Dialogues in health最新文献_第3页

Estimating global public health security preparedness capacity: The contribution of SPAR and JEE 估计全球公共卫生安全防范能力：SPAR和JEE的贡献

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2026-01-17 DOI: 10.1016/j.dialog.2026.100282

Kamal Bishowkarma , Cynthia Bell , Shanlong Ding , Robert Nguni , Luca Vernaccini , Peter Mala , Stéphane de la Rocque , Jun Xing , Dick Chamla , Mary Stephen , Reuben Samuel , Ihor Perehinets , Phuong Nam Nguyen , Nirmal Kandel , Stella Chungong

Background

To promote transparency and mutual accountability in global public health security among WHO States Parties, Article 54 of the International Health Regulations (2005) (IHR) obliges State Parties to regularly report capacities to prevent, protect against, control, and provide a public health response to the international spread of disease. Two prominent tools for assessing capacities, a mandatory State Parties Annual Self-Assessment (SPAR) and a voluntary Joint External Evaluation (JEE), cover similar concepts and structure, but agreement between the tools has not been assessed in a long term global analysis.

Methods

This ecological study compared quantitative capacity scores from 1445 indicator-matched paired observations from 108 SPAR and JEE assessments completed in the same year, by 93 States Parties, between 2016 and 2023. Mixed effects methods were used to estimate mean agreement for each indicator, comparing tool editions/years, regions, and income groups.

Findings

Overall, SPAR scores were higher than JEE scores, with the least agreement observed with indicators scoring near Level 3–4 capacity. However, consistency between SPAR and JEE evaluations improved recently, particularly in the latest 2022–2023 editions where 25 of the 28 matched indicator capacity scores were not significantly different on average. Three indicators with significant score disagreement pertained to infection prevention and control, health-care association infection surveillance, and national IHR focal point functions.

Interpretation

Improved alignment between SPAR and JEE, particularly in recent editions, combined with the identification of remaining indicator disagreement, strengthens the evidence base for continued improvement in these essential assessment tools.

为促进世卫组织缔约国在全球公共卫生安全方面的透明度和相互问责制，《国际卫生条例（2005）》第54条要求缔约国定期报告预防、防范、控制和提供公共卫生应对疾病国际传播的能力。两种主要的能力评估工具，即强制性缔约国年度自我评估（SPAR）和自愿联合外部评估（JEE），涵盖了类似的概念和结构，但在长期全球分析中尚未评估这些工具之间的一致性。本生态研究比较了93个缔约国在2016年至2023年期间完成的108项SPAR和JEE评估中1445项指标匹配的配对观测结果的定量能力得分。混合效应方法用于估计每个指标的平均一致性，比较工具版本/年份、地区和收入群体。总体而言，SPAR得分高于JEE得分，与得分接近3-4级能力的指标最不一致。然而，SPAR和JEE评估之间的一致性最近有所改善，特别是在最新的2022-2023年版本中，28个匹配的指标能力得分中有25个平均没有显着差异。在感染预防和控制、卫生保健协会感染监测和国家《国际卫生条例》归口单位职能方面存在显著得分差异的三个指标。SPAR和JEE之间改进的一致性，特别是在最近的版本中，结合对剩余指标分歧的识别，加强了这些基本评估工具持续改进的证据基础。

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引用次数: 0

Drones in healthcare logistics: Insights from healthcare professionals’ perspective on Zipline delivery services in Ghana 医疗物流中的无人机：从医疗专业人士的角度对加纳滑索交付服务的见解

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2026-02-02 DOI: 10.1016/j.dialog.2026.100285

Emmanuel Komla Dzisi Jr , Morrice Kobby Patterson , Seidu Iddrisu

The use of drones for healthcare delivery has emerged as a promising innovation for improving access to essential medical supplies, particularly in hard-to-reach areas and during emergencies. This study explores healthcare professionals' perspectives on Zipline's drone services in enhancing healthcare delivery in Ghana, focusing on their awareness, perceived benefits, and challenges. Data was collected through a cross-sectional survey of 696 healthcare professionals across Zipline Ghana's six distribution centers and analyzed using descriptive statistics, chi-square tests of association, and the Kruskal-Wallis test. The results indicate relatively high awareness (62%) of drone services, although facility-level usage was uneven. The findings further reveal that, while drones provide valuable logistical support, they are complementary tools rather than substitutes for broader systemic reforms. Major challenges identified included high operational costs, technical limitations, and concerns about their long-term sustainability. As one of the first large-scale empirical assessments of healthcare professionals' perceptions of drone-enabled healthcare logistics in Sub-Saharan Africa, these findings offer new evidence and policy-relevant insights for Ghana's healthcare system and contribute to broader global discussions on the integration of drones into healthcare delivery.

