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1.
J Pediatr Hematol Oncol Nurs ; : 27527530241267296, 2024 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-39257031

RESUMEN

Background: Legacy building is a priority for pediatric oncology. Storytelling is one strategy to help children document their legacies. Understanding story content would advance knowledge of how children want to be remembered but this has yet to be explored. This study explored content of digital stories created by children with advanced cancer. Method: Facebook advertisements were used to recruit families of children (7-17) with relapsed/refractory cancer to participate in a randomized controlled trial testing a legacy intervention through storytelling. Parent-child dyads (N = 150) were randomly assigned to an intervention or usual care group. A web program guided children to answer legacy questions and upload photographs, movies, and music. Families received the final digital stories. Experienced qualitative coders developed a hierarchical coding system to identify major categories/subcategories within 78 stories. Results: Stories included 1,516 unique story entries, including text, photographs, and movies. Two major categories emerged from the data: (a) story entry medium and (b) story content. Photographs frequently reflected people, objects, pets, and places while text often described personal preferences, goals, dreams, and other people. The story content overall included references to (a) people, (b) setting/location, (c) cancer, (d) objects/activities, and (e) expression of emotions/beliefs. Exemplar quotes, counts, and frequencies for each category are reported. Discussion: Children documented their legacies through stories that emphasized the value of family relationships and children's desires to be known for personal traits/preferences. Children chose to include cancer in their stories, indicating that cancer is a part of how children perceive their legacies. Registration Number: ClinicalTrials.gov NCT04059393.

2.
Int J Pharm Pract ; 2024 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-39305489

RESUMEN

OBJECTIVES: Breast cancer remains a prevalent disease in women worldwide. Though advancements in breast cancer care have improved patient survival, a breast cancer diagnosis, and subsequent interventions have a lasting impact on patients' lived experiences during the pandemic. METHODS: We present the collaborative learning process from this patient engagement workshop series as a community-academic partnership. Narrative medicine tools were used to recount patients' lived experiences following diagnosis, where both patients and researchers shared their cancer research activities in each workshop, and the role of the multidisciplinary healthcare team was discussed. KEY FINDINGS: We used an iterative approach to cohort building, narrative development, and the use of multiple media formats to capture stories. Over 20 patients with breast cancer shared their stories for the first time since their diagnosis with a wider audience. Here, we present the learning process and considerations from this event. CONCLUSIONS: Understanding patients' lived experiences can support researchers and healthcare professionals in developing an empathetic approach to shared healthcare decision making. Moreover, understanding the lived experiences of patients is critical to addressing disparities in healthcare.

3.
J Eat Disord ; 12(1): 145, 2024 Sep 19.
Artículo en Inglés | MEDLINE | ID: mdl-39300517

RESUMEN

BACKGROUND: Although eating disorders (EDs) are among the most stigmatised mental illnesses, a number of individuals break past this stigma and engage in ED advocacy by sharing their recovery stories. Little is known, however, about the role of such advocacy in their healing journeys. METHODS: To bridge this gap, the authors examined the role of autobiographical oral storytelling in the ED recovery of adult advocates. Autobiographical oral history interviews were carried out with adult advocates (n = 16) recovering from EDs. The data were analysed using a mixture of actantial and thematic analyses. Authors also used activity theory to categorise how storytelling was translated into concrete social actions. Results were then interpreted through frameworks of embodiment and the intersectionality of identity. RESULTS: Advocates chose to share their ED stories as a way to embody resilience and make meaning from their ED experiences. Beyond personal gains, the social benefits of sharing their stories included raising hope and openness to converse further with audiences, advocating for greater ED resources (e.g., ED literacy among school staff), and offering new training initiatives for healthcare professionals. The ties between storytelling and the unique aspects of one's identity are also discussed. CONCLUSIONS: Engaging in advocacy through storytelling can positively affect both the advocates and the audiences with whom they connect. Future studies, informed by feminist biopsychosocial frameworks, can examine storytelling as a therapeutic intervention. Such frameworks serve as alternatives to biomedical models of EDs and mental illnesses. They also emphasise the need for broader changes that destabilise oppressive body cultures and display how storytelling can help mobilise change.


