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Andina-Díaz E, Welch L, Siles-González J, Serrano-Fuentes N, Gutiérrez-García AI, Solano-Ruiz MC. Photovoice: An active learning tool with community nursing students. Public Health Nurs 2024; 41:392-402. [PMID: 38311870 DOI: 10.1111/phn.13285] [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: 07/14/2023] [Revised: 12/01/2023] [Accepted: 01/11/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE To assess nursing students' experiences of using photovoice as a pedagogical approach to active learning in the community. METHODS A descriptive design with a cross-sectional mixed-method questionnaire was used with 108 students following an educational activity, in which their communities were photographed and the impact of the pandemic on vulnerable populations was reflected. Descriptive statistics and thematic analysis were used to analyze the data. RESULTS Seventy eight percent of the students felt that photovoice was an interesting and useful tool for nurses, 89% affirmed it helped stimulate reflection on social and health inequities in times of pandemic, 82% described that it developed many emotions and feelings and 86% would like to disseminate their photographs directly to stakeholders, citizens, and politicians. Three themes were identified in the data: "stimulate critical reflection", "develop emotional skills", and "encourage action". CONCLUSIONS Photovoice is a successful active learning pedagogical approach that engages nursing students to develop critical awareness while connecting with their communities, with the real world. It fosters students' sensitivity and motivation and encourages them to take action. Teachers need to introduce new scaffolds for active learning, such as photovoice, to provide innovative academic support that nurtures and develops the next generation of nurses appropriately.
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Affiliation(s)
- Elena Andina-Díaz
- Department of Nursing and Physiotherapy, University of León, Vegazana Campus, Leon, Spain
- SALBIS Research Group, University of León, León, Spain
- EYCC Research Group, University of Alicante, Alacant, Spain
| | - Lindsay Welch
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- University Hospitals Dorset NHS Foundation Trust, Bournemouth University, Bournemouth, UK
| | - José Siles-González
- EYCC Research Group, University of Alicante, Alacant, Spain
- Department of Nursing, University of Alicante, Carretera San Vicente del Raspeig, s/n, San Vicente del Raspeig, Spain
| | - Nestor Serrano-Fuentes
- SALBIS Research Group, University of León, León, Spain
- NIHR ARC Wessex, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Ana Isabel Gutiérrez-García
- EYCC Research Group, University of Alicante, Alacant, Spain
- Department of Nursing, University of Alicante, Carretera San Vicente del Raspeig, s/n, San Vicente del Raspeig, Spain
| | - MCarmen Solano-Ruiz
- EYCC Research Group, University of Alicante, Alacant, Spain
- Department of Nursing, University of Alicante, Carretera San Vicente del Raspeig, s/n, San Vicente del Raspeig, Spain
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Masquillier C, Cosaert T. Facilitating access to primary care for people living in socio-economically vulnerable circumstances in Belgium through community health workers: towards a conceptual model. BMC PRIMARY CARE 2023; 24:281. [PMID: 38114909 PMCID: PMC10731868 DOI: 10.1186/s12875-023-02214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Inspired by examples in low- and middle-income countries, 50 community health workers (CHWs) were introduced in Belgium to improve access to primary care for people living in socio-economically vulnerable circumstances. This article aims to explore the ways in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care. METHODS The qualitative research focuses on the first year of implementation of this pioneer nationwide CHW programme in Belgium. To respond to the research aim, thirteen semi-structured in-depth interviews were held with people living in socio-economically vulnerable circumstances. In addition, a photovoice study was conducted with fifteen CHWs comprising four phases: (1) photovoice training; (2) participatory observation with each CHW individually; (3) an individual semi-structured in-depth interview; and (4) three focus group discussions. The transcripts and the observation notes were analysed in accordance with the abductive analysis procedures described by Timmermans and Tavory. RESULTS The qualitative results show that the CHWs' outreaching way of working allows them to reach people living at the crossroads of different vulnerabilities that are intertwined and reinforce each other. They experience complex care needs, while at the same time they face several barriers that interrupt the continuum of access to primary care - as conceptualised in the theoretical access-to-care framework of (Levesque et al. Int J Equity Health. 12:18, 2013). Building on the theoretical access-to-care framework described by (Levesque et al. Int J Equity Health. 12:18, 2013), the conceptual model outlines first the underlying mechanisms of CHW-facilitated access to primary care: (I) outreaching and pro-active way of working; (II) building trust; (III) providing unbiased support and guidance in a culturally sensitive manner; and (IV) tailoring the CHWs' approach to the unique interplay of barriers at the individual and health system level along the access-to-care continuum as experienced by the individual. Further disentangling how CHWs provide support to the barriers in access to care across the continuum and at each step is outlined further in the process characteristics of this conceptual model. Furthermore, the qualitative results show that the way in which CHWs support people is also impacted by the broader health system, such as long waiting times and unwelcoming healthcare professionals after referral from a CHW. DISCUSSION The conceptual model of CHW-facilitated access to primary care developed in this article explores the way in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care in Belgium. Through their outreaching method, they play a valuable bridging role between the Belgian healthcare system and people living in socio-economically vulnerable circumstances.