使用无人机提供医疗保健服务已成为改善获得基本医疗用品的一项有前景的创新，特别是在难以到达的地区和紧急情况下。本研究探讨了医疗保健专业人士对Zipline无人机服务在加强加纳医疗保健服务方面的看法，重点关注他们的意识、感知到的好处和挑战。通过对Zipline Ghana六个配送中心的696名医疗保健专业人员进行横断面调查收集数据，并使用描述性统计、卡方关联检验和Kruskal-Wallis检验进行分析。结果表明，尽管设施层面的使用情况参差不齐，但无人机服务的认知度相对较高（62%）。研究结果进一步表明，尽管无人机提供了宝贵的后勤支持，但它们是补充工具，而不是更广泛的系统性改革的替代品。确定的主要挑战包括高运营成本、技术限制以及对其长期可持续性的担忧。作为对撒哈拉以南非洲医疗保健专业人员对无人机医疗保健物流的看法的首次大规模实证评估之一，这些发现为加纳的医疗保健系统提供了新的证据和与政策相关的见解，并有助于将无人机纳入医疗保健服务的更广泛的全球讨论。

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引用次数: 0

Association of parental stress, depression, anxiety, and somatisation: Mediating role of coping behaviours among mothers of preterm infants in Ghana 父母压力、抑郁、焦虑和躯体化的关联：加纳早产儿母亲应对行为的中介作用

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2026-01-11 DOI: 10.1016/j.dialog.2026.100278

Jacob Owusu Sarfo , Crescens Osei Bonsu Ofori , Priscilla Yeye Adumoah Attafuah , Nuworza Kugbey , Dean Kormla Attigah , Newton Isaac Gbordzoe , Josephine Cudjoe Sarfo

Background

Parenting a preterm infant is a stressful experience that can significantly impact maternal mental health. This cross-sectional study examined the association of parental stress with depression, anxiety, and somatisation in 120 Ghanaian mothers of preterm infants, as well as the mediating role of maternal coping behaviours.

Results

Mediation analyses using the Lavaan package in JASP software indicated that parental stress had significant direct associations with depression and anxiety in both models, but not with somatisation. The association between stress and somatisation emerged only when coping strategies were included. Adaptive coping played a limited mediating role, significant only for somatisation. In contrast, maladaptive coping significantly mediated the relationships between parental stress and all three mental health outcomes, indicating a stronger explanatory role in how stress translates into psychological symptoms.

Conclusion

Maladaptive coping appears to be a key mechanism linking parental stress to poor mental health among Ghanaian mothers of preterm infants. Interventions that reduce maladaptive coping and strengthen effective coping strategies may help mitigate depression, anxiety, and somatic symptoms in this population.

养育早产儿是一种有压力的经历，会对母亲的心理健康产生重大影响。本横断面研究调查了120名加纳早产儿母亲的父母压力与抑郁、焦虑和躯体化之间的关系，以及母亲应对行为的中介作用。结果使用JASP软件中的Lavaan软件包进行的中介分析表明，在两个模型中，父母压力与抑郁和焦虑有显著的直接关联，但与躯体化无关。压力和躯体化之间的联系只有在应对策略被考虑在内时才会显现出来。适应性应对的中介作用有限，仅对躯体化有显著影响。相反，适应不良的应对显著调节了父母压力与所有三种心理健康结果之间的关系，表明压力如何转化为心理症状具有更强的解释作用。结论加纳早产儿母亲的适应不良应对可能是父母压力导致心理健康状况不佳的关键机制。干预措施减少适应不良的应对和加强有效的应对策略可能有助于减轻抑郁，焦虑和躯体症状在这一人群。

