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Napier-Raman S, Hossain SZ, Lee MJ, Mpofu E, Liamputtong P, Dune T. Migrant and refugee youth perspectives on sexual and reproductive health and rights in Australia: a systematic review. Sex Health 2023; 20:35-48. [PMID: 36455882 DOI: 10.1071/sh22081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Abstract
Migrant and refugee youth (MRY) in Australia face specific experiences that inform their sexual and reproductive health and rights (SRHR). Migrant and refugee communities experience poor health outcomes and low service uptake. Additionally, youth are vulnerable to poor sexual health. This review examines the understandings and perspectives of MRY. A systematic review was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol is registered with PROSPERO: CRD42021241213. Nine databases were systematically searched. Inclusion criteria specified literature reporting on migrant and/or refugee youth perspectives and attitudes towards sexual and reproductive health; peer-reviewed qualitative, mixed-methods and/or quantitative studies or grey literature reports; records using Australian research; literature published in English between January 2000 and March 2021. Records that did not report on MRY and did not examine participant views or perspectives; were abstract-only, reviews, pamphlets, protocols, opinion pieces or letters; did not include Australian research; were published before 2000 and/or in a language other than English were excluded. Two reviewers screened titles, abstracts and full-text articles. The Mixed Method Appraisal Tool was used to assess studies' methodological quality. Thematic synthesis methods guided data extraction and analysis. Twenty-eight papers were included in the final review. Three themes were identified in MRY constructions of SRHR: (1) experiences of silence and shame; (2) understandings of and responses to SRHR risks; (3) navigation of relationships and sexual activity. Socioecological factors shaped MRY perspectives at individual, interpersonal, institutional and societal levels. Societal factors and interpersonal relationships significantly influenced decision making.
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Affiliation(s)
- Sharanya Napier-Raman
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Syeda Zakia Hossain
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Mi-Joung Lee
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Elias Mpofu
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; and Rehabilitation and Health Services, University of North Texas, Denton, TX 26203, USA; and School of Human and Community Development, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Pranee Liamputtong
- College of Health Sciences, VinUniversity, Gia Lam District, Hanoi 100000, Vietnam
| | - Tinashe Dune
- School of Health Sciences & Translational Health Research Institute, Western Sydney University, Penrith, NSW 2747, Australia
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Pichon M, Howard-Merrill L, Wamoyi J, Buller AM, Kyegombe N. A qualitative study exploring parent-daughter approaches for communicating about sex and transactional sex in Central Uganda: Implications for comprehensive sexuality education interventions. J Adolesc 2022; 94:880-891. [PMID: 35797512 DOI: 10.1002/jad.12071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/16/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Ugandan adolescent girls and young women are disproportionately impacted by human immunodeficiency virus, and this is largely driven by their engagement in transactional sex. Globally, parent-daughter communication about sex is associated with increased contraceptive use and delayed/decreased sexual activity, but research on parent-daughter communication about transactional sex is lacking. This paper elucidates local perspectives on, and experiences of parent-daughter communication about sex and transactional sex, to inform family-level comprehensive sexuality education interventions. METHODS We conducted a secondary, thematic analysis of 13 focus group discussions (n = 119) and 30 in-depth interviews collected between 2014 and 2015 with adolescent girls and young women aged 14+, and men and women in Kampala and Masaka. RESULTS We found that parents used three approaches to discuss sex and transactional sex with their daughters: (1) frightening their daughters into avoiding sex; (2) being "strict"; and (3) relying on mothers rather than fathers to "counsel" daughters. Mother-daughter communication about transactional sex was common, but frequently unidirectional. Adolescent girls and young women bringing home gifts sparked conversations about the risks of transactional sex, although less in poorer households. Mothers felt they lacked control over their daughters' sexual behaviors and thus restricted their movements and friendships to try to prevent them from having sex. In contrast to previous research, we found some evidence of mothers encouraging condom use and father-daughter communication about sex. CONCLUSIONS Family-level comprehensive sexuality education interventions targeting parent-daughter communication about sex could further highlight the role that fathers might play, and emphasize communication about the inequitable power dynamics in transactional sex and condom negotiation skills, while reducing fear surrounding parent-daughter communication.
