1
|
Chapman AJ, Ebido CC, Tening RN, Huang Y, Sougou NM, Kolopaking R, Diallo AH, Anggorowati R, Dial FB, Massonnié J, Firoozmand M, Niang CEHA, Harder MK. Creating culturally-informed protocols for a stunting intervention using a situated values-based approach (WeValue InSitu): a double case study in Indonesia and Senegal. BMC Public Health 2024; 24:987. [PMID: 38589810 PMCID: PMC11003100 DOI: 10.1186/s12889-024-18485-y] [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: 09/27/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
International development work involves external partners bringing expertise, resources, and management for local interventions in LMICs, but there is often a gap in understandings of relevant local shared values. There is a widespread need to better design interventions which accommodate relevant elements of local culture, as emphasised by recent discussions in global health research regarding neo-colonialism. One recent innovation is the concept of producing 'cultural protocols' to precede and guide community engagement or intervention design, but without suggestions for generating them. This study explores and demonstrates the potential of an approach taken from another field, named WeValue InSitu, to generate local culturally-informed protocols. WeValue InSitu engages stakeholder groups in meaning-making processes which 'crystallize' their envelope of local shared values, making them communicable to outsiders.Our research context is understanding and reducing child stunting, including developing interventions, carried out at the Senegal and Indonesia sites of the UKRI GCRF Action Against Stunting Hub. Each national research team involves eight health disciplines from micro-nutrition to epigenetics, and extensive collection of samples and questionnaires. Local culturally-informed protocols would be generally valuable to pre-inform engagement and intervention designs. Here we explore generating them by immediately following the group WeValue InSitu crystallization process with specialised focus group discussions exploring: what local life practices potentially have significant influence on the environments affecting child stunting, and which cultural elements do they highlight as relevant. The discussions will be framed by the shared values, and reveal linkages to them. In this study, stakeholder groups like fathers, mothers, teachers, market traders, administrators, farmers and health workers were recruited, totalling 83 participants across 20 groups. Themes found relevant for a culturally-informed protocol for locally-acceptable food interventions included: specific gender roles; social hierarchies; health service access challenges; traditional beliefs around malnutrition; and attitudes to accepting outside help. The concept of a grounded culturally-informed protocol, and the use of WeValue InSitu to generate it, has thus been demonstrated here. Future work to scope out the advantages and limitations compared to deductive culture studies, and to using other formative research methods would now be useful.
Collapse
Affiliation(s)
- Annabel J Chapman
- Values & Sustainability Research Group, School of Architecture, Technology and Engineering, University of Brighton, Brighton, UK
| | - Chike C Ebido
- Department of Environmental Science and Engineering, Fudan University, Shanghai, People's Republic of China
- Department of Zoology and Environmental Biology, University of Nigeria, Nsukka, Nigeria
| | - Rahel Neh Tening
- Department of Environmental Science and Engineering, Fudan University, Shanghai, People's Republic of China
| | - Yanyan Huang
- Department of Environmental Science and Engineering, Fudan University, Shanghai, People's Republic of China
| | - Ndèye Marème Sougou
- Preventive Medicine and Public Health, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Risatianti Kolopaking
- Faculty of Psychology, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO RECFON) Universitas Indonesia, Jakarta, Indonesia
| | - Amadou H Diallo
- International Research Laboratory (IRL 3189) Environnement santé et sociétés/CNRS/UCAD, Dakar, Senegal
| | - Rita Anggorowati
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO RECFON) Universitas Indonesia, Jakarta, Indonesia
- Department of Medical Records and Health Information, Faculty of Health and Technology, Universitas Bandung, Bandung, Indonesia
| | - Fatou B Dial
- Laboratory of Cultural Anthropology, IFAN, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Jessica Massonnié
- School of Education, Languages and Linguistics, Faculty of Humanities and Social Sciences, University of Portsmouth, Portsmouth, UK
- Department of Learning and Leadership, IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - Mahsa Firoozmand
- Values & Sustainability Research Group, School of Architecture, Technology and Engineering, University of Brighton, Brighton, UK
| | | | - Marie K Harder
- Values & Sustainability Research Group, School of Architecture, Technology and Engineering, University of Brighton, Brighton, UK.
- Department of Environmental Science and Engineering, Fudan University, Shanghai, People's Republic of China.
| |
Collapse
|
2
|
Fernandes D, Kemigisha E, Achen D, Akatukwasa C, Ruzaaza GN, Coene G, Delobelle P, Nyakato VN, Michielsen K. Process evaluation of a parent-child communication intervention for adolescent sexual and reproductive health in Uganda. BMC Public Health 2024; 24:319. [PMID: 38287314 PMCID: PMC10826092 DOI: 10.1186/s12889-023-17513-7] [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: 01/12/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Previous initiatives concerning adolescent sexual and reproductive health (SRH) education in Low-or-Middle Income Countries (LMICs) have been limited by cultural norms and misinformation perpetuated within families. Responding to the paucity of research on the implementation of SRH interventions in LMICs and limited knowledge regarding their mechanisms, this study undertakes a process evaluation of a parent-focused intervention to promote parent-adolescent communication about SRH in Uganda. METHODS This paper explores the implementation, contextual factors and mechanisms of impact of the intervention, using the Medical Research Council (MRC) guidelines for process evaluations. Implementation was evaluated through indicators of dose, fidelity and adaptations, acceptability and feasibility. The contextual factors and mechanisms of impact were evaluated to refine the intervention's causal assumptions. Data was collected during April - October 2021 in South-Western Uganda using a mixed-methods approach, including document analysis, intervention observations, interviews, focus group discussions and most significant change stories. RESULTS The acceptability of the intervention was related to its community engagement, the strong rapport with delivery agents, and individual characteristics of participants. Five contextual factors influencing implementation were highlighted; (i) cultural norms, (ii) perceptions about youth SRH, (iii) poverty, (iv) Covid-19 pandemic, and (v) prior research projects in the community. When considering the intervention's mechanisms of impact, four causal pathways were identified; (i) Awareness of SRH needs helped parents overcome stigma, (ii) Parenting skills training improved SRH communication, (iii) Group learning stimulated shared parenting, and (iv) Group learning improved co-parenting. CONCLUSION The paper presented three key learnings and corresponding recommendations for future research. Firstly, implementation success was credited to meaningful community engagement which improved acceptability and uptake. Secondly, the complex influences of contextual factors highlighted the need for contextual analysis in research studies to inform intervention design. Finally, this evaluation recognised the interplay between mechanisms of impact and suggested further research consider such combined impacts when designing intervention content.
Collapse
Affiliation(s)
- Danielle Fernandes
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium.
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium.
| | - Elizabeth Kemigisha
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- African Population and Health Research Center, P.O Box 10787-00100, Nairobi, Kenya
| | - Dorcus Achen
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium
| | - Cecilia Akatukwasa
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium
| | - Gad Ndaruhutse Ruzaaza
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Gily Coene
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium
| | - Peter Delobelle
- Department of Public Health, Vrije Universiteit Brussels, Brussels, 1090, Belgium
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Viola N Nyakato
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Kristien Michielsen
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium
- Institute for Family and Sexuality Studies, Dept. of Neurosciences, Fac. of Medicine, KU Leuven, Leuven, Belgium
| |
Collapse
|
3
|
Agblevor EA, Darko NA, Acquah PA, Addom S, Mirzoev T, Agyepong IA. "We have nice policies but…": implementation gaps in the Ghana adolescent health service policy and strategy (2016-2020). Front Public Health 2023; 11:1198150. [PMID: 38148876 PMCID: PMC10749951 DOI: 10.3389/fpubh.2023.1198150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction Although policies for adolescent health exist in Ghana, their implementation is challenging. Availability of services for adolescent sexual and reproductive health and adolescent mental health remains less than desired, with adolescent mental health being particularly neglected despite being an important contributor to poor health outcomes. This study presents an analysis of gaps in the implementation of the Ghana Adolescent Health Service Policy and Strategy (2016-2020), including how and why the context influenced the observed implementation gaps. Methods Data for this study is drawn from 17 in-depth interviews with purposefully identified key stakeholders in adolescent mental, sexual, and reproductive health across the national and subnational levels; four focus group discussions (FGDs) with district health management teams; and 11 FGDs with adolescents in and out of schools in four selected districts in the Greater Accra region. Data were analyzed using both inductive and deductive approaches. The deductive analysis drew on Leichter's conceptualization of context as structural, cultural, situational, and environmental factors. Results Of the 23 planned strategies and programs for implementing the policy, 13 (57%) were partially implemented, 6 (26%) were not implemented at all, and only 4 (17%) were fully implemented. Multiple contextual factors constrained the policy implementation and contributed to the majority of strategies not being implemented or partially implemented. These factors included a lack of financial resources for implementation at all levels of the health system and the related high dependence on external funding for policy implementation. Service delivery for adolescent mental health, and adolescent sexual and reproductive health, appeared to be disconnected from the delivery of other health services, which resulted in weak or low cohesion with other interventions within the health system. Discussion Bottom-up approaches that engage closely with adolescent perspectives and consider structural and cultural contexts are essential for effective policy implementation. It is also important to apply systemic and multi-sectoral approaches that avoid fragmentation and synergistically integrate policy interventions.
