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Background: This qualitative systematic review aims to identify, analyse and discuss barriers and facilitators to formal dementia services for South Asians in the UK with dementia. South Asian individuals in the UK are more likely to face a dementia diagnosis than the White British demographic; a trend which is expected to grow over the following decades. Despite this greater need for support, the UK South Asian demographic is less likely to access formal dementia services.

Methods: MODEM, Web of Science, PubMed, CINAHL via EBSCO, The Cochrane Library, and Scopus were searched (22nd July 2025) using a SPIDER search strategy and included studies' bibliographies were checked, in addition to existing review literature. Data on included studies was extracted using an adapted Cochrane Library data collection form and quality assessed using the JBI critical appraisal instrument for qualitative research. Themes were extracted and analysed using reflexive thematic analysis. Ten articles were found to meet the inclusion criteria and therefore included in this systematic review. While this review is framed as considering UK South Asians, data was only available from Bangladeshi, Indian and Pakistani individuals. However, much literature which claims 'South Asian' only defines South Asia as consisting of these three countries. Therefore, calling this paper a review of the 'South Asian' demographic allows us to critique this homogenisation.

Results: Five main themes were identified: Lack of Knowledge, Racism/Culturally Inappropriate Care, Stigma, a Familial Duty of Care and Service Delivery. There was disagreement in the literature regarding the existence of stigma. Previously unrecognised interrelations between these themes were identified, as a lack of knowledge had a potentially causal effect on both stigma and a familial duty of care.

Conclusion: The results indicate a need for review of current policy and practice, however further research is needed, particularly with regard to facilitators, which lacked data in comparison to barriers.

Background: Health-related social needs (HRSNs), including food insecurity, housing instability, transportation barriers, and financial strain, are increasingly recognized as critical to patient-centered care. Despite growing mandates and incentives to integrate HRSN screening and referral into routine clinical workflows, healthcare systems face significant challenges in implementing HRSN screening and referral processes at scale.

Objectives: This study explores the early implementation of HRSN screening and referral across a multistate healthcare system, using the Health Equity Implementation Framework (HEIF) and Knowledge-to-Action (KTA) Framework to examine multilevel barriers and facilitators.

Design: Qualitative descriptive design.

Methods: Semi-structured interviews (n = 23) were conducted with healthcare leaders, navigators, clinicians, and community health workers (CHW), eliciting their experience with leading and implementation of HRSN screening.

Results: Findings reveal that many frontline staff (including clinicians, navigators, and CHWs) reported disjointed workflows, unclear referral roles, and limited communication related to HRSN implementation. They also reported distress when screening occurred without available resources to address identified needs. CHW's explained their pivotal but under-integrated roles, serving as relational and cultural bridges between health systems and communities. All participant cohorts identified organizational and interpersonal misalignments between implementation mandates and on-the-ground realities. Suggested strategies for improvement included role-specific training, participatory design, improved integration of CHWs into care teams, feedback loops, and locally adapted referral protocols.

Conclusion: These findings reinforce the value of frontline staff knowledge and experience to ensure robust implementation of HRSNs. Aligning system-level priorities with the complex realities of care delivery is essential for realizing the promise of HRSN screening as a tool for health equity.

Objective: In this article, the findings from a scoping review are presented identifying what is known regarding paramedic confidence, competence and education in managing the neurodivergent patient.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) framework was used to identify what is known about the confidence, competence, preparedness and education when engaging with the neurodiverse patient.

Results: Four articles were identified that explored paramedics, their confidence, competence and education in assessment and management of the neurodivergent patient, highlighting the need to increase knowledge and understanding pertaining to the neurodivergent patient in order to improve care.

Conclusion: Given the unique role of the paramedic in contemporary health care, this study contributes to the discourse around appropriate levels of training for paramedics, as it highlights gaps in the literature associated with neurodiversity specific paramedic training.

Background: Unsafe abortion is a major contributor to maternal mortality in low- and middle-income countries. Despite the legalization of abortion and expanded access to services in Nepal, data on abortion practices and patient satisfaction remain limited.

Objective: This study aimed to assess abortion methods, their management, and patient satisfaction among women seeking safe abortion services at a tertiary care hospital in Kathmandu, Nepal.

Design: A hospital-based cross-sectional study.

Methods: The study was conducted from December 2023 to May 2024 among 285 women aged ⩾18 years with gestational age of up to 12 weeks. Data were collected through face-to-face interviews and clinical records, followed by 7-day post-abortion assessment via in-person visits or phone calls. Pearson's chi-square test and binary logistic regression were performed at a 5% level of significance to identify factor associated with patient satisfaction.

