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Robson I, Mphande M, Lee J, Hubbard JA, Daniels J, Phiri K, Chikuse E, Coates TJ, Cornell M, Dovel K. Implementing a male-specific ART counselling curriculum: a quality assessment with healthcare workers in Malawi. J Int AIDS Soc 2024; 27:e26270. [PMID: 39039724 PMCID: PMC11263468 DOI: 10.1002/jia2.26270] [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: 08/30/2023] [Accepted: 04/29/2024] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION There is little HIV counselling that directly meets the needs of men in Eastern and Southern Africa, limiting men's knowledge about the benefits of HIV treatment and how to overcome barriers to engagement, contributing to poorer HIV-related outcomes than women. Male-specific approaches are needed to improve men's outcomes but may be difficult for healthcare workers (HCWs) to implement with fidelity and quality in low-resource settings. We developed a male-specific counselling curriculum which was implemented by male HCWs and then conducted a mixed-methods quality assessment. METHODS We audio-recorded counselling sessions to assess the quality of implementation (n = 50) by male HCWs from two cadres (nurse, n = 10 and lay cadre, n = 10) and conducted focus group discussions (FGDs) with HCWs at 6 and 9 months after rollout to understand barriers and facilitators to implementation. Counselling sessions and FGDs were translated, transcribed and analysed using thematic analysis adapted from WHO Quality Counselling Guidelines. We assessed if sessions were respectful, informative, interactive, motivating and included tailored action plans for overcoming barriers to care. All data were collected September 2021-June 2022. RESULTS All sessions used respectful, non-judgemental language. Sessions were highly interactive with most HCWs frequently asking open-ended questions (n = 46, 92%) and often incorporating motivational explanations of how antiretroviral therapy contributes to life goals (n = 42, 84%). Few sessions included individually tailored action plans for clients to overcome barriers to care (n = 9, 18%). New counselling themes were well covered; however, occasionally themes of self-compassion and safe sex were not covered during sessions (n = 16 and n = 11). HCWs believed that having male HCWs conduct counselling, ongoing professional development and keeping detailed counselling notes facilitated quality implementation. Perceived barriers included curriculum length and client hesitancy to participate in action plan development. Findings were similar across cadres. CONCLUSIONS Implementing high-quality male-specific counselling using male nurses and/or lay cadre is feasible. Efforts to utilize lay cadres should be prioritized, particularly in low-resource settings. Programmes should provide comprehensive job aids to support HCWs. Ongoing training and professional development are needed to (1) improve HCWs' skills in tailored action plans, and (2) sensitize HCWs to the need for self-compassion within male clients to promote holistic sexual health.
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Affiliation(s)
- Isabella Robson
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Implementation Science DepartmentPartners in HopeLilongweMalawi
| | - Misheck Mphande
- Implementation Science DepartmentPartners in HopeLilongweMalawi
| | - Jiyoung Lee
- David Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Julie Anne Hubbard
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Joseph Daniels
- Edson College of Nursing and Health InnovationArizona State UniversityPhoenixArizonaUSA
| | - Khumbo Phiri
- Implementation Science DepartmentPartners in HopeLilongweMalawi
| | - Elijah Chikuse
- Implementation Science DepartmentPartners in HopeLilongweMalawi
| | - Thomas J. Coates
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- University of California Global Health InstituteSan FranciscoCaliforniaUSA
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Kathryn Dovel
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Implementation Science DepartmentPartners in HopeLilongweMalawi
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Omondi Aduda DS, Agot K, Ohaga S, Aoko A, Onyango J, Toroitich-Ruto C, Kambona C, Odoyo-June E. Facility characteristics preferred by older men seeking medical male circumcision services in Kenya: qualitative findings from the 'Tasco' study (May 2014-June 2016). BMC Public Health 2024; 24:1718. [PMID: 38937707 PMCID: PMC11210051 DOI: 10.1186/s12889-024-19234-x] [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: 05/06/2023] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
Primary healthcare facilities are central to the implementation of voluntary medical male circumcision (VMMC) as points of access to integrated health services in line with the Kenya AIDS Strategic Framework II (2020/21-2024/25). Knowledge of factors that explain men's uptake of VMMC and sexual health services at these facilities and preferences of where to get the services remain poorly understood. Using qualitative methodologies, we examined factors that determined facility choice for VMMC services and reasons for preferring the facility among men aged 25-39 years who previously underwent VMMC. The current study draws from focus group discussion interviews with circumcised men and their partners conducted as part of a randomized controlled trial to assess impact of two demand creation interventions in western Kenya. This involved 12 focus group discussions (FGD) with 6-10 participants each. Six FGDs were conducted with circumcised men, and 6 with their sex partners. Thematic issues relevant to a predetermined framework were identified. The themes were organized as follows: service availability, accessibility, affordability, appropriateness and, acceptability. Facility location, physical layout, organization of patient flow, infrastructure, and service provider skills were the outstanding factors affecting the choice of VMMC service outlets by men aged 25-39 years. Additionally, preferences were influenced by individual's disposition, attitudes, knowledge of VMMC services and tacit balance between their own recognized health needs versus desire to conform to social-cultural norms. Facility choice and individual preference are intricate issues, simultaneously involving multiple but largely intra-personal and facility-level factors. The intrapersonal dimensions elicited may also reflect differential responses to strategic communications and demand creation messages with promotion and prevention frames.
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Affiliation(s)
- Dickens S Omondi Aduda
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya.
- Impact Research and Development Organization, Kisumu, Kenya.
