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Jones RT, Spencer FI, Paris LA, Soumaïla D, Kamara N, Hiscox A, Logan JG. Evaluating barriers to reaching women with public health information in remote communities in Mali. BMC Health Serv Res 2024; 24:905. [PMID: 39113052 PMCID: PMC11308311 DOI: 10.1186/s12913-024-11277-5] [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: 03/19/2024] [Accepted: 07/03/2024] [Indexed: 08/10/2024] Open
Abstract
Telecommunications offers an alternative or supplement to community-based interventions as a means of extending healthcare services and improving health outcomes in remote settings but can fail to reach target communities and achieve the desired impact if barriers to access are not overcome. We conducted seven focus group discussions and 26 interviews with community health workers, community leaders, and female members of the public who declared that they had or had not previously accessed free audio health messages provided via a mobile platform in two rural communities of Mali, Koulikoro and Bougouni. A content analysis showed that participants accessed and trusted health information from a range of sources, including radio, telephone and television, as well as town criers, local relays and community health centres. Barriers to access faced by women included economic factors, lack of network or electricity, and social factors such as illiteracy, cultural restrictions and being unaware of mobile communication. Through analysis and interpretation of the participants' responses, we have made recommendations for future campaigns for the dissemination of health-related information for women in remote settings.
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Affiliation(s)
- Robert T Jones
- Arctech Innovation, LondonEast-UK business and technical park, Dagenham, UK
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Freya I Spencer
- Arctech Innovation, LondonEast-UK business and technical park, Dagenham, UK.
| | - Laura A Paris
- Arctech Innovation, LondonEast-UK business and technical park, Dagenham, UK
| | | | | | - Alexandra Hiscox
- Arctech Innovation, LondonEast-UK business and technical park, Dagenham, UK
| | - James G Logan
- Arctech Innovation, LondonEast-UK business and technical park, Dagenham, UK
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
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2
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Logie CH, Lys CL, Taylor SB, Lad A, Mackay KI, Hasham A, Gittings L, Malama K, Pooyak S, Monchalin R, Adamassu Z. Land-Based Retreats as a Method for Building Enabling Environments for HIV Prevention with Northern and Indigenous Adolescents in the Northwest Territories, Canada: Mixed-Methods Findings. AIDS Behav 2024:10.1007/s10461-024-04397-w. [PMID: 38900311 DOI: 10.1007/s10461-024-04397-w] [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: 05/28/2024] [Indexed: 06/21/2024]
Abstract
The Northwest Territories (NWT), Canada has high rates of sexually transmitted infections (STI) that elevate HIV acquisition risks. We conducted a mixed-methods study to explore the potential of land-based peer leader retreats (PLR) in building HIV prevention enabling environments among Northern and Indigenous youth in the NWT. PLRs are grounded in Indigenous principles and ways of knowing, acknowledging the land as a physical, spiritual, emotional, and intellectual being with the potential to facilitate (re)connection to culture, community, and self. We conducted one-week PLRs between 2016 and 2021 with adolescents aged 13-17 in the NWT. PLRs addressed HIV/STIs, safer sex, and gender equity. We conducted post-retreat focus groups (FGs) and pre/post-retreat surveys with youth participants (n = 353), and post-retreat FGs with PLR facilitators (n = 252). We applied thematic analysis to FGs and assessed pre/post-retreat changes in HIV/STI knowledge and safer sex efficacy (SSE) using paired sample t-tests. We assessed factors associated with post-test SSE and HIV/STI knowledge using multivariable linear regression. Youth participants (n = 353; mean age: 14.5, standard deviation [SD]: 1.3) were mostly Indigenous (71%) and women (66%). Participant narratives revealed PLRs enhanced technical communication (e.g., correct condom use). There were significant post-retreat HIV/STI knowledge increases; change score increases were lower for Indigenous participants. Qualitative narratives described how PLRs fostered transformative communication (e.g., sexual consent). There were significant post-retreat increases in SSE, and these were lower among men and sexually diverse (vs. heterosexual) participants. Land-based PLRs offer the potential to build technical and transformative communication to facilitate HIV prevention with youth in Canada's North.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada.
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada.
- Centre for Gender and Sexual Health Equity, Vancouver, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.
| | - Candice L Lys
- Fostering Open eXpression Among Youth (FOXY), Yellowknife, NT, Canada
- Aurora Research Institute, Yellowknife, NT, Canada
| | - Shira B Taylor
- Faculty of Environmental and Urban Change, York University, Toronto, ON, Canada
- SExT: Sex Education by Theatre, Toronto, ON, Canada
| | - Anoushka Lad
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | | | - Aryssa Hasham
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Lesley Gittings
- Faculty of Health Sciences, School of Health Studies, Western University, London, ON, Canada
| | - Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Sherri Pooyak
- Communities, Alliances, and Networks (CAAN), Fort Qu'Appelle, SK, Canada
| | - Renée Monchalin
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
- Well Living House, Li Ka Shing Knowledge Institute of Unity Health Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Zerihun Adamassu
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
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3
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Ingle EA, Shrestha P, Seth A, Lalika MS, Azie JI, Patel RC. Interventions to Vaccinate Zero-Dose Children: A Narrative Review and Synthesis. Viruses 2023; 15:2092. [PMID: 37896868 PMCID: PMC10612020 DOI: 10.3390/v15102092] [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: 08/28/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Zero-dose children, or children who have not received any routine vaccination, are a priority population for global health policy makers as these children are at high risk of mortality from vaccine-preventable illnesses. We conducted a narrative review to identify potential interventions, both within and outside of the health sector, to reach zero-dose children. We reviewed the peer-reviewed and grey literature and identified 27 relevant resources. Additionally, we interviewed six key informants to enhance the synthesis of our findings. Data were organized into three priority settings: (1) urban slums, (2) remote or rural communities, and (3) conflict settings. We found that zero-dose children in the three priority settings face differing barriers to vaccination and, therefore, require context-specific interventions, such as leveraging slum health committees for urban slums or integrating with existing humanitarian response services for conflict settings. Three predominant themes emerged for grouping the various interventions: (1) community engagement, (2) health systems' strengthening and integration, and (3) technological innovations. The barriers to reaching zero-dose children are multifaceted and nuanced to each setting, therefore, no one intervention is enough. Technological interventions especially must be coupled with community engagement and health systems' strengthening efforts. Evaluations of the suggested interventions are needed to guide scale-up, as the evidence base around these interventions is relatively small.
