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Bazié F, Speizer IS, Maytan-Joneydi A, Boukary K, Troaré MF, Agali BI, Onadja Y, Guiella G. "Everyone has their own problems and realities so the religious community cannot judge someone." Contraception motivations and perceived consequences among young contraceptive users who practice a religion in Burkina Faso. Contracept Reprod Med 2024; 9:33. [PMID: 38951885 PMCID: PMC11218151 DOI: 10.1186/s40834-024-00295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Numerous factors at the individual, interpersonal, and societal levels are related to contraceptive use (or non-use) among adolescents and youth. Little is known about the role of religion as an individual and community-level influencer of contraceptive use among young women. METHODS Using in-depth interviews with 24 young contraceptive users ages 18-24 who practice their Catholic, Protestant or Muslim religion in two cities in Burkina Faso, this study examines motivations and perceived consequences of contraceptive use. By including users of modern contraception who were both single and married, a range of perspectives are provided. RESULTS Generally, the young women interviewed who practice their religion and use contraception perceived that their religion was not supportive of contraceptive use. A few exceptions were provided, including perceived acceptance of use of some methods for married women for spacing purposes; this was specifically identified as acceptable among Muslim respondents. Sexual activity and contraceptive use were not acceptable by any of the religions for unmarried young women. That said, young women, both married and unmarried, reported their motivations for use that often related to their and their children's health and the realities of life. Contraceptive use was considered a private matter which meant that the religious community would not find out about women's use. CONCLUSIONS Recognizing that some women are willing and able to use contraception even without the perceived support of their religious communities might help to push social norms to change and be more accepting of contraceptive use that meets young women's and families' circumstances.
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Affiliation(s)
- Fiacre Bazié
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso, Burkina Faso
| | - Ilene S Speizer
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Amelia Maytan-Joneydi
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kindo Boukary
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso, Burkina Faso
| | - Moh Fatimata Troaré
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso, Burkina Faso
| | - Balki Ibrahim Agali
- Groupe de Recherche et d'Action pour le Développement - GRADE Africa, Niamey, Niger
| | - Yentema Onadja
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso, Burkina Faso
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso, Burkina Faso
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Allen EM, Frisancho A, Llanten C, Knep ME, Van Skiba MJ, Izarra C. The Role of Community Health Agents in Promoting Social Change in Peru. J Community Health 2024; 49:485-491. [PMID: 38117386 DOI: 10.1007/s10900-023-01317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Community health agents (CHAs) provide basic health services and increase health care access thereby improving health outcomes for peri-urban regions in Peru. Few studies analyze the effect that becoming a CHA has on women's interpersonal interactions. We aim to explore the impact CHAs may have on gender and social norms through their roles as trusted leaders in male-dominated communities. METHODS We conducted six 90-minute group discussions with CHAs working in Huancayo and Trujillo, Peru. We designed the discussions to extract data about family and community norms that changed as a result of working as a CHA. RESULTS A total of 53 female CHAs participated in six discussion groups. CHAs reported shifting family support (a change in how their family supported them in their role as a CHA), gaining status within their family (feeling more valued for their knowledge and experience), and shifting family gender roles (men and boys taking on more household responsibilities) as a result of their work. CHAs also reported a change in community norms and felt they were more valued and respected within their communities as women leaders. CONCLUSIONS Working as a CHA creates an opportunity to enact social change through altering family dynamics and community perceptions. Moreover, empowering women to become CHAs not only generates tangible benefits in community health, but can help create social change that ultimately improves the lives of women and realize their human rights.
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Affiliation(s)
- Elizabeth M Allen
- St. Catherine University, Public Health, Saint Paul, Minnesota, USA.
| | | | | | - Maren E Knep
- St. Catherine University, Public Health, Saint Paul, Minnesota, USA
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Nelson KA, Magut F, Mulwa S, Osindo J, Kamire V, Khagayi S, Pulerwitz J, Cook S, Gourlay A, Ziraba A, Kwaro D, Floyd S, Birdthistle I. Impact of DREAMS interventions on attitudes towards gender norms among adolescent girls and young women: Findings from a prospective cohort in Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002929. [PMID: 38446820 PMCID: PMC10917282 DOI: 10.1371/journal.pgph.0002929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/26/2024] [Indexed: 03/08/2024]
Abstract
The DREAMS partnership aims to deliver a comprehensive package to reduce HIV incidence among adolescent girls and young women (AGYW), including through shifting gender norms. We evaluate DREAMS' effect on attitudes towards gender norms in two Kenyan settings. AGYW aged 15-22 in Nairobi (n = 852) and Gem (n = 761) were randomly selected for cohort enrolment in 2017-18 and followed-up to 2019. We described the proportion of AGYW and their male peers with equitable attitudes towards gender norms, using an adapted version of the GEM scale. We estimated the association between self-reported invitation to DREAMS (in 2017-18) and AGYW's attitudes towards two dimensions of gender norms, and then applied a causal inference framework to estimate the difference in the proportion of AGYW with equitable attitudes under the counterfactual scenarios that all versus none were DREAMS beneficiaries. We estimated that overall, 90.2% versus 87.1% of AGYW would have equitable norms around sexual and reproductive health decision-making in Nairobi if all versus none were DREAMS beneficiaries (+3.1; 95%CI:-2.5, +9.0). In Gem, we estimated a risk difference of +1.0 (89.6% vs 88.6%, 95%CI: -3.6,+5.6). There was no evidence for an effect of DREAMS on attitudes towards violence-related norms (Nairobi: 82.7% vs 82.2%, +0.5; 95%CI: -5.3,+6.5; Gem: 44.3% vs 48.2%, -3.9; 95%CI: -11.7,+3.0). We found no evidence of an impact of DREAMS invitation on individual attitudes towards gender norms. In some cases, equitable attitudes at enrolment left limited scope for improvement, and additional effort may be required to shift inequitable violence attitudes among both AGYW and their male peers.
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Affiliation(s)
- Kate Andrews Nelson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Faith Magut
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Sarah Mulwa
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- African Population and Health Research Center, Nairobi, Kenya
| | - Jane Osindo
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | - Julie Pulerwitz
- Population Council, Washington, D.C., United States of America
| | - Sarah Cook
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Annabelle Gourlay
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abdhalah Ziraba
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Sian Floyd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Isolde Birdthistle
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Uusimäki K, Schneider L, Lubeka C, Kimiwye J, Mutanen M. Mothers' knowledge and practices on breastfeeding and complementary feeding in an urban slum area and rural area in Kenya: A cross-sectional interview study. J Child Health Care 2023; 27:612-627. [PMID: 35428403 PMCID: PMC10676620 DOI: 10.1177/13674935221083451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Maternal breastfeeding and complementary feeding knowledge is an important determinant of childrens' long-term health and development. This study aims to account for associations between knowledge and practices in Kenya and report the food consumption of children from birth to 18 months. In 2015 mother-child pairs were recruited from Mother-and-Child Health Centers; 415 in an urban slum in Nairobi and 364 in rural Machakos. Knowledge and practice scores were calculated from questionnaire variables and 24-h food frequency questionnaire. The associations of knowledge and practices were studied with regression analysis. Breastfeeding knowledge (Nairobi 6.3/9, Machakos 5.9/9) and practices (Nairobi 7.5/8, Machakos 7.2/8) were good in both areas. Complementary feeding knowledge was not as good (Nairobi 7.5/14, Machakos 7.1/14). Minimum meal frequency was reached by almost 80% of the children but dietary diversity was low (Nairobi 2.7 [SD 1.4], Machakos 2.4. [SD 1.3]). Only 27% of children in Nairobi and 13% in Machakos were fed a minimum acceptable diet. The complementary feeding knowledge score was associated only with minimum dietary diversity in Nairobi (OR: 1.29; 95% CI: 1.105-1.514). Infant and young child feeding knowledge and practices were on a similar level in both areas. Future interventions should focus on improving dietary diversity.
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Affiliation(s)
- Kerttu Uusimäki
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | - Lauriina Schneider
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | - Crippina Lubeka
- Department of Food, Nutrition and Dietetics, School of Applied Human Sciences, Kenyatta University, Nairobi, Kenya
| | - Judith Kimiwye
- Department of Food, Nutrition and Dietetics, School of Applied Human Sciences, Kenyatta University, Nairobi, Kenya
| | - Marja Mutanen
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
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Chandramohan S, Salinger AP, Wendt AS, Waid JL, Kalam MA, Delea MG, Comeau DL, Sobhan S, Gabrysch S, Sinharoy S. Diagnosing norms and norm change in rural Bangladesh: an exploration of gendered social norms and women's empowerment. BMC Public Health 2023; 23:2337. [PMID: 38001422 PMCID: PMC10675851 DOI: 10.1186/s12889-023-17213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Gender-transformative public health programs often aim to address power inequities between men and women and promote women's empowerment. However, to achieve transformative change, it is necessary to first identify the underlying norms that perpetuate these power imbalances. The objective of our study was to use Bicchieri's theory of social norms and model of norm change to identify gendered norms and evidence of norm change amongst participants of the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial in rural Sylhet Division, Bangladesh. METHODS We conducted ten life history interviews, 16 key informant interviews, and four focus group discussions with women and men in communities within the FAARM study site in rural, north-eastern Bangladesh. We performed a thematic analysis as well as a relational analysis of the data. RESULTS We found that social norms dictated the extent and ways in which women participated in household decisions, the locations they could visit, and their autonomy to use household resources. We also found evidence of changes to gendered social norms over time and the desire amongst some men and women to abandon restrictive norms. Certain intersecting factors, such as education and employment, were identified as facilitators and barriers to women's empowerment and the related gendered expectations. CONCLUSIONS Our findings corroborate existing norms literature, which highlights the strong role social norms play in influencing women's empowerment and behaviour. Our study provides an example of rigorous qualitative methodology that others may follow to assess gendered social norms that can be targeted for transformative change.
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Affiliation(s)
- Shivani Chandramohan
- Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Allison P Salinger
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Mailstop 1518-002-7BB Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Amanda S Wendt
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P.O. Box 60 12 03, 14412, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Jillian L Waid
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P.O. Box 60 12 03, 14412, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- Bangladesh Country Office, Helen Keller International, Rd No 82, Dhaka, 1212, Bangladesh
| | - Md Abul Kalam
- Bangladesh Country Office, Helen Keller International, Rd No 82, Dhaka, 1212, Bangladesh
| | - Maryann G Delea
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Mailstop 1518-002-7BB Clifton Rd NE, Atlanta, GA, 30322, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, USA
| | - Dawn L Comeau
- Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Shafinaz Sobhan
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P.O. Box 60 12 03, 14412, Potsdam, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Institute of Public Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Sabine Gabrysch
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P.O. Box 60 12 03, 14412, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Institute of Public Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Sheela Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Mailstop 1518-002-7BB Clifton Rd NE, Atlanta, GA, 30322, USA.
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, USA.
