Gladys Dzansi

Family communication dysfunction significantly impacts HIV medication adherence and mental health outcomes among adolescents in sub‐Saharan Africa, yet evidence‐based family interventions remain scarce in resource‐limited settings. This qualitative descriptive study examined family communication transformation following culturally adapted Multiple Family Group Therapy (MFGT) for adolescents living with HIV and their families in rural Ghana. Focus group discussions were conducted with 20 caregivers and 19 adolescents who completed the 11‐session intervention. All core therapeutic content was delivered across sessions 1 through 10; the 11th session comprised a graduation ceremony and sustainability planning. Reflexive thematic analysis revealed four major themes: preintervention dysfunction (public shaming, adolescent defiance, spousal teknonymy, extended family triangulation); MFGT‐facilitated skills (tone modulation, privacy‐preserving correction, active listening); postintervention transformation (caregiver behavioral consolidation, adolescent reciprocal adaptation, spousal reconnection); and sustaining mechanisms (observational learning, metacognitive awareness, positive reinforcement, peer accountability). Communication improvements occurred bidirectionally, with caregiver changes catalyzing adolescent adaptations. Findings are theoretically interpreted through family systems theory, communication accommodation theory, social cognitive theory, and self‐determination theory. Culturally adapted MFGT successfully transformed communication patterns while preserving traditional authority structures, suggesting potential for integration within HIV care systems in resource‐limited settings.

Background: Multiple family group therapy (MFGT) using the 4Rs and 2Ss (rules, responsibility, relationships, respectful communication, stress management and social support) framework has demonstrated effectiveness in addressing mental health and behavioural problems in high-income countries. However, the MFGT requires cultural adaptation for sub-Saharan African contexts where family structures, traditional healing practices and community support systems differ substantially from Western therapeutic models. Objective: To systematically document the cultural adaptation process of the 4Rs and 2Ss MFGT intervention for adolescents living with HIV (ALHIV) and caregivers in Ghana. Methods: This qualitative participatory cultural adaptation study employed a four-phase stakeholder engagement process guided by the Theory of Triadic Influence, Social Action Theory and the Stirman adaptation framework. This research reports the adaptation phase of a larger three-phase randomised controlled trial ( NCT06701942 ). Thirty-four stakeholders, including ALHIV, parents, extended family members and healthcare providers, participated across the four phases. Community-based participatory research principles ensured authentic cultural integration while preserving intervention fidelity. Systematic documentation categorised all modifications as content, contextual or implementation changes using Stirman’s established adaptation framework. Results: The adapted ‘Abusuafoɔ Apomuden’ not only preserved all core therapeutic components of the MFGT but also allowed for integration of traditional proverbs, extended family networks, spiritual practices and community support systems. Key modifications included expanded group size (10–20 families), trilingual facilitation, task-shifting to health professionals and peer mothers, and interactive activities incorporating drumming, storytelling and traditional games while maintaining therapeutic focus on depression, anxiety and antiretroviral therapy adherence. Conclusion: All six core intervention goals were preserved while enhancing cultural relevance. The adaptation introduces proverb-based therapeutic dialogue and Susu-based community support structures as novel cultural integration strategies for MFGT. This documented adaptation process provides a replicable model for implementing family-based interventions in West African contexts; clinical effectiveness will be tested in the forthcoming randomised controlled trial. Trial registration number: ClinicalTrials.gov ( NCT06701942 ).

Background: Inequalities in breast cancer care remain a major challenge in low- and middle-income countries. In Ghana, women continue to experience barriers that limit timely diagnosis, treatment, and continuity of care. This study explored the structural, health system, and policy factors influencing breast cancer care inequalities in Ghana. Methods: A focused ethnographic study was conducted across five healthcare facilities in Ghana between February 2023 and February 2024. Data were collected from 95 participants through in-depth interviews, observations, field notes, and document reviews and analysed thematically using Spradley’s ethnographic analytical framework. Results: Breast cancer care inequalities were driven by interconnected financial, health system, and governance barriers. Participants reported high out-of-pocket costs, inadequate financial protection, diagnostic and workforce shortages, centralised oncology services, fragmented referral pathways, and limited care coordination. Weak policy implementation, procurement challenges, and inconsistent availability of essential cancer medicines further constrained equitable access to care. Conclusions: Breast cancer care inequalities in Ghana are rooted in systemic weaknesses in financing, service delivery, and governance. Strengthening financial protection, decentralising oncology services, improving diagnostic capacity, enhancing care coordination, and ensuring reliable access to essential medicines are critical to achieving equitable breast cancer care.

