Alyona Mazhnaya

This case study describes a multicomponent methodology for conducting national Behavioural and Cultural Insights (BCI) baseline assessment, illustrated through Ukraine's 2025 experience. The assessment addresses a gap where settings committed to systematic BCI integration lack foundational evidence necessary for strategic planning and targeted capacity development. The methodological framework combined three complementary components: (1) legislative analysis to examine how behavioural considerations are embedded in Ukrainian health policy from 2014 onwards across vaccination, antimicrobial resistance, and non-communicable diseases; (2) literature review to map research capacity and theoretical approaches relevant to behavioural health work through systematic searches of international and local databases from 2000-2024; and (3) stakeholder consultations across five professional groups to identify partnership networks, terminology use, and barriers to systematic BCI integration. All behavioural factors were analysed using the Capability-Opportunity-Motivation-Behaviour (COM-B) model, while intervention-development phases were examined through the Tailoring Health Programmes (THP) framework. The assessment produced three outputs: a Ukrainian-English BCI glossary, a legislation overview through COM-B and THP lenses, and stakeholder network visualisation. Together, these deliverables illustrate both the opportunities and constraints for systematic BCI integration in a multisectoral health context. Ukraine's post-2014 healthcare reform context and European Union candidacy create unique momentum for the evidence-based approaches to health behaviours. While this triangulated approach generates richer insights than isolated methods, it presents inherent constraints, including substantial resource requirements, skilled personnel needs, theoretical dependencies, and limited visibility of informal institutional practices.

The full-scale Russian invasion of Ukraine in February 2022 dramatically increased mental health needs while simultaneously disrupting service delivery sys

Background: In Ukraine women account for quarter of all people who inject drugs. Apart from several non-governmental organizations that provide advocacy and empowerment services to women who inject drugs (WWID), there are no integrated full-service health care facilities tailored specifically to the needs of WWID in Ukraine. They often have diminished access to drug use treatment, health and social services due to bureaucratic rules and processes at the institutions and stigmatizing attitudes among health care providers. In this paper we use the concept of structural stigma to explore the attitudes of Ukrainian health care providers toward WWID across governmental and non-governmental organizations that serve this population. Methods: Between December 2017 and October 2018, we interviewed 41 medical and social service providers in two cities in central and eastern parts of Ukraine. Results: Our analysis revealed that stigmatizing attitudes depended on how familiar providers were with infectious diseases and drug use, how long they have been professionally engaged with WWID, their ability to relate to WWID's drug use due to having similar experience. Healthcare professionals struggled to reconcile chronic disease view of substance use and the societal bias against WWID. Conclusions: Interventions to eliminate the stigma in healthcare must first confront the ingrained societal biases embedded in how providers perceive women's substance use, often treating it as a moral problem. Healthcare regulations that prioritize providing high-quality care to WWID, rather than attempting to control or contain these patients, can cultivate environments that discourage the perpetuation of structural stigma.

In the World Health Organization European Region, an estimated 14 million people live with a chronic hepatitis B virus infection (HBV), and 12 million are affected by a hepatitis C virus infection (HCV). Uzbekistan bears a major burden of HBV and has one of the highest HCV prevalence in the region. Following a presidential decree in May 2022, significant funds were allocated to the viral hepatitis (VH) elimination program in Uzbekistan. The program expands VH testing to reach 500,000 people annually during 2022–2025 as part of the VH elimination strategy that includes the provision of free testing and affordable treatment. Exploring the existing barriers and facilitators to VH testing is pivotal for informing these interventions. This study uses a cross-sectional qualitative design to identify and explore the barriers and facilitators to VH testing among the general population in Uzbekistan. We collected data during October-November 2022 through semi-structured interviews with 12 key informants (KIs) and 7 focus group discussions with two target populations: the general population and healthcare workers (HCW) in Tashkent, Uzbekistan. Following the capability-opportunity-motivation-behavior model (COM-B model) as a framework for the analysis, we identified major capability barriers to VH testing primarily linked to low health literacy and limited knowledge about VH types, symptoms, transmission, testing and treatment. Physical opportunity barriers included the time and financial costs associated with testing, diagnostics, and treatment. Sociocultural opportunity barriers involved anticipated negative reactions and stigmatization, particularly affecting women. Motivational barriers included a reluctance to be tested when asymptomatic and a general fear of receiving positive test results. The involvement of healthcare workers in promoting VH awareness and motivating the general population emerged as a facilitator. A multi-pronged approach is recommended to achieve VH testing goals among the general population, focusing on raising awareness and health literacy and creating an enabling environment that ensures easy accessibility and minimizing VH testing-associated costs.

