Access to healthcare services for people with non-communicable diseases during the COVID-19 pandemic in Ibadan, Nigeria: a qualitative study.

BACKGROUND: Desirable outcomes for people with non-communicable diseases (NCDs) are achieved when they access routine monitoring and care services. Expectedly, the COVID-19 pandemic severely impacted access to healthcare services, leading to poor health outcomes among people with NCDs. We aimed to [1] explore the delays in accessing healthcare services and [2] understand alternative actions adopted by people with NCDs to overcome these delays. METHODS: We conducted an exploratory qualitative research guided by the "Three Delays" model to unpack the barriers to healthcare access for people living with NCDs in Ibadan, Nigeria. The "Three Delays" model conceptualizes the reasons for negative/adverse healthcare outcomes related to the patient's decision-making to seek healthcare, reaching an appropriate healthcare facility, and receiving adequate care at the healthcare facility. Twenty-five (25) people with NCDs were purposively selected from the University College Hospital's medical outpatient department to participate in in-depth interviews. Interview recordings were transcribed verbatim and analyzed using a deductive-inductive hybrid thematic analysis. RESULTS: At the level of individual decision-making, delays were related to fear of contracting COVID-19 in the hospital (considered a hotspot of the COVID-19 pandemic). Regarding reaching an appropriate healthcare facility, delays were mainly attributed to the intra- and inter-city lockdowns, limiting the movements of persons. For those who successfully arrived at the healthcare facilities, delays were related to the unavailability of healthcare professionals, prioritization of COVID-19 patients, and mandatory adherence to COVID-19 protocols, including COVID-19 testing. To overcome the delays mentioned above, people with NCDs resorted to (i) using private healthcare facilities, which were more costly, (ii) using virtual consultation through mobile phone Apps and (iii) self-management, usually by repeating previously prescribed prescriptions to obtain medication. CONCLUSION: Pandemic conditions provide unique challenges to people with chronic illnesses. Recognizing the need for continuous access to monitoring and care services under such conditions remains critical. Alternative health service provision approaches should be considered in pandemic situations, including remote healthcare services such as Mobile health apps (mHealth) that can help manage and prevent NCDs.

COVID-19 vaccine hesitancy among Nigerians living with non-communicable diseases: a qualitative study.

OBJECTIVES: The discovery and subsequent manufacture of various types of COVID-19 vaccines were considered a breakthrough in the fight against the COVID-19 pandemic. Initially, limited supplies of COVID-19 vaccines warranted vulnerable populations such as people living with chronic non-communicable diseases and the elderly to be prioritised for vaccination. Nevertheless, the uptake of the COVID-19 vaccines among these populations was suboptimal. In this study, we aimed to describe the drivers of COVID-19 vaccine hesitancy among people living with chronic non-communicable diseases in Ibadan, Nigeria. METHOD: We applied qualitative methods to explore the feelings and thoughts of people living with chronic non-communicable diseases towards COVID-19 vaccines, at a tertiary hospital in Ibadan, Nigeria. Data were obtained from 25 people living with chronic conditions through in-depth interviews. We thematically analysed the transcripts inductively and deductively. Dedoose qualitative data management software was used to manage the data. FINDINGS: Emerging subthemes were grouped into two major themes: Hesitancy towards the COVID-19 vaccine related to biological concerns and those related to sociopolitical issues. Hesitancy towards the COVID-19 vaccine associated with biological factors included: (1) concerns over the COVID-19 vaccine worsening the underlying chronic condition; (2) fear of harmful physiological consequences; (3) concerns over insufficient testing of vaccine for safety and (4) perceived vaccine infectiveness. Sociopolitical factors were related to (1) misconceptions of vaccines as a treatment for those with COVID-19; (2) mistrust of manufacturers ('the whites'); (3) mistrust of government and (4) COVID-19 misinformation. CONCLUSION: Public health education on the nature and benefits of the COVID-19 vaccine is urgently needed among people living with chronic non-communicable diseases. These measures could improve COVID-19 vaccine uptake and healthcare usage in general. Paying attention to these factors could have implications for the management of the next global pandemic requiring mass vaccination.

