A qualitative study of the stigmatization and coping mechanisms among pregnant teenagers living with HIV in Thailand

PurposeThis aim of this study was to explore the experiences of stigmatization and coping mechanisms during pregnancy among pregnant women who are living with HIV in Thailand. The secondary objective was to determine factors contributing to stigma during motherhood among HIV-infected women as well as explore how they cope with the discrimination from society.Design/methodology/approachQualitative data were collected using in-depth interviews to obtain different versions of stigmatized experience from 16 pregnant women living with HIV on stigmatization and coping mechanisms. There were 5 pregnant adolescents living with HIV and 11 adult pregnant women living with HIV. The content analysis was used to examine patterns of stigmatizations and attributed factors.FindingsPersonal stigma was found among pregnant women living with HIV regardless of age. HIV status disclosure was the crucial barrier of accessing to care for people experiencing stigmatizations. Personal stigma associated with higher HIV status was not disclosed. Interestingly, all teenage mothers who participated in this study disclosed their HIV-status to their family. People who have social support especially from family and significant others are found to be able to cope and get through the difficulties better than those who lack those social support.Originality/valueThis study yields outcomes similar to several other studies that have been conducted either in Thailand or other countries. This study found that family support was crucial in reducing HIV stigma. Furthermore, HIV-infected pregnant female adults were more afraid to disclose their HIV status to their husbands, other family members and their work colleagues.

Effectiveness of an oral hygiene promoting program for elementary school students using a smartphone endomicroscope in Thailand

PurposeThe purpose of this paper is to examine the effectiveness of oral hygiene promoting program (OHPP) using a smartphone endomicroscope among students in elementary schools in Bangkok, Thailand, to enable their oral hygiene maintenance and to compare oral health outcomes in the intervention program between the experimental and control groups.Design/methodology/approachThis is a quasi-experimental research study consisting of two groups, a pretest, a posttest and a follow-up design. The student sample consisted of 59 fifth graders who matched the study criteria on medium and low levels of teeth brushing skills. There were 29 experimental group participants who completed the six-week OHPP using a smartphone endomicroscope. Another 30 participants formed the control group involved in the ordinary oral health education program. The comparison data for oral health behaviors (knowledge, attitude and practice (KAP)) and oral hygiene were statistically analyzed by using multivariate analysis of variance (MANOVA).FindingsResults indicated that the experimental group exhibited higher oral health behaviors regarding KAPs and oral hygiene related to teeth cleanliness and gum health than the control group in the postexperimental and follow-up phases. However, there were no statistically significant differences between the two groups with regard to tongue cleanliness.Originality/valueThe students maintain their own oral hygiene due to a provision of activities related to KAP concerns. The instrument helped the students to find tooth decay and dental plaque associated with teeth cleanliness after brushing their teeth.

A mixed-method systematic review of text-based telehealth interventions in eating disorder management

PurposeEating disorders (EDs) is a major health condition affecting 9% of the global population and 10% of those with EDs lost their lives as a result. Text-based telehealth interventions (TTIs) seem to provide a low-cost and convenient treatment option; however, the evidence is scarce. This study aimed to synthesize evidence relating to the use of TTIs for the management of EDs.Design/methodology/approachFive databases were searched published between January 2020 and May 2019. The authors used keywords relating to telehealth and EDs. The authors used Joanna Briggs Institute's (JBI's) critical appraisal instrument to assess the methodology quality of included studies.FindingsFifteen studies were included in this mix-method systematic review and assessed for methodology quality. Email, web-based texting, text-messaging and online chat room were used as mode for deliver healthcare for patients with EDs. In the treatment phase, all studies (nine studies; n = 860 participants) showed effectiveness (for RCTs) and usefulness (for non-RCT studies). In the aftercare phase (six studies; n = 364 participants), the results regarding the effectiveness of TTIs were mixed. Two studies showed effectiveness whilst four studies did not find statistically significant change of ED outcomes.Research limitations/implicationsThe qualities of these studies varied; firstly, 66% (n = 10) of the studies were non-randomized studies (e.g. single-arm trial, case report) with small samples. Moreover, one-fourth (n = 4) of the studies did not use validated instruments or indicate the instrument. Also, half (n = 7) of the studies used TTIs as adjunct to face-to-face treatment or bigger online treatment, it is hard to make conclusion that the changes were due to TTIs' effect. In addition, follow-up rate is not satisfactory, thus results should be interpreted cautiously.Practical implicationsTTIs seem to be promising for management of EDs, particularly in the treatment phase. This provides an important treatment option for health practitioners and people with EDs as an alternative or in adjunct with face-to-face services.Originality/valueThis is the first review to synthesis the use of TTIs for ED management.

