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Vo AV, Majnoonian A, Shabalala F, Masuku S, Fielding-Miller R. "Hope is being stirred up": Critical consciousness in gender-based violence interventions. Soc Sci Med 2024; 357:117175. [PMID: 39116699 DOI: 10.1016/j.socscimed.2024.117175] [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: 11/28/2023] [Revised: 07/20/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
Gender-based violence (GBV) research in public health has historically paid close attention to gender as a system of oppression, with less attention paid to the intersections between gender and other oppressive systems such as colonialism, white supremacy, and capitalism. In 2019, we adapted and pilot-tested an individual-level evidence-based sexual violence resistance intervention for university-attending women in Eswatini. We conducted a qualitative assessment of our adapted intervention's acceptability and feasibility using a critical pedagogy lens to explore how power operated in delivering an empowerment intervention, using in-depth interviews with intervention participants and facilitators. We analyzed interview transcripts thematically guided by a critical pedagogy framework and organized emergent themes into a concept map with two primary axes: participant-researcher-driven power and proximal-distal determinants. We located participant experiences with the intervention within three quadrants defined by these axes: 1) "Prescriptive," in which the researcher or facilitator primarily controls the content and delivery, with a principal focus on proximal risk reduction strategies; 2) "Solidarity," which emphasizes fostering critical consciousness among facilitators and intervention participants through dialogue, building collective power through participant-driven discussions of individual experiences; and 3) "Liberation," in which participants critically examined the power structures that underpinned their lived experiences, and expressed a desire to transform these in ways the intervention was not designed to address. These three quadrants suggest the existence of a fourth quadrant, "paternalistic," - in which the interventionist seeks to didactically educate participants about structural drivers of their own experience. Our analysis highlights a fundamental tension in the epistemology of GBV research: While there is a clear consensus that 'empowerment' is a necessary component of successful GBV interventions, "liberatory" approaches that cede power to participants are inherently antithetical to the scripted approach typically required for consistent replication in randomized control trials or other 'gold-standard' approaches for post-positivist evidence generation.
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Affiliation(s)
- Anh Van Vo
- University of California, San Diego- Herbert Wertheim School of Public Health and Human Longevity Science, CA, USA.
| | - Araz Majnoonian
- University of California, San Diego- Herbert Wertheim School of Public Health and Human Longevity Science, CA, USA; Joint Doctoral Program in Public Health-Global Health, San Diego State University, San Diego, CA, USA
| | | | - Sakhile Masuku
- Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini
| | - Rebecca Fielding-Miller
- University of California, San Diego- Herbert Wertheim School of Public Health and Human Longevity Science, CA, USA
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Le Cunff AL. Systematic Curiosity as an Integrative Tool for Human Flourishing: A Conceptual Review and Framework. Integr Psychol Behav Sci 2024:10.1007/s12124-024-09856-6. [PMID: 38977624 DOI: 10.1007/s12124-024-09856-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
This paper reviews seventy years of theoretical research and proposes systematic curiosity as an integrative tool for human flourishing with a focus on four key aspects: firstly, acknowledge curiosity's multidimensional nature instead of harmonizing its complex taxonomy; secondly, emphasizing intentional curiosity as opposed to impulsive curiosity; thirdly, prioritizing domain-general curiosity for broader applicability across educational, organizational, and therapeutic settings; and lastly, focusing on curiosity as a developable skill rather than an innate trait. By segmenting systematic curiosity into cognitive, emotional, and behavioral components, and relating these to interactions with the self, others, and the world, the framework aims to apply across the spectrum of human experience. Furthermore, the framework encourages an exploration of various evidence-based activities for flourishing so individuals can discover the most suitable strategies for their specific context. Implications for both theory and practice are examined, limitations are discussed, and avenues for future research are suggested.
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Affiliation(s)
- Anne-Laure Le Cunff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AB, UK.
- Ness Labs, 40 Downham Road, London, N1 5AL, UK.