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Affiliation(s)
- Erin A. Ingle
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
| | - Priyanka Shrestha
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
| | - Aparna Seth
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
| | - Mathias S. Lalika
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
| | - Jacinta I. Azie
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
| | - Rena C. Patel
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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4
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Alessi EJ, Lee YG, Chikalogwe VP, Tarusarira W, Raymond H, Lynn M, Kahn S. Pilot study of an arts- and theatre-based HIV prevention intervention for men who have sex with men and transgender women migrants in South Africa: acceptability, feasibility and preliminary efficacy. HEALTH EDUCATION RESEARCH 2023; 38:392-411. [PMID: 37229526 DOI: 10.1093/her/cyad021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
Innovative approaches addressing the elevated human immunodeficiency virus (HIV) risk among men who have sex with men (MSM) or transgender women (TGW) migrants in South Africa are urgently needed. We sought to present the acceptability, feasibility and preliminary efficacy of 'Externalize and Mobilize!', a multi-session arts- and theatre-based HIV prevention group intervention for MSM and TGW migrants in South Africa. Fourteen participants-MSM (n = 7; 50%), genderqueer/nonbinary persons (n = 4; 29%) and TGW (n = 3; 21%)-in Cape Town were recruited and enrolled in the intervention and administered pre- and post-intervention assessments of HIV knowledge, HIV risk-reduction self-efficacy, stigma and resilience. The intervention, delivered over 4 days, was completed by all 14 participants. Scores on HIV knowledge and HIV risk-reduction self-efficacy were statistically significantly higher at post-intervention compared with pre-intervention. Additionally, participants responded affirmatively (i.e. 'Agree' or 'Strongly agree') on all items assessing intervention acceptability. Findings demonstrate the high acceptability, feasibility and preliminary efficacy of an arts- and theatre-based intervention for increasing HIV knowledge and HIV risk-reduction self-efficacy among MSM and TGW migrants in South Africa. This study provides further support for the use of creative and innovative interventions to address entrenched HIV disparities in South Africa.
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Affiliation(s)
- E J Alessi
- Rutgers University School of Social Work, New Brunswick, NJ 08901, USA
| | - Y G Lee
- Rutgers University School of Social Work, New Brunswick, NJ 08901, USA
| | | | - W Tarusarira
- PASSOP, Cape Town, Western Cape 8001, South Africa
| | - H Raymond
- Rutgers University School of Public Health, Piscataway, NJ 08854, USA
| | - M Lynn
- Rutgers University School of Social Work, New Brunswick, NJ 08901, USA
| | - S Kahn
- McGill University School of Social Work, Montreal, Quebec H3A 1B9, Canada
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Hosaka KRJ, Mandewo D, Mmbaga BT, Ngowi H, Dow DE, Stewart KA. "I am not alone with tears": embodying stigma and longing among youth living with perinatally acquired HIV in Tanzania through a collaborative arts-based approach. MEDICAL HUMANITIES 2023; 49:396-406. [PMID: 36526410 PMCID: PMC10827326 DOI: 10.1136/medhum-2022-012477] [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] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
It is estimated that 4 million youth aged 15-24 years live with HIV globally, 85% of whom live in sub-Saharan Africa. For youth living with perinatally acquired HIV (YPHIV), stigma is frequently linked with negative health outcomes. YPHIV face distinct HIV stigma experiences across the lifespan, particularly because of the centrality of the family context in their HIV experience and the reality that they have lived with HIV since birth. Nevertheless, our understanding and measurement of stigma remains limited. One way to improve our understanding of HIV stigma for YPHIV is through in-depth exploration of embodied narratives of HIV experience. This paper is based on fieldwork that incorporated a collaborative arts-based approach with a group of six YPHIV in Tanzania. Using artwork and a theoretical framework of embodiment, this paper phenomenologically describes their narratives of HIV experience, perceptions of stigma over time and imaginations of the future. This paper highlights that collective solidarity, habitus and participants' desire to reframe others' perceptions about them and relieve the suffering of others shape the embodied experience with HIV. Moreover, this paper argues that stigma experiences for YPHIV are temporal and have changed over time with increased age, interventions and biomedical advances. Broadly, while HIV stigma continues to exist, participants report responding to stigma with agency by creating alternative solidarities and pushing boundaries of possibility, reframing others' perceptions of them and acting on dreams for better futures.
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Affiliation(s)
- Kalei Richard James Hosaka
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
- Division of Internal Medicine-Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, United Republic of Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, United Republic of Tanzania
| | - Happyness Ngowi
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, United Republic of Tanzania
| | - Dorothy E Dow
- Duke Global Health Institute, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Kearsley Alison Stewart
- Duke Global Health Institute, Durham, North Carolina, USA
- Department of Cultural Anthropology, Duke University, Durham, North Carolina, USA
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Hartley F, Knight L, Humphries H, Trappler J, Gill K, Bekker LG, MacKenny V, Passmore JAS. "Words are too small": exploring artmaking as a tool to facilitate dialogues with young South African women about their sexual and reproductive health experiences. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1194158. [PMID: 37638128 PMCID: PMC10450937 DOI: 10.3389/frph.2023.1194158] [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: 03/26/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023] Open
Abstract
Background Adolescents and young women are at high risk for sexually transmitted infections (STIs) and unintended pregnancies. However, conversations about sexual and reproductive health (S&RH) are difficult and stigmatised. Visual art-based approaches have been a useful adjunct to language-dependent interviews, encouraging embodied memory recall. Here, we explored a novel visual art-based methodology-"Stories from the Edge"-with a cohort of young women to understand how artmaking might facilitate dialogue of how S&RH experiences influenced behaviour, to enrich dialogues captured in the individual in-depth interviews (IDIs). Methods Seven isiXhosa-speaking young women (aged 21-25 years) were recruited into a six-session art-based engagement, painting the stories of their S&RH experiences. Large format artmaking and IDIs contributed to the data set. IDIs were audio recorded, transcribed, and translated and then analysed thematically. Results Young women felt that the visual art-based methodology eased barriers to communicating experiences of S&RH-seeking behaviours, with one woman commenting that "words are too small" to capture lived experiences. Artmaking provided the opportunity to express emotional complexities of the pleasures of intimate relationships and the heartbreak of betrayal for which they had no language. Significant social relationships (family, partners, peers) influenced sexual and reproduction attitudes and practices more than healthcare facilities and staff and more distal socio-cultural attitudes/practices. These influences shifted from adolescence to adulthood-from family to peer and partners. Conclusion Young women valued using the art-based methodology, which facilitated recall and verbalising their S&RH experiences more fully than language-only research. The process outlined here could provide a creative method that builds communication skills to negotiate the needs and desires of young women with partners and staff at S&RH services.
