Impact of an educational programme on reproductive health among young migrant female workers in Shenzhen, China: an intervention study

Interventions to improve migrants' access to sexual and reproductive health services: a scoping review

INTRODUCTION

Migrants' access to sexual and reproductive health (SRH) services is constrained by several individual, organisational and structural barriers. To address these barriers, many interventions have been developed and implemented worldwide to facilitate the access and utilisation of SRH services for migrant populations. The aim of this scoping review was to identify the characteristics and scope of interventions, their underlying theory of change, reported outcomes and key enablers and challenges to improve access to SRH services for migrants.

METHODS

A scoping review was conducted according to the Arksey and O'Malley (2005) guidelines. We searched three electronic databases (MEDLINE, Scopus and Google Scholar) and carried out additional searches using manual searching and citations tracking of empirical studies addressing interventions aimed at improving access and utilisation of SRH services for migrant populations published in Arabic, French or English between 4 September 1997 and 31 December 2022.

RESULTS

We screened a total of 4267 papers, and 47 papers met our inclusion criteria. We identified different forms of interventions: comprehensive (multiple individual, organisational and structural components) and focused interventions addressing specific individual attributes (knowledge, attitude, perceptions and behaviours). Comprehensive interventions also address structural and organisational barriers (ie, the ability to pay). The results suggest that coconstruction of interventions enables the building of contextual sensitive educational contents and improved communication and self-empowerment as well as self-efficacy of migrant populations, and thus improved access to SRH.

CONCLUSION

More attention needs to be placed on participative approaches in developing interventions for migrants to improve access to SRH services.

Implementation Evaluation of a Cluster Randomized Controlled Trial to Promote the Use of Respiratory Protective Equipment Among Migrant Workers Exposed to Organic Solvents in Small and Medium-Sized Enterprises

Background

While the effectiveness of several occupational healthcare interventions has been demonstrated, successful implementation of such programs among internal migrant workers (IMWs) in small and medium-sized enterprises (SMEs) has been limited. This study aimed to evaluate the implementation of a three-arm cluster randomized controlled trial promoting respiratory protective equipment (RPE) use among IMWs exposed to organic solvents in SMEs and to assess the association between participants' compliance and effectiveness of intervention.

Methods

A total of 60 SMEs were randomly allocated to a low- or high-intensive intervention group, or a control group that did not receive any intervention. The low-intensive intervention group was subjected to both traditional and mHealth occupational health education. The high-intensive intervention group was subjected to the low-intensive group activities and peer education. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide implementation evaluation of this 6-months intervention. Generalized linear mixed models (GLMMs) were used to evaluate the effects of participants' compliance with the intervention on the primary outcomes, regarding the appropriate use of RPE.

Results

Of 4,527 potentially eligible participants, 1,211 individuals were enrolled, with a reach rate of 26.8%. Sixty of the 66 SMEs approached (90.9%) SMEs adopted the intervention. Fidelity to traditional education (100.0%) and mHealth intervention (97.5%) was higher than fidelity to peer education (20.0%). Peer leaders cited inconvenient time and unfamiliarity with peers as two major barriers to delivering peer education. Compared with the control group, IMWs who complied with the interventions in both groups were more likely to wear RPE appropriately [low-intensive group: adjusted odds ratio (aOR) = 2.58, 95% confidence interval (CI): 1.56–4.28; high-intensive group: aOR = 7.52, 95% CI: 3.72–15.23]. Most participants (95.8%) were satisfied with the program and 93.1% stated that they would maintain the use of RPE in the future.

Conclusions

A multi-component occupational health intervention to promote the use of RPE among IMWs in SMEs was feasible and acceptable. Peer education had great potential to enhance the occupational health behavior of IMWs, and thus strategies to improve participants' adherence to this component warrant further investigation.

Clinical Trial Registration

http://www.chictr.org.cn, identifier: ChiCTR-IOR-15006929.

Promoting labour migrant health equity through action on the structural determinants: a systematic review

Background

Labour migrants, who represent over sixty per cent of international migrants globally, frequently have poorer health status than the population of host countries. These health inequities are determined in a large part by structural drivers including political, commercial, economic, normative and social factors, including living and working conditions. Achieving health equity for migrant workers requires structural-level interventions to address these determinants.

Methods

We undertook a systematic review of peer-reviewed literature designed to answer the question “what is the evidence for the effectiveness of interventions to address the structural determinants of health for labour migrants?” using the Ovid Medline electronic database.

Findings

We found only two papers that evaluated structural interventions to improve the health of labour migrants. Both papers evaluated the impact of insurance – health or social. In contrast, we found 19 evaluations of more proximal, small-scale interventions focused on changing the knowledge, attitudes and behaviours of labour migrants.

