After redevelopment and demarginalization throughout the past half century, this study investigates the current prevalence of anaemia and its aetiologies among adolescents of indigenous (Orang Asli) people in two different types of settlement in Malaysia: (i) Inland Jungle Villages (IJV) and (ii) Resettlement Plan Scheme (RPS). This is a preliminary report of 176 participants (IJV: 55; RPS: 121) out of the 404 targeted for the entire study. The present study employed interviewer-administered questionnaires, a 24-hour dietary recall, anthropometric measurements, blood and stool sample collection. The association between individual variables and anaemia between different Orang Asli (OA) settlements was determined using univariate and multivariate logistic regression analyses. This study found that the prevalence of anaemia among OA adolescents was 35.2% overall, with 40.0% of IJV adolescents and 33.1% of RPS adolescents being anaemic, respectively. IDA is responsible for 67.7% of anaemia cases, particularly those older than 13 and of the female gender. RPS adolescents suffering from IDA at a slightly higher rate (70.0%) than IJV adolescents (63.6%). This study also revealed that 17.6% of OA adolescents are affected by thalassemia and 8.5% by hereditary Southeast Asian ovalostomatocytosis, which is substantially higher than our national data. Significant predictors of betel consumption with anaemia exist in the IJV [aOR: 24.070 (95% CI: 1.828, 31.693); p = 0.016]. In the case of RPS, low household income is a significant predictor of anaemia [aOR: 2.520 (95% CI: 1.029, 6.173); p = 0.043]. According to current findings, the RPS has yielded conflicting results, with an improvement in overall anaemia among OA adolescents but IDA still prevalent in this community. Despite government’s effort to enhance the quality of life of the indigenous OA, a more robust tailor-made intervention focusing on this indigenous in combating anaemia is warranted.

Few studies have examined the association between physical activity or posture and hospitalization or mortality for older adults residing in living residences. This prospective cohort study surveyed the physical activity and posture time of older adults using ActivPAL(accelerometer) and their outcomes. These participants resided in two assisted living residences in Japan and received home medical management. Those patients were enrolled between July 2, 2020, and June 30, 2021, and followed up for 2-2.5 years. ActivPAL was attached to the thigh and trunk of the patients for 4 full days to distinguish their physical activity and posture. The primary composite outcome was all-cause of hospitalization and death. A total of 35 residents (mean age:89.1 years) participated in this study (median survival time:604 days). The participants had a mean of 6.2 comorbidities. The mean values of daily physical activity and daily posture time for all participants were 1599.0 steps and 175.4 min upright posture time including standing and stepping time. A log-rank test showed significantly higher risks of hospitalization or death in participants who spent a mean daily upright time of less than 180 minutes compared with participants who spent 180 minutes or more. A Cox proportional hazards model adjusted with age showed the participants who spent a mean daily upright time of less than 180 minutes indicated significantly higher risks of hospitalization or death compared with those who spent 180 minutes or more (HR, 3.7 95%CI: 1.2-11.3). We explored the association between physical activity or posture and composite outcomes including all-cause of hospitalization and death for older adults residing in assisted-living residences. A mean daily upright time of less than three hours might be a higher risk of suspension of their daily life in the facility.

Background: Promoting evidence-based antibiotic prescribing through successful antimicrobial stewardship are critical to preserve the effectiveness of antibiotics for common infections in primary care. This requires a coordinated multidisciplinary effort. Although South Africa has shown much progress with major shifts in policy towards combatting antibiotic resistance, there is limited published research and evaluation of antibiotic prescribing in primary care, especially in the public sector.

Aim: To assess the implementation of a novel pharmacist-prescriber partnership (PPP) to track and optimise antibiotic prescribing for patients presenting with acute cough in publicly funded primary healthcare clinics in the Cape Town Metropole, South Africa.

Methods: A pharmacist-driven quality improvement study with prospective observational data collection for acute cough and real-time feedback for prescribers through the clinic mobile phone messaging platform (WhatsApp). The primary outcome is a change in guideline concordant antibiotic prescribing for acute cough. Secondary outcomes are subsequent contacts with health services and hospital admission within 7 days of the initial consultation.

Results: Interim findings presented here which will be updated for WONCA World. Eight out of every ten patients were prescribed an antibiotic for ‘acute cough’ (n=405). A clinical diagnosis of community-acquired pneumonia was the top clinical indication for which an antibiotic was prescribed (40%). Our real-time messaging feedback was used in 47% of cases with relatively high agreement with the local prescribing guidance (94%).

Implications: This prospective study provides key data to accurately assess what problems there are in terms of access to, and excess of, antibiotics in socioeconomically disadvantaged communities across the Cape Metro region. This is critical to inform a benchmark for evidence-based initiatives around antimicrobial stewardship and future collaborations around the clinical and cost-effectiveness of point-of-care testing for acute cough.

Socio-cultural characteristics of participants in health service research demonstrate poor representation of underserved populations despite such populations having higher prevalence of health conditions and worse outcomes. So how did ‘the inverse research law’ arise?

