Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?Evidence from Ethiopia

Objectives This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance(CBHI)scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms.There is growing concern about the financial sustainability of CBHI schemes in developing countries.However,few empirical studies have identified potential contributors,including ex-ante and ex-post moral hazards.Methods We implement a household fixed-effect panel data regression model,drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.Results The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals.However,CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms.Particularly,on average,we estimate about 4-6 h delay for malaria symptoms,a little above 4 h for tetanus,and 10-11 h for tuberculosis among the insured households.Conclusions While there is evidence that CBHI improve the utilization of outpatient or primary care services,our study suggests that insured members may wait longer before visiting health facilities.This delay could be partly due to moral hazard problems,as insured households,particularly those from rural areas,may consider the opportunity costs associated with visiting health facilities for minor symptoms.Overall,it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

A community-based friendly health clinic:An initiative adolescent reproductive health project in the rural and urban areas of Indonesia

Objective:This study aims to examine the effects of a community-based friendly health clinic(CFHC)program that adopts manual participatory learning(MPL)intervention on the adolescents living in the rural and urban areas of Indonesia to gain further insights into their knowledge,attitudes,and skills related to adolescent reproductive health(ARH).Methods:A quasi-experimental design was used to obtain information on the ARH knowledge,attitudes,and skills of adolescents.Two intervention studies that used similar protocols and measures were conducted.A total of 192 adolescents(96 adolescents from urban and rural areas)participated in the project,and the participants from each area were divided into eight groups.A questionairre was adopted to measure the ARH knowledge,attitudes,and skills of these participants.A content analysis of the logbook entries of these respondents was conducted to identify their ARH-related problems.The questionnairre and self-reported ARH data were collected before and after the eight-week program.Results:The CFHC program significantly increased the ARH attitudes(p=0.045)and skills(p=0.009)of adolescents in the rural area,but only improved the ARH knowledge(p<0.001)of adolescents in both rural and urban areas.Fourteen themes were identified in three dominant categories,namely,schools,families,and communities.Conclusions:The CFHC with MPL intervention can improve the ARH knowledge,attitudes,and skills of adolescents in the rural area,but can only improve the ARH knowledge of adolescents in the urban area.The ARH program must be designed based on the characterictics of these adolescents to improve their life skills during puberty.

Experience of Mental Health Professionals Collaborating with Peer Supporters in a Community Mental Health Service Team

This study explored how mental health professionals collaborate with peer supporters with mental disabilities in a community mental health institution.From January 19 to February 23,2021,three 60 min interviews were conducted with six mental health professionals working at a Korean community center.The results were qualitatively analyzed and divided into four themes and eight categories.The four themes were the perceptions of and challenges in working with peer supporters with mental disabilities,conflict and confusion about working with peer supporters,forming partnerships with peer supporters,and policy support for peer supporters’job security.Participants reported vague anxiety about working with a peer supporter and difficulties with the trial-and-error process of adjusting to the role as challenging.Over time,however,they realized that they needed to make an effort to develop meaningful relationships with peer supporters and mental health professionals.Thus,through this study,we realized that there was a need to improve the system,such as building infrastructure for job stability for peer support workers and capacity building tailored to the mental disorders.Although peer supporters play various roles while working with mental health professionals,this study showed the possibility of mutual growth through communication and cooperation.These findings will help prepare systems necessary for collaboration between the two teams amidst the increasing institutionalization of peer support for mental disorders.

The Impact of Social Support on the Mental Health of Cancer Patients:Evidence from China

Exploring the relationship between social support and the mental health of cancer patients is a vital endeavor for enhancing mental well-being.The objective of this study was to explore the relationship between social support and psychological well-being in cancer patients and to provide new empirical evidence for psychological improvement in cancer patients.This research holds significant practical implications for optimizing China’s public health system and strengthening the development of a healthy China.Using data from the 2018 China Health and Retirement Longitudinal Study(CHARLS)database,we empirically examined the influence of social support on the mental health of cancer patients.Models such as Ordered Probit and OLogit were used to provide empirical evidence and theoretical insights for enhancing the mental health of cancer patients in a context marked by a high prevalence of cancer.The findings indicated that both formal and informal social support mechanisms were effective in improving the mental health of cancer patients.Furthermore,we utilized the propensity score matching(PSM)model to eliminate the endogeneity issue associated with sample selectivity bias.The results obtained through PSM demonstrated robustness,underscoring the importance of addressing sample selectivity bias when assessing the impact of social support on the mental health of cancer patients.Therefore,the Chinese government is recommended to prioritize the use of social support as a means to proactively enhance the mental health of cancer patients,thereby continuously elevating their overall quality of life.

