Marcus Chilaka

Introduction: The Southeastern region of Nigeria faces a severe public health challenge from hypertension due to its high prevalence. Psychosocial factors including perceived stress, anxiety, depression, coping mechanisms, and social support play essential roles in hypertension development and health behaviour, yet there has been limited scholarly attention to these determinants in Nigerian and international qualitative research. This study addresses this evidence gap by investigating the psychosocial determinants of hypertension-related health behaviour outcomes in adults living in Southeastern Nigeria. Materials and methods: The sequential explanatory mixed methods study includes validated psychometric instruments assessing perceived stress, anxiety, depression, coping mechanisms, and social support. The primary quantitative outcome is the Health Behaviour Index, a composite measure of hypertension-related health behaviours. Regression analyses, correlation tests, and mediation/moderation models will be used to examine relationships among these variables. The research team will collect qualitative data through semi-structured interviews accessible to participants either online or in person. Thematic analysis following Braun and Clarke’s six-phase framework will be employed to explore participants’ lived experiences of stress, coping, and hypertension management. Findings will be disseminated at academic conferences and published in peer-reviewed journals and stakeholder meetings held in both the UK and Nigeria. The research aims to generate evidence to support the development of comprehensive psychosocial care plans that address both physical and mental aspects of hypertension treatment in areas with limited resources.

Introduction: The Southeastern region of Nigeria faces a severe public health challenge from hypertension due to its high prevalence. Psychological factors such as stress, anxiety, depression, coping mechanisms, and social support play essential roles in hypertension development and treatment, yet there has been limited scholarly attention to these factors in Nigerian and international qualitative research. This study addresses this evidence gap by investigating the psychological factors that influence hypertension development in adults living in Southeastern Nigeria. Materials and methods: The sequential explanatory mixed methods study includes validated psychometric instruments assessing perceived stress, anxiety, depression, coping mechanisms, and social support. Regression analyses, correlation tests, and mediation/moderation models will be used to examine relationships among these variables. The research team will collect qualitative data through semi-structured interviews accessible to participants either online or in person. Thematic analysis following Braun and Clarke’s six-phase framework will be employed to explore participants’ lived experiences of stress, coping, and hypertension management. Ethics and dissemination: Ethical approval was obtained from the University of Bradford Research Ethics Committee on 7 ^th August 2025. The research follows all procedures based on the Declaration of Helsinki and institutional ethical guidelines. Findings will be disseminated at academic conferences and published in peer-reviewed journals and stakeholder meetings held in both the UK and Nigeria. The research aims to generate evidence to support the development of comprehensive psychosocial care plans that address both physical and mental aspects of hypertension treatment in areas with limited resources.

BACKGROUND Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older care settings and further improve health and social care systems OBJECTIVE This review aims to compile and synthesise the best available evidence regarding the care of older individuals and the effectiveness of policy and practice QI interventions in older care. It also aims to understand QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. METHODS The mixed-methods review will follow the standard methodology used by the Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycInfo, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of older individuals undergoing older care and any health and care professionals involved in this care delivery; a broad range of QI interventions, including assistive technologies, effects of training and education, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, i.e., PRISMA guidelines, will be followed. RESULTS The results were presented in a PRISMA flow diagram and two draft charting tables in tabular and descriptive formats. A summary of the characteristics of the included studies was then described in terms of location, study sites, timing, participants, and types of interventions. Eight kinds of QI interventions were identified: training (use of technology), education, communication, technology implementation, person-centred care, health and well-being promotion, systematic support, and competence development. The integrated synthesis yielded a range of outcomes and phenomena of interest, including staff self-efficacy, competence and skill enhancement, technology adoption, and user experience, communication and collaboration, co-designing with end users, person-centred care, health and well-being, transitional care and discharge planning, barriers to QI implementation, safety and risk reduction, peer support, and social connection, and promoting active ageing. CONCLUSIONS This comprehensive review provided insights into some QI interventions and their impact, outlined a range of outcomes and phenomena of interest for older care, and benefited both the practical usefulness of care service activities and society. Educational interventions designed for staff and older adults exemplified a promising outlook on enhancing clinical competence and promoting health literacy through various initiatives. Areas promoting health and well-being, targeting physical, mental, and social well-being, have proven to improve quality of life. INTERNATIONAL REGISTERED REPORT RR2-10.2196/56346

