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Background Obstetric violence (OV) constitutes a serious violation of women’s rights and represents a form of gender-based violence. This abuse not only undermines women’s dignity but also poses significant risks to their health and overall well-being. Many women lack awareness of their rights during childbirth, and this gap in knowledge, coupled with unfavorable attitudes toward the issue, allows obstetric violence to persist and become entrenched within healthcare systems. The normalization of such behavior among both healthcare providers and women themselves further exacerbates the prevalence of obstetric violence. A review of existing literature reveals a notable scarcity of studies employing experimental designs to evaluate the impact of interventions on women’s knowledge and attitudes regarding obstetric violence. Consequently, this study aims to assess the effectiveness of a person-centered intervention in enhancing women’s understanding and attitudes toward obstetric violence among those who have given birth in public hospitals in southwest Ethiopia. Methods A quasi-experimental study with a control group was conducted in public hospitals in southwest Ethiopia, involving a randomly selected sample of 396 postpartum women (198 in the control group and 198 in the intervention group). A person-centered intervention comprising a respectful maternity care workshop, maternity open days, and the provision of maternal certificates of recognition was implemented for the 198 women in the intervention group, while the control group received standard care. The chi-square test, independent t-test, and paired sample t-test were used to analyze differences between and within the groups, respectively. Additionally, a generalized linear regression model was employed to determine the effect size of the intervention on women’s knowledge and attitudes, adjusting for background variables. Results The mean scores for women’s knowledge significantly improved in the intervention group, increasing from 14.82 ± 7.08 to 19.17 ± 5.25 ( P  < 0.001). A paired t-test revealed a significant difference ( P  < 0.001) between the pre-test and post-test scores within the intervention group. Furthermore, an independent t-test showed a significant difference in all aspects of knowledge between the intervention and control groups in the post-test ( P  < 0.001), whereas no significant difference was observed during the pre-test stage for either group ( P  > 0.05). On average, women who received the person-centered intervention scored 4.13 points higher in their understanding of rights compared to those in the control group. The study also highlighted a significant difference in women’s attitudes toward obstetric violence between the experimental and control groups after the intervention, with scores of 21.80 ± 5.43 for the intervention group and 32.65 ± 7.40 for the control group ( P  < 0.01). Additionally, being part of the intervention group reduced women’s unfavorable attitudes nearly elevenfold (β = -10.81, 95% CI = -12.17, -9.45). Women’s knowledge increased by an average of four points (β = 4.21, 95% CI = 2.98, 5.43) in the intervention group compared to the control group. Conclusions The findings demonstrated that implementing a person-centered intervention significantly enhanced women’s knowledge and decreased unfavorable attitudes toward obstetric violence, ultimately promoting respectful maternal care. Therefore, we recommend adopting and integrating such interventions into existing maternal health programs in Ethiopia to strengthen maternal health initiatives. Clinical trial number Not applicable. Graphic Abstract

Introduction Long-lasting pain in adolescents may affect education, social interactions, and is associated with mental health challenges. Current interventions are often suboptimal due to insufficient understanding of the challenges faced by adolescents with long-lasting pain and those who support them. Understanding the management challenges experienced by adolescents with long-lasting pain, along with those faced by their parents, education professionals, and healthcare professionals (HCPs), is crucial for informing person-centered interventions and improving care and outcomes. Objectives This study aimed to gather insights and visions from adolescents with long-lasting pain, along with their parents, HCPs, and teachers, to develop a person-centered intervention for managing pain. Methods We used a qualitative Action Research approach, employing three workshops with 1) adolescents with long-lasting pain, 2) HCPs and teachers, and 3) parents. Workshops incorporated case vignettes and design-card exercises to foster dialogue, knowledge construction and articulation of insights and visions to inform intervention design. Data were collected through audio recordings, participant artifacts, and field notes, then analyzed using Reflexive Thematic Analysis and matrix synthesis to create a conceptual model highlighting tension points for future interventions. Results In three separate workshops, 13 adolescents with long-lasting pain, 16 HCPs and teachers (four physiotherapists, four senior high school teachers, three psychologists, three school health nurses, and two General Practitioners), and four parents participated. Adolescents described pain’s pervasive impact on their education, social lives, and self-identity. Barriers to improvement included limited coordination between healthcare and school, as well as a lack of communication. The school setting and school health services were identified as an ideal setting for interventions. Key visions for interventions included early holistic assessments, enhanced interdisciplinary collaboration with dedicated coordination roles, specialized adolescent-focused expertise, and the use of digital tools for personalized management. Conclusion This study brought new insights into the development of a person-centered intervention for adolescents with long-lasting pain, highlighting the impact of pain on those affected and barriers to optimal care. It emphasized the need for including education professionals and school health services in interdisciplinary collaboration, holistic assessments, and improved expertise in adolescent pain management.

