Browsing by Author "Long, Qian"

Background: Maladjustment, categorized as internalizing and externalizing behaviors, is a process whereby an adolescent is unable to satisfy the psychological needs successfully. Youth behavioral problems may strengthen during the COVID-19 pandemic that put individuals through many mental health difficulties. The objectives of this study are to (1) examine the difference of youth behavioral problems between before and during the pandemic; (2) to investigate the association of parental mental health changes with youth behavioral problems during COVID-19; (3) to identify the predictors of parental mental health changes during the COVID-19. Methods: This study used the data from Wave 8 and Wave 10 of the China sample in the Parenting Across Cultures project. The study sample included 115 families in Chongqing, China. Linear mixed-effects models and Full Information Maximum Likelihood estimation were performed. Results: Adolescents experienced a significant increase in internalizing behaviors during COVID-19 (p = 0.002). The COVID-19 disruption brought a 0.20 increment in youth internalizing behaviors. Paternal mental health was significantly associated with youth internalizing behaviors (p = 0.020) and externalizing behaviors (p = 0.034). Youth’s gender, socioeconomic status, family structure, and family mental wellbeing significantly predicted parental mental health changes during COVID-19. Conclusions: As the first longitudinal study in China measuring the changes in youth behavioral problems before and during COVID-19, this study stressed the impact of COVID-19 disruption on the increment of youth internalizing behaviors between 2018 and 2020 in China. The results have important policy implications for adolescents-oriented mental health prevention and mitigation during COVID-19.

Background: The landscape of childbirth has transformed over time, shifting from home births guided by midwives to a medicalized procedure predominantly in hospitals, with Cesarean sections (CS) as a significant innovation. Globally, CS rates have risen, including elective CS without medical necessity. Research conducted by the World Health Organization suggests optimal CS rates are between 10-15%, but many countries exceed this value. Initially, in 2014 Cambodia’s rate was at 6.9%, but the latest data released from the Cambodian Demographic and Health Survey has reported a significant increase of almost 18%. Factors like demographic transitions and improved health care are likely to have contributed to this rise. Understanding the decision-making process for childbirth modes is crucial, with medical opinions sometimes differing from patient preferences. This study focuses on Cambodian women, exploring the factors influencing their birth mode decisions, aiming to highlight the significance of women's perspectives in shaping childbirth practices. Methods: Fourteen in-depth, semi-structured interviews were conducted with either nulliparous, primipara, or multipara pregnant women in Phnom Penh, Cambodia. Participants met eligibility criteria such as having single pregnancies over 28 weeks of gestational age, lacking a medical indication from a physician for cesarean section, and being free from known pre-existing medical illnesses or diseases diagnosed during pregnancy. Lastly, participants were not employed as health professionals. Thematic analysis was used on twelve interview transcriptions to analyze the data. Results: Thematic analysis revealed several influential factors, including utilizing external information sources like physicians and family and/or friends, participants’ knowledge of delivery method and procedure recovery, a mode of birth preference largely based on the patient’s individual circumstances, the discussion of patient autonomy and authority to decide, and the recognition that childbirth expectations might change during labor. Conclusion: These research findings highlight that Cambodian pregnant woman processed their mode of birth based on a variety of influences and factors. This data suggests that an individual’s decision is impacted by their environment and the context of their lives. These results can help medical professionals, other maternal health providers, and policymakers better understand how Cambodian pregnant women process their mode of birth decisions.

Background: Singapore has a fast-growing aged population and increasing numbers of dementia patients. The heavy burden of dementia nursing care imposes challenges on the nursing workforce. The aim of this study is to describe the current situation of nurses’ dementia care training.

Methods: This study reviewed literature and policy documents to investigate the nurse’s profile, nurse education mechanisms, and the social and political support for nurse training in Singapore. Additionally, by conducting in-depth interviews with 17 nurses, this study investigated the current dementia care training status in selected nursing facilities, and obtained nurses’ views on desired training, barriers and challenges for obtaining dementia care training.