Eating disorders (EDs) have been identified as one of the most stigmatised mental illnesses, making it difficult for individuals to seek professional help or disclose their mental health situation. Nevertheless, a handful of individuals become advocates who combat this stigma by sharing their personal struggles and ongoing healing journeys. The researchers of this study used a narrative-based approach to analyse the experiences of such advocates while identifying the personal and social benefits of their storytelling advocacy. The outcomes of this study suggested that advocates found these storytelling initiatives to be deeply meaningful because they were able to reflect on how far they have come while increasing hope among audiences that recovery is possible. The findings from this research support the ongoing need for novel interventions against ED stigma, including the potential to incorporate storytelling as a way to normalise conversations on EDs while enhancing the resilience of individuals undergoing recovery.

4.
Front Psychol ; 15: 1406167, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39114597

RESUMEN

Background: Alzheimer's disease (AD), the most common form of dementia, is a progressive neurodegenerative disorder that predominantly affects the elderly population. Traditional assessment methods, including neuropsychological tests like the MMSE, have been the cornerstone of AD diagnosis for decades. These methods are grounded in a wealth of research and clinical experience, providing a robust framework for understanding the cognitive deficits of AD. The evolution of AD assessment and rehabilitation has recently been tackled with the introduction of Virtual Reality (VR) technologies. Objectives: To evaluate the use of storytelling and reminiscence therapy in virtual reality programs as a complementary and enhancing modality alongside standard assessment and rehabilitation for Alzheimer's patients. To explore how regular interaction with VR narratives can slow cognitive decline or improve relevant features of cognitive functioning over the time. To propose a new assessment and rehabilitative tool based on the use of VR and digital storytelling. Method: A comparative analysis of Standard Neuropsychological Approaches and Virtual Reality Interventions in patients with Alzheimer disorder was carried out. A literature overview on the empirical studies between 2019 and 2024 was conducted. Results: We propose a new VR-based setup mediated by the use of storytelling for the assessment and recovery of AD. Conclusion: The employment of storytelling within VR programs for the assessment and rehabilitation of Alzheimer's disease can positively impact both the cognitive and emotional realms of patients, with beneficial outcomes on caregivers' and families' burden. The successful implementation of this approach requires careful consideration of accessibility, data interpretation, and standard validation protocols.

5.
Health (London) ; : 13634593241270955, 2024 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-39099340

RESUMEN

Drawing on Arthur Frank's conceptualization of narrative repair, we consider how pediatric oncology nurses restore and re-story the narratives of patients and families whose biographies have been thrown off course by the diagnosis and death of a child from cancer, as well as their own narratives as caregivers. Frank argued that when one's life story is shipwrecked by chronic or life-threatening illness, storytelling is way to reorient one's biography to a new ending, repairing the narrative wreckage created by the illness experience. In this critical narrative study with nine pediatric oncology nurses in Ontario, Canada, we highlight how, through physical, narrative, and moral proximity, nurses become entwined in their patients' and families' illness narratives, and how developing this narrative knowledge provides nurses with opportunities to steer families onto new terrain. As well, we examine how nurses re-story and repair their own identities as "good" caregivers in situations when they are prevented from acting on behalf of their pediatric cancer patients. These findings contribute to literature on illness narratives by considering narrative repair as a relational process enacted as part of pediatric oncology caregiving.

