Search Results (2,802)

The research aimed to understand the different cultural needs relating to death and dying of migrant populations in Western Sydney, Australia, and how end-of-life care can be provided in culturally safe ways which can, in turn, inform the policies that shape palliative care and bereavement service delivery. The mixed methods design for this study used an online quantitative survey using the Death Literacy Index, key informant qualitative interviews, culture-based community focus groups, and individual Photovoice interviews with carers. In all, 266 participants across the three largest migrant communities and local area health services took part in the research. The results revealed the importance of cultural practices and rituals for people at end of life and that providing space for these is crucial to cultural safety in service contexts, in addition to relational trust and the need for community input to improve the services that affect them. There is also a need for greater knowledge and understanding in the end-of-life space through two-way exchanges between communities and service providers. Finally, there are important ways that the existing services can facilitate cultural safety and ways of increasing the availability of culturally appropriate end-of-life and bereavement services for the community. Full article

With the rapid growth of social media use in Nepal and their engagement with customers, understanding how these platforms support customer loyalty becomes essential for retail businesses. This study investigates the role of social media marketing in shaping brand loyalty among retail customers in Nepal through an integrated research design that combines systematic bibliometric and survey data analysis. The bibliometric findings suggest a clear progression in the literature, moving from a foundational emphasis on relationship marketing and loyalty theory toward a more integrated framework that incorporates social media engagement and, ultimately, measurable business outcomes. The quantitative results based on survey data conducted with 100 Nepalese consumers active on Facebook, Instagram, and TikTok show that effective social media strategies and the ability to address implementation difficulties significantly enhance brand loyalty. In contrast, the direct influence of customer trust is limited. The findings highlight the importance of tailored and interactive content, supported by appropriate digital practices, particularly in regions with developing infrastructure. This study offers practical recommendations to improve digital engagement, encourage retailers to collaborate with local influencers, respond to customer feedback, maintain transparency in messaging, and enhance digital capabilities to implement effective social media strategies. It also underscores the value of producing culturally relevant content that aligns with local interests and behaviours. Full article

Background: Preterm birth affects about 10% of births globally, often resulting in neurodevelopmental delays and disrupted parent-infant bonding. In low-resource settings, such as South Africa, neonatal intensive care unit (NICU) interventions require contextual adaptation. The NeuroSense PremmieEd Parenting Educational Intervention (PremmieSense) was developed to strengthen parent-infant bonding and promote neuroprotective care during NICU admission. Objectives: To describe the development, components, and pilot delivery of the PremmieSense intervention using the Template for Intervention Description and Replication (TIDieR) framework and document contextual adaptations and implementation lessons in low-resource NICUs. Approach: This project report outlines PremmieSense according to TIDieR. The programme comprises a picture-based booklet in English and Setswana, supplemented by facilitator-led group sessions delivered by trained healthcare professionals. It was piloted at two public-sector NICUs in the North West province of South Africa (N = 60 mothers; 30 per site). Parent knowledge was measured using the Knowledge of Preterm Infant Behavior (KPIB) scale, and stress was measured using the Parental Stress Scale: NICU (PSS:NICU tool). Quantitative outcomes are reported separately in a companion paper. Findings: PremmieSense was feasible and acceptable in low-resource NICUs. Logistical challenges including early discharges, staff constraints and language needs required pragmatic adaptations. The modular, multilingual design supported flexible delivery. TIDieR reporting facilitates replication and contextual adaptation. Conclusions and Recommendations: PremmieSense shows promise as a culturally appropriate and adaptable intervention for resource-constrained NICUs. Future work should tailor content to gestational age, prior parenting experience, and literacy, expand implementation, and assess long-term outcomes. Full article