Collapse
Affiliation(s)
- Emelia Afi Agblevor
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Priscilla Ama Acquah
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Selasie Addom
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Tolib Mirzoev
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Irene Akua Agyepong
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| |
Collapse
|
4
|
Mwakisole AH, Lambert VJ, Nzali A, Aristide C, Laizer E, Cordeiro AA, Gregory L, Mwakisole N, Nicol CEW, Paul N, Kalluvya SE, Kihunrwa A, Downs DJ, Wamoyi J, Downs JA, Lee MH. Partnerships with religious leaders to promote family planning in rural Tanzania: an open-label, cluster randomised trial. Lancet Glob Health 2023; 11:e1943-e1954. [PMID: 37973342 DOI: 10.1016/s2214-109x(23)00453-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Family planning benefits maternal-child health, education, and economic wellbeing. Despite global efforts, an unsatisfied demand for family planning persists in sub-Saharan Africa. Based on previous successful partnerships, the aim of this study was to determine whether an educational intervention for religious leaders would increase community knowledge, demand for, and ultimately uptake of family planning. METHODS In this open-label, cluster randomised trial in Tanzania, 24 communities were randomised (1:1) to intervention or control arm. Communities, defined as the catchment area of a single public health facility, were eligible if they were at least 15 km from Mwanza City and had not previously participated in a health intervention for religious leaders. Random allocations were determined by coin toss and were not revealed to clinicians at health facilities in intervention and control communities, nor to the data entry team; however, due to the nature of the intervention, masking of religious leaders in the intervention communities was not possible. All Christian religious institutions were invited to send four leaders to an educational intervention that incorporated cultural, theological, and medical teaching about family planning. The primary outcome was contraceptive uptake at the community health facility during the year post intervention versus the year before the intervention. This trial was registered at clinicaltrials.gov, NCT03594305. FINDINGS 75 communities in three districts were assessed for eligibility. 19 communities were excluded and 56 were eligible for study inclusion and were placed in random order to be invited to participate. The first 24 communities that were invited agreed to participate and were randomly assigned to receive the educational intervention either during the trial or after trial completion. Between July 10, 2018 and Dec 11, 2021, we provided the intervention in 12 communities and compared contraceptive uptake with 12 control communities. All were followed up for 12 months. In intervention communities, contraceptive uptake increased by a factor of 1·47 (95% CI 1·41-1·53) in the post-intervention (prospective) versus pre-intervention (historical) year (geometric mean of contraceptive uptake, 466 in the prospective year vs 312 in the historical year), versus 1·24 (95% CI 1·20-1·29) in control communities (geometric mean, 521 in the prospective year vs 429 in the historical year). The rate of change in contraceptive uptake was greater in intervention communities (between-group ratio of geometric mean ratios over time, 1·19 [95% CI 1·12-1·25]; p<0·0001). The COVID-19 pandemic was associated with decreased contraceptive uptake (geometric mean, 365 during the pandemic in communities that had the majority of their prospective 12-month data collection periods occur after March 16, 2020, vs 494 before the pandemic; geometric mean ratio, 0·72 [95% CI 0·57-0·90]; p=0·0040). INTERPRETATION This intervention offers a scalable model, leveraging influence of trusted religious leaders to increase knowledge and uptake of family planning. New strategies such as this could help to overcome setbacks that occurred during the COVID-19 pandemic. FUNDING John Templeton Foundation and Weill Cornell Medicine Dean's Diversity and Healthcare Disparity Award. TRANSLATION For the Kiswahili translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
| | | | - Aneth Nzali
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | | | | | | | | | | | - Cecilia E W Nicol
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ndalloh Paul
- Department of Emergency Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | | | - Albert Kihunrwa
- Department of Obstetrics and Gynaecology, Bugando Medical Centre, Mwanza, Tanzania
| | - David J Downs
- Faculty of Theology and Religion, University of Oxford, Oxford, UK
| | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Jennifer A Downs
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.
| | - Myung Hee Lee
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
5
|
Mbengo F, Adama E, Towell-Barnard A, Zgambo M. "A spade was called a spade … ": Youth and intervention implementers' perceptions of a resilience-based HIV-prevention intervention for youth in South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:145-156. [PMID: 37539638 DOI: 10.2989/16085906.2023.2233496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/01/2023] [Indexed: 08/05/2023]
Abstract
The youth (15-24 years old) in South Africa remain at high risk of HIV infection despite varied efforts to control the disease. An understanding of the perspectives of relevant stakeholders of HIV-prevention interventions targeting the youth is important to guide research, policy and practice aimed at improving these interventions. This study explores youth and intervention implementers' perceptions of a resilience-based HIV-prevention intervention (You Only Live Once) aimed at reducing risky sexual behaviours among the youth in South Africa. Semi-structured interviews were conducted with 10 young people who participated in the intervention, and four intervention implementers at a not-for-profit organisation in Maluti-a-Phofung Local Municipality, South Africa. Data were analysed using thematic analysis. Three main themes emerged from the data: (1) Acceptability and impact of the intervention; (2) Factors influencing intervention implementation; and (3) Recommendations to improve intervention implementation. These findings provide insights into the acceptability, impact, barriers and facilitators of resilience-based HIV-prevention interventions for the youth in South Africa and similar contexts, and how implementation of these interventions could be enhanced. The findings can help researchers, policy makers and health care practitioners in the field of HIV prevention to improve interventions targeting young people.
Collapse
Affiliation(s)
- Fungai Mbengo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Esther Adama
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | | | - Maggie Zgambo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| |
Collapse
|
6
|
Li T, Ke X, Li J. Public attitudes towards dialects: Evidence from 31 Chinese provinces. PLoS One 2023; 18:e0292852. [PMID: 37824597 PMCID: PMC10569595 DOI: 10.1371/journal.pone.0292852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/01/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Dialect Attitude is conceptualized as an individual's cognitive and affective evaluation of a dialect and its speakers. In the contemporary China, dialect is suffering from significant stigmatization, resulting in social inequalities, which hinder sustainable development. This study aims to reveal the Chinese public attitudes towards dialects, and clarify the potential determinants related to heterogeneous attitudes at a macro level. METHODS We combine the crawler technology and sentiment analysis to conduct a provincial cross-sectional study. We collect 1,650,480 microblogs about public attitudes towards dialects from Microblog across 31 specific Chinese provinces. Spatial regression models are utilized to clarify the influence of macro-level determinants on differences in public attitudes. RESULTS The present study reveals that: (1) The Chinese public generally holds positive attitudes towards dialects, with significant variation between provinces. (2) Political Resource (β = 0.076, SD = 0.036, P<0.05), Economic Development (β = 0.047, SD = 0.022, P<0.05), and Cultural Resource (β = 0.054, SD = 0.021, P<0.05) promote public positive attitudes towards dialects. (3) Political Resource and Culture Resource influence more significant in the relatively advantaged regions, and Economic Development poses a higher influence in the relatively disadvantaged regions. CONCLUSIONS Basing on the combination of crawler technology and sentiment analysis, the present study develops the most comprehensive database which takes 1,650,480 dialects-related microblogs from 31 Chinese provinces, and describes the following scenario: (1) Overall, the Chinese public shares a relatively positive attitude towards dialects with significant variations among different provinces, (2) Political Resource, Economic Development and Culture Resource pose positive effects on Chinese public attitudes towards dialects and (3) Political Resource and Culture Resource influence more significant in the relatively disadvantaged regions, and Economic Development poses a higher influence in the relatively advantaged regions.
Collapse
Affiliation(s)
- Tianxin Li
- Department of Literature, Shaanxi Normal University, Xi’an, Shaanxi, China
| | - Xigang Ke
- Department of Literature, Shaanxi Normal University, Xi’an, Shaanxi, China
| | - Jin Li
- International School of Chinese Studies, Shaanxi Normal University, Xi’an, Shaanxi, China
| |
Collapse
|
7
|
Msemwa B, Mushi MF, Kidenya B, Okamo B, Keenan K, Sabiiti W, Miyaye DN, Konje ET, Silago V, Mirambo MM, Mwanga JR, Gillespie S, Maldonado-Barragan A, Sandeman A, Holden M, Mshana SE. Urogenital pathogens in urine samples of clinically diagnosed urinary tract infected patients in Tanzania: A laboratory based cross-sectional study. IJID REGIONS 2023; 7:170-175. [PMID: 37069922 PMCID: PMC10105482 DOI: 10.1016/j.ijregi.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
Background Urogenital pathogens such as Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis have been reported to cause pyuria, however they are not routinely cultured from urine samples of patients clinically diagnosed to have urinary tract infections (UTI). In this study, pathogen specific PCR was done to identify the urogenital pathogens in the urine samples among clinically diagnosed UTI patients with negative routine urine culture. Methods A cross-sectional study was conducted involving 227 archived urine samples from clinically diagnosed UTI patients with positive leucocyte esterase but negative urine culture results. The urogenital pathogens were detected using pathogen specific singleplex PCR. Data were cleaned and analyzed using STATA version 15. Results The median age of patients was 31[IQR 23 - 51] years and the majority (174, 76.7%) were females. Two thirds of patients had history of antibiotic use two weeks prior to recruitment (154, 67.8%). A total of 62(27.3%) urine samples were positive for at least one urogenital pathogen. Of 62 positive samples, 9 had two urogenital pathogens and 1 had three urogenital pathogens. The most predominant urogenital pathogen detected was Neisseria gonorrhoeae 25(34.2%) and Trichomonas vaginalis 24(32.9%). Being female (aOR 2.4; 95% CI: 1.04 - 5.49; p-value 0.039) and having history of using antibiotics in the past two weeks (aOR 1.9; 95%CI: 1.04 - 3.60; p-value 0.036) was independently associated with the presence of urogenital pathogens. Conclusion More than a quarter of female patients with clinical symptoms of UTI and routine urine culture negative results were infected with urogenital pathogens mainly Neisseria gonorrhoeae and Trichomonas vaginalis. Further research with a larger sample set in a range of settings is required to understand the implications of these finding generally.