Nurses' Priorities for Perioperative Research in Africa.

BACKGROUND: Mortality rates among surgical patients in Africa are double those of surgical patients in high-income countries. Internationally, there is a call to improve access to and safety of surgical and perioperative care. Perioperative research needs to be coordinated across Africa to positively impact perioperative mortality. METHODS: The aim of this study was to determine the top 10 perioperative research priorities for perioperative nurses in Africa, using a research priority-setting process. A Delphi technique with 4 rounds was used to establish consensus on the top 10 perioperative research priorities. In the first round, respondents submitted research priorities. Similar research priorities were amalgamated into single priorities when possible. In round 2, respondents ranked the priorities using a scale from 1 to 10 (of which 1 is the first/highest priority, and 10 is the last/lowest priority). The top 20 (of 31) were determined after round 2. In round 3, respondents ranked their top 10 priorities. The final round was an online discussion to reach consensus on the top 10 perioperative research priorities. RESULTS: A total of 17 perioperative nurses representing 12 African countries determined the top research priorities, which were: (1) strategies to translate and implement perioperative research into clinical practice in Africa, (2) creating a perioperative research culture and the tools, resources, and funding needed to conduct perioperative nursing research in Africa, (3) optimizing nurse-led postoperative pain management, (4) survey of operating theater and critical care resources, (5) perception of, and adherence to sterile field and aseptic techniques among surgeons in Africa (6) surgical staff burnout, (7) broad principles of infection control in surgical wards, (8) the role of interprofessional communication to promote clinical teamwork when caring for surgical patients, (9) effective implementation of the surgical safety checklist and measures of its impact, and (10) constituents of quality nursing care. CONCLUSIONS: These research priorities provide the structure for an intermediate-term research agenda for perioperative research in Africa.

COVID-19 Vaccine Attitude and Its Predictors Among People Living With Chronic Health Conditions in Ibadan, Nigeria.

Objective: To assess vaccination attitude and its associated factors among people with chronic health conditions. Methods: In this cross-sectional study, participants were 423 patients with chronic medical conditions. Data were collected on socio-demographic and COVID-19-related characteristics, via Open Data Kit software. A Vaccination Attitudes Examination (VAX) Scale was adopted. The main outcome was vaccine attitude status defined as positive if a VAX sum score was above the median value; otherwise, non-positive. Data were analysed using Chi-square and multivariate logistic regression analyses, at 5% level of significance. Results: Overall proportion of patients with a positive attitude towards COVID-19 vaccination uptake was 46.6%. The most influential factor towards positive attitude was rating the government high in handling the pandemic. Other factors were education, income, COVID-19 knowledge and living room arrangement (p < 0.05). Conclusion: Less than half of people living with a chronic medical condition had a positive attitude towards the COVID-19 vaccine. The attitudes are strongly mediated by confidence in the government. The government could promote a positive vaccine attitude by improving the clarity of health instructions that shows government transparency and effective communication. These are critical tools for maintaining public trust and confidence.

Caregivers' perception of the quality of nursing care in child health care services of the University College Hospital, Nigeria.