Background/Objectives: Community participation and community empowerment are key features of people-centred primary health care systems and are crucial ways to make health services more equitable and appropriate for people’s needs while improving these services. This qualitative study investigates the facilitators and barriers that practitioners and stakeholders encounter in their efforts to support community participation and community empowerment in primary health care centres. In this context, we focus on the Case della Salute/Case della Comunità in Emilia-Romagna, Italy. Methods: We conducted semistructured interviews with 19 practitioners and stakeholders who had practical or research experience with this topic from October 2020 to May 2021. These interviews were analysed inductively via qualitative content analysis. Results: The barriers and facilitators identified in this context were related to four themes: (a) the culture and mindset of practitioners and organisations as well as the competences that enable them to support community participation and empowerment; (b) reframing local health care politics, the organisation and the role played by health care organisations in this context; (c) investing human and financial resources and creating appropriate spaces for community participation and empowerment; and (d) operational aspects that facilitate community participation and empowerment. Conclusions: The study presents various barriers and facilitators that operate at different levels, such as the level of the health care system, the organisational level and the operational level. We discuss the barriers and facilitators that are encountered in this context and offer suggestions regarding what stakeholders, managers and practitioners can learn from these insights. Full article

This study examines how climate change interacts with social, ecological, and policy factors to shape food security among Indigenous tribal communities in Jharkhand, focusing on Saraikela Kharsawan district. It combines a scoping review, policy analysis, and a climate–agriculture case study of Saraikela Kharsawan to identify vulnerabilities and pathways for more resilient Indigenous food systems. The research is qualitative, using a scoping review of 28 studies on Indigenous food security and climate impacts in Jharkhand, thematic analysis of nine national and state policies, and a district-level case study using land use, climate trends/projections, and crop statistics for Saraikela Kharsawan. Additionally, findings from participant observation were integrated into how tribal communities in Saraikela Kharsawan experience and respond to climate variability and its implications for local food systems and nutrition. The study identifies a nutrition paradox, where Indigenous communities experience micronutrient deficiencies and anaemia despite rich biodiversity and Indigenous knowledge. This is accompanied by a decrease in the consumption of nutrient-dense Indigenous foods and a predominance of rainfed monoculture rice cultivation. Marked by rising temperatures and erratic rainfall, climate variability is destabilising agroforestry systems, narrowing dietary options and reducing adaptive capacity. Additionally, policy and institutional gaps reveal fragmented support—strong rights laws and calorie-focused welfare schemes but weak integration of Indigenous foods, agroforestry, and traditional ecological knowledge into nutrition and climate programmes. The paper argues that climate change acts as a threat multiplier on already fragile Indigenous food systems and calls for nutrition-sensitive safety nets, community-based agroforestry, gender-inclusive Indigenous knowledge governance, and cross-sectoral policy alignment to support resilient, culturally appropriate food systems in Jharkhand. Full article

One-semester exchange programs place students in university courses within compressed, credit-bearing mobility timelines. This qualitative case study examines how eight Korean undergraduate exchange students described academic learning and adjustment during a one-semester exchange at a U.S. university. Drawing on online written interviews, the study analyzes students’ reported classroom experiences rather than formal course design or enacted instructional practice. The analysis focuses on how students navigated unfamiliar classroom expectations at the level of reported classroom practice. The findings show that participation became visible as academic work when students prepared texts, engaged in discussions, managed language risk, and judged what counted as an appropriate contribution. Feedback and academic help-seeking served as interpretive resources through peer review, instructor clarification, writing tools, and efforts to turn uncertainty into next steps. Across the accounts, adjustment appeared as selective and uneven additions to students’ academic strategies, most visible in discussion, peer feedback, open-ended writing, instructor clarification, and resource assembly. This study contributes to higher education and international student mobility research by showing how temporary exchange students made classroom expectations workable through targeted strategy additions rather than through a shift from one national learning culture to another. It offers implications for participation scaffolding, feedback design, and pre-departure preparation. Full article