Background: In the ICD-11 hierarchical classification structure, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) are separate and distinct but also 'sibling' disorders, meaning that the diagnoses follow from the parent category of traumatic stress disorders. Objective: The aim of this study was to examine the prevalence of CPTSD in treatment-seeking war veterans with PTSD more than 20 years after the exposure to cumulative war-related trauma(s). The second aim was to examine if there was an association between demographic and psychosocial variables and CPTSD or PTSD. Method: A sample of 160 male war veterans with PTSD referred to the outpatient service of the PTSD Referral Centre at the Clinical Hospital Centre (CHC) Rijeka participated in a cross-sectional study. Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview (MINI) and participants completed validated self-report measures: The Life Events Checklist for DSM-5 (LEC-5), International Trauma Questionnaire (ITQ). Results: In total, 80.63% of the sample met criteria for a probable diagnosis of CPTSD. The study revealed that there was no significant difference in the length of deployment, in the intensity of the PTSD symptoms, types of trauma exposure and pharmacotherapeutic treatment between PTSD and CPTSD group. It was found that veterans with PTSD were more likely to be divorced and to participate in PTSD clubs. On the other hand, veterans with CPTSD were significantly more likely to have higher levels of functional impairment and comorbidity with general anxiety disorder (GAD) compared to the PTSD group. Conclusions: This study supports the proposition that a prolonged trauma of severe interpersonal intensity such as war is related to high rates of CPTSD among treatment-seeking veterans, years after the war. The distinction between PTSD and complex PTSD may help the selection of person-centred treatment interventions that would target specific mental health and functional problems in patients.

Despite international growth in policies to increase the identification and response to elder abuse and neglect, there remain considerable barriers to treating the problem. Some of these barriers may be attributed to how older adults from different racial/ethnic backgrounds define, experience and seek to remedy elder mistreatment. Using focus group discussions based on case vignettes, this paper examines how older adults from different racial and ethnic backgrounds in the United States of America perceive elder mistreatment. Five focus groups were conducted with African Americans, English-speaking Latinos, Spanish-speaking Latinos, non-Latino Whites and African American care-givers for older adults. While similar definitions and meanings of elder abuse were expressed across the different racial/ethnic groups, Latino participants introduced additional themes of machismo, respect, love and early intervention to stop abuse, suggesting that perceptions/beliefs about elder mistreatment are determined by culture and degree of acculturation in addition to race/ethnicity. Most differences in attitudes occurred within groups, demonstrating that perceptions vary by individual as well as by culture. In identifying scenarios that constitute elder mistreatment, some participants felt that certain cases of abuse are actually the persistence of intimate partner violence into old age. Participants also indicated that victims may prefer to tolerate mistreatment in exchange for other perceived benefits (e.g. companionship, security); and out of fear that they could be placed in an institution if mistreatment is reported. Findings suggest the need for person-centred intervention and prevention models that integrate the cultural background, care needs and individual preferences of older adults.

ABSTRACTBackgroundPerson-centered care (PCC) is a widely recognized concept in dementia research and care. Dementia Care Mapping (DCM) is a method for implementing PCC. Prior studies have yielded heterogeneous results regarding the effectiveness of DCM for people with dementia (PwD). We aimed to investigate the effectiveness of DCM with regard to quality of life (QoL) and challenging behavior in PwD in nursing homes (NHs). MethodsLeben-QD II is an 18-month, three-armed, pragmatic quasi-experimental trial. The sample of PwD was divided into three groups with three living units per group: (A) DCM applied since 2009, (B) DCM newly introduced during the study, and (C) a control intervention based on a regular and standardized QoL rating. The primary outcome was QoL measured with the Quality of Life-Alzheimer's Disease (QoL-AD) proxy, and the secondary outcomes were QoL (measured with QUALIDEM) and challenging behavior (measured with the Neuropsychiatric Inventory Nursing Home version, NPI-NH). ResultsThere were no significant differences either between the DCM intervention groups and the control group or between the two DCM intervention groups regarding changes in the primary or secondary outcomes. At baseline, the estimated least square means of the QoL-AD proxy for groups A, B, and C were 32.54 (confidence interval, hereafter CI: 29.36–35.72), 33.62 (CI: 30.55–36.68), and 30.50 (CI: 27.47–33.52), respectively. The DCM groups A (31.32; CI: 28.15–34.48) and B (27.60; CI: 24.51–30.69) exhibited a reduction in QoL values, whereas group C exhibited an increase (32.54; CI: 29.44–35.64) after T2. ConclusionsDCM exhibited no statistically significant effect in terms of QoL and challenging behavior of PwD in NHs. To increase the likelihood of a positive effect for PwD, it is necessary to ensure successful implementation of the intervention.

