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Dougherty L, Kassegne S, Nagbe R, Babogou J, Peace P, Moussa F, Kirk K, Tokplo H, Ouro-Gnao D, Agbodjan SP, Loll D, Werwie TR, Silva M. A qualitative exploration of how a community engagement approach influences community and health worker perceptions related to family planning service delivery in Togo. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1389716. [PMID: 39021709 PMCID: PMC11251956 DOI: 10.3389/frph.2024.1389716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Background There is a growing body of evidence that asserts community engagement approaches can improve the quality of reproductive health services. Family planning (FP) programs in Togo are implementing such approaches, which aim to mobilize both health workers and communities to improve FP service quality and FP uptake. However, there is not enough known about the enabling factors and challenges associated with implementation, or the extent to which the programs improve outcomes leading to contraceptive uptake. Methods We qualitatively explored how a community engagement approach influenced health worker and community perceptions related to FP service delivery in and around the city of Lomé, Togo, within the context of the broader integration of social and behavior change and service delivery. We conducted 18 in-depth interviews with health workers and 9 focus group discussions with community members. Results We found the approach, which included community dialogues, site walkthrough visits and the development of community action plans, worked synergistically together to support collaborative action between communities and health workers to increase mutual understanding of their collective needs related to FP services. Community members cited improved reception at the health facilities by health workers and indicated that the site walkthrough visits created a greater sense of empathy towards the providers and the challenges faced in their work environment. Health workers acknowledged a greater understanding of barriers at the community level following community dialogues, particularly among community members that are not routinely encountered at the health facility for reproductive health services such as men and youth. We found limited implementation of health facility improvements included in community action plans because they were dependent on commitment from community leadership and the need to mobilize additional support or financial resources. Conclusion Community engagement approaches are a promising mechanism to support collaboration and enhance mutual understanding between health workers and communities to achieve improved FP service quality. Future programs should consider incorporating additional mechanisms to monitor community action plans and provide support to address structural challenges at the facility level particularly those that require financial resources.
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Affiliation(s)
- Leanne Dougherty
- Breakthrough RESEARCH, Population Council, Washington, DC, United States
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Sidamo NB, Kerbo AA, Gidebo KD, Wado YD. Exploring Barriers to Accessing Adolescents Sexual and Reproductive Health Services in South Ethiopia Regional State: A Phenomenological Study Using Levesque's Framework. Adolesc Health Med Ther 2024; 15:45-61. [PMID: 38562442 PMCID: PMC10984202 DOI: 10.2147/ahmt.s455517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Evidence suggests that adolescents face multiple barriers to accessing Sexual and Reproductive Health (SRH) services. However, there remains a notable gap in the literature regarding the nuanced interplay between supply-side and demand-side barriers. Therefore, this study aimed to examine barriers to accessing SRH services in the Gamo Zone of South Ethiopia Regional State. Methods A descriptive phenomenology study was conducted from September 04 to October 15, 2023. A total of seven Focus Group Discussions (FGDs), four with girls and three with boys, with a total of 75 adolescents, and ten Key informant interviews (KIIs)with healthcare providers participated in the study. A semi-structured interview guide was used to explore their lived experiences. All interviews and discussions were audio-recorded. To analyze and manage data framework analysis approach was applied using ATLAS Ti version 7 software. Results The major barriers preventing adolescents from accessing SRH services are related to the interplay between supply and demand-side barriers across all five domains of the Levesque framework. Despite the high need for access to health care, lack of SRH literacy, lack of outreach activities, and integration of SRH information in health facilities often hampered adolescents' healthcare need. Additionally, fear of stigma from family and community, social norms, and lack of discussion of SRH issues hindered their ability to seek health care. Shortage of supplies and healthcare providers' behaviors further hindering adolescents' ability to access health care services. Furthermore, the limited involvement of adolescents in decision-making and the lack of effective coordination further complicate the appropriateness of services for adolescents. Conclusion The finding of this study reveals that adolescents face multifaceted barriers. Therefore, there is a need for high-impact complex interventions, program and policy that address both supply and demand side barriers needs to give due intention to improve access to SRH services for adolescents.
