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Bang Y, Kim Y, Goto A, Henning M, Kang M. Empowering women as enablers in public health: A quantitative-qualitative systematic review of the gender-transformative approach. Health Care Women Int 2024:1-18. [PMID: 38976814 DOI: 10.1080/07399332.2024.2371372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 06/19/2024] [Indexed: 07/10/2024]
Abstract
Women are expected to take on multiple roles as caregivers and health care providers, but they are still often perceived as victims or beneficiaries rather than enablers. We aimed to explore women's empowerment and gender equality in public health systems and identify proactive enablers that can be incorporated into projects. A systematic review of peer-reviewed literature as well as text analysis were conducted to examine changes in perceptions of women's roles in public health projects. The authors conducted a quantitative analysis of the collected article titles, which revealed a shift in research from identifying risk factors to exploring women's autonomy in health promotion. However, our qualitative review of the articles showed that previous gender-related projects used a gender-sensitive approach that perpetuated the view of women as victims or beneficiaries rather than enablers. The concept of proactive enablers in all aspects of project planning and implementation ensures that women's roles are fully recognized and valued.
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Affiliation(s)
- Yoorim Bang
- Institute for Development and Human Security, Ewha Womans University, Seoul, Republic of Korea
| | - Yanghee Kim
- Department of Global Cooperation, National Health Insurance Service, Wonju, Republic of Korea
| | - Aya Goto
- Department of Public Health, Fukushima Medical University, Fukushima, Japan
| | - Margaret Henning
- Department of Health Sciences, Keene State College, Keene, New Hampshire, USA
| | - Minah Kang
- Department of Public Administration, Ewha Womans University, Seoul, Republic of Korea
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Favina A, Abaatyo J, Kaggwa MM. Dual harm among patients attending a mental health unit in Uganda: a hospital based retrospective study. BMC Psychiatry 2024; 24:154. [PMID: 38388864 PMCID: PMC10885504 DOI: 10.1186/s12888-024-05560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Dual harm encompasses the complex interplay of the co-occurrence of self-harm and aggression. Individuals with dual harm may display a more hazardous pattern of harmful behaviors like homicide-suicide compared to people with sole harm. This study aimed to examine the presence of dual harm among general psychiatry inpatients in a mental health unit in Uganda. METHODS A retrospective chart review of 3098 inpatients from January 2018 to December 2021. Dual harm reported experience at admission was based on experiences of self-harm with harm to people or property or both. Logistic regression assessed the association between dual harm and sociodemographics and clinical characteristics. RESULTS A total of 29 (1%) patients experienced dual harm, with five having experienced self-harm with both harm to others and property, 23 with harm to people, and one with harm to property. Dual harm was statistically significantly associated with the male gender at bivariate analysis. However, there were no statistically significant factors associated with dual harm at multivariate analysis or sensitivity analysis with the specific types of dual harm. CONCLUSION General psychiatry inpatients in Uganda experience dual harm before admission at lower prevalence than in previous literature. However, no investigated sociodemographic and clinical factors could explain these experiences. Further studies looking at dual harm are warranted to understand these unfortunate experiences with serious consequences among patients in Uganda.
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Affiliation(s)
- Alain Favina
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joan Abaatyo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada.
