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Transgender and non-binary individuals frequently engage with healthcare services to obtain gender-affirming care. Little data exist on the experiences of young people accessing gender care. This systematic review and meta-ethnography aimed to identify and synthesise data on youths' experiences accessing gender-affirming healthcare. A systematic review and meta-ethnography focusing on qualitative research on the experiences of transgender and non-binary youth accessing gender care was completed between April-December 2020. The following databases were used: PsychINFO, MEDLINE, EMBASE, and CINAHL. The protocol was registered on PROSPERO, international prospective register of Systematic Reviews (CRD42020139908). Ten studies were included in the final review. The sample included participants with diverse gender identities and included the perspective of parents/caregivers. Five dimensions (third-order constructs) were identified and contextualized into the following themes: 1.) Disclosure of gender identity. 2.) The pursuit of care. 3.) The cost of care. 4.) Complex family/caregiver dynamics. 5.) Patient-provider relationships. Each dimension details a complicated set of factors that can impact healthcare navigation and are explained through a new conceptual model titled \"The Rainbow Brick Road\". This synthesis expands understanding into the experience of transgender and non-binary youth accessing gender-affirming healthcare. Ryvicker's behavioural-ecological model of healthcare navigation is discussed in relation to the findings and compared to the authors' conceptual model. This detailed analysis reveals unique insights on healthcare navigation challenges and the traits, resources, and infrastructure needed to overcome these. Importantly, this paper reveals the critical need for more research with non-binary youth and research which includes the population in the design.

Background While enhancing physical activity has been an essential goal of public health officials, people with physical impairments such as spinal cord injury (SCI) are more likely to live a sedentary lifestyle. Exercise has been shown to decrease the risk for many of the secondary conditions associated with SCI, including osteoporosis, cardiovascular disease, pressure ulcers, urinary tract infections, diabetes and arthritis, yet this population is rarely a target for health promotion efforts. This paper examines the self-reported exercise experiences of people with SCI using a qualitative-exploratory design. Methods We enrolled 26 individuals with SCI (15 self-described 'exercisers' and 11 'non-exercisers') from a non-random pool of survey responders. Semi-structured phone interviews were conducted to record participants' experiences with exercise pre/post injury, barriers and facilitators to being active and perceived health impact. Results Regardless of exercise status, all participants reported physical activity prior to injury and expressed interest in becoming active or maintaining an active lifestyle. Participants identified a range of both motivational and socio-environmental factors that were either facilitating or constraining of such a lifestyle. Non-exercisers identified barriers to exercise, including a perceived low return on physical investment, lack of accessible facilities, unaffordable equipment, no personal assistance and fear of injury. Exercisers identified facilitators, including personal motivation, independence, availability of accessible facilities and personal assistants, fear of health complications, and weight management. Exercisers associated a greater range of specific health benefits with being active than non-exercisers. Conclusion Despite motivation and interest in being exercise active, people with SCI face many obstacles. Removal of barriers coupled with promotion of facilitating factors, is vital for enhancing opportunities for physical activity and reducing the risk of costly secondary conditions in this population.

Ensuring access for older people to Primary Health Care (PHC) is vital to achieve universal health coverage, improve health outcomes, and health-system performance. However, older people living in Low-and Middle-Income Countries (LMICs) face barriers constraining their timely access to appropriate care. This review aims to summarize the nature and breadth of literature examining older people's experiences with access to PHC in LMICs, and access barriers and enablers. Guided by Arksey and O'Malley's framework, four databases [CINAHL, Cochrane, PubMed, and Embase] were systematically searched for all types of peer-reviewed articles published between 2002 and 2023, in any language but with English or French abstract. Gray literature presenting empirical data was also included by searching the United Nations, World Health Organization, and HelpAge websites. Data were independently screened and extracted. Of 1165 identified records, 30 are included. Data were generated mostly in Brazil (50%) and through studies adopting quantitative designs (80%). Older people's experiences varied across countries and were shaped by several access barriers and enablers classified according to the Patient-Centered Access to Healthcare framework, featuring the characteristics of the care delivery system at the supply side and older people's attributes from the demand side. The review identifies that most access barriers and enablers pertain to the availability and accommodation dimension, followed by the appropriateness, affordability, acceptability, and approachability of services. Socio-economic level and need perception were the most reported characteristics that affected older people's access to PHC. Older people's experiences with PHC access varied according to local contexts, socioeconomic variables, and the provision of public or private health services. Results inform policymakers and PHC practitioners to generate policies and services that are evidence-based and responsive to older people's needs. Identified knowledge gaps highlight the need for research to further understand older people's access to PHC in different LMICs.