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Spala Ohaga
- Impact Research and Development Organization, Kisumu, Kenya
| | - Appolonia Aoko
- Division of Global HIV & TB, Division of Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jacob Onyango
- Impact Research and Development Organization, Kisumu, Kenya
| | - Cathy Toroitich-Ruto
- Division of Global HIV & TB, Division of Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Caroline Kambona
- Division of Global HIV & TB, Division of Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Elijah Odoyo-June
- Division of Global HIV & TB, Division of Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
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Meffert SM, Mathai MA, Ongeri L, Neylan TC, Mwai D, Onyango D, Akena D, Rota G, Otieno A, Obura RR, Wangia J, Opiyo E, Muchembre P, Oluoch D, Wambura R, Mbwayo A, Kahn JG, Cohen CR, Bukusi DE, Aarons GA, Burger RL, Jin C, McCulloch CE, Njuguna Kahonge S. Defining a screening tool for post-traumatic stress disorder in East Africa: a penalized regression approach. Front Public Health 2024; 12:1383171. [PMID: 38947359 PMCID: PMC11211862 DOI: 10.3389/fpubh.2024.1383171] [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: 02/07/2024] [Accepted: 05/13/2024] [Indexed: 07/02/2024] Open
Abstract
Background Scalable PTSD screening strategies must be brief, accurate and capable of administration by a non-specialized workforce. Methods We used PTSD as determined by the structured clinical interview as our gold standard and considered predictors sets of (a) Posttraumatic Stress Checklist-5 (PCL-5), (b) Primary Care PTSD Screen for the DSM-5 (PC-PTSD) and, (c) PCL-5 and PC-PTSD questions to identify the optimal items for PTSD screening for public sector settings in Kenya. A logistic regression model using LASSO was fit by minimizing the average squared error in the validation data. Area under the receiver operating characteristic curve (AUROC) measured discrimination performance. Results Penalized regression analysis suggested a screening tool that sums the Likert scale values of two PCL-5 questions-intrusive thoughts of the stressful experience (#1) and insomnia (#21). This had an AUROC of 0.85 (using hold-out test data) for predicting PTSD as evaluated by the MINI, which outperformed the PC-PTSD. The AUROC was similar in subgroups defined by age, sex, and number of categories of trauma experienced (all AUROCs>0.83) except those with no trauma history- AUROC was 0.78. Conclusion In some East African settings, a 2-item PTSD screening tool may outperform longer screeners and is easily scaled by a non-specialist workforce.
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Affiliation(s)
- Susan M. Meffert
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | | | | | - Thomas C. Neylan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel Mwai
- Department of Health Economics, University of Nairobi, Nairobi, Kenya
| | | | - Dickens Akena
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Grace Rota
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Ammon Otieno
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | | | | | | | | | - Dennis Oluoch
- Global Programs for Research and Training, Nairobi, Kenya
| | | | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - James G. Kahn
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - David E. Bukusi
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Rachel L. Burger
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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Mootz JJ, dos Santos PF, dos Santos K, Stith S, Wainberg ML, Oliffe J. Engaging Mozambican men in a couple-based therapy to reduce intimate partner violence and improve mental health: Community stakeholders' perspectives. SSM - MENTAL HEALTH 2024; 5:100297. [PMID: 39055238 PMCID: PMC11270676 DOI: 10.1016/j.ssmmh.2024.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Affiliation(s)
- Jennifer J. Mootz
- Columbia University, Department of Psychiatry, USA
- New York State Psychiatric Institute, USA
| | | | | | - Sandra Stith
- Kansas State University, Couple and Family Therapy Program, USA
| | - Milton L. Wainberg
- Columbia University, Department of Psychiatry, USA
- New York State Psychiatric Institute, USA
| | - John Oliffe
- University of British Columbia, School of Nursing, Canada
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Joko-Fru WY, Bardot A, Bukirwa P, Amidou S, N'da G, Woldetsadik E, Chesumbai G, Korir A, Kamaté B, Koon M, Hansen R, Finesse A, Somdyala N, Chokunonga E, Chigonzoh T, Liu B, Kantelhardt EJ, Parkin DM, Soerjomataram I. Cancer survival in sub-Saharan Africa (SURVCAN-3): a population-based study. Lancet Glob Health 2024; 12:e947-e959. [PMID: 38762297 PMCID: PMC11126368 DOI: 10.1016/s2214-109x(24)00130-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/22/2024] [Accepted: 03/14/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The Cancer Survival in Africa, Asia, and South America project (SURVCAN-3) of the International Agency for Research on Cancer aims to fill gaps in the availability of population-level cancer survival estimates from countries in these regions. Here, we analysed survival for 18 cancers using data from member registries of the African Cancer Registry Network across 11 countries in sub-Saharan Africa. METHODS We included data on patients diagnosed with 18 cancer types between Jan 1, 2005, and Dec 31, 2014, from 13 population-based cancer registries in Cotonou (Benin), Abidjan (CÔte d'Ivoire), Addis Ababa (Ethiopia), Eldoret and Nairobi (Kenya), Bamako (Mali), Mauritius, Namibia, Seychelles, Eastern Cape (South Africa), Kampala (Uganda), and Bulawayo and Harare (Zimbabwe). Patients were followed up until Dec 31, 2018. Patient-level data including cancer topography and morphology, age and date at diagnosis, vital status, and date of death (if applicable) were collected. The follow-up (survival) time was measured from the date of incidence until the date of last contact, the date of death, or until the end of the study, whichever occurred first. We estimated the 1-year, 3-year, and 5-year survival (observed, net, and age-standardised net survival) by sex, cancer type, registry, country, and human development index (HDI). 