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Belaid L, Sarmiento I, Dion A, Pimentel JP, Rojas-Cárdenas A, Cockcroft A, Andersson N. How does participatory research work: protocol for a realist synthesis. BMJ Open 2023; 13:e074075. [PMID: 37775285 PMCID: PMC10546155 DOI: 10.1136/bmjopen-2023-074075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/20/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Participatory research science deals with partnerships underlying research, governance and ownership of research products. It is concerned with relationships behind research objectives and methods. Participatory research has gained significant traction in design of health interventions, contextualising these to local settings and stakeholder groups. Despite a massive increase in participatory research exercises, the field remains undertheorised, and the mechanisms for improving health outcomes remain unclear. This realist review seeks to understand how and under what circumstances participatory research impacts health and social outcomes. METHODS AND ANALYSIS The review will follow four steps: (1) searching for and selecting evidence, (2) assessing the quality of evidence, (3) extracting and categorising data and (4) synthesising the data in the form of context-mechanism-outcomes configurations. The review will follow the Realist And Meta Narrative Evidence Syntheses: Evolving Standards (RAMESES) II guidelines for reporting realist evaluations. We categorise and synthesise data in four steps: (1) identifying outcomes, (2) identifying contextual components of outcomes, (3) theoretical redescription (abduction) and (4) identifying mechanisms. A retroductive analysis will identify mechanisms by moving between empirical data and theories, using inductive and deductive reasoning to explain the outcomes-context matches. The output will generate middle-range theories on how participatory research works, for whom and under what circumstances. ETHICS AND DISSEMINATION This study is a review of a published literature. It does not involve human participants. We will convene a workshop to share and discuss the preliminary results with partners and key stakeholders involved in participatory health research. We will publish the review results in peer-reviewed journals and academic conferences.
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Affiliation(s)
- Loubna Belaid
- Direction de la recherche et de l'enseignement, École Nationale d'Administration Publique (ÉNAP), Quebec, Quebec, Canada
- Family Medicine (CIET/ PRAM), McGill University, Montreal, Quebec, Canada
| | - Ivàn Sarmiento
- Family Medicine (CIET/ PRAM), McGill University, Montreal, Quebec, Canada
- Grupo de Estudios en Sistemas Tradicionales de Salud, Universidad del Rosario, Bogota, Cundinamarca, Colombia
| | - Anna Dion
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Juan Pablo Pimentel
- Department of Family Medicine and Public Health, Universidad de La Sabana, Chía, Colombia
| | | | - Anne Cockcroft
- Family Medicine (CIET/ PRAM), McGill University, Montreal, Quebec, Canada
| | - Neil Andersson
- Family Medicine (PRAM), McGill University, Montreal, Quebec, Canada
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
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Maluka SO, Mpambije CJ, Kamuzora PC, Fitzgerald S. The effects of community-based interventions on the uptake of selected maternal and child health services: experiences of the IMCHA project in Iringa Tanzania, 2015-2020. BMC Pregnancy Childbirth 2023; 23:328. [PMID: 37158851 PMCID: PMC10165785 DOI: 10.1186/s12884-023-05638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 04/24/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Maternal and child health (MCH) improvement has been prioritised in resource-constrained countries. This is due to the desire to meet the global sustainable development goals of achieving a maternal mortality rate of 70 per 100000 live births by 2030. The uptake of key maternal and child health services is crucial for reducing maternal and child health mortalities. Community-Based Interventions (CBIs) have been regarded as among the important strategies to improve maternal and child health service uptake. However, a paucity of studies examines the impacts of CBIs and related strategies on maternal and child health. This paper unveils the contribution of CBIs toward improving MCH in Tanzania. METHODS Convergent mixed method design was employed in this study. Questionnaires were used to examine the trajectory and trend of the selected MCH indicators using the baseline and end-line data for the implemented CBI interventions. Data was also collected through in-depth interviews and focus group discussions, mainly with implementers of the interventions from the community and the implementation research team. The collected quantitative data was analysed using IBM SPSS, while qualitative data was analysed thematically. RESULTS Antenatal care visits increased by 24% in Kilolo and 18% in Mufindi districts, and postnatal care increased by 14% in Kilolo and 31% in Mufindi districts. Male involvement increased by 5% in Kilolo and 13% in Mufindi districts. The uptake of modern family planning methods increased by 31% and 24% in Kilolo and Mufindi districts, respectively. Furthermore, the study demonstrated improved awareness and knowledge on matters pertaining to MCH services, attitude change amongst healthcare providers, and increased empowerment of women group members. CONCLUSION Community-Based Interventions through participatory women groups are vital for increasing the uptake of MCH services. However, the success of CBIs depends on the wide array of contextual settings, including the commitment of implementers of the interventions. Thus, CBIs should be strategically designed to enlist the support of the communities and implementers of the interventions.