Collapse
Affiliation(s)
- Betrand Msemwa
- Department of Medical Laboratory Sciences, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Martha F Mushi
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Benson Kidenya
- Department of Biochemistry and Molecular biology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Bernard Okamo
- Department of Biochemistry and Molecular biology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Katherine Keenan
- Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Wilber Sabiiti
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Donald N Miyaye
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462 Mwanza
| | - Eveline T Konje
- Department of Epidemiology and Biostatistics, and Behavioral Sciences, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Vitus Silago
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Joseph R Mwanga
- School of Public Health, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | | | | | - Alison Sandeman
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Mathew Holden
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| |
Collapse
|
8
|
Broderick K, Aristide C, Bullington BW, Mwanga-Amumpaire J, Downs JA, Sundararajan R. Stigma of infidelity associated with condom use explains low rates of condom uptake: qualitative data from Uganda and Tanzania. Reprod Health 2023; 20:12. [PMID: 36631809 PMCID: PMC9832812 DOI: 10.1186/s12978-023-01563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
Despite widespread messaging supporting male (external) condom use to prevent HIV in endemic settings, utilization of condoms is low across sub-Saharan Africa. A thorough understanding of barriers to condom use as a form of HIV prevention is necessary to reduce HIV transmission. Here, we present qualitative data from rural eastern Africa to explain low utilization of condoms among heterosexual adults. Focus groups and interviews were conducted in Tanzania and Uganda between 2016 and 2019. A content analysis approach was used to identify attitudes about condoms and factors related to use/non-use. We found that strategies such as abstinence and being faithful to one's partner are perceived as ideal but rarely achievable methods of HIV prevention. Condoms are used in the setting of "failure" to abstain or be faithful and are therefore stigmatized as markers of infidelity. As such, use within cohabiting and long-term relationships is low. Our data suggest that negative perceptions of condoms may stem from persistent effects of the formerly applied "ABC" HIV prevention approach, a public health messaging strategy that described A-abstinence, B-be faithful, and C-use a condom as tiered prevention tools. Condom uptake could increase if HIV prevention messaging acknowledges existing stigma and reframes condom use for proactive health prevention. These studies were approved by Weill Cornell Medicine (Protocols 1803019105 and 1604017171), Mbarara University of Science and Technology (Protocol 16/0117), Uganda National Council of Science and Technology (Protocol SS-4338), and the Tanzania National Institute for Medical Research (Protocol NIMR/HQ/R.8c/Vol.I/1330).
Collapse
Affiliation(s)
- Kathryn Broderick
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Christine Aristide
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Brooke W Bullington
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
- Burlington Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Jennifer A Downs
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA
- Weill Cornell Medicine, Center for Global Health, New York, USA
- Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Radhika Sundararajan
- Weill Cornell Medical College, 525 East 68th Street, Room M130, New York, NY, 10065, USA.
- Weill Cornell Medicine, Center for Global Health, New York, USA.
| |
Collapse
|
9
|
Mbengo F, Adama E, Towell-Barnard A, Bhana A, Zgambo M. Barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide: a systematic review. BMC Infect Dis 2022; 22:679. [PMID: 35941562 PMCID: PMC9361597 DOI: 10.1186/s12879-022-07649-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions aimed at reducing risky sexual behavior are considered an important strategy for averting Human Immunodeficiency Virus (HIV) infection among youth (15-24 years) who continue to be at risk of the disease. Enhancing intervention success requires a comprehensive understanding of the barriers and facilitators to interventions targeting youth. However, there is lack of a systematic review of both quantitative and qualitative studies to comprehensively identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide. This review aimed to identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth globally based on original peer-reviewed studies published in the last decade. METHODS The Joanna Briggs Institute approach for mixed methods systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to guide this review. Nine electronic databases, Joint United Nations Programme on HIV/AIDS and World Health Organization websites, and reference lists of included studies and systematic reviews on barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth were searched for eligible articles. Studies that met the inclusion criteria underwent quality appraisal and data extraction. Findings were analyzed using thematic synthesis and underpinned by Nilsen, 2015's Determinant Framework. RESULTS Overall 13 studies comprising of eight qualitative studies, four quantitative studies and one mixed methods study were included in the review. Several barriers and facilitators across the five Determinant Framework domains were identified. Most of the barriers fell under the characteristics of the context domain (e.g., gender-biased norms). The next important group of barriers emerged within the characteristics of the end users domain (e.g., fear of relationship breakdown). In terms of facilitators, the majority fell under the characteristics of the strategy of facilitating implementation domain (e.g., implementation of intervention with fidelity) and characteristics of the end users domain (e.g., fear of pregnancy or sexually transmitted infections). The next common set of facilitators appeared within the characteristics of the context domain (e.g., family support). CONCLUSION This review identified several multi-level barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth. Multi-level and combination approaches are needed to address these factors and enhance intervention success.
Collapse
Affiliation(s)
- Fungai Mbengo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia.
| | - Esther Adama
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
| | - Arvin Bhana
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Maggie Zgambo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
| |
Collapse
|
10
|
Gillespie B, Balen J, Allen H, Soma-Pillay P, Anumba D. Shifting Social Norms and Adolescent Girls' Access to Sexual and Reproductive Health Services and Information in a South African Township. QUALITATIVE HEALTH RESEARCH 2022; 32:1014-1026. [PMID: 35592927 PMCID: PMC9189597 DOI: 10.1177/10497323221089880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite policy on adolescent sexual and reproductive health (SRH) services and education, teen pregnancies remain common in South Africa. Social norms and cultural resistance are a well-documented challenge for SRH program implementation in South Africa, and beyond. To gain insight on the complex picture of adolescents' access to SRH information and services in a peri-urban township, we explored this topic from a diversity of perspectives, carrying out 86 interviews to capture perceptions of adolescents, their parents, community members, and health professionals. Our research shows that despite the taboo nature of the issue of adolescent SRH, individual positions on adolescent access to SRH services and information are shifting and diverse, and are influenced by factors other than cultural norms. This research serves as a reminder to avoid simplistic reference to "culture" as a way of explaining health-related behaviors and people's responses to health challenges.
Collapse
Affiliation(s)
- Bronwen Gillespie
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Julie Balen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Haddijatou Allen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Priya Soma-Pillay
- Department of Obstetrics and Gynaecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Dilly Anumba
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| |
Collapse
|
11
|
De Veauuse Brown NF, Annor FB, Swahn MH, Self-Brown SR. Sexual Violence Experience Among Nigerian Girls and Young Women: What Are the Roles of Early Sexual Debut, Multiple Sex Partnerships, and Traditional Gender Role Beliefs? JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP2747-NP2767. [PMID: 32723138 PMCID: PMC8216592 DOI: 10.1177/0886260520945676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In Nigeria, one in four females has experienced some form of sexual abuse. Therefore, it is imperative to examine risk factors associated with sexual violence victimization of Nigerian girls and young women to identify targets for prevention and help stakeholders prioritize response efforts. The present article focuses on secondary data analyses of 1,766 females, aged 13 to 24, interviewed in the population-based 2014 Nigeria Violence Against Children Survey. The outcome of interest is lifetime sexual violence (LSV). Several potential predictors were explored: beliefs about gender roles related to sex, early sexual debut (aged <16 years), and multiple sex partners in the past 12 months. Other risk factors assessed were age, ethnicity, religion, education, marital status, and employment. Logistic regression analyses estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results revealed that females who endorsed beliefs about patriarchal sexual decision-making (AOR = 2.1, 95% CI = [1.28, 3.32]) or ever attended school (AOR = 2.4, 95% CI = [1.35, 4.34]) were more likely to report experiencing LSV. Prevention programs that target traditional norm beliefs about gender and sexuality have the potential to influence sexual violence in Nigeria. In addition, school attendance may expose females to potential perpetrators. Thus, to prevent sexual violence of girls who attend school, implementing safety measures may be beneficial for protecting them while in and traveling to/from school.