6.
J Med Educ Curric Dev ; 11: 23821205241272358, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39149530

RESUMEN

I am a healer, yet sometimes I do more harm than good…David Hilfiker, 1984. Objectives: Medical error is common and significantly impacts patients, physicians, learners, and public perception of the medical system; however, residents receive little formal training on this topic. Research on error response in practicing physicians is limited, and even more so on medical education interventions to improve this. This study evaluates a curriculum developed to foster the sharing of faculty medical error stories, practice of constructive coping strategies, and growth in resident confidence in managing error. Methods: Researchers identified factors related to effective physician error management and recovery to develop a targeted intervention for family medicine residents. The intervention consisted of three one hour didactic sessions in a medium-sized midwestern, urban family medicine residency program over the course of 6 months. Instructional methods included guided reflection after mentor storytelling, small group discussion, role play, and self-reflection. Results: Of the 30 residents, 22 (73%) completed the preintervention survey, and 15 (50%) completed the postintervention survey. While most residents reported having experienced error (55%), fewer than half of the residents reported they knew what to do when faced with medical errors (46%). This increased to 93% after intervention. Personal error stories from mentors were the most desired type of training reported by residents preintervention, but this was surpassed by legal and malpractice concerns in the postintervention survey. Rates of reported error story sharing increased after the intervention. Residents reported self-efficacy (I can be honest about errors) and self-awareness (I acknowledge when I am at increased risk for error) also increased with intervention. However, these changes did not reach statistical significance. Conclusions: Family medicine residents are receptive to learning from peers and mentors about error management and recovery. A brief intervention can impact the culture around disclosure and support. Future research should focus on the impact of targeted interventions on patient-oriented outcomes related to medical error.

7.
J Prev (2022) ; 2024 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-39212892

RESUMEN

Disparities in vaccine confidence and uptake among racial and ethnic minorities have resulted in a disproportionate burden of COVID-19 in these populations. Social media campaigns have shown promise in public health promotion and behavioral interventions. In January 2022, an academic-community partnership launched #Vax4Community, a 6-month social media campaign centered around the use of digital storytelling videos. The campaign purpose was to decrease vaccine hesitancy, combat vaccine misinformation and disinformation, and increase vaccine confidence within three distinct target communities: the justice-involved population, South Asian residents, and public housing youth in the metropolitan area of New York City (NYC). Our approach included the production and dissemination of digital storytelling videos featuring personal vaccine experiences from target populations. We evaluated key performance indicators (KPIs) of the campaign, including post impressions, reach and engagement across social media platforms, and shares from partner organizations. Overall, we received 1,910,662 post impressions, 699,722 unique users reached, and 2,880 post engagements across Instagram, Facebook, LinkedIn, and Twitter, and 147 shares from 48 partner organizations. Social media campaigns require strategic design in branding, messaging and outreach channels and could serve as an important tool to disseminate emotionally relatable content and trusted information to prime target populations to respond more optimally to public health interventions. The purpose of this paper is to describe the process of creating and disseminating these digital stories and the KPIs of the social media campaign.

8.
J Appl Gerontol ; : 7334648241274545, 2024 Aug 23.
Artículo en Inglés | MEDLINE | ID: mdl-39176418

RESUMEN

Life story work (LSW) uses a narrative, reminiscence approach to capturing memories from one's life and has shown positive outcomes for participants. However, LSW in aged care has been criticized for being resource intensive, often involving care staff using pre-determined process and output formats. This pilot study explored participants' lived experiences of a novel co-creation approach to LSW conducted predominantly with university students and older adults in residential aged care and retirement communities, producing multi-modal outputs. Within a 12-month period, 33 LSW projects were completed (21 books, 5 posters, and 7 digital stories). Semi-structured interviews (n = 44) explored participants' lived experience of completing a LSW project. Findings indicate that working with students and adopting a flexible, co-creation approach that empowers participants to make decisions, engage in learning and reflection, and build meaningful relationships can maximize opportunities for transformative impacts, and enable providers to offer a LSW program despite finite resources.

9.
Violence Against Women ; : 10778012241275692, 2024 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-39196701

RESUMEN

This article draws on the stories told by Indigenous women in the midwestern United States to explore embodied experiences of violence and how they conceptualize healing in the aftermath of violence. Two focus groups-conducted as talking circles-were completed with 16 Indigenous women. Findings highlight four salient themes: embodied impacts of violence; normalization of violence; (im)possibilities of healing; and strategies for healing. In particular, the women highlighted embodied practices like collective storytelling as a means of healing. This study deepens our understanding of violence against women by promoting Indigenous ways of knowing and uplifting the voices of Indigenous women.

