Background: Mentoring programs for nurses already in the health workforce are growing in importance. Yet, the settings, goals, scale, and key features of these programs are not widely known. Objective: To identify and synthesize research on in-service nurse mentoring programs. Methods: We reviewed nurse mentoring research from six databases. Studies either referred explicitly to in-service nurse mentoring programs, were reviews of such programs, or concerned nurse training/education in which mentoring was an essential component. Results: We included 69 articles from 11 countries, published from 1995 to 2019. Most articles were from high-income countries (n = 46) and in rural areas (n = 22). Programs were developed to strengthen clinical care (particularly maternal and neonatal care), promote evidence-based practice, promote retention, support new graduate nurses, and develop nurse leaders. Of the articles with sufficient data, they typically described small programs implemented in one facility (n = 23), with up to ten mentors (n = 13), with less than 50 mentees (n = 25), meeting at least once a month (n = 27), and lasting at least a year (n = 24). While over half of the studies (n = 36) described programs focused almost exclusively on clinical skills acquisition, many (n = 33) specified non-clinical professional development activities. Reflective practice featured to a varying extent in many articles (n = 29). Very few (n = 6) explicitly identified the theoretical basis of their programs. Conclusions: Although the literature about in-service nurse mentoring comes mostly from small programs in high-income countries, the largest nurse mentoring programs in the world are in low- and middle-income countries. Much can be learned from studying these programs in greater detail. Future research should analyze key features of programs to make models of mentoring more transparent and translatable. If carefully designed and flexibly implemented, in-service nurse mentoring represents an exciting avenue for enhancing the role of nurses and midwives in people-centered health system strengthening. The contents in this article are those of the authors and do not necessarily reflect the view of the U.S. President’s Emergency Plan for AIDS Relief, the U.S. Agency for International Development or the U.S. Government.

Background/Objectives: Low- and middle-income countries (LMICs) have the highest global burden of cervical cancer deaths. Human papillomavirus (HPV) vaccination is a key strategy for cervical cancer elimination, and in LMICs, global recommendations to vaccinate girls aged 9–14 years against HPV are generally implemented through school-based immunization platforms. Unfortunately, this strategy risks missing out-of-school (OOS) girls (i.e., girls not enrolled in formal schools). This narrative review maps the literature and synthesizes existing evidence on service delivery strategies for reaching OOS girls with HPV vaccination in LMICs. Methods: Using relevant databases, we conducted a narrative review of published, peer-reviewed literature to map and synthesize the existing evidence on effective service delivery strategies for reaching OOS girls with HPV vaccination in LMICs. Results: The 21 articles identified presented findings on strategies to reach OOS girls, with the most frequently cited strategies being facility-based and community outreach approaches. Authors also described community-based strategies used to identify and enumerate OOS girls, including peer tracing, church outreach initiatives, as well as partnerships with local groups (e.g., civil service organizations) and individuals (e.g., healthcare workers, teachers). The articles discussed barriers at the individual (e.g., lack of parental consent), facility/program delivery (e.g., lack of transportation for vaccines), and community (e.g., distance from homes to vaccination services) levels to HPV vaccine delivery, as well as solutions at the facility/program delivery (e.g., pilot programs) and community (e.g., multi-level partnerships) levels. Conclusions: Additional research is needed to evaluate implementation strategies targeting OOS girls with HPV vaccination. A better understanding of these strategies can provide valuable insights for HPV vaccine policymakers, healthcare providers, and program implementers.

The World Health Organization (WHO) recently endorsed a single-dose human papillomavirus vaccination (HPVV) schedule, but adoption of the revised immunization schedule has not been uniform, notably in low- and middle-income countries (LMICs) with outsized cervical cancer burdens. We sought to characterize the sequence of events, as well as actors/institutions involved, that facilitate or impede country-level decision-making related to the HPVV schedule. From September 2023 to February 2024, we conducted 66 semi-structured interviews with national immunization stakeholders from 19 LMICs in Africa and Asia, sampled purposively by the maturity of the HPVV program and HPVV schedule. Using purposive text analysis to synthesize emerging insights from interviews, we qualitatively discerned a sequence of decision-making pathways and processes, including actors involved at each stage of the decision-making continuum, related to adoption or switch to an HPVV single-dose schedule. We identified six key sequential steps LMICs follow when deciding on an HPV dosing schedule. Firstly, the new recommendation emerges where WHO and the Strategic Advisory Group of Experts (SAGE) release new HPV vaccine recommendations. Second, the information is shared with the Ministry of Health (MoH) and Expanded Programme for Immunization (EPI). The MoH is informed, and they convene a National Immunization Technical Advisory Group (NITAG) to assess the new HPV vaccine schedule recommendation. Third, there is the review and consideration of evidence. The NITAG reviews evidence on factors like cost-effectiveness, supply chain, disease burden, and anticipated vaccine hesitancy. Fourth, the NITAG deliberates, achieves consensus, and submits a recommendation to the MoH, which endorses the NITAG’s recommendation or requests additional evidence/information before rendering a final decision on the immunization schedule. Fifth and finally, the Interagency Coordination Committee (ICC) reviews the MoH’s recommendation and provides final authorization before changes to the HPV immunization schedule is communicated to Gavi.