While there is strong evidence that regular participation in physical activity (PA) brings numerous health benefits to older adults, and interventions to effectively promote PA are being developed and tested, the characteristics and components of the most effective interventions remain unclear. This systematically conducted review of systematic reviews evaluated the effects and characteristics of PA promotion interventions aimed at community dwelling people over 50 years old. Major databases were searched for reviews from January 1990 to May 2015. TIDieR guidelines aided data extraction and the ROBIS tool was used to assess the risk of bias. Primary outcomes were objective and self-reported levels of PA. Indicators of psychological wellbeing and participation rates were secondary outcomes. Of 1284 records identified, 19 reviews met inclusion criteria and eight included meta-analyses. Interventions typically incorporated behaviour change techniques (BCTs) and were delivered as face-to-face, remote, group, individual or as combined interventions. Despite their heterogeneity, interventions often resulted in sustained improvements in PA over the study period, typically at 12 months, and led to improvements in general wellbeing. However, ways to ensure effective maintenance beyond one year are unclear. Certain intervention components were more clearly associated with positive effects (e.g. tailoring promotion strategy with combination of cognitive and behavioural elements, low to moderate intensity activity recommended). We found no evidence that certain other intervention characteristics were superior in achieving positive outcomes (e.g. mode of delivery, setting, professional background of the intervention provider, type of PA recommended). The evidence suggests that interventions to promote PA among older adults are generally effective but there is uncertainty around the most beneficial intervention components. There are indications that purely cognitive strategies and BCTs might be less suitable for older adults than motivators more meaningful to them, including social and environmental support, and enjoyment coming from being physically active. A whole system-oriented approach is required that is tailored to meet the needs of older adults and aligned with social, individual and environmental factors.

Older people in low- and middle-income countries face significant challenges when accessing primary care services. In Lebanon, most older people (75%) living with at least one chronic disease previously accessed private health services for care. However, the economic crisis substantially increased their reliance on primary healthcare centers (PHCCs), while factors shaping access to public services were unknown. This study explores the barriers and enablers influencing access to PHCCs' services. This descriptive qualitative study involved 57 people including older adults (aged 60-92 years), informal caregivers, and service providers, recruited using maximum variation sampling. Data were collected through seven focus groups and fifteen interviews. The Framework Method was adopted for thematic analysis. The Patient-centered Access to Healthcare Framework facilitated mapping of barriers and enablers across five access opportunities. Findings are presented under five themes: 1) perception of healthcare needs, enabled by acute symptoms, free services, literacy, and familial support but hindered by lack of information on services; 2) healthcare seeking, supported by respectful providers, familial support, available quality services, and positive leadership, but constrained by providers' attitudes, poor service organization, limited finances, and negative perceptions; 3) healthcare reaching, enabled by proximity of PHCCs and home care, but limited by transport issues, mobility restrictions, staff and resource shortages, and service delivery challenges; 4) healthcare utilization, facilitated by low fees and economic recession, but hindered by lack of funds and financial resources; and 5) healthcare consequences, facilitated through positive relationships, literacy, and personal abilities, but constrained by cognitive and sensory limitations, poor relationships, and lack of care continuity, coordination, comprehensiveness, and patient-centeredness. This study highlights the challenges for older people, indicating factors to be strengthened and barriers requiring action at the PHCC and multi-sectoral levels. Ensuring adequate funding, information, and health coverage is primordial to improve older people's access to PHCCs.