Background: Health worker migration from Nigeria poses significant challenges to the Nigerian health care sector and has far-reaching implications for health care systems globally. Understanding the factors driving migration, its effects on health care delivery, and potential policy interventions is critical for addressing this complex issue. Objective: This study aims to comprehensively examine the factors encouraging the emigration of Nigerian health workers, map out the effects of health worker migration on the Nigerian health system, document the loss of investment in health training and education resulting from migration, identify relevant policy initiatives addressing migration, determine the effects of Nigerian health worker migration on destination countries, and identify the benefits and demerits to Nigeria of health worker migration. Methods: This study will follow the Joanna Briggs Institute methodology. A search strategy will retrieve published studies from MEDLINE, CINAHL, Embase, Global Health, Academic Search Premiere, and Web of Science. Unpublished studies will be sourced from dissertations and theses. A comprehensive search will involve keyword scans and citation searches. Exclusion criteria will filter out irrelevant studies, such as studies unrelated to the international migration of health workers and non-English language studies. A total of 2 independent reviewers will screen the titles and abstracts and then review the full text. Data will be extracted from the included studies using a data extraction tool developed for this study. The study selection process will be shown using a PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) flowchart. While the traditional risk of bias assessments is not applied to scoping reviews, the quality of included studies will be evaluated based on methodological transparency. Results: The process of selecting studies will be shown using a PRISMA ScR flowchart, and information gathering will be done through a charting table that has been prepared in advance. We plan to collect data from January 2025 to March 2025 and present the results to examine publication patterns and study details. The final summary is expected to be released by the summer of 2025. It will provide an in-depth look at how health worker migration impacts the health care sector in Nigeria. Conclusions: This study holds immense potential to contribute to understanding health worker migration from Nigeria and inform policy and practice interventions to address its challenges. By synthesizing existing evidence, the scoping review will guide future research and policy efforts to mitigate the adverse effects of migration on health care systems and workforce sustainability. Furthermore, the results will aid in recognizing deficiencies in the existing literature; this will offer a defined path for specific policy measures and methods to retain health care workers effectively and thus support the sustainability of health care systems. International Registered Report Identifier (IRRID): PRR1-10.2196/62726

BACKGROUND Health worker migration from Nigeria poses significant challenges to the Nigerian health care sector and has far-reaching implications for health care systems globally. Understanding the factors driving migration, its effects on health care delivery, and potential policy interventions is critical for addressing this complex issue. OBJECTIVE This study aims to comprehensively examine the factors encouraging the emigration of Nigerian health workers, map out the effects of health worker migration on the Nigerian health system, document the loss of investment in health training and education resulting from migration, identify relevant policy initiatives addressing migration, determine the effects of Nigerian health worker migration on destination countries, and identify the benefits and demerits to Nigeria of health worker migration. METHODS This study will follow the Joanna Briggs Institute methodology. A search strategy will retrieve published studies from MEDLINE, CINAHL, Embase, Global Health, Academic Search Premiere, and Web of Science. Unpublished studies will be sourced from dissertations and theses. A comprehensive search will involve keyword scans and citation searches. Exclusion criteria will filter out irrelevant studies, such as studies unrelated to the international migration of health workers and non-English language studies. A total of 2 independent reviewers will screen the titles and abstracts and then review the full text. Data will be extracted from the included studies using a data extraction tool developed for this study. The study selection process will be shown using a PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) flowchart. While the traditional risk of bias assessments is not applied to scoping reviews, the quality of included studies will be evaluated based on methodological transparency. RESULTS The process of selecting studies will be shown using a PRISMA ScR flowchart, and information gathering will be done through a charting table that has been prepared in advance. We plan to collect data from January 2025 to March 2025 and present the results to examine publication patterns and study details. The final summary is expected to be released by the summer of 2025. It will provide an in-depth look at how health worker migration impacts the health care sector in Nigeria. CONCLUSIONS This study holds immense potential to contribute to understanding health worker migration from Nigeria and inform policy and practice interventions to address its challenges. By synthesizing existing evidence, the scoping review will guide future research and policy efforts to mitigate the adverse effects of migration on health care systems and workforce sustainability. Furthermore, the results will aid in recognizing deficiencies in the existing literature; this will offer a defined path for specific policy measures and methods to retain health care workers effectively and thus support the sustainability of health care systems. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/62726

Background: Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their own care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older adult care settings and further improve health and social care systems associated with older adults. Objective: This review aims to compile and synthesize the best available evidence regarding the effectiveness of policy and practice QI interventions in older adult care. The secondary aim is to understand the care of older individuals and QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. Methods: The mixed methods review will follow the standard methodology used by Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycINFO, ASSIA, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of patients undergoing older adult care and any health and care professionals involved in the care delivery for older adults; a broad range of QI interventions, including assistive technologies, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older adult care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, that is, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will be followed. Results: A result-based convergent synthesis design will be used in which both quantitative and qualitative studies will be analyzed separately, and the results of both syntheses will be then integrated during a final (convergent) synthesis. The integration will compare the findings of quantitative and qualitative evidence using tables in light of the results of both syntheses. Conclusions: This comprehensive review is expected to reflect on the insights into some QI interventions and their impact, outline some common challenges of quality for older adult care, and benefit both the practical usefulness of care service activities and the society at large. International Registered Report Identifier (IRRID): PRR1-10.2196/56346

BACKGROUND Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their own care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older adult care settings and further improve health and social care systems associated with older adults. OBJECTIVE This review aims to compile and synthesize the best available evidence regarding the effectiveness of policy and practice QI interventions in older adult care. The secondary aim is to understand the care of older individuals and QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. METHODS The mixed methods review will follow the standard methodology used by Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycINFO, ASSIA, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of patients undergoing older adult care and any health and care professionals involved in the care delivery for older adults; a broad range of QI interventions, including assistive technologies, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older adult care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, that is, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will be followed. RESULTS A result-based convergent synthesis design will be used in which both quantitative and qualitative studies will be analyzed separately, and the results of both syntheses will be then integrated during a final (convergent) synthesis. The integration will compare the findings of quantitative and qualitative evidence using tables in light of the results of both syntheses. CONCLUSIONS This comprehensive review is expected to reflect on the insights into some QI interventions and their impact, outline some common challenges of quality for older adult care, and benefit both the practical usefulness of care service activities and the society at large. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/56346