Background: Misinformation, disinformation, and a lack of information about abortion impede access. Mystery shopping designs are well-suited for evaluating the availability, accuracy, and quality of health services. However, we lack understanding of their use in abortion research. Methods: Our team conducted a scoping review to synthesize evidence of mystery shopping methods in abortion research internationally. We followed the JBI methodology for scoping reviews and engaged the expertise of a clinical research librarian. We included all English and French language studies of abortion using mystery shopping methods (phone, in person, or other). We did not limit the search by date range or jurisdiction. Results: We included 40 studies in our review, published between 2006 and 2025. Settings included 13 countries: USA (13), India (5), Canada (3), Mexico (3), Turkey (3), Bangladesh (2), Colombia (2), Ghana (2), Indonesia (2), and one each in Kenya, Nepal, Tanzania, Zambia, and Latin America. Methods included calls (20), in-person visits (18), texts/online messages (3), and combinations of mystery shopping with interviews/surveys (7) and systematic online searching (2). Themes included service availability and information quality, with seven subthemes, which we mapped to elements of the Levesque framework of patient-centred access: Approachability; acceptability; availability and accommodation; affordability; and appropriateness. Conclusions: Where abortion is decriminalized, efforts to improve abortion can prioritize Levesque’s concepts, such as ensuring care is affordable, culturally safe, and geographically proximal. Mystery shopping can proxy patient experience and be used as a validity check, such as comparing health professionals’ self-reported practice with that experienced by mystery shoppers. Full article

Background/Objectives: Healthcare professionals face high occupational stress, emotional burden, and demanding conditions that increase the risk of burnout, depression, and anxiety, with recent post-pandemic evidence indicating a high and rising global prevalence. Early identification of distress is therefore essential. This review compared three widely used instruments—the Depression, Anxiety and Stress Scales (DASS), the Maslach Burnout Inventory (MBI), and the Zung Self-Rating Depression Scale (SDS)—selected because they jointly cover depression, anxiety, stress, and burnout, unlike unidimensional tools (PHQ-9, GAD-7, PSS, CBI) that would need combining for comparable coverage. Methods: A narrative integrative review searched PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar for peer-reviewed articles (English/Croatian) published up to December 2025 (final search: 26 June 2026). Two reviewers independently screened records, resolving disagreements by consensus; quality was appraised narratively. Of 55 records, 35 were included. Results: The DASS showed a replicated three-factor structure and strong reliability, with shortened forms (DASS-8, DASS-12) enabling rapid screening at reduced domain coverage. The MBI remained the most widely used burnout measure but was limited by its emotional-exhaustion focus, proprietary licensing, and scoring heterogeneity. The Zung SDS offered a brief depression screen, though dated wording and context-dependent cut-offs favor initial-screen use. Notably, much evidence is derived from non-healthcare populations—the principal limitation. Conclusions: The instruments appear complementary rather than interchangeable; their combined use is proposed—as a reasonable suggestion from the literature, not an empirically demonstrated finding—as a multidimensional approach, contingent on context, objective, and appropriate cultural validation. Full article