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引用次数: 0

Gendered role disruption in women with rheumatoid arthritis: A phenomenological study in Kashmir 类风湿性关节炎女性的性别角色中断：克什米尔的现象学研究

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2026-01-11 DOI: 10.1016/j.dialog.2026.100279

Zakir Hussain Gadda , Mohmad Saleem Jahangir, Aneesa Shafi

This study employed a descriptive phenomenological approach to explore the day-to-day social role experiences of women living with Rheumatoid Arthritis (RA) in Kashmir. Participants were recruited through purposive and theoretical sampling until data saturation was reached. The study included 15 women, aged 21 to 67 years, with a clinical diagnosis of RA. Most of these women participants were married homemakers. Data were collected via in-depth semi-structured interviews and analyzed with the help of Colaizzi's method. Results revealed that the challenges posed by RA, including pain, discomfort and progressive disability, have curtailed the patients' ability to fulfill their culturally assigned social roles. Such limitations increased their vulnerability to impaired well-being and a loss of identity and purpose. Furthermore, RA has increased patients' dependence on others, which diminished their perceived significance both within and beyond their familial boundaries. As a result, they have adopted various strategies to adapt to the changing demands and expectations associated with their social roles. The study findings emphasize the need for active family involvement in RA care to promote empathy and support. Moreover, healthcare providers need to address not only the physical aspects of RA, but also its under-recognized emotional, psychological, and sexual impacts to improve the quality of care.

本研究采用描述现象学的方法来探讨生活在克什米尔的类风湿性关节炎（RA）妇女的日常社会角色经验。参与者通过有目的和理论抽样招募，直到达到数据饱和。该研究包括15名年龄在21至67岁之间，临床诊断为类风湿性关节炎的女性。这些女性参与者大多是已婚家庭主妇。通过深度半结构化访谈收集数据，并使用Colaizzi的方法进行分析。结果显示，类风湿性关节炎带来的挑战，包括疼痛、不适和进行性残疾，削弱了患者履行其文化赋予的社会角色的能力。这种限制使他们更容易受到福祉受损和丧失身份和目标的影响。此外，RA增加了患者对他人的依赖，这降低了他们在家庭内外的感知意义。因此，他们采取了各种策略来适应与其社会角色相关的不断变化的需求和期望。研究结果强调需要家庭积极参与类风湿性关节炎的护理，以促进同情和支持。此外，医疗保健提供者不仅需要解决RA的身体方面，还需要解决其未被认识的情绪，心理和性影响，以提高护理质量。

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引用次数: 0

An emerging theoretical lens post global epidemic and turmoil: Psychological immunity 一个新兴的理论镜头后全球流行病和动荡：心理免疫

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2025-12-23 DOI: 10.1016/j.dialog.2025.100271

Yi Xiao , Wei Wang , Xiping Hu

The concept of psychological immunity is not a new idea. In response to the escalating conflicts and chaos that characterizes this era, we conducted this study and reviewed psychological immunity theory from the perspective of psychiatry, psychology, and philosophy. We found that growing evidence has demonstrated the connection between biological and psychological immunity process. This indicates an integrated immunity system that has developed over time for survival in both physical and metaphysical sense. The process-oriented conceptualization of psychological immunity is presented, as well as its intra- and inter-mechanism. We also discussed research, practice, and policy potentials of this field and advocated for its protective application at individual and societal level. Limitations and future research were addressed accordingly.

心理免疫的概念并不是一个新概念。为了应对这个时代不断升级的冲突和混乱，我们进行了这项研究，并从精神病学、心理学和哲学的角度对心理免疫理论进行了回顾。我们发现，越来越多的证据表明，生物免疫过程和心理免疫过程之间存在联系。这表明一个综合的免疫系统，随着时间的推移，在物理和形而上学的意义上发展了生存。提出了心理免疫的过程导向概念，以及心理免疫的内部机制和内部机制。我们还讨论了该领域的研究、实践和政策潜力，并提倡在个人和社会层面上对其进行保护性应用。并指出了局限性和未来的研究方向。