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Affiliation(s)
- Caroline Masquillier
- Department of Family Medicine and Population Health, Faculty of Medicine and Heath Sciences & Department of Sociology, Centre for Population, Family and Health, University of Antwerp, Sint-Jacobstraat 2, 2000, Antwerp, Belgium.
| | - Theo Cosaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Andina-Díaz E, Ventura-Miranda MI, Quiroga-Sánchez E, Ortega-Galán ÁM, Fernández-Medina IM, Ruiz-Fernández MD. Nursing Students' Perception about Gender Inequalities Presented on Social Networks: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1962. [PMID: 36767328 PMCID: PMC9916171 DOI: 10.3390/ijerph20031962] [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: 11/14/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
During the COVID-19 pandemic, gender inequalities in nurses have been exacerbated through the images shown on social networks. This study aimed to explore and describe nursing students' experiences and perceptions about gender inequalities in nurses during the COVID-19 pandemic. A descriptive qualitative study was carried out in two universities in 264 undergraduate nursing students. The photovoice method was used to guide the study. Results: Two main categories and four subcategories were described from the data: "gender-related stereotypes", with "male leadership in a female profession" and "sexualization of female nurses" and "women's vulnerability in the pandemic" with "the gender gap in the face of increased risk of contagion " and "women's emotional fragility". Over the years, care has been considered a female task, and nursing continues to be thought of in this way. The nurse has been discriminated against, poorly considered as a professional, and, as a woman, subjected to gender roles.
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Affiliation(s)
- Elena Andina-Díaz
- Department of Nursing and Physiotherapy, University of León, Vegazana Campus, 24170 Leon, Spain
- SALBIS Research Group, University of León, 24402 Leon, Spain
- EYCC Research Group, University of Alicante, 03690 Alicante, Spain
| | - María Isabel Ventura-Miranda
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Carretera San Urbano, 04120 Almería, Spain
| | - Enedina Quiroga-Sánchez
- Department of Nursing and Physiotherapy, University of León, Vegazana Campus, 24170 Leon, Spain
- SALBIS Research Group, University of León, 24402 Leon, Spain
| | | | - Isabel María Fernández-Medina
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Carretera San Urbano, 04120 Almería, Spain
| | - María Dolores Ruiz-Fernández
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Carretera San Urbano, 04120 Almería, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Providencia 4780000, Chile
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Andina-Díaz E, Siles-González J, Solano-Ruiz MC, Welch L, Delblanco-Ubiergo G, Serrano-Fuentes N. The Impact of COVID-19 Pandemic on Health Inequities: A Photovoice Study With Nursing Students. J Transcult Nurs 2022; 33:732-741. [PMID: 36062488 DOI: 10.1177/10436596221119484] [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: 11/15/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has an amplified impact on vulnerable populations. Also, aspects related to health inequalities are insufficiently taught in higher education. This study aims to promote reflection in nursing students on the impact of the COVID-19 pandemic on vulnerable populations affected by health inequities. METHODOLOGY A photovoice method was used. Undergraduate nursing students (Spain and United Kingdom) took and explained photographs using SHOWED models. RESULTS 108 students participated. Two-domain summary themes were created: The COVID-19 pandemic has impacted ethnic minorities and socioeconomically vulnerable groups, and Proposals to respond to the negative impact on ethnic minorities and socioeconomically vulnerable groups. DISCUSSION The students identified negative health scenarios by linking COVID-19 with aspects of work, salary, and housing of these two specific populations. Holistic actions were also proposed to protect their health. As future health professionals, they must recognize these communities and work to eliminate inequalities.
