Titilayo Tatiana Agbadje

In Côte d’Ivoire, parent–child communication (PCC) about sexual and reproductive health (SRH) is often hindered by cultural and social norms. We aimed to explore parental communication on sexual and reproductive health in the Haut-Sassandra region, Côte d’Ivoire. We used an interpretive description approach. Participants were parents (mothers and fathers), recruited through purposive sampling. Data were collected through individual interviews. We performed a thematic analysis. Overall, 63 parents participated in the study. The mean age of parents was 41.2. Sexuality remains a taboo subject. Sociocultural factors that hinder PCC are tradition, the need for intergenerational respect, and the fear of incitement. Reasons that explain the gap between intention and actual practice are the young age of the child, low parental self-efficacy, child gender, shame and intergenerational respect. Parents who communicate address the following topics: relationships (e.g., stay away from boys); values, rights, culture and sexuality (e.g., don’t date someone else’s husband); skills for health and well-being (e.g., sex has advantages and disadvantages); the human body and development (e.g., menstruation management); sexuality and sexual behaviour (e.g., practice abstinence); and sexual and reproductive health (e.g., protect oneself against disease). This study highlights the need to support parents in their educational role.

In Côte d’Ivoire, parent-child communication (PCC) about sexual and reproductive health (SRH) is often hindered by cultural and social norms. We aimed to explore pa-rental communication on sexual and reproductive health in the Haut-Sassandra re-gion, Côte d’Ivoire. We used an interpretive description approach. Participants were parents (mothers and fathers), recruited through purposive sampling. Data were col-lected through individual interviews. We performed a thematic analysis. Overall, 63 parents participated in the study. The mean age of parents was 41.2. Sexuality remains a taboo subject. Sociocultural factors that hinder PCC are tradition, the need for inter-generational respect, and the fear of incitement. Reasons that explain the gap between intention and actual practice are the young age of the child, low parental self-efficacy, child gender, shame and intergenerational respect. Parents who communicate address the following topics: relationships (e.g. stay away from boys); values, rights, culture and sexuality (e.g. don’t date someone else's husband); skills for health and well-being (e.g. sex has advantages and disadvantages); the human body and development (e.g. menstruation management); sexuality and sexual behaviour (e.g. practice abstinence); and sexual and reproductive health (e.g. protect oneself against disease). This study highlights the need to support parents in their educational role.

In recent years, the sexual and reproductive health of adolescents and young adults (ages 10–24) in Africa has improved through national and international initiatives. However, major challenges remain in enabling young people to exercise their sexual and reproductive health rights (SRHRs), especially in Côte d’Ivoire. This study aimed to explore the perspectives of stakeholders on the freedom of choice of adolescents and young adults with regard to SRHRs in Haut-Sassandra, Côte d’Ivoire. We conducted this qualitative descriptive study between September and October 2023. Participants were selected using a purposive sampling method. Overall, 137 stakeholders participated in the study: 57 teachers and administrators, 17 community leaders, and 63 parents. Data were collected through interviews and focus groups, using an interview guide. Through a deductive thematic approach, we identified three forms of freedom of choice: conditional, absent, and absolute. The average age of the study participants was 46.1 years. The findings reveal that several factors influence the freedom of choice among adolescents and young adults regarding their SRHRs. These include age, gender, parental involvement, prior education, autonomy, and perceived maturity. Limited freedom was commonly associated with younger age (10–18 years), perceived immaturity, and a lack of autonomy. In contrast, greater freedom was linked to older age (18–24 years) and higher levels of perceived maturity. Stakeholders’ perspectives were shaped by cultural and religious norms, a protective attitude toward youth, and a sense of disengagement from adolescent concerns. This study underscores the importance of interventions aimed at increasing stakeholders’ knowledge and awareness of adolescents’ sexual and reproductive rights.

