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Auer SR, Matandirotya N, Mathe P, Moyo M, Sherburne L, Dickin KL. Participants in a peer-based nutrition and health program in Zimbabwe value dialogue, peer support, and tangible action: A qualitative exploration of peer group experiences. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003525. [PMID: 39356690 PMCID: PMC11446453 DOI: 10.1371/journal.pgph.0003525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 08/26/2024] [Indexed: 10/04/2024]
Abstract
Peer support groups are implemented globally, and viewed as cost-effective, scalable platforms for delivering health and nutrition programming. Quality is important for participation and achieving social and behavior change goals. Little research has explored the perspectives of peer group participants on quality. This manuscript describes community-based implementation research, and associated findings, which was conducted to learn how participants of a nutrition and health program define quality peer groups and how they suggest improving peer groups. In-depth interviews on experiences, benefits, and challenges were conducted with participants of health and nutrition peer groups, including group members (n = 64) and facilitators (n = 30), in three districts in Zimbabwe. Qualitative data were analyzed thematically and preliminary results were presented in six follow-up focus group discussions with interviewees to provide input on results and interpretation. Peer groups met some of participants' needs for knowledge, social support, and visible improvements in their lives and homes. Participants described generally positive experiences that sustained participation and motivated behavior change. They highlighted group dynamics, interactive facilitation, and community recognition which support the credibility and motivation of group facilitators. Implementation could be improved by strengthening family engagement and more hands-on learning for encouraging participation. Local adaptation of group activities can address influences on behavior change and increase relevance to participants' needs. The perspectives of core stakeholders are essential to understand what aspects of peer groups are most important to implement the approach with quality across contexts. Implementation research and continued monitoring to understand participant perspectives should be an integral part of all programs to ensure the application of adult learning principles and an appropriate balance between fidelity and adaptation for local relevance and engagement.
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Affiliation(s)
- S. Riley Auer
- JSI Research & Training Institute, Arlington, Virginia, United States of America
| | | | - Prince Mathe
- Kgotso Development Trust, Beitbridge, Matabeleland South, Zimbabwe
| | - Musawenkosi Moyo
- Kgotso Development Trust, Beitbridge, Matabeleland South, Zimbabwe
| | - Lisa Sherburne
- JSI Research & Training Institute, Arlington, Virginia, United States of America
| | - Katherine L. Dickin
- Department of Public & Ecosystem Health, Cornell University College of Veterinary Medicine, Ithaca, New York, United States of America
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Matenga TFL, Agarwal H, Adeniran OP, Lam-McCarthy M, Johnson EA, Nyambe J, Chabaputa R, Chanda S, Habinda DM, Mulenga L, Sakanya S, Kasaro MP, Maman S, Chi BH, Martin SL. Engaging Family Members to Support Exclusive Breastfeeding, Responsive care, and Antiretroviral Therapy Adherence Among Families with Children who are HIV-Exposed and Uninfected. AIDS Behav 2024:10.1007/s10461-024-04467-z. [PMID: 39249627 DOI: 10.1007/s10461-024-04467-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 09/10/2024]
Abstract
Children who are HIV-exposed and uninfected (CHEU) are at increased risk for poor growth, health, and development compared to children who are HIV-unexposed and uninfected. To support families with CHEU, we assessed the acceptability of engaging family members to support women living with HIV (WLWH) with exclusive breastfeeding (EBF) and antiretroviral therapy (ART) adherence and to engage in responsive infant caregiving. We conducted trials of improved practices, a consultative research approach, that follows participants over time as they try recommended behaviors. We enrolled postpartum women in Lusaka, Zambia, who identified home supporters. At visit 1, WLWH were interviewed about current practices. At visit 2, WLWH and home supporters received tailored EBF, responsive care, and ART adherence counseling. At visit 3, WLWH and home supporters were interviewed about their experiences trying recommended practices for 2-3 weeks. Interview transcripts were analyzed thematically. Participants included 23 WLWH, 15 male partners, and 8 female family members. WLWH reported several barriers to EBF. The most common were fear of HIV transmission via breastfeeding-despite high ART adherence-and insufficient breastmilk. After counseling, WLWH reported less fear of HIV transmission and improved breastfeeding practices. Home supporters reported providing WLWH increased support for EBF and ART adherence and practicing responsive caregiving. Both male and female home supporters appreciated being included in counseling and more involved in caregiving, and WLWH valued the increased support. Families with CHEU need focused support. Tailored counseling and family support for WLWH show promise for improving EBF, responsive caregiving, and ART adherence.