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Affiliation(s)
- Marjorie Pichon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Lottie Howard-Merrill
- Department of Education, Practice and Society, University College London Institute of Education, London, UK
| | - Joyce Wamoyi
- Department of Sexual and Reproductive Health, Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Ana Maria Buller
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Razavi SD, Kapiriri L, Abelson J, Wilson M. Barriers to Equitable Public Participation in Health-System Priority Setting Within the Context of Decentralization: The Case of Vulnerable Women in a Ugandan District. Int J Health Policy Manag 2022; 11:1047-1057. [PMID: 33590740 PMCID: PMC9808191 DOI: 10.34172/ijhpm.2020.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Decentralization of healthcare decision-making in Uganda led to the promotion of public participation. To facilitate this, participatory structures have been developed at sub-national levels. However, the degree to which the participation structures have contributed to improving the participation of vulnerable populations, specifically vulnerable women, remains unclear. We aim to understand whether and how vulnerable women participate in health-system priority setting; identify any barriers to vulnerable women's participation; and to establish how the barriers to vulnerable women's participation can be addressed. METHODS We used a qualitative description study design involving interviews with district decision-makers (n=12), sub-county leaders (n=10), and vulnerable women (n=35) living in Tororo District, Uganda. Data was collected between May and June 2017. The analysis was conducting using an editing analysis style. RESULTS The vulnerable women expressed interest in participating in priority setting, believing they would make valuable contributions. However, both decision-makers and vulnerable women reported that vulnerable women did not consistently participate in decision-making, despite participatory structures that were instituted through decentralization. There are financial (transportation and lack of incentives), biomedical (illness/disability and menstruation), knowledge-based (lack of knowledge and/or information about participation), motivational (perceived disinterest, lack of feedback, and competing needs), socio-cultural (lack of decision-making power), and structural (hunger and poverty) barriers which hamper vulnerable women's participation. CONCLUSION The identified barriers hinder vulnerable women's participation in health-system priority setting. Some of the barriers could be addressed through the existing decentralization participatory structures. Respondents made both short-term, feasible recommendations and more systemic, ideational recommendations to improve vulnerable women's participation. Integrating the vulnerable women's creative and feasible ideas to enhance their participation in health-system decision-making should be prioritized.
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Affiliation(s)
- S. Donya Razavi
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence, and Impact (HEI), Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Michael Wilson
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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Nakiganda LJ, Bavinton BR, Grulich AE, Serwadda D, Nakubulwa R, Poynten IM, Bell S. Social Influences on Engagement With HIV Testing, Treatment and Care Services Among Men Who Have Sex With Men Living in Rural Uganda. QUALITATIVE HEALTH RESEARCH 2022; 32:635-645. [PMID: 34923882 DOI: 10.1177/10497323211058162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Men who have sex with men in Uganda are a heterogenous, discriminated population, experiencing high HIV burden, limited access to HIV testing, and low treatment adherence. We contribute to the lack of information about men who have sex with men in rural Uganda by using socio-ecological analyses to examine the social influences shaping their engagement with HIV services. Based on in-depth interviews with 16 men, our findings reveal the inhibitive influence of interpersonal relationships with sexual partners, peers and families, and institutional influences within health service and non-governmental organizational settings. Yet men take action to strategize and seek support to enhance engagement with HIV care in heavily criminalized and stigmatized settings. Future HIV prevention, testing, treatment, and care responses could draw on what affected individuals and communities are already doing to enhance access to HIV services and the effective support strategies of some non-governmental organizations and healthcare workers.
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Affiliation(s)
- Lydia J Nakiganda
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Benjamin R Bavinton
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Andrew E Grulich
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - David Serwadda
- 561068Rakai Health Sciences Program, Kalisizo, Uganda
- 58589Makerere University School of Public Health, Kampala, Uganda
| | | | - Isobel M Poynten
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Stephen Bell
- UQ Poche Centre for Indigenous Health, 1974The University of Queensland, Saint Lucia, QLD, Australia
- School of Public Health, 1974The University of Queensland, Saint Lucia, QLD, Australia
- Centre for Social Research in Health, 7800UNSW Sydney, Sydney, NSW, Australia
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Mitchell E, Bell S. Premarital relationships and condom use among young people in Suva, Fiji. Sex Health 2020; 17:337-343. [PMID: 32717178 DOI: 10.1071/sh20040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/24/2020] [Indexed: 11/23/2022]
Abstract
Background Young people in Fiji experience high rates of sexually transmissible infections and early pregnancy. Despite being identified as a key priority group in national strategies, little is known about use of condoms among young people in premarital relationships. This study aimed to enhance understandings of premarital sex and condom use practices among young people in Fiji. METHODS Focus group discussions with 33 young women and men aged 18-29 years and 17 interviews with young women aged 18-26 years in an urban setting in Fiji were conducted. Inductive thematic analysis examined condom use practices. RESULTS Participants described a range of contextual influences inhibiting or enabling condom use. Factors inhibiting condom use included sociocultural expectations regarding premarital abstinence; young people's engagement in hidden sexual relationships; limited intergenerational dialogue about sexual health issues; judgmental attitude of staff at condom access points; male dominance of condom use preferences; and belief condoms disrupt intimacy, reduce sexual pleasure and infer a lack of trust. Factors that enhanced condom use included accessing condoms through discreet methods; adult beliefs that supported safe sex practices; and refusing to have sex without a condom. CONCLUSION Findings broaden understandings of young people's condom use practices in Suva, Fiji. The findings illustrate the need for culturally appropriate youth-centred sexual and reproductive health (SRH) programs and services. Specific strategies that might enhance young people's condom use include community- and youth-led responses; peer condom distribution; provision of condom dispensers in community settings; scaling up of youth-friendly SRH services; and the delivery of comprehensive sexuality and relationships education.
