McGill Journal of Global Health

Genetic Test Ordering After Chatbot-Based Versus Standard Pre-Test Genetic Counseling

2026-05-08T03:33:15-04:00

Background: Genetic counseling and testing can identify individuals at elevated hereditary cancer risk, but access remains uneven. Digital delivery may improve reach, yet disparities in engagement and uptake may persist.

Purpose: This secondary analysis of the Broadening the Reach, Impact, and Delivery of Genetic Services (BRIDGE) randomized controlled trial examined whether chatbot-based versus standard-of-care pretest genetic counseling was associated with genetic test ordering and whether associations differed by race/ethnicity or preferred language.

Methods: De-identified participant-level data from 3,073 adults randomized across two United States health systems were analyzed. Test ordering was measured using electronic health record data. Firth logistic regression estimated associations while addressing sparse outcomes and quasi-complete separation in some engagement groups.

Results: In engagement-adjusted models, chatbot assignment was associated with lower odds of ordering genetic tests than standard-of-care counseling. Across both pathways, progression to a test-request stage was the strongest correlate of ordering. No clear evidence indicated that modality associations differed by race/ethnicity or preferred language, although smaller subgroup estimates were imprecise.

Conclusion: Digital counseling may expand access, but access alone may not ensure completion of clinically meaningful care. Implementation should pair digital delivery with supports that help patients move from information exposure to action.

Economic Strain and Depressive Symptoms Among University Students in Bangladesh

2026-03-04T18:14:46-05:00

Economic comfort plays a significant role in ensuring students’ quality of life. Measuring the economic condition of students in lower middle-income countries is a vital step in analyzing the impact of economic strain on quality of life. This study investigates the impact of cumulative economic strain on the mental health of a random sample of 500 undergraduate students of a private university in Bangladesh. Three self-reported and validated depression scales (BDI-II, PHQ-9, and CES-D) were used to analyze depressive symptoms, and a new Economic Strain Index (ESI) measured self-reported financial pressure, debt, and satisfaction with living conditions. More severe depressive symptoms are linked to students who experience greater economic strain, and female students are more likely to be impacted by the economic strain. The results suggest that the economic strain is consistently linked to increased depressive symptoms in all subgroups. The current study does not claim any causal relationship because of its cross-sectional design, nor does it claim generalizability given its limited study setting within one private academic institution. Campus-based financial assistance and mental health services, which also specifically focus on culturally sensitive, localized gender norms, could reduce depressive symptoms and enhance students’ quality of life.

The Critical Drivers in the Institutionalization and Implementation of the PhilHealth Outpatient Primary Care Benefit Package

2026-03-04T18:02:09-05:00

Background. PhilHealth’s Konsulta Program has provided financing for outpatient primary care services in the decentralized Philippine health system since 2021. However, despite a record number of accreditations nationwide, many accredited facilities struggle with their institutionalization and operationalization, as evidenced by PhilHealth’s extremely low capitation disbursements. This study examines and identifies the critical drivers of Konsulta implementation in the Batuan Primary Care Facility (PCF), a local government unit (LGU)-owned rural health facility in the fourth-class municipality of Batuan, within the province of Bohol, which generated an aggregate 10.35 million Philippine pesos (Php) alongside significant growth in patient and service coverage.

Methods. A sequential mixed-methods case study design was employed, combining quantitative analysis of secondary financial and service data (2022-2025 PhilHealth Statement of Accounts Payable; Batuan LGU financials) with qualitative thematic narrative analysis drawn from document reviews (AKSK project report, LGU ordinances, and meeting minutes) and semi-structured key informant interviews with PCF staff, LGU officials and national agency representatives. Descriptive statistics assessed performance while thematic analysis ranked drivers.

Results. Batuan generated Php 10.35 million from Konsulta which increased 2023 LGU health funds and compensated 2024 and 2025 budget cuts. Four initial institutionalization constraints emerged 1) governance, 2) health resources, 3) human workforce, and 4) information technology systems, which were addressed by the implementation AKSK project. Critical drivers ranked by salience included 1) strong governance, 2) health workers' commitment, 3) external agency collaboration and 4) community participation.

Conclusion. Batuan’s implementation demonstrates Konsulta’s viability in improving primary care financing. Critical to its success are robust government support, strategic partnerships, driven workforce, and active community engagement. Despite implementation challenges, policy reforms, service enhancement and capability investments enabled Batuan to create a replicable model for other local government units.

Network Fragmentation and the 2025 Funding Shock

2026-03-11T15:02:32-04:00

Background. Global health governance (GHG) has shifted from polycentric coordination to topological fragmentation. COVID-19 expanded World Health Organization (WHO) financing participation but eroded cohesion, producing dispersed connectivity. The 2025 contraction, driven by major donor withdrawal, intersected with existing fragilities.