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Affiliation(s)
- Tulani Francis L Matenga
- UNC Global Projects Zambia, Lusaka, Zambia
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Harsh Agarwal
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Oluwamuyiwa P Adeniran
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa Lam-McCarthy
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | | | | | | | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Packard-Winkler M, Golding L, Tewodros T, Faerber E, Webb Girard A. Core Principles and Practices for the Design, Implementation, and Evaluation of Social and Behavior Change for Nutrition in Low- and Middle-Income Contexts with Special Applications for Nutrition-Sensitive Agriculture. Curr Dev Nutr 2024; 8:104414. [PMID: 39224137 PMCID: PMC11367532 DOI: 10.1016/j.cdnut.2024.104414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background There is currently no cogent set of standards to guide the design, implementation and evaluation of nutrition social and behavior change (SBC), including for nutrition-sensitive agriculture (NSA). Objectives We aimed to capture, consolidate, and describe SBC core principles and practices (CPPs), reflecting professional consensus, and to offer programmatic examples that illustrate their application for NSA projects in low- and middle-income countries. Methods We conducted a narrative review following a 4-step iterative process to identify and describe SBC CPPs. We first reviewed general SBC frameworks and technical documents and developed a preliminary list of CPPs and their definitions. Following review and feedback from 8 content experts, we revised the CPPs, incorporating the panel's feedback, and conducted a more specific search of the peer-reviewed and gray literature. We presented a revised draft of the CPPs to 26 NSA researchers, practitioners, and implementers at the 2022 Agriculture, Nutrition and Health Academy annual conference. We then conducted a focused review of each CPP, and 3 content experts rereviewed the final draft. Results We reviewed ∼475 documents and resources resulting in a set of 4 core principles: 1) following a systematic, strategic method in designing, implementing, and evaluating SBC activities; 2) ensuring design and implementation are evidence-based; 3) grounding design and implementation in theory; and 4) authentically engaging communities. Additionally, we identified 11 core practices and mapped these to the different stages in the SBC design, implementation, and evaluation cycle. Detailed descriptions, illustrative examples and resources for implementation are provided for each CPP. Conclusions An explicit set of CPPs for SBC can serve as a guide for design, research, implementation, and evaluation of nutrition and NSA programs; help standardize knowledge sharing and production; and contribute to improved quality of implementation. Broader consultation with SBC practitioners and researchers will further consensus on this work.
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Affiliation(s)
| | - Lenette Golding
- Save the Children U.S., Department of Global Health, Washington, DC, United States
| | - Tsedenia Tewodros
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
| | - Emily Faerber
- Dietetics and Nutrition Department, College of Health, University of Alaska Anchorage, Anchorage, AK, United States
| | - Amy Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, United States
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Tewodros T, Escobar CX, Berra LS, Webb Girard A. Effectiveness of Elements of Social Behavior Change Activities in Nutrition-Sensitive Agriculture Programs: A Systematic Review. Curr Dev Nutr 2024; 8:104420. [PMID: 39224142 PMCID: PMC11367542 DOI: 10.1016/j.cdnut.2024.104420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/28/2024] [Accepted: 07/17/2024] [Indexed: 09/04/2024] Open
Abstract
Background Limited research exists on the specific approaches and behavior change techniques (BCT) used in nutrition-sensitive agriculture (NSA) programs and their effects on diet diversity. Objectives We aimed to describe nutrition-related social behavior change (SBC) in the context of NSA and quantify the effectiveness of different SBC components of NSA programs in improving diet diversity. Methods We searched PubMed, Embase, Web of Science, the International Food Policy and Research Institute repository, and Agricola for articles published between 2000 and 2023. We identified the agricultural activities each project used as a pathway to improved nutrition (ag-nutrition pathways), identified SBC approaches used by each project, and coded BCTs using validated coding protocols. Effectiveness ratios (ERs) were calculated to assess pathways, approaches, and BCTs in relation to dietary diversity outcomes (minimum diet diversity for children, child dietary diversity score, and women's dietary diversity). Results Of 65 included NSA interventions, the most used agriculture-to-nutrition pathways included 1) agricultural production for home consumption (n = 61); 2) women's empowerment (n = 36); and 3) agricultural income (n = 37) pathways. The most used SBC approaches were interpersonal communication (IPC, n = 59) and community-based approaches (n = 53). Frequently used BCTs included "instructions on how to perform the behavior" (n = 65), "social support (unspecified)" (n = 43), and using a "credible source" (n = 43). The increased production for the home consumption pathway, IPC approach, and the BCT "behavioral practice" had high ERs for diet diversity outcomes. Conclusions Although the agricultural production for home consumption pathway to improved nutrition had the highest ERs for diet diversity, other pathways, such as income generation and reducing wastage, hold promise and require additional investigation. The most commonly applied BCTs focused on information dissemination; however, participatory BCTs related to behavioral demonstration, and behavioral practice had higher ERs. Findings indicate a need to test less frequently utilized SBC components to determine effectiveness.This trial was registered at PROSPERO (=https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=179016) as CRD42020179016.