Effect of aromatherapy on the pain of arteriovenous fistula puncture in patients on hemodialysis: a systematic review

PurposeThis study aims to determine the effect of aromatherapy used in reducing the pain caused by fistula puncture in hemodialysis patients.Design/methodology/approachIn this study, the effect of aromatherapy application on fistula puncture was analyzed and carried out by scanning the relevant literature. The literature review was conducted between August and October 2020. While reviewing the literature, the authors used “aromatherapy,” “pain,” “fistula,” “puncture,” “hemodialysis” keywords and various combinations of these; moreover, Google scientist, Pubmed, Cochrane, ScienceDirect, Web of Science, Medline and Ovid databases and studies, which were conducted in the last 10 years were reviewed. As a result of the literature review, 1183 studies were reached and seven of them were included in the study by taking the inclusion criteria into account.FindingsThe randomized controlled studies are six studies and nonrandomized controlled experimental 1 study were added to the scope of the study and seven studies were included in the sample. In these studies, personal information forms developed by the researchers as data collection tools and the VAS scale, Numerical pain rating, the numeric rating scale were used to evaluate pain.Practical implicationsIt has been determined that aromatherapy application in hemodialysis patients has positive effects on reducing pain due to puncture fistula intervention.Originality/valueThis study provides reduction or elimination of fistula needle insertion pain in hemodialysis patients.

Effects of statewide stay-at-home orders on COVID-19 cases and deaths in the central USA

PurposeThis study seeks to determine the effects of stay-at-home orders in Spring 2020 on COVID-19 cases and deaths in the Central USA by comparing counties and health service areas that were and that were not subject to statewide orders.Design/methodology/approachThis study estimates the effects of statewide stay-at-home orders on new COVID-19 cases and deaths within 19 central states, of which 14 had stay-at-home orders. It uses synthetic control analysis and nearest neighbor matching to estimate the effects at two geographic levels: counties and health service areas.FindingsStatewide stay-at-home orders significantly reduced the number of new COVID-19 cases in the Central USA starting about three weeks after their effective dates; during the fourth week after their effective dates, the orders reduced the number of new cases per capita by 31%–57%. Statewide stay-at-home orders did not reduce the number of new COVID-19 deaths in the Central USA.Social implicationsThe main purpose of stay-at-home orders in Spring 2020 was to “flatten the curve” so that hospitalizations would not exceed capacity. It is likely that stay-at-home orders in the Central USA reduced hospitalizations to some extent, although the effect on hospitalizations was likely smaller than the effect on cases.Originality/valueThis is the first study of stay-at-home orders in the USA to limit the population to a group of interior states. All coastal states had statewide stay-at-home orders and comparing coastal states with orders to interior states without them may be problematic.