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Affiliation(s)
- Stephen Oswald Maluka
- Institute of Development Studies, University of Dar Es Salaam, P.O. Box 35169, Dar Es Salaam, Tanzania
- Dar Es Salaam University College of Education (DUCE), P. O Box 2329, Dar Es Salaam, Tanzania
| | - Chakupewa Joseph Mpambije
- Department of Development Studies, History and Political Sciences, Mkwawa University College of Education (MUCE), P.O. Box 2513, Iringa, Tanzania.
| | - Peter Clever Kamuzora
- Institute of Development Studies, University of Dar Es Salaam, P.O. Box 35169, Dar Es Salaam, Tanzania
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Gregg C, Valdez M, Stollak I, Martin S, Story WT, Perry HB. Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 7. The empowering effect of Care Groups. Int J Equity Health 2023; 21:199. [PMID: 36855142 PMCID: PMC9976358 DOI: 10.1186/s12939-022-01759-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND While there is extensive published evidence regarding the effectiveness of the Care Group Approach in promoting community-wide health behavior change, there is no published evidence regarding its empowering effect on its participants. Our study aimed to understand if the Care Group Approach as applied in the Curamericas/Guatemala Maternal and Child Health Project in isolated rural mountainous communities in Guatemala produced evidence of empowerment among the female participants. This is the seventh of 10 papers describing the expanded Census-Based, Impact-Oriented (CBIO+) Approach in improving the health and well-being of mothers and children in the rural highlands of the Department of Huehuetenango, Guatemala. METHODS We conducted semi-structured individual and group interviews with 96 female Care Group participants -including Level-1 Care Group Promoters, Care Group Volunteers, and Self-Help Group participants. The participants were from six communities - two from each of the three municipalities making up the Project Area. Data were analyzed both using deductive thematic and by exploring the following social constructs: perceived social status, self-efficacy, decision-making autonomy, and formation of social capital. RESULTS The findings supported the hypothesis that Care Group participation was an empowering process. The primary themes that emerged included increased respect accorded to women in the community, women's willingness and ability to make decisions and their confidence in making those decisions, and the development of stronger bonds among Care Group members, with other community members, and with community leaders. CONCLUSION Through increased theoretical and practical knowledge about important maternal and child health matters and through the social experience of obtaining this knowledge and sharing it with other community members, participation in the Care Group Approach empowered participants to make positive health behavior changes for themselves and for their children and families. This, in turn, led many participants to become more engaged in community activities for improved health and beyond, thereby enhancing social capital in the community. We conclude that the Care Group Approach, as applied in this setting, has made it possible for marginalized indigenous women living in a male-dominated society to become more empowered.