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Shaw B, Stevanovic-Fenn N, Gibson L, Davin C, Chipanta NSK, Lubin AB, Martin L, Saman A, Vandu D, Quirke F. Shifting Norms in Faith Communities to Reduce Intimate Partner Violence: Results from a Cluster Randomized Controlled Trial in Nigeria. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:10865-10899. [PMID: 37329160 DOI: 10.1177/08862605231176799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Programs aiming to reduce intimate partner violence (IPV) increasingly seek to shift social norms. Few interventions have been rigorously evaluated for their impact on norms and incidence of IPV, particularly in sub-Saharan Africa. Shifting norms at the community level and subsequent pathways to behavior change remain poorly understood. We assessed shifts in individual- and couple-level factors, social norms, and IPV from an 18-month community-based trial of the Masculinity, Faith, and Peace (MFP) program-a faith-based, norms-shifting approach-in Plateau state, Nigeria. This study was part of a community-based, mixed-methods, two-arm cluster randomized control trial (cRCT) to evaluate the MFP program. Quantitative surveys were conducted with women 18 to 35 years old (n = 350) and their male partners (n = 281). Respondents came from 10 Muslim and 10 Christian congregations. Social norms were measured based on results from factor analysis. Intent-to-treat analyses assessed intervention effects. Qualitative research in MFP congregations explored pathways of change. All forms of IPV reduced over time among MFP participants. Regression analyses showed a significant 61% reduction in odds of reporting experiencing any IPV among women, a 64% reduction among Christians, and a 44% reduction in MFP congregations compared to their respective controls. In addition to improvement in norms, we found significant intervention effects on individual attitudes toward IPV and gender roles, relationship quality, and community cohesion. Qualitative findings reinforce these pathways, suggesting that critical reflection and dialogue on existing norms and the focus on faith and religious texts were valued by participants and supported IPV reductions. This study demonstrates that a faith-based, norms-shifting intervention can significantly reduce IPV in a short time. There are several pathways through which MFP reduced IPV, including shifts in norms, attitudes, relationship quality, and community cohesion.
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Affiliation(s)
- Bryan Shaw
- Georgetown University, Washington, DC, USA
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Aliyi B, Dassie Y, Deressa A, Debella A, Birhanu A, Gamachu M, Eyeberu A, Mamo Ayana G, Fekredin H, Mussa I. Demand of and Access to Health Messages Through Mass Media in the Rural Community of Eastern Ethiopia: A Mixed Method Study. Risk Manag Healthc Policy 2023; 16:1859-1874. [PMID: 37719689 PMCID: PMC10503334 DOI: 10.2147/rmhp.s429712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/08/2023] [Indexed: 09/19/2023] Open
Abstract
Background The demand for health-related information has increased dramatically in recent years. Media is crucial in reaching health messages to audiences, especially those who are distant and rural. Therefore, the study aimed to assess demands, access, and factors associated with access to health messages through mass media in the rural community of Kersa District of East Hararghe, Eastern Ethiopia. Methods A mixed-methods study was conducted from October 15 to November 20, 2020. A quantitative cross-sectional and a qualitative phenomenological study design were applied. A total of 578 participants were included by using a systematic sampling technique. Collected data were entered into Epidata version 3.1 and analyzed using SPSS version 22.0. A multivariate logistic regression analysis model was used and reported using an adjusted odds ratio (AOR) with a 95% confidence interval (CI). Statistical significance was set at p <0.05. For qualitative, six-focused group discussions (FGDs) were used and then analyzed thematically. Results Overall, the demand of and access to health messages through mass media was 32.5% (95% CI=28.5-34.2%) and 26.6% (95% CI=24.6-28.7%), respectively. Factors such as having electric services (AOR=2.36, 95% CI=2.13-5.41), having a mobile phone (AOR=4.56, 95% CI=4.32-8.73), exposure to TV (AOR=4.73, 95% CI=1.03-11.62), and exposure to social media and printed media (AOR=5.24, 95% CI=1.07-15.63), a preference for programs such as news, current affairs, entertainment, health and educational were 2.37, 9.47, 4.75 and 7.55 times more likely to access health messages (AOR=2.37, 95% CI=1.00-5.61; AOR=9.47, 95% CI=3.54-25.34; AOR=4.75, 95% CI=1.23-18.38; and AOR=7.55, 95% CI=3.12-8.66, respectively). Qualitative findings, participants demand for health messages from health workers, radio, and the main source for accessing the message was the radio. Conclusion Approximately one in every three and one in every four rural communities in the study area had demand, and access to health messages through mass media, respectively. As a result, all stakeholders should emphasize and strengthen expanding methods of reaching health messages using mass media.
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Affiliation(s)
- Bushra Aliyi
- Zonal Health Office, Eastern Hararghe, Oromia, Ethiopia
| | - Yadeta Dassie
- School of Public Health, CHMS, Haramaya University, Harar, Ethiopia
| | | | - Adera Debella
- School of Nursing and Midwifery, CHMS, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, CHMS, Haramaya University, Harar, Ethiopia
| | - Mulugeta Gamachu
- School of Medicine, CHMS, Haramaya University, Harar, Ethiopia
- Departments of Public Health, Rift Valley University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, CHMS, Haramaya University, Harar, Ethiopia
| | | | - Hamdi Fekredin
- School of Public Health, CHMS, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, CHMS, Haramaya University, Harar, Ethiopia
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Weber AM, Guo Y, Zhang E, Gruber S, Medina A, Zhou H, Darmstadt GL. Associations of in-hospital postpartum feeding experiences with exclusive breastfeeding practices among infants in rural Sichuan, China. Int Breastfeed J 2023; 18:34. [PMID: 37443078 DOI: 10.1186/s13006-023-00567-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND In rural China, exclusive breastfeeding (EBF) prevalence is low and hospitals often fail to attain baby-friendly feeding objectives, such as ≥ 75% of newborns exclusively breastfed from birth to discharge. Empirical evidence for the impact of increased hospital compliance with recommended feeding guidelines on continued EBF in rural China is lacking. We sought to measure and model the association of newborns' in-hospital feeding experiences with EBF practice in infancy to inform policies for EBF promotion. METHODS Data were cross-sectional from 785 caregivers of infants < 6 months of age, collected from November to December 2019 in four underdeveloped counties/districts in Sichuan Province. In-hospital feeding practices were determined, and prevalence of current infant feeding practices was calculated from 24-h recall and categorized according to WHO/UNICEF Infant and Young Child Feeding categories as EBF, breastfed with non-milk liquids, mixed feeding, breastfed with solids, and not breastfed. Relative risk ratios were estimated using adjusted multinomial logistic regression to examine risk factors for non-EBF practices compared to EBF, including in-hospital feeding experiences. The regression model was used to investigate change in EBF prevalence under alternative in-hospital experiences. RESULTS Only 38.1% of under-six-month-old infants were being exclusively breastfed when data were collected; 61.8% and 77.6% had been fed water and infant formula, respectively, in the hospital. Infants who were fed water or formula before discharge were estimated as 2-3 times as likely to be non-EBF than EBF up to age six months. According to our model, EBF prevalence would have increased to 53.7% (95% confidence interval (CI) 46.1, 61.2) had ≥ 75% of infants been exclusively breastfed and water-based feeds eliminated in-hospital. CONCLUSIONS Given the importance of infants' first feeding experiences in the establishment and continuation of EBF, it is imperative that rural Chinese hospitals actively seek to limit infant formula feeds to medically indicated situations and eliminate water-based feeds.
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Affiliation(s)
- Ann M Weber
- Department of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, NV, USA.
| | - Yian Guo
- Rural Education Action Program (REAP), Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Evelyn Zhang
- Rural Education Action Program (REAP), Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | | | - Alexis Medina
- Rural Education Action Program (REAP), Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Huan Zhou
- Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, No.16, Section 3, South Renmin Road, Chengdu City, Sichuan Province, 610041, People's Republic of China.
| | - Gary L Darmstadt
- Department Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Gayles J, Yahner M, Barker KM, Moreau C, Li M, Koenig L, Mafuta E, Mbela P, Lundgren R. Balancing Quality, Intensity and Scalability: Results of a Multi-level Sexual and Reproductive Health Intervention for Very Young Adolescents in Kinshasa. J Adolesc Health 2023; 73:S33-S42. [PMID: 37330819 DOI: 10.1016/j.jadohealth.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 01/09/2023] [Accepted: 02/03/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE In addition to the rapid physical and cognitive transformations very young adolescents (VYAs) experience between ages 10-14, gender and social norms internalized during this period have long-term implications as adolescents become sexually active. This age presents critical opportunities for early intervention to promote gender-equitable attitudes and norms for improved adolescent health. METHODS In Kinshasa, DRC, Growing Up GREAT! implemented a scalable approach to engage in- and out-of-school VYAs, caregivers, schools, and communities. A quasi-experimental study evaluated the outcomes of sexual and reproductive health (SRH) knowledge, assets and agency, and gender-equitable attitudes and behaviors among VYA participants. Ongoing monitoring and qualitative studies provided insights into implementation challenges and contextual factors. RESULTS Results show significant improvement in SRH knowledge and assets such as caregiver connectedness, communication, and body satisfaction among the intervention group. The intervention was also associated with significant improvements in gender-equitable attitudes related to adolescents' household responsibilities and decreased teasing and bullying. Intervention effects on awareness of SRH services, body satisfaction, chore-sharing, and bullying were stronger for out-of-school and younger VYAs, suggesting the intervention's potential to increase positive outcomes among vulnerable adolescents. The intervention did not shift key gender norm perceptions assessed. Implementation research suggests design decisions made to increase the intervention's scalability necessitated reductions in training and program dosing that may have affected results. DISCUSSION Results affirm the potential of early intervention to increase SRH knowledge, assets and gender-equitable behaviors. They also highlight the need for more evidence on effective program approaches and segmentation for shifting VYA and SRH norms.
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Affiliation(s)
- Jennifer Gayles
- Department of Global Health, Save the Children Federation, Washington, D.C..
| | - Melanie Yahner
- Department of Global Health, Save the Children Federation, Washington, D.C
| | - Kathryn M Barker
- Center for Gender Equity and Health, University of California San Diego, San Diego, California
| | - Caroline Moreau
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Mengmeng Li
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leah Koenig
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric Mafuta
- Department of Health Systems Management and Policy, School of Public Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Pierrot Mbela
- Save the Children International, Democratic Republic of the Congo Country Office, Kinshasa, Democratic Republic of the Congo
| | - Rebecka Lundgren
- Center for Gender Equity and Health, University of California San Diego, San Diego, California
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Silverman JG, Brooks MI, Aliou S, Johns NE, Challa S, Nouhou AM, Tomar S, Baker H, Boyce SC, McDougal L, DeLong S, Raj A. Effects of the reaching married adolescents program on modern contraceptive use and intimate partner violence: results of a cluster randomized controlled trial among married adolescent girls and their husbands in Dosso, Niger. Reprod Health 2023; 20:83. [PMID: 37277837 PMCID: PMC10243049 DOI: 10.1186/s12978-023-01609-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Niger has the highest rate of adolescent fertility in the world, with early marriage, early childbearing and high gender inequity. This study assesses the impact of Reaching Married Adolescents (RMA), a gender-synchronized social behavioral intervention designed to improve modern contraceptive use and reduce intimate partner violence (IPV) among married adolescent couples in rural Niger. METHODS We conducted a four-armed cluster-randomized trial in 48 villages across three districts in Dosso region, Niger. Married adolescent girls (ages 13-19) and their husbands were recruited within selected villages. Intervention arms included home visits by gender-matched community health workers (CHWs) (Arm 1), gender-segregated, group discussion sessions (Arm 2), and both approaches (Arm 3). We used multilevel mixed-effects Poisson regression models to assess intervention effects for our primary outcome, current modern contraceptive use, and our secondary outcome, past year IPV. RESULTS Baseline and 24-month follow-up data were collected April-June 2016 and April-June 2018. At baseline, 1072 adolescent wives were interviewed (88% participation), with 90% retention at follow-up; 1080 husbands were interviewed (88% participation), with 72% retention at follow-up. Adolescent wives had higher likelihood of modern contraceptive use at follow-up relative to controls in Arm 1 (aIRR 3.65, 95% CI 1.41-8.78) and Arm 3 (aIRR 2.99, 95% CI 1.68-5.32); no Arm 2 effects were observed. Relative to those in the control arm, Arm 2 and Arm 3 participants were significantly less likely to report past year IPV (aIRR 0.40, 95% CI 0.18-0.88 for Arm 2; aIRR 0.46, 95% CI 0.21-1.01 for Arm 3). No Arm 1 effects were observed. CONCLUSIONS The RMA approach blending home visits by CHWs and gender-segregated group discussion sessions is the optimal format for increasing modern contraceptive use and decreasing IPV among married adolescents in Niger. Trial registration This trial is retrospectively registered with ClinicalTrials.gov, Identifier NCT03226730.