Background/Objectives: Endophthalmitis is a devastating, vision-threatening intraocular infectious disease. Given the scarcity of long-term cohort data in Asian populations, appropriate empirical antibiotic therapy is essential to prevent irreversible vision loss. The present study aimed to identify the culture-positive pathogen profiles and antimicrobial susceptibility in endophthalmitis. Methods: This retrospective study included 90 culture-positive isolates from patients with endophthalmitis treated between January 1990 and October 2020. The etiology, clinical presentation, and antibiotic susceptibility profiles of the isolates were analyzed. Results: Forty-three isolates were Gram-positive cocci, 23 were Gram-negative bacilli, and 24 were fungi. Postoperative infections were dominated by Gram-positive cocci (72.1%). Furthermore, 47.8% (11/23) of Gram-negative bacilli and 66.7% (16/24) of fungi were recovered from endogenous endophthalmitis isolates. In patients with endophthalmitis caused by Gram-negative bacilli, visual acuity was numerically inferior at both initial presentation and final follow-up visit (p = 0.051 and p = 0.018). All isolates of Gram-positive cocci exhibited full susceptibility to vancomycin and teicoplanin, while linezolid yielded a susceptibility rate of 96.9% (31/32). For Gram-negative bacilli, over 80% of isolates were susceptible to amikacin, aztreonam, and third-generation cephalosporins, whereas carbapenems and fluoroquinolones achieved susceptibility rates exceeding 90%. Among staphylococcal isolates, ciprofloxacin resistance was significantly higher in patients older than 55 years compared with those aged 55 years or younger (71.4% versus 12.5%; exact p = 0.013). Conclusions: Postoperative infection was the leading cause of Gram-positive cocci endophthalmitis. Antimicrobial susceptibility profiles validated intravitreal vancomycin combined with ceftazidime as a rational regimen for empirical antibacterial coverage. Elevated fluoroquinolone resistance among Gram-positive cocci, particularly in elderly patients, underscores the necessity of sustained regional antimicrobial resistance surveillance and periodic reassessment of conventional topical antibiotic prophylatic protocols. Full article

Background/Objectives: Refugee populations face significant barriers in accessing healthcare services, particularly in sexual and reproductive health (SRH), with important implications for menstrual health. Limited access to adequate menstrual products, safe sanitation facilities, and appropriate information contributes to period poverty among migrant and refugee women, exacerbating conditions of vulnerability and discrimination. The present study aims to explore the lived experiences, barriers, and facilitating factors in the management of menstrual health and menarche among refugee women and girls. Methods: A systematic meta-synthesis was carried out between January and May 2026 using the PubMed, Cochrane Library, Scopus and LILACS databases and grey literature sources. The SPIDER framework was applied to guide the research question and search strategy. Qualitative and mixed-method primary studies and grey literature reports containing qualitative findings describing experiences of menstruation among refugee women and girls were included. Studies published in English, Italian, Spanish, and Portuguese were eligible. Study quality was appraised using the Joanna Briggs Institute (JBI) critical appraisal checklist. Data were analysed using a thematic synthesis approach as described by Thomas and Harden. Results: A total of 24 studies were included. Six analytical themes were identified: (1) structural constraints affecting access to resources and services; (2) context-dependent menstrual management practices; (3) female support networks; (4) menstruation as a socially constructed and learned experience; (5) constrained agency and compromised dignity under conditions of stigma; and (6) physical and psychological impacts. Overall, menstrual health was shaped by the interaction of structural barriers and socio-cultural norms, which limited safe and dignified management. Significant gaps in knowledge and preparedness were observed, particularly prior to menarche. Women and girls relied on coping strategies and informal support networks despite associated trade-offs for health and dignity. Conclusions: Menstrual health among refugee women and girls is shaped by structural inequalities, socio-cultural norms, and conditions of displacement. Addressing these challenges requires integrated, multisectoral approaches that go beyond product provision to tackle underlying determinants. Strengthening menstrual health literacy, engaging communities, and supporting the role of healthcare professionals such as midwives is essential to support more equitable and sustainable menstrual health interventions. Findings should be interpreted in light of the heterogeneity of study contexts and methodological quality. Full article

