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Background: Older adults with mental health (MH) challenges often face significant barriers when navigating complex healthcare systems, especially during critical transitions, such as hospital discharge. These challenges are compounded by comorbid physical illnesses, cognitive impairments, and social determinants of health.

Objectives: This qualitative study aimed to gain insights from patients and providers on factors influencing the implementation of an innovative occupational therapy (OT) led Patient Navigation Program (PNP) supporting older adults with complex MH care needs.

Methods: We conducted a qualitative study that was informed by the Consolidated Framework for Implementation Research. Data were collected through semi-structured interviews and focus groups.

Results: Seven patients and caregivers, and 17 healthcare professionals who served as the MH PNP or collaborated with the MH PNP participated in the study. MH Navigators offered valuable, specialized skills to address gaps in MH and functional outcomes among older adults and were highly effective at bridging hospital and community care. However, the success of such a role depends on alignment across organizations, sufficient professional support, clear role expectations, and integrated team structures. Significant barriers for implementation included organizational cultural differences, system constraints, and the high complexity of patient needs.

Conclusion: The OT-led MH PNP holds significant promise for optimizing care delivery for older adults with MH care needs by bridging gaps in the healthcare system and fostering better continuity of care. Insights from this study can refine navigation processes, enhance interprofessional collaboration, improve patient experiences, and provide valuable guidance for implementing MH navigation programs at other sites.

Introduction: Reproductive health awareness is a fundamental component of public health, gender equity, and human rights. This narrative review aimed to systematically describe and synthesise evidence on reproductive health awareness among tribal women and adolescent girls in India and internationally, examine major reproductive health schemes implemented in India, and identify strategies to strengthen awareness and service utilisation.

Material and methods: A structured narrative review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines. Literature published between January 2005 and January 2026 was identified through PubMed, Scopus, Web of Science, and Google Scholar. Peer-reviewed articles, review papers, policy documents, and relevant grey literature published in English were eligible for inclusion. Studies focusing on reproductive health awareness among tribal or Indigenous women and/or adolescent girls were screened and synthesised thematically. A total of 36 evidence sources were included in the review.

Results: A total of 36 studies were included. International and Indian evidence consistently demonstrates lower reproductive health awareness among tribal populations. Awareness of at least one modern contraceptive method among tribal women ranged from approximately 55-90% across studies, while utilisation remained substantially lower (20-60%), highlighting a persistent awareness-utilisation gap. Partial knowledge, menstrual stigma, gendered decision-making, and reliance on traditional practices were common across contexts. Although awareness of government schemes such as JSY, JSSK, and PMMVY was moderate to high, utilisation remained variable, revealing a persistent awareness-utilisation gap.

Conclusion: Reproductive health awareness among tribal women and adolescent girls is shaped by complex socio-cultural and structural determinants. Strengthening culturally responsive health communication, adolescent-friendly services, community engagement, and frontline health worker capacity is essential to improve awareness and equitable utilisation of reproductive health services and schemes. The findings provide policy-relevant evidence to guide tribal health programmes and support progress toward reproductive health equity.

Background: Hepatitis B virus (HBV) poses a significant occupational risk to healthcare workers (HCWs), particularly midwives in highly endemic settings such as Ghana, where frequent exposure to blood and bodily fluids during clinical practice increases their risk of occupational exposure and infection. Despite the availability of HBV vaccination and Post-Exposure Prophylaxis (PEP), uptake remains suboptimal due to multiple barriers. This study explores individual and organizational-level barriers to HBV PEP in northern Ghana.

Method: A qualitative exploratory study was conducted in the Kassena-Nankana West District of Ghana, involving 20 midwives recruited purposively from three healthcare facilities. Semi-structured interviews were conducted, and thematic analysis was used to identify key patterns in line with the socioecological model.

Results: Two major overarching themes emerged across the individual and organizational socioecological levels. At the individual level, participants demonstrated inadequate knowledge of post-exposure prophylaxis (PEP) for HBV, including inadequate knowledge of the concept of PEP and HBV-specific protocols and guidelines. At the organizational level, health facility barriers included unstructured exposure reporting and PEP management pathways, absence of facility-level HBV-specific protocols and guidelines, and inadequate training on PEP for HBV were the factors identified as affecting PEP uptake.