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Affiliation(s)
- Tsedenia Tewodros
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
| | - Carolina X Escobar
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
| | - Liris S Berra
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
| | - Amy Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
- Nutrition and Health Sciences, Emory University, Atlanta, GA, United States
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Aubel J. Grandmothers - a cultural resource for women and children's health and well-being across the life cycle. Glob Health Promot 2024; 31:23-33. [PMID: 37615182 DOI: 10.1177/17579759231191494] [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] [Indexed: 08/25/2023]
Abstract
Grandmothers exist in all societies. Especially in the non-western Majority World, where Elders are both highly respected and responsible for transmitting their knowledge to younger generations, there is extensive anecdotal evidence of Grandmothers' role in health promotion and healing. However, due to Eurocentric and reductionist views of families and communities, in the extensive past research on maternal, child and adolescent health issues across Africa, Asia, Latin America and the Middle East, and in Indigenous societies in North America, Australia and New Zealand, scant attention has been given to the role of Grandmothers. This paper addresses this oversight and supports the imperative to decolonize health promotion in the non-western world by building on non-western worldviews, roles and values. Based on an eclectic body of both published and gray literature, this review presents extensive evidence of Grandmothers' involvement across the life cycle of women and children and of the similar core roles that they play across cultures. While in some cases Grandmothers have a negative influence, in most cases their involvement and support to younger women and children is beneficial in terms of both their advisory and their caregiving roles. For future research and interventions addressing maternal, child and adolescent health, the conclusions of this review provide strong support for: adoption of a family systems framework to identify both gender-specific and generation-specific roles and influence; and the inclusion of Grandmothers in community health promotion programs dealing with different phases of the life cycle of women and children.
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Affiliation(s)
- Judi Aubel
- Grandmother Project - Change through Culture, Mbour, Senegal
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Duh-Leong C, Ortiz R, Messito MJ, Katzow MW, Kim CN, Teli R, Gross RS. Household Food Insecurity and Maternal-Toddler Fruit and Vegetable Dietary Concordance. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:100-109. [PMID: 38142387 PMCID: PMC10922249 DOI: 10.1016/j.jneb.2023.10.018] [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: 04/10/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To examine whether prenatal or concurrent household food insecurity influences associations between maternal and toddler fruit and vegetable (FV) intake. DESIGN Application of a life-course framework to an analysis of a longitudinal dataset. SETTING Early childhood obesity prevention program at a New York City public hospital. PARTICIPANTS One-hundred and fifty-six maternal-toddler dyads self-identifying as Hispanic or Latino. VARIABLES MEASURED Maternal and toddler FV intake was measured using Centers for Disease Control and Prevention dietary measures when toddlers were aged 19 months. Household food insecurity (measured prenatally and concurrently at 19 months) was measured using the US Department of Agriculture Food Security Module. ANALYSIS Regression analyses assessed associations between adequate maternal FV intake and toddler FV intake. Interaction terms tested whether prenatal or concurrent household food insecurity moderated this association. RESULTS Adequate maternal FV intake was associated with increased toddler FV intake (B = 6.2 times/wk, 95% confidence interval, 2.0-10.5, P = 0.004). Prenatal household food insecurity was associated with decreased toddler FV intake (B = -6.3 times/wk, 95% confidence interval, -11.67 to -0.9, P = 0.02). There was a significant interaction between the level of maternal-toddler FV association (concordance or similarity in FV intake between mothers and toddlers) and the presence of food insecurity such that maternal-toddler FV association was greater when prenatal household food insecurity was not present (B = -11.6, P = 0.04). CONCLUSIONS AND IMPLICATIONS Strategies to increase FV intake across the life course could examine how the timing of household food insecurity may affect intergenerational maternal-child transmission of dietary practices.
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Affiliation(s)
- Carol Duh-Leong
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY.
| | - Robin Ortiz
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY; Institute for Excellence in Health Equity, New York University Langone Health, New York, NY
| | - Mary Jo Messito
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
| | - Michelle W Katzow
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Christina N Kim
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Radhika Teli
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Rachel S Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
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Øverby NC, Hillesund ER, Medin AC, Vik FN, Ostojic SM. Nutrition in a lifecourse perspective: From molecular aspects to public health approaches. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 2:e13582. [PMID: 37932597 PMCID: PMC10765348 DOI: 10.1111/mcn.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
This Special Issue covers a variety of topics related to nutrition from a lifecourse perspective, addressing diet in sensitive periods (preconception, pregnancy and infancy/toddlerhood), in different contexts, spanning from molecular nutrition to settings and gatekeepers of diet in these sensitive periods. It highlights challenges and research gaps within the field.