10.
Health Promot Pract ; : 15248399241275634, 2024 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-39188161

RESUMEN

Digital storytelling is an innovative approach that evaluators can adopt to expand their dissemination efforts. The stories use brief audio and video recordings, and they can be used to provide reflections on the perceived value, experiences, or impact of public health efforts. We offer tips for evaluators to add this tool to their portfolio using several traditional evaluation data collection techniques. We also discuss a series of planning considerations and lessons learned based on the experiences of an evaluation of a research capacity-building initiative.

11.
J Agromedicine ; 29(4): 645-652, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39155497

RESUMEN

OBJECTIVE: Storytelling engages audiences, passes down traditions and history, educates, and helps people understand and interpret their environment. Many of those who work in agriculture have been part of the storytelling tradition since childhood. Research has demonstrated the emotional impact of personal stories and how prevention information is conveyed effectively "farmer to farmer" through this method of communication. METHODS: Since 2016, the Telling the Story Project has provided a space for those directly or indirectly involved in an agricultural incident to share their story and unique perspectives on how similar incidents can be avoided. RESULTS: This collaborative project, developed between the National Institute for Occupational Safety and Health (NIOSH) Agriculture Safety Centers, has resulted in 11 stories on a dedicated website, safety and health resources, and educational guides. The stories and educational guidelines have been marketed extensively through traditional and social media sources, employed in safety training, and embraced by educators in agricultural programs. The website has provided a national and international reach with more than 35,000 visits. CONCLUSION: Qualitative thematic analysis of the stories provided data on the circumstances leading up to each incident, valuable information on how the storytellers interpreted the aftermath, and a novel perspective on how safety professionals can create messaging that will resonate with the farming community.


Asunto(s)
Accidentes de Trabajo , Agricultura , Agricultores , Narración , Salud Laboral , Humanos , Agricultores/psicología , Accidentes de Trabajo/prevención & control , Estados Unidos , National Institute for Occupational Safety and Health, U.S. , Traumatismos Ocupacionales/prevención & control , Traumatismos Ocupacionales/psicología , Comunicación
12.
Pediatr Blood Cancer ; : e31272, 2024 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-39138603

RESUMEN

Honoring a child's legacy is an essential aspect of meaning-making for bereaved parents, yet little is known about storytelling as a mechanism. Through narrative analysis of 19 bereaved parent interviews focused on legacy, we examined the role of storytelling in creating and sustaining legacy. Most participants (89%) told stories centered around the child's impact and parent's coping, including the child's character and interpersonal relationships during and after their lifetime as well as how the child's legacy influenced parents' grief experiences. Future research is needed to explore the potential impact of storytelling initiatives to support legacy-making for bereaved caregivers.

13.
Pers Soc Psychol Rev ; : 10888683241259902, 2024 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-39068536

RESUMEN

ACADEMIC ABSTRACT: We articulate an intergenerational model of positive psychosocial development that centers storytelling in an ecological framework and is motivated by an orientation toward social justice. We bring together diverse literature (e.g., racial-ethnic socialization, family storytelling, narrative psychology) to argue that the intergenerational transmission of stories about one's group is equally important for elders and youth, and especially important for groups who are marginalized, because stories provide a developmental resource for resistance and resilience in the face of injustice. We describe how storytelling activities can support positive psychosocial development in culturally dynamic contexts and illustrate our model with a case study involving LGBTQ+ communities, arguing that intergenerational storytelling is uniquely important for this group given issues of access to stories. We argue that harnessing the power of intergenerational storytelling could provide a culturally safe and sustaining practice for fostering psychosocial development among LGBTQ+ people and other equity-seeking populations. PUBLIC ABSTRACT: Understanding one's identity as part of a group with shared history and culture that has existed through time is important for positive psychological functioning. This is especially true for marginalized communities for whom identity-relevant knowledge is often erased, silenced, or distorted in mainstream public discourses (e.g., school curricula, news media, television, and film). To compensate for these limitations around access, one channel for the transmission of this knowledge is through oral storytelling between generations of elders and youth. Contemporary psychological science has often assumed that such storytelling occurs within families, but when families cannot or would not share such knowledge, youth suffer. We present a model of intergenerational storytelling that expands our ideas around who counts as "family" and how knowledge can be transmitted through alternative channels, using LGBTQ+ communities as a case example.