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Affiliation(s)
- Jay G. Silverman
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | | | - Sani Aliou
- Pathfinder International, Watertown, USA
| | - Nicole E. Johns
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Sneha Challa
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | | | - Shweta Tomar
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Holly Baker
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Sabrina C. Boyce
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Lotus McDougal
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Stephanie DeLong
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Anita Raj
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
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Moeti T, Mokhele T, Weir-Smith G, Dlamini S, Tesfamicheal S. Factors Affecting Access to Public Healthcare Facilities in the City of Tshwane, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3651. [PMID: 36834345 PMCID: PMC9958907 DOI: 10.3390/ijerph20043651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Access to healthcare services is largely determined by socioeconomic factors, with economically well-off individuals obtaining healthcare services more efficiently than those who are disadvantaged. This paper aims to assess the effects of socioeconomic and other related factors on access to healthcare facilities in the City of Tshwane, South Africa, during the COVID-19 pandemic. Data were sourced from the Gauteng City-Region Observatory (GCRO) quality of life survey (2020/2021). Multivariate logistic regression was applied. Results showed that 66.3% of the respondents reported that they had access to public healthcare facilities within their area. Furthermore, results showed that those who lived in informal houses were significantly (OR = 0.55, 95% CI [0.37-0.80], p < 0.01) less likely to report that they had access to public healthcare facilities in their area compared to those who lived in formal houses. More efforts need to be undertaken to ensure that all citizens have access to public healthcare facilities, especially among those who are disadvantaged, such as informal dwellers. In addition, future research should encompass locality in relation to the factors that affect access to public healthcare facilities, especially during pandemics such as the COVID-19 pandemic, in order to have geographically targeted interventions.
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Affiliation(s)
- Thabiso Moeti
- Geospatial Analytics, eResearch Knowledge Centre, Human Sciences Research Council, Pretoria 0001, South Africa
- Geography, Environmental Management and Energy Studies, University of Johannesburg, Johannesburg 2006, South Africa
| | - Tholang Mokhele
- Geospatial Analytics, eResearch Knowledge Centre, Human Sciences Research Council, Pretoria 0001, South Africa
| | - Gina Weir-Smith
- Geospatial Analytics, eResearch Knowledge Centre, Human Sciences Research Council, Pretoria 0001, South Africa
- Geography, Archaeology and Environmental Studies, Wits University, Johannesburg 2000, South Africa
| | - Simangele Dlamini
- Geospatial Analytics, eResearch Knowledge Centre, Human Sciences Research Council, Pretoria 0001, South Africa
| | - Solomon Tesfamicheal
- Geography, Environmental Management and Energy Studies, University of Johannesburg, Johannesburg 2006, South Africa
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Boyce SC, Minnis AM, Deardorff J, McCoy SI, Goin DE, Challa S, Johns NE, Aliou S, Brooks MI, Nouhou AM, Baker H, Silverman JG. Mediating effects of inequitable gender norms on intimate partner violence and contraceptive use in a cluster randomized control trial in Niger: A causal inference mediation analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.12.23284504. [PMID: 36711886 PMCID: PMC9882558 DOI: 10.1101/2023.01.12.23284504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Gender inequity, a deeply-rooted driver of poor health globally, is expressed in society through gender norms, the unspoken rules that govern gender-related roles and behavior. The development of public health interventions focused on promoting equitable gender norms are gaining momentum internationally, but there remain critical gaps in the evidence about how these interventions are working to change behavioral outcomes. Methods A four-arm cluster randomized control trial (cRCT) was conducted to evaluate the effects of the Reaching Married Adolescents in Niger (RMA) intervention on modern contraceptive use and intimate partner violence (IPV) among married adolescent girls and their husbands in Dosso, Niger (T1: 1042 dyads; 24 mos. follow-up: 737 dyads, 2016-2019). This study seeks to understand if changes in perceived inequitable gender norms among husbands are the mechanism behind effects on modern contraceptive use and IPV. We estimated natural direct and indirect effects via these gender norms using inverse odds ratio weighting. An intention-to-treat approach and a difference-in-differences estimator in a hierarchical linear probability model was used to estimate prevalence differences, along with bootstrapping to estimate confidence intervals. Results The total effects of the RMA small group intervention (Arm 2) is estimated to be an 8% reduction in prevalence of IPV [95% CI: -0.18, 0.01]. For this arm, the natural indirect effect through gender inequitable social norms is associated with a 2% decrease (95% CI: -0.07, 0.12), accounting for 22.3% of this total effect, and the natural direct effect with a 6% decrease (95% CI: -0.20, -0.02) in IPV. Of the total effect of the RMA household visit intervention (Arm 1) on contraceptive use (20% increase), indirect effects via inequitable gender norms were associated with an 11% decrease (95% CI: -0.18, -0.01) and direct effects with a 32% increase (95% CI: 0.13, 0.44) in contraceptive use. For the combination arm, of the total effects on contraceptive use (19% increase), indirect effects were associated with a 9% decrease (95% CI: -0.20, 0.02) and direct effects with a 28% increase (95% CI: 0.12, 0.46). Conclusion The present study contributes experimental evidence that the small group RMA intervention reduced IPV partially via reductions in perceived inequitable gender norms among husbands. Evidence also suggests that increases in perceived inequitable gender norms resulted in decreased contraceptive use among those receiving the household visit intervention component. Not only do these results open the "black box" around how the RMA small group intervention may create behavior change to help inform its future use, they provide evidence supporting behavior change theories and frameworks that postulate the importance of changing underlying social norms in order to reduce IPV and increase modern contraceptive use.
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Affiliation(s)
- Sabrina C Boyce
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - AM Minnis
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - J Deardorff
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - SI McCoy
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - DE Goin
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - S Challa
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - NE Johns
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - S Aliou
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - MI Brooks
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - A-M Nouhou
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - H Baker
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - JG Silverman
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Kawasaki Y, Nagao-Sato S, Yoshii E, Akamatsu R. Integrated consumers' sustainable and healthy dietary behavior patterns: Associations between demographics, psychological factors, and meal preparation habits among Japanese adults. Appetite 2023; 180:106353. [PMID: 36309231 DOI: 10.1016/j.appet.2022.106353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
The consumers' Sustainable and Healthy Dietary Behaviors (SHDBs) links sustainable behaviors related to eating (e.g., choosing, cooking, eating, and disposing of foods) with the level of "dietary behavior." It was hypothesized that SHDBs will vary depending on consumers' meal preparation habits, such as food selection, cooking frequency, and skill. This study examined (1) some of the behavioral patterns of SHDBs and (2) independent predictors of each pattern. In total, 508 Japanese adults who completed cross-sectional self-administered questionnaire surveys in December 2021 were included in the study. Principal component analysis (PCA) was used to identify the behavioral patterns of the 30-item SHDBs developed previously by the authors. Additionally, independent predictors of each component score were analyzed using multiple linear regression models, which included demographics, psychological factors concerning SHDBs (pros and cons for the decisional balance of SHDBs and number of environmental issues of interest), and meal preparation habits. Participants' median age was 41 (18-59) years (women: n = 259, 51.0%). Five SHDB patterns with several independent predictors were identified: amalgamation of all SHDBs, healthy food choices but unsustainable cooking, sustainable disposal, avoiding plastic products, and sustainable behaviors regarding expiry date. The multiple linear regression analysis demonstrated the independent predictors of the amalgamation of all SHDBs, such as being a man (β = -0.105), greater pros (β = 0.134), higher cooking frequency (β = 0.443) and skill (β = 0.244). Greater pros and/or smaller cons were associated with four of the five SHDB patterns, including an amalgamation of all SHDBs, healthy food choice and unsustainable cooking, avoiding disposal, and avoiding plastic products. Sustainable and healthy diet education must be implemented to ensure the adoption of all SHDBs.
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Affiliation(s)
- Yui Kawasaki
- Institute for SDGs Promotion, Organization for Social Implementation of Sustainability, Ochanomizu University, 2-1-1 Otsuka Bunkyo-ku, Tokyo, 112-8610, Japan.
| | - Sayaka Nagao-Sato
- Graduate School of Humanities and Science, Ochanomizu University, 2-1-1 Otsuka Bunkyo-ku, Tokyo, 112-8610, Japan.
| | - Emi Yoshii
- Department of Food and Health Sciences, Faculty of Health and Human Development, The University of Nagano, Japan.
| | - Rie Akamatsu
- Natural Science Division, Faculty of Core Research, Ochanomizu University, 2-1-1 Otsuka Bunkyo-ku, Tokyo, 112-8610, Japan.
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Bryan E, Mekonnen D. Does small-scale irrigation provide a pathway to women's empowerment? Lessons from Northern Ghana. JOURNAL OF RURAL STUDIES 2023; 97:474-484. [PMID: 36819110 PMCID: PMC9930902 DOI: 10.1016/j.jrurstud.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/10/2022] [Accepted: 12/28/2022] [Indexed: 06/18/2023]
Abstract
Given persistent gender inequalities that influence how the benefits of technologies are distributed, the expansion of small-scale irrigation technologies requires the consideration of important gender dynamics and impacts. Women's lack of agency and access to resources relative to men, and other social constraints, often limit their ability to adopt and benefit from agricultural technologies. At the same time, expanding access to agricultural technology to women may provide a pathway for empowerment. This paper explores the potential for small-scale irrigation technologies to increase women's empowerment by evaluating the impacts of an intervention that distributed motor pumps to small groups of farmers in Northern Ghana. The paper draws on two rounds of survey data that included the Women's Empowerment in Agriculture Index, before and after the motor pump intervention was implemented. To control for possible selection bias at the baseline, the difference-in-difference method is used to estimate the impact of the program on indicators of women's empowerment. Spillover effects are estimated by comparing outcomes of farmers in treatment villages that did not receive the pumps with farmers in control villages, where no motor pumps were distributed. The results show no significant impact of the program on measures of women's empowerment. However, there are potential negative impacts, including among households that did not benefit from the intervention. The results highlight the need to pair interventions that distribute agricultural technologies with complementary investments in infrastructure that increase access to water for irrigation, as well as other activities and approaches that ensure women can reap the benefits.