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Affiliation(s)
- Negussie Boti Sidamo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Amene Abebe Kerbo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kassa Daka Gidebo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Achola R, Atuyambe L, Nabiwemba E, Nyashanu M, Garimoi Orach C. Barriers to contraceptive use in humanitarian settings: Experiences of South Sudanese refugee women living in Adjumani district, Uganda; an exploratory qualitative study. PLoS One 2024; 19:e0278731. [PMID: 38427612 PMCID: PMC10906906 DOI: 10.1371/journal.pone.0278731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/22/2023] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION Contraceptive use can be lifesaving, empowering and cost-effective for women and girls. Access to contraception is still challenging to female refugees due to several barriers including language, low educational level, lack of information, influence by family members, limited income, cultural and religious norms. This study explored barriers to contraceptive use among South Sudanese refugee women living in Adjumani district, Uganda. METHODS An exploratory study design using qualitative methods were employed involving women of reproductive age (15-49 years). Purposive sampling was used to select participants for Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) from three settlements in Adjumani district. We conducted four FGDs, each consisting of 8 participants. We also conducted fourteen in-depth interviews (IDIs) with women of reproductive age. The IDI and FGD guides were translated into local languages before they were used to collect data. The interviews were recorded, transcribed verbatim and translated into English. Audio recordings were labeled before being translated back to English. Deductive, team-based coding was implemented, and a codebook developed. Transcripts were entered, and data coded using Atlas ti version 14. Data were analyzed using content analysis to produce the final outputs for the study. RESULTS The study found several challenges to contraceptive use. These included gender dynamics, socially constructed myths on contraceptive use, cultural norms, limited knowledge about contraceptives, men's negative attitudes, antagonism of contraceptive use by leaders and reprisal of women who use contraception. CONCLUSION The study concluded that there is need for community strategies to break down the barriers to contraception utilization among refugee women. Such strategies should involve men and women alongside gatekeepers to enhance sustainability.
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Affiliation(s)
- Roselline Achola
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mathew Nyashanu
- Department of Health & Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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Steyn PS, Boydell V, Contractor S, Cordero JP, Ruano AL. Social accountability and sexual and reproductive health-implications for research and practice. Int J Equity Health 2024; 21:205. [PMID: 38191465 PMCID: PMC10773071 DOI: 10.1186/s12939-023-02081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Affiliation(s)
- Petrus S Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development of Sexual and Research Training in Human Reproduction (HRP Research), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Victoria Boydell
- Institute of Women's Health, University College London, London, UK
| | - Sana Contractor
- Centre for International Health, Institute of Tropical Medicine Antwerp, University of Bergen Norway, Antwerp, Belgium
- COPASAH, New Delhi, India
- The George Institute for Global Health New Delhi, New Delhi, India
| | - Joanna Paula Cordero
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development of Sexual and Research Training in Human Reproduction (HRP Research), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ana Lorena Ruano
- Center for International Health, Department of Global Public Health & Primary Care, University of Bergen, Bergen, Norway
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Topp SM, Tully J, Cummins R, Graham V, Yashadhana A, Elliott L, Taylor S. Building patient trust in health systems: A qualitative study of facework in the context of the Aboriginal and Torres Strait Islander Health Worker role in Queensland, Australia. Soc Sci Med 2022; 302:114984. [PMID: 35523107 DOI: 10.1016/j.socscimed.2022.114984] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/06/2022] [Accepted: 04/17/2022] [Indexed: 10/18/2022]
Abstract
Healthcare services in Australia are the primary responsibility of state and territory governments, which recruit and deploy health providers in hospital and primary-care services. Among the various health professional roles, that of Aboriginal and Torres Strait Islander Health Worker (A&TSIHW) is one of only two positions that must be occupied by an Aboriginal and/or Torres Strait Islander person, carrying unique responsibility for enacting cultural brokerage and promoting cultural safety at the facility-level. Implicit to these responsibilities is the assumption that A&TSIHW will use cultural capital to build clients' trust in themselves and ultimately the broader health system. Drawing on 82 in-depth interviews including 52 with A&TSIHWs, we applied Kroegar's Facework theory to explore the structures, processes and relationships that contribute to, or inhibit, A&TISHWs' capacity and willingness to build trust (beyond themselves) in government health services in Queensland, Australia. Analysis demonstrates that despite A&TSIHWs viewing and enacting interpersonal trust-building as central to their role, structural features of the health system inhibit the development of service-users' system-level trust. Findings re-establish that health systems are not 'cultureless,' but rather, shaped by a dominant culture that privileges certain actors, types of knowledge, and modes of communication and action, which in turn influence efforts to build trust. The study demonstrates a novel theory-driven approach to exploring the interactions between behavioural and structural factors that influence the production of systems-level trust. In the context of the Queensland public health service findings highlight a disconnect between the expectations of, and support provided to A&TISHWs to engage Aboriginal and Torres Strait Islander service-users.