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Kalra N, Habumugisha L, Shankar A. Impacts of an abbreviated personal agency training with refugee women and their male partners on economic empowerment, gender-based violence, and mental health: a randomized controlled trial in Rwanda. BMC Public Health 2024; 24:1306. [PMID: 38745312 PMCID: PMC11092213 DOI: 10.1186/s12889-024-18780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION We assessed the impact of a personal agency-based training for refugee women and their male partners on their economic and social empowerment, rates of intimate partner violence (IPV), and non-partner violence (NPV). METHODS We conducted an individually randomized controlled trial with 1061 partnered women (aged 18-45) living in a refugee camp in Rwanda. Women received two days of training, and their partners received one day of training. The follow-up survey where all relevant outcomes were assessed was carried out at 6-9 months post-intervention. RESULTS At follow up, women in the intervention arm were more likely to report partaking in income generating activities (aIRR 1.27 (1.04-1.54), p < 0.05) and skill learning (aIRR 1.59 (1.39-1.82), p < 0.001) and reported a reduction in experience of physical or sexual NPV in the past six months (aIRR 0.65 (0.39-1.07), p < 0.09). While improved, no statistically significant impacts were seen on physical or sexual IPV (aIRR 0.80 (0.58-1.09), p = 0.16), food insecurity (β 0.98 (0.93 to 1.03), p = 0.396), or clean cookstove uptake (aIRR 0.95 (0.88 to 1.01), p = 0.113) in the past six months. We found statistically significant reduction in physical and sexual IPV amongst those experiencing IPV at baseline (aIRR 0.72 (0.50 to 1.02), p < 0.07). Small improvements in self-efficacy scores and our indicator of adapting to stress were seen in the intervention arm. Some challenges were also seen, such as higher prevalence of probable depression and/or anxiety (aIRR 1.79 (1.00-3.22), p = 0.05) and PTSD (aIRR 2.07 (1.10-3.91), p < 0.05) in the intervention arm compared to the control arm. CONCLUSION Our findings echo previous research showing personal agency training can support economic well-being of women. We also find potentially promising impacts on gender-based violence. However, there is some evidence that integration of evidence-based mental health support is important when enhancing agency amongst conflict-affected populations. TRIAL REGISTRATION NUMBER The trial was registered with ClinicalTrials.gov, Identifier: NCT04081441 on 09/09/2019.
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Affiliation(s)
- Naira Kalra
- Africa Region Gender Innovation Lab, Office of the Chief Economist, The World Bank Group, Washington D.C., USA
| | | | - Anita Shankar
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
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Dewidar O, John J, Baqar A, Madani MT, Saad A, Riddle A, Ota E, Kung'u JK, Arabi M, Raut MK, Klobodu SS, Rowe S, Hatchard J, Busch‐Hallen J, Jalal C, Wuehler S, Welch V. Effectiveness of nutrition counseling for pregnant women in low- and middle-income countries to improve maternal and infant behavioral, nutritional, and health outcomes: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1361. [PMID: 38034903 PMCID: PMC10687348 DOI: 10.1002/cl2.1361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Background Nutritional counseling, which includes two-way interactive education, has been hypothesized to improve the health and nutritional status of pregnant women, but little is known about the impact such practice of care might have on maternal and infant health and behavioral outcomes of pregnant women living in low income, low-middle income, and upper-middle-income countries (LMIC)s. Objectives We conducted a systematic review to appraise the effectiveness and impact on health equity of two-way nutritional counseling practices in LMICs on maternal and infant behavioral, nutritional, and health outcomes. Search Methods We conducted electronic searches for relevant studies on Medline, Embase, CINAHL, PsychInfo, and the Cochrane CENTRAL for randomized and non-randomized trials on the effectiveness of two-way interactive nutritional counseling among pregnant women from the date of database inception up to June 22, 2021. In addition, we searched references of included studies in systematic reviews, gray literature resources, and unpublished studies or reports that satisfied our eligibility criteria using a focused Google search. Selection Criteria We included randomized and non-randomized controlled studies (NRS), controlled before and after, and interrupted time series that assessed the effectiveness of two-way interactive nutrition counseling targeting pregnant women in LMICs. Data Collection and Analysis Data extraction and risk of bias were conducted in duplicate. The risk of bias (ROB) for randomized trials (RCT) was assessed according to the Cochrane Handbook of