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Affiliation(s)
- Nina C. Øverby
- Department of Nutrition and Public Health, UiA Priority Research Centre for Lifecourse NutritionUniversity of AgderKristiansandNorway
| | - Elisabet R. Hillesund
- Department of Nutrition and Public Health, UiA Priority Research Centre for Lifecourse NutritionUniversity of AgderKristiansandNorway
| | - Anine C. Medin
- Department of Nutrition and Public Health, UiA Priority Research Centre for Lifecourse NutritionUniversity of AgderKristiansandNorway
| | - Frøydis N. Vik
- Department of Nutrition and Public Health, UiA Priority Research Centre for Lifecourse NutritionUniversity of AgderKristiansandNorway
| | - Sergej M. Ostojic
- Department of Nutrition and Public Health, UiA Priority Research Centre for Lifecourse NutritionUniversity of AgderKristiansandNorway
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Okyere J, Bediako VB, Ackah JA, Acheampong E, Owusu BA, Agbemavi W, Nwameme AU, Kamau EM, Asampong E. RTS,S/AS01 E vaccine defaults in Ghana: a qualitative exploration of the perspectives of defaulters and frontline health service providers. Malar J 2023; 22:260. [PMID: 37674197 PMCID: PMC10483715 DOI: 10.1186/s12936-023-04690-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND While Ghana has a good track record in the Expanded Programme on Immunization, there are substantial challenges with regards to subsequent vaccinations, particularly after the first year of life of the child. Given that the last dose of the RTS, S/AS01E vaccine against malaria is administered at 24 months, there is a high likelihood of default. Hence, it is imperative to understand the dynamics and reasons for the defaults to enable the development of effective implementation strategies. This study explored why caregivers default on the RTS, S/AS01E vaccine from the perspective of health service providers and caregivers. METHODS This study employed an exploratory, descriptive approach. Using a purposive sampling technique, caregivers who defaulted and health service providers directly involved in the planning and delivery of the RTS, S/AS01E vaccine at the district level were recruited. A total of five health service providers and 30 mothers (six per FGD) participated in this study. Data analysis was done using NVivo-12 following Collaizi's thematic framework for qualitative analysis. The study relies on the Standards for Reporting Qualitative Research. RESULTS Reasons for defaulting included the overlap of timing of the last dose and the child starting school, disrespectful attitudes of some health service providers, concerns about adverse side effects and discomforts, travel out of the implementing district, the perception that the vaccines are too many, and lack of support from partners. CONCLUSION To reduce the occurrence of defaulting on the RTS, S/AS01E vaccine programme, stakeholders must reconsider the timing of the last dose of the vaccine. The schedule of the RTS, S/AS01E vaccine should be aligned with the established EPI schedule of Ghana. This will significantly limit the potential of defaults, particularly for the last dose. Also, the findings from this study underscore a need to encourage male partner involvement in the RTS, S/AS01E vaccine programme. Health promotion programmes could be implemented to raise caregivers' awareness of potential adverse reactions and discomforts-this is necessary to prepare the caregiver for the vaccine process psychologically.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Vincent Bio Bediako
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- The Graduate Group in Demography, University of Pennsylvania, Philadelphia, USA
| | - Josephine Akua Ackah
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Wonder Agbemavi
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- School of Demography, Australian National University, Canberra, Australia
| | | | - Edward Mberu Kamau
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO), Geneva, Switzerland
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Heidari Dehui P, Negarandeh R, Pashaeypoor S. Weight Management Challenges in Nulliparous Women Being Overweight or Obese Due to Pregnancy: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2023; 11:190-200. [PMID: 37489224 PMCID: PMC10363267 DOI: 10.30476/ijcbnm.2023.97714.2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
Background Getting overweight after pregnancy is a common phenomenon and getting back to pre-pregnancy weight in the postpartum period is a major concern for mothers. This study aimed to explain the challenges in performing post-pregnancy weight-management behaviors in nulliparous women being overweight and obese due to pregnancy. Methods The present qualitative study was conducted with the conventional qualitative content analysis method based on Granheim and Landman's approach from October to December in 2021. In this study, participants were 15 women who referred to comprehensive health service centers in Tehran, Iran; they were purposefully selected according to the inclusion criteria. Data were collected through individual, in-depth, and semi-structured face-to-face interviews and simultaneously analyzed using the MAXQ Data version 10 software. Results The mean age of the participants was 25.93±3.21 years. Data analysis resulted in three main categories: 1) failure to adhere to calorie-restricted diets, 2) inability to engage in physical activity, and 3) lack of adequate social support. Conclusion Women with obesity due to pregnancy face many challenges to improve their weight-control behaviors. As such, improving healthy behaviors not only requires relevant stakeholders' commitment, but also demands women, their families and communities' intention to engage in healthy behaviors.