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Affiliation(s)
- Elizabeth Bryan
- Environment and Production Technology Division, International Food Policy Research Institute, 1201 Eye Street NW, Washington, DC, 20005, USA
| | - Dawit Mekonnen
- Environment and Production Technology Division, International Food Policy Research Institute, IFPRI C/o ILRI P.O. Box, 5689, Addis Ababa, Ethiopia
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Michaelson V, Ensom R. Ending the Social Normalization of Violence against Children in Canada: A Framework, Rationale, and Appeal to Canadian Faith Leaders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17016. [PMID: 36554899 PMCID: PMC9778701 DOI: 10.3390/ijerph192417016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Corporal punishment remains the most common form of violence against children in Canada. Along with being legally permitted, it is made socially acceptable through cultural and social norms often disguised as discipline. Paraphrases of Judeo-Christian sacred texts such as "spare the rod; spoil the child" have been widely used to justify corporal punishment, and to create norms around the idea that it is a god-given responsibility of parents to inflict corporal punishment on their children "for their own good." Corporal punishment is then not only an acceptable part of raising children but can be a godly duty. Though Canada is a secular country, this social norm provides a moral hegemony under which violence becomes the status quo and has proven very difficult to change. In this commentary, we outline the ways that Christian religion has contributed to social norms around corporal punishment. We then argue that religious leaders have an opportunity-and moral responsibility-to contribute to change. We conclude with insights from social norms theory and offer evidence-based recommendations for ways forward that could help shift attitudes around corporal punishment in order to decrease its prevalence and harm. While each of these issues has been written about extensively in isolation, this commentary offers an analysis of these matters together under one umbrella. By making this relationship between Christianity and the social norms that propagate corporal punishment more visible, we draw attention to the role leaders in Christian churches could play in disrupting the social acceptance of violence against our youngest Canadian citizens. We provide a practical and evidence-based framework, rationale, and appeal to Canadian faith leaders to use their influence to add momentum to a critical health, rights-and religion-issue in Canada.
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Affiliation(s)
- Valerie Michaelson
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Ron Ensom
- Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
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Mitchell J, Cooke P, Ahorlu C, Arjyal A, Baral S, Carter L, Dasgupta R, Fieroze F, Fonseca-Braga M, Huque R, Lewycka S, Kalpana P, Saxena D, Tomley F, Tsekleves E, Vu Thi Quynh G, King R. Community engagement: The key to tackling Antimicrobial Resistance (AMR) across a One Health context? Glob Public Health 2022; 17:2647-2664. [PMID: 34882505 DOI: 10.1080/17441692.2021.2003839] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022]
Abstract
Antimicrobial resistance (AMR) is a One Health problem underpinned by complex drivers and behaviours. This is particularly so in low - and middle-income countries (LMICs), where social and systemic factors fuel (mis)use and drive AMR. Behavioural change around antimicrobial use could safeguard both existing and future treatments. However, changing behaviour necessitates engaging with people to understand their experiences. This publication describes a knowledge-exchange cluster of six LMIC-based projects who co-designed and answered a series of research questions around the usage of Community Engagement (CE) within AMR. Findings suggest that CE can facilitate AMR behaviour change, specifically in LMICs, because it is a contextualised approach which supports communities to develop locally meaningful solutions. However, current CE interventions focus on human aspects, and demand-side drivers, of AMR. Our cluster suggests that broader attention should be paid to AMR as a One Health issue. The popularity of mixed methods approaches within existing CE for AMR interventions suggests there is interdisciplinary interest in the uptake of CE. Unfortunately, the specificity and context-dependency of CE can make it difficult to evaluate and scale. Nevertheless, we suggest that in synthesising learnings from CE, we can develop a collective understanding of its scope to tackle AMR across contexts. .
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Affiliation(s)
- Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse, UK
| | - Paul Cooke
- Centre for World Cinema and Digital Cultures, University of Leeds, Woodhouse, UK
| | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | | | - Laura Carter
- School of Geography, University of Leeds, Woodhouse, UK
| | - Rajib Dasgupta
- One Health Poultry Hub, UK
- Centre of Social Medicine & Community Health, Jawaharlal Nehru University, New Delhi, India
| | | | | | | | - Sonia Lewycka
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Ha Noi, Vietnam
| | - Pachillu Kalpana
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
| | - Deepak Saxena
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
| | - Fiona Tomley
- One Health Poultry Hub, UK
- Royal Veterinary College, Hatfield, UK
| | | | - Gioa Vu Thi Quynh
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Ha Noi, Vietnam
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse, UK
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Uwamahoro NS, McRae D, Zibrowski E, Victor-Uadiale I, Gilmore B, Bergen N, Muhajarine N. Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis. BMJ Glob Health 2022; 7:bmjgh-2022-009605. [PMID: 36180098 PMCID: PMC9528638 DOI: 10.1136/bmjgh-2022-009605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Maternity waiting homes (MWHs) link pregnant women to skilled birth attendance at health facilities. Research suggests that some MWH-facility birth interventions are more success at meeting the needs and expectations of their intended users than others. We aimed to develop theory regarding what resources work to support uptake and scale-up of MHW-facility birth interventions, how, for whom, in what contexts and why. Methods A four-step realist review was conducted which included development of an initial programme theory; searches for evidence; selection, appraisal and extraction of data; and analysis and data synthesis. Results A programme theory was developed from 106 secondary sources and 12 primary interviews with MWH implementers. The theory demonstrated that uptake and scale-up of the MWH-facility birth intervention depends on complex interactions between three adopter groups: health system stakeholders, community gatekeepers and pregnant women and their families. It describes relationships between 19 contexts, 11 mechanisms and 31 outcomes accross nine context-mechanism-outcome configurations (CMOCs) which were grouped into 3 themes: (1) Engaging stakeholders to develop, integrate, and sustain MWH-facility birth interventions, (2) Promoting and enabling MWH-facility birth utilisation and (3) Creating positive and memorable MWH-facility birth user experiences. Belief, trust, empowerment, health literacy and perceptions of safety, comfort and dignity were mechanisms that supported diffusion and adoption of the intervention within communities and health systems. Examples of resources provided by implementers to trigger mechanisms associated with each CMOC were identified. Conclusions Implementers of MWHs cannot merely assume that communities will collectively value an MWH-facility birth experience over delivery at home. We posit that MWH-facility birth interventions become vulnerable to under-utilisation when implementers fail to: (1) remove barriers that hinder women’s access to MWH and (2) ensure that conditions and interactions experienced within the MWH and its affiliated health facility support women to feel treated with compassion, dignity and respect. PROSPERO registration number CRD42020173595.
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Affiliation(s)
- Nadege Sandrine Uwamahoro
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Faculty of Medical Sciences, Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Daphne McRae
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Chilliwack Division of Family Practice, Chilliwack General Hospital, Chiliwack, British Colombia, Canada
| | - Elaine Zibrowski
- Best Care COPD, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ify Victor-Uadiale
- Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Ireland
| | - Nicole Bergen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nazeem Muhajarine
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Population Health and Evaluation Research Unit, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Nnyombi A, Bukuluki P, Besigwa S, Ocaya-Irama J, Namara C, Cislaghi B. How social norms contribute to physical violence among ever-partnered women in Uganda: A qualitative study. FRONTIERS IN SOCIOLOGY 2022; 7:867024. [PMID: 36117885 PMCID: PMC9477001 DOI: 10.3389/fsoc.2022.867024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
This paper contributes to the literature that studies how social norms sustain undesirable behavior. It establishes how norms contribute to intimate partner physical violence against women. First, norms organize physical violence as a domestic and private matter. Second, they organize physical violence as a constituent part of women's lives, thereby normalizing women's experience of abuse. Third, norms define appropriate boundaries within which male partners perpetrate violence. The findings draw essential information for social change interventions that target improvement in women's and girls' wellbeing. For social and behavioral programmes to change harmful norms, they have to deconstruct physical violence as a private matter, advance the de-normalization of physical violence, and dismantle acceptable boundaries within which violence happens.
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Affiliation(s)
- Aloysious Nnyombi
- Department of Social and Cultural Anthropology, University of Vienna, Vienna, Austria
| | - Paul Bukuluki
- School of Social Sciences, Makerere University, Kampala, Uganda
| | | | | | | | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Vidal L, Iragola V, Machín L, Brunet G, Girona A, Curutchet MR, de León C, Ares G. A Qualitative Exploration of Parents' Food Choices During Early Childhood. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:764-775. [PMID: 35643750 DOI: 10.1016/j.jneb.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore parents' accounts of the goals they seek when choosing foods for their young children through the lens of goal-systems theory. DESIGN In-depth interviews with parents of children aged from 6 months to 5 years. SETTING Montevideo, Uruguay. PARTICIPANTS Forty-two parents (aged 19-44 years, 90% female). PHENOMENON OF INTEREST Parents' personal experiences, feelings, and opinions related to how they choose foods for their children. ANALYSIS Content analysis based on deductive-inductive coding. RESULTS Parents' accounts confirmed they intended to pursue different goals when choosing foods for their children. Health-related goals mainly motivated the selection of healthy foods, but they also drove the selection of some ultra-processed products because of misconceptions about their healthiness. Pleasure and enjoyment motivated the selection of ultra-processed products, whereas stress avoidance was associated with selecting convenient foods. The selection of unhealthy foods raised conflicts between goals, which were solved using goal shielding, changes in risk perception and/or compensatory health beliefs. CONCLUSIONS AND IMPLICATIONS Results point to the need for communication campaigns and community-based interventions to introduce changes in how ultra-processed products are conceptualized and increase the associations between healthy foods and children's pleasure and enjoyment to promote healthier eating patterns during infancy and early childhood.
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Affiliation(s)
- Leticia Vidal
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Canelones, Uruguay.
| | - Valentina Iragola
- Espacio Interdisciplinario, Universidad de la República, Montevideo, Uruguay
| | - Leandro Machín
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Montevideo, Uruguay
| | - Gerónimo Brunet
- Espacio Interdisciplinario, Universidad de la República, Montevideo, Uruguay
| | - Alejandra Girona
- Departamento de Nutrición Básica, Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - María Rosa Curutchet
- Instituto Nacional de Alimentación, Ministerio de Desarrollo Social, Montevideo, Uruguay
| | - Carolina de León
- Núcleo Interdisciplinario "Alimentación y Bienestar", Universidad de la República, Montevideo, Uruguay
| | - Gastón Ares
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Canelones, Uruguay
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Cannon AC, Mandal M, McGuire C, Calhoun LM, Mumuni T, Speizer IS. A vignette-based approach to understanding social norms around family planning in three Nigerian cities. Glob Public Health 2022; 17:1379-1391. [PMID: 34032182 PMCID: PMC9890377 DOI: 10.1080/17441692.2021.1928261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/21/2021] [Indexed: 02/03/2023]
Abstract
Understanding the mechanisms through which social norms shape contraceptive use can help prevent unintended pregnancies in low-income countries. The Nigerian Urban Reproductive Health Initiative (NURHI) aimed to increase contraceptive uptake through advocacy, service delivery, and demand generation. Using data from focus group discussions, we examined whether social norms around family planning (FP), and specifically use of modern contraception (MC), varied among women and girls of reproductive age exposed to varying levels of the programme in three Nigerian cities. Injunctive social norms were generally unfavourable of unmarried adolescent girls' use of MC, though participants often shared exceptions for certain types of adolescents whose use of MC would be acceptable. There was greater acceptability for MC use by women who wanted to space or limit pregnancies. Participants reported that norms around FP and MC use have become more accepting in their communities over time. Normative differences between cities were identified. Participants' perceptions of religious leaders' support for FP use may have contributed to positively influencing social norms.