Introduction: Viral hepatitis B (HBV) and C (HCV) infections remain major public health threats in Ghana, with prevalence rates significantly higher in prison populations than in the general population. Despite this, incarcerated individuals are frequently excluded from national testing and treatment programmes. Overcrowding, poor sanitation and limited access to healthcare create a high transmission risk. There is an urgent need for targeted, evidence-based interventions to address this health inequity and support Ghana’s progress towards viral hepatitis elimination. This protocol describes a study designed to evaluate the effectiveness of a multicomponent targeted educational intervention in increasing knowledge, intention to test, testing uptake and treatment initiation for HBV and HCV among adult prison inmates in the Greater Accra and Eastern Regions of Ghana. Methods and analysis: A cluster randomised controlled trial (RCT) with a 1:1 parallel design will be conducted in eight prisons stratified by gender (six male, two female) with 208 inmates per arm. The intervention group will receive the Prison Education for Prevention of Hepatitis Intervention, comprising an education programme (posters, infographics, film screenings, peer-led discussions and structured health education) alongside HBV and HCV testing, treatment and care linkage. The control group will receive standard health education and basic printed materials. Testing intentions, uptake, prevalence and treatment outcomes will be measured. Cost-effectiveness analysis will inform sustainability and scale-up. The primary endpoint is uptake of hepatitis B and C testing. Secondary outcomes include changes in hepatitis knowledge and testing intentions, prevalence of hepatitis B and C, treatment uptake among diagnosed inmates, linkage to hepatitis care services and cost-effectiveness of the intervention. Data will be analysed, accounting for prison clustering, using mixed-effects models and regression methods. Outcomes include testing uptake, knowledge, intentions, prevalence, treatment initiation and sustained virologic response, adjusted for key covariates. Baseline characteristics and intervention reach will be summarised descriptively. Analyses will follow intention-to-treat and Consolidated Standards of Reporting Trials guidelines. Cost-effectiveness will estimate Incremental Cost Effectiveness Ratio (ICERs) per inmate tested, infection detected and treatment initiated. Ethics and dissemination: The RCT was approved by the College of Health Sciences ethics and protocol review committee (no. CHS-E/M.1-P 4.7/2025–2026). Results will be presented at relevant national and international meetings and conferences and will be published in international peer-reviewed journals. Furthermore, we plan to communicate the results to relevant stakeholders in the Ghanaian Prisons and Healthcare systems. Trial registration number: PACTR202512558588684.

Introduction People living with HIV/AIDS (PLWHA) have complex physical, psychological, social and spiritual needs following diagnosis and poorer health-related quality of life than the general population. Holistic assessment and care delivery incorporating person-centred principles is required to address these needs. This protocol describes a cluster randomised controlled trial (cRCT) and process evaluation to evaluate the effectiveness of the extra community-based enhanced care intervention (ExtraCECI) to improve the quality of life and person-centred outcomes for PLWHA in Ghana. Methods and analysis This cRCT will randomly assign 26 recruited HIV clinics using 1:1 allocation to either ExtraCECI intervention or standard HIV care, with each clinic recruiting an average of 25 participants, that is, 650 in total. Eligible participants are adult PLWHA aged at least 18 years and in HIV care for at least 6 months, with cognitive ability to consent as guided by the Mental Capacity Act, clinically well to participate, attending an outpatient clinic. Healthcare professionals (HCP) at clinics randomised to the ExtraCECI intervention arm will receive training on person-centred care and holistic assessment of PLWHA in the domains of physical, psychological, social and spiritual well-being. PLWHA will be empowered to contribute to their care decisions including HCP using telehealth for ExtraCECI delivery with ongoing mentorship, while participants in the Standard HIV Care arm continue with usual care. The primary outcome is quality of life measured at the individual level using Medical Outcomes Study-HIV (MOS-HIV). The primary analysis will compare MOS-HIV total scores between groups using repeated measure linear mixed model and adjusting for important baseline characteristics (including stratification factors) and random effect of clinic. The incremental cost-effectiveness ratio will be used to estimate the cost-effectiveness of the ExtraCECI intervention, and a process evaluation will be conducted. Ethics and dissemination This protocol was approved by Edinburgh Napier University School of Health and Social Care Research Integrity Committee (REF: SHSC3681836) and the Ghana Health Service Ethics Review Committee (GHS-ERC:010/07/24). Results from this study whether positive or negative will be presented to participating sites, communities, at scientific conferences and published in peer-reviewed journals. Trial registration number ISRCTN77405303.