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Affiliation(s)
- Felicity Hartley
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Medical School, Observatory, Cape Town, South Africa
- DSI-NRF CAPRISA Centre of Excellence in HIV Prevention, CAPRISA, University of Cape Town, Cape Town, South Africa
| | - Lucia Knight
- Division of Social and Behavioural Sciences, School of Public Health & Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Hilton Humphries
- Human Science Research Council, Sweetwaters, Pietermaritzburg, South Africa
- Department of Psychology, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Jill Trappler
- Private Practitioner, Orange Art Project, Cape Town, South Africa
| | - Katherine Gill
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Medical School, Observatory, Cape Town, South Africa
- Desmond Tutu Health Foundation, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Medical School, Observatory, Cape Town, South Africa
- Desmond Tutu Health Foundation, University of Cape Town, Cape Town, South Africa
| | - Virginia MacKenny
- Michaelis School of Fine Art, University of Cape Town, Cape Town, South Africa
| | - Jo-Ann S. Passmore
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Medical School, Observatory, Cape Town, South Africa
- DSI-NRF CAPRISA Centre of Excellence in HIV Prevention, CAPRISA, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, University of Cape Town, Cape Town, South Africa
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Olaoye A, Onyenankeya K. A systematic review of health communication strategies in Sub-Saharan Africa-2015-2022. Health Promot Perspect 2023; 13:10-20. [PMID: 37309431 PMCID: PMC10257569 DOI: 10.34172/hpp.2023.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/08/2023] [Indexed: 06/14/2023] Open
Abstract
Background: Health communication strategies have become critical in managing public health issues across sub-Saharan Africa. In the literature, health communication strategies have been well documented. The studies are often narrow, focusing on individual countries or specific health issues. No research documented and consolidated the health communication strategies across sub-Saharan Africa. This review attempts to catalogue prevalent health communication strategies, how the various countries have implemented these strategies and the barriers to effective health communication practices in Africa. Methods: We systematically reviewed existing literature on health communication strategies in sub-Saharan Africa to answer formulated questions. A Google search was performed in October 2022 with the keywords 'health communication', 'strategies', 'promotion,' 'education,' and 'engagement,' The data reported in this article included evidence published between 2013 and 2023. Selected documents were content analyzed, and significant sections were mapped against specific strategies/themes. These subsets of data were used to present the results and analysis. Results:The review indicates that different health communication strategies have been deployed across Africa. In some countries, specific strategies are used to tackle specific health issues, while a combination of strategies is used in others. In some countries, the strategies are unclear, and implementation is improvised, sometimes misapplied, or truncated by bureaucratic red tape and incompetence. The prevalent strategies are mainly those prescribed from outside with little input from the beneficiaries. Conclusion: The review suggests that using a holistic or multi-pronged health communication approach that is context-specific and participatory could attract more uptakes of health messages.
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Affiliation(s)
- Adewale Olaoye
- University of Fort Hare, Alice, Eastern Cape, South Africa
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Franchino-Olsen H, Christofides N, Woollett N, Fouche A, Silima M, Thurston C, Monaisa K, Meinck F. Conducting Violence Research Across Multiple Family Generations and with Young Children: Findings from a Mixed-Methods Pilot Study in South Africa. INTERNATIONAL JOURNAL ON CHILD MALTREATMENT : RESEARCH, POLICY AND PRACTICE 2023:1-27. [PMID: 37360288 PMCID: PMC9988603 DOI: 10.1007/s42448-023-00157-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Abstract
This paper presents findings from a pilot study focused on examining intergenerational violence in a three-generation sample, which included young children, in a rural area of South Africa. The aims of the pilot study were to investigate the feasibility of participant recruitment, consent, and interviewing; length and burden of the study questionnaires; appropriateness and acceptability of the measures used; and young children's (age 4-7) ability to comprehend the measures and participate meaningfully in interviews asking about violence. Data were collected for 4 months with three groups of participants, often within families (young adults, their children, and the young adults' former caregivers), using cognitive interviews, quantitative questionnaires, and qualitative in-depth interviews. All groups participated in arts-based methods and child interviews included visual and tactile aids. Pilot study findings demonstrated feasible recruitment within families for a three-generation study using comprehensive consent protocols and mandatory reporting information. Adults and young children were able to participate in the extensive interviews (2-3 h and 1 h, respectively) without significant burden. The employed measures were appropriate and acceptable to the setting, though minor revisions were made to improve comprehension of certain items. Young children were able to engage and participate meaningfully in the research, though they were not able to answer abstract reasoning items in cognitive interviews and children who were less developmentally advanced required more play- and arts-based accommodations to support their participation. Future research around sensitive topics, such as violence, appears feasible within families and including young children as participants even in resource-poor settings. Supplementary Information The online version contains supplementary material available at 10.1007/s42448-023-00157-w.
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Affiliation(s)
| | - Nicola Christofides
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nataly Woollett
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Visual Arts, University of Johannesburg, Johannesburg, South Africa
| | - Ansie Fouche
- School of Health Sciences, North-West University, Vanderbijlpark, South Africa
- Department of Social Wellbeing, United Arab Emirates University, A1 Ain, United Arab Emirates
| | - Mpho Silima
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Thurston
- School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK
| | - Kopano Monaisa
- School of Health Sciences, North-West University, Vanderbijlpark, South Africa
| | - Franziska Meinck
- School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Health Sciences, North-West University, Vanderbijlpark, South Africa
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9
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Bissett M, Gray CM, Abdulla S, Bunn C, Crampin AC, Dillip A, Gill JMR, Kaare HC, Kalima S, Kambalu E, Lwanda J, Makoye HF, Mtema O, Perry M, Strachan Z, Todd H, Mtenga SM. "I see salt everywhere": A qualitative examination of the utility of arts-based participatory workshops to study noncommunicable diseases in Tanzania and Malawi. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000927. [PMID: 36962765 PMCID: PMC10022006 DOI: 10.1371/journal.pgph.0000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/22/2022] [Indexed: 12/28/2022]
Abstract
The burden of noncommunicable diseases (NCDs) including hypertension, diabetes, and cancer, is rising in Sub-Saharan African countries like Tanzania and Malawi. This increase reflects complex interactions between diverse social, environmental, biological, and political factors. To intervene successfully, new approaches are therefore needed to understand how local knowledges and attitudes towards common NCDs influence health behaviours. This study compares the utility of using a novel arts-based participatory method and more traditional focus groups to generate new understandings of local knowledges, attitudes, and behaviours towards NCDs and their risk factors. Single-gender arts-based participatory workshops and focus group discussions were conducted with local communities in Tanzania and Malawi. Thematic analysis compared workshop and focus group transcripts for depth of content and researcher-participant hierarchies. In addition, semiotic analysis examined the contribution of photographs of workshop activities to understanding participants' experiences and beliefs about NCD risk factors. The arts-based participatory workshops produced in-depth, vivid, emotive narratives of participants' beliefs about NCDs and their impact (e.g., "… it spreads all over your body and kills you-snake's poison is similar to diabetes poison"), while the focus groups provided more basic accounts (e.g., "diabetes is a fast killer"). The workshops also empowered participants to navigate activities with autonomy, revealing their almost overwhelmingly negative beliefs about NCDs. However, enabling participants to direct the focus of workshop activities led to challenges, including the perpetuation of stigma (e.g., comparing smells associated with diabetes symptoms with sewage). Semiotic analysis of workshop photographs provided little additional insight beyond that gained from the transcripts. Arts-based participatory workshops are promising as a novel method to inform development of culturally relevant approaches to NCD prevention in Tanzania and Malawi. Future research should incorporate more structured opportunities for participant reflection during the workshops to minimise harm from any emerging stigma.
