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The purpose of this paper is to analyse cost as a barrier to the uptake of antenatal care (ANC) in rural Nepal amidst a variety of barriers and facilitators.

A qualitative study with face-to-face interviews were conducted with 50 ANC users and non-users participants. The setting is rural Nepal, some 20 kilometres outside the capital Kathmandu. Interviews were audiotaped, transcribed and translated into English and results were presented thematically.

Cost was sometimes a barrier to seeking ANC for poor rural women. It included transport costs, opportunity costs of not being able to work in the household and service-related costs (such as blood or urine tests). The effect of cost as a barrier varied between women of different socio-economic status. Cost was a barrier to accessing ANC partly due to the women's lack of control over household resources.

It is important to consider cost in the wider socio-economic context of rural people's lives as financial costs alone do not explain the level of uptake of ANC.

This study provides an original insight of women's experiences on financial issues relating to the use of ANC services in Nepal. Another important aspect of this study was approached with the multiple respondents (i.e. women, their husbands and their mothers-in-law) regarding the use of ANC and financial impact in the use of services. The findings of this study have important implications in health policy formation by providing clear picture of women's financial situation in access to ANC.

Smokebusters is a community‐based smoking prevention initiative for young people which aims to prevent them from starting to smoke. Although the number of clubs throughout the UK and Europe has increased over the last decade, there is little evidence of the effectiveness of this initiative. The authors conducted a systematic review of published and unpublished health promotion evaluation reports in an attempt to assess the effectiveness of this intervention. This paper outlines the methodological and practical difficulties encountered when conducting a systematic review of a community‐based health promotion initiative.

Mental health disparities exist among Black, Asian and Minority Ethnics (BAME) populations. This paper aims to provide an overview of mental health services designed for the BAME population in the UK, both established BAME communities and refugee/asylum-seekers.

A range of electronic databases were searched for peer-reviewed studies conducted within the past decade in the UK. Using the Arksey and O’Malley methodology, data were extracted, analysed and summarised.

A total of 13 papers were identified, mostly non-randomised community-based. Studies were very heterogeneous in terms of their sample and service provided. After the initial appraisal, the authors presented a narrative synthesis. Overall, all studies reported positive mental health outcomes and beneficial effects.

Because of the time limitations and quality of the papers, the authors only included peer-reviewed journal papers.

Mental health services provided for BAME people, both established and refugee/asylum-seekers are feasible and improve engagement with the services and mental health outcomes. Initiatives are required to facilitate the integration of these targeted services within mental health and community services for BAME in the UK.

This scoping review is a snapshot of the mental health services designed for BAME people in the UK, either established or refugee/asylum-seekers in the past 10 years and adds to the evidence-based knowledge from these studies.

Although South Asia is a growing supplier of migrant labour, there is a paucity of research on the health and well-being of male Nepalese migrant workers. The purpose of this paper is to assess the health and mental well-being of Nepalese construction and factory workers employed in Malaysia, Qatar and Saudi Arabia.

A structured questionnaire administered, in and around Nepal’s international airport, to 403 migrants who had worked for over six months in their host countries. Logistic regression was used to investigate factors associated with self-reported health status and mental health symptoms.

Over 13 per cent reported poor or very poor health and nearly a quarter reported mental health issues. Whilst age and exercise were significantly associated with health status, poor work environments and perceived health risks were associated with both mental health issues and health status.

The study is limited to males only and those working in the factories and the construction industry. To improve migrant health and mental well-being, Nepalese and host governments should consider mandatory health insurance and a range of pre-departure and arrival education around general literacy, mental health assessments and workplace health and safety.

There have been no known studies on the health and well-being of Nepalese migrant construction and factory workers in the Middle East and Malaysia. The strong association between self-reported poor health and perceived work environment is an important issue that policy makers in Nepal and destination countries should address.

It is widely believed that transgender individuals in Nepal inject silicone for face and body manipulation, a phenomenon thought to be common among transgender individuals globally. Therefore, this qualitative study conducted in Nepal explored: (1) awareness of silicone use and sources of information; (2) reasons for using silicone; (3) notion of cost and quality of these procedures; (4) reported negative aspects, including side effects and (5) health seeking behaviors of Nepali transgender women.

The authors carried out eight focus group discussions (FGDs) with transgender women at four different districts of Nepal, five in the capital Kathmandu and three in different rural areas. We also interviewed three transgender women who preferred not to participate in the FGD but were happy to be interviewed separately. Similarly, six interviews with stakeholders working for sexual and gender minority populations were also conducted.

Most FGD participants were young (mean age 23.06 ± 3.9 years) and the majority (55%; n = 34) completed grade six to high school level. Peer networks of transgender people and the Internet were the more popular sources of information about silicone. The decision to use silicone was largely influenced by the desire to look beautiful and more feminine. Often they appear not to follow the recommended procedures for silicone use. Their health seeking behavior regarding side effects or complications of these procedures was very poor.

