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Volume 10, Issue 2 (2022)
Health Educ Health Promot 2022, 10(2): 385-393 |
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History
Received: 2022/04/29 | Accepted: 2022/06/15 | Published: 2022/06/20
Received: 2022/04/29 | Accepted: 2022/06/15 | Published: 2022/06/20
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Attitudes and Practices regarding Occupational Hazards among a Sample of Medical and Paramedical Staff in Baghdad Governorate. Health Educ Health Promot 2022; 10 (2) :385-393
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f- Graphical presentation by using: ![src=./files/hehp/images/HTML_Publish/61903/61903-T_1.PNG]()
Table 2) Summary statistics of health care provider's attitudes toward occupational hazards
![src=./files/hehp/images/HTML_Publish/61903/61903-T_2.png]()
Table 3) Summary statistics of health care provider's practices toward occupational hazards
![src=./files/hehp/images/HTML_Publish/61903/61903-T_3.png]()
Continue of Table 3) Summary statistics of health care provider's practices toward occupational hazards
![src=./files/hehp/images/HTML_Publish/61903/61903-T_3(2).PNG]()
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Introduction
Hazards are an intrinsic characteristic of a material, agent, source of power, or circumstance that has the potential to generate undesirable consequences, whereas risk is the probability that damage to “life, health, and environment” that could arise from hazard, Occupational hazards in this context, are workplace reactions that can produce or raise the risk of harm or illness [1, 2].
Occupational hazards refer to any activities that have a possible cause or increase the risk in the workplace [2], The multiplying effects of occupational injuries and diseases among providers of health care include economic loss, physical loss, and psychological disorders such as depression and stress. Consequently, these have a negative effect on the employees, their families, and the nation at large [3].
World Health Organization categorizes the hazards in health care facilities (HCF) as physical, biological, mechanical, ergonomic, chemical, and psycho-social. Occupational illnesses and injuries among health care workers (HCW) are among the greatest in any industry, according to earlier studies, yet they might be lowered or eliminated [4].
Occupational hazards among hospital staff, Lifting, pushing, or dragging patients to beds, chairs, and toilets can cause injuries, work-related stress, and low back discomfort in hospital employees [5].
Furthermore, the high incidence and burden of occupational hazards also include blood-borne diseases such as hepatitis B and human immuno-deficiency virus (HIV) infection since being exposed to infectious sharp objects such as needle stick injuries, scalpel blades, shattered glass, and taking samples of blood, as well as connecting or removing needles from sick people [6-8].
Because workplace accidents do not occur on purpose, they must be studied extensively and openly discussed when they occur. These must be considered as a source of knowledge that produces attitude and information because events offer the opportunity for learning and knowledge formation in preparation for future events [7-9].
An increasing prevalence of occupational hazards may also deteriorate the overall facility climate and the efficiency of patient care provided by healthcare staff [10].
In the developing world, occupational health risks are frequent, particularly as they relate to job overload, the inadequacy of task control, and role conflicts. Other reasons include inefficient administration, unequal management methods, and human and economic aspects, staff behaviors and practices have significant consequences in terms of care settings such as psychosocial, physical, chemical, mechanical, and biological risk [11].
According to a study conducted in Palestine, a disproportionately high number of needlestick injuries is caused by inadequate practices such as incorrect nurse vaccination and violations of infection control guidelines at work [12].
In addition, due to a lack of awareness of suitable post-injury treatments and the assumption that the source was not contagious, health personnel fail to take preventive measures to reduce the occurrence of further losses [13].
Data on awareness of safety procedures and work-related dangers and hazards among healthcare workers and their methods remain poor in most poor and developing countries [14].
attitudes and practices' impacts do not overlook the role of working environment elements such as temperature, humidity, lighting, noise, and housekeeping on performance levels. Each of these factors can impair employees' cognitive abilities, such as concentration, awareness, reasoning, judgment, and so on, making them more vulnerable to occupational accidents [15, 16].
In a recent research study, the healthcare staff made it clear that training programs and functional advanced education would offer them a comprehensive indication of the essential skills and knowledge required to deal with occupational hazards, Preventing injury from occupational hazards in a healthcare setting entails preventing work-related associated risks and enhancing health-care conditions [17], and making emergency care available to all levels of health workers, and having occupational dangers and hazards related to safety practices [18].
