Public Health Institute Journal (LJMU)
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A survey on the barriers to uptake of sexual and reproductive health services amongst LJMU students
No full textBackground: University students acquiring Sexually Transmitted Infections (STI) can be linked to engagement in casual sex, high-risk social behaviours and inconsistent condom use. As such, most Universities offer a wide range of sexual health services to prevent and manage STIs, as well as unwanted pregnancies, and aim to promote healthy sexual behaviours. However, regardless of the availability of these services, university students can often delay or avoid access to these services with male students particularly being either unaware of or hesitant to seek guidance and treatment relating to their sexual health. Factors perceived to influence students accessing sexual health services includes the availability of services, concerns about confidentiality and the stigma associated with using such services.
Methods: Liverpool John Moore University Students (LJMU) were recruited to an online questionnaire. The questionnaire consisted of three sections; 1) demographics, 2) participants knowledge of sexual and reproductive health services (SRH), and 3) barriers to accessing services. The questionnaire was advertised in University buildings, through social media and via a University gatekeeper. Data was analysed using both descriptive and inferential statistics via SPSS.
Results: Eighty-five LJMU students participated in this study. One in three (30.6%; n=26) identified as male and 69.4% (n=59) as female. For age, 14.1% (n=12) participants reported being below 20 years of age, 35.3% (n=30) were between 20 and 24 years, 27.1% (n=23) were between 25 and 29 years, 16.5% (n=14) were between 30 and 34 years and 7.1% (n=6) reported being 35 years and above. Over a third (34.1%; n=29) were students of the Faculty of Health, 23.5% (n=20) reported being students of the Faculty of Science, 18.8% (n=16) were students of the Faculty of Business and Law, 14.1% (n=12) were students of the Faculty of Engineering and Technology, 9.4% (n=8) were students of the Faculty of Arts, Professional and Social sciences. The majority of students (66.7%; n=56) preferred accessing SRH service face to face, with 22.6% (n=19) preferring to access online services and 10.7% (n=9) preferring phone access. Students generally received SRH information from healthcare providers and hospitals (39.3%; n=33), with 25% (n=21) receiving advice from the media, 21.4% (n=18) from their friends, 4.8% (n=4) from family, and 9.5% (n=8) reported teachers as their main sources of SRH information.
Conclusion: LJMU students should be encouraged to access SRH knowledge and services with services needing to be visible. Further research could explore the design of digital interventions, however these require service user involvement
Understanding “Moon face”: The non-medical use of Corticosteroids amongst Women in the Middle East and North Africa Context
No full textBackground: In order to adhere to specific beauty standards, women in the Middle East and North Africa (MENA) resort to various methods such as traditional mixes, dietary changes, or medications (including corticosteroids) to achieve a desired physical appearance. Their specific reasons for using such methods may be different, but their common goal is to gain weight. A consequence of corticosteroid use is ‘moon face’, where extra fat builds up on the side of the skull which causes the face to have a round, puffy, or full appearance, however this side effect can also be a desired outcome. The aim of this scoping review is to explore the use and motivations of corticosteroids for weight gain and other cosmetic reasons by women in MENA.
Methods: A scoping review was utilised to understand why women use corticosteroids for non-medical use. A search of peer reviewed literature was conducted in key databases, and in English, French and Arabic languages, limited to countries within the MENA region. Initial searches resulted in 270 studies and following removal of duplicates and screening, 8 articles were included. The data extracted was charted, categorised and thematically analysed.
Results: The review highlighted that there is an extremely limited peer review base pertaining to the use of corticosteroids among MENA women for the purpose of gaining weight. From the extant literature, several themes were identified comprising 1) Motives and drives of use for beautification and weight gain, 2) The availability and easy access to corticosteroids, 3) Side effects of unregulated corticosteroid use, and 4) Implications for clinical practice and public health.
Conclusion: The review highlights the various motivators for MENA women use of corticosteroids as a method to gain weight and modify their physical appearance. This review also calls for stricter laws around the dispensing of medications in MENA and for more research around the concept of ‘moon face’
“Free, safe, legal, local”: Examining barriers to abortion services in the Republic of Ireland after the repeal of the 8th Amendment
No full textBackground: The Republic of Ireland\u27s (ROI) abortion legislation can be considered one of the most repressive and restrictive abortion laws in the world. Whilst the implementation of the Health (Termination of Pregnancy) Act 2018 is a significant advancement in abortion provision, there are still key issues within the Act. As a lack of access to safe abortion care is a critical public health and human rights concern, the research aims to gain insight into the experience of those who have accessed or attempted to access an abortion in the ROI since the introduction of the Health Act 2018. As this research topic can only be investigated from January 2019, this research aims to fill the gap in literature concerning legal and non-legal barriers associated with accessing abortion care in the ROI.