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Affiliation(s)
- Elke Mitchell
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia; and Corresponding author.
| | - Stephen Bell
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia; and Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia
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Mitchell E, Bennett LR. Young women's perceptions and experiences of sexual risk in Suva, Fiji. CULTURE, HEALTH & SEXUALITY 2020; 22:504-519. [PMID: 31144607 DOI: 10.1080/13691058.2019.1614669] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
This paper explores young iTaukei (Indigenous Fijian) women's perceptions and experiences of sexual risk. It draws on qualitative data collected in Suva, Fiji in 2011 and 2012. Participants included iTaukei female university students aged 18-29 years. We describe nine forms of sexual risk identified by young iTaukei women, and group these risks into three clusters - social risks, physical risks and intimate relational risks. We discuss how young women prioritise these risks differently depending on context, location and relationship. Findings point to a critical mismatch between current public health risk priorities and those risks identified as most important in the lives of young iTaukei women. Findings have important implications for strengthening sexual and reproductive health policy and practice in Fiji.
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Affiliation(s)
- Elke Mitchell
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, NSW, Australia
| | - Linda Rae Bennett
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
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Mitchell E, Bennett LR. Pressure and Persuasion: Young Fijian Women's Experiences of Sexual and Reproductive Coercion in Romantic Relationships. Violence Against Women 2019; 26:1555-1573. [PMID: 31663433 DOI: 10.1177/1077801219882505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intimate partner violence (IPV) is a violation of women's human rights and dramatically increases women's vulnerability to sexual and reproductive health morbidities. This article examines young iTaukei (Indigenous Fijian) women's experiences of, and responses to, nonphysical forms of coercion in romantic relationships. It draws on ethnographic research with young unmarried women attending university in Suva, Fiji. Young women disclosed experiencing a continuum of coercive behaviors, including verbal pressure, deception, and manipulation by male partners to initiate sexual intercourse, unprotected sex, and unsafe abortions. Findings indicate an urgent need to address IPV within premarital relationships in Fiji to promote young women's sexual and reproductive health and autonomy.
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Affiliation(s)
| | - Linda Rae Bennett
- The Nossal Institute for Global Health, University of Melbourne, Victoria, Australia
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Lundgren R, Burgess S, Chantelois H, Oregede S, Kerner B, Kågesten AE. Processing gender: lived experiences of reproducing and transforming gender norms over the life course of young people in Northern Uganda. CULTURE, HEALTH & SEXUALITY 2019; 21:387-403. [PMID: 29882476 DOI: 10.1080/13691058.2018.1471160] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 04/27/2018] [Indexed: 06/08/2023]
Abstract
The years between 10-19 represent a critical stage of human development during which boys and girls learn and embody socially constructed gender norms, with long-term implications for their sexual and reproductive health. This ethnographic cohort study sought to understand how gendered norms and practices develop during the transition from child to young adult in post-conflict northern Uganda. A total of 60 girls and boys aged 10-19 were selected using purposive sampling for in-depth interviews over a three-year period; 47 individuals completed all four interviews. Drawing on feminist theory and an ecological perspective, findings were used to create a conceptual framework displaying the experiences of young people navigating patriarchal and alternative norms, emphasising their lived processes of performing and negotiating norms within six key domains (work, puberty, family planning, intimate partner relations, child discipline and alcohol). The framework identifies: (1) personal factors (knowledge, agency and aspirations); (2) social factors (socialisation processes, capital, costs and consequences); and (3) structural factors (health/educational systems, religious institutions, government policies) which may encourage young people towards one norm or another as they age. These findings can inform policies and programmes to transform gender norms and promote equitable, healthy relationships.
