Background: The mental health burden is high and rising among Bangladeshi university students. Understanding barriers to mental healthcare and how barriers impact mental health outcomes may inform the development of targeted interventions to decrease barriers and improve access to care. Aims: This study identifies barriers to mental healthcare and their association with mental health outcomes in a Bangladeshi university student sample. Methods: We conducted a cross-sectional survey (n = 350) on stigma-related, attitudinal, and instrumental barriers to accessing mental healthcare among Bangladeshi university students. We examined the association between stigma and non-stigma (i.e., attitudinal and instrumental) barriers with four mental health outcomes: suicidal ideation, depression, high perceived stress, and wellness. Results: Attitudinal barriers were the most reported barriers. Stigma-related barriers were significant for individuals who had experienced suicidal ideation (aOR = 2.97, p = 0.001), not for individuals with depression. Non-stigma-related barriers were significant for individuals who had experienced depression (aOR = 2.80, p = 0.011). Conclusions: The current work advances our understanding of how to improve access to mental healthcare among university students in Bangladesh. Stigma-related barriers were particularly salient for individuals who experienced suicidal ideation. Further study is needed on how stigma may impact access to care distinctly for different mental health problems among Bangladeshi university students.

Implementation evaluations have increasingly taken into account how features of local context help determine implementation outcomes. The purpose of this study was to determine which contextual features of organizational capacity led directly to the RE-AIM Framework implementation outcomes of intervention reach and number of days taken to implement, in an implementation trial of a series of cancer education workshops conducted across 13 African-American churches in Maryland. We used a configurational approach with Coincidence Analysis to identify specific features of organizational capacity that uniquely distinguished churches with implementation success from those that were less successful. Aspects of organizational capacity (e.g., congregation size, staffing/volunteers, health ministry experience) were drawn from an existing measure of church organizational capacity for health promotion. Solution pathways leading to higher intervention reach included: having a health ministry in place for 1–4 years; or having fewer than 100 members; or mid-size churches that had conducted health promotion activities in 1–4 different topics in the past 2 years. Solution pathways to implementing the intervention in fewer number of days included: having conducted 1–2 health promotion activities in the past 2 years; having 1–5 part-time staff and a pastor without additional outside employment; or churches with a doctorally prepared pastor and a weekly attendance of 101–249 members. Study findings can inform future theory, research, and practice in implementation of evidence-based health promotion interventions delivered in faith-based and other limited-resource community settings. Findings support the important role of organizational capacity in implementation outcomes in these settings.Clinical trial registration The study was pre-registered at clinicaltrials.gov. Identifier: NCT02076958. Registered 3/4/2014. https://clinicaltrials.gov/ct2/show/NCT02076958.

Substance use during the perinatal period and while parenting can pose a significant risk to children's safety and well‐being. Mothers who have experienced child maltreatment are more likely to use substances than mothers without a history of maltreatment. This study explores how child welfare social workers experience supporting young, maltreated mothers struggling with substance use to prevent the intergenerational transmission of child maltreatment. Semi‐structured in‐depth interviews were conducted with four social workers working with young mothers with a history of maltreatment and substance use. Interpretative Phenomenological Analysis revealed two themes: (1) grappling with system challenges and (2) supporting strategies for disrupting intergenerational transmission of child maltreatment. The results highlight the need for systemic changes around support for social workers who work with young mothers who use substances and have a history of maltreatment, and substance use treatment and mental health programs themselves. Mothers need access to prenatal programs that are trauma‐informed, non‐judgemental and that support participants' basic needs and parenting skills.

Although statistically unlikely, early-onset breast cancer tends to be more aggressive and leads to greater mortality than breast cancer among women of screening age. Young African American women are disproportionately impacted by early-onset breast cancer compared to women of other races. Given the racial disparities and because young women are typically not the primary audience for breast cancer educational messaging, there is a need to identify recommendations for age-appropriate breast cancer education for African American women below mammogram eligibility. Through N = 30 key informant interviews with young African American breast cancer survivors, family members of young survivors, community organization leaders and healthcare providers, we identified breast cancer educational message content and communication channels relevant for these women. Participants recommended that message content should emphasize the need to address family cancer history and self-advocacy in healthcare encounters in addition to concerns about loss of womanhood, financial costs and opportunity costs associated with preventive healthcare visits. Breast cancer messages for this audience should consider the influences of earlier life stage, culture and race. Recommended communication channels highlighted use of social media and videos. Findings will inform future age-appropriate educational messaging aimed at eliminating early-onset breast cancer disparities disproportionately impacting young African American women.

Community health advisors (CHAs) play a key role in promoting health in medically underserved communities, including in addressing cancer disparities. There is a need to expand the research on what characteristics make for an effective CHA. We examined the relationship between CHA personal and family history of cancer, and implementation and efficacy outcomes in a cancer control intervention trial. Twenty-eight trained CHAs implemented a series of three cancer educational group workshops for N = 375 workshop participants across 14 churches. Implementation was operationalized as participant attendance at the educational workshops, and efficacy as workshop participants’ cancer knowledge scores at the 12-month follow-up, controlling for baseline scores. CHA personal history of cancer was not significantly associated with implementation, nor knowledge outcomes. However, CHAs with family history of cancer had significantly greater participant attendance at the workshops than CHAs without family history of cancer (P = 0.03) and a significant, positive association with male workshop participants’ prostate cancer knowledge scores at 12 months (estimated beta coefficient = 0.49, P < 0.01) after adjusting for confounders. Findings suggest that CHAs with family history of cancer may be particularly suitable for cancer peer education, although further research is needed to confirm this and identify other factors conducive to CHA success.