Interpretation

Despite the rise in international migration, including for work, and evidence that labour migrants have some higher health risks, there is a paucity of research addressing the structural determinants of health inequities in labour migrants. The research community (including funders and academic institutions) needs to pay greater attention to the structural determinants of health – which generally requires working across disciplines and sectors and thinking more politically about health and health inequities.

Funding

Wellcome Trust (208712/Z/17/Z).

At the limits of "capability": The sexual and reproductive health of women migrant workers in Malaysia

Despite the centrality of sexual and reproductive health (SRH) to UN Sustainable Development Goals (SDGs), women migrant workers in Malaysia face an environment inimical to their SRH needs. Drawing on qualitative case study material, we present the first empirical application of the capability approach (CA) to explore the reproductive health needs of women migrant workers in a developing country, offering an original analysis of the capability for SRH of these women. Specifically, we explore the resources available to them; their opportunities and freedoms ("capabilities"); and factors that mediate transformation of resources into capability sets ("conversion factors"). While SRH information and health care are notionally available, women migrant workers face multiple challenges in converting resources into functionings, constraining the achievement of capability for SRH. Challenges include language barriers, personal beliefs, power relations between workers and employers and the consequences of current migration policy. We consider the scale of the challenges facing these women in securing SRH rights, the difficulties of operationalising the CA within such a setting, and the implications of our findings for the adequacy of the CA in supporting marginalised populations.

Efficacy of HIV interventions among factory workers in low- and middle-income countries: a systematic review

Background

Factory workers in low- and middle-income countries (LMICs) are vulnerable to HIV transmission. Interventions are needed to prevent HIV in this population. We systematically reviewed published literature on the efficacy of various HIV interventions in reducing stigma, risk behaviors and HIV transmission among factory workers.

Methods

A systematic review was performed using predefined inclusion and exclusion criteria. Four databases (PubMed, PsycINFO, Scopus and EMBASE) were searched for relevant publications between January 1, 1990 and December 31, 2018. Two independent reviewers assessed the methodological quality of studies.

Results

Thirteen articles were included, with 2 randomized controlled trials and 11 cohort studies. Five interventions and their combinations were summarized. Educational intervention increased condom use and reduced the use of recreational drugs and alcohol before sex. Community intervention that proactively provide HIV counselling and testing (HCT) services could increase the detection rate of HIV and other sexually transmitted diseases (STDs). Lottery intervention increased HCT uptake and decreased HIV public stigma. Education combined with community intervention reduced the proportion of workers with casual sex and enhanced HIV knowledge. Peer education combined with community intervention increased the proportion of workers who were willing to take their partners to HCT. Policy intervention combined with peer education enhanced HIV knowledge, perceived condom accessibility and condom use with regular partners.

Conclusions

Various interventions improved HIV knowledge, decreased HIV stigma and reduced HIV-related risk behaviors among factory workers in LMICs. The combination of multiple interventions tended to achieve better efficacy than a single intervention. Persistent combination interventions are essential to address HIV in this population.

Results of a Cluster Randomized Controlled Trial to Promote the Use of Respiratory Protective Equipment among Migrant Workers Exposed to Organic Solvents in Small and Medium-Sized Enterprises

Background: Existing evidence shows an urgent need to improve respiratory protective equipment (RPE) use, and more so among migrant workers in small and medium-sized enterprises (SMEs). The study aimed to assess the effectiveness of a behavioral intervention in promoting the appropriate use of RPE among internal migrant workers (IMWs) exposed to organic solvents in SMEs. Methods: A cluster randomized controlled trial was conducted among 1211 IMWs from 60 SMEs in Baiyun district in Guangzhou, China. SMEs were deemed eligible if organic solvents were constantly used in the production process and provided workers with RPE. There were 60 SMEs randomized to three interventions on a 1:1:1 ratio, namely a top-down intervention (TDI), a comprehensive intervention, and a control group which did not receive any intervention. IMWs in the comprehensive intervention received a module encompassing three intervention activities: An occupational health education and training component (lectures and leaflets/posters), an mHealth component in the form of messages illustrative pictures and short videos, and a peer education component. The TDI incorporated two intervention activities, namely the mHealth and occupational health education and training components. The primary outcome was the self-reported appropriate RPE use among IMWs, defined as using an appropriate RPE against organic solvents at all times during the last week before measurement. Secondary outcomes included IMWs' occupational health knowledge, attitude towards RPE use, and participation in occupational health check-ups. Data were collected and assessed at baseline, and three and six months of the intervention. Generalized linear mixed models were performed to evaluate the effectiveness of the trial. Results: Between 3 August 2015 and 29 January 2016, 20 SMEs with 368 IMWs, 20 SMEs with 390 IMWs, and 20 SMEs with 453 IMWs were assigned to the comprehensive intervention, the TDI, and the control group, respectively. At three months, there were no significant differences in the primary and secondary outcomes among the three groups. At six months, IMWs in both intervention groups were more likely to appropriately use RPE than the control group (comprehensive intervention: Adjusted odds ratio: 2.99, 95% CI: 1.75-5.10, p < 0.001; TDI: 1.91, 95% CI: 1.17-3.11, and p = 0.009). Additionally, compared with the control group, the comprehensive intervention also improved all three secondary outcomes. Conclusions: Both comprehensive and top-down interventions were effective in promoting the appropriate use of RPE among IMWs in SMEs. The comprehensive intervention also enhanced IMWs' occupational health knowledge, attitude, and practice. Trial registration: ChiCTR-IOR-15006929. Registered on 15 August 2015.