Results: This study found that Singapore has established a mature nurse education model consists of advanced school education and well-designed continuing education. A supportive social environment was established to cultivate nurses and enhance nursing professionalism. Nurses expressed that existing dementia care training is insufficient with low frequency, unsatisfied curriculum contents, and unreasonable candidate selection. Besides, the shortage of workforce, the high turnover rate and overlook of nurses’ needs in designing course content were viewed as challenges for providing and obtaining training.

Conclusions: This study portrays the situation of nurses’ professional training on dementia care in Singapore. The findings emphasize the value of fostering nurses’ dementia care training with higher frequency, need-oriented contents and reasonable candidate selection method. Results generated in this study lay the foundation for future research, policy analysis, and regulation establishment, hence, to improve nurse training and to ensure responsive dementia care services.

AbstractBackground China has witnessed a rapid increase in the prevalence of diabetes and childhood obesity over the past decades with an alarming increase in free sugar consumption, especially through sugar-sweetened beverages (SSBs). However, there are no national policies on SSBs in China. Little is known about the acceptability, adaptability, and scalability of policies on SSB consumption in China. Therefore, this study aims to explore stakeholder perceptions on the introduction of SSB policies and implementation challenges in China, and draw policy implications from the information gained.

MethodsThis study design is adapted from a theoretical framework “Analyzing and addressing governance in sector operations”, with context analysis, qualitative interviews and stakeholder analysis. Semi-structured interviews were conducted with 37 stakeholders in Shanghai and Chongqing, China, including health commission officers, CDC officers, market regulation officers, academia, nutrition association, industries, and consumers (parents of children and adolescents).

Results Currently, there is a rising trend of SSB consumption among children and adolescents in China, and the interviewed stakeholders were aware of the change in behaviors. Different stakeholders shared different understandings of the rising SSB consumption trends and conflicting prospects on whether SSB policies should be introduced in China. Besides, they also expressed different views on the choice of SSB policies, effectiveness, acceptability, and scalability. Most policy makers and nutrition experts agreed that health education is the most important and appropriate strategy to control SSB consumption by Chinese children and adolescents, and market regulation officers believe stricter policies such as taxes and mandatory front-of-pack labelling would be effective. On the other hand, industry stakeholders would prefer step-by-step policies including policies with multiple stages and voluntary labelling, wishing to create a better transition period for the market to respond. Furthermore, the interviewed consumers also observed the increasing trend of SSB consumption from their children. Some parents were aware of the health risk of excess SSB intake and believed in the positive impact of public health policy guidance, others would prefer the freedom to make their own choice as consumers and enjoy the sweet tastes of SSBs. In addition, perceived facilitators to the introduction of SSB policies include standard establishment or reform, the multi-sector collaboration of health, marketing, education departments and the industries, and step-by-step adaptation of SSB policies. Besides, potential challenges include responsibility distribution between different departments, resistance from industries, and consumer opposition.

ConclusionThis study examined the perceptions of SSB policy introduction among different Chinese stakeholders, including policy makers, nutrition experts, the industry and consumers. Although the SSB intake among Chinese children and adolescents is growing, interviewed stakeholders showed inadequate knowledge and awareness of SSB policies. Valid policy action on a national scale would require national standard reforms, as well as improving awareness of policy makers and the nutrition literacy of Chinese consumers. Future studies could conduct formative research and collect implementation evidence to better facilitate the establishment of SSB policies in China.