The aim of the study was to identify the levels of attitudes and practices of medical and paramedical staff, and determine the association of different demographic variables of medical and paramedical staff with attitudes and practices regarding occupational hazards in their workplaces.
Instrument and Methods
Descriptive cross-sectional study, in which The data collection continued for more than 4 months starting on 3rd December 2021 and ending on 10th March 2022, with 7 days a week of sample data collection during this period, The interview of each participant for the entire questionnaire took about approximately 15 minutes, the study was done at Baghdad governorate, which is the capital and biggest city in Iraq, Its estimated population in 2019 was 8,340,711 people [19], 2 hospitals and one health center from each of the three health directorates that are located in Baghdad. The sample number was 485 participants, (184 Medical staff and 301 Paramedical staff) selected randomly from the selected places of study. The study population consists of all the medical and paramedical staff who works in Baghdad governorate health directorates which were 485 and the sample size was estimated using the Raosoft sample size calculator, by using this calculation, the total sample was 382 participants. We add 25% (95.5) to ensure compensation for the loss or refusal to participate by some respondents, so the total number becomes 382+95.5=477.5 ≈ 485 to more accurate. Inclusion criteria included the Medical and paramedical staff from both genders in selected hospitals and health centers from AL-Karkh, AL-Rusafa, and Medical City Health Directorates, While the exclusion criteria included any Visiting or rotating physicians from other departments and medical and paramedical staff that are not cooperative or not willing to participate.
The study instrument used to gather the information about attitudes and Practices of medical and paramedical staff was a structured questionnaire that the researcher developed depending on previous studies [20, 21] and modified, The questionnaire was divided into 3 sections.
-Demographic and socio-economic concerning demographic and socio-economic data contain 13 items including age, gender, years of experience, educational level, health care specialty, Residence, Marital Status, number of Family members, Property, Department (Working area), and Years of experience.
-Attitudes of medical and paramedical staff contain 16 questions, evaluated by setting five Likert scales (Strongly Disagree, Disagree, Undecided, Strongly agree) with integer numbers (1, 2, 3, 4, 5) respectively, evaluation intervals are symbolized due to relative sufficiency statistic for the attitudes items by 20.00-46.66 for poor; 46.67-73.33 for an accepted; and 73.34-100 for the good evaluations.
-Practices of medical and paramedical staff contains 31 questions practices domain evaluated by setting three Likert scales (Never, Sometimes, and Always) with integer numbers (1, 2, 3) respectively, evaluation intervals are symbolized due to relative sufficiency statistic by (33.33-55.55 for poor; 55.56-77.77 for an accepted and 77.78– 100 for the good evaluations.
Reliability of the questionnaire was used to determine the accuracy of the questionnaire since the results showed a very high level of stability and internal consistency of the studied items of the applied questionnaire (α=0.88).
The statistical data analysis approaches were used to analyze and assess the results of the study under the application of the statistical package (SPSS) ver. 21.0:
Descriptive data analysis:
Hazards are an intrinsic characteristic of a material, agent, source of power, or circumstance that has the potential to generate undesirable consequences, whereas risk is the probability that damage to “life, health, and environment” that could arise from hazard, Occupational hazards in this context, are workplace reactions that can produce or raise the risk of harm or illness [1, 2].
Occupational hazards refer to any activities that have a possible cause or increase the risk in the workplace [2], The multiplying effects of occupational injuries and diseases among providers of health care include economic loss, physical loss, and psychological disorders such as depression and stress. Consequently, these have a negative effect on the employees, their families, and the nation at large [3].
World Health Organization categorizes the hazards in health care facilities (HCF) as physical, biological, mechanical, ergonomic, chemical, and psycho-social. Occupational illnesses and injuries among health care workers (HCW) are among the greatest in any industry, according to earlier studies, yet they might be lowered or eliminated [4].
Occupational hazards among hospital staff, Lifting, pushing, or dragging patients to beds, chairs, and toilets can cause injuries, work-related stress, and low back discomfort in hospital employees [5].
Furthermore, the high incidence and burden of occupational hazards also include blood-borne diseases such as hepatitis B and human immuno-deficiency virus (HIV) infection since being exposed to infectious sharp objects such as needle stick injuries, scalpel blades, shattered glass, and taking samples of blood, as well as connecting or removing needles from sick people [6-8].