Methods: An exploratory quantitative study was conducted using online, anonymised, self-administered questionnaires. Research participants were selected purposefully, whereby only individuals over the age of 18 who successfully accessed, or attempted to access abortion care services in the ROI following the implementation of the Health Act were permitted to partake in the study. The study comprised of both inferential and descriptive statistical data. Quantitative data was transferred to Microsoft Excel, where results were presented through pie charts, histograms, and tables. Quantitative data was analysed and coded thematically to ensure that relevant themes emerged that complemented the study\u27s objectives.
Results: 32 participants completed the anonymised online questionnaire (Appendix 1), establishing multiple key findings. Significantly, 28% of participants\u27 individual circumstances did not meet the criteria outlined within the Health Act to successfully obtain an abortion in the ROI. Specific to the legal barriers, the geographical unevenness of services was faced by 50% of respondents, the mandatory 3-day wait was a barrier for 34% of respondents and gestational limits affected 17% of respondents. Further, 21 respondents revealed that they had to travel to access care - with 12 respondents forced to travel abroad and 9 participants made to travel locally. Significantly, 10 respondents did not receive any follow-up care, and 23 respondents encountered anti-abortion campaigns when accessing abortion services. Further, 41% of respondents felt that COVID-19 exacerbated their experiences accessing abortion care.
Conclusion: Whilst the study suggests that the implementation and expansion of abortion services under the Health Act is positive, the research also identifies multiple legal and non-legal barriers specific to Ireland that restrict access to abortion care services
Health professionals’ knowledge, attitudes and practice around identifying and responding to children exploited by “county lines” in the United Kingdom: a scoping review
No full textBackground: County lines is a term used to describe gangs and organised criminal networks involved in exporting illegal drugs into areas across the United Kingdom. They exploit children and young people to move and store drugs, weapons and money. It is argued that county lines exploitation is more than a policing problem and represents a major public health concern, with children and young people involved with drugs, violence, criminal and sexual exploitation, trafficking and modern slavery, exposed to short- and long-term physical, emotional, and generational risks to health, and is a major safeguarding concern. The aim of the scoping review is to map out the existing evidence base around health professionals’ knowledge, attitudes and responses to county lines, examine current practice, to synthesise findings and identify gaps in evidence, and identify areas for further research.
Methods: A total of 111 studies from 7 databases were identified, duplicates were then removed, studies were then reviewed by title and abstract, then selected for full text screening against the exclusion and inclusion criteria. A manual search of reference lists and a grey literature search was completed and identified 8 further articles. A total of 8 studies were included in the review, 2 peer reviewed articles and 6 grey literature studies. The Arksey and O’Malley five stage methodological framework was followed throughout.
Results: The scoping review highlighted there is currently limited evidence around health professionals’ knowledge, attitudes and practice. However, it does highlight that county lines exploitation is insufficiently understood, children are not being recognised as victims, multiagency working is disjointed, there is inadequate data collection and information sharing, and very few practitioners felt adequately equipped to tackle county lines exploitation. It proposes although health professionals are often placed at a critical site for responding and identifying to victims, they are missing opportunities.
Conclusion: Future research should be conducted with health professionals to provide a broader evidence base of the attitudes, responses, knowledge and practice of health professionals, to gain a richer understanding and look at ways to improve practice
A qualitative study exploring the health and wellbeing of international students studying at LJMU
No full textBackground: Being away from home and family can antagonistically affect wellbeing. When researching about the wellbeing of international students at universities in various countries, one may frequently witness the adverse consequences of studying away from home. Uncertainty and ignorance about how international students perceive and address their health and well-being are contributing factors to the absence of adequate service. The ability to satisfy their needs and enhance the general wellbeing of this significant group may be improved, if we listen to the international student\u27s perceptions. However, although there are numerous research studies regarding the international students, there is only scarce information available regarding how wellbeing is experienced and maintained among international students from their own perspectives. This study will add further insight to the perception of international students on their health and wellbeing before and after arriving the UK in concern with the challenges faced. It also involves the difficulties faced while travelling to the UK amidst the COVID-19 situation.
Methods: A generic qualitative approach was utilised to execute the research, employing semi-structured online interviews. Snowball and convenience sampling techniques were employed to recruit a sample of ten participants. The transcripts of interviews were analysed thematically to generate themes.
Results: This study found that international students reported moderate levels of both physical and emotional wellbeing and faced issues like loneliness, anxiety, frustration, hair loss, weight loss, dark circles, migraine and fatigue, but normalized it to be a part of life and did not seek support although they had ample of resources. Findings have corroborated existing research that international students are more likely to face acculturation, language barrier, financial instability, dietary issues, emotional crisis, academic stress, accommodation problems and lack social support. Despite the challenges faced, international students claimed that it is a wonderful experience staying in the UK and no one complained much about the country or university.