The health care system has increasingly emphasized consumers' satisfaction in developing models of health care quality. Among health professionals, nurses spend more time with patients, hence, the measure of consumers' perception of quality nursing care is crucial. Children are vulnerable and unable to effectively express their views; hence, their caregivers often serve as their decision makers.This study aimed to assess caregivers' perception of the quality of nursing care in child health care services. A descriptive cross-sectional survey was conducted using a stratified sampling technique to recruit 308 caregivers attending Immunization and Child welfare clinics of University College Hospital, Nigeria. Participants were surveyed using an adapted version of the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ) which was analyzed using descriptive and inferential statistics at a 0.05 level of significance. A large percentage of the caregivers were female (86.9%)."Concern and caring by the nurses", "recognition of carers' needs", "coordination of care" and "privacy" were perceived to be fair (50.2%, 54.9%, 56.3%, 57%) while "clarity about instructions given", "helpfulness", "skill and competence" were perceived to be good (61.7%, 56.3%, 63.8%).The age, occupation, and marital status of the caregivers had a significant association with their perception of nursing care (p<0.05). The attitudes of nurses regarding concern, caring and privacy were perceived to be fair as compared with the skill and competence of nurses which were perceived to be good. Although caregivers had an overall average perception of quality of nursing care, more efforts should be geared towards improving on areas that were fair, like care and concern, courtesy, friendliness, and kindness, which are central to nursing as a caring profession. Good interpersonal relationships and acknowledgment of caregivers as decision-makers in health care which were perceived to be inadequate in this study are key factors that drive a good perception of quality nursing care. Nurses must continue to provide inclusive quality care where caregivers are seen as significant contributors to health care.

Family-integrated diabetes education for individuals with diabetes in South-west Nigeria.

Objectives: This study aimed to determine the effects of family-integrated diabetes education on diabetes knowthe ledge of patients and family members, as well as its impact on patients' glycosylated haemoglobin (A1C). Design: The design was a two-group Pretest Posttest quasi-experimental. Setting: The study took place at the diabetes clinics of two tertiary hospitals in southwestern Nigeria. Participants: People Living with Diabetes (PLWD) and family members aged 18 years and over and without cognitive impairment were placed, as clusters, into either a control group (CG) or an intervention group (IG) The CG comprised 88 patients and 88 family members while IG comprised 82 patients and 82 family members. Of these, 78 and 74 patients completed the study in CG and IG, respectively. Interventions: PLWD in IG along with their family members were given an educational intervention on diabetes management and collaborative support with an information booklet provided. This was followed by three (3) complimentary Short Messaging Service (SMS). Main outcome measures: A1C and diabetes knowledge. Results: Over half (52.4%) and about a fifth (18.2%) of family members and patients, respectively, had never had diabetes education. There was a statistically significant increase in the knowledge of patients and family members in IG. Unlike CG, the A1C of patients in IG improved significantly at three and six-month post-intervention, (p<0.01). Regression showed an independent effect of family members' knowledge on IG's A1C. Conclusions: Improved family members' diabetes knowledge positively impacted patients' glucose level. There is a need to integrate family members into diabetes care better. Funding: African Doctoral Dissertation Research Fellowship (ADDRF) award offered by the Africa Population and Health Research Center (APHRC) in partnership with the International Development Research Centre.

Family-integrated diabetes education for individuals with diabetes in South-west Nigeria

Objectives: This study aimed to determine the effects of family-integrated diabetes education on diabetes knowthe ledge of patients and family members, as well as its impact on patients' glycosylated haemoglobin (A1C). Design: The design was a two-group Pretest Posttest quasi-experimental. Setting: The study took place at the diabetes clinics of two tertiary hospitals in southwestern Nigeria. Participants: People Living with Diabetes (PLWD) and family members aged 18 years and over and without cognitive impairment were placed, as clusters, into either a control group (CG) or an intervention group (IG) The CG comprised 88 patients and 88 family members while IG comprised 82 patients and 82 family members. Of these, 78 and 74 patients completed the study in CG and IG, respectively. Interventions: PLWD in IG along with their family members were given an educational intervention on diabetes management and collaborative support with an information booklet provided. This was followed by three (3) complimentary Short Messaging Service (SMS). Main outcome measures: A1C and diabetes knowledge. Results: Over half (52.4%) and about a fifth (18.2%) of family members and patients, respectively, had never had diabetes education. There was a statistically significant increase in the knowledge of patients and family members in IG. Unlike CG, the A1C of patients in IG improved significantly at three and six-month post-intervention, (p<0.01). Regression showed an independent effect of family members' knowledge on IG's A1C. Conclusions: Improved family members' diabetes knowledge positively impacted patients' glucose level. There is a need to integrate family members into diabetes care better