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Affiliation(s)
- Abby C. Cannon
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mahua Mandal
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Courtney McGuire
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lisa M. Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tolulope Mumuni
- Centre for Population and Reproductive Health, University of Ibadan, Nigeria
| | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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21
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Matanda DJ, Kabiru CW, Okondo C, Shell-Duncan B. Plurality of beliefs about female genital mutilation amidst decades of intervention programming in Narok and Kisii Counties, Kenya. CULTURE, HEALTH & SEXUALITY 2022; 24:750-766. [PMID: 33630717 DOI: 10.1080/13691058.2021.1880641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
Female genital mutilation derails efforts to achieve gender equality and the empowerment of girls and women. In Kenya, national estimates show a steady decline in prevalence, although there is considerable variation at the sub-national level. There is a need to better understand female genital mutilation-related norms and meanings and whether there have been changes in these given long-term and diverse efforts to promote abandonment. Focusing on Narok and Kisii counties, we conducted a cross-sectional qualitative study to identify social norms surrounding the practice of female genital mutilation, as well as consensus or contestation with respect to these norms. Ten focus group discussions were held with men and women aged 18 years and older from the Maasai and Abagusii communities that have traditionally practised female genital mutilation. Study findings showed that norms associated with female genital mutilation such as sexuality and marriageability were actively contested by community members. This change may provide a useful starting point for programmes that seek to create dialogue and critical reflection on female genital mutilation to accelerate its abandonment.
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22
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OUP accepted manuscript. Health Promot Int 2022:6556290. [DOI: 10.1093/heapro/daac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pedro H, Meiyanto S, Andayani B. Transformation of women's leadership through producing natural-dyed hand-woven fabrics (ethnographic study on Palue weavers). GACETA SANITARIA 2021; 35 Suppl 2:S554-S557. [PMID: 34929899 DOI: 10.1016/j.gaceta.2021.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to find an explanation for the transformation process of the Palue female weavers' leadership, which changes along with changes in the use of color materials in the sarong from chemical colors that are harmful to health and not in accordance with tradition to natural color materials that are safer and in accordance with tradition. METHODS An ethnographic approach was used in this study. Data collection was carried out for 17 months through direct involvement in the activities of producing natural-dyed and hand-woven traditional fabrics done by 15 families. RESULT The results showed that a transformation of leadership took place in each of these families. CONCLUSION Replacing chemicals with natural ingredients that are safer in sarong coloring, not only makes women healthier but also makes them a leader in the home industry as well as becoming more empowered and daring to pass on their sarong-making skills to the next generation because natural color materials are safe for children. Women are the managers of the home industry of making naturally dyed hand-woven fabrics, involving their husbands and children. There has been a cultural change in which husbands have been willing to help their wives with the dyeing and weaving works. Leadership by women in this home industry has an impact on the decision-making process in the family, cooperatives and community.
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Affiliation(s)
- Hendrikus Pedro
- Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia; Faculty of Social Science, Nusa Nipa University, Maumere, Indonesia.
| | - Sito Meiyanto
- Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia
| | - Budi Andayani
- Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia
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Gram L, Chakraborty P, Daruwalla N, Osrin D. Social and Psychological Readiness to Take Collective Action Against Violence Against Women: A Mixed Methods Study of Informal Settlements in Mumbai, India. Violence Against Women 2021; 27:3176-3196. [PMID: 33227227 PMCID: PMC8521371 DOI: 10.1177/1077801220971360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Past failures to mobilize communities in collective action against violence against women (VAW) have been ascribed to contextual challenges, but researchers have not systematically mapped community capacity for collective action against VAW. We conducted a mixed methods study in Mumbai, India using quantitative data from a household survey (n = 2,642) and qualitative data from 264 community meetings. We found attitudes supporting gender inequality and violence coexisted with significant enthusiasm and support for collective action against VAW. These findings open up avenues for policymakers to treat communities as less vulnerable and more capable of changing situations and problems that affect them.
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Affiliation(s)
- Lu Gram
- University College London, UK
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25
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Palutturi S, Saleh LM, Rachmat M, Shabir AM, Rosmanely S, Aidillah MR, Malek JA, Nam EW. Inter-community Relations Factor on the Empowerment of the Aisle Community in Makassar City: A Structural Equation Model. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: There are several important factors in building community empowerment, one of them is the inter-community relationship. However, further research is rarely done on this dimension. The dimension of the relationship includes community structure, community strength, community motivation, community communication, community integrity, community participation, and community development. Objective: This study aimed to find the best model of the effect of the inter-community relationship on the condition of healthy aisle in Makassar City. Method: This research was conducted in 2 sub-districts in Makassar City, those are Rappocini District and Ujung Tanah District. The research samples involved were 560 households in Lorong. Data analysis was performed using multivariate analysis through the structural equation model (SEM) test. Results: The results of this study found that clear vision (CR = 3.219 and p = 0.01), capacity development (CR = 3.166 and p = 0.02), norms existence (CR = 3.143 and p = 0.02) on inter-community relationship significantly affected the aisle community empowerment. Conclusion: Inter-community relationship is the best model in developing a healthy aisle in Makassar City through solidarity, shared motivation, shared trust, clear vision, resources shares, capacity building, norms in society, government support, and community development. This study recommends that in order to maximize a clear vision for the aisle community working group, the government should carry out legality regarding the aisle community structure.
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Cislaghi B, Berkowitz AD. The evolution of social norms interventions for health promotion: Distinguishing norms correction and norms transformation. J Glob Health 2021; 11:03065. [PMID: 34737854 PMCID: PMC8562258 DOI: 10.7189/jogh.11.03065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Webb KA, Mavhu W, Langhaug L, Chitiyo V, Matyanga P, Charashika P, Patel D, Prost A, Ferrand RA, Bernays S, Cislaghi B, Neuman M. 'I was trying to get there, but I couldn't': social norms, vulnerability and lived experiences of home delivery in Mashonaland Central Province, Zimbabwe. Health Policy Plan 2021; 36:1441-1450. [PMID: 34139011 DOI: 10.1093/heapol/czab058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/04/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Increasing facility-based delivery rates is pivotal to reach Sustainable Development Goals to improve skilled attendance at birth and reduce maternal and neonatal mortality in low- and middle-income countries (LMICs). The translation of global health initiatives into national policy and programmes has increased facility-based deliveries in LMICs, but little is known about the impact of such policies on social norms from the perspective of women who continue to deliver at home. This qualitative study explores the reasons for and experiences of home delivery among women living in rural Zimbabwe. We analysed qualitative data from 30 semi-structured interviews and 5 focus group discussions with women who had delivered at home in the previous 6 months in Mashonaland Central Province. We found evidence of strong community-level social norms in favour of facility-based delivery. However, despite their expressed intention to deliver at a facility, women described how multiple, interacting vulnerabilities resulted in delivery outside of a health facility. While identified as having delivered 'at home', narratives of birth experiences revealed the majority of women in our study delivered 'on the road', en route to the health facility. Strong norms for facility-based delivery created punishments and stigmatization for home delivery, which introduced additional risk to women at the time of delivery and in the postnatal period. These consequences for breaking social norms promoting facility-based delivery for all further increased the vulnerability of women who delivered at home or on the road. Our findings highlight that equitable public health policy and programme designs should include efforts to actively identify, mitigate and evaluate unintended consequences of social change created as a by-product of promoting positive health behaviours among those most vulnerable who are unable to comply.
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Affiliation(s)
- Karen A Webb
- Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - W Mavhu
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), 4 Bath Rd, Belgravia, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - L Langhaug
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Meyrick Park, Mabelreign, Harare, Zimbabwe
| | - V Chitiyo
- Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
| | - P Matyanga
- Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
| | - P Charashika
- Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
| | - D Patel
- Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
| | - A Prost
- University College London, London, UK
| | - Rashida A Ferrand
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Biomedical Research and Training Institute (BRTI), 10 Seagrave Road, Avondale, Harare
| | - S Bernays
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- University of Sydney, School of Public Health, University of Sydney, Camperdown, 2006, Australia
| | - B Cislaghi
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - M Neuman
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
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The Effectiveness of Interventions in Improving Hand Hygiene Compliance: A Meta-Analysis and Logic Model. ACTA ACUST UNITED AC 2021; 2021:8860705. [PMID: 34336066 PMCID: PMC8313351 DOI: 10.1155/2021/8860705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/12/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Background Despite the availability of various guidelines, rules, and strategies, hand hygiene adherence rates among healthcare workers are reported significantly lower than expected. The aim of this meta-analysis is to determine the most effective interventions to improve hand hygiene and to develop a logic model based on the characteristics of the most effective interventions. Methods A literature search was conducted on PubMed, ProQuest, Web of Knowledge, Scopus, Cochrane Library, and ScienceDirect databases up to December 21, 2019, with no time limit. Randomized clinical trials which had designed interventions to improve hand hygiene were reviewed. Data were extracted independently by two authors. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) software (version 2.0). A random-effects model was used to estimate odds ratios. Results Although 14 studies were initially reviewed, only 12 studies entered the meta-analysis, since they had identified percentage rates of hand hygiene compliance. The most effective intervention (odds ratio 18.4, 95% CI (13.6–24.8)) was a multilevel strategy that influenced the determinants of hand hygiene behavior at individual, interpersonal, and organizational levels. Following this, a theory-driven logic model was mapped out to promote hand hygiene, based on situational analysis. Conclusion This study suggests that designing integrated interventions based on a multilevel socioecological approach has the greatest potential to improve hand hygiene compliance in healthcare workers. The logical model proposed in this study can thus provide a useful guide for designing and conducting future experimental research.
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Eaton J, Krishna A, Sudi C, George J, Magomba C, Eckman A, Houck F, Taukobong H. Gendered Social Norms Change in Water Governance Structures Through Community Facilitation: Evaluation of the UPWARD Intervention in Tanzania. FRONTIERS IN SOCIOLOGY 2021; 6:672989. [PMID: 34291106 PMCID: PMC8287258 DOI: 10.3389/fsoc.2021.672989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/03/2021] [Indexed: 06/13/2023]
Abstract
Background: In rural Tanzania, women and girls disproportionately bear the burden of water scarcity. Gendered social norms on the acceptability of women's participation in the public sphere limit their decision-making power within local water governance structures. The UPWARD (Uplifting Women's Participation in Water-Related Decision-Making) intervention sought to understand how a community-based gendered social norms approach using organized diffusion can lead to changes in the gendered social norms impacting women's participation in water-related governance structures. Methods: As part of WARIDI, a 5-years integrated water resource management (IWRM) program, a gendered-social norms change (GSNC) activity (UPWARD: Uplifting Women's Participation in Water-Related Decision-Making) was implemented in two villages in Iringa and Kilombero districts. Encouraging organized diffusion, UPWARD promoted gender-equitable norms among a critical mass of community members. WARIDI identified and trained a Community Facilitation Team (CFT) of three women and men to lead a series of education and empowerment sessions in two communities. The intervention reached >300 individuals directly (∼10% of total village population). Changes in social norms were assessed through social norms analysis plots (SNAP) delivered in focus group discussions (FGDs) of 8-12 participants. Results: At baseline, most participants reported that women's involvement in water-related decision-making was restricted to household decisions. Men viewed themselves as primary decision-makers in water governance. Women who spoke in village meetings experienced sanctions for disrespect and outspokenness; their husbands were teased for being "controlled." At endline, participants reported fewer instances of ridicule towards women's participation. Women expressed a greater sense of solidarity with each other; men reported greater respect for men whose wives contribute. The intervention's effects appeared more pronounced in areas with greater cultural heterogeneity, suggesting norm change may be harder to affect where norms are tighter. Conclusion: UPWARD provides evidence that gendered social norms change programs can have identifiable impacts on women's participation in water-related decision-making over a short time. While other interventions have used larger, multi-level strategies to affect gender norms, UPWARD has shown that community mobilization with brief (∼4 months) but concentrated engagement with communities can promote changes in social norms that persist at least 6 months after intervention's end.