Factors associated with male involvement in reproductive care in Bangladesh

Background

Men’s active involvement in reproductive healthcare has shown to be positively associated with maternal and child health outcomes. Bangladesh has made appreciable progress in its pursuance of maternal mortality related goals in the framework of the MDGs. However, there remains a lot to be accomplished to realise the long-term goals for which active participation of male counterparts in reproductive care is crucial. Therefore, the objective of the present study was to investigate factors associated with male involvement in reproductive health among Bangladeshi men.

Methods

We used data from Bangladesh Demographic and Health Survey (BDHS) conducted in 2011. Study participants were 1196 married men, aged between 15 and 69 years and living in both urban and rural households. Level of male involvement (outcome variable) was measured based on the responses on knowledge, awareness and practice regarding reproductive health. Chi-square tests and multivariable logistic regression models were performed for data analysis.

Results

Out of 1196 participants, only 40% were found to be active about partners’ reproductive healthcare. Chi-square test showed significant association between active involvement and ever hearing about family planning (FP) in television, learning about FP through community health events, community health workers and poster/billboard. Results from logistic regression analysis revealed that type of residency [p = 0.004, AOR = 0.666, 95% CI = 0.504–0.879], literacy [secondary/higher education- p = 0.006. AOR = 0.579, 95% CI = 0.165–0.509], learning about family planning from Newspaper [p < 0.001. AOR = 1.952, 95% CI = 1.429–2.664], and television [p = 0.017. AOR = 1.514 95% CI = 1.298–1.886], and having been communicated about family planning by community health workers [p = 0.017. AOR = 1.946, 95% CI = 1.129–3.356] were significantly associated with active involvement of men in reproductive health issues.

Conclusions

Level of male involvement was associated with schooling experience, type of residency and exposure to electronic media. National health policy programs aimed at promoting male involvement in reproductive care should focus on improving knowledge and awareness of reproductive health though community health education programs with a special focus in the rural areas.

Effect of improving the knowledge, attitude and practice of reproductive health among female migrant workers: a worksite-based intervention in Guangzhou, China

Background The sexual and reproductive health (SRH) knowledge and attitudes of female migrant workers are far from optimum in China. A worksite-based intervention program on SRH-related knowledge, attitude and practice (SRH KAP) modification may be an effective approach to improve the SRH status among migrant workers. This study aimed to identify better intervention approaches via the implementation and evaluation of two intervention packages.

METHODS

A worksite-based cluster-randomised intervention study was conducted from June to December 2008 in eight factories in Guangzhou, China. There were 1346 female migrant workers who participated in this study. Factories were randomly allocated to the standard package of interventions group (SPIG) or the intensive package of interventions group (IPIG). Questionnaires were administered to evaluate the effect of two interventions.

RESULTS

SRH knowledge scores were higher at follow up than at baseline for all participants of the SPIG; the knowledge scores increased from 6.50 (standard deviation (s.d.) 3.673) to 8.69 (s.d. 4.085), and from 5.98 (s.d. 3.581) to 11.14 (s.d. 3.855) for IPIG; SRH attitude scores increased among unmarried women: the attitude scores changed from 4.25 (s.d. 1.577) to 4.46 (s.d. 1.455) for SPIG, and from 3.99 (s.d. 1.620) to 4.64 (s.d. 1.690) for IPIG; most SRH-related practice was also modified (P<0.05). In addition, after intervention, the IPIG had a higher knowledge level than the SPIG; the scores were 11.14 (s.d. 3.855) versus 8.69 (s.d. 4.085), and unmarried women in the IPIG had higher condom use rate than the SPIG (86.4% versus 57.1%).

CONCLUSIONS

The interventions had positive influences on improvements in SRH knowledge, attitudes and behaviours. Additionally, IPIs were more effective than SPIs, indicating that a comprehensive intervention may achieve better results.