Background Despite advances in treatment and the well-established benefits of cardiac rehabilitation in Portugal, patient engagement in recovery after myocardial infarction remains limited. One contributing factor is the insufficient integration of person-centred care (PCC), which emphasises collaborative partnerships between patients and healthcare professionals to support recovery. PCC practices have been shown to improve self-efficacy in managing recovery from acute cardiac events. This study aimed to adapt a Swedish evidence-based PCC intervention to the Portuguese healthcare context, with the goal of enhancing patients’ self-efficacy following myocardial infarction. Methods The Portuguese person-centred care intervention to enhance self-efficacy in patients following a myocardial infarction (P2MIR) was adapted to the Portuguese healthcare context based on the Medical Research Council framework further enhanced by best practices for adapting interventions. A two-phase exploratory and qualitative study was conducted in co-design with several stakeholders, including researchers, patients who experienced a myocardial infarction, and healthcare professionals from a cardiology department. Implementation outcomes and key adaptations were assessed through four semi-structured focus group discussions with patients ( n  = 6) and healthcare professionals ( n  = 11). Data were analysed using a deductive content analysis approach. Results In Phase I, the intervention was systematically adapted to the Portuguese healthcare context, resulting in P2MIR 1.0. Phase II findings showed that participants perceived the PCC intervention to be acceptable and seemed appropriate, and feasible, with promising potential to integrate care across hospital, outpatient and primary care settings. Patients reported that PCC had the potential to lead to better care experiences, increased involvement in their recovery, and fewer unplanned visits, while professionals noted potential benefits for job satisfaction and clinical support. These insights guided the refinement of the intervention, leading to a final version, P2MIR 2.0. Conclusions The P2MIR 2.0 retain components from the original intervention with additional two co-designed components to further strengthen the possibility to create a partnership between healthcare professionals and myocardial infarction patients after hospital discharge, thereby enhancing self-efficacy in recovery. Targeted training in PCC for health care professionals, along with culturally adapted tools, will support integration and future scaling.

Background Empowerment approaches are essential for building the capacity of individuals with chronic disease to be in control of their health. Reviews of empowerment interventions have been focused on specific chronic diseases, thereby limiting the scope of findings. This study had three aims: 1) to describe the characteristics of empowerment interventions covering a broad range of chronic diseases, 2) to clarify consistency with the World Health Organization`s (WHO) definition of empowerment as a process composed of four fundamental components and 3) to summarize outcome measures and estimate the effects in group and individual intervention formats. Methods Systematic literature review and meta-analysis. CINAHL, Medline, Embase, PsycINFO, Web of Science, COCHRANE and Central Register of Controlled Trials were searched using Chronic Disease, NCD, Empowerment, as MeSH terms. Eligible randomized and quasi randomized controlled trials were included. Review Manager 5.4 was used to conduct the meta-analysis. Risk of bias was assessed with the Cochrane risk-of-bias tool (ROB 2). Results Thirty-nine articles representing 8,011 participants were included in the review. A majority (82%) of studies reported robust evidence for changes on study-defined outcome measures in favor of interventions. Intervention content was assessed against WHO’s four fundamental components of empowerment, showing that all studies incorporated one component, but none targeted all components. Components reflecting knowledge acquisition, patient engagement with their health care providers and facilitating environment were scarcely reported. Meta-analyses found evidence for positive effects of group-format interventions measuring empowerment, HbA1c, and self-efficacy. Effects on empowerment were also found in some individual-format interventions. High levels of heterogeneity and variability among the conceptual frameworks were identified. Conclusion Empowerment interventions in group-format were most efficient, however, considerable conceptual inconsistencies were identified. Future studies should consolidate conceptual understandings by using WHO’s empowerment framework to ensure that fundamental components of empowerment are explicitly included in intervention design. Furthermore, there is a need to clarify the role of empowerment through pathways that include patient activation, self- management, and clinical outcomes. This systematic review will inform the clinicians and researchers who aim to develop novel empowerment interventions to assist patients in the process of gaining control of their health. Trial registration PROSPERO: International Prospective register of systematic reviews ID=CRD42020178286.