Systematic Reviews, and ROB for NRS was assessed using the Newcastle-Ottawa scale (NOS). RCT and NRS were meta-analyzed separately. Main Results Our search identified 6418 records and 52 studies met our inclusion criteria, but only 28 were used in the quantitative analysis. Twenty-eight studies were conducted in Asia, the most in Iran. Eight studies were conducted in Africa. Two-way interactive nutritional counseling during pregnancy may improve dietary caloric intake (mean difference [MD]: 81.65 calories, 95% confidence interval [CI], 15.37-147.93, three RCTs; I 2 = 42%; moderate certainty of evidence using GRADE assessment), may reduce hemorrhage (relative risk [RR]: 0.63; 95% CI, 0.25-1.54, two RCTs; I 2 = 40%; very low certainty of evidence using GRADE assessment), may improve protein (MD: 10.44 g, 95% CI, 1.83-19.05, two RCTs; I 2 = 95%; high certainty of evidence using GRADE assessment), fat intake (MD: 3.42 g, 95% CI, -0.20 to 7.04, two RCTs; I 2 = 0%; high certainty of evidence using GRADE assessment), and may improve gestational weight gain within recommendations (RR: 1.84; 95% CI, 1.10-3.09, three RCTs; I 2 = 69%). Nutrition counseling probably leads to the initiation of breastfeeding immediately after birth (RR: 1.72; 95% CI, 1.42-2.09, one RCT). There was little to no effect on reducing anemia (RR: 0.77; 95% CI, 0.50-1.20, three RCTs; I 2 = 67%; very low certainty of evidence using GRADE assessment) risk of stillbirths (RR: 0.81; 95% CI, 0.52-1.27, three RCTs; I 2 = 0%; moderate certainty of evidence using GRADE assessment) and risk of cesarean section delivery (RR: 0.96; 95% CI, 0.76-1.20, four RCTs; I 2 = 36%; moderate certainty of evidence using GRADE assessment). Authors’ Conclusions Our review highlights improvements in maternal behavioral and health outcomes through interactive nutrition counseling during pregnancy. However, we are uncertain about the effects of nutrition counseling due to the low certainty of evidence and a low number of studies for some key outcomes. Moreover, the effects on health equity remain unknown. More methodologically rigorous trials that focus on a precise selection of outcomes driven by the theory of change of nutrition counseling to improve maternal and infant behavioral and health outcomes and consider equity are required.
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Affiliation(s)
- Omar Dewidar
- Bruyere Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Jessica John
- Eat, Drink and Be HealthyTunapunaTrinidad and Tobago
| | - Aqeel Baqar
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | | | - Ammar Saad
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Alison Riddle
- Bruyere Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Erika Ota
- Global School of Nursing Science, Global Health NursingSt. Luke's International UniversityChuo‐kuJapan
| | | | | | | | - Seth S. Klobodu
- Department of Nutrition and Food ScienceCalifornia State University, ChicoChicoCaliforniaUSA
| | - Sarah Rowe
- Nutrition InternationalOttawaOntarioCanada
| | | | | | - Chowdhury Jalal
- Global Technical Services, Nutrition InternationalOttawaOntarioCanada
| | | | - Vivian Welch
- Bruyere Research InstituteUniversity of OttawaOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
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Hoffmann A, Plotkina D, Roger P, D’Hondt C. Superstitious beliefs, locus of control, and feeling at risk in the face of Covid-19. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022; 196:111718. [PMID: 35573936 PMCID: PMC9085462 DOI: 10.1016/j.paid.2022.111718] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/31/2022]
Abstract
Unprecedented uncertainty during the Covid-19 pandemic stimulated anxiety among individuals, while the associated health restrictions contributed to a feeling of loss of control. Prior research suggests that, in times of crisis, some individuals rely on superstitious beliefs as a coping mechanism, but it remains unclear whether superstition is positively or negatively associated with fear of Covid-19 during the pandemic, and the role that individuals' locus of control plays in this regard. In two studies conducted among individuals in Belgium and the U.S., we therefore examined the relationship between superstitious beliefs, locus of control, and feeling at risk of Covid-19. Across both countries, we found that superstition is positively, and internal locus of control negatively, related with feeling at risk of Covid-19. Moreover, in Belgium, the effect of superstition was less pronounced for individuals with a higher level of internal locus of control. The absence of an interaction effect between superstition and locus of control in the U.S. could be explained by this country's higher level of superstitious beliefs and lower level of internal locus of control combined with a stronger feeling of being at risk of Covid-19 or cultural differences such as Belgium's higher uncertainty avoidance compared to the U.S.