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Affiliation(s)
- Corey Gregg
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Mario Valdez
- Curamericas/ Guatemala, Calhuitz, San Sebastián Coatán, Huehuetenango, Guatemala
| | - Ira Stollak
- Curamericas Global, Raleigh, North Carolina, USA
| | - Shayanne Martin
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - William T Story
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Henry B Perry
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Stollak I, Valdez M, Story WT, Perry HB. Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 8. Impact on women's empowerment. Int J Equity Health 2023; 21:200. [PMID: 36855052 PMCID: PMC9976544 DOI: 10.1186/s12939-022-01760-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Indigenous Maya women in the rural highlands of Guatemala have traditionally faced constraints to decision-making and participation in community affairs. Anecdotal experiences from previous Curamericas Global projects in Guatemala and Liberia have suggested that interventions using the CBIO+ Approach (which consists of implementing together the Census-Based, Impact-Oriented Approach, the Care Group Approach, and Community Birthing Centers), can be empowering and can facilitate improvements in maternal and child health. This paper, the eighth in a series of 10 papers examining the effectiveness of CBIO+ in improving the health and well-being of mothers and children in an isolated mountainous rural area of the Department of Huehuetenango, explores changes in women's empowerment among mothers of young children associated with the Curamericas/Guatemala Maternal and Child Health Project, 2011-2015. METHODS Knowledge, practice, and coverage (KPC) surveys and focus group discussions (FGDs) were used to explore six indicators of women's empowerment focusing on participation in health-related decision-making and participation in community meetings. KPC surveys were conducted at baseline (January 2012) and endline (June 2015) using standard stratified cluster sampling. Seventeen FGDs (9 with women, 3 with men, 2 with mothers-in-law, and 3 with health committees), approximately 120 people in all, were conducted to obtain opinions about changes in empowerment and to identify and assess qualitative factors that facilitate and/or impede women's empowerment. RESULTS The KPC surveys revealed statistically significant increases in women's active participation in community meetings. Women also reported statistically significant increases in rates of participation in health-related decision-making. Further, the findings show a dose-response effect for two of the six empowerment indicators. The qualitative findings from FGDs show that the Project accelerated progress in increasing women's empowerment though women still face major barriers in accessing needed health care services for themselves and their children. CONCLUSION The Project achieved some notable improvements in women's decision-making autonomy and participation in community activities. These improvements often translated into making decisions to practice recommended health behaviors. Traditional cultural norms and the barriers to accessing needed health services are not easily overcome, even when empowerment strategies are effective.
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Affiliation(s)
- Ira Stollak
- Curamericas Global, Raleigh, North Carolina, USA
| | - Mario Valdez
- Curamericas/Guatemala, Calhuitz, San Sebastián Coatán, Huehuetenango, Guatemala
| | - William T Story
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Henry B Perry
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Burgess RA, Jeffery M, Odero SA, Rose-Clarke K, Devakumar D. Overlooked and unaddressed: A narrative review of mental health consequences of child marriages. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000131. [PMID: 36962120 PMCID: PMC10021205 DOI: 10.1371/journal.pgph.0000131] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Child Marriage (before the age of 18) affects over 12 million young women globally, annually. Despite acknowledgement of the negative impacts of the practice on reproductive health, mental health consequences are largely overlooked. Given the ability for poor mental health to intensify other health and social challenges, understanding the mental health consequences linked to child marriage is vital. Our study is the first to examine how mental health is approached in current literature on child marriage. Our conceptual framework was informed by a rapid assessment of key issues in the field. Systematic searches of papers published between 2000-2020 were completed on four electronic databases with no language restrictions. Our protocol was registered on Prospero (CRD42019139685). Articles were assessed using PRISMA guidelines, and their quality assessed using the Joanna Briggs Institute Critical Appraisal Tools. Of the 4,457 records identified, 21 papers meeting inclusion criteria were analysed using narrative synthesis. The final sample included 5 qualitative, 1 mixed-methods and 15 quantitative studies (14 cross-sectional and 1 longitudinal study) reporting on data from 12 countries, largely in the global south. Intimate partner violence, poverty, challenges in childbirth and isolation were identified as social factors linked to emotional distress by those married as children. Depression was the most reported mental disorder. Anxiety, phobias, psychological distress, substance misuse, negative well-being and anti-social personality disorder were reported less frequently. Findings highlight that while significant emotional distress and specific mental health conditions are linked to child marriage, gaps in our understanding remain. Future studies are needed to; clarify directionality in these relationships; understand the mental health needs of young men, LGBTQI communities and those in humanitarian settings. Given the well documented cyclical relationship between social determinants and mental health conditions, we outline a series of community-oriented interventions which blend psychological, social and structural support to promote mental health and wellbeing in the contexts of child marriage.
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Affiliation(s)
- Rochelle A Burgess
- Institute for Global Health, University College London, London, United Kingdom
| | - Mairi Jeffery
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Kelly Rose-Clarke
- Department of Global and Social Medicine, Kings College London, London, United Kingdom
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