1-year and 3-year survival data were available for all registries and all cancer sites, whereas availability of 5-year survival data was slightly more variable; thus to provide medium-term survival prospects, we have focused on 3-year survival in the Results section. FINDINGS 10 500 individuals from 13 population-based cancer registries in 11 countries were included in the survival analyses. 9177 (87·4%) of 10 500 cases were morphologically verified. Survival from cancers with a high burden and amenable to prevention was poor: the 3-year age-standardised net survival was 52·3% (95% CI 49·4-55·0) for cervical cancer, 18·1% (11·5-25·9) for liver cancer, and 32·4% (27·5-37·3) for lung cancer. Less than half of the included patients were alive 3 years after a cancer diagnosis for eight cancer types (oral cavity, oesophagus, stomach, larynx, lung, liver, non-Hodgkin lymphoma, and leukaemia). There were differences in survival for some cancers by sex: survival was longer for females with stomach or lung cancer than males with stomach or lung cancer, and longer for males with non-Hodgkin lymphomas than females with non-Hodgkin lymphomas. Survival did not differ by country-level HDI for cancers of the oral cavity, oesophagus, liver, thyroid, and for Hodgkin lymphoma. INTERPRETATION For cancers for which population-level prevention strategies exist, and with relatively poor prognosis, these estimates highlight the urgent need to upscale population-level prevention activities in sub-Saharan Africa. These data are vital for providing the knowledge base for advocacy to improve access to prevention, diagnosis, and care for patients with cancers in sub-Saharan Africa. FUNDING Vital Strategies, the Martin-Luther-University Halle-Wittenberg, and the International Agency for Research on Cancer. TRANSLATIONS For the French and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- W Yvonne Joko-Fru
- The African Cancer Registry Network, Oxford, UK; Department of Medical Genetics, University of Cambridge, Cambridge, UK; Global Health Working Group, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Aude Bardot
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Phiona Bukirwa
- Kampala Cancer Registry, Makerere University School of Medicine, Kampala, Uganda
| | | | - Guy N'da
- Registre des cancers d'Abidjan, Abidjan, Côte d'Ivoire
| | | | - Gladys Chesumbai
- Eldoret Cancer Registry, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | | | - Marvin Koon
- National Cancer Registry of Mauritius, Quatre Bornes, Mauritius
| | | | - Anne Finesse
- National Cancer Registry of Seychelles, Victoria, Seychelles
| | | | - Eric Chokunonga
- Zimbabwe National Cancer Registry, Parirenyatwa Hospital, Harare, Zimbabwe
| | | | - Biying Liu
- The African Cancer Registry Network, Oxford, UK
| | - Eva Johanna Kantelhardt
- Global Health Working Group, Martin-Luther-University Halle-Wittenberg, Halle, Germany; Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Donald Maxwell Parkin
- The African Cancer Registry Network, Oxford, UK; Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France; Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Elkins C, Kokera S, Vumbugwa P, Gavhera J, West KM, Wilson K, Makunike-Chikwinya B, Masimba L, Holec M, Barnhart S, Matinu S, Wassuna B, Feldacker C. "Endless opportunities": A qualitative exploration of facilitators and barriers to scale-up of two-way texting follow-up after voluntary medical male circumcision in Zimbabwe. PLoS One 2024; 19:e0296570. [PMID: 38728277 PMCID: PMC11086850 DOI: 10.1371/journal.pone.0296570] [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: 12/18/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
In Zimbabwe, the ZAZIC consortium employs two-way, text-based (2wT) follow-up to strengthen post-operative care for voluntary medical male circumcision (VMMC). 2wT scaled nationally with evidence of client support and strengthened follow-up. However, 2wT uptake among healthcare providers remains suboptimal. Understanding the gap between mobile health (mHealth) potential for innovation expansion and scale-up realization is critical for 2wT and other mHealth innovations. Therefore, we conducted an exploratory qualitative study with the objective of identifying 2wT program strengths, challenges, and suggestions for scale up as part of routine VMMC services. A total of 16 in-depth interviews (IDIs) with diverse 2wT stakeholders were conducted, including nurses, monitoring & evaluation teams, and technology partners-a combination of perspectives that provide new insights. We used both inductive and deductive coding for thematic analysis. Among 2wT drivers of expansion success, interviewees noted: 2wT care benefits for clients; effective hands-on 2wT training; ease of app use for providers; 2wT saved time and money; and 2wT strengthened client/provider interaction. For 2wT scale-up challenges, staff shortages; network infrastructure constraints; client costs; duplication of paper and electronic reporting; and complexity of digital tools integration. To improve 2wT robustness, respondents suggested: more staff training to offset turnover; making 2wT free for clients; using 2wT to replace paper VMMC reporting; integrating with routine VMMC reporting systems; and expanding 2wT to other health areas. High stakeholder participation in app design, implementation strengthening, and evaluation were appreciated. Several 2wT improvements stemmed from this study, including enrollment of multiple people on one number to account for phone sharing; 2wT inclusion of minors ages 15+; clients provided with $1 to offset SMS costs; and reduced SMS messages to clients. Continued 2wT mentoring for staff, harmonization of 2wT with Ministry e-health data systems, and increased awareness of 2wT's client and provider benefits will help ensure successful 2wT scale-up.