Community-Based Hepatitis B Campaign in Asian Americans

Chronic hepatitis B (CHB) disproportionately affects minority groups in the US, particularly Asian Americans, with numerous factors contributing to this disparity. Of the 2.4 million people living with chronic HBV in the US, 60% are Asian American. Many are unaware of their status and lack access to proper clinical care, with less than ten percent receiving necessary antiviral treatment. Barriers to screening and care include lack of disease awareness, language and cultural barriers, and financial constraints. Additionally, healthcare providers and systems in the US often overlook the importance of CHB, leading to inadequate care. In response, the Center for Viral Hepatitis (CVH) has implemented a community-based outreach program over the past sixteen years, employing a multifaceted approach involving all sectors of society and various organizations to combat health disparities in CHB. This grassroots campaign has proven highly effective, leveraging CVH’s leadership in spearheading numerous collaborative activities with community members, healthcare professionals, and policymakers. We have summarized the key points of CVH's efforts and their significance in combating CHB-related health disparities. The CHB Screening and Awareness Campaign, tailored to the Asian American community, serves as a successful model for increasing CHB screening, linkage-to-care, and addressing socio-cultural barriers and health literacy. Insights from these outreach programs have guided the development of culturally relevant resources and education initiatives. These findings suggest that such community-driven approaches are essential for addressing health disparities. The strategies and outcomes of CVH’s efforts can inform future health initiatives for other minority communities in the US and globally.

Enhancing adolescent mental health through cognitive and social support:Insights from study on depression in Chinese adolescents

Adolescent depression is a growing global health concern,affecting 14%of adolescents and leading to severe consequences such as academic failure,substance abuse,and suicidal ideation.The study by Yu et al,investigates the cognitive and social factors influencing depression in 795 Chinese adolescents.Findings reveal that negative life events(NLEs)and dysfunctional attitudes are strongly associated with depressive symptoms,while social support moderates the impact of NLEs but not dysfunctional attitudes.The study highlights the need for cognitivebehavioural interventions targeting perfectionism and autonomy,and the importance of strengthening social support systems in schools and communities.Culturally sensitive,holistic approaches to adolescent mental health are crucial for addressing both the internal vulnerabilities and external pressures contributing to depression.Further research is needed to explore the roles of peer and parental support and the long-term effects of these factors across diverse cultural contexts.

Factors determining membership in community-based health insurance in West Africa:a scoping review

Background:In many low-income countries,households bear most of the health care costs.Community-based health insurance(CBHI)schemes have multiplied since the 1990s in West Africa.They have significantly improved their members’access to health care.However,a large proportion of users are reluctant to subscribe to a local CBHI.Identifying the major factors affecting membership will be useful for improving CBHI coverage.The objective of this research is to obtain a general overview of existing evidence on the determinants of CBHI membership in West Africa.Methods:A review of studies reporting on the factors determining membership in CBHI schemes in West Africa was conducted using guidelines developed by the Joanna Briggs Institute.Several databases were searched(PubMed,ScienceDirect,Global Health database,Embase,EconLit,Cairn.info,BDPS,Cochrane database and Google Scholar)for relevant articles available by August 15,2022,with no methodological or linguistic restrictions in electronic databases and grey literature.Results:The initial literature search resulted in 1611 studies,and 10 studies were identified by other sources.After eliminating duplicates,we reviewed the titles of the remaining 1275 studies and excluded 1080 irrelevant studies based on title and 124 studies based on abstracts.Of the 71 full texts assessed for eligibility,32 additional papers were excluded(not relevant,outside West Africa,poorly described results)and finally 39 studies were included in the synthesis.Factors that negatively affect CBHI membership include advanced age,low education,low household income,poor quality of care,lack of trust in providers and remoteness,rules considered too strict or inappropriate,low trust in administrators and inadequate information campaign.Conclusions:This study shows many lessons to be learned from a variety of countries and initiatives that could make CBHI an effective tool for increasing access to quality health care in order to achieve universal health coverage.Cover-age through CBHI schemes could be improved through communication,improved education and targeted financial support.

