk of overweight and obesity among adolescents is a significant public health concern, primarily associated with their frequent consumption of nutrient-poor snacks, sugar-sweetened beverages, and fast foods. Identifying the determinants of their food choices is crucial for developing effective nutrition promotion strategies. This study aimed to identify the determinants of food choices among adolescents in two metro cities in North and South India using a cross-sectional, mixed-methods approach. The study involved adolescents (n = 869) studying in 8th and 9th grades from randomly selected government and private schools, utilizing a pre-tested questionnaire and virtual food preference flip cards (quantitative phase), along with in-depth interviews with adolescents, teachers, and parents (n = 11) (qualitative phase). A four-level socio-ecological model was adopted to categorize the determinants associated with adolescent's food choices. The findings revealed that taste (51%) was the primary determinant driving adolescents to choose outside foods, followed by peer influence (31%) and trendy foods (27%). In-depth interviews further highlighted the impact of social media, parental influence, celebrity endorsements, popular food trends, and marketing incentives such as toys and coupons on adolescents' food choices. The study provides a springboard for future research into the development of a nutrition-friendly choice architecture to encourage adolescents to make healthy food choices. Public health policy should utilize these determinants to transform the existing food environment of adolescents.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0004776"},"PeriodicalIF":2.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133101","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":"Characteristics and six-month viral load suppression of clients presenting with advanced HIV disease in South Africa.","authors":"Elizabeth Kachingwe, Nyasha Mutanda, Vinolia Ntjikelane, Mariet Benade, Musa Manganye, Lufuno Malala, Sydney Rosen, Mhairi Maskew","doi":"10.1371/journal.pgph.0004927","DOIUrl":"10.1371/journal.pgph.0004927","url":null,"abstract":"<p><p>Despite advances in antiretroviral therapy (ART), a notable proportion of individuals still present with advanced HIV disease (AHD) at treatment initiation, defined by CD4 < 200 cells/µL or WHO stage 3/4. This group experiences higher mortality and more opportunistic infections. While guidelines exist, they often do not address AHD clients specific needs early in treatment. Addressing these gaps could improve outcomes. Between September 2022 and June 2023, we surveyed a sequential sample of clients initiating ART or ≤6 months post-initiation at 18 primary healthcare facilities across three provinces. This observational cohort collected socio-demographic data, HIV care history, and service delivery preferences, and linked surveys to routine medical records and described client characteristics using descriptive statistics. Relative risks and risk differences compared outcomes between AHD and non-AHD clients. Primary outcomes were 6-month retention and viral load suppression. Of 1,098 clients (72% female, median age 33), 938 had CD4 or WHO staging at ART start. Of these, 29% (n = 275) had AHD, with a median CD4 of 108 cells/µL. AHD clients were more often male (44% vs. 21%), older (median age: 38 vs. 31 years), and sought care due to illness (63% vs. 33%). TB diagnosis (42% vs. 12%) and testing (76% vs. 67%) were higher. Service preferences and health resource use were similar. Retention at 6 months was similar (80% vs. 75%), but mortality was higher in AHD clients (1.0% vs. 0.2%). AHD clients had more low-level viremia (24% vs. 11%; RR = 2.27, 95% CI = 1.67-3.09) and slightly lower suppression (43% vs. 47%). AHD remains a key barrier to optimal ART outcomes. Clients with AHD experienced poorer viral suppression, despite similar retention rates highlighting the need for early detection, tailored clinical support, and strengthened monitoring. Updating ART guidelines to address AHD-specific needs is critical to improving outcomes in this high-risk population.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0004927"},"PeriodicalIF":2.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133175","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":"Understanding systemic barriers to blood donation for people of South Asian ancestry: A qualitative study.","authors":"Poojan Joshi, Kelly Holloway","doi":"10.1371/journal.pgph.0005163","DOIUrl":"10.1371/journal.pgph.0005163","url":null,"abstract":"<p><p>We explored how South Asian communities in the Greater Toronto Area (GTA) understand and experience blood donation, systemic barriers to donation, and offer recommendations for blood operators to foster inclusivity and equity in blood donation systems. Using a community-based participatory research approach, we conducted semi-structured interviews with 10 community leaders of South Asian ancestry. Reflexive thematic analysis was used to identify themes related to identity, belonging, and barriers to blood donation, and these themes were understood through the lens of transnationalism. Participants demonstrated the complexity of identity and belonging, and the responsibility of balancing cultural ties with integration into Canada. They faced systemic challenges, including settlement, economic and social challenges, racism and discrimination, and demonstrated resilience in balancing personal and community needs and responsibilities. Blood donation served as a personal commitment and an act of service to society. Key motivations to donate included service to humanity, upholding cultural and spiritual values, and reciprocity. Key barriers included accessibility, language barriers, deferral policies, and lack of tailored outreach and education strategies. Despite these barriers, participants demonstrated their commitment to donation and increasing participation in Canada's blood donation system. Blood operators can work towards addressing systemic barriers to donation by building relationships with community leaders, adopting culturally sensitive outreach strategies, and improving accessibility. Although limited to community leaders in the GTA, this study provides meaningful insights into the challenges faced by South Asian communities. Further research involving other underrepresented demographics can inform efforts to enhance participation, inclusivity, and equity in blood donation systems.