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Affiliation(s)
| | | | | | | | - Christopher Magomba
- Iris Group, Chapel Hill, NC, United States
- School of Agricultural Economics and Business Studies (SAEBS), Sokoine University of Agriculture, Morogoro, Tanzania
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Leight J, Deyessa N, Verani F, Tewolde S, Sharma V. Community-level spillover effects of an intervention to prevent intimate partner violence and HIV transmission in rural Ethiopia. BMJ Glob Health 2021; 6:bmjgh-2020-004075. [PMID: 33509840 PMCID: PMC7845680 DOI: 10.1136/bmjgh-2020-004075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 01/28/2023] Open
Abstract
Background Intimate partner violence (IPV) is associated with adverse health and psychosocial outcomes. We analysed the spillover effects of Unite for a Better Life (UBL), an intervention evaluated in a cluster randomised controlled trial using a double-randomised design; previous evidence suggests UBL reduced IPV in rural Ethiopia among direct beneficiaries. Methods Villages (n=64) were randomly allocated to control, or to receive UBL delivered to men, women or couples. Each cluster comprised 106 surveyed households, including 21 randomly selected indirect beneficiary households who were not included in the intervention. Primary and secondary IPV outcomes included women’s experience and men’s perpetration of past-year physical or sexual IPV 24 months postintervention. An intention-to-treat analysis was conducted comparing indirect beneficiaries to sampled households in control communities. The analysis includes 2516 households surveyed at baseline in 2014–2015 (1680 households in the control arm, 258 indirect beneficiary households in the couples’ arm, 287 indirect beneficiary households in the women’s arm and 291 indirect beneficiary households in the men’s arm). Follow-up data were available from 88% of baseline respondents and 86% of baseline spouses surveyed in 2017–2018, a total of 4379 individuals. Results Among indirect beneficiaries, there was no statistically significant intervention effect on women’s past-year experience of physical or sexual IPV, while men’s UBL significantly reduced reported perpetration of past-year sexual IPV (Adjusted Odds Ratio: 0.55; 95% CI 0.38 to 0.80, p=0.002). The intervention effects among indirect beneficiaries were statistically similar to those reported for the direct beneficiaries. In general, the hypothesis of equal effects cannot be rejected. Conclusion A gender-transformative intervention delivered to men was effective in reducing reported IPV even among indirect beneficiaries, suggesting that the programme had positive spillover effects in diffusing information and changing behaviours within the broader community. Trial registration numbers NCT02311699 and American Economic Association Registry (AEARCTR-0000211).
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Affiliation(s)
- Jessica Leight
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Negussie Deyessa
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | | | | | - Vandana Sharma
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
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Mannell J, Amaama SA, Boodoosingh R, Brown L, Calderon M, Cowley-Malcolm E, Lowe H, Motta A, Shannon G, Tanielu H, Vergara CC. Decolonising violence against women research: a study design for co-developing violence prevention interventions with communities in low and middle income countries (LMICs). BMC Public Health 2021; 21:1147. [PMID: 34130681 PMCID: PMC8205204 DOI: 10.1186/s12889-021-11172-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been substantial progress in research on preventing violence against women and girls (VAWG) in the last 20 years. While the evidence suggests the potential of well-designed curriculum-based interventions that target known risk factors of violence at the community level, this has certain limitations for working in partnership with communities in low- and middle-income (LMIC) countries, particularly when it comes to addressing the power dynamics embedded within north-south research relationships. METHODS As an alternative approach, we outline the study design for the EVE Project: a formative research project implemented in partnership with community-based researchers in Samoa and Amantaní (Peru) using a participatory co-design approach to VAWG prevention research. We detail the methods we will use to overcome the power dynamics that have been historically embedded in Western research practices, including: collaboratively defining and agreeing research guidelines before the start of the project, co-creating theories of change with community stakeholders, identifying local understandings of violence to inform the selection and measurement of potential outcomes, and co-designing VAWG prevention interventions with communities. DISCUSSION Indigenous knowledge and ways of thinking have often been undermined historically by Western research practices, contributing to repeated calls for better recognition of Southern epistemologies. The EVE Project design outlines our collective thinking on how to address this gap and to further VAWG prevention through the meaningful participation of communities affected by violence in the research and design of their own interventions. We also discuss the significant impact of the COVID-19 pandemic on the project in ways that have both disrupted and expanded the potential for a better transfer of power to the communities involved. This article offers specific strategies for integrating Southern epistemologies into VAWG research practices in four domains: ethics, theories of change, measurement, and intervention design. Our aim is to create new spaces for engagement between indigenous ways of thinking and the evidence that has been established from the past two decades of VAWG prevention research and practice.
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Affiliation(s)
| | | | | | - Laura Brown
- Institute for Global Health, University College London, London, UK
| | | | | | - Hattie Lowe
- Institute for Global Health, University College London, London, UK
| | - Angélica Motta
- Department of Anthropology, San Marcos University, San Marcos, Peru
| | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
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Gram L, Desai S, Prost A. Classroom, club or collective? Three types of community-based group intervention and why they matter for health. BMJ Glob Health 2021; 5:bmjgh-2020-003302. [PMID: 33328198 PMCID: PMC7745328 DOI: 10.1136/bmjgh-2020-003302] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Interventions involving groups of laywomen, men and adolescents to promote health are increasingly popular, but past research has rarely distinguished between different types of intervention with groups. We introduce a simple typology that distinguishes three ideal types: classrooms, clubs and collectives. Classrooms treat groups as a platform for reaching a population with didactic behaviour change strategies. Clubs seek to build, strengthen and leverage relationships between group members to promote health. Collectives engage whole communities in assuming ownership over a health problem and taking action to address it. We argue that this distinction goes a long way towards explaining differences in achievable health outcomes using interventions with groups. First, classrooms and clubs are appropriate when policymakers primarily care about improving the health of group members, but collectives are better placed to achieve population-level impact. Second, classroom interventions implicitly assume bottleneck behaviours preventing a health outcome from being achieved can be reliably identified by experts, whereas collectives make use of local knowledge, skill and creativity to tackle complexity. Third, classroom interventions assume individual participants can address health issues largely on their own, while clubs and collectives are required to engender collective action in support of health. We invite public health researchers and policymakers to use our framework to align their own and communities’ ambitions with appropriate group-based interventions to test and implement for their context. We caution that our typology is meant to apply to groups of laypeople rather than professionalised groups such as whole civil society organisations.
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Affiliation(s)
- Lu Gram
- Institute for Global Health, Department of Population Health Sciences, University College London, London, UK
| | - Sapna Desai
- Population Council India, New Delhi, Delhi, India
| | - Audrey Prost
- Institute for Global Health, Department of Population Health Sciences, University College London, London, UK
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Stewart R, Wright B, Smith L, Roberts S, Russell N. Gendered stereotypes and norms: A systematic review of interventions designed to shift attitudes and behaviour. Heliyon 2021; 7:e06660. [PMID: 33912699 PMCID: PMC8066375 DOI: 10.1016/j.heliyon.2021.e06660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/06/2020] [Accepted: 03/29/2021] [Indexed: 02/01/2023] Open
Abstract
In the face of ongoing attempts to achieve gender equality, there is increasing focus on the need to address outdated and detrimental gendered stereotypes and norms, to support societal and cultural change through individual attitudinal and behaviour change. This article systematically reviews interventions aiming to address gendered stereotypes and norms across several outcomes of gender inequality such as violence against women and sexual and reproductive health, to draw out common theory and practice and identify success factors. Three databases were searched; ProQuest Central, PsycINFO and Web of Science. Articles were included if they used established public health interventions types (direct participation programs, community mobilisation or strengthening, organisational or workforce development, communications, social marketing and social media, advocacy, legislative or policy reform) to shift attitudes and/or behaviour in relation to rigid gender stereotypes and norms. A total of 71 studies were included addressing norms and/or stereotypes across a range of intervention types and gender inequality outcomes, 55 of which reported statistically significant or mixed outcomes. The implicit theory of change in most studies was to change participants' attitudes by increasing their knowledge/awareness of gendered stereotypes or norms. Five additional strategies were identified that appear to strengthen intervention impact; peer engagement, addressing multiple levels of the ecological framework, developing agents of change, modelling/role models and co-design of interventions with participants or target populations. Consideration of cohort sex, length of intervention (multi-session vs single-session) and need for follow up data collection were all identified as factors influencing success. When it comes to engaging men and boys in particular, interventions with greater success include interactive learning, co-design and peer leadership. Several recommendations are made for program design, including that practitioners need to be cognisant of breaking down stereotypes amongst men (not just between genders) and the avoidance of reinforcing outdated stereotypes and norms inadvertently.
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Affiliation(s)
- Rebecca Stewart
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Breanna Wright
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Liam Smith
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Steven Roberts
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, Victoria, Australia
| | - Natalie Russell
- Victorian Health Promotion Foundation (VicHealth), Melbourne, Victoria, Australia
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Gram L, Granados R, Krockow EM, Daruwalla N, Osrin D. Modelling collective action to change social norms around domestic violence: social dilemmas and the role of altruism. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2021; 8:53. [PMID: 34553143 PMCID: PMC7611687 DOI: 10.1057/s41599-021-00730-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/05/2021] [Indexed: 06/03/2023]
Abstract
Interventions promoting collective action have been used to prevent domestic violence in a range of settings, but their mechanisms of operation remain unclear. We formalise and combine feminist theoretical approaches to domestic violence into a game-theoretic model of women's collective action to change gendered social norms and outcomes. We show that social norms create a social dilemma in which it is individually rational for women to abstain from action to prevent domestic violence among neighbours, but all women suffer negative consequences if none take action. Promoting altruism among women can overcome the social dilemma. Discouraging women from tolerating domestic violence, imposing additional external punishment on men for perpetrating violence, or lowering costs to women of taking action against violence may not work or even backfire. We invite researchers on community mobilisation to use our framework to frame their understandings of collective action to prevent domestic violence.