Because workplace accidents do not occur on purpose, they must be studied extensively and openly discussed when they occur. These must be considered as a source of knowledge that produces attitude and information because events offer the opportunity for learning and knowledge formation in preparation for future events [7-9].
An increasing prevalence of occupational hazards may also deteriorate the overall facility climate and the efficiency of patient care provided by healthcare staff [10].
In the developing world, occupational health risks are frequent, particularly as they relate to job overload, the inadequacy of task control, and role conflicts. Other reasons include inefficient administration, unequal management methods, and human and economic aspects, staff behaviors and practices have significant consequences in terms of care settings such as psychosocial, physical, chemical, mechanical, and biological risk [11].
According to a study conducted in Palestine, a disproportionately high number of needlestick injuries is caused by inadequate practices such as incorrect nurse vaccination and violations of infection control guidelines at work [12].
In addition, due to a lack of awareness of suitable post-injury treatments and the assumption that the source was not contagious, health personnel fail to take preventive measures to reduce the occurrence of further losses [13].
Data on awareness of safety procedures and work-related dangers and hazards among healthcare workers and their methods remain poor in most poor and developing countries [14].
attitudes and practices' impacts do not overlook the role of working environment elements such as temperature, humidity, lighting, noise, and housekeeping on performance levels. Each of these factors can impair employees' cognitive abilities, such as concentration, awareness, reasoning, judgment, and so on, making them more vulnerable to occupational accidents [15, 16].
In a recent research study, the healthcare staff made it clear that training programs and functional advanced education would offer them a comprehensive indication of the essential skills and knowledge required to deal with occupational hazards, Preventing injury from occupational hazards in a healthcare setting entails preventing work-related associated risks and enhancing health-care conditions [17], and making emergency care available to all levels of health workers, and having occupational dangers and hazards related to safety practices [18].
The aim of the study was to identify the levels of attitudes and practices of medical and paramedical staff, and determine the association of different demographic variables of medical and paramedical staff with attitudes and practices regarding occupational hazards in their workplaces.
Instrument and Methods
Descriptive cross-sectional study, in which The data collection continued for more than 4 months starting on 3rd December 2021 and ending on 10th March 2022, with 7 days a week of sample data collection during this period, The interview of each participant for the entire questionnaire took about approximately 15 minutes, the study was done at Baghdad governorate, which is the capital and biggest city in Iraq, Its estimated population in 2019 was 8,340,711 people [19], 2 hospitals and one health center from each of the three health directorates that are located in Baghdad. The sample number was 485 participants, (184 Medical staff and 301 Paramedical staff) selected randomly from the selected places of study. The study population consists of all the medical and paramedical staff who works in Baghdad governorate health directorates which were 485 and the sample size was estimated using the Raosoft sample size calculator, by using this calculation, the total sample was 382 participants. We add 25% (95.5) to ensure compensation for the loss or refusal to participate by some respondents, so the total number becomes 382+95.5=477.5 ≈ 485 to more accurate. Inclusion criteria included the Medical and paramedical staff from both genders in selected hospitals and health centers from AL-Karkh, AL-Rusafa, and Medical City Health Directorates, While the exclusion criteria included any Visiting or rotating physicians from other departments and medical and paramedical staff that are not cooperative or not willing to participate.
The study instrument used to gather the information about attitudes and Practices of medical and paramedical staff was a structured questionnaire that the researcher developed depending on previous studies [20, 21] and modified, The questionnaire was divided into 3 sections.
-Demographic and socio-economic concerning demographic and socio-economic data contain 13 items including age, gender, years of experience, educational level, health care specialty, Residence, Marital Status, number of Family members, Property, Department (Working area), and Years of experience.
-Attitudes of medical and paramedical staff contain 16 questions, evaluated by setting five Likert scales (Strongly Disagree, Disagree, Undecided, Strongly agree) with integer numbers (1, 2, 3, 4, 5) respectively, evaluation intervals are symbolized due to relative sufficiency statistic for the attitudes items by 20.00-46.66 for poor; 46.67-73.33 for an accepted; and 73.34-100 for the good evaluations.