Result: Among 285 women, 76.8% underwent medical abortion with oral mifepristone followed by misoprostol via sublingual, buccal, or vaginal routes, while 23.2% received surgical abortion through vacuum aspiration after misoprostol pre-treatment and local anesthesia. Discharge medications commonly included analgesics (paracetamol and ibuprofen) and antibiotics (ciprofloxacin, and metronidazole). Post-abortion contraceptive uptake was 79.3%, with implants (28.8%) and condoms (28.4%) being the most chosen methods. Overall, 50.2% of women reported satisfaction with the abortion services received. Logistic regression analysis showed that higher education (AOR: 5.63; 95% CI: 2.40-13.16), extended family structure (AOR: 7.25; 95% CI: 3.11-16.91), and no history of live birth (AOR: 4.20; 95% CI: 1.48-11.93) were significantly associated with higher satisfaction, while age ⩾35 years was negatively associated (AOR: 0.52; 95% CI: 0.28-0.95).

Conclusion: Medical abortion was the preferred method, and overall management was aligned with WHO guidelines. However, patient satisfaction was moderate. Improving infrastructure, ensuring privacy, reducing waiting times, enhancing post-abortion counseling, and providing tailored health education with regular service evaluations are needed to improve the quality of abortion care and patient satisfaction.

Introduction: Globally, between the ages of 10 and 19, 15% of teenagers have mental health issues, according to the World Health Organization (WHO). Mental health issues in schools lead to dropouts, poor academic performance, social isolation, and increased substance misuse. Various strategies, including universal screening and raising mental health literacy, have been implemented. However, constraints like limited resources and inadequate training hinder effective management. Therefore, this paper aimed to explore student access to and utilisation of the school health system for mental health challenges, and to identify key barriers to its effectiveness from the perspective of students and staff in Mapanzure Masvingo District.

Methods: A mixed-method survey was used with interviews and questionnaires to gather information from key informants and 62 randomly selected students. The key informants were purposively sampled, including two nurses, two teachers, three health masters, and two administrators. Quantitative data was analysed in Excel and SPSS and presented as tables and graphs, while the qualitative data was recorded, transcribed verbatim, coded, and thematically analysed.

Results: The study found a high prevalence of self-reported mental health symptoms among students, including attention deficit (62.9%) and low self-esteem (72.6%). This high burden of need contrasted sharply with utilisation of the school health system was low (40.3%), primarily due to a lack of student awareness. This indicates a significant gap between system provision and student access. Key informants identified health clubs and guidance counselling as core components of the system, but their effectiveness was hampered by major barriers like poverty and substance abuse.

Conclusion: It can be concluded that students are experiencing mental health issues, and key informants generally view school health systems as helpful. However, there are certain obstacles, such as poverty and substance use and abuse hindering implementation and optimal functioning of school health systems. These results may help create a supportive and inclusive environment that values student health and emotional wellbeing that can lead to improved academic outcomes and positive life for students.

Objective: Evaluating user satisfaction and its associated factors in two primary healthcare centers in Ucayali, Peru.

Methods: The study was cross-sectional analytical study conducted in April 2025 among patients who received care at two primary healthcare centers located in Ucayali, Peru. To assess their satisfaction with the care received, we used the Ambulatory Medical Consultation Satisfaction Scale (ESCOMA). To identify the factors associated with the ESCOMA satisfaction score, we used linear regression models.

Results: A total of 465 patients were included; 66.5% of those surveyed were women, and the median age was 40 years (IQR 31-52). Of these, 74.8% lived in the same city as the healthcare center. The median ESCOMA score was 7 points (range 6.17-8.28). Medical care received the highest dimensional score (mean: 7.94 ± 1.5), while facility infrastructure recorded the lowest (mean: 6.37 ± 1.9). The questions with the highest and lowest scores were "How would you rate this facility regarding the treatment by medical staff?" (mean: 8.33, SD ± 1.7) and "How would you rate this facility regarding the equipment?" (mean: 5.71, SD ± 2.7), respectively. Age ⩾ 47 years (β = .34; 95% CI: 0.02-0.67) was the main factor associated with a higher ESCOMA satisfaction score; on the other hand, patients who lived 2 hours from the health center had lower satisfaction (β = -.68; 95% CI: -1.09 to -0.28).

Conclusion: User satisfaction with primary healthcare centers in Ucayali is favorable regarding medical care and staff treatment. However, perception is significantly lower concerning infrastructure and equipment availability. As the distance from homes to the health centers increases, satisfaction with medical care decreases. These findings highlight the need to improve physical conditions and equipment to optimize the quality of care in these institutions.

Background: When parents or other guardians of children need treatment for a substance use disorder, it presents challenges impacting both them and their children, as a lack of childcare can be a barrier to treatment access. However, some treatment facilities provide childcare services to increase access. Little is known about how local economic factors like childcare costs and income levels are associated with the availability of childcare services in addiction treatment programs in the United States.

Objectives: This study's objectives were twofold: (1) assess whether county-level childcare prices are associated with the availability of childcare services in substance use disorder treatment facilities, and (2) assess whether county-level median household income is associated with the availability of childcare services in substance use disorder treatment facilities.

Design: This is a cross-sectional study.

Methods: This study examined n = 9003 substance use disorder treatment facilities in the United States. Childcare costs and median income estimates were linked with facilities based on the county in which they were located. Univariable and bivariable statistics were used to examine the facilities. An adjusted logistic regression model was used to evaluate associations between childcare availability and county-level economic indicators, while controlling for facility-level characteristics.

