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Background: Patients performing self-triage for chest pain need to pick an algorithm which includes questions pertinent to chest pain to triage accurately.

Objective: Our study reviews patient self-triage choices and outcomes for patients who completed an online self-triage encounter before being triaged by a nurse for chest pain.

Methods: Patients who underwent telephone nurse triage for chest pain, and also had an online self-triage encounter within the prior 24 hours were reviewed for the frequency with which they chose "chest pain" as their symptom to triage for during self-triage, whether they reported chest pain during the self-triage encounter (if asked as part of the algorithm for their chosen self-triage symptom) and whether the patient had any follow up evaluation within 1 week.

Results: There were 70 self-triage and nurse triage dyads during the study period where triage nurses chose "chest pain" as the primary symptom to be triaged for during the telephone triage encounter. Of these, only 5 (7.1%) patients chose the "chest pain" self-triage option during online self-triage. During the self-triage encounter, 50 (71%) reported chest pain, 10 (14%) denied chest pain and 10 chose to self-triage their symptoms with an algorithm that did not include a question on whether chest pain was present. Of the 70 total dyads 59 (84%) had a follow up emergency department (40 patients) or office visit (19 patients) documented.

Conclusion: Most patients chosen to be triaged for chest pain by triage nurses did not choose the online self-triage algorithm for chest pain even though the majority did report chest pain during their self-triage encounter (when asked). This is concerning from a safety perspective as a non-chest pain self-triage option chosen by the patient may not always ask about the presence or absence of chest pain and thus could increase the risk of being triaged inaccurately. Implications for improvement of self-triage could include diagrams for patients to choose the symptom area.

Background: Many health systems fail to fully link evidence to decisions and suffer from inadequate ability to respond to priority health needs. Routine data use capacity-building efforts are poorly implemented, lacking integration, quality training, and adequate support.

Objective: This study was aimed to evaluate the effect of Augmented Capacity Development Interventions (ACDI) strategies on information utilization for decision-making in the Routine Health Information System (RHIS).

Methods: A two-arm parallel-group cluster randomized controlled trial was conducted across clusters of public health institutions. Baseline data were collected in April 2023, an eight-month intervention was implemented from July 2023 to February 2024, and end-line data were collected in April 2024. Training, supportive supervision, mentorship, recognition, and monitoring and evaluation were the ACDI strategies implemented in this study. The study involved 72 health institutions and 304 health workers. A general linear mixed model analysis was used to assess the effect of the intervention on information utilization.

Results: The proportion of participants with good information utilization increased significantly from 55.2% at baseline to 82.3% at the end-line among the intervention groups. The ACDI intervention has a significant effect on information utilization (β = 0.19, 95% CI: 0.05, 0.33, P = .006). Moreover, availability of internet service (β = 0.21, 95% CI: 0.04, 0.38; P = .017), culture of information utilization (β = 0.12; 95% CI: 0.02, 0.22; P = .018), ease or skill of data management (β = 0.31, 95% CI: 0.23, 0.39; P < .001) and timeliness of reports (β = 0.27; 95% CI: 0.13, 0.40; P < .001) were predictors that increased information utilization in intervention health institutions as compared to control institutions.

Conclusion: This study demonstrated that the implementation of ACDI led to a significant improvement in information utilization. These results suggest that the intervention effectively improved information use in the RHIS and support adopting this approach in similar settings.

Trial registration id: PACTR202212472091194, registered on 14 December 2022.

Health systems in Canada and elsewhere are reeling from ongoing syndemic shocks and mounting political-economic concerns that are having significant negative impacts on health equity, and on staff recruitment, wellbeing, and retention. Pressures to privatize delivery of publicly funded healthcare services in Canada are mounting, posing an additional risk to equity in access and outcomes, especially for those least well-served by current systems. This paper examines existing approaches to health system improvement and their alignment with the quintuple aim of enhancing patient experiences and outcomes, service and system efficiency, provider well-being, and health equity. Quality improvement efforts derived from private sector models such as Lean and Six Sigma have been shown, in the Canadian context and elsewhere, to add costs and negatively impact key aims such as provider well-being and patient experiences of care, though they can improve process-specific aspects of care, especially when an integrated team approach is applied in properly resourced contexts. Models that treat equity as an add-on to Lean/Six Sigma-based approaches have not been well-tested. Equity-oriented health care (EOHC) provides a promising alternative for health system improvement aligned with the quintuple aim, and is positioned as an emerging, innovative way to mitigate mounting system pressures, enhance health service effectiveness, and improve population health.

Background: The Ontario government launched the High Priority Communities Strategy (HPCS) in December 2020, funding community agencies operating in neighborhoods disproportionately affected by COVID-19 in Durham, Peel, Toronto, York, and Ottawa. Community-led task forces and networks also formed with the aim to increase vaccine confidence and uptake among minoritized communities.

Objectives: To explore how community-led task forces, networks and agencies mobilized and engaged faith-based and ethno-racial communities in Peel Region and Toronto to improve vaccine confidence and uptake, including perceived facilitators and barriers.

Design: Multi-method qualitative study.