Introduction Older people's experiences with access to primary healthcare are overlooked in LMICs, leading to inequitable access and limited delivery of person‐centred care. In Lebanon, the economic crisis has increased older people's vulnerabilities and reliance on services provided through primary healthcare centres (PHCCs). This study explores (1) factors shaping decisions of using PHCCs; (2) experiences of older people accessing PHCCs from three perspectives: the older people themselves, family members and service providers; (3) family members' experiences with accessing PHCCs; and (4) service providers' experiences with providing care for older people within PHCCs in a Northern Lebanese district. Methods This study adopts a qualitative descriptive design with an inductive content analysis approach. Data were collected through seven focus group discussions and 15 individual interviews (n = 57 older people, family members, and service providers). Results Factors shaping decisions of using PHCCs' services include socio‐economic status, knowledge of services, influences of family members, perceived service quality and proximity, age‐related changes, and providers' attitudes and behaviours. Older people reported varied access experiences shaped by factors at individual, organisational, communal, governmental and global levels. Positive experiences included enhanced autonomy, gratitude for receiving needed services, perceived care quality and socialising opportunities. However, negative experiences included humiliation and discomfort, anxiety, dependency, perceived status regression, perceived poor quality and a sense of being a burden. While some family members reported relief from getting affordable care, others reported discomfort, perceived status regression, blame for neglect and challenges with coordinating care across multiple providers. Service providers' experiences included pride in supporting older people, but resentment due to unfair remuneration. Conclusion Findings reveal aspects of care that older people and family members appreciate and others that contribute to negative experiences. Experiences of older people, family members and service providers are interconnected. Quality improvement requires comprehensive approaches addressing their needs. Findings inform practitioners and policymakers to design multidimensional and people‐centred approaches to maximise healthcare access. Patient and Pubic Contribution No PPI engagement methods were applied in this study or analysis. However, the findings informed discussions with older people and facilitated partnerships to co‐design a follow‐up study focused on developing solutions.

Background Nurses and midwives role in sexual healthcare is essential to help patients, particularly women, ensure a satisfactory sexual wellbeing. Yet, these professionals often overlook this aspect of patients’ health. Little is known regarding nurses and midwives’ attitudes, views and experiences concerning sexual healthcare. Using a naturalistic inquiry approach, this qualitative study was conducted to overcome this limitation and gain insights into nurses and midwives' role in the delivery of sexual healthcare. Methods A purposive sample of nurses and midwives was chosen from different clinical sites. Data generated by focus group discussions were were analysed using the Framework Analysis while adopting different strategies to ensure rigour. The study aligns with the consolidated criteria for reporting qualitative research checklist. Results Five themes illustrated the participants’ views and experiences. These are: ‘Perceptions of sexuality’, ‘Appreciating the discussion around the individuals' sexual issues’, ‘Muting the discussion around the individuals’ sexual issues, ‘Coping with embarrassment’, and ‘Promoting nurses’ and midwives’ roles sexual healthcare’. Nurses and midwives discussed the importance of sexuality in the couple's life. They reported controversial views and highlighted many challenges that make them reluctant in playing an efficient role in sexual healthcare. They discussed many suggestions, mainly getting a solid sexual health education to become better equipped to meet patients’ sexual health needs. Conclusion Findings are critical to empower nurses and midwives, break the barriers in discussing sexual healthcare and integrate this aspects of care more actively and confidently in daily practice.