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Kitson C, Haines M, O’Byrne P. Understanding the Perspectives of Women Who Use Intravenous Drugs and are Experiencing Homelessness in an Urban Centre in Canada: An Analysis of Ethnographic Data. Glob Qual Nurs Res 2022; 9:23333936221080935. [PMID: 35340820 PMCID: PMC8941687 DOI: 10.1177/23333936221080935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Injection drug use has long been a topic of investigation, whether through a health or
criminal justice lens. Whilst these bodies of literature offer important perspectives,
missing from the extant literature is evidence, particularly involving women who use
drugs, and more specifically evidence about the health beliefs of these women. To address
this knowledge gap, we undertook an ethnographic study of homeless women in downtown
Ottawa who inject drugs. This included interviews, observations, and artifact analyses. In
this paper, we report on these ethnographic data to show the context and nature of the
subjective lives of women who use injection drugs and their beliefs and perspectives on
health. We use these data to make recommendations for nursing and healthcare practice
moving forward.
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Affiliation(s)
| | | | - Patrick O’Byrne
- University of Ottawa, Ottawa, ON, Canada
- Patrick O’Byrne, University of Ottawa, 451 Smyth
Road, Ottawa K1H 8M5, ON, Canada.
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Nuwematsiko R, Nabiryo M, Bomboka JB, Nalinya S, Musoke D, Okello D, Wanyenze RK. Unintended socio-economic and health consequences of COVID-19 among slum dwellers in Kampala, Uganda. BMC Public Health 2022; 22:88. [PMID: 35027023 PMCID: PMC8757926 DOI: 10.1186/s12889-021-12453-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/20/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To reduce the spread of COVID-19, several countries in Africa instituted countrywide lockdowns and other public health measures. Whereas lockdowns contributed to the control of the pandemic, there were concerns about the unintended consequences of these measures especially in the most vulnerable populations. We assessed unintended socio-economic and health consequences due to the COVID-19 pandemic and the mitigation measures among slum dwellers in Kampala to inform the on-going and future pandemic response strategies. METHODS This was a mixed methods cross-sectional study conducted in Bwaise I and Bwaise III slums of Kawempe division, Kampala Uganda from October to December 2020. We used systematic sampling to randomly select 425 household heads for the face-to-face quantitative interviews. We also conducted six focus group discussions (FGDs) with slum dwellers and used photovoice among eight Community Health Workers (CHWs) to document unintended socio-economic and health consequences. Quantitative data were imported into STATA version 14.0 for analysis, while qualitative data were analysed thematically using NVivo version 12. Modified Poisson regression analysis was conducted to establish factors associated with impact on access to food. RESULTS Most respondents reported limited access to food (71.1%; 302/425); disruption in education (77.1%; 270/350); drop in daily income and wages (86.1%; 329/382) and loss of employment (63.1; 125/198). Twenty five percent of the respondents (25.4%; 86/338) reported domestic violence as one of the challenges. Seven themes emerged from the qualitative findings on the impact of COVID-19 including: limited access to food; negative impact on children's rights (child labour and teenage pregnancies) and education; poor housing and lack of accommodation; negative social behaviours; negative impact on family and child care; reduced income and employment; and negative impact on health and access to health care services. CONCLUSION The slum dwellers of Bwaise I and Bwaise III experienced several negative socio-economic and health consequences of COVID-19 and its prevention measures that severely affected their wellbeing. Children experienced severe consequences such as child labour and teenage pregnancies among the girls. Response activities should be contextualised to different settings and protocols to protect the vulnerable groups in the community such as children and women should be developed and mainstreamed in response activities.