Conclusion: Despite the availability of a national occupational health and safety policy recommending structured HBV PEP, protocol implementation at the facility level was weak, leaving midwives unprotected. The study underscores the urgent need for improved HBV education, structured exposure management pathways, and strengthened facility-level policies to enhance HBV PEP uptake. Addressing these gaps is crucial to reducing the risk of occupational HBV infection and ensuring midwives' safety in highly endemic settings.

Background: Patient navigation (PN) exemplifies a complex health intervention, involving multiple interacting components yet tailored to individual patient contexts and needs. Identifying functions and processes of complex interventions like PN enables a better understanding of how they are meant to work, moving beyond descriptions of program components such as tasks and services. With broad variation across programs, the navigator role can look quite different depending on context.

Objective: To explore the functions of PN from the perspective of patient navigators in Alberta, Canada.

Design: Qualitative descriptive approach.

Methods: Semi-structured interviews were conducted with patient navigators working in a range of patient-facing program types and settings across Alberta. Interviews were recorded and transcribed, then coded using NVivo 12^TM software. A thematic content analysis approach guided data analysis.

Results: We interviewed 29 navigators from a range of PN programs including cancer care, primary care networks, community agencies, and youth to adult transition. Nursing was the most common educational background of participants (n=12), followed by social work (n=9). Themes generated through thematic analysis highlighted three core functions of PN that collectively define its role as a complex, adaptive intervention: 1) creating a safety net for patients (theme 1), by addressing health and psychosocial needs (theme 1a) or by reducing barriers to care (theme 1b), 2) using advocacy and skill-building to enable patients to become more active participants in managing their health (theme 2), and 3) building relationships to strengthen patient trust and engagement (theme 3).

Conclusions: PN is a complex, multi-functional intervention that enhances patient care through relational, practical, and systemic support. Defining and understanding these key functions provides clarity and is critical for effective implementation and integration of PN into health systems and to inform future implementation and evaluation of PN programs in Canada.

Introduction: Burnout among healthcare workers threatens workforce well-being and quality of care. Evidence from Ghana remains limited, particularly regarding demographic and professional differences in tertiary hospitals. This study aimed to examine burnout prevalence and its association with key demographic characteristics, including age, gender, marital status, and professional category among healthcare workers in a tertiary facility in Ghana.

Methods: A cross-sectional retrospective study analyzed secondary data from a routine clinical audit of 333 healthcare workers (86 doctors, 233 nurses, and 14 health assistants) at Cape Coast Teaching Hospital. Burnout was measured using the validated Burnout Assessment Tool with sound psychometric properties. Associations between burnout and age, gender, marital status, and profession were examined using descriptive statistics and multivariable logistic regression. Statistical significance was set at p≤ 0.05.

Results: Among the 333 healthcare workers studied, the overall burnout prevalence was 62.4% (n = 208). Women and men had comparable overall burnout prevalence (62.9% versus 61.7%), although women reported higher psychosomatic symptoms. Burnout prevalence declined with increasing age, from 64.4% among those aged 20-29 years to 56.5% among those aged 50-59 years. Single healthcare workers experienced slightly higher burnout prevalence than married workers (64.7% versus 59.6%). Bivariate analysis identified profession as the only demographic factor significantly associated with burnout (χ² = 6.24, p = 0.044). In multivariable logistic regression analysis, nurses and health assistants had significantly lower odds of burnout compared to doctors (adjusted odds ratio [aOR] = 0.47, 95% CI: 0.26-0.83; p = 0.009).

Conclusion: Burnout at Cape Coast Teaching Hospital is both substantial and varies by profession, underscoring the need for differentiated responses. Nurses and health assistants had lower odds of experiencing burnout compared to doctors. These findings highlight the need for targeted interventions, including workload adjustments, structured mental health support, and organizational wellness programs.