Lifestyle changes, in addition to preventive medications, optimise stroke secondary prevention. Evidence from systematic reviews support behaviour-change interventions post-stroke to address lifestyle-related risk. However, understanding of the theory-driven mediators that affect behaviour-change post-stroke is lacking. Electronic databases MEDLINE, Embase, Epistemonikos and Cochrane Library of Systematic Reviews were searched to March 2023 for systematic reviews addressing behaviour-change after stroke. Primary studies from identified systematic reviews were interrogated for evidence supporting theoretically-grounded interventions. Data were synthesized in new meta-analyses examining behaviour-change domains of the Theoretical Domains Framework (TDF) and secondary prevention outcomes. From 71 identified SRs, 246 primary studies were screened. Only 19 trials (N = 2530 participants) were identified that employed theoretically-grounded interventions and measured associated mediators for behaviour-change. Identified mediators mapped to 5 of 14 possible TDF domains. Trial follow-up ranged between 1-12 months and no studies addressed primary outcomes of recurrent stroke or cardiovascular mortality and/or morbidity. Lifestyle interventions targeting mediators mapped to the TDF Knowledge domain may improve the likelihood of medication adherence (OR 6.08 [2.79, 13.26], I2 = 0%); physical activity participation (OR 2.97 [1.73, 5.12], I2 = 0%) and smoking cessation (OR 10.37 [3.22, 33.39], I2 = 20%) post-stroke, supported by low certainty evidence; Lifestyle interventions targeting mediators mapping to both TDF domains of Knowledge and Beliefs about Consequences may improve medication adherence post-stroke (SMD 0.36 [0.07, 0.64], I2 = 13%, very low certainty evidence); Lifestyle interventions targeting mediators mapped to Beliefs about Capabilities and Emotions domains may modulate low mood post-stroke (SMD -0.70 [-1.28, -0.12], I2 = 81%, low certainty evidence). Limited theory-based research and use of behaviour-change mediators exists within stroke secondary prevention trials. Knowledge, Beliefs about Consequences, and Emotions are the domains which positively influence risk-reducing behaviours post-stroke. Behaviour-change interventions should include these evidence-based constructs known to be effective. Future trials should address cardiovascular outcomes and ensure adequate follow-up time.

Homelessness is a significant public policy and health service challenge globally. Often identified as a 'wicked problem' homelessness is hard to define with limited data confirming the exact numbers of people who are homeless due to varying metrics employed many of which likely exclude women by design. Research and policy have primarily focused on the experiences of single men, and the impact of homelessness on women and their experiences of it are not well understood. To synthesise evidence from qualitative studies of homelessness to identify key dimensions of women in high-income countries (HIC) and their experiences navigating lives when homeless. Systematic searches of six databases [MEDLINE, Embase, Global Health, PsycINFO, CINAHL and ASSIA] were completed from 2012 to 8th January 2024. We included peer-reviewed publications published in English reporting primary qualitative data on women's experiences of homelessness in high-income countries only. A review protocol was developed and published. Noblit and Hare's Metaethnography steps guided the synthesis and are reported according to the eMERGe guidelines. Thirty-two studies were identified describing the experiences of 227 women across nine HICs. A conceptual model comprising three themes is presented within a social-ecological theoretical framework within structural and temporal axes of impact with effects on individual and societal levels. These themes, 1) Precarity, 2) Existing with Risk and Surviving, and 3) Fracturing Identity, describe the implications of homelessness and how the experience of precarity impacts identity and decision-making abilities. The impact of risk arising from violence and exclusion, coupled with descriptions of shame and stigma, presents insight into women's experiences that have hitherto had a limited presence in clinical discourses. The evidence in this review highlights the perpetual reporting of a deficit lens on homelessness. Women experiencing homelessness in HICs are a heterogeneous group that is poorly recognised and understood in the literature. It appears that there is a lack of tailored and responsive service availability and that this further perpetuates the structural underpinnings of homelessness, which cluster in highly gendered ways.

The influence of a spinal cord injury on sexuality must be seen in the light of sexuality being a central aspect of being human according to WHO. The term is broad and covers many aspects of being. The focus in this paper is the lived experiences of sex life with a spinal cord injury understood as sex being a part of life. The aim of the study was to explore the experiences of sex life from the onset of a spinal cord injury to 10 years after. The fact that sex life after a spinal cord injury cannot be separated from what it means to have a ‘damaged spine’ and how this impact on a person’s life was illuminated in interviews collected among ten participants during 10 years after the injury. The themes of re-establishing a sex life consisted of overcoming hinderances related to the body, the self, and the partner. (1) Handling physical impairment, (2) feeling attractive despite physical changes, (3) establishing and sustaining a sexual relationship, (4) regaining a sex life by finding new ways, (5) losing sex life and maybe also intimacy. This was an elongated process with many challenges related to returning to an everyday life. The findings indicated a need for professional support. The consequences for the relationship and hence the sex life as well as the loss thereof with all that it implies point out that couples therapy could be beneficial.