The homogenous academic community in high-income countries does not reflect multicultural societies and contributes to distrust, particularly amongst ethnic minority and indigenous populations, that were subjected to historical, unethical, exploitative research practice. Metrices-driven research recruitment policies have dominated research delivery for decades. This research team also suggests that convenience sampling of highly health literate participants and perceived research efficiency (easier recruitment, low attrition) have been prioritised over research rigor ( representative sampling) and research justice

This study aimed to explore how auto-ethnographic reflection-on-action within our team engendered collective, reflective research practice which challenged intersectional discrimination in research and supported inclusion of underserved populations

Autoethnography is a methodological approach whereby the researcher connects personal experiences to contextual cultural, political, and social meanings and understandings. Reflecting on experiences across five qualitative and mixed methods research case studies with underserved populations, the authors wrote reflexively about how their positionality influenced study design , participant recruitment, data interpretation and team culture. Themes from these reflexive accounts were discussed in a focus group of 6 researchers using a participatory, reflection-on-action approach and drawing on theory around participatory research in order to generate a final thematic framework and recommendations.

Key insights:
We integrated policy documentary analysis and experiential evidence relevant to inclusive and reflective research practice. A 'roadmap' of methodological recommendations to support inclusion-by- study design of under-represented populations will be presented . The recommendations are underpinned by theory, including Arnstein's 'Ladder of Participation' (1969), and describe how rebalancing power between the researcher and the researched might achieve greater research equity and justice

Background: Primary care research requires primary care providers' (PCPs) participation. Several strategies have been proposed to recruit PCPs into research projects, however little is known about the impact of these strategies, especially with limited financial resources.
Objective: To assess the impact of a recruitment strategy in a research study inviting PCPs to assess their clinic’s primary care attributes.
Methods: Community-based participatory research approaches were used. Researchers partnered with the Metropolitan Southwest Health Service of Santiago, Chile, which oversees the health service delivery of nine cities, including a total of 32 primary care clinics. A two-phase recruitment process was designed and implemented sequentially to engage PCPs: 1) Indirect, through clinic directors, and 2) Direct, with direct PCP invitations from the research team. Sub-strategies of the indirect recruitment approach included: 1.a) Personal meeting with the clinic director, 1.b) Email from researchers, 1.c) Email from the Health Service, and 1.d) Reminder email from researchers. Direct recruitment sub-strategies included: 2.a) Personalized email to PCPs, and 2.b) Reminders (up to 9). Indirect recruitment sub-strategies were implemented weekly, while direct recruitment sub-strategies were implemented every other day. The number of enrolled PCPs was registered for each strategy.
Results: One City Health Department (with 6 primary care clinics), and three clinic directors declined participation. A total of 553 participants were recruited from 1,049 eligible PCPs from the 23 participating clinics (52.7%), ranging between 34.1% and 88.6% of clinic PCPs. Indirect recruitment strategies allowed enrolling 167 PCPs (15.9%), while direct recruitment strategies enrolled 386 PCPs (43.8%). The impact of the different recruitment strategies differed between primary care clinics.
Conclusion: A two-phase sequential recruitment process allowed enrolling a large sample of Chilean PCPs in a research project without a significant financial burden on the project.
Funding: This project was funded by the Fondo Nacional de Investigacion en Salud #SA19I0202.

1. Primary care providers are essential participants in primary care research.
2. Several strategies have been used to recruit primary care providers in research.
3. A two-phase recruitment strategy enabled recruiting more than half of eligible providers in a research study including 32 primary care clinics.

Background: A strong primary care system is associated with population health outcomes. The Primary Care Assessment Tool (PCAT) was developed to measure primary care functioning from patient and provider perspectives. Although relevant to have both perspectives, frequently these evaluations are not integrated.
Objective: To report patient-provider concordance assessing primary care attributes.
Method: Primary care attributes were measured in 23 primary care clinics in Santiago, Chile. Patients and providers were invited to complete the Chilean version of the PCAT, measuring primary care attributes, including first contact access and utilization, ongoing care, coordination with specialists, comprehensiveness of service available and provided/received, family-centeredness, community orientation, and cultural competency. Attribute and overall scores were calculated for each participant type at each clinic. Concordance between patient and provider perceptions was explored using several strategies: 1) Statistical: a) Pearson correlations, b) discrepancy scores (the difference between patient and provider perceptions), and c) four discrepancy and concordance categories (concordance on high scores, concordance on low scores, discordance with patients reporting higher scores than providers, and discordance with providers reporting higher scores than patients); and 2) Graphical: using bar and spider graphs.
Results: A total of 1,360 patients and 504 providers completed PCAT assessments for the 23 primary care clinics. Score concordance was only observed for the attribute coordination with specialists. Perceptions of all other primary care attributes diverged between patients and providers.
Conclusion: Low concordance between patient and provider perceptions of primary care attributes was observed. Future studies should assess the impact of these perceptions on health indicators and the different strategies to better understand the meaning and impact of patient and provider assessment discrepancies.
Funding: This project was funded by the Fondo Nacional de Investigacion en Salud #SA19I0202.

1. The Primary Care Assessment Tool evaluates primary care attributes from patients' and providers' perspectives.
2. Patient and provider perspectives of primary care attributes diverged in a Chilean sample using several strategies to assess convergence and divergence of findings.
3. Future studies should assess the significance of these findings.