引用次数: 0

Preserving the tribal identity: A policy imperative for indigenous well-being and conservation of the Nilgiri Biosphere Reserve in South India 保护部落身份：印度南部尼尔吉里生物圈保护区的土著福利和保护的一项必要政策

Dialogues in health

Pub Date : 2025-12-01 Epub Date: 2025-08-22 DOI: 10.1016/j.dialog.2025.100234

Geetha Veliah , Padma Venkatasubramanian , Irene Sambath

Purpose

This short communication explores how identity erosion among Particularly Vulnerable Tribal Groups (PVTGs) in the Nilgiris district of Tamil Nadu, India, impacts their wellness and ecological stewardship. It aims to highlight culturally specific disruptions across generations and recommend policy responses that are identity-affirming and context-sensitive.

Methods

This exploratory qualitative study used an epistemological approach to understand tribal perceptions through in-depth interviews and focus group discussions with elders and youth from select members of the PVTGs in the Nilgiris. A semi-structured interview guide covering six wellness domains was developed through deductive and inductive methods. Data were collected over four months, transcribed, translated, and thematically analyzed using manual coding. Institutional ethical clearance was obtained, and informed consent was secured from all participants and community leaders.

Results

The study found that well-intentioned mainstream developmental interventions, such as non-contextual education and biomedical health models, have disrupted cultural transmission, resulting in identity erosion and loss of sacred landscapes. Many participants expressed concern over mental health issues, substance use, climate vulnerability, and inadequate community representation in governance. Mobile technologies and media consumption have contributed to cultural disorientation among tribal youth.

Conclusion

Preserving tribal identity is essential to ensuring community wellness and conserving the Nilgiri Biosphere Reserve. Policy efforts must shift from generalized welfare to culturally grounded, participatory frameworks that integrate traditional knowledge systems and support Indigenous autonomy.

本文探讨了印度泰米尔纳德邦尼尔吉里斯地区特别脆弱部落群体（pvtg）的身份侵蚀如何影响他们的健康和生态管理。它旨在强调跨代文化特定的中断，并建议政策应对是身份确认和上下文敏感。方法本探索性质的研究采用认识论方法，通过深度访谈和焦点小组讨论，从尼尔吉里斯的pvtg成员中挑选长老和青年，了解部落观念。通过演绎法和归纳法制定了涵盖六个健康领域的半结构化访谈指南。数据收集超过四个月，转录，翻译，并使用手动编码进行主题分析。获得了机构伦理许可，并获得了所有参与者和社区领导人的知情同意。结果研究发现，非情境教育和生物医学健康模式等善意的主流发展干预措施破坏了文化传播，导致身份侵蚀和神圣景观的丧失。许多与会者对精神健康问题、药物使用、气候脆弱性以及社区在治理中的代表性不足表示关切。移动技术和媒体消费导致部落青年在文化上迷失方向。结论保护部落身份是保障社区健康和保护尼尔吉里生物圈保护区的关键。政策努力必须从广义福利转向基于文化的参与性框架，整合传统知识体系并支持土著自治。

{"title":"Preserving the tribal identity: A policy imperative for indigenous well-being and conservation of the Nilgiri Biosphere Reserve in South India","authors":"Geetha Veliah , Padma Venkatasubramanian , Irene Sambath","doi":"10.1016/j.dialog.2025.100234","DOIUrl":"10.1016/j.dialog.2025.100234","url":null,"abstract":"<div><h3>Purpose</h3><div>This short communication explores how identity erosion among Particularly Vulnerable Tribal Groups (PVTGs) in the Nilgiris district of Tamil Nadu, India, impacts their wellness and ecological stewardship. It aims to highlight culturally specific disruptions across generations and recommend policy responses that are identity-affirming and context-sensitive.</div></div><div><h3>Methods</h3><div>This exploratory qualitative study used an epistemological approach to understand tribal perceptions through in-depth interviews and focus group discussions with elders and youth from select members of the PVTGs in the Nilgiris. A semi-structured interview guide covering six wellness domains was developed through deductive and inductive methods. Data were collected over four months, transcribed, translated, and thematically analyzed using manual coding. Institutional ethical clearance was obtained, and informed consent was secured from all participants and community leaders.</div></div><div><h3>Results</h3><div>The study found that well-intentioned mainstream developmental interventions, such as non-contextual education and biomedical health models, have disrupted cultural transmission, resulting in identity erosion and loss of sacred landscapes. Many participants expressed concern over mental health issues, substance use, climate vulnerability, and inadequate community representation in governance. Mobile technologies and media consumption have contributed to cultural disorientation among tribal youth.</div></div><div><h3>Conclusion</h3><div>Preserving tribal identity is essential to ensuring community wellness and conserving the Nilgiri Biosphere Reserve. Policy efforts must shift from generalized welfare to culturally grounded, participatory frameworks that integrate traditional knowledge systems and support Indigenous autonomy.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100234"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Perceived risk factors and their influence on compliance with meat safety guidelines among butchers and fresh meat retailers in Ghana 感知到的风险因素及其对加纳屠夫和鲜肉零售商遵守肉类安全准则的影响