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Affiliation(s)
- Pooran Heidari Dehui
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahzad Pashaeypoor
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Schuler C, Waldboth V, Ntow GE, Agbozo F. Experiences of families and health professionals along the care continuum for low-birth weight neonates: A constructivist grounded theory study. J Adv Nurs 2023; 79:1840-1855. [PMID: 36762678 DOI: 10.1111/jan.15566] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/16/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023]
Abstract
AIMS To explore the experiences of health professionals and families concerning supporting low-birth weight (LBW) infants along the continuum of care (CoC) in Ghana with the goal to unveil new strategies to improve the quality of neonatal care. DESIGN A constructivist grounded theory. METHOD Simultaneous data collection and analysis among health professionals alongside families with LBW infants from September 2020 to April 2021. The study used constructivist grounded theory strategies for data collection and analysis. RESULTS The analysis of 25 interviews resulted in a theoretical model describing 10 themes along the CoC for LBW infants, categorized into health and family systems drivers. In this paper, we focus on the latter. Early bonding and family involvement were empowering. Mothers needed assistance in balancing hope and confidence which enabled them to render special care to their LBW infants. Providing mothers with financial and domestic support as well as creating awareness on newborn health in communities were important. CONCLUSION To achieve family involvement, a coordinated CoC must entail key players and be culturally inclusive. It must be applied at all levels in the CoC process in a non-linear faction. This can help LBW infants to thrive and to reach their full developmental potential. IMPACT The theoretical model developed shows the importance of family involvement through family systems care for a comprehensive response in addressing needs of health professionals and families with LBW infants and bridging the fragmentations in the neonatal CoC in Ghana. Context-tailored research on family systems care in the neonatal period is necessary to achieve a quality CoC for LBW infants and their families. PATIENT OR PUBLIC CONTRIBUTION Caregivers and providers participated by granting in-depth interviews. Care providers further contributed through their feedback on preliminary findings.
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Affiliation(s)
- Christina Schuler
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Veronika Waldboth
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | | | - Faith Agbozo
- Department of Family and Community Health, University of Health and Allied Sciences, School of Public Health, Ho, Ghana
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Jaber DJ, Basheer HA, Albsoul-Younes AM, Elsalem LM, Hamadneh JM, Dweib MK, Ahmedah HT. Prevalence and predictive factors for infertility-related stress among infertile couples: A cross-sectional study from Jordan and the occupied Palestinian territories. Saudi Med J 2022; 43:1149-1156. [PMID: 36261208 PMCID: PMC9994507 DOI: 10.15537/smj.2022.43.10.20220411] [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: 07/27/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To assess the level of infertility-related stress, associated socio-economic, and demographic factors among infertile couples living in Jordan and those living under the chronic Israeli-Palestinian conflict in the occupied Palestinian territories. METHODS A cross-sectional study was carried out in a number of fertility and reproductive clinics in Jordan and occupied Palestinian territories over a period of 6 months. Trained clinical pharmacists interviewed the identified couples. RESULTS A total of 443 participants were interviewed. Three variables were significantly and independently associated with global stress scores. The need of parenthood appears higher in women than men among infertile couples in Jordan and Palestine (p=0.005). The country of origin (p<0.001) made the greatest contribution of unique variance followed by family type (p=0.035). Additionally, a significant contribution to the model was carried out by the number of clinicians who followed up on the case (p=0.013). The average total cost of treatment since the problem had been diagnosed was 2936±4529 Jordanian dinar, which may be of concern to both Jordanians and Palestinians given the limited resources available in developing nations. CONCLUSION This study shows a significant degree of stress among infertile couples. The place of origin, family structure, and presence of medical insurance had a significant impact on the infertility global stress score. This study emphasizes the necessity for specific psychological therapies that are currently lacking in public healthcare practices in both Jordan and Palestine.
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Affiliation(s)
- Deema J. Jaber
- From the Department of Clinical Pharmacy (Jaber, Basheer), Faculty of Pharmacy, Zarqa University, Zarqa, from the Department of Clinical Pharmacy (Albsoul-Younes), University of Jordan, Amman, from the Department of Pharmacology (Elsalem); from the Department of Obstetrics and Gynecology (Hamadneh), Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan, from the Department of Clinical Pharmacy (Dweib), Faculty of Pharmacy, Hebron University, Hebron, Palestine, and from the Department of Medical Laboratory Technology (Ahmedah), Faculty of Applied Medical Sciences, King Abdulaziz University, Rabigh, Kingdom of Saudi Arabia.
| | - Haneen A. Basheer
- From the Department of Clinical Pharmacy (Jaber, Basheer), Faculty of Pharmacy, Zarqa University, Zarqa, from the Department of Clinical Pharmacy (Albsoul-Younes), University of Jordan, Amman, from the Department of Pharmacology (Elsalem); from the Department of Obstetrics and Gynecology (Hamadneh), Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan, from the Department of Clinical Pharmacy (Dweib), Faculty of Pharmacy, Hebron University, Hebron, Palestine, and from the Department of Medical Laboratory Technology (Ahmedah), Faculty of Applied Medical Sciences, King Abdulaziz University, Rabigh, Kingdom of Saudi Arabia.
