Breast cancer is a leading cause of cancer-related death among women. Women with lower income, those living in rural areas and women of Black ethnicity are more likely to be diagnosed at advanced stages and have poorer survival outcomes. Reducing these inequities is an important public health priority. This study aimed to identify a cost-effective strategy for reducing breast cancer-related inequities and to evaluate the equity impact of the intervention across population subgroups.

We developed a novel individual-level microsimulation model to assess both the equity impact and cost-effectiveness of a community health worker-led education intervention in rural areas. The model, with annual cycles, simulated rural and urban breast cancer populations in South Africa using data from national and regional cancer datasets and followed individuals over a lifetime horizon. Costs were estimated from the provider perspective and outcomes included life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) compared with three willingness-to-pay thresholds (ZAR 58 018/ZAR 109 468/ZAR 328 408). Parameter uncertainty was explored using probabilistic sensitivity analysis. Equity impact was evaluated by estimating changes in age-standardised all-cause mortality across subgroups defined by place of residence (rural vs urban) and ethnicity (Black vs non-Black), using both absolute (rate differences) and relative (rate ratios) measures.

The intervention generated average gains of 0.35 life-years and 0.31 QALYs per patient across the breast cancer population. Inequities by residence decreased, with an absolute reduction of 229.65 per 1000 patients with breast cancer in the age-standardised mortality rate difference, and a relative reduction in the rate ratio of 0.80. By ethnicity, absolute and relative reductions of 110.26 per 1000 patients and 0.27, respectively, were observed between Black and non-Black populations. The intervention was cost-effective, with an ICER of ZAR 44 124 (I$6036) per QALY gained, which is below all three willingness-to-pay thresholds considered.

Community health worker programmes represent a cost-effective strategy to reduce breast cancer-related inequities. Their integration into national cancer control plans in low-income and middle-income countries should be prioritised and supported.

Non-communicable diseases (NCDs) are rapidly escalating in developing countries and social factors such as the dynamics of the family play an important part in the lifestyle choices that lead to the onset and maintenance of chronic illness. There remains a gap in Malaysia as the majority of the studies were focused on the normal population rather than directly towards persons having NCDs. This study aimed to examine emerging risk factors such as family functionality and its association with NCD.

A cross-sectional survey was conducted using a multistage random sampling method.

Urban residential areas in Selangor, Malaysia.

A total of 2542 adults residing in urban areas of Selangor were recruited.

Family functionality was measured using the APGAR (Adaptation, Participation, Gain or Growth, Affection and Resources) scale and multiple logistic regression was performed to measure the association between emerging risk factors and NCD.

The prevalence of diabetes mellitus and hypertension was 10.8% and 6.1%, respectively. Widowed/separated status (adjusted OR (AOR) 41.53, 95% CI 19.06 to 90.48, p value=0.001) was reported to be a predictor of diabetes. As for hypertension, familial functionality (AOR 4.2, 95% CI 1.11 to 14.50, p value

There is a growing concern that family functionality is an emerging risk factor for NCDs. Future family-centred health promotion programmes should be incorporated to improve self-management behaviours and health outcomes.

Workplace violence (WPV) is a significant occupational hazard in healthcare, negatively impacting healthcare workers’ (HCWs) mental health and quality of care. Psychosocial safety climate (PSC), an organisational factor emphasising psychological well-being, may influence how HCWs perceive, experience and cope with WPV. However, its role in shaping HCWs’ coping strategies remains underexplored. This study aims to examine the relationship between PSC and coping mechanisms among HCWs experiencing WPV in public hospitals.

This explanatory sequential mixed-method study comprises two phases. In Phase 1, a multicentre cross-sectional survey will be conducted among at least 440 HCWs working in Malaysian public hospitals that are selected through multistage random sampling. PSC, WPV exposure and coping mechanisms will be assessed using validated tools, including the Psychosocial Safety Climate (PSC-12) scale and the Brief Coping Orientation to Problems Experienced (Brief COPE) questionnaire. Linear regression will examine the association between PSC and coping mechanisms among HCWs exposed to WPV. In Phase 2, 6–12 HCWs with WPV experience in the past year and employed in high-PSC departments will be selected via criterion sampling with maximum variation for in-depth interviews. A semistructured interview guide based on the Transactional Model of Stress and Coping will be developed and pilot tested. Data will undergo thematic analysis until saturation is reached, identifying key themes on how PSC influences coping. Findings from both phases will be integrated using joint display analysis to inform PSC-driven interventions that promote coping and reduce WPV impacts among HCWs.

The study has been approved by the Ministry of Health Medical Research and Ethics Committees and Universiti Teknologi MARA Research Ethics Committee. Informed, written consent will be obtained from all participants. Findings will be disseminated to the Ministry of Health and through peer-reviewed publications.