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Affiliation(s)
- Chelsea Elkins
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Sandra Kokera
- Zimbabwe Technical Training and Education Centre for Health (Zim-TTECH), Harare, Zimbabwe
| | - Phiona Vumbugwa
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Zimbabwe Technical Training and Education Centre for Health (Zim-TTECH), Harare, Zimbabwe
| | - Jacqueline Gavhera
- Zimbabwe Technical Training and Education Centre for Health (Zim-TTECH), Harare, Zimbabwe
| | - Kathleen M. West
- Health Systems & Population Health, University of Washington, Seattle, Washington, United States of America
| | - Katherine Wilson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America
| | | | - Lewis Masimba
- Zimbabwe Technical Training and Education Centre for Health (Zim-TTECH), Harare, Zimbabwe
| | - Marrianne Holec
- Department of Global Health, International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America
| | - Scott Barnhart
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Sulemana Matinu
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Caryl Feldacker
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America
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Mokua SN, Ombogo L, Mathu D, Otambo P, Nyandieka L, Onteri SN, Mbuka SJ, Kariuki J, Ahmed I, Wanjihia V, Mutai J, Bukania Z. "For a man to go to hospital, then that would be his last option": A qualitative study exploring men's experiences, perceptions and healthcare needs in the implementation of Universal Health Coverage in Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002925. [PMID: 38713655 DOI: 10.1371/journal.pgph.0002925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/16/2024] [Indexed: 05/09/2024]
Abstract
The achievement of Universal Health Coverage (UHC) requires equitable access and utilization of healthcare services across all population groups, including men. However, men often face unique barriers that impede their engagement with health systems which are influenced by a myriad of socio-cultural, economic, and systemic factors. Therefore, understanding men's perspectives and experiences is crucial to identifying barriers and facilitators to their healthcare-seeking behaviour under UHC initiatives. This qualitative study sought to explore men's perceptions, experiences, healthcare needs and potential strategies to inform an impartial implementation of Universal Health Coverage (UHC) in Kenya. The study employed a qualitative research design to investigate men's healthcare experiences in 12 counties across Kenya. Thirty focus group discussions involving 296 male participants were conducted. Men were purposively selected and mobilized through the support of health facility-in-charges, public health officers, and community health extension workers. Data was coded according to emergent views and further categorized thematically into three main domains (1) Perspectives and experiences of healthcare access (2) Socio-cultural beliefs and societal expectations (3) Desires and expectations of health systems. Findings revealed complex sociocultural, economic, and health system factors that influenced men's healthcare experiences and needs which included: masculinity norms and gender roles, financial constraints and perceived unaffordability of services, lack of male-friendly and gender-responsive healthcare services, confidentiality concerns, and limited health literacy and awareness about available UHC services. Our study has revealed a disconnect between men's needs and the current healthcare system. The expectations concerning masculinity further exacerbate the problem and exclude men further hindering men's ability to receive appropriate care. This data provides important considerations for the development of comprehensive and gender-transformative approaches challenging harmful masculine norms, pushing for financial risk protection mechanisms and gender-responsive healthcare delivery attuned to the unique needs and preferences of men.
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Affiliation(s)
- Sharon N Mokua
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lorraine Ombogo
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - David Mathu
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Prisca Otambo
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lilian Nyandieka
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Stephen N Onteri
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Schiller J Mbuka
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - James Kariuki
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Ismail Ahmed
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Violet Wanjihia
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Joseph Mutai
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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Donkor A, Adotey PN, Ofori EO, Ayitey JA, Ferguson C, Luckett T, Vanderpuye V, Osei-Bonsu EB, Phelan C, Hunt K. Prevalence of Preferences for End-of-Life Place of Care and Death Among Patients With Cancer in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. JCO Glob Oncol 2024; 10:e2400014. [PMID: 38815191 DOI: 10.1200/go.24.00014] [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: 01/08/2024] [Revised: 02/18/2024] [Accepted: 03/22/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE There is limited information on preferences for place of care and death among patients with cancer in low- and middle-income countries (LMICs). The aim was to report the prevalence and determinants of preferences for end-of-life place of care and death among patients with cancer in LMICs and identify concordance between the preferred and actual place of death. METHODS Systematic review and meta-analysis guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted. Four electronic databases were searched to identify studies of any design that reported on the preferred and actual place of care and death of patients with cancer in LMICs. A random-effects meta-analysis estimated pooled prevalences, with 95% CI, with subgroup analyses for region and risk of bias. RESULTS Thirteen studies were included. Of 3,837 patients with cancer, 62% (95% CI, 49 to 75) preferred to die at home; however, the prevalence of actual home death was 37% (95% CI, 13 to 60). Subgroup analyses found that preferences for home as place of death varied from 55% (95% CI, 41 to 69) for Asia to 64% (95% CI, 57 to 71) for South America and 72% (95% CI, 48 to 97) for Africa. The concordance between the preferred and actual place of death was 48% (95% CI, 41 to 55) for South Africa and 92% (95% CI, 88 to 95) for Malaysia. Factors associated with an increased likelihood of preferred home death included performance status and patients with breast cancer. CONCLUSION There is very little literature from LMICs on the preferences for end-of-life place of care and death among patients with cancer. Rigorous research is needed to help understand how preferences of patients with cancer change during their journey through cancer.
