Eric Sven Kroeber

Introduction: Human papillomavirus vaccine acceptance is influenced by the parental perceptions of the vaccine, but there are few related studies in Ethiopia, and most have focused on quantitative approaches. Therefore, this qualitative study intended to explore parental perceptions about the human papillomavirus vaccine acceptance. Objective: To explore the perceived facilitators and barriers against human papillomavirus among rural parents with eligible daughters in the Alle district, southern Ethiopia. Methods: A qualitative study using focus group discussion and in-depth interviews was conducted from April 25, 2023, to May 25, 2023, among eligible parents of daughters in the Alle district, southern Ethiopia. A convenience sample of 53 parents was recruited for focus group discussions, and 15 parents were purposely sampled for in-depth interviews. The data were collected by a semi-structured focus group discussion guide and in-depth interview questionnaires. The interview data were translated into English after transcription, and thematic analysis was done by Atlas software version 7.1.16. Results: Among the total participants, 66.2% were female parents and 60.2% were protestant religious followers. Findings were split between two major themes: perceived facilitators and barriers to human papillomavirus vaccine acceptance. The perceived facilitators identified were preventing cervical cancer, seeing it as an expression of parental role and responsibility, and believing in the recommendation of health professionals as facilitators of human papillomavirus vaccination. The identified perceived barriers to human papillomavirus vaccination included: a lack of awareness, a lack of reliable information sources, a lack of trust in the vaccine, misconceptions, fear of side effects, and cultural and religious factors affecting the acceptance of human papillomavirus vaccination. Conclusion: Parents identified various facilitators and barriers to accepting the human papillomavirus vaccine. Therefore, we recommend that the government and concerned institutions work in collaboration to address the identified challenges to improve the acceptance of human papillomavirus vaccination.

Background: Chemotherapy is an essential component of comprehensive cancer care and timely access can improve survival outcomes. The objective of this study was to assess the time to chemotherapy initiation and patient-reported barriers to cancer care among patients from Addis Ababa, Ethiopia. Methods: We conducted a retrospective study using a randomly selected sample of 350 patients with common cancers (breast [ICD-10: C50], cervical [C53], colorectal [C18-20], oesophageal [C15], gastric [C16] and ovarian [C56]) registered at the population-based Addis Ababa City Cancer Registry (AACCR) in 2021. Patients or their relatives were followed-up via questionnaire-based telephone interview and treatment data were extracted from their medical records. The time from pathological diagnosis to initiation of chemotherapy (time to treatment) was calculated. Regression analyses were conducted to identify predictors of chemotherapy initiation and treatment delays. Results: Most patients (71.7%) received chemotherapy and the median time to treatment was 63 days (IQR 36.5 to 128 days). Patients reported considerable barriers to treatment regarding fear, cost and waiting times. Having health insurance (OR 2.70; 95% CI 1.33 to 5.50) and trust in healthcare professionals (OR 1.76; 95% CI 1.16 to 2.68) were associated with higher odds of receiving chemotherapy. Patients with cervical (OR 0.07; 95% CI 0.03 to 0.18), gastric (OR 0.21; 95% CI 0.05 to 0.86) or oesophageal cancer (OR 0.10; 95% CI 0.02 to 0.53) were less likely to initiate chemotherapy compared to breast cancer patients. Longer time to treatment was not associated with any of the assessed characteristics or perceived barriers. Conclusion: Over half of the cancer patients from Addis Ababa wait more than two months to initiate chemotherapy after a pathological diagnosis. Expanding oncology services and health insurance coverage could enhance access to treatment. Health professionals should promote patient trust by appropriately addressing their psychosocial needs, including cancer-related fear, to improve the uptake of treatment and thus clinical outcomes. Implications for practice: Improving access to timely chemotherapy requires coordinated action across multiple levels. Strengthening health system capacity and care coordination is essential to reduce delays, while improving provider-patient communication and integrating psychosocial support can address fear and enhance treatment uptake and adherence. Expanding health insurance coverage may reduce financial barriers but must be accompanied by increased service availability to be effective.