Dialogues in health

Pub Date : 2025-12-01 Epub Date: 2025-10-10 DOI: 10.1016/j.dialog.2025.100250

George Agana Akuriba , Dadson Awunyo-Vitor , Camillus Abawiera Wongnaa , Richard Owusu-Afriyie , Margaret Aba Sam Hagan , Benjamin Sarfo

Meat safety is critical for safeguarding public health, as contaminated meat poses serious risks, and compliance with safety guidelines largely depends on meat handlers' risk perceptions. This study assessed how butchers and fresh meat retailers in Ghana perceive risk factors contributing to unsafe meat production and examines the extent to which these perceptions influence their compliance with meat safety guidelines. The study used primary data obtained from 87 butchers and 299 fresh meat retailers. The data were analyzed using descriptive statistics, including means, standard deviations, and F-statistics, as well as Partial Least Squares Structural Equation Modeling (PLS-SEM). The findings on the perceived risk factors reveals a positive risk perception index of 0.88 and 0.86 for butchers and retailers respectively. This indicates a high level of awareness or concern about risks. The most highly perceived risk factors were institutional risks (1.30), financial risks (1.29), and microbiological/chemical risks (1.27). The PLS-SEM results revealed that butchers' compliance with safety guidelines was positively influenced by perceived environmental risk (β = 0.192, P = 0.10), and perceived financial risk (β = 0.257, P = 0.05) and negatively influenced by perceived market risk (β = −0.202, P = 0.066) while retailers' compliance was positively influenced by perceived microbiological risk (β = 0.351, P = 0.03), and perceived market risk (β = 0.117, P = 0.07). The study concludes that while butchers and fresh meat retailers in Ghana demonstrate generally high risk perceptions, their compliance with meat safety guidelines is shaped by different risk factors. The study recommends a collaborative monitoring and enforcement framework in which butchers and fresh meat retailers work closely with regulatory bodies to translate high institutional risk perceptions into compliance. This can be achieved through quarterly stakeholder meetings, streamlined licensing, and on-the-ground support, which together enhance practical adherence while minimizing bureaucratic challenges.

肉类安全对保障公众健康至关重要，因为受污染的肉类会带来严重风险，而遵守安全准则在很大程度上取决于肉类加工者的风险认知。本研究评估了加纳的屠夫和鲜肉零售商如何看待导致不安全肉类生产的风险因素，并考察了这些看法在多大程度上影响了他们遵守肉类安全准则。这项研究使用了来自87家肉店和299家鲜肉零售商的原始数据。数据分析采用描述性统计，包括均值、标准差和f统计，以及偏最小二乘结构方程模型（PLS-SEM）。在感知风险因素方面，肉贩和零售商的风险感知指数分别为0.88和0.86。这表示对风险有高度的认识或关注。最高感知的风险因素是制度风险（1.30）、金融风险（1.29）和微生物/化学风险（1.27）。调查结果显示，肉贩的环境风险感知（β = 0.192, P = 0.10）、财务风险感知（β = 0.257, P = 0.05）和市场风险感知（β = - 0.202, P = 0.066）对肉贩的安全遵循有正向影响，而零售商的微生物风险感知（β = 0.351, P = 0.03）和市场风险感知（β = 0.117, P = 0.07）对肉贩的安全遵循有正向影响。该研究的结论是，虽然加纳的屠夫和鲜肉零售商普遍表现出高风险意识，但他们对肉类安全准则的遵守程度受到不同风险因素的影响。该研究建议建立一个协作监测和执法框架，在该框架中，肉店和鲜肉零售商与监管机构密切合作，将对机构高风险的认识转化为合规。这可以通过季度利益相关者会议、简化的许可和实地支持来实现，这些共同增强了实际的遵守，同时最大限度地减少了官僚主义的挑战。