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0005163"},"PeriodicalIF":2.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133194","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":"Prevalence and determinants of contraceptive use among men in Tanzania: Analysis of the 2022 demographic and health survey.","authors":"Pankras Luoga, Jovinary Adam, Siri A Abihudi","doi":"10.1371/journal.pgph.0005226","DOIUrl":"10.1371/journal.pgph.0005226","url":null,"abstract":"<p><p>Globally, contraceptive use is an important strategy in fighting maternal and neonatal deaths. The spacing and avoiding unplanned pregnancies while providing woman with enough time recovering her health and newborns growing. However, the contraception uses in developing countries including Tanzania is low and is worse among men, culturally regarded as the dominant decision makers in sexual relationships. This study intended to assess prevalence and determinants of the contraceptive use among Tanzanian men using the Tanzania Demographic and Health Survey (TDHS) 2022. The study analyzed secondary data collected using cross-sectional study design of weighted 5763 men obtained from the TDHS 2022. A dependent variable was contraceptive use and independent variables were man's demographic and socio-economic characteristics. Bivariate and multivariable analysis were conducted and p-value<0.05 determined a significant factor. The prevalence of contraceptive use among Tanzanian men is 26%. The logistic regression showed men aged 45-49 years (aOR=3.08, 95% CI = 1.90-5.01) had higher odds to use contraceptive compared to men aged 15-19. Men with higher education (aOR=2.94, 95% CI = 1.79-4.84) had higher odds to use contraceptive compared to those with informal education, from rich quantile (aOR=1.42, 95% CI = 0.92-1.46) had higher odds compared to poor. Men with five and above children (aOR=1.62, 95% CI = 1.08-2.43) had higher odds to use contraceptive compared to those with no child. Those desired no more child had odds of 1.4 times higher to use contraceptive (aOR=1.40, 95% CI = 1.05-1.88), men who heard family planning on radio (aOR=1.39, 95% CI = 1.16-1.66) had higher odds of using contraceptive to those who did not. The contraceptive use among Tanzanian men is generally low with a prevalence rate of only 26% and was associated with man's age, education level, wealth index, number of children, and occupation. More tailored programs targeting men to increase their education level particularly health education are crucial in increasing men's contraceptive use in Tanzania.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0005226"},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126742","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":"Burden of hemoglobinopathies and hemolytic anemias in the World Health Organization African region, 2000-2021: Findings from the Global Burden of Disease 2021 study.","authors":"Temitope T Ojo, Prince M Amegbor, Farha Islam, Joyce Gyamfi, Andi Mai, Carly M Malburg, Deborah B Adenikinju, Nicholas J Kassebaum, Shimelis Tadesse Abebe, Richard Gyan Aboagye, Ganiyu Adeniyi Amusa, Seth Christopher Yaw Appiah, Haftu Asmerom Asmerom, Isaac Sunday Chukwu, Tadesse Asmamaw Dejenie, Fitsum Wolde Demisse, Gashaw Dessie, Mengistie Diress, Christopher Imokhuede Esezobor, Habitu Birhan Eshetu, Adeniyi Francis Fagbamigbe, Sefineh Fenta, Teferi Gebru Gebremeskel, Segun Emmanuel Ibitoye, Robel Hussen Kabthymer, Woldeteklehaymanot Dagne Kassahun, Biruk Getahun Kibret, Osaretin Christabel Okonji, Prof Mayowa O Owolabi, Prof Léon Muepu M Tshilolo, Berhanu Woldu, Emmanuel K Peprah","doi":"10.1371/journal.pgph.0005197","DOIUrl":"10.1371/journal.pgph.0005197","url":null,"abstract":"<p><p>Hemoglobinopathies and hemolytic anemias (HHA) are genetic blood disorders associated with diverse clinical complications, affecting an estimated 2.1 billion people worldwide. The World Health Organization (WHO) African Region accounts for approximately 425.8 million individuals, or 20% of the global HHA prevalence, yet comprehensive assessments of this burden have been lacking. We present the first systematic analysis of HHA burden in the WHO African Region from 2000-2021 using data from the Global Burden of Disease (GBD) 2021 study. We estimated regional, sex-, and age-specific rates (per 100,000 population) of mortality, incidence at birth, and years lived with disability (YLDs) in five-year intervals. Mortality estimates were generated using the Cause of Death Ensemble model (CODEm), supplemented with spatiotemporal Gaussian process regression. Incidence at birth was estimated using DisMod-MR 2.1, a Bayesian meta-regression tool, while YLDs were calculated by multiplying prevalence by disability weights reflecting severity and duration. Between 2000 and 2021, the WHO African Region experienced persistently higher age-standardized death rates from HHA compared to global levels, although regional mortality declined over the period. Sickle cell disorder (SCD) was the predominant contributor, with the highest mortality [3.68 deaths (95% UI 2.04-6.29) per 100,000] and disability burden [41.08 YLDs (95% UI 26.09-58.61)], while thalassemias contributed the least. Disability-adjusted life years (DALYs) were concentrated in western sub-Saharan Africa, accounting for 71.3% of the regional burden. Age-specific estimates revealed that children under five years faced a disproportionate share of mortality and disability. Despite overall declines in mortality, the WHO African Region continues to bear a disproportionate global burden of HHA, particularly affecting young children. These findings underscore the urgent need for strengthened newborn screening, early treatment, and health system interventions to reduce preventable deaths and disability.