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Affiliation(s)
- Maria Bissett
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M. Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sharifa Abdulla
- Fine and Performing Arts Department, University of Malawi, Zomba, Malawi
| | - Christopher Bunn
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Amelia C. Crampin
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Angel Dillip
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Jason M. R. Gill
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Heri C. Kaare
- Taasisi ya Sanaa na Utamaduni Bagamoyo (TaSUBa), Bagamoyo, United Republic of Tanzania
| | | | | | - John Lwanda
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Herbert F. Makoye
- Taasisi ya Sanaa na Utamaduni Bagamoyo (TaSUBa), Bagamoyo, United Republic of Tanzania
| | | | - Mia Perry
- School of Education, University of Glasgow, Glasgow, United Kingdom
| | - Zoë Strachan
- School of Critical Studies, University of Glasgow, Glasgow, United Kingdom
| | - Helen Todd
- Art and Global Health Centre Africa, Zomba, Malawi
| | - Sally M. Mtenga
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
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10
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Mendelsohn JB, Fournier B, Caron-Roy S, Maina G, Strudwick G, Ojok S, Lim HJ, Sanches M, Logie CH, Sommerfeldt S, Nykiforuk C, Harrowing J, Adyanga FA, Hakiigaba JO, Bilash O. Reducing HIV-related stigma among young people attending school in Northern Uganda: study protocol for a participatory arts-based population health intervention and stepped-wedge cluster-randomized trial. Trials 2022; 23:1043. [PMID: 36564802 PMCID: PMC9782285 DOI: 10.1186/s13063-022-06643-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND HIV-related stigma negatively impacts HIV prevention, treatment, and care, particularly among children and adolescents in sub-Saharan Africa. Interventions that are culturally grounded and relevant for addressing root causes may reduce the stigma experienced by HIV-positive and HIV-affected young people. This study, to be conducted in a post-conflict, rural setting in Omoro District, Uganda, will develop and evaluate a transformative arts-based HIV-related stigma intervention rooted in local cultural knowledge to reduce stigma and improve HIV prevention and care for young people living with HIV. The intervention will be delivered to young people attending school by community Elders, with the support of teachers, through the transfer of local cultural knowledge and practices with the aim of re-establishing the important cultural and social role of Elders within a community that has suffered the loss of intergenerational transfer of cultural knowledge throughout a 25-year civil war. METHODS A formative research phase consisting of interviews with students, teachers, and Elders will inform the intervention and provide data for study objectives. Workshops will be delivered to Elders and teachers in participating schools to build capacity for arts-based, educational workshops to be conducted with students in the classroom. The intervention will be evaluated using a stepped-wedge cluster-randomized trial. Government-funded schools in Omoro District will be randomized into three blocks, each comprised of two primary and two secondary schools (n=1800 students). Schools will be randomly assigned to a crossover sequence from control to intervention condition in 8-week intervals. A process evaluation will be implemented throughout the study to evaluate pathways between intervention development, implementation, and effects. DISCUSSION This study will generate comprehensive, in-depth participatory research and evaluation data to inform an effective and sustainable protocol for implementing arts-based HIV stigma interventions for young people in school settings. Findings will have widespread implications in post-conflict settings for HIV prevention, treatment, and care. TRIAL REGISTRATION ClinicalTrials.gov NCT04946071 . Registered on 30 June 2021.
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Affiliation(s)
- Joshua B. Mendelsohn
- grid.261572.50000 0000 8592 1116College of Health Professions, Pace University, 163 William Street, New York, NY 10038 USA
| | - Bonnie Fournier
- grid.265014.40000 0000 9945 2031School of Nursing, Thompson Rivers University, 805 TRU Way, Kamloops, BC V2C 0C8 Canada
| | - Stéphanie Caron-Roy
- grid.265014.40000 0000 9945 2031School of Nursing, Thompson Rivers University, 805 TRU Way, Kamloops, BC V2C 0C8 Canada
| | - Geoffrey Maina
- grid.25152.310000 0001 2154 235XCollege of Nursing, University of Saskatchewan, Health Science Building - 1A10, Box 6, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5 Canada
| | - Gillian Strudwick
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H1 Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Santo Ojok
- Tochi Youth Resource Centre, PO Box 416, Gulu, Uganda
| | - Hyun June Lim
- grid.25152.310000 0001 2154 235XDepartment of Community Health & Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5 Canada
| | - Marcos Sanches
- grid.155956.b0000 0000 8793 5925Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8 Canada
| | - Carmen H. Logie
- grid.17063.330000 0001 2157 2938Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, Ontario M5S 1V4 Canada ,grid.417199.30000 0004 0474 0188Women’s College Hospital, 76 Grenville Ave, Toronto, ON M5S 1B2 Canada
| | - Susan Sommerfeldt
- grid.17089.370000 0001 2190 316XFaculty of Nursing, University of Alberta, 11405 - 87 Ave, Edmonton, Alberta T6G 1C9 Canada
| | - Candace Nykiforuk
- grid.17089.370000 0001 2190 316XSchool of Public Health, University of Alberta, 11405 – 87 Ave, Edmonton, Alberta T6G 1C9 Canada
| | - Jean Harrowing
- grid.47609.3c0000 0000 9471 0214Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta T1K 3M4 Canada
| | - Francis Akena Adyanga
- grid.449527.90000 0004 0534 1218Faculty of Education, Kabale University, Plot 364 Block 3 Kikungiri Hill, Kabale Municipality, Uganda
| | | | - Olenka Bilash
- grid.17089.370000 0001 2190 316XFaculty of Education, University of Alberta, 249 Education Centre – South, 11210 - 87 Ave NW, Edmonton, Alberta T6G 2G5 Canada