An aging society and a growing shortage of healthcare professionals pose increasing challenges for nursing homes in Germany. Enhanced collaboration between nursing home staff and General Practitioners is essential to ensure quality care. Understanding nurses' perspectives is crucial to identifying current issues and suitable solutions. To explore nursing home staff's perspectives on communication and current channels with General Practitioners and evaluate specifically their attitudes towards digital communication options. This qualitative study involved semi-structured interviews with 13 nursing home employees from seven German nursing homes, conducted between January 2020 and April 2022. Data were transcribed verbatim and analysed thematically. Reporting adhered to COREQ guidelines. We used paradox theory from management studies to interpret communication tensions and solution strategies. We identified three key themes: (1) Interprofessional communication problems between nurses and general practitioners, including limited direct contact, technical barriers, and time-related inefficiencies; (2) Perceived ability of digital options to reduce communication problems; and (3) Suggestions to improve communication, with a focus on digital options. Participants expressed a strong openness to digital communication tools, highlighting their potential to alleviate current tensions. Digital tools were viewed as opportunities to streamline communication, enhance efficiency, and ultimately improve collaboration and patient care. This study provides insights into tensions in healthcare collaboration in nursing homes and possible solution strategies. Participants see digital tools as promising pathways to resolve current inefficiencies and support better interprofessional collaboration. These insights are essential for guiding the development of practical, sustainable solutions to improve care delivery in nursing homes.

Although radiotherapy is an essential part of comprehensive cancer care, access is heavily limited in most sub‐Saharan African (SSA) countries. Patients' barriers to care can be grouped as availability, accessibility, accommodation, affordability, and acceptability. We aimed to assess cancer patient‐ and caregiver‐reported barriers in nine SSAn countries (Republic of the Congo, Ethiopia, Gabon, Kenya, Mali, Nigeria, Tanzania, Uganda, and Zimbabwe). We conducted a telephone‐based survey among 553 randomly selected patients with breast, cervical, colorectal, and prostate cancer, Kaposi sarcoma and non‐Hodgkin lymphoma diagnosed between 2018 and 2019 registered in population‐based registries of the African Cancer Registry Network. We inquired about receipt of radiotherapy and barriers irrespective of recalling a recommendation. Among all categories, 21.6% ( Use of alternative medicine ) to 39.6% ( Cost of treatment ) of patients reported severe barriers. Most common was problematic Cost of treatment (69.0% overall). A high share of patients from Congo, Kenya, Nigeria, and Tanzania reported barriers. Higher education and wealth were associated with reduced problems in all categories except increased problems with Fear and Use of alternative medicine . Receipt of radiotherapy was associated with fewer problems with Availability of transport (odds ratio [OR]: 0.34; 95% confidence interval [CI], 0.13–0.88) and Trust in healthcare workers (OR: 0.44; 95% CI, 0.24–0.8), and increased Fear (OR: 2.33; 95% CI, 1.33–4.05). Seeing that one‐third of the patients reported severe problems in all dimensions, shortage of radiotherapy units is not the only problematic aspect of access to radiotherapy. Improvements in affordability, patient–healthcare worker communication, and psychosocial support are needed.

Background: A weak referral system combined with limited diagnostic facilities is among the key systemic barriers to the early detection of breast cancer. Strengthening patient pathways is essential to improve follow-up and reduce delays in cancer diagnosis and care. This study aims to assess the effectiveness of the DINKNESH referral and follow-up app, a digital, app-based patient referral system linking early detection of breast-related abnormalities at primary healthcare settings with diagnostic facilities in Ethiopia. Methods: A two-arm cluster randomised trial with an embedded qualitative study is being conducted at eight primary health facilities and affiliated satellite hospitals in Ethiopia. The study includes women aged ≥18 years presenting with breast abnormalities, as well as women aged ≥30 years with positive findings on clinical breast examination. In intervention cluster facilities, the referral process for further diagnosis is supported by the DINKNESH referral and follow-up app, which facilitates patient registration, data transfer, and reminder services. This is compared with the routine paper-based referral process in the control clusters. The primary outcome is the proportion of completed referrals. All outcome measures will be analysed using IBM SPSS Statistics 25.0. A mixed-effects logistic regression model will be applied, adjusting for potential confounders and accounting for clustering at the facility level. At the end of the intervention period, qualitative interviews will be conducted using the RE-AIM framework to explore the acceptability, challenges, sustainability, and scalability of the intervention. Discussion: This study will provide robust evidence on whether app-based referral systems for women with breast symptoms can improve follow-up and facilitate early breast cancer detection in low-resource settings such as Ethiopia. The findings will support the WHO Global Breast Cancer Initiative’s goal of diagnosing more than 60% of breast cancer cases at an early stage. Trial registration: PACTR202411893209747. Registered on 25 November 2024, https://pactr.samrc.ac.za/