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0005197"},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126691","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":"TB stigma in India: A narrative review of types of stigma, gender differences, and potential interventions.","authors":"Madeline E Carwile, Senbagavalli Prakash Babu, Chelsie Cintron, Madolyn Dauphinais, Susie Jiaxing Pan, Mahalakshmi Thulasingam, C Robert Horsburgh, Sonali Sarkar, Natasha S Hochberg, Lora L Sabin, David Flynn, Blessina Kumar, Pranay Sinha, Urvashi B Singh","doi":"10.1371/journal.pgph.0005109","DOIUrl":"10.1371/journal.pgph.0005109","url":null,"abstract":"<p><p>In India, persons with tuberculosis (PWTB) and their households experience significant disease-related stigma. The objective of this narrative review was to conduct a review of existing literature related to the types of stigma experienced by PWTB and their household members, with a focus on the effects of stigma, possible interventions, and gender differences. A literature search was conducted on PubMed, EMBASE, and Web of Science using key search terms. We found that tuberculosis (TB)-related stigma has negative effects on emotional and mental health, relationships, and treatment adherence. Women experience a higher burden of TB stigma compared to men. Moreover, TB stigma can affect mental well-being and lead directly to reductions in the number of PTWB seeking treatment, treatment adherence, and treatment completion. All these factors can lead to negative health outcomes for the PWTB, higher costs to the government, and even the spread of the infectious disease to other members of the community. The consequences of TB-related stigma require additional attention.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0005109"},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126706","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 Dialogic Health Systems Research Framework (DHSRF): A tool for facilitating self-criticality, researcher interactions and knowledge management in Health Systems Research & Policy Studies.","authors":"Ritu Priya, Sayan Das, Liz M Kuriakose, Madhurima Shukla, Amitabha Sarkar, Neha Dumka, Erin Hannah, Nisha Basheer, Atul Kotwal","doi":"10.1371/journal.pgph.0004209","DOIUrl":"10.1371/journal.pgph.0004209","url":null,"abstract":"<p><p>Health Systems Research (HSR) has witnessed significant progress in theory, methodology and practice over the last two decades. The complexity of health systems has allowed for diverse lenses for HSR. However, given the absence of dialogue between the different streams of HSR, the diversity of this field, perhaps its greatest strength, is turning out to be quite the challenge. Without a common language that enables researcher interaction and critical examination of the field, diversity can easily turn into a din. To overcome this confusion, evidence-based policy making requires tools that can assess the diverse evidence generated for designing systems coherent with the desired values and principles. Hence, we need a common research framework for HSR, to understand, describe and explain the systems' structure and functioning, including observed and projected processes of change, across streams. It should be able to make sense of the formulation of HSR, allowing diverse research paradigms their appropriate place in HSR, and make them talk to each other rather than against each other. This paper presents the Dialogic Health Systems Research Framework (DHSRF), developed through a multi-method approach which was theory-based, iterative and reflexive involving an initial systematic narrative review and a later national expert consultation for feedback and validation. The DHSRF locates itself within a public health disciplinary frame and draws upon the comprehensive primary health care principles and a complexity lens. This led to adopting a comprehensive socio-cultural approach to health systems, incorporating their formal and informal components, addressing the techno-managerial and social-economic-political-cultural aspects with understandings drawn from epidemiology, historical analysis, knowledge pluralism and a bottom-up approach, making the framework context-sensitive, open to diverse perspectives, adaptable to different settings, value-critical and dialogic. It potentially contributes to knowledge management by a) allowing for a comprehensive review of HSR at the proposal and design stage to ensure a 'good fit for purpose', and b) assessing the strength of the outcomes of HSR in relation to the purpose and objective(s) of the research. By surfacing the inner workings of HSR, the framework can galvanise dialogue and debate to enrich the field and facilitate utilisation of its outcomes for policy, planning and implementation.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 9","pages":"e0004209"},"PeriodicalIF":2.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093261","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}