Aim: We determined treatment adherence and quality of life of adults living with hypertension in rural Ghana.Design: A quantitative cross‐sectional survey was conducted.Method: We randomly sampled 351 persons diagnosed with hypertension at the Baptist Medical Centre in Nalerigu, Ghana. A shortened version of the World Health Organization's Quality of Life (WHOQOL‐BREF) questionnaire was used, and information on treatment adherence was collected using a modified Morisky Medication Adherence Scale. Data analyses were conducted with the aid of SPSS 23.0 at a 95% confidence level.Results: The study revealed a high rate of treatment adherence, 226 (64%) with low quality of life among the participants. Adherence to treatment was more associated with the males compared to females. The social health dimension of the quality of life was significantly associated with treatment adherence. The role of social networks in enhancing adherence was a major finding in this study and could be harnessed by nurses and midwives to improve the lives of persons diagnosed with hypertension. It is recommended that measures that promote remembrance and reduce forgetfulness regarding hypertension medications, such as mobile health and digital technologies, be implemented by health workers to enhance treatment adherence. Further, measures aimed at improving resource allocation for women in rural communities, such as women‐economic empowerment programmes, are encouraged to enhance health‐seeking and treatment adherence.Patient or Public Contribution: None.

Introduction Migration of the health workforce from low- and middle-income countries (LMCIs) is increasingly becoming a phenomenon of interest within migration governance systems. The COVID-19 pandemic aggravated health workforce shortages that have created job opportunities in high-income countries such as the USA, UK, Canada and Germany among others. Conditions of service in LMCIs are unattractive, leading to the search for better opportunities. The digital environment is becoming one of the facilitators of migration intentions due to the activities of recruitment agencies and the search for job opportunities on the World Wide Web. The digital environment creates opportunities for migration but also poses a security threat, economic loss and a brain drain to departure countries. However, there is a paucity of evidence on how the proliferation of advertisements on health workforce recruitment within social media, unsolicited emails and activities of recruitment agencies in the digital environment influence the migration of the health workforce and the implications of migration governance. Method and analysis This scoping review protocol describes a comprehensive systematic extraction and examination of existing literature to map key concepts and identify previous literature, noting the gaps in how social media and the digital environment are influencing the migration of the health workforce. We lean on Arksey and O'Malley’s scoping framework in developing this protocol. This involves the following: identifying research questions, searching for the literature, selecting articles or studies, charting the data and organising and reporting the outcome of the review. The review question is informed by the population, concept and context framework, which details the population as the health workforce (doctors, nurses, midwives and pharmacists), the key concepts as migration, social media and digital environment, and the context as LMICs. The search strategy was developed with the assistance of an experienced librarian who will work with the team to conduct a Peer Review of Electronic Search Strategies to evaluate titles, abstracts and full-text articles for inclusion from databases such as Scopus, PubMed, MEDLINE and Google Scholar. Additionally, we will search grey literature sources including online news media, social media platforms (Facebook, Instagram and Twitter), web pages of WHO, UN and migration-related agencies, and interfaces like EBSCO host. Two members of the team will screen titles and abstracts, and all team members will screen full text for data extraction. Data from grey sources will be converted to transcripts, coded and grouped into themes and subthemes consistent with thematic analysis strategies. All authors will be involved in the synthesis of the data. We intend to follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines in reporting the outcome of peer-review sources. Ethics and dissemination This is a scoping review protocol that addresses a subject of interest that poses no risk to individuals or groups. All the information will be retrieved from open sources only. The protocol was registered with the Open Science Framework registry (osf.oi/zan3q) to serve as an audit trail. Reports from the review will be published in peer-reviewed journals and presented at conferences.