Post-surgical pyoderma gangrenosum (PSPG) is a challenging diagnosis associated with significant morbidity, often misidentified as postoperative infections, leading to inappropriate management. This systematic review aims to elucidate the characteristics, management strategies, and outcomes of PSPG in the context of foot and ankle surgery to improve diagnostic accuracy and patient care. A systematic literature search was conducted across multiple databases, including PubMed, Scopus, and Embase, for cases of PSPG following foot and ankle surgery published up to January 2023. Data on demographics, clinical presentation, management, and outcomes were extracted and analyzed. Ten cases met the inclusion criteria, predominantly females presenting with rapidly worsening and painful postoperative ulcers. A high rate of negative cultures was observed during the patients’ treatment period. Dermatology consults initially suspected 83.33% of the cases. Notably, 30% of patients underwent amputation of various parts of the lower extremity, all diagnosed more than 35 days after symptom onset, and were female. The mainstream treatment for PSPG involved systemic immunosuppressants, with corticosteroids being the most common, effectively resolving symptoms in the majority of instances. PSPG should be suspected in patients with unexplained, worsening postoperative wounds. Early recognition and appropriate treatment with immunosuppressants are crucial to prevent severe outcomes. Multidisciplinary management involving dermatologists and surgeons is recommended to optimize patient outcomes. Further research is needed to establish robust diagnostic and management protocols for PSPG in the surgical context. Full article

Acute diarrheal disease (ADD) caused by parasites and Tuberculosis (TB) remain major public health concerns in vulnerable indigenous communities with limited access to sanitation, safe water, and healthcare, and where humans, animals and the environment interact closely. Using a One Health framework, this study investigated TB and Intestinal parasites in human, animal and environmental samples from 15 Wayuu indigenous communities in Manaure, La Guajira. A total of 190 samples, including human sputum and feces, animal milk and feces, soil and drinking water, were analyzed according to sample type, preservation suitability, and availability using parasitological concentration techniques, qPCR for helminth detection, metatranscriptomic sequencing, Xpert ^® MTB/RIF assay, and mycobacterial culture. Mycobacterium tuberculosis was detected in 8.3% of human sputum samples, with no evidence of rifampicin resistance, whereas Mycobacterium bovis was not detected in animal milk. Human fecal samples analyzed by microscopy showed Blastocystis sp. and the Entamoeba histolytica/Entamoeba dispar complex (38.8% each), followed by Giardia (19.4%), Hymenolepis nana and Trichuris trichiura (5.1% each) and Hymenolepis diminuta (1%). Commensal parasites were also identified, with Entamoeba coli (46.9%) being the most frequent species, indicating inadequate sanitary conditions and poor hygiene practices. Co-infections were common in humans (60.2%). In animal fecal samples, strongylids (66.7%), amoebas (16.7%) and Giardia (8.3%) were observed. Giardia sp. was detected in 2.38% of soil samples by microscopy, supporting environmental circulation, whereas no parasites were detected in water sediments. Multiplex qPCR detected Trichuris trichiura DNA in human feces and Trichuris spp. DNA in soil and sheep fecal samples. Metatranscriptomic analysis of 22 human fecal samples revealed a high diversity and frequency of parasitic protozoa (90.9%), with Blastocystis spp. being the most frequent (81.8%). Additionally, reads of free-living amoebae, including Acanthamoeba spp. (10%) and Naegleria spp. (5%) were detected in community drinking water sources. These findings suggest active transmission of TB and parasitic-associated ADD in Wayuu communities and highlight the need for integrated surveillance and culturally appropriate interventions focused on sanitation, hygiene, veterinary services and community health education to improve the living and health conditions of these vulnerable populations. Full article

Implementing technological change in rural or culturally distinct settings requires moving beyond the modernization bias that treats Western technical solutions as universally applicable. This article develops a process-based reflection on culturally grounded co-design for sustainable technology, drawing on social design, just transition principles, and appropriate technology. Rather than evaluating final project outcomes, the article examines how technology and social organization can be approached as context-specific practices that must be negotiated, adapted, and maintained with local actors. The discussion is informed by the O-Waste Project in The Gambia, which is used as an illustrative case to examine the role of local councils, women’s organizations, market committees, and implementing partners in shaping technological adoption. By emphasizing vernacular knowledge, locally maintainable systems, and participatory decision-making, the article argues that sustainable innovation depends on technical performance as well as cultural legitimacy, institutional trust, and procedural justice. The analysis suggests that development in diverse cultural contexts requires a careful balance between external technical expertise and community appropriation. The O-Waste case therefore offers process-based insights into how sustainable technologies can be introduced without reducing local communities to passive recipients of modernization. Full article