-Practices of medical and paramedical staff contains 31 questions practices domain evaluated by setting three Likert scales (Never, Sometimes, and Always) with integer numbers (1, 2, 3) respectively, evaluation intervals are symbolized due to relative sufficiency statistic by (33.33-55.55 for poor; 55.56-77.77 for an accepted and 77.78– 100 for the good evaluations.
Reliability of the questionnaire was used to determine the accuracy of the questionnaire since the results showed a very high level of stability and internal consistency of the studied items of the applied questionnaire (α=0.88).
The statistical data analysis approaches were used to analyze and assess the results of the study under the application of the statistical package (SPSS) ver. 21.0:
Descriptive data analysis:
a- Tables (Frequencies, and Percentages) with Arithmetic mean, and standard deviation (SD).
b- Where relative sufficiency (RS%) is calculated by:
![src=./files/hehp/images/HTML_Publish/61903/61903-Formula_1.PNG]()
c- Transformed studied domains for screening estimators grand and global mean of the score of overall assessments through transforming the recorded responses of each period in quantitative measure scale using percentile transformation technique by applying:
![src=./files/hehp/images/HTML_Publish/61903/61903-Formula_2.PNG]()
d- Reliability Coefficient for the Pilot study through using Al-Naqeeb Formula [*]:
![src=./files/hehp/images/HTML_Publish/61903/61903-Formula_3.PNG]()
e- Alpha Cronbach (α) for the reliability of the questionnaire (Internal consistency).
Where ;
![src=./files/hehp/images/HTML_Publish/61903/61903-Formula_4.PNG]()
Where; K is the number of items (questions) and
Where; K is the number of items (questions) and
f- Graphical presentation by using:
• Bar Charts.
• Cluster Bar Charts.
Inferential data analysis:
These were used to accept or reject the statistical hypotheses, which included the following: One sample Chi-Square test, Binomial test for testing the difference of distribution of the observed frequencies, Contingency Coefficients test.
Findings
The mean age of participants was 32.29±8.93. Table 1 shows distribution of studied health care provider's socio-demographical characteristics and distribution of the studied Sample according to Departments (Working Area) showing their observed frequencies and cumulative percent, Health care providers from the “medical technician” specialty of the sample size are formed 99 (20.4%) then followed by nurse specialty with 98 (20.2%), for “Residency” variable, urban residents formed 429 (88.5%), as well as “Educational Levels” showed that most of studied health care providers are graduated institute, regarding bachelor's degrees since they are accounted 274 (56.5%), and then for “Marital Status” the married formed 275 (56.7%), while single status are formed 190 (39.2%), as for “Years of Experience”, more than half of studied health care providers with (1-5) years of experience represented by the first group, and finally “Working overtime”, results shows more than half of studied health care providers who hadn’t work overtime, and they are accounted 266 (54.8%).
Table 2 shows statistics for “Health care Provider's Attitudes toward occupational hazards from a point of view's medical and paramedical staff” among sampling population hospitals and Health care Centers in Baghdad governorate.
Table 3 shows a summary statistic for “medical and paramedical staff Practices toward occupational hazards among sampling population hospitals and Health care Centers in Baghdad governorate.
Results that observed the most responses regarding of preceding domain had a “Good” evaluation and are assigned 28 (87.5%) items, and an “Accepted” evaluation are assigned 1 (3.23%), and the leftover items has a “Poor” evaluation 2 (6.45%).
These were used to accept or reject the statistical hypotheses, which included the following: One sample Chi-Square test, Binomial test for testing the difference of distribution of the observed frequencies, Contingency Coefficients test.
Findings
The mean age of participants was 32.29±8.93. Table 1 shows distribution of studied health care provider's socio-demographical characteristics and distribution of the studied Sample according to Departments (Working Area) showing their observed frequencies and cumulative percent, Health care providers from the “medical technician” specialty of the sample size are formed 99 (20.4%) then followed by nurse specialty with 98 (20.2%), for “Residency” variable, urban residents formed 429 (88.5%), as well as “Educational Levels” showed that most of studied health care providers are graduated institute, regarding bachelor's degrees since they are accounted 274 (56.5%), and then for “Marital Status” the married formed 275 (56.7%), while single status are formed 190 (39.2%), as for “Years of Experience”, more than half of studied health care providers with (1-5) years of experience represented by the first group, and finally “Working overtime”, results shows more than half of studied health care providers who hadn’t work overtime, and they are accounted 266 (54.8%).