Collapse
Affiliation(s)
| | - Francis B Annor
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | |
Collapse
|
12
|
Tomberge VMJ, Shrestha A, Meierhofer R, Inauen J. Understanding safe water-carrying practices during pregnancy and postpartum: A mixed-methods study in Nepal. Appl Psychol Health Well Being 2021; 14:691-711. [PMID: 34862740 PMCID: PMC9300039 DOI: 10.1111/aphw.12325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
Daily carrying of heavy loads of domestic water, especially during pregnancy and postpartum, bears a threat to maternal health in low‐income countries. Using an extended health action process approach (HAPA), we examined women's reasons for and psychosocial determinants of safe water‐carrying during pregnancy and postpartum. In a mixed‐methods study, trained local interviewers conducted 1001 quantitative interviews with women of reproductive age (n = 921 analyzed) and 21 qualitative interviews with women of reproductive age, in‐laws, and spouses in rural Nepal. We analyzed the quantitative data with generalized estimating equations to model the HAPA‐based psychosocial determinants of avoiding water‐carrying during pregnancy and postpartum. Subjective perspectives were investigated with thematic analysis. Outcome expectancies (B = 0.24), self‐efficacy (B = 0.20), and injunctive norms (B = 0.23) were significantly associated with the intention to avoid water‐carrying. Self‐efficacy (B = 0.36) and instrumental support (B = 0.05) are related to behavior (all p < 0.05). Women explained water‐carrying during pregnancy by a lack of family support, a shift of health decision‐making power to in‐laws, and low behavioral control. Overall, the necessity of water, family decision‐making structures, and low support make it difficult for women to discontinue water‐carrying. Additionally to infrastructural improvements, behavioral interventions may increase women's self‐efficacy for safe water‐carrying (e.g. reducing weight) and social support.
Collapse
Affiliation(s)
- Vica Marie Jelena Tomberge
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Akina Shrestha
- School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Regula Meierhofer
- Department of Sanitation, Water and Solid Waste for Development (SANDEC), Eawag - Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| |
Collapse
|
13
|
Mcharo RD, Mayaud P, Msuya SE. Where and how do young people like to get their sexual and reproductive health (SRH) information? Experiences from students in higher learning institutions in Mbeya, Tanzania: a cross-sectional study. BMC Public Health 2021; 21:1683. [PMID: 34530796 PMCID: PMC8444543 DOI: 10.1186/s12889-021-11728-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 09/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background Sexual and reproductive health (SRH) among young adults in low- and middle-income countries (LMIC) is still a major public health challenge. Early school-based sexuality education programs and sexual health information sharing between teachers, parents and young people have been considered protective against the sexual health risks to which young people are exposed. There is, however, limited information on the preferred choices of “where”, “how” and “from whom” young people would like to receive SRH information. We aimed to describe the experience and preferences of young people regarding their SRH education and learning and in particular communication with their parents/guardians. Methods We conducted a cross-sectional study among randomly selected students aged 18-24y attending Higher Learning Institutions (HLIs) in Mbeya, Tanzania. We used a self-administered questionnaire to collect information on SRH education received, ability to discuss SRH matters with a parent/guardian and SRH information gaps encountered during their early sexual experience. Results We enrolled 504 students from 5 HLIs, of whom 446 (88.5%) reported to be sexually active, with mean age at sexual debut of 18.4y (SD 2.2). About 61% (307/504) of the participants found it difficult to discuss or did not discuss SRH matters with their parent/guardian while growing up. Learning about SRH matters was reported from peers (30.2%) and teacher-led school curriculum (22.7%). There was a strong gender-biased preference on SRH matters’ discussions, female and male participants preferred discussions with adults of their respective sex. Peers (18.2%), media (16.2%) and schools (14.2%) were described as the preferred sources of SRH information. On recalling their first sexual experience, sexually-initiated participants felt they needed to know more about sexual feelings, emotions and relationships (28.8%), safer sex (13.5%), how to be able to say ‘No’ (10.7%) and how to use a condom correctly (10.2%). Conclusion Young people have a gender preference when it comes to learning about SRH matters from their parents; however, such conversations seldom occur. Community health education should focus on building skills of parents on parent-child communication on SRH matters so as to empower them to confidently initiate and convey accurate SRH information. Comprehensive SRH education and skills building need to be strengthened in the current school SRH curriculum in order to meet the demand and needs of students and increase the competence of teachers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11728-2.
Collapse
Affiliation(s)
- Ruby Doryn Mcharo
- National Institute for Medical Research-Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania. .,Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.
| | - Philippe Mayaud
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Sia E Msuya
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.,Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.,Community Health Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| |
Collapse
|
14
|
HIV testing and ethnicity among adolescent girls and young women aged 15-24 years in Ghana: what really matters? J Biosoc Sci 2021; 54:812-828. [PMID: 34511162 DOI: 10.1017/s0021932021000456] [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: 11/06/2022]
Abstract
Despite the high prevalence of HIV among adolescent girls and young women (AGYW) aged 15-24 years in Ghana, HIV testing remains low among this population. The objective of this study was to examine the relationship between ethnicity and HIV testing among AGYW in Ghana. The 2014 Ghana Demographic and Health Survey data were used and analyses were restricted to 3325 female participants aged 15-24 years. Chi-squared tests and a logistic regression model were used to assess the association between ethnicity and HIV testing. Furthermore, the PEN-3 cultural model informed the conceptual framework that explained the relationship between ethnicity and HIV testing behaviour. Results from the bivariate analysis showed an association between ethnicity and HIV testing among AGYW (p<0.05). However, when controlling for other behavioural and socioeconomic determinants of HIV testing in the logistic regression, there was no association between ethnicity and HIV testing. The significant predictors of HIV testing were marital status, having multiple sexual partners, and condom use. The AGYW who were married (adjusted odds ratio [aOR] = 4.56, CI: 3.46-6.08) or previously married (aOR = 4.30, CI: 2.00-9.23) were more likely to test for HIV compared with those who were never married. Having multiple sexual partners (aOR = 0.41, CI: 0.20-0.85) and condom use (aOR = 0.56, CI: 0.38-0.84) were associated with lower odds of HIV testing. The results provide evidence that ethnicity is not associated with HIV testing among AGYW in Ghana, as the bivariate association was attenuated when other behavioural and socioeconomic determinants of HIV testing were accounted for. These findings highlight the importance of considering individual-level factors, community-level factors, and other socio-cultural factors as they really matter in the development of HIV prevention programmes for adolescent girls and young women in Ghana.
Collapse
|
15
|
Using Andersen's Behavioral Model of Health Care Utilization to Assess Contraceptive Use among Sexually Active Perinatally HIV-Infected Adolescents in Uganda. Int J Reprod Med 2020; 2020:8016483. [PMID: 33062664 PMCID: PMC7542496 DOI: 10.1155/2020/8016483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Contraceptive practices of perinatally HIV-infected adolescents (PHIAs) have implications related to pregnancy prevention, risks of HIV heterosexual transmission, reinfection, and vertical transmission. The study assessed contraceptive use among sexually active PHIAs in Uganda. Methods Mixed methods consisting of a survey and in-depth interviews were employed among 213 sexually active PHIAs who were attending antiretroviral therapy (ART) clinics. The study was guided by Andersen's Behavioral Model of Health Service Use as a theoretical framework to identify factors that influence contraceptive use. These factors include health care factors, personal characteristics, enabling factors, and needs. The outcome was contraceptive use. Multivariable logistic regression was used to establish determinants of contraceptive use. Qualitative data were analyzed by thematic analysis. Results Most PHIAs were female (67.6%); the mean (SD) and median (IQR) age was 17.5 (±1.4) and 18 (17-19) years. The mean age of sexual debut and at marriage were 15 (±1.7) and 17 (±1.1), respectively. Condoms were the most known method of family planning (indicated by 55.4%). Only 16.9% of the participants knew about dual protection (condom use for FP as well as HIV/STI prevention). Of the PHIAs, 43.6% had ever used modern contraception and 56.9% of the females had ever been pregnant. The odds of contraceptive ever-use were significantly higher among adolescents aged 17-19 years (OR 5.1, 95% CI: 2.1-13.3) compared to those aged 10-16 years, those in school (OR 1.8, 95% CI: 1.07-3.2) compared to those out of school, and those with perceived need to use FP (OR 2.0, 95% CI: 1.1-3.9) compared to their counterparts. The odds of contraceptive used were lower among females (OR 0.13, 95% CI: 0.06-0.28) compared to males. From the in-depth interviews, the attitude of health workers, availability of health workers, having a friend using family planning, and waiting time were viewed to affect contraceptive use. Conclusion Contraceptive use among sexually active perinatally HIV-infected adolescents was (43.6%). However, out of those who used family planning majority were using short-term methods. The unmet need for family planning was high (47%) with high reports of pregnancy (56.9%). The factors associated with contraceptive use included education, age, sex (predisposing factors), and perceived need of family planning (need factors). Other factors that could affect contraceptive use from qualitative analysis included attitude of health workers, availability of health workers, having a friend using family planning (predisposing factors), and waiting time (health system factors). HIV care for adolescents should be promoted using SRH approach. There is a need to provide training for all providers to cater for SRH services. We should continue to provide youth-responsive adolescent sexual and reproductive health services across all ART facilities and build a supportive environment and continue to integrate SRH services into HIV care.