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Lee YJ, Rauben K, Liu C, Kim R, van der Velde N, Taylor C, Walsh A, Asasira M, Katongole I, Hatfield-King J, Blackwell S, Iheanacho T, Christ R, Ssekalo I. Evaluation of a pilot, community-led mental illness de-stigmatization theater intervention in rural uganda. BMC Psychiatry 2022; 22:794. [PMID: 36526984 PMCID: PMC9756628 DOI: 10.1186/s12888-022-04441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In rural areas of low- and middle- income countries, mental health care is often unavailable and inaccessible, and stigma is a major barrier to treatment. Destigmatization can increase treatment-seeking attitudes, community support, and acceptance of individuals suffering from mental illness. This study's primary objective was to evaluate the impact of a community-led, theater-based destigmatization campaign for mental illness conducted in the Busoga region of Eastern Uganda. METHODS One hundred residents of the Busoga region were randomly selected via cluster sampling to complete a structured questionnaire assessing mental health stigma. Four focus groups were conducted for qualitative data on mental health stigma. Common misconceptions and specific points of stigma were identified from these responses, and local village health team personnel developed and performed a culturally-adapted theatrical performance addressing these points. Changes in perceptions of mental illness were measured among 57 attendees using two measures, the Broad Acceptance Scale (designed to reflect factors that contribute to structural stigma) and Personal Acceptance Scale (designed to reflect factors that contribute to interpersonal, or public stigma), before and after the performance. RESULTS There was a significant increase in acceptance according to the Broad Acceptance Scale (p < .001) and Personal Acceptance Scale (p < .001). Qualitative responses from play attendees also indicated a decrease in stigma and an increased sense of the importance of seeking treatment for mentally ill patients. CONCLUSION This study shows community-led, theater intervention may be an effective tool for the destigmatization of mental illness in rural areas of Uganda. Larger studies are needed to further test the efficacy of this approach and potential for longer-term scalabilityand sustainability.
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Affiliation(s)
| | | | - Curtis Liu
- grid.268275.c0000 0001 2284 9898Williams College, Williamstown, USA
| | - Rebecca Kim
- grid.268275.c0000 0001 2284 9898Williams College, Williamstown, USA
| | | | - Chelsea Taylor
- grid.268275.c0000 0001 2284 9898Williams College, Williamstown, USA
| | - Alyssa Walsh
- grid.261331.40000 0001 2285 7943The Ohio State University, Columbus, USA
| | - Mildred Asasira
- grid.442658.90000 0004 4687 3018Uganda Christian University, Mukono, Uganda
| | - Ivan Katongole
- grid.442658.90000 0004 4687 3018Uganda Christian University, Mukono, Uganda
| | | | | | | | - Ryan Christ
- grid.47100.320000000419368710Yale University, New Haven, USA
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12
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Walker GR. Analysing behavioural outcome effectiveness in a musical theatre-based HIV/AIDS intervention among South African farm workers. Health Promot Int 2022; 37:6749050. [DOI: 10.1093/heapro/daac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
In 2005, an applied theatre community outreach programme was launched to address low levels of HIV/AIDS awareness among farm workers in the Cape Winelands of South Africa. In cooperation with HIV testing organizations, the Lucky, the Hero mini-musical promoted regular HIV testing, condom use and acceptance of people living with HIV until being retired in 2017. Applying principles of the health belief model to interview data collected in 2015 from former Lucky, the Hero participants, this paper examines the effectiveness of the theatre production to achieve the behavioural outcomes of (i) encouraging regular HIV testing and ongoing awareness of HIV serostatus, and (ii) reducing AIDS-related social stigma. The findings suggest that the interventions were successful in persuading participants to know their HIV status immediately following the shows, as well as potentially contributing to a reduction of community-based external social stigma. However, the interventions were unable to maintain engagement with these behavioural outcomes in the years following the performances, resulting in low adherence to regular HIV testing and inconsistent condom use. Additionally, ongoing social and structural barriers to regular HIV testing and the potential for self-imposed HIV-related stigma were highlighted during the discussions. While applied theatre can be an effective avenue for HIV awareness and prevention, the paper demonstrates the importance of creating and maintaining strong community networks to support continued engagement with health-related behavioural outcomes.
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Affiliation(s)
- Gavin Robert Walker
- Minjiang University , 200, Xiyuangong Road, Fuzhou, Fujian , People’s Republic of China
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13
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Chan VF, Belluigi D, Yong AC, Mulewa D, Poonsamy-Govender P, Graham C, Mashayo E, Graham R, Price-Sanchez C, Omar F. Co-creating an arts-based eye health education strategy in Zanzibar: process, outcomes and lessons learnt. BMJ Glob Health 2022. [PMCID: PMC9454078 DOI: 10.1136/bmjgh-2022-009317] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Published examples of health programme co-creation are scarce and we found none in the field of eye care. We described the outcomes and lessons learnt from the ZANZIbar Arts for Children’s Eyesight (ZANZI-ACE) eye health programme co-creation process. Methods We used a 2.5-day stakeholder workshop (number of participants=34) to develop the ZANZI-ACE intervention, which aimed to use music performances in eye health education to improve child eye health service uptake in Zanzibar. A Zanzibar-wide music competition was then launched to encourage local participation, followed by a judging session to select three pieces as the ZANZI-ACE eye health programme intervention materials. Results The barriers to the improved uptake of child eye health services raised by the participants were mainly cultural and social. Sensitising parents, teachers, children and community members with proper eye health knowledge was the key to addressing these barriers. The goal of sensitisation is to improve children’s vision so that they can achieve their fullest potential. Music and song ranked highest among the proposed art forms, so three music pieces were chosen as the ZANZI-ACE eye health programme intervention materials. A detailed ZANZI-ACE implementation strategy, a theory of change and key performance outcomes indicators were developed. Conclusion The co-creation process and outcomes of the ZANZI-ACE eye health programme show that engaging a diverse group of stakeholders is critical to developing locally relevant health programmes. The lessons learnt from the process will prove useful to researchers who aspire to design innovative health programmes.