Background: In 2015, colorectal cancer (CRC) constituted approximately 10% of all global cancer incidences, with China witnessing 388,000 new cases. Initiated in 2006, the Central Government's Rural Cancer Screening and Early Diagnosis and Treatment Project represents a significant national health initiative, extending across 252 sites, including Tongling City. Tongling People's Hospital is responsible for overseeing this project, implementing a digital platform for managing the participants’ screening data, electronic colonoscopy findings, pathological diagnoses, and follow-up treatments. This study seeks to: (i) elucidate the processes of implementation of the program; (ii) examine the challenges faced in the administration of this project; and (iii) offer policy recommendations.Method: This study used mixed methods. The quantitative data on CRC is derived from the registry data of Tongling People’s Hospital. The quantitative data was designed to elucidate sociodemographic characteristics of the study population, ascertain the prevalence of positive cases, and identify factors associated with an elevated risk of CRC. The qualitative method encompasses conducting individual interviews with village doctors, who guide participants aged 40-74 through demographic surveys prior to administering fecal immunochemical tests (FIT) if they are at high risk of CRC and focus group interviews with hospital managers. It was implemented to examine the challenging experiences, alongside gathering recommendations. Results: In the quantitative analysis, FIT was administered to 8,768 participants, resulting in 1,484 positive findings. Female participants exhibited a significantly higher rate of positive results in comparison to their male counterparts, with this discrepancy achieving statistical significance (p=0.015). An elevated positivity rate was observed among the older age cohorts, particularly those aged 65 to 75 years, a difference that was also statistically significant (p=0.003). Qualitative analysis highlighted several challenges: (i) Incomplete integration of diagnostics and follow-up data into the digital platform, limited to questionnaires and preliminary screening; (ii) Financial constraints and the pandemic's impact hindering research expansion, especially male participation; (iii) Regulatory deficiencies in data quality assurance, including insufficient preliminary screening quality control, the necessity for enhanced training of village doctors; (iv) Obstacles in integrating digital platforms with outdated medical infrastructure, primarily due to the pathology information system's inability to effectively synchronize pathology reports with patient data. In the individual interviews, hospital managers articulated the following recommendations: (i) Enhancing public awareness; (ii) Applying for People’s Livelihood Projects; (iii) Upgrading the capabilities of electronic colonoscopy and establishing performance metrics for quality assurance. Conclusion: The study reveals the implementation, processes, challenges of the CRC Screening and Early Diagnosis and Treatment Project in Tongling city. The policy recommendations made by the researcher are: (i) Enhance financial subsidies for the screening platform, alongside the establishment of contingency reserves; (ii) Use a performance-based remuneration framework that could bolster the data quality furnished by village doctors; (iii) Build communication with provincial organizations; (iv) Boost male participation by strategies such as adaptable scheduling options and mobile screening units. Future research should focus on enhancing financial support, data quality, participant engagement, and educational initiatives.

Background: Indonesia has one of the highest TB burdens in the world and is one of ten countries that accounted for 77% of the global gap between treatment enrollment and the estimated number of new cases of MDR/RR-TB in 2019. However, there are knowledge gaps about how the delay of MDR-TB treatment initiation might affect this situation. Therefore, this study aimed to examine challenges of implementing MDR-TB treatment initiation in a Programmatic Management of Drug-Resistant Tuberculosis (PMDT) national referral hospital in Indonesia. Method: This study used mixed methods to collect both quantitative data through hospital records of MDR-TB patients and qualitative data through interviews with patients and health workers. Result: The median time between diagnosis and treatment initiation was 26 days, and was associated with co-morbidities, MDR-TB knowledge, and support assessment. This study also revealed the complex situation of people affected with MDR-TB with lack of social support and health system challenges during the MDR-TB treatment initiation process. Conclusion: The results of this study revealed the challenges of the treatment initiation process from the complex perspectives of the patients, the aspects of the health system that need to be improved, and the importance of social support starting from diagnosis.