Background: Nowadays, mobile health technology has been increasingly used for treatment and prevention at all levels of health care. Associating this technology with the promotion of healthy salt consumption—both cost-effective and cost-saving public health strategies—can reduce this risk factor that contributes significantly to the increase of noncommunicable diseases worldwide. Objective: We aim to assess the usability and the efficacy of a mobile app intervention—“Sal na Medida” app—on the promotion of a healthy salt intake among adults, based on the Behavior Change Wheel framework. Additionally, to investigate if intention, self-efficacy, and habit variables mediated the effect of intervention on salt intake behavior. Methods: An experimental, randomized, and longitudinal study that evaluated the intervention effect with assessments at baseline, postintervention (1 mo), and at follow-up (2 mo). Sociodemographic and clinical data were collected from participants recruited at primary health care centers. The behavior of salt intake and per capita salt consumption were the primary outcomes. Psychosocial variables of intention, self-efficacy, and habit were assessed as possible mediators. Usability was evaluated after 1 month and 2 months of using the app. Results: Eighty-six participants were randomized in the intervention group (IG; n=43) or control group (CG; n=43). Most of the participants were female (IG: n=36, 84% and CG: n=37, 86%). Usability of app intervention scored 77.8 points (on a scale of 0 to 100) among IG participants. There was a significant reduction in salt intake in IG according to the variables of per capita salt and the behavior of salt intake. Furthermore, at the end of the follow-up, individuals in IG were 63% more likely to have a lower salt intake than those in the CG. The regression analysis showed an increase in intention and the perception of self-efficacy, and a more pronounced reduction in the habit of using more than 3 g of salt/day in preparing meals in IG when compared to CG. Habit and self-efficacy were identified as mediators of the intervention’s effect. Conclusions: The theory-based mobile app intervention for reducing salt intake has shown promise both in terms of usability and efficacy among adults. Conducting further studies to assess its potential for implementation on a larger scale would be valuable for determining its real-world impact and feasibility.

Community health workers (CHWs) are key players in providing primary healthcare in low- and middle-income countries. However, their absence from the formal health system in many of these countries often presents a challenge to their remuneration. The objective of this scoping review is to document programs implemented at both small and large scales in low- and middle-income countries, the remuneration strategies they have established, and the effects of these strategies on the work of CHWs. In total, we included 50 articles in this review. We have identified four types of compensation: fixed compensation, performance-based compensation, compensation based on income-generating activities (IGAs), and combined compensation. We identified the strengths and weaknesses of each type of compensation. A common strength for most models was improvement in motivation and performance. A common weakness for most models was irregular payments. The results of this review highlight the need to consider the economic, social, and cultural settings of the countries or environments at hand, and to include CHWs in discussions regarding the selection of a compensation model.

Background: Mobile health tools can support shared decision-making. We developed a computer-based decision aid (DA) to help pregnant women and their partners make informed, value-congruent decisions regarding prenatal screening for trisomy. Objective: This study aims to assess the usability and usefulness of computer-based DA among pregnant women, clinicians, and policy makers. Methods: For this mixed methods sequential explanatory study, we planned to recruit a convenience sample of 45 pregnant women, 45 clinicians from 3 clinical sites, and 15 policy makers. Eligible women were aged >18 years and >16 weeks pregnant or had recently given birth. Eligible clinicians and policy makers were involved in prenatal care. We asked the participants to navigate a computer-based DA. We asked the women about the usefulness of the DA and their self-confidence in decision-making. We asked all participants about usability, quality, acceptability, satisfaction with the content of the DA, and collected sociodemographic data. We explored participants’ reactions to the computer-based DA and solicited suggestions. Our interview guide was based on the Mobile App Rating Scale. We performed descriptive analyses of the quantitative data and thematic deductive and inductive analyses of the qualitative data for each participant category. Results: A total of 45 pregnant women, 14 clinicians, and 8 policy makers participated. Most pregnant women were aged between 25 and 34 years (34/45, 75%) and White (42/45, 94%). Most clinicians were aged between 35 and 44 years (5/14, 36%) and women (11/14, 79%), and all were White (14/14, 100%); the largest proportion of policy makers was aged between 45 and 54 years (4/8, 50%), women (5/8, 62%), and White (8/8, 100%). The mean usefulness score for preparing for decision-making for women was 80/100 (SD 13), and the mean self-efficacy score was 88/100 (SD 11). The mean usability score was 84/100 (SD 14) for pregnant women, 77/100 (SD 14) for clinicians, and 79/100 (SD 23) for policy makers. The mean global score for quality was 80/100 (SD 9) for pregnant women, 72/100 (SD 12) for clinicians, and 80/100 (SD 9) for policy makers. Regarding acceptability, participants found the amount of information just right (52/66, 79%), balanced (58/66, 88%), useful (38/66, 58%), and sufficient (50/66, 76%). The mean satisfaction score with the content was 84/100 (SD 13) for pregnant women, 73/100 (SD 16) for clinicians, and 73/100 (SD 20) for policy makers. Participants thought the DA could be more engaging (eg, more customizable) and suggested strategies for implementation, such as incorporating it into clinical guidelines. Conclusions: Pregnant women, clinicians, and policy makers found the DA usable and useful. The next steps are to incorporate user suggestions for improving engagement and implementing the computer-based DA in clinical practice.