Findings reflect that targeted interventions aimed at transgender individuals should educate them on the use of silicone, as well as explore safe and affordable approaches to meet gender-related appearance needs of Nepali transgender people.

Traditionally the role of the external examiners in UK universities or more formally Higher Education Institutions (HEIs) is that of quality assurance (QA). Typically, an experienced academic who is not affiliated with the HEI (i.e., someone from another university) is invited to act as an external examiner for a particular course or a module. The external examiner’s primary role is to provide impartial and independent advice to ensure academic standards are upheld for a degree program; and that the degree is comparable with similar programs across the country and that the achievements of students are also comparable with students on courses at other universities. This primary role makes external examiners highly valued people in UK universities, and as a result, their views are nearly always taken seriously. Over and above this recognized primary role of QA, external examiners can also be engaged by the host university in other ways. These additional roles or tasks of the external examiner can help enhance teaching and learning in higher education. This chapter will reflect on the range of roles, including the ones that go beyond QA.

This paper discusses the use of diary‐keeping as part of an evaluation of a complex, community‐based health promotion initiative, using the Mobile Information Bus (MIB) as an example. The MIB was designed to provide health and related information for living adolescents in rural areas of Northeast Scotland. The general strengths and limitations of diary‐keeping as a research method are discussed alongside an account of the evaluators' experiences of using this method within the MIB context, as well as suggestions for improving the efficacy of diary‐keeping as a research method. In addition, the results of an extensive literature search on the topic of diaries as a research method are reported. As part of the MIB evaluation, the diary provided a contemporaneous, in‐depth account of the intervention in operation. Those engaged in evaluation of similar types of projects (particularly related to process evaluation) may find the use of a project diary a useful adjunct to other research methods.

Purpose – This chapter critically examines the purportedly growing phenomenon of Maternal Request Caesarean Sections (MRCS) and its relative contribution to the rising caesarean section (CS) rates.

Methodology – We apply a decentred comparative methodological approach to this problem by drawing upon and comparatively examining empirical data from Canada, the US, the UK and Finland.

Findings – We find that the general argument that has emerged within the obstetric community, evidenced in particular by a recent “State of the Science” conference, is that the reduced risks and benefits of MRCS are evenly balanced, thus ethically it could be seen as a valid choice for women. This approach, taken in particular in the North American context, negates the problematic nature of accurately measuring, and therefore assessing the importance of maternal request in addressing rising CS rates. Moreover, although some of the blame for rising CS rates has focused on MRCS, we argue that it has a relatively minor influence on rising rates. We show instead how rising CS rates can more appropriately be attributed to obstetrical policies and practices.

Originality – In presenting this argument, we challenge some of the prevailing notions of consumerism in maternity care and its influence on the practice patterns of maternity care professionals.

Practical implications – Our argument also calls into question how successful efforts to address MRCS will be in reducing CS rates given its relatively minor influence.

Using an external examiner in an institution is not a new phenomenon; the evidence of having an outsider to scrutinize the quality control process has been prevalent since the 1800s. However, the concept has undergone considerable changes and has been subjected to mounting criticism and validity of the process. There are several challenges that are faced by institutions in recruiting and defining the role of external examiners and the assumption that they are assessment literate. Universities are engaged in safeguarding the procedure, and at the same time, enhancing the quality standards. Researchers have been collaborating to create best practices and working on key developments that would ensure that degree standards are maintained in higher education. There is no “one size fits all” guidelines, but hiring an external examiner with the view to safeguarding academic quality is the prevalent norm across the globe. The book on the role of external examiners put forth such challenges and best practices by academia in various parts of the world. Authors have written about how to mitigate disadvantages and how to create opportunities without compromising the quality assurance process. International standards have been discussed with the view to make external examining a rigorous process that is fair, reliable and consistent.

This study aims to investigate how Lean Six Sigma (LSS), a widely used paradigm that promotes competitive advantage of different organisations in a more sustainable and environmentally friendly way, affects operational performance in different organisational contexts. Although LSS is widely used to improve operational performance, the impact of LSS on operational performance appears to be different in different organisational contexts, prompting the attention of researchers and managers to shift from lean philosophy to the impact of contextual variables on the effectiveness of LSS implementation.

This study uses a quantitative research design and conducts an empirical study in Pakistan. The sample consists of 339 management employees with an effective response rate of 67.8% in various sectors. In this study, partial least square structural equation modelling is used to examine the relationships among the variables using the resource-based view (RBV) and dynamic capability theory (DCT) to support the model of this study.

This study reveals that the relationship between LSS and operational performance is partially mediated by green human resource management (GHRM) and internal environmental management (IEM). The moderating effect of the organisational developmental culture between LSS and operational performance is not identified, implying that the effect of developmental culture could vary under different cultures.

There is a lack of empirical studies investigating the role of GHRM, IEM and developmental culture in developing countries. This study extends the literature on the RBV and DCT in operational performance. The study’s outcome provides theoretical and practical implications for enhancing the effect of LSS implementation on operational performance in focal small and medium-sized enterprises (SMEs) through human and environmental management factors.