Introduction: Following the full-scale invasion of Ukraine by the Russian Federation on 24 February 2022, over 6,000 patients were at risk of potential disruptions in treatment with medications for opioid use disorder (MOUD) in Ukraine. Before 2022, privatized MOUD clinics had emerged, partly driven by restrictive governmental policies and practices in state-funded facilities. Nevertheless, scant information exists regarding their operation and the patient’s experiences, especially during crises. This study seeks to elucidate the initial lived experiences of patients utilizing private MOUD clinics, integrating these insights with an analysis of the responding health system during war.Methods: The findings are derived from 20 qualitative semi-structured interviews conducted between March and June 2022, engaging participants from five major Ukrainian cities: Kharkiv, Kyiv, Odesa, Poltava, and Zaporizhzhya. Employing a rapid analysis procedure, we examined the data through descriptive and analytical summaries aligned with the domains of the data collection instrument.Results: Emergent themes encompassed stress and uncertainty following the invasion’s onset, challenges accessing MOUD, and consequent perceptions concerning state-funded versus private clinics. The study identified disruptions in the operation of private MOUD clinics across most cities examined. Issues pertaining to MOUD medication availability were linked to dosage reductions at state-funded clinics or pharmacy medication shortages or closures. Despite varied experiences at different MOUD clinics and cities, most participants continued their treatment.Discussion: This qualitative exploration provides a perspective on lived experiences with MOUD treatment at private clinics amidst the initial months of the invasion, illuminating how the early days’ stress, access challenges, varied responses from private MOUD clinics, and precarious conditions informed or altered preferences regarding MOUD treatment options. Moreover, these findings corroborate previously documented efforts by myriad stakeholders to mitigate war-related disruptions to MOUD delivery. These insights contribute to the international understanding of health system navigation and resilience during major crises, offering valuable lessons for preparedness development.

Vaccination uptake is essential to controlling the ongoing COVID-19 pandemic. Healthcare workers (HCWs) play a critical role in receiving, recommending and delivering COVID-19 vaccination. Understanding the specific influences on each behaviour enables the development of targeted and tailored interventions to improve vaccination uptake. This paper presents a qualitative synthesis of HCWs’ individual and context barriers and drivers to these three vaccination behaviours across 10 countries in Europe and Central Asia. Qualitative data from interviews and focus group discussions with 378 HCWs between December 2020 and March 2022 were synthesised and organised by four COM (capability, physical and social opportunity, motivation) factors. Differences by stage of COVID-19 vaccine roll-out (in preparation, early and late delivery) were explored. Receiving vaccination related to all four factors. Recommending vaccination mostly related to capability and motivation. HCWs were generally well-informed by official sources and viewed vaccination as the way to end the pandemic, acknowledging their important role in this. Colleagues, family and friends were positive influences on personal vaccination decisions. However, knowledge gaps were evident, particularly amongst nurses who relied on (social) media. Concerns about safety and effectiveness, often connected to knowledge gaps, were heightened by the accelerated timeline for COVID-19 vaccine development and approval. This impeded some HCWs’ motivation to receive and recommend vaccination even in the later roll-out countries. Delivering vaccination was facilitated by support from public health organisations, teamwork and service re-organisation, more evident amongst later roll-out countries. Ongoing high workloads, stress and burnout hindered delivery. Complex and inter-related factors affecting HCWs’ vaccination behaviours were identified. These insights should inform the design of multifaceted interventions (e.g., communication skills training, management support for HCWs’ mental health, and engaging them in decision-making for service redesign); not only for COVID-19 vaccination as it is integrated into routine services but for routine immunization as a whole.

The Covid pandemic has yielded new insights into psychological vaccine acceptance factors. This knowledge serves as a basis for behavioral and communication interventions that can increase vaccination readiness for other diseases. The Covid pandemic has yielded new insights into psychological vaccine acceptance factors. This knowledge serves as a basis for behavioral and communication interventions that can increase vaccination readiness for other diseases.

This article analyzes interviews with women who use drugs in Ukraine to understand the care conundrum they face as members of a stigmatized group. In the interviews, the women sought to position themselves as deserving and needing care as members of a vulnerable category—sometimes as women who use drugs or people living with HIV, but also as mothers—yet also themselves capable of providing care for others. We examine how women who use drugs in Ukraine navigate a moral economy of care involving judgments about deservedness and social worth, the obligatory nature of care, and expectations for reciprocity. For programs for women who use drugs to be successful, they must acknowledge and engage with the moral economies of care in which these women operate. We offer recommendations for how health and social service providers can better meet the unique needs of women who use drugs.