EHealth interventions have demonstrated potential to address challenges related to health and the health care system in low- and middle-income countries. To effectively leverage eHealth in supporting health care in Ethiopia, the assessment and development of the eHealth literacy of patients are essential. This study aimed to translate the eHealth Literacy Questionnaire (eHLQ) to Amharic and assess its psychometric properties. A systematic process of translation, including forward and backward translation, expert review, and cognitive interviews, was applied. Then, a cross-sectional questionnaire-based study using a convenience sample (N=300) of patients with internet access in the primary health care level between January and March 2025 in the capital and a larger city of Ethiopia was conducted. Internal consistency was assessed using Cronbach α and McDonald ω. The factor structure was assessed using confirmatory factor analysis. Convergent and discriminant validity were examined by calculating Spearman correlations between each eHLQ scale and the total score of the eHealth Literacy Scale (eHEALS). A total of 300 participants were included in the analysis. The mean age was 30.4 (SD 6.8, range 18-55) years, and 69.7% (209/300) were women. Internal consistency was acceptable for all scales (Cronbach α=0.72-0.91; McDonald ω=0.79-0.96), except for Scale 4 (α=0.62; ω=0.70). The 7-factor model showed a satisfactory fit, with a comparative fit index of 0.97, Tucker-Lewis index of 0.97, and standardized root mean square residual of 0.07. Factor loadings exceeded 0.40 for all items except one. Strong correlations between Scales 1 to 3 and eHEALS (range r=0.69-0.74) supported convergent validity, whereas moderate correlations between Scales 5 to 7 and eHEALS (range r=0.66-0.67) indicated limited discriminant validity. The Amharic eHLQ demonstrated generally satisfying psychometric properties and can be considered a valid tool for assessing eHealth literacy among patients with internet access in Ethiopia, marking the first validation of the eHLQ in sub-Saharan Africa. Future studies could provide additional evidence to substantiate the psychometric robustness of Scale 4 ("feeling safe and in control"). Overall, the Amharic eHLQ can support the development of tailored eHealth interventions in Ethiopia.

Background: Training of health care professionals and their participation in continuous medical education are crucial to ensure quality health care. Low-resource countries in Sub-Saharan Africa struggle with health care disparities between urban and rural areas concerning access to educational resources. While e-learning can facilitate a wide distribution of educational content, it depends on learners’ engagement and infrastructure. Objective: This study aims to assess knowledge, attitude, practice, and access to infrastructure related to e-learning among health care professionals in primary health care settings in Ethiopia. Methods: In April 2023, we carried out a quantitative, questionnaire-based cross-sectional study guided by the knowledge, attitudes, and practice framework, including additional items on available infrastructure. The scores in each category are defined as “high” and “low” based on the median, followed by the application of logistic regression on selected sociodemographic factors. We included health care professionals working in general and primary hospitals, health centers, and health posts. Results: Of 398 participants (response rate 94.5%), more than half (n=207, 52%) reported feeling confident about their understanding of e-learning and conducting online searches, both for general (n=247, 62.1%) and medical-related content (n=251, 63.1%). Higher levels of education were associated with better knowledge (adjusted odds ratio [AOR] 2.32, 95% CI 1.45-3.68). Regardless of financial and personal efforts, we observed a generally positive attitude. Almost half of the participants (n=172, 43.2%) reported using the internet daily, compared to 16.8% (n=67) of participants who never used the internet. Higher education (AOR 2.56, 95% CI 1.57-4.16) and income levels (AOR 1.31, 95% CI 1.06-1.62) were associated with higher practice scores of e-learning-related activities. Women, however, exhibited lower practice scores (AOR 0.44, 95% CI 0.27-0.71). Regular access to an internet-enabled device was reported by 43.5% (n=173) of the participants. Smartphones were the primarily used device (268/393, 67.3%). Common barriers to internet access were limited internet availability (142/437, 32.5%) and costs (n=190, 43.5%). Higher education (AOR 1.56, 95% CI 0.98, 2.46) and income (AOR 1.50; 95% CI 1.21-1.85) were associated with increased access to infrastructure, while it was decreased for women (AOR 0.48, 95% CI 0.30-0.77). Conclusions: Although Ethiopian health care professionals report mixed levels of knowledge, they have a positive attitude toward e-learning in medical education. While internet use is common, especially via smartphone, the access to devices and reliable internet is limited. To improve accessibility, investments in the digital infrastructure and individual digital education programs are necessary, especially targeting women and those with lower income. Due to their widespread availability, e-learning programs should be optimized for smartphones.