A Model to Estimate the Impact of Thresholds and Caps on Coverage Levels in Community-Based Health Insurance Schemes in Low-Income Countries

Background: Community-based health insurance (CBHI) schemes are increasingly implemented in low-income settings. These schemes limit the coverage they offer both by the types of care considered, and by applying thresholds and/or caps to costs reimbursed. The consequences of these thresholds and/or caps on insurance coverage have hitherto been usually ignored, for lack of data on the distributions of healthcare costs or understanding of their impact on effective coverage levels. This article describes a theoretical model to obtain the distributions even without data collection in the field, and demonstrates the quantitative impact of thresholds and/or caps on claim reimbursements. Methods: This model applies to applications on healthcare expenditures in low-income settings, following research methods examined in the Western world. We looked at hospitalizations and tests;we compared the simulated distributions to empirical data obtained through 11 household surveys conducted between 2008 and 2010 in rural locations (9 in India and 2 in Nepal). Results: We found that the shape of the distributions was very similar in all locations for both benefits, and could be represented by a model based on a lognormal distribution. The agreement between theoretical and empirical results was satisfactory (mostly within 10% difference). Conclusions: The model makes it possible to simulate the expected performance of the CBHI (represented by the percentage of costs or bills covered). The aim is to match costs with local levels of willingness-to-pay for health insurance. This model makes it possible to determine at the stage of package-design the optimal levels of thresholds and/or caps for each benefit-type included.

Community-Based Health Insurance： An Evolutionary Approach to Achieving Universal Coverage in Low-Income Countries

The WHO World Health Assembly, and the most recent WHO World Health Report, have called for all health systems to move toward universal coverage. However, low-income countries have made little progress in this respect. We use existing evidence to describe the evolution of community-based health insurance in low-income countries through the three stages of basic model, enhanced model, and nationwide model. We have concluded that community-based health insurance development is a potential strategy to meet the urgent need for health financing in low-income countries. With careful planning and implementation, it is possible to adopt such evolutionary approach to achieve universal coverage by extending tax-based financing/social insurance characteristics to community-based health insurance schemes.

Evaluation Items for Community-Based Health Care Focusing on Social Aspects: A Literature Review

The progressive aging of society has become a global concern, and is expected to lead to the development of effective, sustainable, person-centered, integrated community-based care systems. However, there is insufficient evidence regarding effective integrated community-based care. In particular, few studies have focused on social aspects of the community environment related to elderly health. This study aimed to consider social aspects as evaluation items, focusing particularly on social determinants from the perspective of community-dwelling people, to explore truly effective integrated community-based care to improve elderly health. The definition of social determinants means social cohesion in social and community contexts. A literature review of English articles published in peer-reviewed journals up to October 2019 was conducted using PubMed, MEDLINE, and CINAHL with the following search terms: “social cohesion,” “elderly health,” “mental health” and “community.” Identified articles were screened based on title and abstract, and selected articles were subjected to full-text assessment and critical review. All references cited in the selected articles were also reviewed. The following inclusion criteria were used: 1) studies targeting community-dwelling elderly people or community-dwelling people including elderly people as participants;2) studies with clear descriptions of social factors in the Methods section;and 3) studies with clear descriptions of health-related items in the Methods section. From the 21 articles analyzed, of which 9 articles defined social determinants as social cohesion in social and community context, 37 items were extracted as social aspects at the community level that reflect the perspective of residents. These items can be developed as evaluation items for community-based health care outcomes through consensus among community health care providers and further investigation.