Background: There is sound evidence associating high salt intake and a greater risk of cardiovascular and noncardiovascular diseases. High salt intake has been observed in several populations worldwide. Therefore, promoting healthier salt consumption has been encouraged as a low-cost strategy to reduce this risk factor. However, these strategies need to be sound, built on theoretical and methodological bases, and consider the target population’s context. Objective: This protocol aims to describe a mobile phone app intervention to promote healthy salt intake among adults. Methods: This is an experimental and longitudinal study protocol conducted in three modules. Module 1 refers to the planning of the intervention based on the Behaviour Change Wheel framework. Module 2 is the development of the mobile phone app intervention based on the date of module 1. In module 3, the intervention will be evaluated using a randomized controlled study, with three steps of data collection in a 2-month follow-up in a sample of 86 adults (43 participants for each group: the control group and intervention group) recruited from the primary health care centers of a Brazilian town. The discretionary salt intake questionnaire will assess salt consumption, the app usability will be assessed using the System Usability Scale, and psychosocial variables (habit, intention, and self-efficacy) will also be measured. Results: Recruitment began in October 2021, and the follow-up will end in August 2022. The results of this study are expected to be published in 2023. Conclusions: Results from this study will help people to control salt intake when cooking at home, will stimulate self-care, will work as an alternative or supportive method in the relationship between health care professionals and patients, and will contribute to implementing the app intervention to promote healthy salt intake on a large scale. Trial Registration: The Brazilian Clinical Trials Registry RBR-4s8qyyq; https://ensaiosclinicos.gov.br/rg/RBR-4s8qyyq International Registered Report Identifier (IRRID): DERR1-10.2196/37853

BACKGROUND Mobile health tools can support shared decision making. We developed a computer-based decision aid (DA) to help pregnant women and their partners make informed value-congruent decisions about prenatal screening for trisomy. OBJECTIVE We assessed the usability and usefulness of the computer-based DA among pregnant women and their partners, clinicians and policy makers. METHODS For this mixed-methods sequential explanatory study, we planned to recruit a convenient sample of 45 pregnant women with or without their partners and 45 clinicians in three clinical sites, and 15 policy makers identified in organigrams of organizations or institutions of interest. Eligible women were over 18 and more than 16 weeks pregnant or had given birth recently. Eligible clinicians and policy makers were involved in prenatal care. We asked participants to navigate the computer-based DA. Using validated tools, we collected data from pregnant women on its usefulness and their self-confidence about decision-making. From all participants, we collected data on usability, quality, acceptability, their satisfaction with its content and sociodemographic data. We also interviewed participants to explore their reactions to the computer-based DA and solicit suggestions. Our interview guide was based on the user version of the Mobile App Rating Scale. We performed descriptive analyses of quantitative data and thematic deductive and inductive analysis of qualitative data for each participant category. RESULTS Forty-five pregnant women (76% 25-34 years old, 93% Caucasian) with or without their partners (n=5) (51% 25-34 years old, 89% Caucasian), 14 clinicians (36% 35-44 years old, 79% female, all Caucasian) and eight policy makers (36% 45-54 years old, 62% female, all Caucasian) participated. Mean usefulness score for preparing for decision-making for women and their partners was 80/100 (SD 13), and mean self-efficacy score was 88 (SD 11). Mean usability score was 84 (SD 14) for pregnant women and their partners, 77 (SD 14) for clinicians and 79 (SD 23) for policy makers. Mean global score for quality was 80 (SD 9) for pregnant women and their partners, 72 (SD 12) for clinicians, and 80 (SD 9) for policy makers. Regarding acceptability, participants found the amount of information just right (79%), that it was balanced (88%), useful (50%) and sufficient (76%). Mean satisfaction score with content was 84 (SD 13) for pregnant women and their partners, 73 (SD 16) for clinicians, and 73 (SD 20) for policy makers. Participants thought the decision aid could be more engaging (e.g. more customizable), and suggested strategies for implementation such as incorporating it into clinical guidelines. CONCLUSIONS Pregnant women and their partners, clinicians and policy makers found the DA was usable and useful. Next steps are to incorporate users’ suggestions for improving engagement and implement the computer-based DA in clinical practice.