Methods: Between June 2023 and March 2024, we conducted ten online focus groups with three task forces and six HPCS-funded community agencies, as well as four key-informant interviews with representatives from two task forces and one network. We used thematic analysis to explore respondents' perceptions and experiences.

Results: Three key themes emerged. First, community-led task forces, the network and agencies used community mobilization strategies, such as tailored outreach, mitigating vaccine access barriers and leveraging trusted community voices, to improve vaccine confidence and uptake. Second, fostering a sense of community was central to their work, enabled through member engagement and power (knowledge and resource) sharing for collective impact. Third, sustaining community-led efforts was a challenge. The volunteer-driven task forces and network lacked the capacity to formally evaluate their activities or long-term infrastructure, and most disbanded post-pandemic. However, community agencies pivoted to preventative and primary care initiatives under HPCS.

Conclusion: Community-led structures contributed to promoting vaccine uptake among ethno-racial and faith-based communities in hotspot areas. Facilitators included the use of trusted messengers and power sharing, while barriers included short-term funding and challenges sustaining efforts over time. Long-term sustainability of these efforts requires continued investment, sustained infrastructure, and strong community partnerships. Lessons from these findings can help strengthen community-led responses to future public health emergencies.

Background: The work of addressing veteran homelessness has largely been focused on veterans who are already homeless.

Objectives: This study aimed to identify factors that can be targeted upstream before military personnel leave the military to prevent veteran homelessness during the critical transition from active duty to civilian life.

Design: Data were analyzed from a 2001 to 2014 longitudinal cohort study of 418 624 post-9/11 veterans who entered Veterans Affairs (VA) healthcare after leaving the military.

Methods: Department of Defense (DoD) data on clinical diagnoses, demographics, and military history were linked to VA data on homelessness and neighborhood of residence.

Results: Homelessness in the 2 years after military discharge was associated with residing in a socioeconomically disadvantaged neighborhood after discharge as well as with younger age; Black race; and diagnoses of substance use disorder (SUD), serious mental illness (SMI), and personality disorder. Veterans with co-occurring SUD, SMI, and personality disorder had 5 times higher incidence of homelessness than veterans with none of these diagnoses, with rates most elevated among veterans residing in disadvantaged neighborhoods.

Limitations and conclusion: Several limitations include potential for missed cases of homelessness due to the use of medical records and lack of generalizability as note all veterans utilize VA services. Nevertheless, this large-sample, longitudinal sampling frame revealed critical environment-level and individual-level risk factors predicting homelessness after military separation that can be addressed proactively by policy and programs aimed at improving community reintegration of veterans transitioning to civilian life.

Background: Stroke is a leading cause of long-term disability, significantly impacting health-related quality of life (HRQoL). However, evidence from Nepal remains limited.

Objective: This study aimed to assess HRQoL and identify its associated factors among stroke patients in a tertiary care hospital in Nepal.

Design: Cross-sectional study.

Methods: This study was conducted at the Annapurna Neurological Institute and Allied Sciences (ANIAS) between November 2023 and April 2024 among 120 stroke patients aged ⩾18 years. Baseline data were collected using a semi-structured questionnaire, and HRQoL was assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) scale. Statistical analyses included descriptive statistics, bivariate analyses, and multiple linear regression to identify factors associated with HRQoL. A p-value < .05 was considered statistically significant.

Results: The mean HRQoL score was 21.13 ± 6.62, indicating substantial impairment, particularly in usual activities (Mean ± SD: 4.32 ± 1.32), self-care (4.26 ± 1.34), and mobility (4.22 ± 1.32). Lower HRQoL was significantly associated with older age, unemployment, lower educational attainment, and moderate to severe stroke-related disability (p< .001). Strong positive correlations were observed among all five HRQoL domains.

Conclusion: HRQoL is significantly impacted by stroke, with major impairments in usual activities, self-care, and mobility, influenced by both socio-demographic and clinical factors. Implementing targeted, multidimensional rehabilitation strategies such as structured physiotherapy is essential to enhance recovery and improve the quality of life in this population.

Background: Multiplex polymerase chain reaction (PCR) testing for viral acute respiratory infections (ARI) at the Point of Care (POC) has demonstrated clinical and economic value in secondary care, yet its impact in primary care remains uncertain. United Kingdom (UK) guidelines make conflicting recommendations on the use of testing in primary care settings.

Objectives: This study provides expert consensus on the potential clinical and economic implications of rapid PCR testing at the POC in primary care settings.

Design: A modified Delphi consensus panel approach was employed, with consensus statements developed from existing literature and evaluated through two rounds of questionnaires. Open-ended questions were posed to explore potential barriers to implementation, evidence generation, and suitable settings for testing.

Methods: A multistakeholder panel of 9 experts was purposely recruited, representing stakeholders from seven areas. A narrative literature review was conducted to generate consensus on the potential value of implementing rapid PCR testing at the POC for ARIs in primary care settings. Two Delphi rounds were completed, with participants rating their level of agreement with presented statements on a Likert scale from 1 to 5.