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引用次数: 0

Corrigendum to “A culturally-specific education strategy to improve stroke health literacy in Vietnamese communities in South Western Sydney” [Dialogues in Health: Volume 6 (2025)- 100211] “提高悉尼西南部越南社区中风健康素养的文化特定教育战略”的更正[健康对话：第6卷(2025)- 100211]

Dialogues in health

Pub Date : 2025-12-01 Epub Date: 2025-06-16 DOI: 10.1016/j.dialog.2025.100222

Jessica Ly , Christopher Blair , Helen Badge , Michael Camit , Khoi Do , Timmy Pham , Nicola Chappelow , Dennis J. Cordato , Mark W. Parsons

引用次数: 0

Role of comprehensive HIV knowledge as a mediator between receiving HIV information during antenatal care visits and positive attitudes toward people living with HIV among reproductive-age women in Bangladesh 全面的艾滋病毒知识在产前检查期间接受艾滋病毒信息与孟加拉国育龄妇女对艾滋病毒感染者的积极态度之间的中介作用

Dialogues in health

Pub Date : 2025-12-01 Epub Date: 2025-10-01 DOI: 10.1016/j.dialog.2025.100245

Chowdhury Abdullah Al Asif , Md. Abul Kalam , Nayla Ferdousi Haque , Sabrina Karim , Lima Rahman , Muhammad Imran , Paul Bouey , Rounak Khan , Mohammad Rifat Haider

Objective

Comprehensive knowledge of HIV transmission and positive attitudes toward people with HIV (PWH) are key to HIV prevention and care. This study assessed the potential mediational role of comprehensive HIV knowledge between receiving HIV information during antenatal care (ANC) visits and positive attitudes toward PWH among reproductive-age women in Bangladesh.

Methods

We analyzed the 2019 Multiple Indicator Cluster Survey data (N = 5118). Comprehensive HIV knowledge scale (9-item; Cronbach's alpha = 0.706) and Attitudes toward PWH scale (2-item; Cronbach's alpha = 0.84) were constructed. Receiving HIV information was a dichotomous variable (yes/no). A multivariable structural equation model was controlled for age, ethnicity, education, rural/urban residence, media exposure, marital status, wealth index, and division. All analyses were performed using Stata 18.0.

Results

After adjusting for sociodemographic characteristics, receiving HIV transmission knowledge during ANC was not associated with positive attitudes toward PWH (B = 0.06, p = 0.101). Receiving HIV information was positively associated with comprehensive HIV knowledge (B = 0.39; p < 0.0.001), and comprehensive HIV knowledge was positively associated with positive attitudes toward PWH (B = 0.13; p < 0.001). The indirect effect of comprehensive HIV knowledge on the relationship between receiving HIV information during ANC and positive attitudes toward PWH was statistically significant (B = 0.05, p < 0.001).

Conclusion

Given the mediational role of comprehensive HIV knowledge between receiving HIV information and positive attitudes toward PWH, providing HIV information during ANC should be a routine practice to capture the teachable moments to prevent HIV transmission.

