From the literature

INTRODUCTION: Despite being recognised as a critical component of high-quality care, shared decision-making is still not consistently achieved during childbirth. TeamBirth is a care process developed to promote intrapartum teamwork and shared decision-making, adapted to the Swedish context and implemented in two labour wards. This study aims to explore how care providers engage women and their partners in intrapartum decision-making during the implementation of the adapted Swedish version of TeamBirth. METHODS: A qualitative design, based on 23 observations comprising 79 huddles, and 65 interviews with the care providers involved, was used. Data were collected April 2022 - June 2023, and analysed deductively using directed content analysis, guided by the Conceptual Framework for Patient and Family Engagement in Healthcare. RESULTS: Four levels of engagement were found. No Engagement involved care providers giving instructions without explanations. Providing Information entailed brief updates followed by instructions, with limited opportunities for questions. Involvement, the most common level, included discussions and planning with women and their partners, although final decisions were made by care providers. Partnership and Shared Leadership, the least observed level, was characterised by dialogue and joint decisions. Barriers for engagement included limited Swedish proficiency, high workload, and critical situations, whereas continuous support, effective pain management, and use of the TeamBirth care process were enabling factors. CONCLUSIONS: Engagement in decision-making occurred on a continuum, with modifiable factors including workload, continuous support, and use of TeamBirth. Although conducted during the implementation of a care process designed to improve engagement, Partnership and Shared Leadership remained the least observed level.

IntroductionScreening for lung, breast, and cervical cancer can reduce morbidity and mortality by enabling earlier detection and treatment. However, participation remains below target levels, particularly among individuals experiencing marginalization. While primary care providers (PCPs) can play a key role in improving screening uptake, few reviews have focused on interventions targeting individuals experiencing marginalization that are aimed at PCPs, delivered by PCPs, or that occurred in a primary care setting.MethodsThe aim of this scoping review was to examine the extent and types of PCP interventions implemented to increase lung, breast, and cervical cancer screening uptake among individuals experiencing marginalization and identify gaps to inform future practice and research. We searched for studies of PCP interventions aimed at increasing lung, cervical, and/or breast cancer screening among marginalized populations in Ovid MEDLINE, Ovid Embase, Scopus, EBSCO CINAHL Complete and Ovid EBM Reviews - Cochrane Central Register of Controlled Trials from 2000 to March 31, 2022. Title, abstract, and full-text articles were screened, and data extraction was performed by three independent reviewers. The charted data were summarized using narrative synthesis.ResultsForty-two studies were included: 13 for cervical cancer, 15 for breast cancer, one for lung cancer, and 13 on multiple cancer sites. Interventions included education (for both patients and PCPs), self-collected human papillomavirus (HPV) testing, patient navigation, clinic system tools, event-based, and multicomponent. Increases in screening rates were observed across various intervention types for breast and cervical cancer, with multi-site interventions evaluated based on their reported effects on breast and cervical cancer screening independently.ConclusionsEducational interventions demonstrated the greatest effectiveness for breast cancer screening, and self-collected HPV testing demonstrated the greatest effectiveness for cervical cancer screening. There is a clear gap in the literature regarding interventions aimed at increasing lung cancer screening participation, and further research is needed to evaluate the effectiveness of such interventions. Screening programs and PCPs should consider targeted strategies to support greater participation among individuals experiencing marginalization.

INTRODUCTION: Rabies remains a persistent public health threat in India, while gaps in surveillance and coordination of control measures undermine progress towards ending human rabies deaths. The WHO advocates a One Health approach, combining mass dog vaccination, postexposure prophylaxis (PEP) and Integrated Bite Case Management (IBCM). IBCM is not yet incorporated into India's national rabies action plan for rabies elimination. This study seeks to generate robust evidence on the effectiveness, cost-effectiveness, feasibility, facilitators and barriers of IBCM implemented within Kerala's Rabies Control Programme. METHODS AND ANALYSIS: This implementation research adopts a stepped-wedge cluster randomised controlled trial (RCT) design. IBCM will be implemented across six administrative blocks in Thiruvananthapuram District, Kerala, across diverse rural and urban settings and including tribal population representation. The IBCM intervention includes stakeholder training and support and active animal surveillance aligned with WHO guidance. Suspect or probable rabies exposures presenting at selected health facilities will be identified via a community-based hotline. This will trigger investigations and responses including dog vaccination and sensitisation. Prior to IBCM implementation, baseline data will be collected on management of dog bites, bite patient incidence and healthcare seeking behaviours. Hospital-based event tracking of bite cases will be conducted at enrolled public health facilities before and during IBCM implementation. The resulting RCT data will be used to model the impacts and cost-effectiveness of IBCM, including the potential for cost savings through judicious PEP if scaled across Kerala. To understand the barriers and facilitators to IBCM implementation, we will use in-depth interviews and focus group discussions with stakeholders.There is an urgent need to strengthen rabies surveillance, including coordination across health and animal health sectors and outbreak responses to accelerate rabies elimination. IBCM is expected to lead to improved PEP completion, increased detection and laboratory confirmation of rabid dogs, strengthened dog vaccination coverage and targeted outbreak responses in high-risk areas. This RCT will provide critical evidence to inform policy, support scale-up, generate insights into contextual barriers and facilitators for IBCM implementation, and guide India's One Health rabies elimination strategy. This study will evaluate a health-sector-initiated IBCM approach that identifies cases through dog-bite patients presenting to health facilities, supporting comprehensive One Health integration and improved patient care. ETHICS AND DISSEMINATION: The study was approved by WHO Ethics Committee (2024.9.Ind), Kerala University of Health Sciences (AX04/SOP07A/V2) and the ethics committee of Government Medical College, Thiruvananthapuram (HEC No.12/06/2024/MCT); informed written consent will be obtained from all participants, analysis will be limited to de-identified data, and findings will be disseminated through peer-reviewed publications and policy-relevant platforms. TRIAL REGISTRATION NUMBER: CTRI/2024/08/073117.