Results: Seventeen statements were generated based on the results of a narrative literature review, with eight achieving consensus and further evidence generation recommendations developed for six statements. Two statements were removed due to non-agreement and two were merged into a single statement, which later achieved consensus. The lack of cost and clinical effectiveness data was ranked as the greatest barrier to implementation. Primary care settings with high and low risk patients, such as general practices and care homes, were considered ideal for implementation.

Conclusion: There is potential value in rapid multiplex viral PCR testing for ARIs in primary care settings and care homes. While existing evidence and expert consensus indicate a likely benefit, further real-world evidence trials are recommended to evaluate the cost-effectiveness of this approach.

Background: Calibration of medical devices is vital for diagnostic reliability, quality healthcare delivery and patient safety. While awareness is critical, the confidence of healthcare professionals (HCPs) in calibration-related knowledge significantly influences adherence to best practices in calibration-related tasks. However, this area is underexplored in sub-Saharan Africa.

Objectives: This study aimed to assess the confidence levels of HCPs in Ghana regarding their calibration-related knowledge and competencies. It examined how these vary by professional role, training status, and years of experience.

Methods: A cross-sectional survey was conducted among 461 HCPs in Ghana, including doctors, nurses, midwives and technicians/clinical engineers, using a structured questionnaire covering five thematic areas: general understanding of calibration knowledge, knowledge of calibration procedures, device-specific knowledge, training and institutional support, and the perceived impact on patient care.

Results: Statistical analyses revealed variations in sentiment scores across profession, experience levels and training status. Technicians/clinical engineers consistently reported higher confidence, while doctors, nurses and midwives scored significantly lower. Additionally, respondents with prior calibration training, regardless of experience level, showed substantially greater confidence than their untrained counterparts.

Conclusion: These findings demonstrate the need for targeted, hands-on calibration training and continuous professional development to improve confidence and competencies in calibration practices. Such initiatives are essential for effective device management and overall healthcare system performance. This study offers evidence to guide policy improvements and capacity-building efforts to strengthen calibration knowledge and practices in Ghana's healthcare sector.

Background: Kenya experienced a 55% increase in maternal mortality between the years 2017 and 2020. While the global targets are yet to be realized, neonatal and infant mortality has improved over the years, but the rate of decline for neonatal mortality has been slow. The persistent high maternal mortality and slow improvements in neonatal and infant mortality warrant regular inquiries into health service provision, its quality and uptake.

Objective: We assessed bottlenecks in accessing reproductive, maternal, newborn and child health (RMNCH) services in Kwale County, Kenya.

Design: We used a cross sectional mixed methods approach.

Methods: We adapted the Tanahashi model to evaluate RMNCH services using 5 key measures that reflect different stages along the service delivery continuum: availability of services; accessibility; initial contact with the health system; continued utilization; and quality coverage. Secondary quantitative data was collected from the Kenya Demographic and Health Survey 2022, Kenya Health Facility Census Report 2023 and other peer reviewed publications. Primary qualitative data was collected from 20 focus group discussions with 176 members including lay community members, community health promoters (CHPs) and traditional birth attendants. Primary data was collected over a 1 month period, between October and November 2022.

Results: The main bottleneck identified from the supply side was the limited number and negative attitude of the healthcare workers. Access to core health workers was at 13/10 000 people, lower than the national average and World Health Organization (WHO) recommendation. From the supply side, low health literacy, gender norms and financial constraints were the major factors fueling the poor health seeking behavior.

Conclusion: Kwale County needs to prioritize investments in human resources for health, advocacy, communication and social mobilization.

Background: Mental illness is a widespread issue that affects millions of people worldwide. Its impact is not only limited to the individuals suffering from it but also extends to their families and communities. Caregivers suffer physically, psychologically, and socially twice than general population related to care giving process.

Methods: An institutional-based cross-sectional study design was employed from January 21 to February 21, 2024, at public hospitals in Harari Regional State and Dire Dawa City Administrative; 437 primary caregivers were selected via a systematic sampling technique. Data were collected using interview-administered questionnaires. Simple and multiple linear regression analysis were used to assess the contributing factors of quality of life domains among the participants, and the ꞵ-coefficient with a 95% confidence interval was used. Statistical significance was accepted at a P-value < .05.

Results: A total of 421 respondents participated, for a response rate of 96.3%. The results found that the mean quality of life scores of caregivers of people living with mental illness for each domain (mean ± SD) were 58.05 ± 18.81, 57.29 ± 16.28, 51.19 ± 23.12, and 53.04 ± 16.13, for physical, psychological, social and environmental factors, respectively. Multiple regression analysis revealed that the caregiver's educational status, depression, perceived stigma, perceived burden and patient's diagnosis were negatively associated with all domains of quality of life, whereas the caregiver's resilience and social support were strongly positively associated with all domains of quality of life.

Conclusion: Caregivers' quality of life found to be low across the four domains of quality of life, with the lowest score in the social domain. Resilience and social support found to plays a positive role in the quality of life of caregivers. Regular evaluation of risky caregivers, and psycho-support are crucial to address these challenges and improve caregivers' well-being.