Background: Vietnam has made substantial progress in maternal health, achieving high coverage of antenatal care (ANC) under the Millennium Development Goals. However, focusing solely on the number of ANC contacts may obscure whether women receive the essential services recommended during pregnancy. This study examined trends in ANC contacts and service content across sociodemographic groups and assessed whether inequalities changed over time.

Methods: We analyzed nationally representative Multiple Indicator Cluster Survey (MICS) data from 2011, 2014, and 2021 for women aged 15-49 years who had a live birth in the two years preceding the survey (N = 4,413). Outcomes included ANC coverage (≥4 and ≥8 contacts), ANC provided by skilled health personnel, ANC provided by medical doctors, receipt of four core ANC services (tetanus immunization, blood pressure measurement, blood test, and urine test), and a Complete ANC Coverage Index reflecting both service contacts and essential ANC content. Survey-weighted logistic regression models examined temporal trends and differences by wealth, residence, region, and ethnicity.

Results: From 2011 to 2021, all ANC indicators improved significantly (all p < 0.001). Coverage of ANC provided by skilled health personnel increased from 93.3% to 97.0%, while ANC provided by medical doctors increased from 80.6% to 95.0%. The proportion of women receiving all four core ANC services increased from 39.9% to 63.2%, and the Complete ANC Coverage Index more than doubled from 15.2% to 39.2%. Improvements were observed across all sociodemographic groups; however, substantial inequalities persisted. For the Complete ANC Coverage Index, temporal trends differed significantly across regions and places of residence (p < 0.05). Still, they were similar across wealth quintiles and ethnic groups (p > 0.05), despite persistent differences in absolute coverage.

Conclusion: Vietnam has achieved substantial improvements in both ANC contacts and service content, yet important inequalities remain. Monitoring both service contacts and essential ANC content, using complementary measures such as the Complete ANC Coverage Index, provides a more comprehensive assessment of effective ANC coverage and may better inform policies to promote equitable maternal healthcare.

Background: Despite its life-saving potential, cesarean delivery (CD) remains a major concern due to its increased risk of intra/post-operative complications. This study therefore evaluated adverse maternal outcomes following cesarean section (CS) and identified correlated factors among women who delivered at Yirgalem General Hospital.

Methods: A retrospective cross-sectional study was conducted from March 4 to 25, 2024, involving 372 mothers. Data were collected using a structured checklist through a review of medical records of women who gave birth by CS between February 6, 2022 and January 5, 2024. The data were entered into EpiData 3.1, and then exported to SPSS version 21 for analysis. Association between outcome variable and its predictors was examined using bivariable and multivariable logistic regression analysis. Statistical significance was defined as a p-value ≤0.05, with adjusted odds ratios (AORs) and 95% confidence intervals reported.

Results: The overall prevalence of maternal adverse outcome following CS was 27.7% (95% CI: 23.3%, 32.4%). Significant factors of adverse outcome encompassed rural residence (AOR = 2.05, 95% CI: 1.09 - 3.86), lack of antenatal care follow-up (AOR = 2.26, 95% CI: 1.22 - 4.21), and a history of pre-existing medical illness (AOR = 2.31, 95% CI: 1.26 - 4.23).

Conclusion: The occurrence of maternal adverse outcome following CS in the study setting was notably high. Rural residence, lack of ANC, and pre-existing medical conditions were significant determinants. Strengthening healthcare access in rural areas, improving antenatal care coverage, and ensuring early diagnosis and management of medical conditions are essential to reducing complications associated with cesarean delivery.

Background: Communication breakdowns in perioperative settings are a major contributor to elevated stress, heightened anxiety, and emotional vulnerability among patient caregivers, thus highlighting the need for reliable communication practices. This qualitative study investigated communication practices through the perceptions and experiences of patient caregivers and healthcare providers across the perioperative stages, exploring the benefits and challenges of both verbal and digital communication methods.

Methodology: A qualitative research design was adopted, involving semi-structured in-depth interviews with 23 purposively selected participants from a tertiary hospital in Coastal Karnataka. The interview guides were pilot tested and validated to ensure accuracy and comprehensiveness. The interviews were audio-recorded, transcribed, and analyzed using ATLAS. ti 8 software for thematic analysis. A two-cycle coding process was employed to analyze the data from the participants' perspectives, resulting in eleven different codes that were further organized into six emerging themes.