Sociodemographic and body image measures associated with overall and domain-specific physical activity among a group of Malaysian university undergraduates

PurposeThis study aims to determine the prevalence of overall and work, transport and leisure domain physical activity (PA) and their associated factors among Malaysian university undergraduates.Design/methodology/approachThis is an online cross-sectional study, which gathered data on sociodemographic parameters, PA and body image. Global Physical Activity Questionnaire (GPAQ) was used to collect data on PA while Multidimensional Body-Self Relation Questionnaire-Appearance Scale (MBSRQ-AS) for body image constructs. Three faculties were chosen through stratified random sampling where all its undergraduates were invited. A total of 898 students responded, of which 718 were accepted for analysis.FindingsPrevalence of overall work, transport and leisure domain PA among the students was 82.2%, 47.8%, 36.1% and 51.4% respectively. Overall PA was associated with male students (adjusted odds ratio [AOR]: 1.840, 95% confidence interval [CI]: 1.182–2.865); work PA was associated with the Malay race (AOR: 1.728, 95% CI: 1.240–2.409) and having part-time jobs (AOR: 3.098, 95% CI: 1.680–5.714); transport PA was associated with medical faculty (AOR: 1.677, 95% CI: 1.214–2.317) and leisure PA was associated with male students (AOR: 3.836, 95% CI: 2.746–5.360) and high overweight preoccupation (AOR: 1.486, 95% CI: 1.089–2.028).Research limitations/implicationsSelf-reported variables may be subjected to overestimation and bias.Practical implicationsDistributions of PA and its associated factors may be used as guidance for health promotions catering to university students.Social implicationsFactors affecting PA among the youth are correlated with social life events.Originality/valueFocus on domain-specific PA in association with body image measures may add values to existing PA studies, which is lacking in Malaysia.

A causal model of functional status among persons with liver cirrhosis from four public hospitals in Thailand

PurposeThe purpose of this study is to develop and test the causal relationships between alcohol consumption, social support, illness perception, fatigue and functional status among persons with liver cirrhosis. The hypothesized model was developed based on the theory of unpleasant symptoms.Design/methodology/approachA cross-sectional study was conducted among 400 persons with liver cirrhosis by stratified random sampling. Data were collected at outpatient departments from four public hospitals across three regions in Thailand. Six self-report questionnaires were utilized to collect data from March to August 2020. The developed model was verified via a structural equation modeling analysis.FindingsThe proposed model fit with the empirical data considering from χ2/df = 2.397 (p = 0.061), root mean square error of approximation (RMSEA) = 0.056, comparative fit index (CFI) = 0.985, Tucker–Lewis index (TLI) = 0.981, and standardized root mean square residual (SRMR) = 0.048. The model explained 71.30% of the total variance in functional status. Social support was the most influential factor affecting functional status both directly and indirectly through illness perception. Illness perception had a negative direct effect on functional status and a positive indirect effect on functional status through fatigue. Fatigue had a negative direct effect on functional status. Alcohol consumption was found as the lowest influential factor affecting functional status.Originality/valueThis is the first study that explores the characteristics of functional status among persons with liver cirrhosis comprehensively. A causal relationship among various variables found in this study would shed light as important fundamental data for developing interventions to enhance functional status among this population.

Coverage and correlates of health insurance in the north-eastern states of India

PurposeThe paper aims to analyze the coverage of health insurance and its correlates in the north-eastern region of India.Design/methodology/approachThe study accessed the raw data of the National Family Health Survey (NFHS-4) (2015–16), which was an extensive, multiround survey conducted in a representative sample of households throughout India, which included socioeconomic, demographic and information on coverage of health insurance of any member of the household. The multivariate analysis of logistic regression was adopted to find the correlates of health insurance for all the eight (8) north-eastern states of India.FindingsThe results observed that among the north-eastern states, the coverage of health insurance was highest in Arunachal Pradesh (59%) followed by Tripura (58%), Mizoram (47%) surpassing the all India level of 27%, whereas the lowest was in Manipur (4%) followed by Nagaland (6%) and Assam (10%). The multivariate analysis of logistic regression found that the socioeconomic and demographic factors, households with a bank account and below poverty line (BPL) cardholders played a significant role in the coverage of health insurance in the north-eastern states of India.Research limitations/implicationsThe study focuses only on the coverage and correlates of health insurance. Further evaluation studies on each scheme of the social health insurance are needed for proper assessment of the health insurance schemes in the region.Practical implicationsThere has been evidence around the world (South Korea, Taiwan and Thailand) that health insurance could be a protective shield from the entrapment into poverty due to high health expenditure. The NFHS-4 put up the finding that in the north-eastern part of India, the coverage of health insurance had been low. This implied that the region could fall into poverty due to high medical expenses on health. Taking account of multiple health insurance providers, risk pooling and consolidation of health insurance providers have become the need of the hour.Originality/valueThe study is different from other studies of health insurance since it covered all the eight (8) north-eastern states of India, which are ethnically, culturally and historically distinct from the rest of India in general and within the region and states in particular and examines the impact of each of the independent variables with the dependent variables. The study has shown that the variation in health insurance coverage associated with socioeconomic and other household-level demographic attributes (although not very strong).