Objective. To assess whether changes in WHO’s financing architecture (2016–2025) exhibit early-warning patterns of declining resilience and critical transition dynamics.

Methods. Social network analysis (SNA) of WHO Programme Budget data across five biennia, examining network cohesion, fragmentation, and component structure through Scheffer’s critical transitions framework.

Results. Pre-pandemic networks showed declining density and rising modularity. During COVID-19, participation surged but cohesion eroded, with density halving, clustering declining sharply, and weakly connected components multiplying. Post-pandemic stabilization retained a segmented and concentrated structure, while temporal autocorrelation increased across biennia, indicating reduced flexibility.

Conclusion. The WHO financing network exhibits patterns compatible with lower-resilience configurations approaching critical thresholds. For WHO leadership, topology-based metrics may offer diagnostics of systemic vulnerability. For donor states, findings suggest that concentrated bilateral funding can affect multilateral resilience through network cohesion. Findings should be interpreted cautiously given the number of observations, partial coverage of the 2024–2025 biennium (Q1), and the observational design, which does not permit causal inference or prediction.

Antimicrobial Resistance in War Zones

2025-03-26T22:40:25-04:00

Introduction. Antimicrobial resistance (AMR) poses a growing threat to global health, particularly in conditions that facilitate disease transmission. Conditions in the Gaza Strip caused by armed conflict, including poor sanitation, overcrowding, and significant damage to healthcare infrastructure, hinder effective infection control measures, and may facilitate the rapid spread of resistant pathogens.

Methods. This paper reviewed existing literature and reports on the ongoing conflict in Gaza and its relationship to the spread of AMR.

Results. The review identified significant implications of AMR in conflict settings for both the health and economic sectors while considering the ethical and political challenges of international intervention.

Conclusion. Potential measures to limit the spread of AMR in war zones include vaccination campaigns, strengthened humanitarian aid, and antimicrobial stewardship initiatives. Improved international cooperation may help to address the spread of AMR in conflict settings and its broader global health implications.

Medicine as a Tool of Gendered Colonial Violence

2025-03-01T11:22:17-05:00

Introduction. Medicine in North America is widely perceived as a healing institution devoted to human welfare, yet this framing obscures its historical and ongoing role in perpetuating gendered colonial violence.

Methods. This commentary analyses the intersections of race, gender, and colonialism in Canadian and American health care systems, examining how colonial medical frameworks position racialized populations as the “Other”.

Results. Colonial medical frameworks systematically devalue racialized populations through intersecting mechanisms. Whiteness and heteropatriarchy establish the white male body as the normative standard, excluding women and racialized groups from research and clinical decision- making. For populations facing intersecting systems of oppression, these harms compound: Indigenous women’s access to regular healthcare providers declined from 75 percent (2015) to 48 percent (2020), while Black women face higher cardiovascular disease and cancer mortality alongside persistent undertreatment. The patriarchal and white-centred foundations of healthcare are structurally embedded and perpetuate gendered colonial violence.

Conclusion. Recognising medicine’s entanglement with systemic harm is essential to dismantling the colonial structures that continue to shape health systems. Confronting these legacies requires addressing the intersections of race, gender, and colonialism through sustained efforts to decolonize medicine and rebuild health systems rooted in equity and justice.

The Paternal Mental Health in the Perinatal and Postnatal Period

2025-03-06T11:31:42-05:00

Background. Fatherhood lifestyle changes may contribute to stress and depression. Previous studies have highlighted risk factors for poor paternal mental health, including lack of social support, unemployment, and substance use. This review aimed to synthesize current evidence on paternal mental health during the perinatal and postnatal periods.

Methods. A five-stage scoping review framework based on Arksey and O’Malley was used to map current evidence on paternal mental health during the perinatal and postnatal periods, focusing on the prevalence of paternal stress and depression, risk factors, psychosocial impacts, and assessment tools. Articles published between 2015 and 2024 were retrieved from PubMed, Scopus, and Google Scholar. Data were extracted using a standardized charting form and analysed using narrative synthesis.

Results. A total of 1,142 articles were retrieved, and 11 were included in the final analysis. Studies represented Nigeria, Ethiopia, Finland, the United Kingdom, Australia, and China. Reported prevalence of paternal postpartum depression ranged from 2.5 to 54 percent. Common risk factors included unemployment, low income, lack of social support, and substance use. Psychosocial impacts included father-infant bonding difficulties, marital conflict, social isolation, and reduced quality of life.

Conclusion. Early intervention and culturally sensitive mental health support may help address these challenges.