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Gonzalez MB, Sittner KJ, Walls ML. Cultural efficacy as a novel component of understanding linkages between culture and mental health in Indigenous communities. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 70:191-201. [PMID: 35285956 PMCID: PMC9452443 DOI: 10.1002/ajcp.12594] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 05/22/2023]
Abstract
We used a novel measure of cultural efficacy to examine empirical pathways between enculturation, efficacy, and two wellbeing outcomes. Cultural factors are not consistently linked to better wellbeing in the academic literature despite widespread understanding of these processes in Indigenous communities. Healing pathways is a community-based participatory study with eight reservations/reserves in the upper Midwest and Canada. This study uses data collected in 2017-2018 (n = 453, 58.1% women, mean age = 26.3 years) and structural equation modeling to test the relationships between enculturation, cultural efficacy, and mental health. The direct effect of enculturation on anxiety was positive. The indirect effect of enculturation via cultural efficacy was negatively associated with anxiety and positively associated with positive mental health. Cultural efficacy is an important linking variable through which the protective effects of culture manifest. The complex nature of culture must be met with innovative measures and deep understanding of Indigenous peoples to fully capture the protective role of culture.
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Affiliation(s)
- Miigis B. Gonzalez
- Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Great Lakes HubDuluthMinnesotaUSA
| | - Kelley J. Sittner
- Department of SociologyOklahoma State UniversityStillwaterOklahomaUSA
| | - Melissa L. Walls
- Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Great Lakes HubDuluthMinnesotaUSA
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Marimuthu M, Taghizadeh SK, Kandampully J. Understanding the process of patient empowerment and their well-being in the context of outpatient services. TQM JOURNAL 2022. [DOI: 10.1108/tqm-07-2021-0202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PurposeThis study has conceptualized and empirically investigated how the psychological empowerment process is generated from a patient's cognitive knowledge and participation at different recovery places that results in a state of empowerment and predicts positive outcomes.Design/methodology/approachData were collected from 150 physiotherapy outpatients who have been attending a series of physiotherapy courses at clinic and concurrently progressing with home physio exercise plan. Data were analyzed using structural equation modeling (SEM) with SmartPLS software.FindingsThe results reveal that psychological empowerment best formed when patient centric knowledge is combined with place-based behavioral experiences that are gathered via healthcare encounters and experience patient gained outside of the clinic. Patients' involvement at different environmental settings contributes to patients' empowerment which further assists their well-being.Practical implicationsUnderstanding the process of empowerment in different environmental contexts can help healthcare organizations to better design patient empowerment strategies and support patients through the empowerment journey to demonstrate their capability to achieve more effective health recovery outcomes.Originality/valuePatient empowerment is a concept of growing importance in the healthcare industry, yet the journey about how patients are being empowered within their sphere has not been well studied in the past. To the authors' knowledge, this study is the first study that discusses the utilization of patient empowerment must be aimed at both the process and the outcomes. This study provides empirical insights to understand the factors that formulate patient empowerment and predicts positive patient outcomes such as feelings of well-being.
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Dewidar O, Saad A, Baqar A, John JC, Riddle A, Ota E, Kung'u JK, Arabi M, Raut MK, Klobodu SS, Rowe S, Hatchard J, Busch‐Hallen J, Jalal CSB, Wuehler S, Welch V. PROTOCOL: Effectiveness of nutrition counselling for pregnant women in low- and middle-income countries to improve maternal, infant and child behavioural, nutritional and health outcomes: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1202. [PMID: 36950337 PMCID: PMC8988835 DOI: 10.1002/cl2.1202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The objective of this systematic review is to identify, appraise and synthesise the best available evidence on the effectiveness of nutritional counselling and education interventions on maternal, infant and child health outcomes, and assess the differences in effects across participants' PROGRESS+ characteristics. To achieve these objectives, we will aim to answer the following research questions: What is the effectiveness of nutrition counselling interventions for pregnant women in low- or middle-income countries on maternal, infant and child health outcomes? What are the impacts of nutrition counselling interventions on maternal, infant and child health outcomes across participants' PROGRESS+ characteristics?