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Affiliation(s)
- Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Rolando Granados
- Institute for Global Health, University College London, London, UK
| | - Eva M Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Nayreen Daruwalla
- Prevention of Violence against Women and Children, Society for Nutrition, Education and Health Action (SNEHA), Mumbai, India
| | - David Osrin
- Institute for Global Health, University College London, London, UK
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Ahmad D, Mohanty I, Hazra A, Niyonsenga T. The knowledge of danger signs of obstetric complications among women in rural India: evaluating an integrated microfinance and health literacy program. BMC Pregnancy Childbirth 2021; 21:79. [PMID: 33485310 PMCID: PMC7824939 DOI: 10.1186/s12884-021-03563-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Maternal mortality can be prevented in low-income settings through early health care seeking during maternity complications. While health system reforms in India prioritised institutional deliveries, inadequate antenatal and postnatal services limit the knowledge of danger signs of obstetric complications to women, which delays the recognition of complications and seeking appropriate health care. Recently, a novel rapidly scalable community-based program combining maternal health literacy delivery through microfinance-based women-only self-help groups (SHG) was implemented in rural India. This study evaluates the impact of the integrated microfinance and health literacy (IMFHL) program on the knowledge of maternal danger signs in marginalised women from one of India's most populated and poorer states - Uttar Pradesh. Additionally, the study evaluates the presence of a diffusion effect of the knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages. METHODS Secondary data from the IMFHL program comprising 17,232 women from SHG and non-member households in rural Uttar Pradesh was included. Multivariate logistic regression models were used to identify the program's effects on the knowledge of maternal danger signs adjusting for a comprehensive range of confounders at the individual, household, and community level. RESULTS SHG member women receiving health literacy were 27% more likely to know all danger signs as compared with SHG members only. Moreover, the results showed that the SHG network facilitates diffusion of knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages. The study found that the magnitude of the program impact on outcome remained stable even after controlling for other confounding effects suggesting that the health message delivered through the program reaches all women uniformly irrespective of their socioeconomic and health system characteristics. CONCLUSIONS The findings can guide community health programs and policy that seek to impact maternal health outcomes in low resource settings by demonstrating the differential impact of SHG alone and SHG plus health literacy on maternal danger sign knowledge.
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Affiliation(s)
- Danish Ahmad
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia.
- Public Health Foundation of India, and Indian Institute of Public Health-Gandhinagar (IIPH-G), New Delhi and Gandhinagar, India.
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
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Patel P, Meagher K, El Achi N, Ekzayez A, Sullivan R, Bowsher G. "Having more women humanitarian leaders will help transform the humanitarian system": challenges and opportunities for women leaders in conflict and humanitarian health. Confl Health 2020; 14:84. [PMID: 33292351 PMCID: PMC7709302 DOI: 10.1186/s13031-020-00330-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It is estimated that over 40% of the half a million humanitarian workers who provide frontline care during emergencies, wars and disasters, are women. Women are at the forefront of improving health for conflict-affected populations through service delivery, education and capacity strengthening, advocacy and research. Women are also disproportionately affected by conflict and humanitarian emergencies. The growing evidence base demonstrating excess female morbidity and mortality reflects the necessity of evaluating the role of women in leadership driving health research, policy and programmatic interventions in conflict-related humanitarian contexts. Despite global commitments to improving gender equality, the issue of women leaders in conflict and humanitarian health has been given little or no attention. The aim of this paper focuses on three domains: importance, barriers and opportunities for women leaders in conflict and humanitarian health. Following thematic analysis of the material collected, we discuss the following themes: barriers of women's leadership domain at societal level, and organisational level, which is subcategorized into culture and strategy. Building on the available opportunities and initiatives and on inspirational experiences of the limited number of women leaders in this field, recommendations for empowering and supporting women's leadership in conflict health are presented. METHODS A desk-based literature review of academic and grey sources was conducted followed by thematic analysis. RESULTS There is very limited evidence on women leaders in conflict and humanitarian health. Some data shows that women have leadership skills that help to support more inclusive solutions which are incredibly important in this sector. However, deeply imbedded discrimination against women at the organisational, cultural, social, financial and political levels is exacerbated in conflict which makes it more challenging for women to progress in such settings. CONCLUSION Advocating for women leaders in conflict and health in the humanitarian sector, governmental bodies, academia and the global health community is crucial to increasing effective interventions that adequately address the complexity and diversity of humanitarian crises.
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Affiliation(s)
- Preeti Patel
- Department of War Studies, Conflict and Health Research Group, and R4HC-MENA, King's College London, London, UK
| | - Kristen Meagher
- Research Associate, R4HC-MENA and Conflict and Health Research Group, King's College London, London, UK.
| | - Nassim El Achi
- Research Associate, R4HC-MENA, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Abdulkarim Ekzayez
- Research Associate, R4HC-MENA and Conflict and Health Research Group, King's College London, London, UK
| | - Richard Sullivan
- Department of War Studies, Conflict and Health Research Group, and R4HC-MENA, King's College London, London, UK
- Professor of Cancer and Global Health, King's College London, London, UK
| | - Gemma Bowsher
- Senior Research Associate, Conflict and Health Research Group, King's College London, London, UK
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McDougal L, Shakya H, Dehingia N, Lapsansky C, Conrad D, Bhan N, Singh A, McDougal TL, Raj A. Mapping the patchwork: Exploring the subnational heterogeneity of child marriage in India. SSM Popul Health 2020; 12:100688. [PMID: 33319026 PMCID: PMC7726340 DOI: 10.1016/j.ssmph.2020.100688] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/25/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022] Open
Abstract
Despite dramatic reductions in child marriage over the past decade, more than one in four girls in India still marry before reaching age 18. This practice is driven by a complex interplay of social and normative beliefs and values that are inadequately represented in national- or even state-level analyses of the drivers of child marriage. A geographic lens was employed to assess variations in child marriage prevalence across Indian districts, identify hot and cold spots, and quantify spatial dependence and heterogeneity in factors associated with district levels of child marriage. Data were derived from the 2015-16 National Family Health Survey and the 2011 India Census, and represent 636 districts in total. Analyses included global Moran's I, LISAs, spatial Durbin regression and geographically weighted regression. This study finds wide inter- and intra-state heterogeneity in levels of child marriage across India. District levels of child marriage were strongly influenced by geographic characteristics, and even more so by the geographic characteristics of neighboring districts. Districts with higher levels of female mobile phone access and newspaper use had lower levels of child marriage. These relationships, however, were all subject to substantial local spatial heterogeneity. The results indicate that characteristics of neighboring districts, as well as characteristics of a district itself, are important in explaining levels of child marriage, and that those relationships are not constant across India. Child marriage reduction programs that are targeted within specific administrative boundaries may thus be undermined by geographic delineations that do not necessarily reflect the independent and interdependent characteristics of the communities who live therein. The geographic, social and normative characteristics of local communities are key considerations in future child marriage programs and policies. Child marriage prevalence is highly heterogeneous across Indian districts. Districts near state border districts tend to have higher levels of child marriage. Characteristics of districts and their neighbors influence child marriage. Geography affects the relationship between social normative factors and child marriage. Child marriage interventions may require joint action across states.
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Affiliation(s)
- Lotus McDougal
- Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA, 92093, USA
| | - Holly Shakya
- Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA, 92093, USA
| | - Nabamallika Dehingia
- Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA, 92093, USA
| | - Charlotte Lapsansky
- United Nations Children's Fund (UNICEF), UNICEF House 3, United Nationsl Plaza, New York, NY, 10017, USA
| | - David Conrad
- United Nations Children's Fund (UNICEF), UNICEF House 3, United Nationsl Plaza, New York, NY, 10017, USA
| | - Nandita Bhan
- Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA, 92093, USA
| | - Abhishek Singh
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400 088, India
| | - Topher L McDougal
- Kroc School of Peace Studies, University of San Diego, 5998 Alcala Park, San Diego, CA, 92110, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA, 92093, USA
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Francis S, Shrestha PN, Shrestha B, Ferguson G, Batayeh B, Hennink M, Clark CJ. The Influence of Organised Diffusion on Social Norms Change: Addressing Intimate Partner Violence in Nepal. Glob Public Health 2020; 16:610-622. [PMID: 33186501 DOI: 10.1080/17441692.2020.1845767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intimate partner violence (IPV) is a significant global health issue. Organised diffusion has potential to influence changes in norms that perpetuate harmful practices by spreading anti-IPV messaging throughout social networks. The Change Starts at Home intervention in Nepal leverages radio programming and community mobilisation to address the perpetration of IPV. This qualitative analysis of couple interviews at the 18-month follow-up (N = 35 individuals) seeks to evaluate how the intervention messaging diffused into the community using organised diffusion as a framework, and how this influenced any changes in norms related to the perpetration of IPV. Overall, this study provides evidence that the Change at Home Intervention effectively diffused into the community and began to promote changes around IPV norms, especially among relationships that were socially and geospatially close. This analysis demonstrates the potential for organised diffusion to facilitate social norms change around IPV.
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Affiliation(s)
- Simone Francis
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | | | - Brian Batayeh
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Monique Hennink
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Cari Jo Clark
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Clark CJ, Batayeh B, Shrestha PN, Morrow G, Shrestha B, Ferguson G. Diffusion in social norms change about violence against women: A longitudinal analysis of intervention data from a cluster randomised trial. Glob Public Health 2020; 16:1618-1630. [PMID: 33021877 DOI: 10.1080/17441692.2020.1828984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examines the diffusion effects of a Social and Behaviour Change Communication intervention in Nepal targeting gender equity and violence against women. The Change trial involves weekly radio programming, listening and discussion groups (LDGs), and community engagement. This longitudinal study analyses a repeated cross-sectional two-armed, pair-matched, single blinded cluster trial of a 9-month intervention. We used probability proportionate to size methodology to identify 72 wards in the Terai region, half of which were randomly assigned to the intervention. For the community-based survey, 20 women per ward were chosen using simple random sampling (N = 1440). Ten women from each intervention ward (N = 360) were also selected to participate in radio LDGs. Injunctive norms were measured with the Partner Violence Norms Scale-PVNS. Each one person increase in diffusion was associated with a 0.04 (SE = 0.01, p-value < 0.01) higher endline norms score, adjusting for confounders. There was evidence of effect modification with a significant baseline norm by diffusion interaction term (Estimate = -0.12, p-value = 0.04). Findings demonstrated that diffusion was related to endline norms only in communities with lower baseline levels of gender equitable norms. Study findings support the importance of diffusion as a pathway to intervention scale-up and norms change.