Collapse
|
16
|
Knight L, Allen E, Mirembe A, Nakuti J, Namy S, Child JC, Sturgess J, Kyegombe N, Walakira EJ, Elbourne D, Naker D, Devries KM. Implementation of the Good School Toolkit in Uganda: a quantitative process evaluation of a successful violence prevention program. BMC Public Health 2018; 18:608. [PMID: 29743105 PMCID: PMC5941678 DOI: 10.1186/s12889-018-5462-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Good School Toolkit, a complex behavioural intervention designed by Raising Voices a Ugandan NGO, reduced past week physical violence from school staff to primary students by an average of 42% in a recent randomised controlled trial. This process evaluation quantitatively examines what was implemented across the twenty-one intervention schools, variations in school prevalence of violence after the intervention, factors that influence exposure to the intervention and factors associated with students' experience of physical violence from staff at study endline. METHODS Implementation measures were captured prospectively in the twenty-one intervention schools over four school terms from 2012 to 2014 and Toolkit exposure captured in the student (n = 1921) and staff (n = 286) endline cross-sectional surveys in 2014. Implementation measures and the prevalence of violence are summarised across schools and are assessed for correlation using Spearman's Rank Correlation Coefficient. Regression models are used to explore individual factors associated with Toolkit exposure and with physical violence at endline. RESULTS School prevalence of past week physical violence from staff against students ranged from 7% to 65% across schools at endline. Schools with higher mean levels of teacher Toolkit exposure had larger decreases in violence during the study. Students in schools categorised as implementing a 'low' number of program school-led activities reported less exposure to the Toolkit. Higher student Toolkit exposure was associated with decreased odds of experiencing physical violence from staff (OR: 0.76, 95%CI: 0.67-0.86, p-value< 0.001). Girls, students reporting poorer mental health and students in a lower grade were less exposed to the toolkit. After the intervention, and when adjusting for individual Toolkit exposure, some students remained at increased risk of experiencing violence from staff, including, girls, students reporting poorer mental health, students who experienced other violence and those reporting difficulty with self-care. CONCLUSIONS Our results suggest that increasing students and teachers exposure to the Good School Toolkit within schools has the potential to bring about further reductions in violence. Effectiveness of the Toolkit may be increased by further targeting and supporting teachers' engagement with girls and students with mental health difficulties. TRIAL REGISTRATION The trial is registered at clinicaltrials.gov , NCT01678846, August 24th 2012.
Collapse
Affiliation(s)
- Louise Knight
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Elizabeth Allen
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | | | | | - Jennifer C Child
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Joanna Sturgess
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Nambusi Kyegombe
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - Diana Elbourne
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - Karen M Devries
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
17
|
Kingori C, Ice GH, Hassan Q, Elmi A, Perko E. 'If I went to my mom with that information, I'm dead': sexual health knowledge barriers among immigrant and refugee Somali young adults in Ohio. ETHNICITY & HEALTH 2018; 23:339-352. [PMID: 27892706 DOI: 10.1080/13557858.2016.1263285] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Adequate knowledge of sexual health among young adults is a critical step in prevention of sexually transmitted diseases and maintenance of adult sexual health. Knowledge of specific barriers to accessing sexual health knowledge can help tailor approaches appropriately. The purpose of this paper was to identify sexual health knowledge barriers among Somali young adults in Ohio. DESIGN In-depth interviews were conducted with a convenience sample of 27 Somali young adults aged 18-25 years. Using a grounded theory approach, a semi-structured interview guide comprising open-ended questions and probes was utilized to collect data. Data were analyzed and coded using constant comparative analysis. RESULTS Findings revealed sexual health knowledge barriers in the following broad categories: religion, culture and stigma. Cultural and religious norms were deemed an important influence on the community norms largely impacting sexual health knowledge due to stigma and fear of judgment. Participants overcame barriers by seeking information from external sources such as doctors, Internet and peers. CONCLUSION Study findings support an approach that will address sexual health barriers in the Somali immigrant young community at multiple levels: individual, interpersonal and community levels. A collaborative effort across religious, cultural and educational setting is necessary to tailor approaches that meet the needs of the priority group.
Collapse
Affiliation(s)
- Caroline Kingori
- a Department of Social and Public Health, College of Health Sciences and Professions , Ohio University , Athens , OH , USA
| | - Gillian Harper Ice
- b Department of Social Medicine, Heritage College of Osteopathic Medicine , Ohio University , Athens , OH , USA
- c Global Health Initiative, College of Health Sciences and Professions , Ohio University , Athens , OH , USA
| | - Qorsho Hassan
- d Dwight Schar College of Education , Ashland University , Columbus , OH , USA
| | - Abdul Elmi
- e Luitpold Pharmaceutical , Canal Winchester , OH , USA
| | - Erin Perko
- f Department of Social and Public Health, College of Health Sciences and Professions , Ohio University , Athens , OH , USA
| |
Collapse
|
18
|
Martin S, Leitão J, Muhangi D, Nuwa A, Magul D, Counihan H. Community dialogues for child health: results from a qualitative process evaluation in three countries. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2017; 36:29. [PMID: 28583170 PMCID: PMC5460475 DOI: 10.1186/s41043-017-0106-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 05/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Across the developing world, countries are increasingly adopting the integrated community case management of childhood illnesses (iCCM) strategy in efforts to reduce child mortality. This intervention's effectiveness is dependent on community adoption and changes in care-seeking practices. We assessed the implementation process of a theory-driven community dialogue (CD) intervention specifically designed to strengthen the support and uptake of the newly introduced iCCM services and related behaviours in three African countries. METHODS A qualitative process evaluation methodology was chosen and used secondary project data and primary data collected in two districts of each of the three countries, in purposefully sampled communities. The final data set included 67 focus group discussions and 57 key informant interviews, totalling 642 respondents, including caregivers, CD facilitators community leaders, and trainers. Thematic analysis of the data followed the 'Framework Approach' utilising both a deduction and induction process. RESULTS Results show that CDs contribute to triggering community uptake of and support for iCCM services through filling health information gaps and building cooperation within communities. We found it to be an effective approach for addressing social norms around child care practices. This approach was embraced by communities for its flexibility and value in planning individual and collective change. CONCLUSIONS Regular CDs can contribute to the formation of new habits, particularly in relation to seeking timely care in case of child sickness. This study also confirms the value of process evaluation to unwrap the mechanisms of community mobilisation approaches in context and provides key insights for improving the CD approach.
Collapse
Affiliation(s)
- Sandrine Martin
- Malaria Consortium Mozambique, Rua Joseph Ki-Zerbo 191, PO Box 3655, Coop, Maputo Mozambique
| | - Jordana Leitão
- Independant consultant, Rua Custódio Bento de Azevedo n° 24, Luanda, Angola
| | - Denis Muhangi
- Department of Social Work and Social Administration, Makerere University, P.O.Box 7062, Kampala, Uganda
| | - Anthony Nuwa
- Malaria Consortium Uganda, Plot 25 Upper Naguru East Road, P.O.Box 8045, Kampala, Uganda
| | - Dieterio Magul
- Malaria Consortium Mozambique, Av. Prof. De Moçambique, 62, Inhambane, Mozambique
| | - Helen Counihan
- Malaria Consortium Headquarters, Development House 56-64 Leonard Street, London, EC2A 4LT UK
| |
Collapse
|
19
|
Downs JA, Mwakisole AH, Chandika AB, Lugoba S, Kassim R, Laizer E, Magambo KA, Lee MH, Kalluvya SE, Downs DJ, Fitzgerald DW. Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial. Lancet 2017; 389:1124-1132. [PMID: 28214093 PMCID: PMC5364327 DOI: 10.1016/s0140-6736(16)32055-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 08/09/2016] [Accepted: 09/22/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Male circumcision is being widely deployed as an HIV prevention strategy in countries with high HIV incidence, but its uptake in sub-Saharan Africa has been below targets. We did a study to establish whether educating religious leaders about male circumcision would increase uptake in their village. METHODS In this cluster randomised trial in northwest Tanzania, eligible villages were paired by proximity (<60 km) and the time that a free male circumcision outreach campaign from the Tanzanian Ministry of Health became available in their village. All villages received the standard male circumcision outreach activities provided by the Ministry of Health. Within the village pairs, villages were randomly assigned by coin toss to receive either additional education for Christian church leaders on scientific, religious, and cultural aspects of male circumcision (intervention group), or standard outreach only (control group). Church leaders or their congregations were not masked to random assignment. The educational intervention consisted of a 1-day seminar co-taught by a Tanzanian pastor and a Tanzanian clinician who worked with the Ministry of Health, and meetings with the study team every 2 weeks thereafter, for the duration of the circumcision campaign. The primary outcome was the proportion of male individuals in a village who were circumcised during the campaign, using an intention-to-treat analysis that included all men in the village. This trial is registered with ClinicalTrials.gov, number NCT 02167776. FINDINGS Between June 15, 2014, and Dec 10, 2015, we provided education for church leaders in eight intervention villages and compared the outcomes with those in eight control villages. In the intervention villages, 52·8% (30 889 of 58 536) of men were circumcised compared with 29·5% (25 484 of 86 492) of men in the eight control villages (odds ratio 3·2 [95% CI, 1·4-7·3]; p=0·006). INTERPRETATION Education of religious leaders had a substantial effect on uptake of male circumcision, and should be considered as part of male circumcision programmes in other sub-Saharan African countries. This study was conducted in one region in Tanzania; however, we believe that our intervention is generalisable. We equipped church leaders with knowledge and tools, and ultimately each leader established the most culturally-appropriate way to promote male circumcision. Therefore, we think that the process of working through religious leaders can serve as an innovative model to promote healthy behaviour, leading to HIV prevention and other clinically relevant outcomes, in a variety of settings. FUNDING Bill & Melinda Gates Foundation, National Institutes of Health, and the Mulago Foundation.