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Affiliation(s)
- Stephanie M Topp
- College of Public Health Medical and Vet Sciences, James Cook University, Australia; Nossal Institute for Global Health, University of Melbourne, Australia.
| | - Josslyn Tully
- Torres and Cape Hospital and Health Service, Queensland, Australia
| | - Rachel Cummins
- College of Public Health Medical and Vet Sciences, James Cook University, Australia
| | - Veronica Graham
- College of Public Health Medical and Vet Sciences, James Cook University, Australia
| | - Aryati Yashadhana
- Centre for Primary Health Care, University of New South Wales, Australia; School of Population Health, University of New South Wales, Australia; School of Social Sciences, University of New South Wales, Australia
| | - Lana Elliott
- College of Public Health Medical and Vet Sciences, James Cook University, Australia; School of Public Health and Social Work, Queensland University of Technology, Australia
| | - Sean Taylor
- NT Health, Darwin, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia
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Arnott G, Otema C, Obalim G, Odallo B, Nakubulwa T, Okello SBT. Human rights-based accountability for sexual and reproductive health and rights in humanitarian settings: Findings from a pilot study in northern Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000836. [PMID: 36962804 PMCID: PMC10021271 DOI: 10.1371/journal.pgph.0000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Ensuring accountability for the realization of sexual and reproductive health and rights is a human rights obligation and central tenet of strategies to improve health systems and outcomes in humanitarian settings. This pilot study explored the feasibility and acceptability of deploying human rights strategies, specifically through a participatory community-led complaints mechanism, to hold humanitarian health systems to account for the sexual and reproductive health and rights of refugee and host community women and girls in northern Uganda. Over a fifteen-month period we conducted a multi-methods exploratory study with refugee and host community rights-holders and duty-bearers using longitudinal in-depth interviews, focus groups, and secondary data document review. Deductive and inductive coding techniques were used to analyze data iteratively for content and themes. 107 sexual and reproductive health and rights related complaints and feedback were collected through the community complaints mechanism. Complaints concerned experiences of disrespect and abuse by health care workers; lack of adolescent access to sexual and reproductive health services and information; sexual and gender-based violence; and lack of access to acceptable and quality health goods and services. Participants reported an increased understanding and claiming of human rights through the intervention, acceptability of rights-based accountability strategies among humanitarian health system actors, and improved access to remedies when sexual and reproductive health rights are not respected. Findings demonstrate integrating rights-based social accountability mechanisms at the level of humanitarian response as a promising approach for strengthening and holding humanitarian health systems accountable for the sexual and reproductive health and rights of women and girls affected by humanitarian situations.
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Affiliation(s)
- Grady Arnott
- Center for Reproductive Rights, Global Legal Program, New York, New York, United States of America
| | - Charles Otema
- CARE International in Uganda, Health Equity and Rights Team, Bugolobi, Kampala, Uganda
| | - Godfrey Obalim
- CARE International in Uganda, Health Equity and Rights Team, Bugolobi, Kampala, Uganda
| | - Beatrice Odallo
- Center for Reproductive Rights, Global Legal Program, Nairobi, Kenya
| | - Teddy Nakubulwa
- CARE International in Uganda, Gender Justice Program, Bugolobi, Kampala, Uganda
| | - Sam B T Okello
- CARE International in Uganda, Gender Justice Program, Bugolobi, Kampala, Uganda
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