目的全面认识艾滋病毒传播，积极对待艾滋病毒感染者（PWH）是预防和护理艾滋病毒的关键。本研究评估了全面的艾滋病毒知识在产前护理（ANC）访问期间接受艾滋病毒信息和孟加拉国育龄妇女对PWH的积极态度之间的潜在中介作用。方法对2019年多指标聚类调查数据（N = 5118）进行分析。构建HIV知识综合量表（9项，Cronbach’s alpha = 0.706）和PWH态度量表（2项，Cronbach’s alpha = 0.84）。接受艾滋病毒信息是一个二分类变量（是/否）。采用多变量结构方程模型控制年龄、种族、教育程度、城乡居住、媒体接触、婚姻状况、财富指数和划分等因素。所有分析均使用Stata 18.0进行。结果在调整了社会人口学特征后，ANC期间获得HIV传播知识与对PWH的积极态度无关（B = 0.06, p = 0.101）。接受HIV信息与全面的HIV知识呈正相关（B = 0.39; p < 0.0.001），全面的HIV知识与对PWH的积极态度呈正相关（B = 0.13; p < 0.001）。HIV综合知识对ANC期间接受HIV信息与PWH积极态度之间关系的间接影响有统计学意义（B = 0.05, p < 0.001）。结论综合艾滋病毒知识在接受艾滋病毒信息与对PWH的积极态度之间具有中介作用，应在ANC期间定期提供艾滋病毒信息，以抓住预防艾滋病毒传播的教育时刻。

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引用次数: 0

Socio-economic and insurance factors in preventive care: A two-stage weighted structural analysis 预防保健中的社会经济和保险因素：两阶段加权结构分析

Dialogues in health

Pub Date : 2025-12-01 Epub Date: 2025-10-06 DOI: 10.1016/j.dialog.2025.100243

Florent Nkouaga

This study investigates the key determinants influencing the utilization of preventive health services among insured individuals in the United States following the implementation of the Affordable Care Act (ACA). Leveraging nationally representative data from the 2024 Financial Inclusion Survey, the research employs weighted logistic regression and Structural Equation Modeling (SEM) to analyze how perceived insurance coverage quality, access to a primary care physician, financial knowledge, and experiences with healthcare costs are associated with the uptake of no-cost preventive care. The findings reveal that individuals who report higher satisfaction with their insurance coverage, maintain ongoing relationships with primary care providers, and demonstrate greater financial literacy are more likely to engage in preventive health behaviors. Notably, while cost-related barriers are initially associated with increased utilization, their direct influence diminishes when financial knowledge is accounted for, highlighting the mitigating role of financial literacy. The SEM approach further clarifies the complex interplay between latent constructs such as perceived coverage quality and cost experiences, showing that these factors interact with each other and with other determinants to shape preventive care decisions. Importantly, once these structural and informational dimensions are considered, traditional demographic variables — such as race and gender — lose statistical significance, underscoring the greater impact of systemic and educational factors. These results suggest that policies aimed solely at eliminating financial barriers may be insufficient to maximize preventive care participation. Instead, fostering trust in insurance coverage, strengthening primary care relationships, and enhancing financial literacy are critical strategies for increasing preventive service utilization. By addressing the informational, relational, and economic dimensions of healthcare access, policymakers and stakeholders can more effectively promote preventive health engagement and advance population health outcomes.

本研究调查了在实施平价医疗法案（ACA）后，影响美国参保个人使用预防性医疗服务的关键决定因素。利用来自2024年金融包容性调查的具有全国代表性的数据，该研究采用加权逻辑回归和结构方程模型（SEM）来分析感知保险覆盖质量、获得初级保健医生、财务知识和医疗保健成本经验如何与接受无成本预防性护理相关联。研究结果显示，那些对自己的保险覆盖面满意度较高、与初级保健提供者保持持续关系、并表现出更高的金融素养的个人更有可能参与预防性健康行为。值得注意的是，虽然与成本有关的障碍最初与提高利用率有关，但当考虑到金融知识时，它们的直接影响就会减弱，从而突出了金融知识的缓解作用。扫描电镜方法进一步阐明了潜在结构（如感知覆盖质量和成本经验）之间复杂的相互作用，表明这些因素相互作用，并与其他决定因素相互作用，形成预防性护理决策。重要的是，一旦考虑到这些结构和信息方面的因素，传统的人口变量- -例如种族和性别- -就失去了统计意义，强调了制度和教育因素的更大影响。这些结果表明，仅仅旨在消除经济障碍的政策可能不足以最大限度地提高预防保健的参与。相反，促进对保险范围的信任、加强初级保健关系和提高金融知识是提高预防性服务利用率的关键战略。通过处理卫生保健获取的信息、关系和经济层面问题，决策者和利益攸关方可以更有效地促进预防性卫生参与并推进人口健康成果。

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引用次数: 0