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Affiliation(s)
- Rebecca Nuwematsiko
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maxencia Nabiryo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - John Bosco Bomboka
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah Nalinya
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Masquillier C, De Bruyn S, Musoke D. The role of the household in the social inclusion of children with special needs in Uganda - a photovoice study. BMC Pediatr 2021; 21:386. [PMID: 34488683 PMCID: PMC8419971 DOI: 10.1186/s12887-021-02805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Social inclusion establishes a basis for the overall wellbeing of children with special needs. Although children’s lives are centred around the household, little is known about the household’s influence on social inclusion. Therefore, the aim is to investigate the household’s role in the social inclusion of children with special needs in Uganda. Methods Twelve carers of children with special needs participated in this photovoice study on the outskirts of Kampala, Uganda – including a training workshop, home visits, in-depth individual interviews and focus group discussion. Results The social inclusion of children with special needs is highly complex because it has the potential to both benefit and cause harm. The results show that when a disability is socially devalued to a certain degree, carers and their household members have to deal with the ongoing process of stigma management. Depending on the characteristics of the child, carer and household, this can lead to an upward spiral towards visibility or a downward spiral towards concealment – reinforcing social inclusion or stigma, respectively. Conclusions Despite the fact that there is disability among Ugandan children it remains a ‘hidden reality’. This research helps to reveal this hidden reality by understanding the role of the household in social inclusion in a stigmatized context.
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Affiliation(s)
| | - Sara De Bruyn
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - David Musoke
- School of Public Health, Makerere University, Kampala, Uganda
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Majid U, Kandasamy S. The rationales for and challenges with employing arts-based health services research (ABHSR): a qualitative systematic review of primary studies. MEDICAL HUMANITIES 2021; 47:266-273. [PMID: 32958530 DOI: 10.1136/medhum-2020-011845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
Health services research (HSR) is an interdisciplinary field that investigates and improves the design and delivery of health services from individual, group, organisational and system perspectives. HSR examines complex problems within health systems. Qualitative research plays an important role in aiding us to develop a nuanced understanding of patients, family, healthcare providers, teams and systems. However, the overwhelming majority of HSR publications using qualitative research use traditional methods such as focus groups and interviews. Arts-based research-artistic and creative forms of data collection such as dance, drama and photovoice-have had limited uptake in HSR due to the lack of clarity in the methods, their rationales and potential impacts. To address this uncertainty, we conducted a qualitative systematic review of studies that have employed arts-based research in HSR topics. We searched four databases for peer-reviewed, primary HSR studies. Using conventional content analysis, we analysed the rationales for using arts-based approaches in 42 primary qualitative studies. We found four rationales for using arts-based approaches for HSR: (1) Capture aspects of a topic that may be overlooked, ignored or not conceptualised by other methods (ie, quantitative and interview-based qualitative methods). (2) Allow participants to reflect on their own experiences. (3) Generate valuable community knowledge to inform intervention design and delivery. (4) Formulate research projects that are more participatory in nature. This review provides health services researchers with the tools, reasons, rationales and justifications for using arts-based methods. We conclude this review by discussing the practicalities of making arts-based approaches commensurable to HSR.
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Affiliation(s)
- Umair Majid
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sujane Kandasamy
- Health Research Methods, Evidence & Impact, Health Research Methdology PhD Program, McMaster University, Hamilton, Ontario, Canada
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Dowhaniuk N, Ojok S, McKune SL. Setting a research agenda to improve community health: An inclusive mixed-methods approach in Northern Uganda. PLoS One 2021; 16:e0244249. [PMID: 33411706 PMCID: PMC7790286 DOI: 10.1371/journal.pone.0244249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The United Nations Sustainable Development Goals stress the importance of equitable partnerships in research and practice that integrate grass-roots knowledge, leadership, and expertise. However, priorities for health research in low-and-middle income countries are set almost exclusively by external parties and priorities, while end-users remain "researched on" not "researched with". This paper presents the first stage of a Community-Based Participatory Research-inspired project to engage communities and public-health end-users in setting a research agenda to improve health in their community. METHODS Photovoice was used in Kuc, Gulu District, Uganda to engage community members in the selection of a research topic for future public health research and intervention. Alcohol-Use Disorders emerged from this process the health issue that most negatively impacts the community. Following identification of this issue, a cross-sectional survey was conducted using the Alcohol Use Disorder Identification Test (n = 327) to triangulate Photovoice findings and to estimate the prevalence of Alcohol-Use Disorders in Kuc. Logistic regression was used to test for associations with demographic characteristics and Alcohol-Use Disorders. RESULTS Photovoice generated four prominent themes, including alcohol related issues, sanitation and compound cleanliness, water quality and access, and infrastructure. Alcohol-Use Disorders were identified by the community as the most important driver of poor health. Survey results indicated that 23.55% of adults in Kuc had a probable Alcohol Use Disorder, 16.45 percentage points higher than World Health Organization estimates for Uganda. CONCLUSIONS Community members engaged in the participatory, bottom-up approach offered by the research team to develop a research agenda to improve health in the community. Participants honed in on the under-researched and underfunded topic of Alcohol-Use Disorders. The findings from Photovoice were validated by survey results, thereby solidifying the high prevalence of Alcohol-Use Disorders as the health outcome that will be targeted through future long-term research and partnership.