Background Process evaluations are useful in clarifying results obtained from randomised controlled trials (RCTs). Traditionally, the degree of intervention usage in process evaluations is monitored by measuring dose or evaluating implementation fidelity. From a person-centred perspective, such evaluations should be supplemented with patients’ experiences of meaningful use, given that intervention use should be agreed upon between interested parties and tailored to each patient. This study aimed to elucidate patients’ experiences of a remote person-centred care (PCC) intervention by deepening the understanding of, if, how and for whom the intervention contributed to meaningful use. Methods Patients ( n  = 86) were recruited from the RCT PROTECT intervention group. A convergent mixed-method approach was implemented. Data were collected in parallel with the ongoing RCT via a survey, including ratings and written comments on meaningful or non-meaningful use. Also, interviews were performed with twelve purposefully selected participants. Descriptive statistics, logistic regression and content analysis were employed. Data sources were integrated in the results. Results Most participants rated the overall intervention as meaningful to use, with the telephone support rated as most meaningful. Interviews and written comments showed that patient ratings on meaningful use were explained by four categories: Not in need, Communication deficiency, Benefits in everyday life and A personal boost . Meaningful use of rating symptoms on the digital platform was predicted by living alone (adjusted odds ratio [aOR] = 2.8 P  = .044). A diagnosis of chronic obstructive pulmonary disease (COPD) predicted meaningful use of digital platform direct messaging (aOR = 3.5, P  = .045). Moreover, having access to direct-dial telephone contact explained meaningful use among participants with low ratings of technical competence (aOR = 3.6, P  = .014). Conclusions The combined digital platform and structured telephone support could be helpful in identifying preventive actions to maintain health for people diagnosed with COPD and chronic heart failure but tends to be more meaningful for those diagnosed with COPD. Overall, lower adoption of the digital platform was seen compared to telephone support. Shortcomings were noted in the digital platform’s implementation that negatively influences experiences of meaningful use. When used, the intervention proved to be an easily applicable and valued tool to support preventive actions in a person-centred manner.

INTRODUCTION iWHELD is a digital person‐centered care program for people with dementia in nursing homes adapted for remote delivery during the COVID‐19 pandemic. METHODS A 16‐week two‐arm cluster‐randomized controlled trial in 149 UK nursing homes compared iWHELD with treatment as usual (TAU). Primary outcome was the overall quality of life with secondary outcomes of agitation and psychotropic use. RESULTS iWHELD conferred benefit to quality of life on the primary (F = 4.3, p = 0.04) and secondary measures of quality of life (F = 6.45, p = 0.01) and reduced psychotropic medication use (χ2 = 4.08, p = 0.04) with no worsening of agitation. Benefit was seen in participants who contracted COVID‐19, those with agitation at baseline, and those taking psychotropic medications. DISCUSSION iWHELD confers benefits to quality of life and key measures of well‐being, can be delivered during the challenging conditions of a pandemic, and should be considered for use alongside any emerging pharmacological treatment for neuropsychiatric symptoms. Highlights iWHELD is the only remote, digital delivery nursing home training programme for dementia care iWHELD improved quality of life in people with dementia and reduced antipsychotic use without worsening of agitation Residents who contracted Covid‐19 during the study also experienced benefits from iWHELD iWHELD offers a valuable, pandemic‐safe tool for improving dementia care

Demonstrating the differential effectiveness of instructional approaches for learners is difficult because learners differ on multiple dimensions. The present study tests a person-centered approach to investigating differential effectiveness, in this case of reading instruction. In N = 517 German third-grade students, latent profile analysis identified four subgroups that differed across multiple characteristics consistent with the simple view of reading: poor decoders, poor comprehenders, poor readers, and good readers. Over a school year, different instructional foci showed differential effectiveness for students in these different profiles. An instructional focus on vocabulary primarily benefited good readers at the expense of poor decoders and poor comprehenders, while a focus on advanced reading abilities benefitted poor comprehenders at the expense of poor decoders and good readers. These findings are in contrast to those obtained by multiple regression, which, focusing on only one learner characteristic at a time, would have suggested different and potentially misleading implications for instruction. This study provides initial evidence for the advantages of a person-centered approach to examining differential effectiveness.