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Affiliation(s)
- Andrew Donkor
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Prince Nyansah Adotey
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Esther Oparebea Ofori
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jennifer Akyen Ayitey
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Caleb Ferguson
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Verna Vanderpuye
- National Centre for Radiotherapy Oncology Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Caroline Phelan
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Katherine Hunt
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
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Nardell MF, Govathson‐Mandimika C, Garnier S, Watts A, Babalola D, Ngcobo N, Long L, Lurie MN, Miot J, Pascoe S, Katz IT. "Emotional stress is more detrimental than the virus itself": A qualitative study to understand HIV testing and pre-exposure prophylaxis (PrEP) use among internal migrant men in South Africa. J Int AIDS Soc 2024; 27:e26225. [PMID: 38462755 PMCID: PMC10935710 DOI: 10.1002/jia2.26225] [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: 08/22/2023] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION South Africa has one of the highest rates of internal migration on the continent, largely comprised of men seeking labour in urban centres. South African men who move within the country (internal migrants) are at higher risk than non-migrant men of acquiring HIV yet are less likely to test or use pre-exposure prophylaxis (PrEP). However, little is known about the mechanisms that link internal migration and challenges engaging in HIV services. METHODS We recruited 30 internal migrant men (born outside Gauteng Province) during August 2022 for in-depth qualitative interviews at two sites in Johannesburg (Gauteng) where migrants may gather, a factories workplace and a homeless shelter. Interviewers used open-ended questions, based in the Theory of Triadic Influence, to explore experiences and challenges with HIV testing and/or PrEP. A mixed deductive inductive content analytic approach was used to review data and explain why participants may or may not use these services. RESULTS Migrant men come to Johannesburg to find work, but unreliable income, daily stress and time constraints limit their availability to seek health services. While awareness of HIV testing is high, the fear of a positive diagnosis often overshadows the benefits. In addition, many men lack knowledge about the opportunity for PrEP should they test negative, though they express interest in the medication after learning about it. Additionally, these men struggle with adjusting to urban life, lack of social support and fear of potential stigma. Finally, the necessity to prioritize work combined with long wait times at clinics further restricts their access to HIV services. Despite these challenges, Johannesburg also presents opportunities for HIV services for migrant men, such as greater anonymity and availability of HIV information and services in the city as compared to their rural homes of origin. CONCLUSIONS Bringing HIV services to migrant men at community sites may ease the burden of accessing these services. Including PrEP counselling and services alongside HIV testing may further encourage men to test, particularly if integrated into counselling for livelihood and coping strategies, as well as support for navigating health services in Johannesburg.
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Affiliation(s)
- Maria Francesca Nardell
- Division of Global Health EquityBrigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Caroline Govathson‐Mandimika
- Health Economics and Epidemiology Research Office (HE2RO)JohannesburgSouth Africa
- Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | | | - Nkosinathi Ngcobo
- Health Economics and Epidemiology Research Office (HE2RO)JohannesburgSouth Africa
- Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office (HE2RO)JohannesburgSouth Africa
- Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Global HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Mark N. Lurie
- Brown University School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Jacqui Miot
- Health Economics and Epidemiology Research Office (HE2RO)JohannesburgSouth Africa
- Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sophie Pascoe
- Health Economics and Epidemiology Research Office (HE2RO)JohannesburgSouth Africa
- Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Ingrid T. Katz
- Harvard Medical SchoolBostonMassachusettsUSA
- Division of Women's HealthBrigham and Women's HospitalBostonMassachusettsUSA
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10
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Eze II, Okeke C, Ekwueme C, Mbachu CO, Onwujekwe O. Acceptability of a community-embedded intervention for improving adolescent sexual and reproductive health in south-east Nigeria: A qualitative study. PLoS One 2023; 18:e0295762. [PMID: 38096148 PMCID: PMC10721091 DOI: 10.1371/journal.pone.0295762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Adolescents have limited access to quality sexual and reproductive health (SRH) services that are key to healthy sexual lives in many low and middle-income countries such as Nigeria. Hence, context-specific interventions are required to increase adolescents' access to and utilisation of SRH. This paper provides new knowledge on the acceptability of a community-embedded intervention to improve access to SRH information and services for adolescents in Ebonyi state, southeast Nigeria. METHODS A community-embedded intervention was implemented for six months in selected communities. Thereafter the intervention was assessed for its acceptability using a total of 30 in-depth interviews and 18 focus group discussions conducted with policymakers, health service providers, school teachers, community gatekeepers, parents and adolescents who were purposively selected as relevant stakeholders on adolescent SRH. The interview transcripts were coded in NVivo 12 using a coding framework structured according to four key constructs of the theoretical framework for acceptability (TFA): affective attitude, intervention coherence, perceived effectiveness, and self-efficacy. The outputs of the coded transcripts were analysed, and the emergent themes from each of the four constructs of the TFA were identified. RESULTS The intervention was acceptable to the stakeholders, from the findings of its positive effects, appropriateness, and positive impact on sexual behaviour. Policymakers were happy to be included in collaborating with multiple stakeholders to co-create multi-faceted interventions relevant to their work (positive affective attitude). The stakeholders understood how the interventions work and perceived them as appropriate at individual and community levels, with adequate and non-complex tools adaptable to different levels of stakeholders (intervention coherence). The intervention promoted mutualistic relations across stakeholders and sectors, including creating multiple platforms to reach the target audience, positive change in sexual behaviour, and cross-learning among policymakers, community gatekeepers, service providers, and adolescents (intervention effectiveness), which empowered them to have the confidence to provide and access SRH information and services (self-efficacy). CONCLUSIONS Community-embedded interventions were acceptable as strong mechanisms for improving adolescents' access to SRH in the communities. Policymakers should promote the community-embedded strategy for holistic health promotion of adolescents.
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Affiliation(s)
- Irene Ifeyinwa Eze
- Department of Community Medicine, College of Health Sciences Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Chinyere Okeke
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, College of Health Sciences, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Chinazom Ekwueme
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, College of Health Sciences, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Chinyere Ojiugo Mbachu
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, College of Health Sciences, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
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11
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Ringwald B, Mwiine AA, Chikovore J, Makanda G, Amoah-Larbi J, Millington KA, Horton KC. Ending TB means responding to socially produced vulnerabilities of all genders. BMJ Glob Health 2023; 8:e014151. [PMID: 38070882 PMCID: PMC10728965 DOI: 10.1136/bmjgh-2023-014151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Beate Ringwald
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Amon Ashaba Mwiine
- School of Women and Gender Studies, Makerere University, Kampala, Uganda
| | - Jeremiah Chikovore
- Public Health, Societies and Belonging, Human Sciences Research Council, Durban, South Africa
| | | | | | - Kerry A Millington
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Katherine C Horton
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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12
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dos Santos FV, Rodrigues ILA, Nogueira LMV, de Andrade EGR, Soares AS, de Andrade ÉFR. Knowledge and practices about health among Quilombola men: contributions to health care. Rev Bras Enferm 2023; 76Suppl 2:e20230138. [PMID: 38088663 PMCID: PMC10706987 DOI: 10.1590/0034-7167-2023-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/09/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE to analyze health knowledge and practices among Quilombola men. METHODS a qualitative, descriptive study, carried out with 40 men from two Quilombola communities in Santa Izabel do Pará, state of Pará, Brazil. Individual interviews were carried out using a semi-structured script. Text corpus was subjected to analysis with Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires 0.6, alpha 3, through Descending Hierarchical Classification. RESULTS among participants, eight (20.00%) were aged 55 to 59 years. 382 text segments were identified, with 299 (78.27%) being used, generating five lexical classes, which made up two subcorpora. The classes were organized into four thematic axes, covering knowledge about health and practices to prevent and solve health problems. FINAL CONSIDERATIONS men highlighted popular/traditional wisdom permeated by biomedical knowledge, translating their understanding of how to act to remain or become healthy.