Objectives To summarise the best available evidence on tertiary prevention interventions for patients with stroke conducted in African countries, identify the gaps in stroke prevention research and augment efforts to establish stroke rehabilitation guidelines in African countries. Design We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement on the basis of a published protocol. Data sources We conducted a systematic search of nine electronic databases, including PubMed, the Cochrane Library and African Index Medicus, published until August 2023 and additionally contacted authors and screened reference lists. Eligibility criteria We included randomised controlled trials (RCTs) and prospective cohort studies on African adult patients with a clinical diagnosis of stroke. The primary outcome was global disability, and secondary outcomes were neurologic function scales. Data extraction and synthesis Two authors independently screened the search results, with data extracted by one author and verified by a second author. The data were narratively synthesised. A meta-analysis was done using a random-effects model for metric data using standardised mean differences. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results Of 3305 publications, 25 studies met the inclusion criteria involving cumulatively 973 patients with subacute and chronic stroke. Two-thirds of the trials were conducted in Nigeria and Egypt. The interventions covered physiotherapeutic, electrophysiologic, psychotherapeutic and transitional care domains with mostly beneficial outcomes. All included studies were RCTs with some concerns about methodologic quality. Conclusion This systematic review comprises heterogeneous effective interventions for tertiary stroke prevention mostly conducted in small productive research clusters. There is a growing body of research from African countries covering important fields of stroke rehabilitation, including local adaptations of the rehabilitation process and new knowledge concerning transcranial magnetic stimulation. There remains an urgent need to implement interventions aimed at overcoming barriers to stroke rehabilitation. PROSPERO registration number CRD42020159125.

Introduction: Breast and cervical cancers are the most frequent and fatal cancers among women. Thus, early detection is necessary to improve the prognosis of affected women. However, in Ethiopia, the rates of screening remain alarmingly low. Objective: To assess the magnitude of screening attendance for breast or cervical cancer, as well as the factors that predict it, among women aged 30–49 years old in Gedeo Zone, South Ethiopia, in 2023. Method: A community-based cross-sectional study was conducted using a multi-stage cluster sampling technique. Data were collected using pretested, structured questionnaires by trained interviewers. Univariate and multivariate logistic regression models were employed to identify factors associated with screening attendance. Results: A total of 554 women participated in the study. Of them, 132 (23.8%) were screened for breast or cervical cancer. Higher age of 40–44 versus 45–49 years (adjusted odds ratio [AOR] 4.18 [95% CI 1.59, 10.9]), higher education status ([AOR] 5.49 [95% CI 2.01, 13.1]), having family or a friend with history of breast or cervical cancer ([AOR] 5.55 [95% CI 2.47, 12.5]), short anticipated time to seek help ([AOR] 4.66 [1.31, 11.7]), adequate health literacy ([AOR] 6.98 [95% CI 2.82,13.3]) and high self-efficacy ([AOR] 2.32 [95% CI 1.08, 4.96]) were positive factors with higher screening attendance. High response cost ([AOR] 0.19 95% CI [0.08, 0.50]) was a negative factor and associated with lower screening attendance. Conclusion and recommendation: The study found that only one in four women attended breast or cervical cancer screening. Screening uptake was better in women with higher education, health literacy, self-efficacy, and older age–similar to factors associated with other health seeking behavior. Interestingly, history of breast or cervical cancer in a friend or relative was also associated with higher uptake. This indicates that in addition to awareness campaigns, personal testimonials of survivors could encourage women to visit screening facilities.

Background/Objectives: Hypertension is often asymptomatic, progresses slowly, and leads to multiple secondary diseases. Thus, a regular blood pressure check is recommended. The objective of this study is to assess the intention to undergo a blood pressure check and its associated factors among adults in Southwest Shewa Zone, Ethiopia. Methods: A healthcare-facility-based cross-sectional design was utilized. A standardized questionnaire, adapted from previous research, was administered by trained interviewers. Binary logistic regression analysis was used to determine the factors the intention to undergo blood pressure checks is associated with, utilizing SPSS version 27. Results: Four hundred twenty-one participants provided a complete response, yielding a 99.7% response rate. Of these participants, 153 (36%) had had their blood pressure checked at some point. The vast majority of the study participants (387, 91.9%) did not know the normal blood pressure range. The median score for intention to undergo blood pressure check was 11 (interquartile range 10–13). Female participants were 59% less likely (adjusted odds ratio [AOR] 0.408, 95% confidence interval 0.208–0.801) to intend to undergo a blood pressure check than male participants. Participants in the poorest wealth quintile were 82% less likely (AOR 0.183, 95% CI = 0.063–0.533) to intend to undergo a blood pressure check than those in the richest quintile. Participants who intended to undergo a blood pressure check had a significantly favorable attitude (t = 10.801, p < 0.001) and lower perceived behavioral control (t = −2.865, p < 0.001) compared with those who had no intention of checking. Conclusion: A high intent to undergo a blood pressure check should prompt healthcare facilities to offer regular blood pressure check-up services. Behavioral change communication interventions should address the attitude and perceived behavioral controls of individuals associated with the intention to undergo a blood pressure check. In doing so, special attention should be given to female and economically disadvantaged populations.