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Affiliation(s)
- Rebecka Lundgren
- a Institute for Reproductive Health , Georgetown University , Washington , USA
| | - Sarah Burgess
- a Institute for Reproductive Health , Georgetown University , Washington , USA
- d Camber Collective , San Francisco , USA
| | - Heather Chantelois
- a Institute for Reproductive Health , Georgetown University , Washington , USA
| | - Susan Oregede
- b Pathfinder International , Kampala , Uganda
- e UN Women Uganda , Kampala , Uganda
| | | | - Anna E Kågesten
- a Institute for Reproductive Health , Georgetown University , Washington , USA
- f Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
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Bell S, Kennedy E, Black K, Vallely A, Vallely L, Mola G, Kaldor J, Bagita M, Ninnes C, Pomat W, Kelly-Hanku A. Youth-centred research to help prevent and mitigate the adverse health and social impacts of pregnancy amongst young Papua New Guineans. REPRODUCTIVE HEALTH MATTERS 2018; 26:5-12. [DOI: 10.1080/09688080.2018.1512297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Stephen Bell
- Senior Research Fellow, Kirby Institute, UNSW Sydney, Sydney, Australia
- Visiting Fellow, Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elissa Kennedy
- Co-Program Director, Maternal and Child Health, Burnet Institute, Melbourne, Australia
- Adjunct Senior Lecturer, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Honorary Fellow, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Kirsten Black
- Associate Professor, Joint Head of Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - Andrew Vallely
- Associate Professor, Kirby Institute, UNSW Sydney, Sydney, Australia
- Professorial Research Fellow, PNG Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea
| | - Lisa Vallely
- Research Fellow, Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Glen Mola
- Professor, Head of Obstetrics and Gynecology, School of Medicine and Health Sciences, University of PNG, Port Moresby, Papua New Guinea
| | - John Kaldor
- Scientia Professor, Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Mary Bagita
- Co-ordinator, O&G Division, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Caroline Ninnes
- Health Service Programs Manager, Susu Mamas, Papua New Guinea
| | - William Pomat
- Director, PNG Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea
| | - Angela Kelly-Hanku
- Scientia Fellow, Kirby Institute, UNSW Sydney, Sydney, Australia
- Senior Principal Reseach Fellow and Head, Sexual & Reproductive Health Unit, PNG Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea
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Dusabe-Richards E, Rutakumwa R, Zalwango F, Asiimwe A, Kintu E, Ssembajja F, Seeley J. Dealing with disclosure: Perspectives from HIV-positive children and their older carers living in rural south-western Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:387-395. [PMID: 27974016 DOI: 10.2989/16085906.2016.1256330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There are limited data on the challenges faced by carers, in particular older carers, in managing the difficult task of status disclosure for HIV-positive children. We report findings from qualitative interviews with 18 care dyads of older people and HIV-positive children living in rural south-western Uganda. Our data provide insights into perceptions and norms influencing communication during and following disclosure among both carers and children, including those shaped by gendered expectations of girls' and boys' sexual behaviour. Young participants reported several advantages of knowing their status and showed considerable resilience in the face of HIV disclosure. Better and more support is needed to help health workers and carers (particularly older carers) manage cross-generational communication around HIV disclosure and other related aspects of sexual and reproductive health as critical aspects of children's psychosocial development and well-being.
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Affiliation(s)
- Esther Dusabe-Richards
- a Department of International Public Health , Liverpool School of Tropical Medicine , Pembroke Place, Liverpool , United Kingdom
| | - Rwamahe Rutakumwa
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Flavia Zalwango
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Allen Asiimwe
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Elvis Kintu
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Fatuma Ssembajja
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Janet Seeley
- b Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda.,c Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , United Kingdom
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Kisaalita WS, Katimbo A, Sempiira EJ, Mugisa DJ. Cultural Influences in Women-Friendly Labor-Saving Hand Tool Designs: The Milk Churner Case. HUMAN FACTORS 2016; 58:27-42. [PMID: 26764373 PMCID: PMC4768704 DOI: 10.1177/0018720815623146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to highlight the importance of culture in sustainable, labor-saving solutions design for women in low-resource settings. BACKGROUND One of the reasons behind the gender asset gap among Sub-Saharan African women is the higher labor burden these women face, making it difficult for them to produce for the home and markets. Hand tools are the simplest form and therefore the best first step to address this problem. But designing women-friendly (sustainable) hand tools calls for better understanding of the low-resource settings where these women reside. METHOD A milk churner was redesigned using a human-centered (participatory) approach with groups of women from two dominant ethnolinguistic groups of Bantu and Nilotic of Uganda, and its usability was tested. RESULTS The churner reduced labor up to eightfold and has potential to expand the range of uses to include children and husbands due to its simplicity. Also, the churner significantly reduced undesirable health effects, like pain in knee joints. Based on the experience with the churner, a six-item "survival guide" is proposed to complement human-centered design guiding principles for facilitating the generation of solutions in low-resource settings. CONCLUSION By paying great attention to culture in relation to human factors, a labor-reducing churner has been successfully introduced among Ugandan women. The ultimate goal is to make the churner available to female smallholder dairy-farming households throughout Sub-Saharan Africa. APPLICATIONS This study provides a survival guide for generating solutions to problems from low-resource settings.
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Affiliation(s)
| | - Abia Katimbo
- University of Georgia, AthensSmallholder Fortunes, Kampala, Uganda
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