Collapse
Affiliation(s)
- Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.
| | - Agrey H Mwakisole
- St Paul College, Mwanza, Tanzania; Fuller Theological Seminary, Pasadena, California
| | | | - Shibide Lugoba
- Care and Treatment Centre, Bugando Medical Centre, Mwanza, Tanzania
| | - Rehema Kassim
- Care and Treatment Centre, Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Myung Hee Lee
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Samuel E Kalluvya
- Care and Treatment Centre, Bugando Medical Centre, Mwanza, Tanzania; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - David J Downs
- St Paul College, Mwanza, Tanzania; Fuller Theological Seminary, Pasadena, California
| | - Daniel W Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
20
|
Odimegwu C, Somefun OD. Ethnicity, gender and risky sexual behaviour among Nigeria youth: an alternative explanation. Reprod Health 2017; 14:16. [PMID: 28143542 PMCID: PMC5282662 DOI: 10.1186/s12978-017-0284-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/07/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While studies in demography and public health have acknowledged the role of ethnic differences, the influence of ethnicity on youth sexual behaviour in Nigeria has received little or no attention. It is important to know how cultural norms and gender roles, which vary by ethnicity, may promote or prevent risky behaviour. Such information could provide insights into previously undetected sexual behaviour in multi-ethnic situations. METHODS The Nigeria Demographic and Health Surveys (NDHS) for 2003, 2008 and 2013 were pooled to examine the relationship between ethnicity and youth sexual reproductive health, proxied by age at sexual debut, multiple sexual partners (MSP) and condom use at last sexual activity, among the 6304 females and 1549 males who reported being sexually active in the four weeks preceding the survey. Multivariate analysis using a Cox proportional hazard regression model was used to determine the risk factors for early sexual activity among young people (15-24). Logistic regression was used to predict condom use at last sexual activity and MSP. RESULTS The median age at first sexual activity was 16 for females and 17 for males. 43% of male youths used condoms in their last sexual activity, compared to only 16% among females and a higher number of males (81%) had multiple sexual partners compared to females (35%). For females, elevated risks of first sex was higher among Hausa/Fulanis aged 15-19 and elevated risk of first sex was higher among Yoruba males. CONCLUSION This study provides further evidence that in order to promote protective sexual behaviours among youth in Nigeria, social, cultural and gender-specific tactics should be put in place for the prevention of HIV and other STIs.
Collapse
Affiliation(s)
- Clifford Odimegwu
- Demography and Population Studies, School of Public Health and Social Sciences, Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2000 South Africa
| | - Oluwaseyi Dolapo Somefun
- Demography and Population Studies, School of Public Health and Social Sciences, Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2000 South Africa
| |
Collapse
|
21
|
Ivanova O, Cordova-Pozo K, Segura ZE, Vega B, Chandra-Mouli V, Hindin MJ, Temmerman M, Decat P, De Meyer S, Michielsen K. Lessons learnt from the CERCA Project, a multicomponent intervention to promote adolescent sexual and reproductive health in three Latin America countries: a qualitative post-hoc evaluation. EVALUATION AND PROGRAM PLANNING 2016; 58:98-105. [PMID: 27347640 PMCID: PMC4987454 DOI: 10.1016/j.evalprogplan.2016.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 04/16/2016] [Accepted: 06/03/2016] [Indexed: 06/06/2023]
Abstract
The Community-Embedded Reproductive Health Care for Adolescents (CERCA) Project was implemented in Bolivia, Ecuador and Nicaragua (2011-2014) to test the effectiveness of interventions preventing teenage pregnancies. As the outcome evaluation showed limited impact, a post-hoc process evaluation was carried out to determine if and how CERCA's design, implementation, monitoring and evaluation affected the results. We did a document analysis and conducted 18 in-depth interviews and 21 focus group discussions with stakeholders and beneficiaries. Transcripts were analyzed using directed content analysis. Data showed that CERCA sensitized stakeholders and encouraged the discussion on this sensitive issue. In terms of design, a strong point was the participatory approach; a weak point was that the detailed situation analysis was completed too late. In terms of implementation, a strong point was that multifaceted activities were implemented; a weak point was that the activities were not pilot tested for feasibility/acceptability and evolved substantially throughout the Project. In terms of monitoring, strong points were that regular monitoring kept the Project on track administratively/financially; a weak point was that monitoring indicators did not change as the intervention package changed. In terms of evaluation, weak points were the substantial attrition rate and narrow focus on adolescents. This study provides recommendations for future projects.
Collapse
Affiliation(s)
- Olena Ivanova
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium.
| | | | | | - Bernardo Vega
- University of Cuenca (UC), Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador.
| | - Venkatraman Chandra-Mouli
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland.
| | - Michelle J Hindin
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland.
| | - Marleen Temmerman
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland.
| | - Peter Decat
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium.
| | - Sara De Meyer
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium.
| | - Kristien Michielsen
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium.
| |
Collapse
|
22
|
Ruark A, Fielding-Miller R. Using Qualitative Methods to Validate and Contextualize Quantitative Findings: A Case Study of Research on Sexual Behavior and Gender-Based Violence Among Young Swazi Women. GLOBAL HEALTH: SCIENCE AND PRACTICE 2016; 4:373-83. [PMID: 27688715 PMCID: PMC5042694 DOI: 10.9745/ghsp-d-16-00062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/08/2016] [Indexed: 11/15/2022]
Abstract
Nesting qualitative data collection methods within quantitative studies improves results by assessing validity and providing depth and context. Using data from 3 sources from Swaziland, we triangulate qualitative and quantitative findings to highlight how different methodologies produce discrepant data regarding risky sexual behaviors among young women. We found that women reported similar numbers of lifetime sex partners in all sources, but the proportion reporting multiple and concurrent partnerships was several times higher in qualitative interviews. In addition, qualitative data can provide deeper understanding of how participants, such as those experiencing gender-based violence, understood the experiences behind the quantitative statistics.
Collapse
Affiliation(s)
- Allison Ruark
- Brown University, Department of Medicine, Providence, RI, USA
| | | |
Collapse
|
23
|
Young Men's Social Network Characteristics and Associations with Sexual Partnership Concurrency in Tanzania. AIDS Behav 2016; 20:1244-55. [PMID: 26271813 DOI: 10.1007/s10461-015-1152-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Social network influence on young people's sexual behavior is understudied in sub-Saharan Africa. Previous research identified networks of mostly young men in Dar es Salaam who socialize in "camps". This study describes network characteristics within camps and their relationship to young men's concurrent sexual partnerships. We conducted surveys with a nearly complete census of ten camp networks (490 men and 160 women). Surveys included name generators to identify camp-based networks. Fifty seven percent of sexually active men (n = 471) reported past year concurrency, measured using the UNAIDS method. In a multivariable model, men's individual concurrency was associated with being a member of a closer knit camp in which concurrency was the normative behavior. Younger men who had older members in their networks were more likely to engage in concurrency. Respondent concurrency was also associated with inequitable personal gender norms. Our findings suggest strategies for leveraging social networks for HIV prevention among young men.
Collapse
|
24
|
Adolescents' Communication with Parents, Other Adult Family Members and Teachers on Sexuality: Effects of School-Based Interventions in South Africa and Tanzania. AIDS Behav 2015; 19:2162-76. [PMID: 25724974 DOI: 10.1007/s10461-015-1019-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cluster-randomized controlled trials were carried out to examine effects on sexual practices of school-based interventions among adolescents in three sites in sub-Saharan Africa. In this publication, effects on communication about sexuality with significant adults (including parents) and such communication as a mediator of other outcomes were examined. Belonging to the intervention group was significantly associated with fewer reported sexual debuts in Dar es Salaam only (OR 0.648). Effects on communication with adults about sexuality issues were stronger for Dar es Salaam than for the other sites. In Dar, increase in communication with adults proved to partially mediate associations between intervention and a number of social cognition outcomes. The hypothesized mediational effect of communication on sexual debut was not confirmed. Promoting intergenerational communication on sexuality issues is associated with several positive outcomes and therefore important. Future research should search for mediating factors influencing behavior beyond those examined in the present study.