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Affiliation(s)
- Omar Dewidar
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Ammar Saad
- University of Ottawa/Bruyère Research InstituteOttawaOntarioCanada
| | - Aqeel Baqar
- Faculty of Medicine, School of Epidemiology and Public HealthUniversity of OttawaStittsvilleOntarioCanada
| | | | - Alison Riddle
- Faculty of Medicine, School of Epidemiology and Public HealthUniversity of OttawaMarmoraOntarioCanada
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing ScienceSt. Luke's International UniversityChuo‐kuJapan
| | | | | | | | - Seth S. Klobodu
- Department of Nutrition and Food ScienceCalifornia State University, ChicoChicoCaliforniaUSA
| | - Sarah Rowe
- Nutrition InternationalOttawaOntarioCanada
| | | | | | | | | | - Vivian Welch
- Methods Centre, Bruyère Research InstituteOttawaOntarioCanada
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Riddle A, Ramage A, Kroeger CM, Bhutta ZA, Kristjansson E, Taljaard M, Vlassoff C, Wuehler S, Skidmore B, Bennett AL, Rizvi A, Welch V, Wells GA. PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of women of reproductive age in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1183. [PMID: 37051449 PMCID: PMC8988768 DOI: 10.1002/cl2.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The systematic review will answer the follow research questions: (1) What is the effectiveness of different empowerment approaches employed within nutrition interventions on the nutritional status of women of reproductive age in low- and middle-income countries? (2) What implementation and contextual factors contribute to or detract from the effectiveness of these interventions?
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Affiliation(s)
- Alison Riddle
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | | | - Cynthia M. Kroeger
- Charles Perkins Centre, Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyAustralia
| | - Zulfiqar A. Bhutta
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoCanada
| | | | | | - Carol Vlassoff
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | | | | | | | - Anita Rizvi
- School of PsychologyUniversity of OttawaOttawaCanada
| | - Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | - George A. Wells
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
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Morton C, Habib S, Morris J. What women want: the effect of health agency advertising on patient-doctor communication. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2021. [DOI: 10.1108/ijphm-07-2020-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to investigate the relationship between women’s sexual health agency and their intent to initiate communications with their doctors. The research questions examined the effect sexual health agency has on patient-doctor communication, women’s emotional responses to health advertisements encouraging patient communication with their doctors, attitude toward the message and behavioral intentions after exposure to the advertising message.
Design/methodology/approach
An experimental design was implemented via an online questionnaire instrument to test the differences between younger-aged women (25 to 45 years) and mature-aged women (46 to 70 years). It was observed that 188 women who reported their status as single and sexually active in the past 12 months were exposed to a health advertisement that encouraged patient-doctor communication. Analyses were conducted to compare between-group measures on sexual health agency, emotional response and attitude toward the ad and behavioral intention.
Findings
No statistical difference existed between younger and older women. In general, women expect their doctor to lead conversations about sexual health but are positively reinforced by health messages that encourage their assertiveness as patients.
Research limitations/implications
The small sample size also may have limited the study’s potential to evaluate differences between age segments. Future research should explore this further.
Practical implications
The study provides evidence that sexual health advertising can reinforce women’s intent to initiate conversations with doctors regardless of age.
Social implications
Health communications can bolster women’s sexual health agency and improve patient-initiated conversations with doctors.
Originality/value
The study is the first to explore advertising messaging’s potential for applying health agency as a communication strategy for encouraging sexual health communications between women and their doctors.
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Peters LER, Kelman I, Shannon G, Tan D. Synthesising the shifting terminology of community health: A critiquing review of agent-based approaches. Glob Public Health 2021; 17:1492-1506. [PMID: 34097587 DOI: 10.1080/17441692.2021.1938169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The field of community health promotion encompasses a wide range of approaches, including bottom-up approaches that recognise and build on the agency and strengths of communities to define and pursue their health goals. Momentum towards agent-based approaches to community health promotion has grown in recent years, and several related but distinct conceptual and methodological bodies of work have developed largely in isolation from each other. The lack of a cohesive collection of research, practice, and policy has made it difficult to learn from the innovations, best practices, and shortcomings of these approaches, which is exacerbated by the imprecise and inconsistent use of related terms. This article provides a review of three agent-based approaches to promoting community health: asset-based approaches, capacity building, and capabilities approaches, noting the theoretical origins and fundamental concepts, applications and methodologies, and limitations and critiques of each. This article discusses their commonalities and differences in terms of how they conceptualise and approach the promotion of community health, including a critical consideration of their limitations and where they may prove to be counterproductive. This article argues that agent-based approaches to community health must be met with meaningful opportunities to disengage from the structures that constrain their health.