Family-integrated diabetes education for individuals with diabetes in South-west Niger

Objectives: This study aimed to determine the effects of family-integrated diabetes education on diabetes knowthe ledge of patients and family members, as well as its impact on patients' glycosylated haemoglobin (A1C). Design: The design was a two-group Pretest Posttest quasi-experimental. Setting: The study took place at the diabetes clinics of two tertiary hospitals in southwestern Nigeria. Participants: People Living with Diabetes (PLWD) and family members aged 18 years and over and without cognitive impairment were placed, as clusters, into either a control group (CG) or an intervention group (IG) The CG comprised 88 patients and 88 family members while IG comprised 82 patients and 82 family members. Of these, 78 and 74 patients completed the study in CG and IG, respectively. Interventions: PLWD in IG along with their family members were given an educational intervention on diabetes management and collaborative support with an information booklet provided. This was followed by three (3) complimentary Short Messaging Service (SMS).Main outcome measures: A1C and diabetes knowledge. Results: Over half (52.4%) and about a fifth (18.2%) of family members and patients, respectively, had never had diabetes education. There was a statistically significant increase in the knowledge of patients and family members in IG. Unlike CG, the A1C of patients in IG improved significantly at three and six-month post-intervention, (p<0.01). Regression showed an independent effect of family members' knowledge on IG's A1C. Conclusions: Improved family members' diabetes knowledge positively impacted patients' glucose level. There is a need to integrate family members into diabetes care better.

Psychological state, family functioning and coping strategies among undergraduate students in a Nigerian University during the COVID-19 lockdown.

INTRODUCTION: The curtailment of social gatherings and the lack of online academic engagement during the COVID-19 lockdown could have potentially damaging effects on the psychological state of university students in Nigerian public universities. This study examined the prevalence of anxiety and depression, including associated factors and coping methods, among undergraduate students. METHODS: This cross-sectional study, which involved 386 undergraduate students, was assigned approval number UI/EC/20/0242. An online questionnaire consisting mainly of the Hospital Anxiety and Depression Scale and the McMaster Family Assessment Device was circulated among the students. The results were analysed by means of descriptive statistics, chi-square, Analysis of Variance (ANOVA) and linear logistical regression, at α 0.05. RESULTS: Mean age was 21 ± 2.9 years, with females constituting 60.1% of the sample. The prevalence rates of anxiety and depression were 41.5 and 31.9%, respectively. Students in health-related faculties were significantly less anxious than others. Inability to afford three square meals, negative family functioning, chronic illness and living in a State/Region with a high incidence of COVID-19 were significantly associated with depression. These factors jointly accounted for 14% of depression. Coping methods included the use of social media, watching movies and participating in online skills-development programs. CONCLUSION: The overall level of anxiety and depression among undergraduate students during the COVID-19 lockdown was higher than the levels previously reported. Inadequate nutrition and poor family functioning contributed significantly to this. Proactive measures ought to be taken to support undergraduate students in order to prevent the negative consequences of poor mental health.

A survey on patients' characteristics, perception of family support and diabetes self-management among type 2 diabetes patients in South-West Nigeria.

AIM: To determine the association between patients' characteristics, perception of family support and diabetes self-management (DSM) behaviours among type 2 diabetes patients. DESIGN: A descriptive cross-sectional design was used and data were collected between July-September 2016. The study is part of a larger quasi-experimental study. METHODS: One hundred and ninety-seven diabetes mellitus (DM) patients from two teaching hospitals in south-west Nigeria participated. Questionnaire was used in collecting information on sociodemographic, clinical data, DSM and perception of family support. RESULTS: Most (71.6%) of the participants were females and 35% were on insulin therapy. Mean age was 60.7 (SD: 11.3) years and 11.7% had had DM for over 20 years. Overall, DSM was positively influenced by previous diabetes education and duration of diabetes. Perception of family support was also positively associated with and influenced DSM.