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13
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Baker P, Leon N, Colvin CJ, Griffith DM. Health policies must consider gender, including men. Lancet Glob Health 2023; 11:e1847-e1848. [PMID: 37973331 DOI: 10.1016/s2214-109x(23)00428-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Peter Baker
- Global Action on Men's Health, London SE1 4YR, UK.
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Christopher J Colvin
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Derek M Griffith
- Global Action on Men's Health, London SE1 4YR, UK; Center for Men's Health Equity, Racial Justice Institute, Georgetown University, Washington, DC, USA
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14
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Nguyen Hoai B, Hoang L, Nguyen Cao T, Pham Minh Q, A Jannini E. Testosterone and aging male, a perspective from a developing country. Aging Male 2023; 26:2223712. [PMID: 37335039 DOI: 10.1080/13685538.2023.2223712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE Hypogonadism is associated with a wide range of physical and psychological symptoms that can affect the overall health of men. However, in a developing country, there are several imposing challenges in the diagnosis and treatment of hypogonadism, including a lack of awareness and understanding of the condition among healthcare providers and patients, limited resources and the high cost of treatment. This review aimed to examine the potential benefits and risks of testosterone replacement therapy (TRT) and provides a perspective of a developing country on the topic. MATERIALS AND METHODS A comprehensive literature review was conducted to gather relevant information on the impact of testosterone deficiency on ageing males and the effectiveness of TRT for treating hypogonadism. Published peer-reviewed articles were analyzed to evaluate the benefits and risks of TRT. Additionally, the unique challenges faced in the diagnosis and treatment of hypogonadism in a developing country were considered. RESULTS Testosterone replacement therapy has been shown to be an effective treatment for hypogonadism, particularly in symptomatic men with low testosterone levels. It offers potential benefits such as improvements in symptoms and overall quality of life. However, there are associated risks and side effects that need to be considered. In a developing country, challenges such as limited awareness and understanding of hypogonadism, resource constraints, and high treatment costs pose additional barriers to accessing TRT and comprehensive care. CONCLUSION In conclusion, TRT holds promise as a treatment for hypogonadism, but its implementation and accessibility face significant challenges in a developing country. Addressing these challenges, including raising awareness, allocating resources, and finding cost-effective solutions, is crucial for ensuring that men with hypogonadism in such settings receive appropriate diagnosis and treatment. Further research and efforts are needed to improve the management of hypogonadism in developing countries and optimize the potential benefits of TRT for affected individuals.
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Affiliation(s)
- Bac Nguyen Hoai
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Long Hoang
- Department of Urology, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Thang Nguyen Cao
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Quan Pham Minh
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Emmanuele A Jannini
- Chair of Endocrinology and Sexual Medicine (ENDOSEX), University of Rome Tor Vergata, Rome, Italy
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15
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Sawalma M, Shalash A, Wahdan Y, Nemer M, Khalawi H, Hijazi B, Abu-Rmeileh N. Sexual and reproductive health interventions geared toward adolescent males: A scoping review. J Pediatr Nurs 2023; 73:e19-e26. [PMID: 37474422 DOI: 10.1016/j.pedn.2023.07.004] [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: 02/27/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
PROBLEM Male adolescent sexual and reproductive health (SRH) interventions are rare worldwide. The high prevalence of sexually transmitted infections and pregnancies among female and male adolescents worldwide highlights the need for comprehensive interventions that include both genders in the educational process. OBJECTIVE Our main focus is studying and analysing male-focused SRH interventions globally to include males in evidence-based interventions that improve SRH of adolescent males. ELIGIBILITY CRITERIA This Review was conducted using the PRISMA extension for scoping reviews. The following databases were searched: PubMed, Embase, Web of science, Scopus, CINAHL and PsycInfo. INCLUSION CRITERIA 1) No time or date limits; 2)all types of studies; 3)SRH campaign; 4)males; 5)10 to 19 years. SAMPLE Five thousand and sixty-eight articles were identified and 166 peer-reviewed articles met the inclusion criteria. RESULTS Family planning was identified as the primary domain covered for adolescents. While interactive activities was the most common method used to deliver information to adolescents about sexual health. SRH interventions for males were most prevalent in America. While in the Eastern Mediterranean region (EMR), no male interventions were found in our review. CONCLUSION This scoping review emphasizes the need to include adolescent males in sexual and reproductive health interventions, particularly in low- and middle-income countries (LMICs) and the EMR. Policymakers should develop comprehensive programs that address male-specific needs, improve training for intervention providers, and enhance reporting processes to identify gaps and barriers to male inclusion. IMPLICATION Future research should be directed toward the obstacles that prevent SRH interventions targeting males from being carried out.