Table 2 shows statistics for “Health care Provider's Attitudes toward occupational hazards from a point of view's medical and paramedical staff” among sampling population hospitals and Health care Centers in Baghdad governorate.
Table 3 shows a summary statistic for “medical and paramedical staff Practices toward occupational hazards among sampling population hospitals and Health care Centers in Baghdad governorate.
Results that observed the most responses regarding of preceding domain had a “Good” evaluation and are assigned 28 (87.5%) items, and an “Accepted” evaluation are assigned 1 (3.23%), and the leftover items has a “Poor” evaluation 2 (6.45%).
Table 1) Distribution of the studied health care provider's socio-demographical characteristics variables with comparisons significant
Table 2) Summary statistics of health care provider's attitudes toward occupational hazards
Table 3) Summary statistics of health care provider's practices toward occupational hazards
Continue of Table 3) Summary statistics of health care provider's practices toward occupational hazards
To find out relationships between redistribution of medical and paramedical staffs' responses regarding studied main domains: Attitudes, and Practices, as well as overall domains in admixed form through a cutoff point (≤ Md, and > Md), and studied health care provider's socio-demographical characteristics, and some others relate variables, Table 4 shows the statistics of relationships by estimating a contingency coefficients values and testing their significant levels. Results show that regarding the subject of (Attitudes) an overall main domain responding, results observed a weak relationship since no signs are accounted for at p>0.05 variables with socio-demographical characteristics and some related variables.
Concerning subjects of Practices, an overall main domain result observed strong relationships due to the significant levels with Department (Working area), and Socio-Economic Status) only, since significant relationships are accounted in at least at p<0.05.
Table 4) Relationships between subjects' attitudes and practices with their socio-demographical characteristics based on a contingency coefficient test.
![src=./files/hehp/images/HTML_Publish/61903/61903-T_4.PNG]()
Discussion
Regarding the educational level, the study sample had the largest part of people with a bachelor's degree (56.5%). This result differs from what [22, 23] found in other parts of Iraq, where the highest percentage of the analyzed sample held a Diploma degree, this could be attributed to the presence of many colleges in Baghdad, which gives students a lot of choices, and the city has a lot of private businesses, which makes it a good place for elite people to live.
According to the current study, medical technicians (20.4%) and nurses (20.4%) had the greatest levels of health care provider specialty. This result is comparable to what was found in the city of Sulaymaniyah [23].
The majority of the staff who were studied here stated that the most occupational hazard that they are aware of is “Biological hazard.” There has been no previous study to compare the staff's awareness of particular hazards, but this is an expected result because another study in Iraq found that the vast majority of staff that they studied had been exposed to “Biological hazards” alone [23].
Results from this study reveal that staff has a “Good” attitude toward occupational hazards in the workplace, which is consistent with findings from a prior study in Kerbala city [24].
The study results, on the other hand, conflict with an Ethiopian study [25] and a Cypriot study [26], in which this study was higher than the Ethiopian and Cypriot staff attitudes, This difference could be linked to the fact that, in recent years, Iraqi employees have developed a predisposition for favorable attitudes toward OSH as an outcome of recent knowledge and modern information technology.
the practices of staff regarding the occupational hazards that surround them in healthcare facilities is “Good” practice, which is coherent with the previous findings in Kerbala City [22] and Egypt [27,28].
On the other hand, the results of this study, which revealed a “Good” overall practice for the studied medical and paramedical staff, contradict many previous studies because it has a higher score than studies [29-33].
Concerning subjects of Practices, an overall main domain result observed strong relationships due to the significant levels with Department (Working area), and Socio-Economic Status) only, since significant relationships are accounted in at least at p<0.05.
Table 4) Relationships between subjects' attitudes and practices with their socio-demographical characteristics based on a contingency coefficient test.
Discussion
Regarding the educational level, the study sample had the largest part of people with a bachelor's degree (56.5%). This result differs from what [22, 23] found in other parts of Iraq, where the highest percentage of the analyzed sample held a Diploma degree, this could be attributed to the presence of many colleges in Baghdad, which gives students a lot of choices, and the city has a lot of private businesses, which makes it a good place for elite people to live.