Results: Approximately 5.7% (n = 514) of the facilities in the sample had childcare services. The multivariable logistic regression model identified factors associated with facilities having childcare including having outpatient and residential treatment (compared to having only outpatient only), accepting females only (compared to accepting males only), having a pregnant or postpartum program/group, accepting Medicaid, slightly higher county-level toddler center prices, and slightly higher county-level preschool center prices.

Conclusion: Local childcare costs, but not median income appears to be slightly associated with the availability of childcare services in substance use disorder treatment settings. Economic investment in family-friendly services may help reduce access barriers for parents seeking treatment.

Background: The colorectal cancer (CRC) screening adherence rate among the uninsured population in the United States (US) is lower than the overall rate across all US adults aged 45 to 75.

Objectives: To assess the cost-effectiveness of community health worker (CHW) navigation services promoting CRC screening in a low-income, uninsured population.

Methods: Using internal cost and effectiveness data from the Texas A&M Cancer Screening, Training, Education, and Prevention (CSTEP) program, which included 3196 participants, along with published sources such as the U.S. Preventive Services Task Force (USPSTF) recommendations, we estimated incremental cost-effectiveness ratios (ICERs) for CRC screening with CHW navigation versus usual care. The analysis was conducted from a societal perspective using Excel-based modeling in hypothetical cohorts initiating screening at age 45.

Results: Under base-case assumptions, a 10 percentage-point improvement in CRC screening attributable to the program increased LYG by 0.160 at an additional lifetime cost of $101, resulting in an ICER of $3098 per LYG. One-way and two-way sensitivity analyses were conducted, varying program costs, screening rate improvements, lifetime CRC costs, and life-years gained (LYG).

Conclusion: Our findings underscore the importance of CHW navigation services incorporating CRC screening promotion strategies tailored to uninsured populations to alleviate disparities in colorectal cancer screening and outcomes. Further research should consider the characteristics of uninsured populations, and the applicability of the program targeted for various types of underserved populations.

Background: Low vision care and rehabilitation (LVCR) remains critically underdeveloped in sub-Saharan Africa, despite a high prevalence of moderate to severe visual impairment.

Objective: This study assessed the current state of LVCR in five sub-Saharan African countries using a modified World Health Organization (WHO) health systems framework.

Method: A qualitative design was employed, involving semi-structured interviews which were based on a modified WHO health system building blocks: governance and leadership, health service delivery, human resource, low vision aid and technology, and financing. Optometrists providing low vision care in Ghana, Nigeria, Malawi, Kenya, and South Africa were recruited as participants through a combination of stratified random sampling and snowballing. Thematic analysis was conducted to identify the underlying themes.

Results: Practitioners reported systemic deficiencies across all five blocks investigated. Governance and leadership lacked clear policies, coordination, and data infrastructure. Health service delivery was characterized by poor coverage, the absence of dedicated LVCR centres, and limited integration into public health systems. Human resources were inadequate, with no structured training or recruitment of practitioners, and low recognition of the sub-specialty. Essential assistive technologies were largely inaccessible due to high costs and procurement challenges. Financing was insufficient, with patients primarily paying out-of-pocket and health insurance schemes offering limited support.

Conclusion: None of the five blocks of the WHO health systems framework were adequate for LVCR in this study. Consequently, strengthening each block particularly governance, workforce development, and financing is essential for advancing equitable and sustainable LVCR systems in sub-Saharan Africa.

Introduction: Considering the global increase in cancer, integrative medicine combines conventional and complementary methods, offering a holistic approach to treating cancer patients. To optimize care and support care continuity for oncological patients, the integrative healthcare structure CCC-Integrativ provided evidence-based, interprofessional counseling in four oncology centers in Southern Germany. A process evaluation explored the program's perceived effects and factors relevant to the implementation process to identify opportunities and challenges for a sustainable implementation of the program.

Methods: In a qualitative study, semi-structured guide-based interviews with medical and nursing staff directly and indirectly involved in the program were conducted to explore their perspectives. The generated data were analyzed in a content analysis. Participant perceptions regarding potential program effects and factors influencing its' implementation were first identified through open inductive coding. The Consolidated Framework for Implementation Research (CFIR) was then used as a categorizing analytical framework to guide further coding and facilitate a deeper understanding of the implementation process.

Results: N = 21 interviews were analyzed (n = 12 directly involved in counseling; n = 9 indirectly involved through leadership position). Participants perceived an added value of the integrative care approach and expressed a positive attitude towards a continuation of the program. Patient interest in complementary medicine and care, their positive response to the program, and a perceived supportive effect of the interprofessional collaboration were reported as promoting factors. Still, insufficient evidence and a perceived low acceptance of some complementary medicine methods by hospital staff, skepticism, lack of space, and recruitment problems, were identified as key challenges for successful long-term implementation.

Conclusions: A variety of factors need to be addressed for sustained implementation. Promoting acceptance of supportive complementary methods is essential for evidence-based, patient-centered cancer care. Consideration of interprofessional care could be a key factor for the long-term implementation of consultations on complementary and integrative healthcare.