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AbstractThe Global Fund is the world's largest global health financing organization to fight AIDS, tuberculosis, and malaria, which provides about $4 billion annually to support countries and organizations fighting the three infectious diseases. However, no literature has been published to give a detailed assessment of its allocation model. This study examines the Global Fund's allocation process for the 2020-2022 cycle, using both qualitative and quantitative methods to explore whether the Global Fund’s allocation model can effectively respond to its strategic objectives and the needs of the countries. After the 207-2019 allocation, the Global Fund reported effective fund absorption across HIV, tuberculosis, and malaria, employing measures like "portfolio optimization," mid-cycle fund reprogramming, and intentional overallocation to stimulate optimal fund utilization and prevent returns to the central pool. Experts provided a positive assessment of the allocation process, emphasizing consistency in disease split percentages (HIV=50%, TB=18%, Malaria=32%) and adjustments to address historical issues. Challenges encompassed human costs, data quality, financial issues, and factors beyond epidemiology. The disease split design, unchanged since 2014-2016, historically favored HIV due to the Global Fund's initial focus on AIDS. Suggestions for dynamic disease split percentages in future cycles were made, acknowledging challenges in adjusting the split and potential impacts on underfunded programs. Financial need assessment aimed for equitable fund distribution, considering disease burden, economic capacity, and other indicators. Prevention needs focused on disease burden and key populations, while community delivery needs were treated as implementation issues. Countries' specific needs evolved annually, necessitating continuous evaluation. However, experts expressed pessimism, asserting that current allocations did not cover all essential services due to significant funding gaps attributed to the COVID-19 pandemic, inflation, and political issues. Quantitative analysis of allocation data from 112 countries, totaling $12,659,254,481, revealed a disease split following the Global Fund's methodology, with regional variations. Strong correlations were observed globally and continentally between Allocation and Budget, Allocation and Disease Burden, and Budget and Disease Burden for the three diseases. The analysis found weak correlations for malaria at the continent level in LAC. The budget for the 2020-2022 cycle exceeded the allocation by $3,605,274,211 due to carry-over and additional COVID-19 Response Mechanism resources. Africa received the largest budget, especially in HIV, Malaria, TB&HIV, and standalone RSSH components. EECA did not receive Malaria and standalone RSSH budgets. The global standalone RSSH budget constituted about 4.16% of the total budget. Combining HIV, TB, and TB/HIV components, the budget for total HIV and TB represented 66% of the total budget, with Africa receiving the largest budget for the three disease components. The Global Fund's implementation currently relies heavily on government and civil society organizations to ensure country ownership. Governments, representing nations at the international level, contribute to negotiations and resource allocation, leveraging their larger resources for stable and sustainable support. Civil society organizations, with a better understanding of local needs, enhance realistic project implementation. However, private sector involvement is limited due to potential profit prioritization and concerns about regulation and transparency. While the private sector may be necessary in certain projects, alignment with the Global Fund's objectives and values is crucial. At the country level, the response to diseases like AIDS faces human resource shortages, affecting healthcare access and fund absorption delays. This study underscores the intricate interplay between qualitative and quantitative aspects in the Global Fund's allocation process, recognizing ongoing efforts to address challenges, balance disease and RSSH priorities, and adapt to changing global circumstances.

Background: Previous studies in Sri Lanka showed a high prevalence- 30% of postpartum depression (PPD). PPD screening using the Edinburgh Postnatal Depression Scales (EPDS) was included in postnatal care in 2012. This study aimed to estimate the prevalence of PPD in 2017 in two medical offices of health (MOH) areas, identify the association between risk factors and presence of postpartum depression, understand current practice, challenges, and suggestions of PPD screening in Sri Lanka.

Methods: The study consists of a population-based quantitative study and a qualitative study. PPD outcomes were assessed by mothers’ responses to the EPDS. Potential factors were extracted from routine paper-based medical records. The association was examined at unadjusted level first, and at adjusted level using multivariate linear regression and multivariate logistic regression models. Individual in-depth interviews were conducted among public health midwives. Framework approach was adopted to analyze the transcripts.