According to the current study, medical technicians (20.4%) and nurses (20.4%) had the greatest levels of health care provider specialty. This result is comparable to what was found in the city of Sulaymaniyah [23].
The majority of the staff who were studied here stated that the most occupational hazard that they are aware of is “Biological hazard.” There has been no previous study to compare the staff's awareness of particular hazards, but this is an expected result because another study in Iraq found that the vast majority of staff that they studied had been exposed to “Biological hazards” alone [23].
Results from this study reveal that staff has a “Good” attitude toward occupational hazards in the workplace, which is consistent with findings from a prior study in Kerbala city [24].
The study results, on the other hand, conflict with an Ethiopian study [25] and a Cypriot study [26], in which this study was higher than the Ethiopian and Cypriot staff attitudes, This difference could be linked to the fact that, in recent years, Iraqi employees have developed a predisposition for favorable attitudes toward OSH as an outcome of recent knowledge and modern information technology.
the practices of staff regarding the occupational hazards that surround them in healthcare facilities is “Good” practice, which is coherent with the previous findings in Kerbala City [22] and Egypt [27,28].
On the other hand, the results of this study, which revealed a “Good” overall practice for the studied medical and paramedical staff, contradict many previous studies because it has a higher score than studies [29-33].
This study recommends that the government health authorities establish active, effective programs to develop the existing OSH departments in health facilities, elevate them to high administrative levels, and provide them with the necessary resources to implement and maintain OSH regulations in their facilities, Practical workshops is essential that continual efforts be made to improve the staff's attitudes and practices regarding occupational hazards, how they impact them, and how to control and prevent them, and There should be an active, strict surveillance system to make sure that the staff and the health facility's management are following the guidelines regarding occupational hazards.
Conclusion
Most hospital and health center employees have “good” attitudes and good practices regarding occupational hazards in their surrounding workplaces, with indications of the presence of “poor” practices as related to “prolonged standing” and “inadequate use of modern facilities” in the workplace. The influence of educational level on total assessment is quite evident; the higher the educational level of the employees, the better the result. Among the other departments, the laboratory staff has the highest scores.
Acknowledgments: None declared.
Ethical Permissions: Ethical approval and all administrative agreements were obtained from the College of Health and Medical Technology/ Baghdad/ Community Health Department and the research committee at Middle Technical University, Followed by a formal agreement from AL-Karkh, AL-Rusafa, and Medical City Health Directorates and then from the hospitals and health centers that belong to these directorates in which the data collection will occur in them, and the acceptance of all participants before the enrollment with the guarantee of the privacy of their responses.
Conflicts of Interests: None declared.
Authors’ Contributions: Hasan SM (First Author), Introduction Writer/Methodologist/Main Researcher/
Statistical Analyst/Discussion Writer (40%); Hassoun SM (Second Author), Assistant Researcher/Discussion Writer (30%); Ali LH (Third Author), Methodologist (30%)
Funding/Support: None declared.
Conclusion
Most hospital and health center employees have “good” attitudes and good practices regarding occupational hazards in their surrounding workplaces, with indications of the presence of “poor” practices as related to “prolonged standing” and “inadequate use of modern facilities” in the workplace. The influence of educational level on total assessment is quite evident; the higher the educational level of the employees, the better the result. Among the other departments, the laboratory staff has the highest scores.
Acknowledgments: None declared.
Ethical Permissions: Ethical approval and all administrative agreements were obtained from the College of Health and Medical Technology/ Baghdad/ Community Health Department and the research committee at Middle Technical University, Followed by a formal agreement from AL-Karkh, AL-Rusafa, and Medical City Health Directorates and then from the hospitals and health centers that belong to these directorates in which the data collection will occur in them, and the acceptance of all participants before the enrollment with the guarantee of the privacy of their responses.
Conflicts of Interests: None declared.
Authors’ Contributions: Hasan SM (First Author), Introduction Writer/Methodologist/Main Researcher/
Statistical Analyst/Discussion Writer (40%); Hassoun SM (Second Author), Assistant Researcher/Discussion Writer (30%); Ali LH (Third Author), Methodologist (30%)
Funding/Support: None declared.