Results: The study revealed existing communication practices in surgical settings, with verbal communication practices characterized by direct updates and mic announcements emerging as more prominent. However, limited intraoperative updates intensified patient caregiver anxiety and uncertainty. The participants perceived the benefits of digital adoption of communication tools to bridge the communication gaps in surgical settings, although concerns remained about digital literacy, data privacy, and over-reliance on technology.

Conclusions: The successful implementation of digital communication practices depends on overcoming structural, socio-ethical, and technological limitations. Alternatively, a tailored communication approach that reflects stakeholder needs in peri-operative contexts would be more effective in sustainable communication delivery.

Background: Health information systems are a cornerstone for assessing health system performance, particularly for leading conditions contributing to disease burden, such as hypertension, making effective monitoring indispensable. In October 2023, Mexico initiated the federalisation of public health services for the population without social security, creating an integrated national public health care provider and increasing the need for system-level monitoring tools capable of supporting longitudinal assessment across heterogeneous settings.

Objective: To describe the development and early application of an integrative monitoring platform using routinely collected clinical data to support system-level oversight of hypertension care within Mexico's federalised public health care provider.

Design: Descriptive health services research study based on secondary analysis of routinely collected clinical data.

Methods: An integrative monitoring platform was developed to organise data into a structured indicator framework covering four domains: care engagement and continuity; clinical care processes; intermediate clinical outcomes; and case-mix and clinical complexity. The platform enables longitudinal and subnational analyses across selected indicators presented as illustrative use cases. Institutional reach was assessed using an overall monitoring period from January 2024 to September 2025, while clinical process and intermediate outcome indicators, including blood pressure control, were calculated within a predefined active six-month monitoring cohort using the September 2025 reporting date.

Results: From January 2024 to September 2025, a total of 486,044 individuals received hypertension-related care within primary care services across participating states. The active six-month cohort included 322,661 individuals, with 67.2% (95% CI, 67.04-67.37) achieving blood pressure control (<140/90 mmHg), and 36.8% (95% CI, 36.62-36.96) achieving strict control (<130/80 mmHg). For those with sub-optimal control, 63% had timely clinical follow-up and 48% underwent treatment intensification. A high proportion of individuals presented high risk features including obesity (36.4%; 95%CI, 36.2-36.5), diabetes (48.7%; 95%CI, 48.5-48.8) or high cardiovascular risk characteristics (81.7%, 95%IC, 81.5-81.8).

Conclusion: Transforming routinely collected clinical data into an integrative monitoring platform is feasible within a newly federalised public health care provider. Routine monitoring of relevant indicators across multiple dimensions of care provides a structured basis for system-level oversight, longitudinal assessment, data-informed decision-making, and continuous learning within large public service delivery systems.

Background: In a context of rapid population ageing, most countries face major challenges to prepare their long-term care systems to meet rising demands. It is vital that research examines how systems can adapt to these demographic changes. International comparisons between long-term care systems can support the identification of shared lessons on the advantages and disadvantages of different systems and associated outcomes.

Objective: To analyse and compare the long-term care systems in Norway and in England and identify lessons from this comparison.

Method: Using Donabedian's structure-process-outcome framework, this comparative overview analysed the commonalities and differences between the two systems. Data were identified from Government websites, relevant publications, and websites from key national sector organisations from the time period in which the study was conducted (2021-2025).

Results: The Norwegian and English systems exhibit more similarities than differences. The most notable differences emerged in the structure component, particularly in terms of funding mechanisms and the degree of care integration. Differences were also evident in the outcome component, where national outcome measures are less systematically embedded in the Norwegian system. In contrast, the process component revealed that both countries have implemented similar initiatives to address shared challenges within their services.

Conclusion: We argue that to build a system fit for the future, we need to confront elements currently unaddressed and to understand the interdependence within the triad of care (care recipient-informal carer-workforce), as well as its gendered nature.