Results: The prevalence of PPD was 15.5% and 7.8% among mothers assessed 10 days postpartum (in Dankotuwa) and 4 weeks postpartum (in Bope Poddala), respectively. PPD was associated with earlier screening time, mothers’ delivery age > 35, >= 4 living children, and mothers’ illness. Mothers who attended prenatal sessions and whose partners were employed were less likely to report potential PPD. Other risk factors of PPD noted from interviews include socio-economic factors, interpersonal relationship, mother’s disease history, delivery method, and baby’s illness. The challenges of screening PPD included social stigma, mother’s difficulty of understanding EPDS and lack of privacy at home.

Conclusions: Mothers exposed to various socio-economic, interpersonal, and other risk factors deserve special attention. Family-based interventions, further cultural validation of EPDS, development of risk-assessing instrument could be introduced for future practice. Future research on other risk factors for PPD with larger sample size should be conducted, and qualitative research could engage other stakeholders in maternal mental health care to assess the accessibility, capacity, and quality of PPD care.

Background: Indonesia has a population of over 69 million women of reproductive age and struggles to reduce national maternal mortality rates. The transitioning health system must contend with improving the quality of maternity care. This study aimed to investigate the provision of maternity care from the perspective of two key stakeholders: providers and clients. Methods: We conducted individual, in-depth qualitative interviews with 31 pregnant and postpartum mothers and held two focus group discussions with 10 midwives in a community health center to examine attitudes and perceptions of quality maternity care. We then analyzed data through mapping emergent themes to the WHO QMNC framework. Results: Participants across both groups most frequently referenced interpersonal relationships, more than physical or human resources, as the main determinate to perceptions of quality care. Additionally, socioeconomic, religious and cultural factors also played a significant role in the provision of care; yet, was not fully captured in the definition of quality care. Conclusions: Interpersonal relationships are critical components to the provision of quality care. Investments in further fostering these relationships are important in strengthening the capability of the health system to provide safe, effective and high quality maternity care.