| | - Abla M. Albsoul-Younes
- From the Department of Clinical Pharmacy (Jaber, Basheer), Faculty of Pharmacy, Zarqa University, Zarqa, from the Department of Clinical Pharmacy (Albsoul-Younes), University of Jordan, Amman, from the Department of Pharmacology (Elsalem); from the Department of Obstetrics and Gynecology (Hamadneh), Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan, from the Department of Clinical Pharmacy (Dweib), Faculty of Pharmacy, Hebron University, Hebron, Palestine, and from the Department of Medical Laboratory Technology (Ahmedah), Faculty of Applied Medical Sciences, King Abdulaziz University, Rabigh, Kingdom of Saudi Arabia.
| | - Lina M. Elsalem
- From the Department of Clinical Pharmacy (Jaber, Basheer), Faculty of Pharmacy, Zarqa University, Zarqa, from the Department of Clinical Pharmacy (Albsoul-Younes), University of Jordan, Amman, from the Department of Pharmacology (Elsalem); from the Department of Obstetrics and Gynecology (Hamadneh), Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan, from the Department of Clinical Pharmacy (Dweib), Faculty of Pharmacy, Hebron University, Hebron, Palestine, and from the Department of Medical Laboratory Technology (Ahmedah), Faculty of Applied Medical Sciences, King Abdulaziz University, Rabigh, Kingdom of Saudi Arabia.
| | - Jehan M. Hamadneh
- From the Department of Clinical Pharmacy (Jaber, Basheer), Faculty of Pharmacy, Zarqa University, Zarqa, from the Department of Clinical Pharmacy (Albsoul-Younes), University of Jordan, Amman, from the Department of Pharmacology (Elsalem); from the Department of Obstetrics and Gynecology (Hamadneh), Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan, from the Department of Clinical Pharmacy (Dweib), Faculty of Pharmacy, Hebron University, Hebron, Palestine, and from the Department of Medical Laboratory Technology (Ahmedah), Faculty of Applied Medical Sciences, King Abdulaziz University, Rabigh, Kingdom of Saudi Arabia.
| | - Mohammad K. Dweib
- From the Department of Clinical Pharmacy (Jaber, Basheer), Faculty of Pharmacy, Zarqa University, Zarqa, from the Department of Clinical Pharmacy (Albsoul-Younes), University of Jordan, Amman, from the Department of Pharmacology (Elsalem); from the Department of Obstetrics and Gynecology (Hamadneh), Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan, from the Department of Clinical Pharmacy (Dweib), Faculty of Pharmacy, Hebron University, Hebron, Palestine, and from the Department of Medical Laboratory Technology (Ahmedah), Faculty of Applied Medical Sciences, King Abdulaziz University, Rabigh, Kingdom of Saudi Arabia.
| | - Hanadi T. Ahmedah
- From the Department of Clinical Pharmacy (Jaber, Basheer), Faculty of Pharmacy, Zarqa University, Zarqa, from the Department of Clinical Pharmacy (Albsoul-Younes), University of Jordan, Amman, from the Department of Pharmacology (Elsalem); from the Department of Obstetrics and Gynecology (Hamadneh), Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan, from the Department of Clinical Pharmacy (Dweib), Faculty of Pharmacy, Hebron University, Hebron, Palestine, and from the Department of Medical Laboratory Technology (Ahmedah), Faculty of Applied Medical Sciences, King Abdulaziz University, Rabigh, Kingdom of Saudi Arabia.
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12
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Allotey D, Flax VL, Ipadeola AF, Kwasu S, Adair LS, Valle CG, Bose S, Martin SL. Fathers' Complementary Feeding Support Strengthens the Association Between Mothers' Decision-Making Autonomy and Optimal Complementary Feeding in Nigeria. Curr Dev Nutr 2022; 6:nzac098. [PMID: 35854939 PMCID: PMC9283102 DOI: 10.1093/cdn/nzac098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Evidence about the effects of mothers' decision-making autonomy on complementary feeding is not consistent, generating hypotheses about whether complementary feeding social support moderates the relation between mothers' decision-making autonomy and the practice of complementary feeding. Objectives This study examined the moderation effect of fathers' complementary feeding support on the association of mothers' decision-making autonomy with the WHO complementary feeding indicators of minimum dietary diversity, minimum meal frequency, and minimum acceptable diet, and post hoc secondary outcomes of feeding eggs or fish the previous day. The study also examined the concordance between mothers' and fathers' perspectives of mothers' autonomy and fathers' complementary feeding support. Methods Data were from cross-sectional surveys of 495 cohabiting parents of children aged 6-23 mo enrolled in an Alive & Thrive initiative implementation research study in Kaduna State, Nigeria. Logistic regression models were used to examine moderation, and κ statistics and 95% CIs were used to assess the concordance in reported perspectives of the parents. Results The moderation results show that the simple slopes for decision-making were significant for minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day when fathers offered ≥2 complementary feeding support actions. There were no significant findings in the moderation models for minimum dietary diversity or feeding children eggs the previous day. The findings from the concordance tests show moderate to substantial agreement (ranging from 57.6% to 76.0%) between parents' perspectives of mothers' autonomy, and moderate to excellent agreement (ranging from 52.1% to 89.1%) between parents' perspectives of fathers' complementary feeding support. Conclusions In Nigeria, high levels of fathers' complementary feeding support strengthen the association of mothers' decision-making autonomy with minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day.This study was registered with clinicaltrials.gov (NCT04835662).