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Affiliation(s)
- Ving Fai Chan
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Dina Belluigi
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
- Critical Study of Higher Education Transformation, Nelson Mandela University, Port Elizabeth, South Africa
| | - Ai Chee Yong
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Damaris Mulewa
- Partnership for Child Development, Imperial College London, London, UK
| | | | - Christine Graham
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Eden Mashayo
- Tanzanian Optometry Association, Dar es Salaam, Tanzania
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Potts A, Kolli H, Fattal L. Whose voices matter? Using participatory, feminist and anthropological approaches to centre power and positionality in research on gender-based violence in emergencies. Glob Public Health 2022; 17:2530-2546. [PMID: 35437105 DOI: 10.1080/17441692.2022.2062026] [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: 11/04/2022]
Abstract
An expansive view of 'rigorous' research is needed, particularly when studying complex health and human rights issues in settings where the imbalance of power between research participants, users and producers is heightened. This article examines how applying participatory, feminist and anthropological methods in gender-based violence research can hold researchers accountable to both acknowledging and explicitly addressing these power disparities. Applying these approaches throughout the research process takes time - to build trust and share stories rather than 'extract' data, to engage in collective meaning-making with those whose lived experiences are a form of expertise, and to consider how knowledge is represented and with whom it is shared. We provide examples and reflections from Empowered Aid, participatory action research that examines sexual exploitation and abuse in relation to humanitarian aid distributions, and tests ways for making aid safer. The study is grounded in ethnographic research by Syrian and South Sudanese women and girls living as refugees in Lebanon and Uganda, to safely take an active role in asking and answering questions about their own lives.
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Affiliation(s)
- Alina Potts
- The Global Women's Institute, The George Washington University, Washington, DC, USA
| | - Harriet Kolli
- Women's Protection and Empowerment Team, International Rescue Committee, Kampala, Uganda
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15
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Robert Walker G. Pulsing bodies and embodying pulse: musical effervescence in a South African HIV/AIDS community outreach program. Anthropol Med 2021; 29:289-304. [PMID: 34913756 DOI: 10.1080/13648470.2021.1994335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Early in South Africa's HIV/AIDS crisis, entertainment education emerged as a powerful vehicle for communicating health and social messaging to combat the epidemic. Applied theatre now accounts for the majority of arts-based HIV interventions in sub-Saharan Africa, and continues a history of theatre for social change in South Africa in particular. While much has been written about the dramaturgical and communication theories that support such interventions, the role of music, a formidable tool in the applied theatre intervention arsenal, has received considerably less attention within applied arts intervention scholarship. This paper draws from Durkheim's collective effervescence to propose a theoretical approach to music within the creation and maintenance of effervescent assemblies that is being employed by HIV/AIDS interventions to encourage participation in HIV testing. The theoretical model of musical effervescence is situated within ethnographic fieldwork conducted while accompanying an applied HIV/AIDS theatre company on a national tour of South Africa.
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Benavides JA, Caparrós C, da Silva RM, Lembo T, Tem Dia P, Hampson K, Dos Santos F. The Power of Music to Prevent and Control Emerging Infectious Diseases. Front Med (Lausanne) 2021; 8:756152. [PMID: 34901067 PMCID: PMC8655130 DOI: 10.3389/fmed.2021.756152] [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: 08/10/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
Music is a powerful approach to engage communities and disseminate information. Specifically, health campaigns employing music have been used to promote behaviors that can prevent emerging infectious diseases (EIDs). For example, hip hop artists supported campaigns to prevent acquired immunodeficiency syndrome in the 70s in the United States, while Brazilian funk promoted vaccination to mitigate the ongoing COVID-19 pandemic. Similarly, we broadcast musical messages in local languages to increase community awareness and support prevention measures in Guinea and Liberia in response to the recent Ebola outbreak in 2021. Given the potential of music to promote both individual and population-level behavioral changes to prevent transmission, there is a need to consolidate information on music-based health interventions, and on how we can measure their effectiveness. In this perspective, we provide examples of relevant initiatives, discussing challenges and solutions associated with implementing interventions based on our experience with the 2021 Ebola outbreak. We recommend four steps for a successful music-based health intervention including (1) establishing a task force, (2) compose a "catchy" song including critical preventive measures, (3) deliver the song to the target audience, and (4) evaluate the campaign effectiveness. We argue that close interactions between scientists and musicians can produce rapid musical content for disease prevention. We also identify and discuss several methodological frameworks for testing the effectiveness of such interventions. We conclude that support from public health authorities, government media departments, and international agencies, is necessary to deliver wide outreach and long-term sustainability of musical messaging toward effective EID prevention.
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Affiliation(s)
- Julio A Benavides
- Departamento de Ecología y Biodiversidad, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
- Centro de Investigación para la Sustentabilidad, Facultad de Ciencias de la Vida, Centro de Investigación Para la Sustentabilidad, Universidad Andrés Bello, Santiago, Chile
- Department of Veterinary Hygiene and Public Health, São Paulo State University, Botucatu, Brazil
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Cristina Caparrós
- Departamento de Ecología y Biodiversidad, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
- Centro de Investigación para la Sustentabilidad, Facultad de Ciencias de la Vida, Centro de Investigación Para la Sustentabilidad, Universidad Andrés Bello, Santiago, Chile
| | - Ramiro Monã da Silva
- Department of Veterinary Hygiene and Public Health, São Paulo State University, Botucatu, Brazil
| | - Tiziana Lembo
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Katie Hampson
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Hovland OJ, Hole AF, Chiduo MG, Johannessen B. Experiences from cross-cultural collaboration in health campaigns in Tanzania: a qualitative study. Arch Public Health 2021; 79:199. [PMID: 34784960 PMCID: PMC8597226 DOI: 10.1186/s13690-021-00730-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Health campaigns are an important aspect of preventive health work. They can aim to improve health literacy in rural areas where residents lack access to health information and knowledge, and to improve both local and global health through cross-cultural collaboration. In Tanga District, Tanzania, exchange students and local youths participate together with Tanga International Competence Centre (TICC) to plan and accomplish health campaigns in local communities. The aim of this study was to explore the participants’ experiences with the cross-cultural collaboration in the planning and delivery of TICC’s health campaigns. Methods This study used a focused ethnographic approach. Five weeks of fieldwork included four observations of health campaigns and nine interviews: three individual interviews with employees at TICC (all Tanzanians), two group interviews with nine Norwegian nursing students, two group interviews with five local youths enrolled in TICC’s Youth Program, one interview with a local village leader, and one interview with a local primary school teacher. The interview material was analyzed using systematic text condensation. Results All participants experienced the cross-cultural collaboration as successful. Having enough time, adapting to local conditions, and understanding the needs of the target groups were perceived as essential to the campaigns’ success. Music and role-play, which are dominant within Tanzanian culture but not common among the Norwegian students, created excitement and motivation among the audiences. The interviewees identified changes in people’s health behavior in the aftermath of the campaigns. Conclusion All participants in this study identified positive outcomes from the cross-cultural collaboration within TICC’s health campaigns. The health campaigns were considered beneficial because of the poor access to health information among residents in the local communities.