Multiple mediation effects of health locusof control and hope on the relationshipbetween stroke patients’ social supportand self-management

Objective:This study aimed to identify the mediation effects of health locus of control(HLC)and hope between stroke patients’social support and self-management.Methods:A cross-sectional study was conducted.A total of 300 Chinese stroke patients were recruited by convenient sampling from the acupuncture department of two Chinese Traditional Medical Hospitals in Tianjin Province from June to September 2018.The self-report questionnaires include Social Support Assessment Scale,Herth Hope Index,Mental Health Locus of Control Scale,Stroke Self-management Behavior Scale,and personal information questionnaires.All the survey data were entered in Excel and analyzed using the SPSS 24.0 program.Mediation was tested with Bootstrapping in AMOS 23.0 program.Results:The result showed that internal health locus of control(IHLC),chance health locus of control(CHLC)and hope were the mediators between social support and self-management.The direct,indirect,and total effects of social support on self-management behavior were 0.306 (P<0.01),0.109(P<0.01),and 0.415(P<0.01),respectively.Conclusions:Social support can directly influence self-management,and it can also indirectly influence self-management through IHLC,CHLC,and hope.

Factors influencing self-efficacy in breastfeeding support among public health nurses in Japan

This study investigated self-efficacy in breastfeeding support among public health nurses (PHNs) working at maternal and child health (MCH) services in Japanese municipalities, and its related factors such as education, working experience, breastfeeding experience, and postgraduate/continuous education. Directors of the MCH divisions were requested to select one PHN to answer the self-report questionnaires sent. The questionnaires were collected from October 2010 to January 2011. Of the 1750 questionnaires sent, 831 were returned (response rate: 47.5%);102 were excluded from analysis because of missing data (valid response rate: 41.7%). After adjusting the weights of PHN sampling and collection rates by prefecture and population size, Model 1 of the multiple regression analysis showed that the self-efficacy in breastfeeding support was significantly higher in large/urban municipalities (β = 0.13) and in the Kanto district. Model 2 revealed that self-efficacy was significantly associated with working experience (β = 0.13) and breastfeeding experience (β = 0.22) but not with educational background. Model 3 showed that self-efficacy was significantly associated with postgraduate education (β = 0.14) and continuous education (β = 0.12). This suggested that PHNs’ self-efficacy increased through self-enrichment. It is necessary to create training opportunities about breastfeeding support for PHNs—especially those working in remote and/or small municipalities— and to provide them with new and important information.

The Relationship between Mental Health Literacy and Subjective Well-Being of Young and Middle-Aged Residents: Perceived the Mediating Role of Social Support and Its Urban-Rural Differences

This study investigates mental health literacy among young and middle-aged urban and rural residents and the differences in mental health literacy,perceived social support and subjective well-being.From January to February 2022,620 participants(320 rural and 300 urban residents)from three provinces of China were selected by con-venience sampling.A general data questionnaire,mental health literacy scale,perceived social support scale and subjective well-being scale were administered.The mental health literacy scores of urban residents were 3.34±0.57 and those of rural residents were 2.73±0.79.The results of multiple regression analysis showed that the mental health literacy scores of rural residents were more significant than those of urban residents in terms of sex and age,while urban residents’mental health literacy scores were more significant than those of rural resi-dents in terms of monthly income.Mental health literacy,perceived social support and subjective well-being of young and middle-aged urban and rural residents were all positively correlated(P<0.01).While the level of mental health literacy is better among urban residents than rural residents,perceived social support plays a partial mediating role between mental health literacy and subjective well-being of both urban and rural residents,and should be the focus of researchers seeking to improve the level of well-being of residents.

Implementing and Popularizing Health Clinics and Educational Programs in NJ School Areas for Supporting NJ Pregnant Teenagers

