Forced migrants (i.e., asylum seekers and refugees) experience greater mental health disparities and inequities in care. Mental health services and systems lack clear policy on integrated mental healthcare. Understanding the causal mechanisms of integrated mental health for migrants can promote a resilient and adaptive health and social care system. However, to achieve a functional mental health service integration, there is a need to understand how and why mental health system integration works and under what health systems conditions. The purpose of this realist review protocol will be to outline a process for refining an initial programme theory (IPT), developed through deliberative dialogues with key interest groups in British Columbia, Canada, and to test the IPT against the global evidence base.

A realist review is an interpretive methodological approach to synthesising the literature based on the realist philosophy of science. Realist reviews are pragmatic approaches to theory development because they involve the participation of real-world actors or people who work within complex systems. Realist reviews are particularly useful for synthesising complex knowledge. We plan to conduct a seven-step review process, with iteration between each step. Steps 1–3 have already been completed in our previous work and included the development of an IPT, which will be refined systematically by exploring the global literature and consulting with an international advisory group. These will be used iteratively to identify, test and refine the programme theory. The quality of included literature will be appraised using the relevance, richness and rigour criteria and the realist quality appraisal tool, TAPUPASM (transparency, accessibility, propriety, utility, purposiveness, accuracy, specificity and modified objectivity). Steps 4–7 will include data extraction and realist analysis through retroductive theorising using the ICAMO (intervention, context, actor, mechanism and outcome) heuristic to help distinguish actors and resources from contexts, mechanisms and outcomes.

Ethics approval for the deliberative dialogue interviews that inform this realist review and IPT were obtained by the University of British Columbia (ref: REB Number: H22-03195). Study recruitment occurred between 21 November 2023 and 16 January 2024. All participants provided informed consent to take part in deliberative dialogues and to have their interviews audio recorded and transcribed for the purpose of this research. We will disseminate results of the review through academic papers, conference presentations and through iterative interest group workshops and discussions.

CRD42024580083.

Health cadres, who assist midwives in supporting pregnant women in community settings, need to enhance their competencies in identifying risk factors and referring high-risk pregnant women to midwives for further care. Since the capabilities of these health cadres are influenced by maternal complications, an educational programme was implemented to strengthen their skills. Therefore, this study aimed to evaluate the competency of health cadres by providing a researcher-developed educational programme.

An open-label, cluster non-randomised controlled trial.

Health cadres with at least 1 year of work experience were recruited at six public health centres (PHCs) in Banjarnegara Regency, Indonesia.

Six PHCs were selected and allocated into intervention group (IG=3 PHCs) and control group (CG=3 PHCs) groups. A total of 133 female health cadres were enrolled across the selected PHCs. At each PHC, a systematic random sampling method was used to select the participants. The researchers and health professionals provided a 3-week period of theoretical and scenario-based simulations to the IG, while the CG received no education.

Researcher-developed questionnaires and checklists were used to assess the knowledge, skills (health assessment, communication, attitude) and confidence. The primary endpoint was competency, a total score of knowledge and skills. The outcome domains were compared between the two groups, and a linear mixed-effect model was used to account for cluster-level variation.

A total of 130 (97.7%) completed the study (IG:64, CG:66). The competency score showed significant improvement at endline (CG=49.5 and IG=52.5; p=0.002). The median scores for health assessment skills (CG=12 vs IG=14; p

Education effectively increased the competency of health cadres. A well-structured education programme is necessary for health cadres to improve and maintain their competencies in monitoring high-risk pregnant women.

NCT06134518.

We explored how key sociodemographic characteristics were associated with correct knowledge about antibiotics and antibiotic resistance (ABR) and appropriate usage of antibiotics from a One Health perspective among rural community members in Bangladesh.

Cross-sectional single-period survey.

Rural villages in Cumilla district, Bangladesh.

Eligibility criteria: aged ≥18. Across 50 clusters of villages, we approached 2160 community members and 2187 (98.8%) agreed to participate.

Primary outcomes: we collected two knowledge outcomes measuring the number of correctly answered binary/multiple-choice questions about (1) antibiotics and ABR and appropriate usage of antibiotics in relation to human illness and (2) antibiotics and ABR and appropriate usage of antibiotics in relation to animal health and the environment. Secondary outcomes: self-reported awareness of (1) antibiotics and (2) ABR.

Several sociodemographic characteristics were associated with variation in both knowledge outcomes. Education showed the strongest associations, with higher education levels associated with higher knowledge scores. For example, compared with having no formal/incomplete primary education, having higher education was associated with 10 percentage points (95% CI 8 to 12) and 6 percentage points (95% CI 3 to 8) higher mean knowledge scores for the knowledge outcomes 1 and 2, respectively. Having worked in the last month compared with not having worked was also weakly positively associated with both knowledge outcomes, and being female compared with being male was also weakly negatively associated with both knowledge outcomes.

Better public education is required to tackle ABR in Bangladesh but correct knowledge about antibiotics and ABR and appropriate usage of antibiotics in relation to humans, animals and the environment varies in relation to individuals’ education level, sex and working status. To maximise their effectiveness, interventions to tackle ABR must be flexible given recipients’ sociodemographic characteristics and pre-existing knowledge levels.

Rapid urbanisation in Bangladesh has posed significant challenges to the urban health system, particularly in the delivery of primary healthcare (PHC). The country’s PHC system is fragmented, involving public, non-government organization (NGO), private and informal providers, leading to inequitable access, high out-of-pocket expenditure and inefficiencies. Strategic purchasing, which links resource allocation to health priorities and outcomes, offers a potential pathway to strengthening urban PHC systems. This study aims to assess the current urban PHC system, examine stakeholders’ perspectives on the feasibility of strategic purchasing, understand community health needs and preferences and develop a policy framework for strategically purchasing PHC services in urban settings.

This study will follow a sequential mixed-methods approach, integrating qualitative and quantitative data. A scoping review will be conducted to assess the characteristics and funding modalities of the existing urban PHC purchasing mechanisms. Key informant interviews with stakeholders, including policy makers and health experts, will explore the strengths and challenges of the current urban PHC system and the feasibility of implementing strategic purchasing. Community healthcare needs and preferences will be examined through in-depth interviews (IDIs), focus group discussions (FGDs) and a discrete choice experiment (DCE) survey in urban informal settlements. Insights from IDIs and FGDs will inform the DCE survey, which will present hypothetical scenarios to participants to identify the most important attributes for improving PHC services. Qualitative data will be coded deductively and inductively, and DCE data will be analysed using latent class models, with sensitivity analyses conducted using the multinomial logit model. Findings will contribute to the development of a strategic purchasing framework, validated through consultation workshops with health system stakeholders.

Ethical approval has been obtained from the ethics committees in both Bangladesh and the UK. Findings will be disseminated through workshops, peer-reviewed publications, policy briefs and conference presentations.