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Affiliation(s)
- Olav Johannes Hovland
- Department of Health and Nursing Sciences, Faculty of Health and Sports Sciences, University of Agder, Building I, Postbox 422, 4604, Kristiansand, Norway.
| | - Ane Falnes Hole
- Department of Health and Nursing Sciences, Faculty of Health and Sports Sciences, University of Agder, Building I, Postbox 422, 4604, Kristiansand, Norway
| | - Mercy Grace Chiduo
- National Institute for Medical Research, Tanga Medical Research Centre, P. O Box 5004, Tanga, United Republic of Tanzania
| | - Berit Johannessen
- Department of Health and Nursing Sciences, Faculty of Health and Sports Sciences, University of Agder, Building I, Postbox 422, 4604, Kristiansand, Norway
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Dressel A, Mkandawire E, Mkandawire-Valhmu L, Dyke E, Bisai C, Kantayeni H, Kako P, Ochoa-Nordstrum B. A black dog enters the home: hunger and malnutrition in Malawi. MEDICAL HUMANITIES 2021; 47:e8. [PMID: 34088800 DOI: 10.1136/medhum-2020-012130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
Hunger and inadequate nutrition are ongoing concerns in rural Malawi and are exemplified in traditional proverbs. Traditional proverbs and common expressions offer insight into commonly held truths across societies throughout sub-Saharan Africa. Strong oral traditions allow community beliefs embodied in proverbs to be passed down from generation to generation. In our qualitative study, we conducted 8 individual and 12 focus group interviews with a total of 83 participants across two districts in rural central Malawi with the aim of soliciting context-specific details on men and women's knowledge, attitudes and practices related to nutrition, gender equality and women's empowerment. Each interview began by asking participants to share common proverbs related to nutrition. Our qualitative analysis, informed by an indigenous-based theoretical framework that recognises and centres African indigenous knowledge production, yielded six themes: 'a black dog enters the home', 'don't stay with your hands hanging', 'a man is at the stomach', 'showers have fallen', 'we lack peace in our hearts' and 'the hunger season'. Traditional proverbs can provide insight into the underlying causes of hunger and malnutrition. Physicians, nurses and other allied health professionals around the world have a role to play in addressing hunger and malnutrition, which have been exacerbated by climate change. We have an ethical duty to educate ourselves and others, and change our behaviours, to mitigate the root causes of climate change, which are contributing to food insecurity and resultant poor health outcomes in countries like Malawi.
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Affiliation(s)
- Anne Dressel
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Elizabeth Mkandawire
- African Research University Alliance (ARUA) Global Challenges Research Fund (GCRF) UK Research and Innovation (UKRI), University of Pretoria, Pretoria, South Africa
| | | | - Elizabeth Dyke
- Health and Social Development, Consultant, Gatineau, Quebec, Canada
| | | | | | - Peninnah Kako
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Manana PN, Jewett S, Zikhali J, Dlamini D, Mabaso N, Mlambo Z, Ngobese R, Munhenga G. "Maskandi experience": exploring the use of a cultural song for community engagement in preparation for a pilot Sterile Insect Technique release programme for malaria vector control in KwaZulu-Natal Province, South Africa 2019. Malar J 2021; 20:204. [PMID: 33910575 PMCID: PMC8082840 DOI: 10.1186/s12936-021-03736-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/16/2021] [Indexed: 11/12/2022] Open
Abstract
Background An assessment of the Sterile Insect Technique (SIT) as a complementary malaria vector control tool, is at an advanced stage in South Africa. The technique involves the release of laboratory-reared sterilized male mosquitoes of the major malaria vector Anopheles arabiensis, raising social, ethical and regulatory concerns. Therefore, its implementation largely depends on community participation and acceptance. Against this background, it is critical that robust and effective community strategies are developed. This study describes the development of a cultural song to engage the community and increase awareness on SIT and malaria control in KwaZulu-Natal, South Africa. Methods An exploratory concurrent mixed-methods study was conducted to get opinions about the effectiveness of a cultural song developed to engage communities and increase acceptability of the SIT technology. Two self-administered surveys (expert and community) were conducted. Additionally, more in depth opinions of the song and its effectiveness in conveying the intended information were investigated through three community dialogue sessions with community members in the study area. Results A total of 40 experts and 54 community members participated in the survey. Four themes were identified in relation to the appropriateness and effectiveness of the song, with a fifth theme focused on recommendations for adaptations. Overall, the song was well received with the audience finding it entertaining and informative. Responses to unstructured questions posed after the song showed an increase in the knowledge on malaria transmission and SIT technology. In particular, the explanation that male mosquitoes do not bite allayed anxiety and fears about the SIT technology. Conclusion The song was deemed both culturally appropriate and informative in engaging community members about the SIT technology. It proved useful in promoting health messages and conveying SIT technology as a complementary malaria vector control tool. With minor adaptations, the song has potential as an area-wide community engagement tool in areas targeted for sterile male releases. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03736-9.
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Affiliation(s)
- Pinky N Manana
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases (NICD), Division of National Health Laboratory Services (NHLS), Johannesburg, South Africa. .,Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Sara Jewett
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jabulani Zikhali
- Clinton Health Access Initiative, Malaria, KwaZulu-Natal, South Africa.,Department of Health, Environmental Health, Malaria and Communicable Disease Control, KwaZulu-Natal, South Africa
| | - Dumsani Dlamini
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nondumiso Mabaso
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zothile Mlambo
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Roxanne Ngobese
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Givemore Munhenga
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases (NICD), Division of National Health Laboratory Services (NHLS), Johannesburg, South Africa.,Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Thompson RGA, Nutor JJ, Johnson JK. Communicating Awareness About COVID-19 Through Songs: An Example From Ghana. Front Public Health 2021; 8:607830. [PMID: 33537281 PMCID: PMC7847897 DOI: 10.3389/fpubh.2020.607830] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/10/2020] [Indexed: 11/18/2022] Open
Abstract
Research has shown that music can be used to educate or disseminate information about public health crises. Grounded in the edutainment approach, we explored how songs are being used to create awareness about COVID-19 in Ghana, a sub-Saharan African country. YouTube was searched, and 28 songs met the study inclusion criteria. We conducted a thematic analysis of the song lyrics. Most lyrics were in English, Ghanaian Pidgin English, Akan, Ga, or Dagbani. Reflecting the multilingual population of Ghana, half of the songs contained three languages to convey their message, and only five songs were in one language. Eight themes emerged from the analysis: public health guidelines, COVID-19 is real and not a hoax, COVID-19 is infectious, prayer as method to stop the virus, emotional reaction and disruption of "everyday" activities; verbally expelling the virus, call for unity and collective efforts, and inspiring hope. We show that songs have the potential as a method for rapidly sharing information about emerging public health crises. Even though, it is beyond the scope of this study to draw conclusions about the reception and impact of songs on awareness and knowledge, the study shows that examining song lyrics can still be useful in understanding local attitudes toward COVID-19, as well as strategies for promoting preventive behaviors. We note that additional multidimensional efforts are needed to increase awareness among the general public about the COVID-19 pandemic.