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Affiliation(s)
- Nicholas Dowhaniuk
- Department of Geography, University of Florida, Gainesville, Florida, United States of America
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, United States of America
- Tropical Conservation and Development Program, University of Florida, Gainesville, Florida, United States of America
| | - Susan Ojok
- Uganda Women's Action Program, Gulu, Uganda
| | - Sarah L. McKune
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, United States of America
- African Studies Program, University of Florida, Gainesville, Florida, United States of America
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Musoke D, Ndejjo R, Lubega GB, Ekirapa-Kiracho E. Use of photovoice to explore the potential role of youth in contributing to maternal health in rural Wakiso district, Uganda. Sex Reprod Health Matters 2020; 28:1854152. [PMID: 33308091 PMCID: PMC7888067 DOI: 10.1080/26410397.2020.1854152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Despite youth constituting a large portion of the population in Uganda, their involvement in improving maternal health in their communities has been minimal. This paper explores the potential role of youth in contributing to maternal health in rural communities in Wakiso district, Uganda using photovoice. Photovoice was used as a community-based participatory research method among 10 youth (5 males and 5 females) over a period of 5 months. The photos taken by the youth were discussed in monthly meetings, and emerging data was analysed using thematic content analysis. Four themes emerged regarding how youth can contribute to improving maternal health in their communities. These themes were: community health education; advocacy for health improvement; community voluntary work; and being exemplary. The fifth and final theme provides the avenues, including drama and sports, that the youth suggested they could use for conveying messages to the community concerning maternal and general health. Health education on topics such as the importance of delivering at health facilities was emphasised. Regarding advocacy, the youth said they can be involved in reaching out to various stakeholders to raise concerns affecting maternal health. Voluntary work such as construction of energy stoves for pregnant women emerged. The youth also highlighted that they could be exemplary for instance by males accompanying their spouses during antenatal visits. With the need to continuously engage community actors in health initiatives, youth should be considered and supported as important stakeholders so they may engage in activities to improve health within their communities.
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Affiliation(s)
- David Musoke
- Lecturer, Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rawlance Ndejjo
- Research Associate, Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Biyinzika Lubega
- Research Assistant, Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Ekirapa-Kiracho
- Senior Lecturer, Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Auma CI, Pradeilles R, Blake MK, Musoke D, Holdsworth M. Factors influencing dietary practices in a transitioning food environment: a cross-sectional exploration of four dietary typologies among rural and urban Ugandan women using Photovoice. Nutr J 2020; 19:127. [PMID: 33238992 PMCID: PMC7690007 DOI: 10.1186/s12937-020-00634-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Healthy and sustainable dietary practices offer a possible solution to competing tensions between health and environmental sustainability, particularly as global food systems transition. To encourage such dietary practices, it is imperative to understand existing dietary practices and factors influencing these dietary practices. The aim of this study was to identify multi-level factors in lived rural and urban Ugandan food environments that influence existing dietary practices among women of reproductive age (WRA). METHODS A mixed methods study was conducted. Multiple correspondence analysis followed by hierarchical cluster analysis were performed on dietary data collected among a sample (n = 73) of Ugandan WRA in Kampala (urban) and Wakiso (rural) districts to elicit dietary clusters. Dietary clusters, which were labelled as dietary typologies based on environmental impact and nutrition transition considerations, were reflective of dietary practices. Following this, a smaller sample of WRA (n = 18) participated in a Photovoice exercise and in-depth interviews to identify factors in their social, physical, socio-cultural and macro-level environments influencing their enactment of the identified dietary typologies, and therefore dietary practices. RESULTS Four dietary typologies emerged: 'urban, low-impact, early-stage transitioners', 'urban, medium-impact, mid-stage transitioners', 'rural, low-impact, early-stage transitioners' and 'rural, low-impact, traditionalists'. Although experienced somewhat differently, the physical environment (access, availability and cost), social networks (parents, other family members and friends) and socio-cultural environment (dietary norms) were cross-cutting influences among both urban and rural dietary typologies. Seasonality (macro-environment) directly influenced consumption of healthier and lower environmental impact, plant-based foods among the two rural dietary typology participants, while seasonality and transportation intersected to influence consumption of healthier and lower environmental impact, plant-based foods among participants in the two urban dietary typologies. CONCLUSION Participants displayed a range of dietary typologies, and therefore dietary practices. Family provides an avenue through which interventions aimed at encouraging healthier and lower environmental impact dietary practices can be targeted. Home gardens, urban farming and improved transportation could address challenges in availability and access to healthier, lower environmental impact plant-based foods among urban WRA.