This proposal focuses on the prevalence of teenage pregnancy issue in NJ and illustrates the benefits of school-based health clinics and educational programs which should be implemented for teenage pregnancy and childbearing.Without the early intervention of educational programs and preventive medical services which should be implemented in school areas,teen pregnancy and childbearing can have physical and emotional health influences on teen mothers,their babies and other family members,and the worst consequence should be abortion.What’s more,teenage pregnancy and childbearing have substantial economic consequence for state.The annual estimated cost associated with teen childbearing (teens 19 and younger) in NJ to taxpayers is at least $167 million in 2004 (24% federal costs and 76% state and local costs).Studies demonstrated that a much larger amount of money is spent on the consequences of teenage pregnancy than on prevention.NJ has an opportunity to invest in prevention and reduce not only the monetary but also the societal costs to our youth burdened by the often overwhelming responsibilities of teenage pregnancy and parenting.According to the 15 years follow-up research and data analyzing,two models of success which specifically implemented in South Carolina high schools and Chicago public schools have been proved to effectively reduce incidence of repeat pregnancy and emergency room visits,reduce incidence of teen mothers smoking during pregnancy,improve emotional outcomes among teen mothers,decrease incidence of teen mothers drug impairment,arrest,conviction,or jail time and reduce use of food stamps and other public assistances,which can consequently increase the state public health costs.In order to support teen mothers’ academic,physical,emotional and social needs in a stable and consistent school environment,the plan which titled "Physical and Mental Health Promotion for NJ Teen Mothers" is effective and practical enough to arouse the attention of some relevant departments.It’s worth patron to fund the plan because supporting teenage pregnancy at early stage can subsequently benefit the national and state economy and teen mothers.

Designing a Scale to Assess Breastfeeding Support among Public Health Nurses in Japan

Background: Promoting breastfeeding support by public health nurses (PHN) requires first that the support which they currently provide to be assessed. However, there is no assessment tool for this purpose. The aim of this study was therefore to develop a scale to assess breastfeeding support currently provided by PHN. Methods: We developed the Practice of Breastfeeding Support Scale (PBSS) for PHN based on the results of a previous study. The content validity of the PBSS was established through discussion with three other researchers. A pilot study was conducted to confirm face validity. To confirm reliability and validity, an anonymous, self-reported questionnaire was sent to PHN working in municipal offices. The statistical analyses included the Kaiser-Meyer-Olkin (KMO), Barlett’s Test of Sphericity, exploratory factor analysis (EFA), Cronbach’s alpha and correlation coefficient. Results: 768 PHN participated in this study. Cronbach’s alpha of PBSS was 0.85. The KMO measure was 0.892, and Bartlett’s Test of Sphericity was p Conclusion: The reliability and validity of PBSS were confirmed. These findings suggested that the PBSS has the potential to help promote breastfeeding support by PHN by clarifying their current breastfeeding support practices and related factors.

Qualitative Study of Breastfeeding Support by Public Health Nurses in Japan

This study aimed to explore breastfeeding support by public health nurses (PHNs) working in Japanese municipalities in order to promote a breastfeeding-friendly environment. We interviewed 20 participants including five PHNs, four midwives, four doctors (one obstetrician and three pediatricians), and seven mothers who experienced breastfeeding between June and August 2010 and analyzed the data using content analysis. Collected data were classified into four categories including “collecting information”, “assessment”, “direct and individual support”, and “support for group and community” with 15 subcategories: infant’s condition, mother’s condition, mother-infant relationship, child rearing environment, mother’s state-of-mind, identifying necessary support, psychological support, concrete support, breastfeeding on demand, necessary information, advice to supporters, introducing services, breastfeeding-friendly environment, breastfeeding support groups and cooperation with relevant organization. This study suggested that the PHNs’ responsibilities for breastfeeding support should be extended beyond the currently understood scope of their duties. The study demonstrated that PNH needed to create a breastfeeding-friendly environment that included networking with breast care support organizations and peer groups and to promote breastfeeding in public areas including the workplace.

The Japanese Community Pharmacists’ Perceptions of the Health Support Pharmacy System

A questionnaire survey was conducted employing pharmacists at 350 Japanese Federation of Democratic Medical Institutions (Min-Iren) member pharmacies, evaluating the challenges related to registering as a Health Support Pharmacy (HSP). Completed responses were received from 193 pharmacies (55.1%). Fifty-five (28.5%) of these pharmacies were approved as meeting the HSP criteria. Some difficulties encountered in registering as an HSP included the preparation of the numerous required documents and placing a health support pharmacist. The obstacles that prevented pharmacists from registering were physical, including “placement of two or more health support pharmacists” and “placement of the required over-the-counter drugs (OTCs).” Based on these, 51.8% of supervising pharmacists stated the opinion that the government should “loosen current criteria.” However, a survey conducted among the 724 participant pharmacists, working in a pharmacy, showed no significant difference in their answering tendencies depending on whether or not they worked at an HSP. This could be attributed to the effort that Min- Iren pharmacies have been putting into health support and primary care functions. Overall, 64.5% of pharmacists working at HSPs were proud that the pharmacy they worked had HSP status. The present survey revealed the physical obstacles of HSP registration. Conformity to the criteria of HSP is essential for performing their fundamental functions as pharmacies. The relaxation of the criteria is anticipated.