Conclusion: This study demonstrates how international students\u27 attitudes have evolved over the years, since they are increasingly motivated to explore and improve things despite the barriers rather than complaining and worrying. Hence, university organisations should appreciate this evolution and promote interventions to improve international students’ quality of life according to their requirements
A qualitative study exploring stigma towards those who use substances
No full textBackground: The aim of this study was to explore professional perceptions of towards people who use substances in order to identify barriers to this population group receiving appropriate and quality care.
Methods: This study adopted a qualitative approach utilising semi structured interviews via the online platform MS Teams. The data was recorded then transcribed via MS Teams and Microsoft Word. The data was then analysed via thematic analysis also utilising the programme NVivo. This study utilised a sample of adult individuals over 18 who worked within drug services across England. A total of 4 participants took part in this research. A gatekeeper was approached to select participants for this research.
Results: The participants within this study worked within drug services across England and therefore had experience and knowledge of working with individuals who use substances. However, during interviews the participants often referred to mental health experiences as they disclosed there is a strong correlation between mental health, substances, and stigma. The participant’s identified stigma has slightly improved but in some areas is still an issue and creates significant barriers for individuals who use substances accessing relevant support and treatment when required.
Conclusion: All participant’s identified that more work on education, knowledge and awareness is required to combat stigma and improve services in the future, as this contributes to stigma and suboptimal care for this group in society. All participants highlighted mental health services and policy reshape are required to help this population and reduce premature mortality. Additionally, all participants disclosed good support in home environments and positive attitudes from professionals are key to optimal care in the future
‘It’s such a drag!’ Assessing the impact of air quality and post pandemic views and opinions regarding the future of smoking in Liverpool’s outdoor hospitality venues
No full textBackground: The aim of this research is to determine if a smoke free pavement licence would be appropriate to introduce in Liverpool. Whilst the original pavement licence does not require pavements to-be smoke free, some councils in the UK have imposed a smoke free condition within all pavement licences.
Methods: To determine if it is appropriate for Liverpool to introduce this condition this study will utilise a multi-method approach to data collection, essentially two mini studies coming together to answer the research aims. The first aim focuses predominantly on the attitudes and opinions of residents in Liverpool, collected through online questionnaires. The second aim to see if smoking outdoors effects general air quality, to assess this air quality readings were taken outside of hospitality venues with and without the presence of smokers.
Results: After the analysis of both questionnaires and air quality data, the findings were merged to identify if the levels of air quality alongside public attitudes are enough to support the need for policy change in Liverpool’s pavement licence permits. The questionnaire results were varied, those against a smoke free pavement licence were concerned about enforcement, freedom, and compliance. Whilst those in favour believed that non-smokers should not be exposed to the harmful smoke and be subject to second hand smoke (SHS). It was evidenced from the air quality monitoring, that smoking outside does not cause detrimental impacts on general air quality as the readings taken did not exceed the WHO (2021) guidelines. However, PM2.5 was detected at all locations.
Conclusion: Finally, this research has concluded that a smoke-free condition would only work in Liverpool if it was introduced nationwide. Extending the condition nationally would help ensure compliance so that Liverpool did not feel it was being singled out. The benefit of smoke free pavement licences would reduce smoking normalisation, SHS exposure and improve cessation rates which would help improve population health for all and thereby continue on the journey which started in 1964 to reduce the harmful impacts of smoking
A quantitative investigation of the knowledge and attitudes to obesity among LJMU students
No full textBackground: Obesity is regarded as an important public health issue that affects an increasing number of people worldwide due to its prevalence, high cost, and negative health consequences. Global data reveals that obesity affects more than one billion people globally, including 650 million adults. University students are more prone to stress, unhealthy eating, and reduced physical activity which contributes to obesity. The aim of the study was to investigate the knowledge and attitudes to obesity among LJMU students.
Methods: A descriptive cross-sectional study of LJMU Faculty of Health students was carried out. An online self-administered and validated questionnaire was used to evaluate the knowledge and attitude of the students. The survey was completed by a total of 27 participants.
Results: The main findings of this investigation showed that majority of the participants had better knowledge about the definition of obesity (81.5%), recommended daily calorie intake for men and women (63.0%), and had less knowledge on the percentage of world’s obese population (85.1%). According to the study, there is a statistically significant difference between students\u27 knowledge of the causes of obesity, their attitudes towards obesity, and both their level of study and their international status. The study also found a statistically significant correlation between students\u27 knowledge of the health consequences of obsesity and their international status. Additionally, the research found that students of both genders were equally knowledgeable on the causes and consequences of obesity and showed no variations in their attitude towards obesity.