This study develops a digital tactile graphic learning framework based on Korean cultural heritage images to support potential concept learning of students with visual impairments and examines its educational appropriateness through expert validation. The lack of standardized tactile graphic guidelines in visual-centric educational environments imposes considerable burden on teachers, who must restructure content individually. Using a design-based research (DBR) methodology grounded in the Universal Design for Learning (UDL) framework, this study constructed a dataset of 200 cultural heritage images from elementary textbooks across four categories—architecture, artifacts, cultural symbols, and traditional objects—and restructured them through illustration simplification, initial tactile graphic conversion (informed by braille production principles), and two expert revision cycles. Ninety educationally applicable items were finalized for second-stage validation, and five tactile graphic design guidelines were derived. A panel of 15 experts evaluated the materials using a 5-point Likert scale and Content Validity Index (CVI) analysis. The overall mean was M = 4.69 (SD = 0.51), with the final 15-item instrument yielding an overall S-CVI/Ave of 0.99 (initial 0.98 across the original 16 items, refined after removal of one underperforming item per standard CVI practice); the practical usability domain reached S-CVI/Ave = 1.00, indicating full expert agreement. The study contributes a cultural heritage image dataset, a systematic image restructuring procedure, UDL-based design guidelines, iteratively refined and expert-validated CVI evaluation criteria, and a prototype TUI-based tactile learning environment configuration. Full article

Background/Objectives: Initiation of empiric antibiotic therapy for neonatal early-onset sepsis (EOS) is prudent to prevent morbidity and mortality, particularly in low- and middle-income countries (LMICs). Inappropriate or prolonged antibiotic exposure in neonates is associated with poor clinical outcomes. Antimicrobial stewardship programs (ASPs) have been shown to optimize antibiotic use, but data from LMICs are limited. In this study, we aimed to evaluate adherence to a locally developed and adopted guideline for antibiotic use in EOS. Methods: We conducted a retrospective before-and-after study during the pre- (June 2024–January 2025) and post-implementation (May–December 2025) of ASP guideline for EOS. The intervention involved consolidating best practices—previously shared verbally and applied variably into a locally united written guideline, then provide training to neonatologists, pharmacists, and nurses. Adherence to best practices was evaluated by indication, dosing, timing, and duration of antibiotic therapy. Results: In a cohort of 388 neonates with EOS (i.e., 205 pre- and 183 post-implementation), the median gestational age was 38 (IQR: [37–39]) weeks, with the median birthweight of 3000 (IQR: [2800–3400]) grams, and 63% were male. The total adherence improved from 2.0% to 65.6% (p < 0.001) from pre- to post-implementation of ASP. In the post period, adherence rates were 96.7% for empiric antibiotics indication, 95.6% for antibiotics indication after culture results are obtained, 88.5% for antibiotic dosing, 83.1% for timely antibiotic initiation, and 89.1% for appropriate discontinuation of antibiotics. The median days of therapy and length of therapy significantly decreased by 139 per 1000 patient-days, from 1806 (IQR: [1556–2083] to 1667 (IQR: [1400–2000]; p < 0.001)] patient-days; and from 1000 (IQR: [875–1000]) to 875 (IQR: [769–1000]; p < 0.001) patient-days in the pre- versus the post-implementation, respectively. Median length of hospitalization of 8 [7–12] days and recovery (~93%) from EOS were similar pre- and post-implementation. Conclusions: The results support the effectiveness of ASP implementation in improving guideline adherence and reducing antibiotic exposure among neonates with EOS in low-resource settings. In-hospital clinical outcomes, including mortality at discharge, were similar between periods; however, further studies with longer follow-up are needed to better evaluate clinical outcomes. Full article