A tale of dual-approach construct validation and reliability testing for a Zika infection awareness knowledge questionnaire

PurposeThis study aims to validate the English version of a WHO-adapted questionnaire: Zika infection awareness/knowledge questionnaire using a unique dual-approach validation model.Design/methodology/approachA cross-sectional pilot study of 30 adult respondents in Malaysia completed the self-administered questionnaire on knowledge and perception to Zika infection. Construct validity was assessed by exploratory factor analysis (EFA) of SPSS and Rasch partial credit. Reliability is tested using pKR20 and Cronbach’s alpha.FindingsKnowledge construct was unidimensional, good model fit, easy to endorse and well discriminative. Five-rating Likert scale for perception domain was appropriate. Knowledge domain should be separated into 6 level of difficulties. Perception domain should remain as one construct. Knowledge domain was highly reliability (pKR20 = 0.96), perception domain was fairly reliable (Cronbach’s alpha = 0.641). Respondent's ability to answer knowledge domain and perception domain were separated into 3 and 4 levels.Research limitations/implicationsSmall sample size may affect factor analysis.Practical implicationsThe questionnaire has good psychometric properties to measure the knowledge and perception of Zika infection among Malaysian community.Social implicationsThe questionnaire helped to gauge knowledge and perception of the general community in Malaysia to aid preparation of health education tool for Zika infection.Originality/valueThis paper validated questionnaire with two biostatistical software programs in bidirectional approach – items difficulty and respondents' ability – is the first field test of WHO questionnaire among general population in Southeast Asia.

Early marriage and spousal age difference: predictors of preconception health of young married women in Delhi, India

PurposeThis study aims to assess the associations of early marriage and spousal age difference (independent of early marriage) with reproductive and sexual health and autonomy in decision-making among married women before conception.Design/methodology/approachThe present study was a part of a three-year community intervention to improve the preconception health of young married women (20–35 years) in the West Delhi district of India. The six key outcomes assessed were: knowledge of reproductive health, discussions related to sexual health, history of anemia, use of contraceptives by women, frequency of consumption of meals per day and the autonomy in decision-making for household expenditures. Unadjusted and adjusted logistic regression models were used to explore the associations between the two key predictors (early marriage or spousal age difference), sociodemographic variables and six outcomes. The results were expressed as odds ratio (OR) and 95% confidence interval (CI). A total of 2,324 women, enrolled from four wards in the district using cluster-based sampling, were interviewed.FindingsAround 17% of women were married by the exact age of 18, and 20% were elder or just one year younger than their husbands. Women who were married early had low reproductive health knowledge (OR (95% CI): 0.48 (0.38–0.60)) and a lower probability of expressing autonomy (OR (95% CI): 0.78 (0.62–0.97)). However, women older than men or younger by just one year in the married relationship had higher reproductive health knowledge (OR (95% CI): 1.25 (1.01–1.54)) than women younger than men more than two years.Originality/valueUnder the umbrella of the preconception care domain, frontline workers should emphasize counseling girls and young women to marry late and delay the first pregnancy.