Collapse
|
25
|
Cáceres CF, Mayer KH, Baggaley R, O'Reilly KR. PrEP Implementation Science: State-of-the-Art and Research Agenda. J Int AIDS Soc 2015; 18:20527. [PMID: 26198351 PMCID: PMC4581083 DOI: 10.7448/ias.18.4.20527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
|
26
|
Celum CL, Delany-Moretlwe S, McConnell M, van Rooyen H, Bekker LG, Kurth A, Bukusi E, Desmond C, Morton J, Baeten JM. Rethinking HIV prevention to prepare for oral PrEP implementation for young African women. J Int AIDS Soc 2015; 18:20227. [PMID: 26198350 PMCID: PMC4509892 DOI: 10.7448/ias.18.4.20227] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/13/2015] [Accepted: 05/21/2015] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION HIV incidence remains high among young women in sub-Saharan Africa in spite of scale-up of HIV testing, behavioural interventions, antiretroviral treatment and medical male circumcision. There is a critical need to critique past approaches and learn about the most effective implementation of evidence-based HIV prevention strategies, particularly emerging interventions such as pre-exposure prophylaxis (PrEP). DISCUSSION Women in sub-Saharan Africa are at increased risk of HIV during adolescence and into their 20s, in part due to contextual factors including gender norms and relationship dynamics, and limited access to reproductive and sexual health services. We reviewed behavioural, behavioural economic and biomedical approaches to HIV prevention for young African women, with a particular focus on the barriers, opportunities and implications for implementing PrEP in this group. Behavioural interventions have had limited impact in part due to not effectively addressing the context, broader sexual norms and expectations, and structural factors that increase risk and vulnerability. Of biomedical HIV prevention strategies that have been tested, daily oral PrEP has the greatest evidence for protection, although adherence was low in two placebo-controlled trials in young African women. Given high efficacy and effectiveness in other populations, demonstration projects of open-label PrEP in young African women are needed to determine the most effective delivery models and whether women at substantial risk are motivated and able to use oral PrEP with sufficient adherence to achieve HIV prevention benefits. CONCLUSIONS Social marketing, adherence support and behavioural economic interventions should be evaluated as part of PrEP demonstration projects among young African women in terms of their effectiveness in increasing demand and optimizing uptake and effective use of PrEP. Lessons learned through evaluations of implementation strategies for delivering oral PrEP, a first-generation biomedical HIV prevention product, will inform development of new and less user-dependent PrEP formulations and delivery of an expanding choice of prevention options in HIV prevention programmes for young African women.
Collapse
Affiliation(s)
- Connie L Celum
- Department of Global Health, University of Washington Seattle, WA, USA
- Department of Medicine, University of Washington Seattle, WA, USA
- Department of Epidemiology, University of Washington Seattle, WA, USA;
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health Boston, MA, USA
| | | | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Ann Kurth
- College of Nursing, New York University New York, NY, USA
| | | | - Chris Desmond
- Human Sciences Research Council, Durban, South Africa
| | - Jennifer Morton
- Department of Global Health, University of Washington Seattle, WA, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington Seattle, WA, USA
- Department of Medicine, University of Washington Seattle, WA, USA
- Department of Epidemiology, University of Washington Seattle, WA, USA
| |
Collapse
|
27
|
Aninanya GA, Debpuur CY, Awine T, Williams JE, Hodgson A, Howard N. Effects of an adolescent sexual and reproductive health intervention on health service usage by young people in northern Ghana: a community-randomised trial. PLoS One 2015; 10:e0125267. [PMID: 25928562 PMCID: PMC4415997 DOI: 10.1371/journal.pone.0125267] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/22/2015] [Indexed: 11/29/2022] Open
Abstract
Background While many Ghanaian adolescents encounter sexual and reproductive health problems, their usage of services remains low. A social learning intervention, incorporating environment, motivation, education, and self-efficacy to change behaviour, was implemented in a low-income district of northern Ghana to increase adolescent services usage. This study aimed to assess the impact of this intervention on usage of sexual and reproductive health services by young people. Methods Twenty-six communities were randomly allocated to (i) an intervention consisting of school-based curriculum, out-of-school outreach, community mobilisation, and health-worker training in youth-friendly health services, or (ii) comparison consisting of community mobilisation and youth-friendly health services training only. Outcome measures were usage of sexually-transmitted infections (STIs) management, HIV counselling and testing, antenatal care or perinatal services in the past year and reported service satisfaction. Data was collected, at baseline and three years after, from a cohort of 2,664 adolescents aged 15–17 at baseline. Results Exposure was associated with over twice the odds of using STI services (AOR 2.47; 95%CI 1.78–3.42), 89% greater odds of using perinatal services (AOR 1.89; 95%CI 1.37–2.60) and 56% greater odds of using antenatal services (AOR 1.56; 95%CI 1.10–2.20) among participants in intervention versus comparison communities, after adjustment for baseline differences. Conclusions The addition of targeted school-based and outreach activities increased service usage by young people more than community mobilisation and training providers in youth-friendly services provision alone.
Collapse
Affiliation(s)
- Gifty Apiung Aninanya
- Navrongo Health Research Centre, Navrongo, Ghana
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail:
| | | | | | | | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
28
|
Cornish F, Priego-Hernandez J, Campbell C, Mburu G, McLean S. The impact of community mobilisation on HIV prevention in middle and low income countries: a systematic review and critique. AIDS Behav 2014; 18:2110-34. [PMID: 24659360 PMCID: PMC4196137 DOI: 10.1007/s10461-014-0748-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
While community mobilisation (CM) is increasingly advocated for HIV prevention, its impact on measurable outcomes has not been established. We performed a systematic review of the impact of CM within HIV prevention interventions (N = 20), on biomedical, behavioural and social outcomes. Among most at risk groups (particularly sex workers), the evidence is somewhat consistent, indicating a tendency for positive impact, with stronger results for behavioural and social outcomes than for biomedical ones. Among youth and general communities, the evidence remains inconclusive. Success appears to be enhanced by engaging groups with a strong collective identity and by simultaneously addressing the socio-political context. We suggest that the inconclusiveness of the findings reflects problems with the evidence, rather than indicating that CM is ineffective. We discuss weaknesses in the operationalization of CM, neglect of social context, and incompatibility between context-specific CM processes and the aspiration of review methodologies to provide simple, context-transcending answers.
Collapse
Affiliation(s)
- Flora Cornish
- Department of Methodology, The London School of Economics and Political Science, London, UK
| | - Jacqueline Priego-Hernandez
- Department of Social Psychology, The London School of Economics and Political Science, 3rd Floor St Clements Building, Houghton Street, London, WC2A 2AE UK
| | - Catherine Campbell
- Department of Social Psychology, The London School of Economics and Political Science, 3rd Floor St Clements Building, Houghton Street, London, WC2A 2AE UK
| | - Gitau Mburu
- International HIV/AIDS Alliance, Brighton, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | | |
Collapse
|
29
|
Wamoyi J, Wight D. "Dying a hero": parents' and young people's discourses on concurrent sexual partnerships in rural Tanzania. BMC Public Health 2014; 14:742. [PMID: 25048413 PMCID: PMC4223426 DOI: 10.1186/1471-2458-14-742] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 07/08/2014] [Indexed: 11/16/2022] Open
Abstract
Background Concurrent sexual partnerships (CSPs) have been speculated to drive the HIV pandemic in many sub-Saharan African countries. We have limited understanding of how people think and talk about CSPs, how beliefs are transmitted across generations, and how this might affect the practice. This paper explores these issues to understand how CSPs are perpetuated and help identify opportunities for interventions to modify them. Methods The study employed an ethnographic research design involving: participant observation in 10 households, 60 in-depth interviews (IDIs), and nine participatory focus group discussions (FGDs). Participants were young people aged 14-24 and parents/carers of young people within this age group. The 60 IDIs were conducted with: 17 fathers, 13 mothers, 13 young men and 17 young women (six of whom had had unplanned pregnancies and 11 had no children). The nine FGDs were conducted with groups of: fathers (2), mothers (2), young women (2), and young men (3). A discourse analysis was carried out with all the transcripts. Data were analysed with the aid of NVIVO 8 software. Results Six distinct discourses were identified from the way participants talked about CSPs and the norms driving the practice: 1) predatory masculine sexuality; 2) masculine respectability; 3) feminine respectability; 4) empowered modern women; 5) traditional health beliefs; 6) public health. Discourses legitimating CSPs were drawn on and reproduced primarily by young people and the media and only indirectly by parents. Discourses discouraging CSPs were used primarily by parents, religious leaders and learning institutions and only indirectly by young people themselves. Conclusion Better knowledge of the discourses through which young people CSPs, and how these discourses are transmitted across generations, might help develop “culturally compelling” interventions that modify these discourses to enhance sexual health.
Collapse
Affiliation(s)
- Joyce Wamoyi
- Department of Sexual and Reproductive Health, National Institute for Medical Research, P,O Box 1462, Mwanza, Tanzania.
| | | |
Collapse
|
30
|
Higgins JA, Mathur S, Eckel E, Kelley L, Kelly L, Nakyanjo N, Sekamwa R, Namatovu J, Ddaaki W, Nakubulwa R, Namakula S, Nalugoda F, Santelli JS. Importance of relationship context in HIV transmission: results from a qualitative case-control study in Rakai, Uganda. Am J Public Health 2014; 104:612-20. [PMID: 24524490 DOI: 10.2105/ajph.2013.301670] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We present results from life history interviews with 60 young adults from southern Uganda. Using a novel qualitative case-control design, we compared newly HIV-positive cases with HIV-negative controls matched on age, gender, marital status, and place of residence. Relationship context was the most salient theme differentiating cases from controls. Compared with HIV-negative respondents, recent seroconverters described relationships marked by poorer communication, greater suspicion and mistrust, and larger and more transitory sexual networks. Results highlight the importance of dyadic approaches to HIV and possibly of couple-based interventions. Using HIV-matched pairs allowed additional understanding of the factors influencing transmission. This hybrid methodological approach holds promise for future studies of sexual health.