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Affiliation(s)
- Carolyn I Auma
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Sheffield, LE11 3TU, UK
| | - Megan K Blake
- Department of Geography, University of Sheffield, Winter Street, Sheffield, S3 7ND, UK
| | - David Musoke
- School of Public Health, Makerere University, New Mulago Hill Road, Kampala, Uganda
| | - Michelle Holdsworth
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.,UMR NUTRIPASS: Institute of Research for Development- IRDUM, SupAgro Montpellier, Montpellier, France
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O’Donovan J, Hamala R, Namanda AS, Musoke D, Ssemugabo C, Winters N. ‘We are the people whose opinions don’t matter’. A photovoice study exploring challenges faced by community health workers in Uganda. Glob Public Health 2019; 15:384-401. [DOI: 10.1080/17441692.2019.1663233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- James O’Donovan
- Learning and New Technologies Research Group, Department of Education, The University of Oxford, Oxford, UK
- Division of Research and Health Equity, Omni Med, Mukono, Uganda
| | - Rebecca Hamala
- Division of Research and Health Equity, Omni Med, Mukono, Uganda
| | | | - David Musoke
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Charles Ssemugabo
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Niall Winters
- Learning and New Technologies Research Group, Department of Education, The University of Oxford, Oxford, UK
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Musoke D, Ssemugabo C, Ndejjo R, Ekirapa-Kiracho E, George AS. Reflecting strategic and conforming gendered experiences of community health workers using photovoice in rural Wakiso district, Uganda. HUMAN RESOURCES FOR HEALTH 2018; 16:41. [PMID: 30134905 PMCID: PMC6104020 DOI: 10.1186/s12960-018-0306-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 08/12/2018] [Indexed: 05/25/2023]
Abstract
BACKGROUND Community health workers (CHWs) are an important human resource in Uganda as they are the first contact of the population with the health system. Understanding gendered roles of CHWs is important in establishing how they influence their performance and relationships in communities. This paper explores the differential roles of male and female CHWs in rural Wakiso district, Uganda, using photovoice, an innovative community-based participatory research approach. METHODS We trained ten CHWs (five males and five females) on key concepts about gender and photovoice. The CHWs took photographs for 5 months on their gender-related roles which were discussed in monthly meetings. The discussions from the meetings were recorded, transcribed, and translated to English, and emerging data were analysed using content analysis in Atlas ti version 6.0.15. RESULTS Although responsibilities were the same for both male and female CHWs, they reported that in practice, CHWs were predominantly involved in different types of work depending on their gender. Social norms led to men being more comfortable seeking care from male CHWs and females turning to female CHWs. Due to their privileged ownership and access to motorcycles, male CHWs were noted to be able to assist patients faster with referrals to facilities during health emergencies, cover larger geographic distances during community mobilization activities, and take up supervisory responsibilities. Due to the gendered division of labour in communities, male CHWs were also observed to be more involved in manual work such as cleaning wells. The gendered division of labour also reinforced female caregiving roles related to child care, and also made female CHWs more available to address local problems. CONCLUSIONS CHWs reflected both strategic and conformist gendered implications of their community work. The differing roles and perspectives about the nature of male and female CHWs while performing their roles should be considered while designing and implementing CHW programmes, without further retrenching gender inequalities or norms.