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Affiliation(s)
- Diana Allotey
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valerie L Flax
- RTI International, Research Triangle Park, Durham, NC, USA
| | | | - Sarah Kwasu
- Alive & Thrive, Kaduna State, Kauna, Nigeria
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carmina G Valle
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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McClintic EE, Ellis A, Ogutu EA, Caruso BA, Ventura SG, Arriola KRJ, Kowalski AJ, Linabarger M, Wodnik BK, Muga R, Freeman MC, Girard AW. Application of the Capabilities, Opportunities, Motivations, and Behavior (COM-B) Change Model to Formative Research for Child Nutrition in Western Kenya. Curr Dev Nutr 2022; 6:nzac104. [PMID: 35898312 PMCID: PMC9314706 DOI: 10.1093/cdn/nzac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background Interventions aimed at improving dietary intake and feeding practices have alone proven insufficient for combatting stunting resulting from poor nutrition and repeated infections. Objectives To support the development of an integrated water, sanitation, and hygiene (WASH) and nutrition, social, and behavior change strategy aimed at reducing stunting, formative research was conducted in 2 program sites in western Kenya. Methods Twenty-nine key informant interviews were conducted with community leaders, health workers, and project staff, and 24 focus group discussions with caregivers of children under 2 y on topics related to feeding, sanitation, and hygiene behaviors. Three frameworks informed the study design and analysis of our formative research: the Capabilities, Opportunities, and Motivations model for behavior change, which identifies what needs to change in order for behavior change interventions to be effective; the Grandmother Project's Change Through Culture Approach, which values the important role of influential household and community members in producing household health; and Starr and Fornoff's approach to Theory of Change development. Results Caregivers exhibited sufficient psychological capabilities (knowledge and skills) for many of the key maternal and infant nutrition behaviors. However, reflective motivation to perform optimal behaviors was undermined by limitations in physical and social opportunities, including limited time and competing priorities for mothers, limited accessibility and availability of diverse foods, low self-efficacy for exclusive breastfeeding, and fears of negative consequences related to specific foods and recommended practices. Conclusions Interventions that aim to improve maternal and child diets should address the underlying social, cultural, and environmental determinants that contribute to motivations and opportunities to perform recommended practices.
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Affiliation(s)
- Emilie Ewart McClintic
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna Ellis
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Emily A Ogutu
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sandra Gomez Ventura
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kimberly R Jacob Arriola
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alysse J Kowalski
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA USA
| | - Molly Linabarger
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Breanna K Wodnik
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amy Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA USA
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14
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Tomori C, Hernández-Cordero S, Busath N, Menon P, Pérez-Escamilla R. What works to protect, promote and support breastfeeding on a large scale: A review of reviews. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 3:e13344. [PMID: 35315573 PMCID: PMC9113479 DOI: 10.1111/mcn.13344] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/08/2023]
Abstract
Globally women continue to face substantial barriers to breastfeeding. The 2016 Lancet Breastfeeding Series identified key barriers and reviewed effective interventions that address them. The present study updates the evidence base since 2016 using a review of reviews approach. Searches were implemented using the Epistomenikos database. One hundred and fifteen reviews of interventions were identified and assessed for quality and risk of bias. Over half of reviews (53%) were high- or moderate quality, with the remaining low or critically low quality due to weaknesses in assessment of bias. A large portion of studies addressed high-income and upper-middle income settings, (41%), and a majority (63%) addressed health systems, followed by community and family settings (39%). Findings from reviews continue to strengthen the evidence base for effective interventions that improve breastfeeding outcomes across all levels of the social-ecological model, including supportive workplace policies; implementation of the Baby-Friendly Hospital Initiative, skin to skin care, kangaroo mother care, and cup feeding in health settings; and the importance of continuity of care and support in community and family settings, via home visits delivered by CHWs, supported by fathers', grandmothers' and community involvement. Studies disproportionately focus on health systems in high income and upper-middle income settings. There is insufficient attention to policy and structural interventions, the workplace and there is a need for rigorous assessment of multilevel interventions. Evidence from the past 5 years demonstrates the need to build on well-established knowledge to scale up breastfeeding protection, promotion and support programmes.