14.
Clin Gerontol ; : 1-12, 2024 Jul 11.
Artículo en Inglés | MEDLINE | ID: mdl-38992935

RESUMEN

OBJECTIVES: We assessed whether individuals with mild Alzheimer's disease (AD), despite some deficits in autobiographical memory, could effectively convey their personal experiences through storytelling. METHODS: We invited 37 individuals with mild AD and 37 control participants to share their personal experiences. We rated these narratives based on five characteristics of storytelling: focus, reflection, entertainment, structure, and specificity. RESULTS: Analyses demonstrated that individuals with AD conveyed more general than specific memories, and no significant differences were observed between structured and unstructured memories. Importantly, individuals with AD recounted more memories with focus than without, with reflection than without, and that were entertaining than were not. Compared with those of the control participants, the narratives of the individuals with AD were less focused, structured, and specific. However, no significant differences were observed between the two samples regarding reflection or entertainment. CONCLUSIONS AND CLINICAL IMPLICATIONS: Individuals with mild AD can have difficulties in retrieving specific memories, but their storytelling of personal experience can be focused, exhibit reflection, and be entertaining. Individuals with mild AD can engage in reflective and entertaining autobiographical storytelling, potentially contributing to their sense of identity and connection with others.

15.
Cognition ; 251: 105884, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39047582

RESUMEN

Memories are not only stored for personal recall, but also to communicate knowledge to others in service of adaptive decision-making. Prior research shows that goals to share information can change which content is communicated in memory as well as the linguistic style embedded in this communication. Yet, little is known as to how communication-related alterations in memory narration drive differences of value processing in listeners. Here, we test how memory communication alters multi-featural recall for complex events and the downstream consequence on value estimations in naïve listeners. Participants recalled a memory of playing an exploratory videogame at a 24-h delay under instructions to either share (i.e., social condition) or recall (i.e., control condition) their memory. Sharing goals systematically altered the content and linguistic style of recall, such that narrators from the social condition were biased towards recall of non-episodic details and communicated their memories with more clout, less formality, and less authenticity. Across two independent samples of naïve listeners, these features differentially influenced value estimations of the video game. We found that greater clout was associated with greater enjoyment while listening to memories (hedonic value), and that greater inclusion of non-episodic details resulted in greater willingness to purchase the video game (motivational drive). These findings indicate that sharing an experience as a story can change the content and linguistic tone of memory recall, which in turn shape perceived value in naïve listeners.


Asunto(s)
Recuerdo Mental , Narración , Humanos , Recuerdo Mental/fisiología , Femenino , Masculino , Adulto , Adulto Joven , Juegos de Video
16.
Arts Health ; : 1-18, 2024 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-38956989

RESUMEN

BACKGROUND: References to transformative and therapeutic benefits of digital storytelling are often made, yet this remains an under-explored area, which we foreground in this study. METHODS: A phenomenological research design was adopted to explore through interview how a purposive sample of Patient Voices storytellers experienced participation in more than one digital storytelling workshop. Analysis was through thematic coding, linguistic analysis and use of van Manen's lifeworld existentials framework. RESULTS: We find that for this particular group, the therapeutic and transformative experiences that re-centre and re-frame personal meaning do so through inter-personal connections and can be understood as a process of social learning. The lifeworld existentials analysis demonstrates that a pluralist and relational conception of wellbeing holds and there is a close relationship between this and Yalom's 11 therapeutic factors. CONCLUSIONS: Drawing on group analytic literature, we suggest the concept of a social learning methodology as useful in grounding further research that seeks to understand the beneficial impacts of digital storytelling methodologies in healthcare and in contributing evidence in this field with fidelity to the lived experience as central.

