No abstract

Background Primary healthcare (PHC) providers are widely acknowledged for putting the most efficient and long-lasting efforts for addressing community health issues and promoting health equity. This study aimed to explore PHC providers’ experiences with coronavirus pandemic preparedness and response in Armenia. Methods We applied a qualitative study design using semi-structured in-depth interviews and structured observation checklists. Study participants were recruited using theoretical and convenience sampling techniques throughout Armenia. Inductive conventional content analysis was utilized to analyze the in-depth interviews. Nineteen in-depth interviews were conducted with 21 participants. Observations took place in 35 PHC facilities. The data collected during the observations was analyzed using the “SPSS22.0.0.0” software. Results Five main themes of primary healthcare providers’ experiences were drawn out based on the study findings: 1) the gap in providers’ risk communication skills; 2) uneven supply distributions; 3) difficulties in specimen collection and testing processes; 4) providers challenged by home visits; 5) poor patient-provider relationships. The results revealed that primary care providers were affected by uneven supply distribution throughout the country. The lack of proper laboratory settings and issues with specimen collection were challenges shaping the providers’ experiences during the pandemic. The study highlighted the health systems’ unpreparedness to engage providers in home visits for COVID-19 patients. The findings suggested that it was more challenging for healthcare providers to gain the trust of their patients during the pandemic. The study results also underlined the need for trainings to help primary care providers enhance their risk communication expertise or assign other responsible bodies to carry out risk communication on PHC providers’ behalf. Conclusion The study discovered that PHC providers have a very important role in healthcare system’s preparedness and response to handle public health emergencies such as the COVID-19 pandemic. Based on the findings the study team recommends prioritizing rural PHC development, ensuring appropriate supply distributions, developing comprehensive protocols on safe home visits and specimen collection and testing processes, and trainings PHC providers on risk communication, patient-centeredness, as well as proper use of personal protective equipment.

Background Competencies, knowledge and skills of health care professionals largely depend upon their education. Well-educated and competent midwives can improve women’s and infants’ health related outcomes. The current study evaluated the compliance of the current midwifery education system in Armenia with the global International Confederation of Midwives (ICM) standards. Methods The research team used a qualitative cross-sectional study design with deductive content analysis. Through purposeful sampling we recruited five nursing colleges providing midwifery education in Armenia; two in the capital city and three in different regions. The study population included midwifery students, faculty and administrative representatives of the selected colleges (n = 56). During fall 2018, we conducted observations of midwifery education textbooks and equipment and in-depth interviews and focus group discussions with participants. Results Despite widely used interactive teaching methodology and more than 60% of teaching time allocated for practical learning, students graduated from the program without obtaining essential competencies. Lack of teaching resources, especially in the regional colleges, and lack of quality clinical learning opportunities in hospitals were barriers for students to develop essential practical skills. Conclusions The study recommends the governmental bodies to ensure provision of equity-based distribution of finances and tangible resources between the capital city and regional nursing colleges. The practical component of midwifery education programs need substantial enhancement. Key messages The lack of teaching resources and access to hospital sites were barriers to obtaining essential competencies for midwifery students. In order to develop a sufficient professional skillset, midwifery education programs should arrange comprehensive and structured practical experience for students.

The worldwide uptake of COVID-19 vaccines was suboptimal throughout the pandemic; vaccine hesitancy played a principle role in low vaccine acceptance both globally and in Armenia. In order to understand the factors behind the slow vaccine uptake in Armenia, we aimed to explore the prevailing perceptions and experiences of healthcare providers and the general public related to COVID-19 vaccines. The study applied a convergent parallel mixed-methods study design (QUAL-quant) through in-depth interviews (IDI) and a telephone survey. We completed 34 IDIs with different physician and beneficiary groups and a telephone survey with 355 primary healthcare (PHC) providers. The IDIs found that physicians held variable views on the need for COVID-19 vaccination which, combined with mixed messaging in the media landscape, fueled the public’s vaccine hesitancy. The survey results were mostly consistent with the qualitative findings as 54% of physicians hypothesized that COVID-19 vaccines were rushed without appropriate testing and 42% were concerned about the safety of those vaccines. Strategies to improve vaccination rates must target the main drivers of hesitancy, such as physicians’ poor knowledge of specific vaccines and spiraling misconceptions about them. Meanwhile, timely educational campaigns with targeted messaging for the general public should address misinformation, promote vaccine acceptance, and empower their capacity to make decisions about their health.

Background Negative attitudes towards healthy eating behaviors are common among school-aged children. Given the scarcity of studies investigating eating behaviors among adolescents in Armenia, the current study sought to explore eating behaviors among high school students and assess the attitudes, norms and behaviors enhancing unhealthy food choices among them. Theory of Planned Behavior (TPB) was applied as a theoretical framework. Methods A qualitative study with focus group discussions and in-depth interviews was conducted using semi structured interview guides developed based on TPB framework. The study covered high school students aged 15-18 years old, their parents, teachers and school canteen staff, residing in cities and villages of Shirak province, Armenia. Direct content analysis with deductive approach was used for data analysis. Results The most preferred foods by the adolescents were fast foods, sweets, salads and sugar sweetened beverages. Taste was the most powerful attitudinal factor influencing their food choices. Friends and advertisements were the main role models affecting adolescents’ eating behaviors. Knowledge on unhealthy food choices and the consequences of unhealthy diet on one’s health were adequate among all participants, but unlike rural participants, this factor did not result in healthy eating behavior among urban participants. Lack of time, high cost of food, seasonal changes in food availability, limited food choices in school canteens and low coverage of schools with canteens, especially in the villages, had considerable impact on adolescent’s food choices. Conclusions According to the study results, most of the TPB constructs played role in shaping unhealthy eating behaviors among adolescents. Based on the findings, recommendations were made to conduct social advertising of healthy food choices and healthy eating behaviors among adolescents, empower school cafeterias and increase the coverage of schools with cafeterias. Key messages In Armenia, adolescents’ eating behaviors are mainly influenced by taste, availability, and affordability of food choices, eating behavior of peers and advertisements. Government needs to increase the coverage of schools with cafeterias and empower school cafeterias, so that they suggest healthy, tasty and affordable food choices.