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Affiliation(s)
- Cari Jo Clark
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Brian Batayeh
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Grace Morrow
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Rewley J, Fawzi MCS, McAdam K, Kaaya S, Liu Y, Todd J, Andrew I, Onnela JP. Evaluating spillover of HIV knowledge from study participants to their network members in a stepped-wedge behavioural intervention in Tanzania. BMJ Open 2020; 10:e033759. [PMID: 33033007 PMCID: PMC7542922 DOI: 10.1136/bmjopen-2019-033759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aim to describe the social network members of participants of a behavioural intervention, and examine how the effects of the intervention may spillover among network members. DESIGN Secondary analysis of a step-wedge randomised controlled trial. SETTING Change agents (CAs) were recruited from waiting rooms of HIV treatment facilities in Dar es Salaam, Tanzania, and their network members (NMs) were recruited directly by CAs. PARTICIPANTS We enrolled 662 CAs in an HIV behavioural intervention. They, along with 710 of their NMs, completed baseline and follow-up interviews from 2011 to 2013. PRIMARY AND SECONDARY OUTCOMES The primary outcome of this study was change in NMs' HIV knowledge, and the secondary outcome was whether the NM was lost to follow-up. RESULTS At baseline, many characteristics were different between NMs and CAs. We found a number of NM characteristics significantly associated with follow-up of NMs, particularly female gender (OR=1.64, 95% CI: 1.02 to 2.63) and HIV knowledge (OR=20.0, 95% CI: 3.70 to 125); only one CA variable was significantly associated with NM follow-up: having a private source of water (OR=2.17, 95% CI: 1.33 to 3.57). The 14.2% increase in NMs' HIV knowledge was largely due to CAs feeling empowered to pass on prior knowledge, rather than transmitting new knowledge to their NMs. CONCLUSIONS Characteristics of social network members of persons living with HIV persons living with HIV may play a role in study retention. Additionally, the HIV knowledge of these NMs increased largely as a function of CA participation in the intervention, suggesting that intervening among highly-connected individuals may maximise benefits to the potential population for whom spillover can occur. TRIAL REGISTRATION NUMBER Clinical Trial: NCT01693458; Post-results.
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Affiliation(s)
- Jeffrey Rewley
- Center for Health Care Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- CHERP, Philadelphia VAMC, Philadelphia, Pennsylvania, USA
| | - Mary C Smith Fawzi
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Keith McAdam
- Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sylvia Kaaya
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yuanyuan Liu
- University of Texas School of Public Health, Austin, Texas, USA
| | - Jim Todd
- Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Irene Andrew
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Jukka Pekka Onnela
- Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Chatterji S, Stern E, Dunkle K, Heise L. Community activism as a strategy to reduce intimate partner violence (IPV) in rural Rwanda: Results of a community randomised trial. J Glob Health 2020; 10:010406. [PMID: 32257154 PMCID: PMC7125418 DOI: 10.7189/jogh.10.010406] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background There is considerable interest in community organising and activism as a strategy to shift patriarchal gender norms, attitudes and beliefs and thus reduce intimate partner violence (IPV). Yet there is limited insight into how activism actually translates into reduced violence, including how aspects of programme implementation or cultural context may affect impact. This study evaluates the community activism/mobilisation portion of Indashyikirwa, a multi-component, IPV prevention programme implemented in rural Rwanda. The activism part of Indashyikirwa was based on SASA!, a promising program model from Uganda with demonstrated effectiveness. Methods We implemented two separate cross-sectional surveys as part of a larger community randomised controlled trial to assess the impact of the community portion of Indashyikirwa on preventing physical and/or sexual IPV and other secondary outcomes at a community level. The survey consisted of a random household-based sample of 1400 women and 1400 men at both waves. Surveys were conducted before community-level activities commenced and were repeated 24 months later with a new cross-sectional sample. Longitudinal, qualitative data were collected as part of an embedded process evaluation. Results There was no evidence of an intervention effect at a community level on any of the trial's primary or secondary outcomes, most notably women's experience of physical and/or sexual IPV from a current male partner in the past 12 months (adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 0.92-1.70, P = 0.16), or men's perpetration of male-to-female physical and/or sexual IPV (aOR = 1.02; 95% CI = 0.72-1.45, P = 0.89). Process evaluation data suggest that delays due to challenges in adapting and implementing SASA!-style activites in rural Rwanda may account for the trial's failure to measure an effect. Additionally, the intervention strategy of informal activism was not well suited to the Rwandan context and required considerable modification. Conclusions Failure to reduce violence when implementing an adaptation of SASA! in rural Rwanda highlights the importance of allowing sufficient time for adapting evidence-based programming (EBP) to ensure cultural appropriateness and fidelity. This evaluation held little chance of demonstrating impact since the project timeline forced endline evaluation only months after certain elements of the programme became operational. Donors must anticipate longer time horizons (5 to 7 years) when contemplating evaluations of novel or newly-adapted programmess for reducing IPV at a population level. These findings also reinforce the value of including embedded process evaluations when investing in rigorous trials of complex phenomena such as community activism. Trial registration ClinicalTrials.gov, NCT03477877.
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Affiliation(s)
- Sangeeta Chatterji
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Erin Stern
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Af.,London School of Hygiene and Tropical Medicine, London, UK (affiliation at start of project)
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Af
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.,London School of Hygiene and Tropical Medicine, London, UK (affiliation at start of project)
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42
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Clark CJ, Shrestha B, Ferguson G, Shrestha PN, Calvert C, Gupta J, Batayeh B, Bergenfeld I, Oakes JM. Impact of the Change Starts at Home Trial on Women's experience of intimate partner violence in Nepal. SSM Popul Health 2020; 10:100530. [PMID: 31890850 PMCID: PMC6928358 DOI: 10.1016/j.ssmph.2019.100530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/05/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
Intimate partner violence (IPV) affects 1 in 3 women worldwide. Research in low- and middle-income countries suggests that multicomponent interventions incorporating media, group work, and community mobilization may be effective at changing social norms that enable such violence. Our study aimed to evaluate the impact of a radio programme plus community engagement versus radio programming alone on the 12-month prevalence of IPV. Using a cluster randomized, repeat cross-sectional, single-blinded approach, thirty-six village communities were pair-matched within three districts in Nepal and randomly assigned to either control or intervention. Both groups were exposed to social behaviour change communication through radio programming. In addition, weekly listening and discussion groups (LDGs) were formed in intervention communities to meet and discuss radio programming over the 40-week intervention period. Participants were also exposed to other community mobilization activities such as street theatre and messaging from local leaders who were engaged in intervention programming. IPV was measured at baseline, 12 months post-baseline at program conclusion, and 28 months post-baseline using a simple random sample of 40 married women per cluster (n = approximately 1440 at each time point) along with 382 women who participated in the LDGs. Although control and intervention groups were demographically similar, baseline rates of IPV were higher in control areas. The trend in IPV for both groups was nonlinear, largely declining at midline (control condition) and rising again at endline (control and intervention conditions), possibly reflecting greater reporting due to awareness-raising activities. Significant differences between the two groups were largely absent at endline. Higher LDG attendance was associated with decreases in several forms of IPV, some of which persisted to endline. These findings suggest that intensive community engagement over longer timespans or social network measurement may be necessary to detect significant changes at the community level (NCT02942433).
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Affiliation(s)
- Cari Jo Clark
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Binita Shrestha
- Equal Access International, 1001 Connecticut Ave, NW Suite 909, Washington, DC, 20036,, USA
| | - Gemma Ferguson
- Equal Access International, 1001 Connecticut Ave, NW Suite 909, Washington, DC, 20036,, USA
| | | | - Collin Calvert
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Minneapolis, MN, 55454, USA
| | - Jhumka Gupta
- Department of Global and Community Health, College of Health and Human Services, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Brian Batayeh
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Irina Bergenfeld
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - J. Michael Oakes
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Minneapolis, MN, 55454, USA
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Clark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, Balabanova D, Bhan MK, Bhutta ZA, Borrazzo J, Claeson M, Doherty T, El-Jardali F, George AS, Gichaga A, Gram L, Hipgrave DB, Kwamie A, Meng Q, Mercer R, Narain S, Nsungwa-Sabiiti J, Olumide AO, Osrin D, Powell-Jackson T, Rasanathan K, Rasul I, Reid P, Requejo J, Rohde SS, Rollins N, Romedenne M, Singh Sachdev H, Saleh R, Shawar YR, Shiffman J, Simon J, Sly PD, Stenberg K, Tomlinson M, Ved RR, Costello A. A future for the world's children? A WHO-UNICEF-Lancet Commission. Lancet 2020; 395:605-658. [PMID: 32085821 DOI: 10.1016/s0140-6736(19)32540-1] [Citation(s) in RCA: 405] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Helen Clark
- The Helen Clark Foundation, Auckland, New Zealand; Partnership for Maternal Newborn & Child Health, Geneva, Switzerland
| | | | - Anshu Banerjee
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | - Stefan Peterson
- UNICEF Headquarters, Programme Division, Health Section, New York, USA
| | - Sarah L Dalglish
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, OT, Canada; Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - John Borrazzo
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Mariam Claeson
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Fadi El-Jardali
- Department of Health Management and Policy, Beirut, Lebanon; Knowledge to Policy Center American University of Beirut, Beirut, Lebanon
| | - Asha S George
- School of Public Health, University of Western Cape, Bellville, South Africa
| | | | - Lu Gram
- Institute for Global Health, London, UK
| | - David B Hipgrave
- UNICEF Headquarters, Programme Division, Health Section, New York, USA
| | - Aku Kwamie
- Health Policy and Systems Research Consultant, Accra, Ghana
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Raúl Mercer
- Program of Social Sciences and Health, Latin American School of Social Sciences, Buenos Aires, Argentina
| | - Sunita Narain
- Centre for Science and Environment, New Delhi, India
| | | | | | | | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Papaarangi Reid
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, Data and Analytics Section, New York, USA
| | - Sarah S Rohde
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Nigel Rollins
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | | | - Harshpal Singh Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Rana Saleh
- Knowledge to Policy Center American University of Beirut, Beirut, Lebanon
| | - Yusra R Shawar
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jeremy Shiffman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jonathon Simon
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | - Peter D Sly
- Children's Health and Environment Program, The University of Queensland, Brisbane, QLD, Australia
| | - Karin Stenberg
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Rajani R Ved
- National Health Systems Resource Centre, New Delhi, India
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Cislaghi B, Heise L. Gender norms and social norms: differences, similarities and why they matter in prevention science. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:407-422. [PMID: 31833073 PMCID: PMC7028109 DOI: 10.1111/1467-9566.13008] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Two streams of theory and practice on gender equity have begun to elide. The first is work conducted to change social norms, particularly using theory that emerged from studies in social psychology. The second is work done on gender norms, emerging historically from feminist scholars working to counter gender inequality. As these two streams of work intersect, conceptual clarity is needed to understand differences and similarities between these two traditions. Increased clarity will improve efforts to address harmful norms and practices. In this article, we review similarities and differences between social and gender norms, reviewing the history of the concepts and identifying key tension points of contrast. We identified six areas of comparison that might be helpful for practitioners working for the promotion of global health as they make sense of social and gender norms. We then offer a definition of gender norms for practitioners and researchers working at the intersection between these two theories. Our definition draws from the two different streams of thought of how norms influence people's actions, acknowledging the double nature of gender norms: beliefs nested in people's minds and embedded in institutions that profoundly affect health-related behaviours and shape differential access to health services.
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Affiliation(s)
- Beniamino Cislaghi
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Lori Heise
- Department of Population, Family, and Reproductive HealthBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
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Abstract
The theoretical literature on social norms is multifaceted and at times contradictory. Looking at existing reviews, we aimed to offer a more complete understanding of its current status. By investigating the conceptual frameworks and organizing elements used to compare social-norms theories, we identified four theoretical spaces of inquiry that were common across the reviews: what social norms are, what relationship exists between social norms and behavior, how social norms evolve, and what categories of actors must be considered in the study of social norms. We highlight areas of consensus and debate in the reviews around these four themes and discuss points of agreement and disagreement that uncover trajectories for future empirical and theoretical investigation.
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Affiliation(s)
- Sophie Legros
- Department of International Development, London School of Economics
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine
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