Background: Breast cancer ranks as the most prevalent malignancy among Chinese women, constituting approximately 12.2% of all newly diagnosed cases globally. Furthermore, breast cancer imposes substantial economic expenditure on patients in China. From 2012 to 2014, the average expenditure for Chinese breast cancer patients amounted to $8,450, with medical costs constituting a significant proportion of this expenditure. To address the economic vulnerabilities inherent in accessing medical and healthcare services for cancer patients, China has implemented various fundamental medical insurance schemes since 1998. However, previous research lacks an analysis on outpatient services for breast cancer patients and qualitative data interpretation. Therefore, this study aims to analyze the disparities in the utilization of health care and medical expenditure among breast cancer patients under different basic medical insurance schemes in a city in 2022, while also providing qualitative interview data to interpret quantitative findings.Method: This study employs a mixed-method encompassing quantitative and qualitative analyses. The quantitative analysis data originates from the medical insurance settlement data of the city, and analysis is conducted on breast cancer patients who sought diagnosis and treatment for breast cancer in 2022 among the population participating in the basic medical insurance of the city after obtaining permission from the municipal medical insurance bureau. Quantitative analysis encompasses the analysis of the characteristics of these patients, as well as an evaluation of the utilization of health care parameters. These parameters include outpatient visits, the number of hospital admissions, length of stay (LOS), and LOS per admission. Additionally, the analysis extends to the domain of medical expenditure, encompassing total health expenditure, reimbursed expenses from health insurance, out-of-pocket expenses (OOPs), the percentage of OOPs, and the proportion of OOPs relative to individuals' disposable income of this city as a substitution, rather than the individual income of research participants, to estimate the economic burden for breast cancer patients. Qualitative analysis involves conducting interviews with breast cancer treating doctors from a general hospital capable of treating breast cancer, and a personnel from the hospital's medical insurance office, and officials from the city's medical insurance bureau. The aim is to explore the underlying reasons for the observed disparities in quantitative analysis results and seek insights and perspectives from these stakeholders. Result: In a cohort of 550 breast cancer patients subjected to quantitative analysis, 339 were identified as recipients of coverage under the Urban Employee Basic Medical Insurance (UEBMI), with the remaining 211 falling under the Urban and Rural Resident Basic Medical Insurance (URRBMI). Regarding reimbursement policies, UEBMI breast cancer patients demonstrate a higher reimbursement proportion than those covered by URRBMI. UEBMI provides a reimbursement range of 87% to 97% for general inpatient expenses, while URRBMI offers a comparatively lower range of 65% to 80%. Furthermore, in terms of outpatient services, UEBMI presents an 80% reimbursement proportion, surpassing URRBMI, which provides a lower reimbursement proportion of 60%. Quantitative analysis demonstrates that UEBMI breast cancer patients utilize outpatient care, general inpatient care, and combined outpatient and inpatient care significantly more than those covered by URRBMI, with P values all <0.05. Conversely, URRBMI breast cancer patients display a significantly higher utilization in intermittent inpatient care and combined general inpatient with intermittent inpatient care compared to UEBMI patients, with P values all <0.05. Additionally, breast cancer patients under the URRBMI exhibit a significantly higher average number of hospitalizations (4.79) compared to those under the UEBMI (3.64). Moreover, URRBMI breast cancer patients experience a markedly lower average LOS (30.90 days) for combined general and intermittent inpatient services, in contrast to UEBMI patients (57.69 days). The average outpatient visits for UEBMI breast cancer patients are significantly higher across existing combined outpatient and inpatient care, and outpatient combined with general inpatient and intermittent inpatient services, with numbers of 3.21 and 4.11 respectively, compared to URRBMI breast cancer patients, where the number are 1.98 and 2.11. Analysis of medical expenses among breast cancer patients indicates that, despite those covered by URRBMI incurring higher total medical expenditure compared to those under UEBMI, OOPs for UEBMI breast cancer patients are notably lower (8432.43 RMB) than those covered by URRBMI (16603.44 RMB). Furthermore, OOPs for breast cancer patients under UEBMI and URRBMI accounted for 18.16% and 81.94% of their respective per capita disposable incomes. Moreover, concerning combined outpatient and intermittent inpatient services for UEBMI breast cancer patients, outpatient care constitutes 60.09% of the total medical expenditure, exceeding inpatient expenses which comprise 39.91%. Additionally, qualitative analysis indicates that disparities in the quantitative analysis results are primarily attributed to variations in the covered medical services and differences in outpatient and inpatient medication, external drug usage, and requirements of drug proportions, leading to disparities in medical services provided to breast cancer patients by doctors. Moreover, interviewees emphasized the need to improve commercial health insurance coverage, intensify breast cancer screening initiatives, and incorporate a variety of breast cancer treatment drugs into existing centralized procurement policies. Conclusion: The results of this study indicate that breast cancer patients covered by URRBMI face a significant economic burden when seeking medical services, compared to those covered by UEBMI.

Background: The literature indicates that only 100% smoke-free public places can adequately shield the public from second-hand smoke. Recent smoking bans in mainland China only partially prohibit smoking in public places despite previous comprehensive bans in some cities. This study aims to identify factors contributing to the imbalance in smoking legislation and enforcement in China. Methods: We began by reviewing literatures and policies to gather data on the current smoking laws, as well as identify potential study sites and key stakeholders. Next, we interviewed 16 key stakeholders in the two selected cities including former policymakers and tobacco control experts at municipal and district levels, enforcement officers, and employees of public places such as catering and accommodation. Results: Only 24 cities in mainland China have implemented comprehensive smoking bans, and enforcement is weak due to the limited scope of partial bans. The tobacco industry's direct involvement in discussions of smoking ban drafts and spread of misinformation to policy makers continue to influence smoking legislation. The partial smoking ban has not received enough attention from the target population, and ineffective law enforcement may result from the lack of a detailed department responsible for coordinating anti-smoking advocacy and law enforcement in the legal text. Conclusion: This study identified factors contributing to the uneven progress of smoking legislation and enforcement in mainland China. These findings underscore the complexity of the process and suggest the need for policy recommendations to address the factors affecting progress.