Duration of untreated psychosis and pathways to care in Suriname:a qualitative study among patients, relatives and general practitioners

PURPOSE: Psychosis is a severe mental health problem and is responsible for poor health outcomes, premature mortality and morbidity, especially in low- and middle-income countries. The duration of untreated psychosis (DUP), that is the time period between onset of symptoms until initiation of appropriate treatment by a healthcare professional, is one of the main determinants for successful treatment in western settings. This study aims to explore the factors related to the DUP among Surinamese patients using the perspectives from patients, their families and first-line healthcare professionals in Suriname. METHODS: Semi-structured interviews were conducted with patients having a history of psychosis, family members and general practitioners between February 2019 and April 2019 in Suriname. Interviews were tape-recorded and transcribed verbatim. Data were analysed using a thematic analysis for which an inductive and deductive approach was applied. RESULTS: In total, 28 patients, 13 family members and 8 general practitioners were interviewed. Five patients were excluded from the study. A median DUP of 4 months was found (IQR 1–36). Identified themes related to DUP included presentation of symptoms and illness awareness, help-seeking behaviour and alternative medicine, social support and stigma, financial and practical factors. CONCLUSION: Multiple factors were related to DUP, of which poor illness awareness, traditional medicine, stigma and social support were predominant. Poor illness awareness and use of alternative medicine were related to a longer DUP. Stigma was often an obstacle for patients and their families. Social and family support was important in helping patients to get medical help sooner. Other explored factors including financial and practical factors did not contribute to DUP

Effectiveness of a Comprehensive Health Literacy Consultation Skills Training for Undergraduate Medical Students:A Randomized Controlled Trial

Comprehensible communication by itself is not sufficient to overcome health literacy related problems. Future doctors need a larger scope of capacities in order to strengthen a patient's autonomy, participation, and self-management abilities. To date, such comprehensive training-interventions are rarely embedded in curricula, nor systematically evaluated. We assessed whether comprehensive training increased these health literacy competencies, in a randomized controlled trial (RCT), with a waiting list condition. Participants were international undergraduate medical students of a Dutch medical faculty (intervention: 39; control: 40). The 11-h-training-intervention encompassed a health literacy lecture and five interactive small-group sessions to practise gathering information and providing comprehensible information, shared decision-making, and enabling of self-management using role-play and videotaped conversations. We assessed self-reported competencies (knowledge and awareness of health literacy, attitude, self-efficacy, and ability to use patient-centred communication techniques) at baseline, after a five and ten-week follow-up. We compared students' competencies using multi-level analysis, adjusted for baseline. As validation, we evaluated demonstrated skills in videotaped consultations for a subsample. The group of students who received the training intervention reported significantly greater health literacy competencies, which persisted up to five weeks afterwards. Increase was greatest for providing comprehensible information (B: 1.50; 95% confidence interval, CI 1.15 to 1.84), shared decision-making (B: 1.08; 95% CI 0.60 to 1.55), and self-management (B: 1.21; 95% CI 0.61 to 1.80). Effects regarding demonstrated skills confirmed self-rated competency improvement. This training enhanced a larger scope of health literacy competences and was well received by medical students. Implementation and further evaluation of this training in education and clinical practice can support sustainable health literacy capacity building of future doctors and contribute to better patient empowerment and outcomes of consultations

Patient Perspectives to Inform a Health Literacy Educational Program:A Systematic Review and Thematic Synthesis of Qualitative Studies

Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with LHL within the curricula of (future) healthcare providers (HCP). This systematic review aimed to explore and synthesize evidence on the needs, experiences and preferences of patients with LHL and to inform an existing educational framework. We searched three databases: PsychInfo, Medline and Cinahl, and extracted 798 articles. One-hundred and three articles met the inclusion criteria. After data extraction and thematic synthesis, key themes were identified. Patients with LHL and chronic diseases encounter multiple problems in the care process, which are often related to a lack of person-centeredness. Patient perspectives were categorized into four key themes: (1) Support system; (2) Patient self-management; (3) Capacities of HCPs; (4) Barriers in healthcare systems. “Cultural sensitivity” and “eHealth” were identified as recurring themes. A set of learning outcomes for (future) HCPs was developed based on our findings. The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for (future) HCPs, and contribute to better person-centred care for patients with LHL

Artificial intelligence and visual inspection in cervical cancer screening

INTRODUCTION: Visual inspection with acetic acid is limited by subjectivity and a lack of skilled human resource. A decision support system based on artificial intelligence could address these limitations. We conducted a diagnostic study to assess the diagnostic performance using visual inspection with acetic acid under magnification of healthcare workers, experts, and an artificial intelligence algorithm.METHODS: A total of 22 healthcare workers, 9 gynecologists/experts in visual inspection with acetic acid, and the algorithm assessed a set of 83 images from existing datasets with expert consensus as the reference. Their diagnostic performance was determined by analyzing sensitivity, specificity, and area under the curve, and intra- and inter-observer agreement was measured using Fleiss kappa values.RESULTS: Sensitivity, specificity, and area under the curve were, respectively, 80.4%, 80.5%, and 0.80 (95% CI 0.70 to 0.90) for the healthcare workers, 81.6%, 93.5%, and 0.93 (95% CI 0.87 to 1.00) for the experts, and 80.0%, 83.3%, and 0.84 (95% CI 0.75 to 0.93) for the algorithm. Kappa values for the healthcare workers, experts, and algorithm were 0.45, 0.68, and 0.63, respectively.CONCLUSION: This study enabled simultaneous assessment and demonstrated that expert consensus can be an alternative to histopathology to establish a reference standard for further training of healthcare workers and the artificial intelligence algorithm to improve diagnostic accuracy.</p

Understanding cervical cancer awareness in hard-to-reach areas of Bangladesh:A cross-sectional study involving women and household decisionmakers

INTRODUCTION: In Bangladesh, the uptake of cervical cancer screening is low. Lack of knowledge and understanding of symptoms and risk factors contributes to low screening uptake. The purpose of this study was to explore the knowledge of cervical cancer risk factors and symptoms and to measure the association with socio-demographic characteristics among women and household decisionmakers living in hard-to-reach areas of Bangladesh.METHODS: A cross-sectional survey was conducted in five districts in Bangladesh among women aged between 30 and 60 years, their husbands, and their mothers-in-law from April to September 2022. Data were collected using a modified version of the validated AWACAN questionnaire tool. The significance level was considered at p-value &lt;0.05 and odds ratios with 95% confidence.RESULTS: Nearly 50% of participating women in hard-to-reach areas of Bangladesh and their family decisionmakers had low levels of knowledge of the risk factors and symptoms of cervical cancer. Only 20% of respondents in our survey knew about HPV, the most important risk factor for developing cervical cancer. Most respondents were familiar with the terminology of cervical cancer as a disease; however, approximately 40% of respondents did not know that not adhering to cervical cancer screening could be seen as a risk factor. Women do not make decisions about participation in cervical cancer screening on their own. Knowledge of cervical cancer risk factors and symptoms among decisionmakers was significantly associated with higher education and higher household monthly expenditure.CONCLUSION: Women, their husbands, and mothers-in-law in hard-to-reach areas of Bangladesh had limited knowledge about cervical cancer risk factors and symptoms. Engaging these key decision-makers in targeted health education is vital to improve screening uptake. Conduction of future research to identify and address screening barriers is also essential for effective prevention efforts.</p