BACKGROUND There is sound evidence associating high salt intake and a greater risk of cardiovascular and noncardiovascular diseases. High salt intake has been observed in several populations worldwide. Therefore, promoting healthier salt consumption has been encouraged as a low-cost strategy to reduce this risk factor. However, these strategies need to be sound, built on theoretical and methodological bases, and consider the target population’s context. OBJECTIVE This protocol aims to describe a mobile phone app intervention to promote healthy salt intake among adults. METHODS This is an experimental and longitudinal study protocol conducted in three modules. Module 1 refers to the planning of the intervention based on the Behaviour Change Wheel framework. Module 2 is the development of the mobile phone app intervention based on the date of module 1. In module 3, the intervention will be evaluated using a randomized controlled study, with three steps of data collection in a 2-month follow-up in a sample of 86 adults (43 participants for each group: the control group and intervention group) recruited from the primary health care centers of a Brazilian town. The discretionary salt intake questionnaire will assess salt consumption, the app usability will be assessed using the System Usability Scale, and psychosocial variables (habit, intention, and self-efficacy) will also be measured. RESULTS Recruitment began in October 2021, and the follow-up will end in August 2022. The results of this study are expected to be published in 2023. CONCLUSIONS Results from this study will help people to control salt intake when cooking at home, will stimulate self-care, will work as an alternative or supportive method in the relationship between health care professionals and patients, and will contribute to implementing the app intervention to promote healthy salt intake on a large scale. CLINICALTRIAL The Brazilian Clinical Trials Registry RBR-4s8qyyq; https://ensaiosclinicos.gov.br/rg/RBR-4s8qyyq INTERNATIONAL REGISTERED REPORT DERR1-10.2196/37853

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Nurses provide maternity care and thus play an important role in supporting pregnant women making decisions about prenatal screening for Down syndrome. We developed a web-based shared decision making (SDM) training program for health professionals focusing on Down syndrome screening decisions. Objective: We assessed the impact of a SDM training program on nurses’ intention to use a decision aid with pregnant women deciding about prenatal screening for Down syndrome. Methods: In this 2-arm parallel controlled trial, French-speaking nurses working with pregnant women in the province of Quebec were recruited online by a private survey firm. They were allocated by convenience either to the intervention group (web-based SDM course that included prenatal screening) or to the control group (web-based course focusing on prenatal screening alone, with no SDM content). The primary outcome was intention to use a decision aid. Secondary outcomes were psychosocial variables of intention (e.g. social influence), as well as knowledge, satisfaction, acceptability, perceived usefulness and reaction to the pedagogical approach. All outcomes were self-assessed through online questionnaires including space for written comments. No blinding was performed. We used Student's t test and Fisher's exact test to compare continuous and categorical variables between groups. Results: Of 57 participants assessed for eligibility, 40 were allocated to the intervention (n=20) or control group (n=20) and 36 (n=18 in each) completed the courses. Mean age of participants was 41 years (SD 9). Most were women (97.5%), Caucasian (95%), clinical nurses (70%), and had completed a baccalaureate degree (65%). Post-intervention, the mean score of intention was 6.3 (95% CI: 5.9; 6.7) for the intervention group and 6.0 (5.42; 6.64) for the control group (scale 1 to 7). The difference in intention and other psychosocial variable scores between groups was not statistically significant. Knowledge scores about SDM were significantly higher in the intervention group (79% [70; 89] versus 64% [57; 71], p=0.009). The intervention was significantly more acceptable in the intervention group (4.6 [4.4; 4.8] versus 4.3 [4.1; 4.5]; p=0.02) and reaction to the pedagogical approach was also significantly more positive in the intervention group (4.7 [4.5; 48]) versus 4.4 [4.2; 4.5], p=0.02). There was no significant difference in overall satisfaction (4.5 [4.01; 4.9] versus 4.2 [4.05; 4.4], or in perceived usefulness (4.6 [4.4; 4.8] versus 4.4 [4.2; 4.6]). Seventeen participants (9 in the intervention group and 8 in the control group) provided feedback on the intervention. Conclusions: This study focuses on web-based nursing education and its potential for supporting pregnant women's decision-making needs. It showed that nurses’ intention to use a decision aid to enhance shared decision making in prenatal care is high, with training or without, but that their knowledge about shared decision making can be improved with web-based training. Clinical Trial: ClinicalTrials.gov NCT04162288; https://clinicaltrials.gov/ct2/show/NCT04162288?term=NCT04162288&draw=2&rank=1