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Affiliation(s)
- Mariam Sawalma
- Institute of Community and Public Health, Birzeit University, Palestine.
| | - Aisha Shalash
- Institute of Community and Public Health, Birzeit University, Palestine; School of Medicine, University of Limerick, Limerick, Ireland.
| | - Yasmeen Wahdan
- Institute of Community and Public Health, Birzeit University, Palestine
| | - Maysaa Nemer
- Institute of Community and Public Health, Birzeit University, Palestine.
| | - Hala Khalawi
- The Department of Social Sciences, Bethlehem University, Palestine
| | | | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Palestine.
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Zielke J, Batram-Zantvoort S, Razum O, Miani C. Operationalising masculinities in theories and practices of gender-transformative health interventions: a scoping review. Int J Equity Health 2023; 22:139. [PMID: 37501204 PMCID: PMC10375736 DOI: 10.1186/s12939-023-01955-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: 05/11/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
Gender-transformative health interventions that involve men and boys are gaining global reach, adaptability to specific geographical, population and epidemiological contexts, public endorsement, and conceptual sophistication. However, the ways in which masculinities are conceptualised and operationalised in theory and practice across these interventions remains unclear. The purpose of this scoping review is to map intervention studies that conceptually grapple with masculinities and analyse: a) how the concept of masculinities is adapted and operationalised in gender-transformative interventions, with respect to intervention population and context, b) what the relationship between the concept of masculinities and its wider theoretical embedding is, and c) on which levels transformation can be observed when working with 'masculinities'.We conducted a search in APA Psych Articles, APA PsycINFO, and CINAHL via EBSCO, MedLine, PubMed, and Web of Sciences (December 2021) looking for peer-reviewed studies on gender-transformative health interventions which engaged with masculinities conceptually. There were no restrictions regarding language, publication date, or geography. Forty-two articles were included in this review. Our abductive analysis finds that 'hegemonic masculinities' is a central concept in almost all included studies. This shows how the concept is adaptable to a range of different intervention contexts. The review further identifies five theoretical approaches, that help operationalise masculinities on an analytical level: feminist framework, affect theory, critical pedagogy, theories of social change, and ecological approaches. Lastly, this review draws out six levels on which transformation can be observed in the intervention outcomes: relational level, symbolic level, material level, affective level, cognitive-behavioural level, and community-structural level. The discussion underlines that processes and practices of (gender) transformation also require engagement with theories of transformation more widely and advocates for theoretical pluralism. Lastly, implications for practice, including preventative, ecological and community-based care models, are drawn out.
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Affiliation(s)
- Julia Zielke
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
- Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), 9 Cr Des Humanités, 93300, Aubervilliers, France
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17
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Muhindo R, Okoboi S, Kiragga A, King R, Arinaitwe WJ, Castelnuovo B. COVID-19 vaccine acceptability, and uptake among people living with HIV in Uganda. PLoS One 2022; 17:e0278692. [PMID: 36459514 PMCID: PMC9718389 DOI: 10.1371/journal.pone.0278692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite being a priority population for COVID-19 vaccination, limited data are available regarding acceptability of COVID-19 vaccines among people living with HIV (PLWH) in Sub-Saharan Africa. We described COVID-19 vaccine acceptability and factors associated with vaccine acceptability among PLWH in Uganda. METHODS This was a cross-sectional study conducted among PLWH, aged ≥18 years, enrolled participants who were seeking HIV care from six purposely selected accredited ART clinics in Kampala. We obtained data on vaccine acceptability defined as willingness to accept any of the available COVID-19 vaccines using interviewer-administered questionnaires. In addition, we assessed vaccination status, complacency regarding COVID-19 disease, vaccine confidence, and vaccine convenience. Factors associated with COVID-19 vaccine acceptability were evaluated using modified Poisson regression with robust standard errors. RESULTS We enrolled 767 participants of whom 485 (63%) were women. The median age was 33 years [interquartile range (IQR) 28-40] for women and 40 years [IQR], (34-47) for men. Of the respondents 534 (69.6%,95% confidence interval [CI]: 66.3%-72.8%) reported receiving at least one vaccine dose, with women significantly more likely than men to have been vaccinated (73% vs. 63%; p = 0.003). Among the unvaccinated 169 (72.7%, 95% CI: 66.6%-78.0%) were willing to accept vaccination, had greater vaccine confidence (85.9% had strong belief that the vaccines were effective; 81.9% that they were beneficial and 71% safe for PLWH; 90.5% had trust in health care professionals or 77.4% top government officials), and believed that it would be easy to obtain a vaccine if one decided to be vaccinated (83.6%). Vaccine acceptability was positively associated with greater vaccine confidence (adjusted prevalence ratio [aPR] 1.44; 95% CI: 1.08-1.90), and positive perception that it would be easy to obtain a vaccine (aPR 1.57; 95% CI: 1.26-1.96). CONCLUSION vaccine acceptance was high among this cohort of PLWH, and was positively associated with greater vaccine confidence, and perceived easiness (convince) to obtained the vaccine. Building vaccine confidence and making vaccines easily accessible should be a priority for vaccination programs targeting PLWH.