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Charles Ssemugabo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Barrington C, Villa-Torres L, Abdoulayi S, Tsoka MG, Mvula PM. Using Photo-Elicitation Methods to Understand Resilience Among Ultra-Poor Youth and Their Caregivers in Malawi. HEALTH EDUCATION & BEHAVIOR 2017; 44:758-768. [PMID: 28892651 DOI: 10.1177/1090198117728756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Unconditional cash transfer programs are a form of structural intervention to address poverty, a "fundamental cause" of disease. Such programs increasingly aim to build resilience to sustain improved outcomes and provide a solid foundation for longer term transformations. As such, there is a need to understand what resilience means in specific contexts. The goal of this formative study was to explore local experiences of resilience and vulnerability among 11 youth-caregiver dyads ( n = 22) who were beneficiaries of the Malawi Social Cash Transfer Program in Balaka district. We used a photo-elicitation approach informed by the participatory, visual methodology photovoice to guide the study and conducted an iterative content analysis using thematic coding of transcripts and photos. Participants took pictures of their daily struggles and shocks and participated in audio-recorded discussions to reflect on the photos using an adapted version of the SHOWeD method. We found that participants characterized resilience as a tireless process of using all available individual, family, and community resources at all times in pursuit of survival and well-being. In the context of daily struggles, resilience was an essential part of survival. Shocks, mostly health-related, were depicted through staged images candidly highlighting individual and environmental vulnerabilities. Community support was an essential component of resilience for both daily struggles and shocks. Using photo-elicitation methods facilitated an intergenerational, community-driven reflection on the meaning of resilience and the multilevel determinants of health in a context of extreme poverty. Findings can inform the design of resilience-focused cash transfer programs to improve health equity.
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Olumide AO, Adebayo ES, Ojengbede OA. Using photovoice in adolescent health research: a case-study of the Well-being of Adolescents in Vulnerable Environments (WAVE) Study in Ibadan, Nigeria. Int J Adolesc Med Health 2016; 30:/j/ijamh.ahead-of-print/ijamh-2016-0040/ijamh-2016-0040.xml. [PMID: 27740918 DOI: 10.1515/ijamh-2016-0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/30/2016] [Indexed: 11/15/2022]
Abstract
Photovoice is a participatory action research method in which people are given cameras and asked to take pictures of specific issues within their community. It is often used among marginalised populations. This method helps people capture specific issues within their community using photographs, critically discuss these issues within a group and present their findings to inform policies within their community. Photovoice has been used in developed countries and among adult participants; however, the extent to which it has been used in developing countries and among adolescent participants is yet to be extensively reported. In this paper, we describe the use of photovoice among male and female adolescents aged 15-19 years who participated in the qualitative phase (phase I) of the Well-being of Adolescents in Vulnerable Environments (WAVE) study in Ibadan, Nigeria. The main study was conducted among adolescents residing in disadvantaged communities within five global cities (Baltimore, USA; Ibadan, Nigeria; Johannesburg, South Africa; New Delhi, India and Shanghai, China). Our findings revealed that adolescents in Ibadan were very eager to participate, remained fully engaged throughout the process and the data obtained were rich and detailed. Some challenges encountered with using this method were that younger adolescents had a tendency to attain saturation when taking pictures much earlier than older adolescents; however, they equally discussed the pictures taken enthusiastically. Overall, our findings affirm that photovoice as a data collection method can be successfully used in research among adolescents in developing countries like Nigeria.
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Affiliation(s)
- Adesola O Olumide
- Institute of Child Health and Centre for Population and Reproductive Health, College of Medicine, University of Ibadan/University College Hospital, PMB 5116, Ibadan 200001, Oyo State, Nigeria, Phone: +23 48033265796
| | | | - Oladosu A Ojengbede
- Department of Obstetrics and Gynaecology and Centre for Population and Reproductive Health, College of Medicine, University of Ibadan/University College Hospital, PMB 5116, Oyo State, Nigeria
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