Introduction Although they face higher occupational risk of contracting viral respiratory infections, hospital healthcare worker vaccine hesitancy persists. While most studies have used survey methods to quantify the prevalence of and reasons for healthcare worker vaccine hesitancy, this study employs a qualitative approach to understand their attitudes and beliefs associated with influenza and COVID-19 vaccination. Methods To understand frontline healthcare worker experiences and perspectives on influenza and COVID-19 vaccination, 30 semi-structured interviews were conducted in summer/fall 2022 with staff recruited from two Johns Hopkins hospitals in Maryland. An in-depth, key informant interview was conducted with an expert in public health audience engagement. Interviews were audio recorded and transcribed for thematic and Framework analysis using NVivo software (QSR International, Melbourne, Australia). Results Healthcare workers engaged in little influenza vaccine information seeking due to their familiarity with the disease and low perceived disease severity. Approximately half (n=16) of healthcare workers reported no vaccine hesitancy towards influenza or COVID-19 vaccines. No physicians or physician assistants expressed any vaccine hesitancy, while most nurses expressed some (n=10). More than half of the women (n=14) expressed COVID-19 vaccine hesitancy compared to none of the men. Structural factors including hospital tier, unit assignment, and professional role influenced perceived risk of disease exposure and subsequent healthcare worker vaccination decisions. Institutional policies, including mandates and a pro-vaccine environment encouraged vaccination uptake. Healthcare workers reported being more receptive to vaccine messaging that focused on protection from disease, scientific and public health data and their heightened occupational exposure to pathogens. Conclusions Despite their medical knowledge, healthcare workers are susceptible to vaccine hesitancy. Strategies to address specific concerns are needed and can be informed by our findings. A flexible and multi-pronged approach that considers individual anxieties, workplace structures, and the need for open communication with tailored messaging is necessary to promote vaccine acceptance in healthcare settings. What is already known on this topic Healthcare worker vaccine hesitancy has been associated with many factors including race, gender, age and concerns about vaccine safety. What this study adds Much of the research on healthcare worker vaccine hesitancy has used surveys and questionnaires giving a broad description of the prevalence and patterns of vaccine hesitancy in the healthcare workforce. This qualitative study examines vaccine behavior (rather than merely intent) through a cross comparison of healthcare workers’ experiences and attitudes towards influenza and COVID-19 vaccination. How this study might affect research, practice or policy Study findings can be used to help tailor vaccine messaging to hospital healthcare workers which could offset concerns regarding vaccine efficacy and risk, to promote vaccine uptake.

Diarrheal illnesses remain a leading cause of morbidity and mortality worldwide. Understanding when and where individuals seek healthcare is essential for accurately assessing disease burden and improving access to appropriate care. In this study, we conducted a meta-synthesis of qualitative research examining barriers and facilitators to care-seeking for diarrheal illness, either for individuals themselves or for their children. Specifically, we performed a systematic review of qualitative studies from any geographic location and time period that explored motivations for seeking care outside the home for diarrheal illness across all age groups. We then conducted a thematic analysis of the included studies to identify recurring patterns related to care-seeking behavior and to synthesize qualitative insights across contexts. In total, 47 studies met our inclusion criteria, the majority of which focused on caregiver decision-making for children with diarrhea in sub-Saharan Africa. Our meta-synthesis identified several key factors that influenced whether and when individuals sought care. Sociocultural norms, including locally held beliefs about disease causation, were frequently cited as influencing decisions to seek or delay formal care. Additional barriers included long travel distances to health facilities, transportation costs, limited trust in healthcare providers, negative feelings, and inconsistent availability of care. Conversely, episodes perceived as severe were more likely to prompt care-seeking outside the home. These findings highlight the importance of contextually grounded interventions that improve physical and financial access to care, foster trust in healthcare providers through consistent and effective service delivery and strengthen community engagement around recognizing signs of severe illness and the potential benefits of timely treatment. They also underscore the need for future studies to define diarrhea in locally relevant terms and to clearly define sources of care-seeking, as variation in these definitions can limit our full understanding of who is affected and how individuals respond to illness.

Long COVID is a chronic illness affecting multiple organ systems, which can be at odds with a highly specialized and siloed U.S. healthcare system. Patients frequently see multiple specialists for diverse symptoms, creating substantial coordination challenges. We conducted a qualitative study using semi-structured interviews with 69 U.S. Mid-Atlantic adults diagnosed with or suspected of having Long COVID, recruited through a Long COVID clinic, MyChart patient-portal outreach, and snowball sampling. Interviews were conducted via Zoom, phone, or in person, audio-recorded, transcribed, and analyzed using the Framework Approach. Participants described significant difficulty navigating a fragmented healthcare system characterized by siloed care, communication breakdowns, long wait times, and unclear provider responsibilities, as well as difficulties obtaining a diagnosis. When coordination failed, patients were often forced to organize and direct their own healthcare, a task that was cognitively and physically taxing, particularly for those experiencing brain fog and fatigue, and, for some, ultimately led to delaying or forgoing care. Strengthening care coordination for Long COVID could reduce patient burden and improve access to care. Needed strategies include standardized diagnostic definitions, enhanced primary care roles, interoperable referral pathways, and institutional case conferencing to clarify provider responsibilities. Patient navigators, expanded telehealth options, and community-based support, especially culturally tailored services for disproportionately affected groups, may further reduce fragmentation, scheduling strain, and inequities. Addressing these systemic barriers is essential to creating a more efficient, patient-centered care experience in which patients are no longer responsible for coordinating their own complex care.