Sub-Saharan African countries, including Ghana, are disproportionately affected by hepatitis B. In Ghana, the burden of hepatitis B is unevenly distributed, with the Brong Ahafo region having the highest prevalence (13.7%). Given that people with hepatitis B (PWHB) in Ghana have previously been found to have a lack of understanding of the impact of the infection, we sought to explore their health-seeking behaviour using the health belief model as an organising framework. A qualitative exploratory design was used. In total, 18 people were purposively selected for face-to-face interviews. The data was processed and analysed using QSR NVivo version 11.0 and the Braun and Clarke thematic analysis procedure. The belief that hepatitis B can cause liver cancer and death was the most important determinant of health seeking. Furthermore, access to accurate hepatitis B information, particularly information about availability of effective hepatitis B treatment, influenced a number of participants to seek formal care. However, the high cost of clinical monitoring and treatment to use herbal medicine, despite their concerns about the effectiveness of herbal medicines in managing hepatitis B. Given that hepatitis B information was a factor in health seeking, it is recommended that a hepatitis B awareness campaign focusing on the availability of hepatitis B treatment and where it can be obtained be carried out in the study area. Counselling PWHB at the point of diagnosis should highlight the relevance of life-long clinical monitoring. To remove financial barriers to hepatitis B care in Ghana, the government should include the cost of hepatitis B laboratory investigations and treatment in the health insurance scheme.

Globally, the right to work is a modest human right. It is a right acknowledged under the Universal Declaration of Human Rights which delineates the various types of work. As such, each person is at liberty to take up any job granted that one has the capacity and skills. This decision must be free from stigma or discrimination. However, this is not the case with mortuary attendants in Ghana. This study explored the viewpoints of Ghanaian mortuary attendants and how society perceives their rights to work. The study used a qualitative research approach, with exploratory and descriptive designs, that sought an in-depth understanding from sampled mortuary attendants on the perception of their community members toward their work. Saturation was attained with nineteen (19) participants from nine (9) health facilities located in the three regions. Semi-structured interviews were conducted and audio recorded with concurrent data transcription and analysis using content analysis. Purposive sampling was used. The study included male or female mortuary employees with at least 1 year of working experience. The themes that emerged were as follows; self-stigma, public stigma, stigma-by-association, and structural stigma. The results were structured according to a stigma model. The study reveals high levels of stigmatization and discrimination against mortuary attendants. Researchers recommend the need for public education, and policy changes to reverse the scornful stigmatization and discrimination against death care workers and those in related profiles.

Background: The growing burden of life-threatening illnesses and advancements in care interventions call for the intentional integration of palliative care services into existing care systems. The absence of active, functioning palliative care services in most hospitals in Ghana is a major concern. This study explored the factors influencing the integration of palliative care services in one of such institutions. Objectives: The aim of the study was to explore the institutional drivers of palliative care integration in a military health facility. Design: Exploratory qualitative study. Methods: We employed a qualitative exploratory study design situated within a constructivist paradigm. A purposive sampling method was used to select and interview 11 healthcare professionals. A semistructured interview was used to conduct face-to-face, in-depth interviews with participants between April and May 2022. A thematic data analysis was done based on the Braun and Clarke analysis process with the aid of QSR NVivo-12. Results: The six themes that describe the institutional driving factors for integrating palliative care services were cognitive restructuring, supportive logistics and infrastructure, staffing, healthcare professional skills, institutional policies and priorities, and utilization of focal persons. It was observed that a paradigm shift in the mindset of healthcare professionals and administrators was a major driver that would determine the integration of palliative care services. A cognitive restructuring will facilitate a more aggressive integration of palliative care services because logistics, staffing, and medication access will be prioritized. Conclusion: Institutions have the responsibility of aligning with the WHO policy on palliative care service access and must invest in training, staffing, prioritizing palliative care needs and policies, procurement of essential drugs, and the provision of logistics and supportive infrastructure to scale up the implementation of palliative care services.