Conclusion: Most of the international students and postgraduate students had poor knowledge about the causes and health consequences of obesity and also showed significant variations on their attitudes towards obesity. Therefore, there is a need for enhanced health education programmes among these students focusing on obesity and other associated issues both inside and outside of university campuses
The growing burden of Non-Communicable Diseases in the prisons of Pakistan – a scoping review
No full textBackground: In recent times, non-communicable diseases (NCDs) have risen and vulnerable populations such as, imprisoned groups, have been affected the most. Pakistan, like the rest of the world, has been facing a massive challenge as the health authorities are not prepared for this increased burden of NCDs. The scoping review aims to map and describe the data on the incidence of NCDs in the prisons of Pakistan from available research literature.
Methods: The Arksey and O’Malley approach was used for this scoping review. Electronic databases such as Web of Science, PubMed (from 1991 to September 2022) and EMBASE (from 1980 to September 2022) were explored from inception until September 2022. Any study that identified, discussed or observed the prevalence of NCDs in various prison of Pakistan was eligible for inclusion. The studies were independently screened and data was abstracted from the included studies. These studies were charted and thematically analysed. All the data was summarised by mapping out the identified, included and excluded studies using a PRISMA flow diagram.
Results: 18 studies reported in 8 publications that fulfilled the eligibility criteria were included. Five main themes were generated as follows: 1) Nutritional and dietary facilities, 2) Body Mass Index (BMI), 3) Addictions, 4) Physical health status and facilities and 5) Mental well-being.
Conclusion: Globally, the prevalence of NCDs is a rapidly increasing public health concern. The scoping review draws particular attention to the unsettling state of the population imprisoned in the jails of Pakistan. It was discovered that the prevalence of NCD risk factors, including smoking, alcohol use, a nutrient-poor diet, inactivity, hypertension, obesity and depression were extremely high among Pakistani inmates
Identifying parental reasons for MMR1 vaccine hesitancy or acceptance: A quantitative, cross-sectional survey in Liverpool using the 5As model of vaccine acceptance: Public Health Dissertation Prize Winner
No full textMeasles is a globally prevalent, vaccine preventable disease which is highly contagious and potentially deadly. Those most at risk are young children and unimmunized people (ECDC, 2022). Worldwide, measles cases declined by 83% during 2000-2017 (WHO, 2018), but measles vaccine coverage is inconsistent and below the World Health Organisation’s recommended 95% at population level, for public protection and disease eradication (WHO, 2021). In the UK, the free Measles Mumps and Rubella (MMR) vaccine is routinely offered in childhood (NHS, 2019) but national MMR vaccine coverage is below 95%. Some local authorities such as Liverpool, have experienced a larger decline in MMR uptake compared to others (2013, 94.7%, 2022, 82.1%) (NHS Digital, 2022). Vaccine hesitancy is considered the main reason for declining MMR1 uptake (WHO, 2020) and is largely driven by lack of confidence in the vaccine and a retracted link between the MMR vaccine and autism in the 1990’s (Tannous, Barlow and Metcalfe, 2014). UK MMR campaigns intending to increase vaccine uptake focus on raising public confidence, but this is one hesitancy factor which is not sympathetic to local nuances. Identifying the reasons for MMR vaccine hesitancy in local populations and tailoring MMR vaccine programme delivery according to need, is the most effective way to increase vaccine uptake and close vaccine gaps (PHE, 2021). This study explores Liverpool parents’ reasons for MMR1 vaccine acceptance, refusal or delay using the 5A model of non-sociodemographic factors relating to vaccine uptake. Using the same 5A model, it explored the lesser researched impact of parent\u27s income and education on their MMR vaccine acceptance. The study population was sampled using non-probability and convenience methods and empirical data was collected by anonymous online questionnaire. Problems with recruitment resulted in a low study sample (N=28) and findings have potential to be impacted by over and under representation and non-response bias. The low quantity of study data prevented any significant statistical analysis of study findings, and the robustness and validity of results is therefore uncertain. No data was received from participants who refused the MMR vaccine, which limited full exploration of the study question. Findings largely concurred with previous studies and perceived confidence in the vaccines safety and effectiveness was a predictor of overall vaccine acceptance in Liverpool. Although not statistically confirmed, findings suggest university education, and not higher income is a predictor of timely MMR1 vaccine receipt. Generally, statement responses observed a relationship between participants of university education and participants of higher income. The influence of peers and the functionality of prompts did not follow this trend and a more complex socioeconomic relationship may exist in Liverpool. The 5A statement set was effective at exploring the topic but this study will need to be replicated in similar cities with a larger study sample for the findings of this study to have relevance to Liverpool. The researcher recommends future MMR vaccine hesitancy research should investigate the importance of university education on parent\u27s reasons for accepting MMR1 as there is a potential link between formal education and peer influence
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