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Affiliation(s)
- Laura E R Peters
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK.,College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, Corvallis, OR, USA.,Stema Health Systems, London, UK
| | - Ilan Kelman
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK.,University of Agder, Kristiansand, Norway
| | - Geordan Shannon
- Institute for Global Health, University College London, London, UK.,Stema Health Systems, London, UK
| | - Des Tan
- Stema Health Systems, London, UK
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12
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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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Obiezu-Umeh C, Gbajabiamila T, Ezechi O, Nwaozuru U, Ong JJ, Idigbe I, Oladele D, Musa AZ, Uzoaru F, Airhihenbuwa C, Tucker JD, Iwelunmor J. Young people's preferences for HIV self-testing services in Nigeria: a qualitative analysis. BMC Public Health 2021; 21:67. [PMID: 33413246 PMCID: PMC7792110 DOI: 10.1186/s12889-020-10072-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV self-testing (HIVST) provides young people with a convenient, discreet, and empowering way to know their HIV status. However, there is limited knowledge of young people's preferences for HIVST services and potential factors that may influence the uptake of HIVST among this population. The purpose of this research was to use qualitative methods to examine HIVST preferences among Nigerian youth. METHODS Semi-structured in-depth interviews with a purposive sample of young people 14-24 years old were conducted in Lagos, Nigeria. Data were analyzed thematically to identify themes and domains related to preferences and factors influencing the use of HIV self-testing. RESULTS A total of 65 youth with mean age of 21 years, were interviewed, and the majority were females (56%). Four themes emerged as the most important characteristics that may influence young people's preferences for HIV self-testing: 1) Cost (i.e. majority of participants noted that they would pay between NGN500 to NGN1,500 naira (USD1.38-USD4.16) for oral HIV self-testing kits); 2) Testing method (i.e. although blood-based sample kits were more popular than oral-based self-testing kits, most preferred the oral-based option due to its perceived benefits and for some, phobia of needles); 3) Access location (i.e. participants suggested they preferred to obtain the HIVST kits from youth-friendly centers, pharmacies, private health facilities, and online stores); and 4) Continuing care and support (i.e. participants highlighted the importance of linkage to care with trained youth health workers for positive or negative test results or toll-free helpline). CONCLUSION HIV self-testing preferences among Nigerian youth appear to be influenced by several factors including lower cost, less invasive testing method, location of testing, and linkage to care and support post testing. Findings underscore the need to address young people's HIV self-testing preferences as a foundation for implementing programs and research to increase the uptake of HIVST.
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Affiliation(s)
- Chisom Obiezu-Umeh
- College for public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA.
| | - Titilola Gbajabiamila
- Department of Clinical Sciences National Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Oliver Ezechi
- Department of Clinical Sciences National Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Ucheoma Nwaozuru
- College for public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Jason J Ong
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Central Clinical School, Monash University, Clayton, Australia
| | - Ifeoma Idigbe
- Department of Clinical Sciences National Institute of Medical Research, Yaba, Lagos, Nigeria
| | - David Oladele
- Department of Clinical Sciences National Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Adesola Z Musa
- Department of Clinical Sciences National Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Florida Uzoaru
- College for public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | | | - Joseph D Tucker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Juliet Iwelunmor
- College for public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
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14
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Desai S, Misra M, Das A, Singh RJ, Sehgal M, Gram L, Kumar N, Prost A. Community interventions with women's groups to improve women's and children's health in India: a mixed-methods systematic review of effects, enablers and barriers. BMJ Glob Health 2020; 5:e003304. [PMID: 33328199 PMCID: PMC7745316 DOI: 10.1136/bmjgh-2020-003304] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION India is home to over 6 million women's groups, including self-help groups. There has been no evidence synthesis on whether and how such groups improve women's and children's health. METHODS We did a mixed-methods systematic review of quantitative and qualitative studies on women's groups in India to examine effects on women and children's health and to identify enablers and barriers to achieving outcomes. We searched 10 databases and included studies published in English from 2000 to 2019 measuring health knowledge, behaviours or outcomes. Our study population included adult women and children under 5 years. We appraised studies using standard risk of bias assessments. We compared intervention effects by level of community participation, scope of capability strengthening (individual, group or community), type of women's group and social and behaviour change techniques employed. We synthesised quantitative and qualitative studies to identify barriers and enablers related to context, intervention design and implementation, and outcome characteristics. FINDINGS We screened 21 380 studies and included 99: 19 randomised controlled trial reports, 25 quasi-experimental study reports and 55 non-experimental studies (27 quantitative and 28 qualitative). Experimental studies provided moderate-quality evidence that health interventions with women's groups can improve perinatal practices, neonatal survival, immunisation rates and women's and children's dietary diversity, and help control vector-borne diseases. Evidence of positive effects was strongest for community mobilisation interventions that built communities' capabilities and went beyond sharing information. Key enablers were inclusion of vulnerable community members, outcomes that could be reasonably expected to change through community interventions and intensity proportionate to ambition. Barriers included limited time or focus on health, outcomes not relevant to group members and health system constraints. CONCLUSION Interventions with women's groups can improve women's and children's health in India. The most effective interventions go beyond using groups to disseminate health information and seek to build communities' capabilities. TRIAL REGISTRATION NUMBER The review was registered with PROSPERO: CRD42019130633.