Collapse
Affiliation(s)
- Jenny A Higgins
- At the time of data collection and analysis, Jenny A. Higgins, Sanyukta Mathur, Elizabeth Eckel, Laura Kelly, and John S. Santelli were with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY. At the time of article preparation, Jenny A. Higgins was with the Department of Gender and Women's Studies, University of Wisconsin-Madison. Neema Nakyanjo, Richard Sekamwa, Josephine Namatovu, William Ddaaki, Rosette Nakubulwa, and Sylvia Namakula are with the Qualitative Research Section, Rakai Health Sciences Program, Kalisizo, Uganda. Fred Nalugoda is with the Kalisizo Field Station, Rakai Health Sciences Program, Kalisizo, Uganda
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Maman S, van Rooyen H, Stankard P, Chingono A, Muravha T, Ntogwisangu J, Phakathi Z, Srirak N, F.Morin S. NIMH Project Accept (HPTN 043): results from in-depth interviews with a longitudinal cohort of community members. PLoS One 2014; 9:e87091. [PMID: 24489841 PMCID: PMC3906114 DOI: 10.1371/journal.pone.0087091] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 12/18/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction NIMH Project Accept (HPTN 043) is a community- randomized trial to test the safety and efficacy of a community-level intervention designed to increase testing and lower HIV incidence in Tanzania, Zimbabwe, South Africa and Thailand. The evaluation design included a longitudinal study with community members to assess attitudinal and behavioral changes in study outcomes including HIV testing norms, HIV-related discussions, and HIV-related stigma. Methods A cohort of 657 individuals across all sites was selected to participate in a qualitative study that involved 4 interviews during the study period. Baseline and 30-month data were summarized according to each outcome, and a qualitative assessment of changes was made at the community level over time. Results Members from intervention communities described fewer barriers and greater motivation for testing than those from comparison communities. HIV-related discussions in intervention communities were more grounded in personal testing experiences. A change in HIV-related stigma over time was most pronounced in Tanzania and Zimbabwe. Participants in the intervention communities from these two sites attributed community-level changes in attitudes to project specific activities. Discussion The Project Accept intervention was associated with more favorable social norms regarding HIV testing, more personal content in HIV discussions in all study sites, and qualitative changes in HIV-related stigma in two of five sites.
Collapse
Affiliation(s)
- Suzanne Maman
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Heidi van Rooyen
- Social, Behavioural and Biomedical Interventions Unit, Human Sciences Research Council, Pieternaritzburg, South Africa
| | - Petra Stankard
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Alfred Chingono
- Department of Psychiatry, University of Zimbabwe. Harare, Zimbabwe
| | - Tshifhiwa Muravha
- Perinatal HIV Research Unit, Witswatersrand University, Soweto, South Africa
| | - Jacob Ntogwisangu
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Zipho Phakathi
- Social, Behavioural and Biomedical Interventions Unit, Human Sciences Research Council, Pieternaritzburg, South Africa
| | - Namtip Srirak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Stephen F.Morin
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, Califorinia, United States of America
| | | |
Collapse
|
32
|
Small E, Nikolova SP, Narendorf SC. Synthesizing gender based HIV interventions in Sub-Sahara Africa: a systematic review of the evidence. AIDS Behav 2013; 17:2831-44. [PMID: 23832574 DOI: 10.1007/s10461-013-0541-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Gender is a critical component of HIV and sexual risk interventions. Examining the range, effectiveness and methodological rigor of studies that include a gender based component can inform current interventions and future directions for intervention research. This review investigated gender informed intervention studies conducted in sub-Saharan Africa that measured an outcome related to HIV. We reviewed 311 articles, 41 of which met our inclusion criteria, resulting in 11 articles that described eight different studies used in the analyses. The findings demonstrated wide variations in the types of interventions from low intensity educational content to multi-component interventions. Study outcomes were categorized into biological outcomes, HIV risk, behavioral, violence and risk reduction. Most interventions showed positive effects, and although research methodologies varied considerably, longer interventions appeared to be more effective. More research, however, is needed to build the evidence base for effectiveness of gender-based programs in reducing HIV infections in sub-Saharan Africa.
Collapse
|
33
|
Kennedy EC, Bulu S, Harris J, Humphreys D, Malverus J, Gray NJ. "Be kind to young people so they feel at home": a qualitative study of adolescents' and service providers' perceptions of youth-friendly sexual and reproductive health services in Vanuatu. BMC Health Serv Res 2013; 13:455. [PMID: 24176059 PMCID: PMC3842673 DOI: 10.1186/1472-6963-13-455] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual activity during adolescence is common in Vanuatu, however many adolescents lack access to sexual and reproductive health (SRH) services and subsequently suffer a disproportionate burden of poor SRH. There is limited peer-reviewed research describing adolescents' SRH service delivery preferences in Vanuatu to inform policy and programs. The aim of this qualitative study was to explore the barriers preventing adolescents from accessing SRH services in Vanuatu and the features of a youth-friendly health service as defined by adolescents. METHODS Sixty-six focus group discussions were conducted with 341 male and female adolescents aged 15-19 years in rural and urban communities. Additionally, 12 semi-structured interviews were undertaken with policymakers and service providers. Data were analysed using thematic analysis. RESULTS Socio-cultural norms and taboos regarding adolescent sexual behaviour were the most significant factors preventing adolescents from accessing services. These contributed to adolescents' own fear and shame, judgmental attitudes of service providers, and disapproval from parents and community gate-keepers. Lack of confidentiality and privacy, costs, and adolescents' lack of SRH knowledge were also important barriers. Adolescents and service providers identified opportunities to make existing services more youth-friendly. The most important feature of a youth-friendly health service described by adolescents was a friendly service provider. Free or affordable services, reliable commodity supply, confidentiality and privacy were also key features. The need to address socio-cultural norms and community knowledge and attitudes was also highlighted. CONCLUSIONS There are significant demand and supply-side barriers contributing to low utilisation of SRH services by adolescents in Vanuatu. However, there are many opportunities to make existing SRH services more youth-friendly, such as improving service provider training. Investment is also required in strategies that aim to create a more supportive environment for adolescent SRH.
Collapse
Affiliation(s)
- Elissa C Kennedy
- Centre for International Health, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, Australia.
| | | | | | | | | | | |
Collapse
|
34
|
Lemme F, Doyle AM, Changalucha J, Andreasen A, Baisley K, Maganja K, Watson-Jones D, Kapiga S, Hayes RJ, Ross DA. HIV Infection among Young People in Northwest Tanzania: The Role of Biological, Behavioural and Socio-Demographic Risk Factors. PLoS One 2013; 8:e66287. [PMID: 23805209 PMCID: PMC3689734 DOI: 10.1371/journal.pone.0066287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 05/05/2013] [Indexed: 11/25/2022] Open
Abstract
Background Young people are at high risk of HIV and developing appropriate prevention programmes requires an understanding of the risk factors for HIV in this age group. We investigated factors associated with HIV among participants aged 15–30 years in a 2007–8 cross-sectional survey nested within a community-randomised trial of the MEMA kwa Vijana intervention in 20 rural communities in northwest Tanzania. Methods We analysed data for 7259(53%) males and 6476(47%) females. Using a proximate-determinant conceptual framework and conditional logistic regression, we obtained sex-specific Odds Ratios (ORs) for the association of HIV infection with socio-demographic, knowledge, behavioural and biological factors. Results HSV-2 infection was strongly associated with HIV infection (females: adjOR 4.4, 95%CI 3.2–6.1; males: adjOR 4.2, 95%CI 2.8–6.2). Several socio-demographic factors (such as age, marital status and mobility), behavioural factors (condom use, number and type of sexual partnerships) and biological factors (blood transfusion, lifetime pregnancies, genital ulcers, Neisseria gonorrhoeae) were also associated with HIV infection. Among females, lifetime sexual partners (linear trend, p<0.001), ≥2 partners in the past year (adjOR 2.0, 95%CI 1.4–2.8), ≥2 new partners in the past year (adjOR 1.9 95%CI 1.2, 3.3) and concurrent partners in the past year (adjOR 1.6 95%CI 1.1, 2.4) were all associated with HIV infection. Conclusions Efforts must be intensified to find effective interventions to reduce HSV-2. Effective behavioural interventions focusing on reducing the number of sexual partnerships and risk behaviour within partnerships are also needed. An increase in risky sexual behaviour may occur following marriage dissolution or when a young woman travels outside of her community and interventions addressing the needs of these subgroups of vulnerable women may be important. Trial Registration ClinicalTrial.gov NCT00248469.
Collapse
Affiliation(s)
- Francesca Lemme
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Aoife M. Doyle
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Aura Andreasen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Kathy Baisley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kaballa Maganja
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Deborah Watson-Jones
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Saidi Kapiga
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Richard J. Hayes
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David A. Ross
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| |
Collapse
|