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Affiliation(s)
- Cecília Tomori
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA.,Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Natalie Busath
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Purnima Menon
- International Food Policy Research Institute, Delhi, India
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Rhode Island, USA
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15
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Zevallos-Roberts E, Cunningham K, Adhikari RP, Thapa B, Sear R. Beyond the mother-child dyad: Is co-residence with a grandmother associated with adolescent girls’ family planning knowledge? PLoS One 2022; 17:e0265276. [PMID: 35290416 PMCID: PMC8923440 DOI: 10.1371/journal.pone.0265276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background In South Asian countries, adolescent girls are generally embedded in multigenerational households. Nevertheless, public health research continues to focus on the nuclear family and overlook the role of grandmothers in adolescent socialization and the transfer of health information. This study compares family planning knowledge of adolescent girls in households with and without a resident grandmother. Two main types of family planning knowledge were assessed: (1) modern contraceptive knowledge and (2) healthy timing and spacing of pregnancy knowledge. Methods This study is a secondary data analysis of the 2017 Suaahara II cross-sectional survey in 16 of Nepal’s 77 districts. Family planning knowledge among 769 adolescent girls was assessed and compared between those living with a grandmother (n = 330) and those not living with a grandmother (n = 439). An analysis of the relationship between co-residence and family planning knowledge was carried out using multivariate logistic regression, adjusting for potential confounders and clustering. Additionally, we used the same method to analyze the association between grandmothers’ family planning knowledge and that of co-resident adolescents. Results The odds of correct adolescent modern family planning knowledge were 1.81 (95% CI = 1.27,2.58) times higher in households with a grandmother. The study also identified higher odds of adolescent knowledge of modern contraceptives in households where grandmothers also had correct knowledge (OR 2.00, 95%, CI = 0.97,4.11), although this association was not statistically significant at the 0.05 alpha level. There was insufficient evidence to support the association between grandmother’s co-residency and correct adolescent knowledge of the healthy timing and spacing of pregnancy. Conclusion This study provides support for expanding adolescent reproductive health to include the role of senior women in promoting and transmitting health care knowledge to younger women in the household.
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Affiliation(s)
- Emilia Zevallos-Roberts
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Kenda Cunningham
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Suaahara II, Helen Keller International, Kathmandu, Nepal
| | | | - Basant Thapa
- Suaahara II, Helen Keller International, Kathmandu, Nepal
| | - Rebecca Sear
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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16
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Lowery CM, Craig HC, Litvin K, Dickin KL, Stein M, Worku B, Martin SL. Experiences Engaging Family Members in Maternal, Child, and Adolescent Nutrition: A Survey of Global Health Professionals. Curr Dev Nutr 2022; 6:nzac003. [PMID: 35224418 PMCID: PMC8866103 DOI: 10.1093/cdn/nzac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/17/2021] [Accepted: 01/07/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Family members influence maternal, child, and adolescent nutrition and are increasingly engaged in nutrition interventions and research. However, there remain gaps in the literature related to programmatic experiences and lessons learned from engaging these key influencers in nutrition activities. OBJECTIVES This research aimed to document global health professionals' experiences engaging family members in nutrition activities, and their perceived barriers, facilitators, and recommendations for nutrition activities that engage family members. METHODS Global health and nutrition professionals were invited to complete an online survey about their experiences engaging family members in nutrition activities. The survey included 42 multiple-choice questions tabulated by frequency and 4 open-response questions, which were analyzed thematically. RESULTS More than 180 respondents (n = 183) in 49 countries with experience engaging fathers, grandmothers, and other family members in nutrition activities participated in the survey. Participants highlighted the importance of conducting formative research with all members of the family system and using participatory processes in intervention design and implementation. Respondents reported engaging family members increases support for recommended behaviors, improves program sustainability, and facilitates family and community ownership. Some respondents also shared experiences with positive and negative unintended consequences when engaging family members; for example, one-fifth of participants reported that mothers were uncomfortable with involving men in discussions. Common challenges centered on limited resources for program delivery, not involving all influential family members, and traditional gender norms. Recommendations included incorporating family members in the project design phase and ensuring sufficient project resources to engage family members throughout the project lifecycle. CONCLUSIONS Surveying global health professionals provides an opportunity to learn from their experiences and fill gaps in the peer-reviewed literature to strengthen intervention design and implementation. Community ownership and sustainability emerged as key benefits of family engagement not previously reported in the literature, but responses also highlighted potential negative unintended consequences.
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Affiliation(s)
- Caitlin M Lowery
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hope C Craig
- Master of Public Health Program, Population Medicine & Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - Kate Litvin
- USAID Advancing Nutrition, Arlington, VA, USA
| | - Katherine L Dickin
- Master of Public Health Program, Population Medicine & Diagnostic Sciences, Cornell University, Ithaca, NY, USA
- USAID Advancing Nutrition, Arlington, VA, USA
| | - Maggie Stein
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beamlak Worku
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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