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Affiliation(s)
- Sapna Desai
- Population Council India, New Delhi, Delhi, India
| | | | | | | | | | - Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Neha Kumar
- International Food Policy Research Institute, Washington, DC, USA
| | - Audrey Prost
- University College London Institute of Child Health, London, UK
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15
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Riddle AY, Kroeger CM, Ramage AK, Bhutta ZA, Kristjansson E, Vlassoff C, Taljaard M, Skidmore B, Welch V, Wells GA. PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of adolescent girls in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:CL21042. [PMID: 37131509 PMCID: PMC8356511 DOI: 10.1002/cl2.1042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Alison Y. Riddle
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Cynthia M. Kroeger
- School of Pharmacy, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia
| | | | - Zulfiqar A. Bhutta
- Centre for Global Child HealthHospital for Sick ChildrenTorontoOntarioCanada
| | | | - Carol Vlassoff
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | | | | | | | - George A. Wells
- Cardiovascular Research Methods CentreUniversity of Ottawa Heart InstituteOttawaOntarioCanada
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16
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Challenges and opportunities for outreach workers in the Prevention of Mother to Child Transmission of HIV (PMTCT) program in India. PLoS One 2018; 13:e0203425. [PMID: 30180186 PMCID: PMC6122806 DOI: 10.1371/journal.pone.0203425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Prevention of Mother-to-Child Transmission of HIV (PMTCT) program in India is one of the largest in the world. It uses outreach workers (ORWs) to facilitate patient uptake of services, however, the challenges faced by the ORWs, and their views about the effectiveness of this program are unknown. METHODS The COMmunity-Home Based INDia (COMBIND) Prevention of Mother to Child Transmission of HIV study evaluated an integrated mobile health and behavioral intervention to enhance the capacity of ORWs in India. To understand the challenges faced by ORWs, and their perceptions of opportunities for program improvement, four group discussions were conducted among 60 ORW from four districts of Maharashtra, India, as part of the baseline assessment for COMBIND. Data were qualitatively analyzed using a thematic approach. RESULTS Numerous personal-, social-, and structural-level challenges existed for ORW as they engaged with their patients. Personal-level challenges for ORWs included disclosure of their own HIV status and travelling costs for home visits. Personal-level challenges for patients included financial costs of travelling to ART centers, non-adherence to ART, loss of daily wages, non-affordability of infant formula, lack of awareness of the baby's needs, financial dependence on family, four time points (6weeks, 6 months, 12 months and 18 months) for HIV tests, and need for nevirapine (NVP) prophylaxis. Social-level challenges included lack of motivation by patients and/or health care staff, social stigma, and rude behavior of health care staff and their unwillingness to provide maternity services to women in the PMTCT programme. Structural-level challenges included cultural norms around infant feeding, shortages of HIV testing kits, shortages of antiretroviral drugs and infant NVP prophylaxis, and lack of training/knowledge related to PMTCT infant feeding guidelines by hospital staff. The consensus among ORWs was that there was a critical need for tools and training to improve their capacity to effectively engage with patients, and deliver appropriate care, and for motivation through periodic feedback. CONCLUSIONS Given the significant challenges in PMTCT programme implementation reported by ORW, novel strategies to address these challenges are urgently needed to improve patient engagement, and access to and retention in care.
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