17.
J Eval Clin Pract ; 2024 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-39038176

RESUMEN

RATIONALE: There is growing evidence that fathers play an important role in the breastfeeding process and that fathers need education about breastfeeding. In our age of rapidly developing technology, the use of new teaching techniques in the education of fathers will provide more effective results. AIMS: In this study, the effect of breastfeeding education given with digital storytelling method on fathers' breastfeeding self-efficacy was examined. METHODS: The study is a pretest-posttest randomized controlled trial. The study was conducted with the husbands of 80 pregnant women admitted to the childbirth preparation class of a state hospital. The study included a control group and an intervention of educational videos using a digital storytelling technique. Fathers were recruited from hospital antenatal classes and randomized to one of the two groups. Personal Information Form and Paternal Breastfeeding Self-Efficacy Scale-Short Form were used for data collection. Each father completed data collection forms at the beginning of the study and at 3 months postpartum. The η2 effect size was calculated for significant differences in the independent and dependent groups t test methods used in the analysis. RESULTS: There was a significant difference between the posttest scores of the fathers in the intervention and control groups (p < 0.05). When the effect sizes were analysed, it was found that the increase in the intervention group (t = -24.342) was higher than the control group (t = -8.385). CONCLUSION: In the current study, the effect of using digital storytelling method in breastfeeding education on fathers' breastfeeding self-efficacy was found to be significantly higher than routine education. It is recommended that this new method be used in education and counselling and that studies be conducted to examine its effect on breastfeeding behaviour and fathers' breastfeeding support.

18.
Lancet Reg Health West Pac ; 48: 101123, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-39045484

RESUMEN

Background: Approximately 20% of adults in Vietnam have hypertension, and management of this chronic condition remains challenging. This study aimed to assess the effectiveness of a multicomponent intervention in reducing blood pressure (BP) in adults with uncontrolled hypertension. Methods: This cluster randomised controlled trial was conducted in sixteen communities (8 intervention and 8 comparison) in a rural setting in Vietnam (2017-2022). Consenting adults (aged ≥ 18 years) with uncontrolled hypertension were enrolled. Sixteen communities were equally randomised to an intervention or comparison group stratified by district. Consenting adults were assigned to study groups by community. The comparison arm received training sessions about hypertension prevention and management for health workers, and patient education materials. The intervention arm received training sessions about hypertension prevention and management for health workers, and patient education materials and three enhancement components including a storytelling intervention, home BP self-monitoring, and expanded community health worker services. The primary outcome was the difference in changes in patient's levels of systolic BP between the study groups over a 12-month follow-up period. Patients and outcome assessors were masked. Findings: A total of 671 patients (340: intervention, 331: comparison) were enrolled in the trial. The mean age was 66 years and 45% were men. At the 12-month follow-up, the mean systolic BP declined by 18.4 mmHg in the intervention group and 3.7 mmHg in the comparison group (differential decline of 14.7 mmHg [95% CI: 11.8-17.6]). The intervention group also achieved better BP control and medication adherence than the comparison group. There were no serious adverse events related to study participation. Interpretation: The results of this trial demonstrate that a multicomponent intervention can effectively reduce elevated BP in individuals with uncontrolled hypertension in Vietnam. Trial registration: This trial was registered at ClinicalTrials.gov, NCT03590691. Funding: National Heart, Lung, and Blood Institute.

19.
Vaccines (Basel) ; 12(7)2024 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-39066456

RESUMEN

This study explores the enhancement of MMR vaccination rates in the deep south of Thailand through a culturally tailored intervention that incorporates storytelling and singing, aligning with local cultural and religious values. The "Anees has Measles" intervention, developed with input from community stakeholders including health workers, religious leaders, and parents, featured traditional melodies in its singing activities. The intervention comprised two main components: storytelling sessions and singing activities, both utilizing culturally resonant content and formats to effectively engage the community. Conducted from December 2019 to March 2020 across eight districts in five provinces, the study targeted children aged 18 months to 5 years in government child care centers. Results indicated a substantial increase in MMR vaccination coverage from 44.3% to 72.0% twelve months post-intervention, and further to 77.0% at 48 months post-intervention, representing a significant and sustained improvement (p < 0.001). This marked and continuous increase demonstrates the effectiveness of culturally adapted health education in areas with significant vaccine hesitancy. The findings highlight the importance of integrating culturally and religiously sensitive methods into public health strategies, significantly enhancing vaccine acceptance and coverage in diverse and conservative settings. This approach suggests a broader applicability for similar interventions in comparable contexts globally.

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