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Affiliation(s)
- Richard Muhindo
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Stephen Okoboi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rachel King
- University of California, San Francisco, California, United states of America
| | - Walter Joseph Arinaitwe
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Zielke J, Strong J, Ahmed F, Miani C, Namer Y, Storey S, Razum O. Towards gender-transformative SRHR: a statement in reply to EUPHA and offer of a working definition. Eur J Public Health 2022; 32:668-669. [PMID: 35972449 PMCID: PMC9527956 DOI: 10.1093/eurpub/ckac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Julia Zielke
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Joe Strong
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Furqan Ahmed
- Leibniz-Institut für Präventionsforschung und Epidemiologie, Universität Bremen, Bremen, Germany
| | - Céline Miani
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Yudit Namer
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Simone Storey
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Oliver Razum
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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Tembo M, Renju J, Weiss HA, Dauya E, Gweshe N, Ndlovu P, Nzombe P, Chikwari CD, Mavodza CV, Mackworth-Young CRS, A Ferrand R, Francis SC. Integration of a menstrual health intervention in a community-based sexual and reproductive health service for young people in Zimbabwe: a qualitative acceptability study. BMC Health Serv Res 2022; 22:421. [PMID: 35354445 PMCID: PMC8966602 DOI: 10.1186/s12913-022-07818-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite being fundamental to the health and well-being of women, menstrual health is often overlooked as a health priority and access to menstrual health education, products, and support is limited. Consequently, many young women are unprepared for menarche and face challenges in accessing menstrual health products and support and in managing menstruation in a healthy and dignified way. In this paper, we examine the acceptability of a comprehensive menstrual health and hygiene (MHH) intervention integrated within a community-based sexual and reproductive health (SRH) service for young people aged 16-24 years in Zimbabwe called CHIEDZA. METHODS We conducted focus group discussions, that included participatory drawings, with CHIEDZA healthcare service providers (N = 3) and with young women who had attended CHIEDZA (N = 6) between June to August 2020. Translated transcripts were read for familiarisation and thematic analysis was used to explore acceptability. We applied Sekhon's thematic framework of acceptability that looks at seven key constructs (affective attitudes, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy). Data from FGDs and meeting minutes taken during the study time period were used to triangulate a comprehensive understanding of MHH intervention acceptability. RESULTS The MHH intervention was acceptable to participants as it addressed the severe prevailing lack of access to menstrual health education, products, and support in the communities, and facilitated access to other SRH services on site. In addition to the constructs defined by Sekhon's thematic framework, acceptability was also informed by external contextual factors such as sociocultural norms and the economic environment. Providers highlighted the increased burden in their workload due to demand for MHH products, and how sociocultural beliefs around insertable menstrual products compromising virginity can negatively affect acceptability among young people and community members. CONCLUSIONS MHH interventions are acceptable to young women in community-based settings in Zimbabwe as there is great unmet need for comprehensive MHH support. The integration of MHH in SRH services can serve as a facilitator to female engagement with SRH services. However, it is important to note that contextual external factors can affect the implementation and acceptability of integrated SRH and MHH services within communities. TRIAL REGISTRATION Registry: Clinicaltrials.gov, Registration Number: NCT03719521 , Registration Date: October 25, 2018.
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Affiliation(s)
- Mandikudza Tembo
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK. .,Biomedical Research and Training Institute, Harare, Zimbabwe.
| | - Jenny Renju
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nancy Gweshe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Precious Ndlovu
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Portia Nzombe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Constancia Vimbayi Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Constance R S Mackworth-Young
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanna C Francis
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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Khalid S, Dixon S, Vijayasingham L. The gender responsiveness of social entrepreneurship in health - A review of initiatives by Ashoka fellows. Soc Sci Med 2021; 293:114665. [PMID: 34954676 DOI: 10.1016/j.socscimed.2021.114665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
There are vocal calls to act on the gender-related barriers and inequities in global health. Still, there are gaps in implementing programmes that address and counter the relevant dynamics. As an approach that focuses on social problems and public service delivery gaps, social entrepreneurship has the potential to be a closer health sector partner to tackle and transform the influence of gender in health to achieve health systems goals better. Nevertheless, social entrepreneurs' engagement and impact on gender and health remain understudied. Using the Ashoka Fellows database as a sampling frame in November 2020 (n = 3352, health n = 129), we identified and reviewed the work of 21 organizations that implemented gender-responsive health-related programmes between 2000 and 2020. We applied the UNU-IIGH 6-I Analytic Framework to review the gender issues, interventions, included populations, investments, implementation, and impact in each organization. We found that a low proportion of fellows engage in gender-responsive health programming (<1%). Many organizations operate in low-and middle-income countries (16/21). The gender-responsive programmes include established health sector practices, to address gendered-cultural dynamics and deliver people-centred resources and services. Interestingly, most organizations self-identify as NGOs and rely on traditional grant funding. Fewer organizations (6/21) adopt market-based and income-generating solutions - a missed opportunity to actualise the potential of social entrepreneurship as an innovative health financing approach. There were few publicly available impact evaluations-a gap in practice established in social entrepreneurship. All organizations implemented programmes at community levels, with some cross-sectoral, structural, and policy-level initiatives. Most focused on sexual and reproductive health and gender-based violence for predominantly populations of women and girls. Closer partnerships between social entrepreneurs and gender experts in the health sector can provide reciprocally beneficial solutions for cross-sectorally and community designed innovations, health financing, evidence generation and impact tracking that improve the gender-responsiveness of health programmes, policies, and systems.
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Affiliation(s)
- Shazmin Khalid
- United Nations University International Institute for Global Health, UKM Medical Centre, Jalan Yaacob Latiff, 56000, Kuala Lumpur, Malaysia; School of Business, Monash University Malaysia, Jalan Lagoon Selatan, 46150, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Shrijna Dixon
- United Nations University International Institute for Global Health, UKM Medical Centre, Jalan Yaacob Latiff, 56000, Kuala Lumpur, Malaysia; Rockefeller College of Public Affairs and Policy, University at Albany- State University of New York 1400 Washington Ave, Albany, NY, 12222, USA
| | - Lavanya Vijayasingham
- United Nations University International Institute for Global Health, UKM Medical Centre, Jalan Yaacob Latiff, 56000, Kuala Lumpur, Malaysia.
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