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Affiliation(s)
| | - Jerry John Nutor
- Family Health Care Nursing Department, School of Nursing, University of California, San Francisco, CA, United States
| | - Julene K. Johnson
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, CA, United States
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21
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Stewart L, McConnell BB, Darboe B, Glover V, Huma HB, Sanfilippo KRM, Cross I, Ceesay H, Ramchandani P, Cornelius V. OUP accepted manuscript. Health Promot Int 2021; 37:i18-i25. [PMID: 35171287 PMCID: PMC9162175 DOI: 10.1093/heapro/daab210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Arts in Health initiatives and interventions to support health have emerged from and been applied to mainly WEIRD (Western, Educated, Industrialized, Rich and Democratic) contexts. This overlooks the rich cultural traditions that exist across the globe, where community groups often make prolific use of participatory song and dance as a part of ceremonies, ritual and gatherings in everyday life. Here, we argue that these practices can provide a valuable starting point for the co-development of health interventions, illustrated by the CHIME project for perinatal mental health in The Gambia, which worked with local Kanyeleng groups (female fertility societies) to design and evaluate a brief intervention to support maternal mental health through social singing. Here, we use the project as a lens through which to highlight the value of co-creation, cultural embeddedness and partnership building in global health research.
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Affiliation(s)
- Lauren Stewart
- Psychology Department, Goldsmiths, University of London, London, UK
- Corresponding author. E-mail:
| | - Bonnie B McConnell
- School of Music, Australian National University, Canberra, ACT 2601, Australia
| | - Buba Darboe
- The Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, London SW7 2AZ, UK
| | - Hajara B Huma
- The Ministry of Health and Social Welfare, Banjul, The Gambia
| | | | - Ian Cross
- Centre for Music and Science, University of Cambridge, Cambridge CB3 9DP, UK
| | - Hassoum Ceesay
- The National Centre for Arts and Culture, Banjul, The Gambia
| | - Paul Ramchandani
- PEDAL Research Centre, Faculty of Education, University of Cambridge, Cambridge CB2 8PQ, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London SW7 2AZ, UK
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22
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Daniels J, Struthers H, Soler J, Ricco E, Blackmon J, Teklehaimanot S, McIntyre J, Coates T. Building self-advocacy in HIV care: the use of role-play to examine healthcare access for HIV-positive MSM in rural South Africa. Glob Health Promot 2020; 28:32-40. [PMID: 33300432 DOI: 10.1177/1757975920974008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is high HIV prevalence and low rates of viral suppression for men who have sex with men (MSM) in South Africa, with few MSM-centered interventions to address these outcomes along the HIV treatment cascade. Participatory interventions may support community building among HIV-positive MSM through which they can share approaches of self-advocacy that are contextually grounded. We conducted a pilot study to assess the use of role-plays in influencing social isolation while also updating our understanding of MSM healthcare experiences in Mpumalanga, South Africa. The study was conducted with 21 MSM leaders who were HIV-positive. There were three groups of seven participants each who created and performed role-plays based on their healthcare experiences, with a focus group discussion (FGD) conducted afterward. Audio-recordings were transcribed, translated, and analyzed using a constant comparison approach. We found that MSM described role-play as cathartic and a future HIV care educational tool for other MSM, and that they outlined points of self-advocacy during HIV care in clinics. Our study suggests that future research should utilize role-play so to integrate contextual factors influencing HIV treatment, especially in high HIV prevalence settings.
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Affiliation(s)
- Joseph Daniels
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Helen Struthers
- Anova Health Institute, Johannesburg, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Joshua Soler
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Emilio Ricco
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Joshaun Blackmon
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Senait Teklehaimanot
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - James McIntyre
- Anova Health Institute, Johannesburg, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Thomas Coates
- Center for World Health, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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23
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Alba S, Lenglet A, Verdonck K, Roth J, Patil R, Mendoza W, Juvekar S, Rumisha SF. Bridging research integrity and global health epidemiology (BRIDGE) guidelines: explanation and elaboration. BMJ Glob Health 2020; 5:e003237. [PMID: 33115860 PMCID: PMC7594201 DOI: 10.1136/bmjgh-2020-003237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022] Open
Abstract
Over the past decade, two movements have profoundly changed the environment in which global health epidemiologists work: research integrity and research fairness. Both ought to be equally nurtured by global health epidemiologists who aim to produce high quality impactful research. Yet bridging between these two aspirations can lead to practical and ethical dilemmas. In the light of these reflections we have proposed the BRIDGE guidelines for the conduct of fair global health epidemiology, targeted at stakeholders involved in the commissioning, conduct, appraisal and publication of global health research. The guidelines follow the conduct of a study chronologically from the early stages of study preparation until the dissemination and communication of findings. They can be used as a checklist by research teams, funders and other stakeholders to ensure that a study is conducted in line with both research integrity and research fairness principles. In this paper we offer a detailed explanation for each item of the BRIDGE guidelines. We have focused on practical implementation issues, making this document most of interest to those who are actually conducting the epidemiological work.
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Affiliation(s)
- Sandra Alba
- Health, KIT Royal Tropical Insititute, Amsterdam, The Netherlands
| | - Annick Lenglet
- Médecins Sans Frontières, Amsterdam, North Holland, The Netherlands
| | | | - Johanna Roth
- European and Developing Countries Clinical Trials Partnership, The Hague, South Holland, The Netherlands
| | - Rutuja Patil
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India
| | | | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India
| | - Susan F Rumisha
- National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
- Big Data Institute, University of Oxford, Oxford, Oxfordshire, UK
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