How the Health Care Nurse Supports and Enhances the Child’s Attachment to Their Parents

Objective: The aim of this study was to provide insight into how the Child Healthcare Clinic (BVC) nurse supports and encourages the child’s bonding to their parents during the regularly scheduled checkups at the healthcare clinics. Method: The study was done using a qualitative approach. The data was collected from the interviews of four focus groups which were comprised of a total of eighteen BVC nurses who work solely for the BVC. The resulting data was analyzed using qualitative content analysis. Results: The following theme emerged from the research material: Empower the parents in order to enable the child to have a healthy connection to the parents. This is accomplished by the BVC nurse building and creating a trusting relationship with the parents and providing support for them in their new roles as parents. The BVC nurses must have comprehensive knowledge about the needs and development of children and they need to have exceptional communication skills as well. It is also mandatory that the BVC nurse have access to cooperation and support from their colleagues and the support of other related professions. Conclusion: Providing support to parents during the bonding period of their infant children is a most important function for BVC nurses because there is much to be determined about children’s development and future possibilities during this formative period.

A Retrospective Analysis of the Capacity Built through a Community-Based Participatory Research Project Addressing Diabetes and Obesity in South and East Los Angeles

Chronic diseases, such as diabetes and obesity, are more prevalent in low-income and minority communities. One promising method to understand and address these chronic conditions is through Community Based Participatory Research (CBPR). CBPR engages and empowers community members to identify risk factors and work toward solutions as equal partners with researchers. One positive and lasting outcome may be an increase in the community capacity which includes individual and community leadership development, policy making, creating connections and utilizing existing community resources. Evaluating community capacity created as a result of a CBPR project is one way to measure its effectiveness. This paper is a retrospective analysis of the capacity built during a CBPR study of diabetes and obesity in East and South Los Angeles which are two low-income and minority neighborhoods. Four people, who were heavily involved in the project, completed a retrospective analysis of the capacity built utilizing a validated instrument. There was consensus about the capacity built, which included: excellent participation by community members, inclusion of members’ ideas to leverage additional funding, and pride of community members in their participation in the project. One area that could have been strengthened was increased access for leadership and research experience among community members, especially since the project ended prematurely. There were differences among the two community groups with East Los Angeles members focusing more on tangible interventions and grant writing, while South Los Angeles members had a greater policy focus. Communities and researchers who are embarking on a CBPR project can learn from those who have implemented the strategy. Measuring capacity built during and after the project, can be one way to understanding the contributions of a project in a community. CBPR is an empowering research methodology which, done correctly, can build community capacity and have long-term impacts on individuals and communities.

Assessment of Knowledge, Attitudes and Support of Health Professionals towards Biobanks in Eastern Morocco

Background: Health professionals play a key role in increasing the rate of biobanking participation. Here, we assessed the knowledge and attitude of health professionals in Eastern Morocco towards biobanks and their willingness to recruit patients into biobanks. Methods: A cross-sectional study carried out among health professionals working in various public and private health centers in Eastern Morocco. The data were obtained using a self-administered anonymous questionnaire. Results: 600 health professionals were included in the study. Only 37.5% of them had knowledge of biobanks. Associations analysis showed that among health professionals, physicians had more knowledge of biobanks (OR = 2.50, p = 0.000), and health professionals working at the University Hospital had more knowledge of biobanks compared to those working in the other participating health centers (p Conclusions: This study indicates that health professionals in Eastern Morocco showed a notable lack of knowledge about biobanks. However, the majority were willing to donate their own biospecimens and supported the recruitment of patients into biobanks. This study was a good opportunity to raise awareness among health professionals about the interest of biobanks in the development of biomedical research in Eastern Morocco.