Application of the ecohealth model to translate knowledge into action in the health sciences

Integrated agriculture programs to address malnutrition in northern Malawi

BACKGROUND

In countries where the majority of undernourished people are smallholder farmers, there has been interest in agricultural interventions to improve nutritional outcomes. Addressing gender inequality, however, is a key mechanism by which agriculture can improve nutrition, since women often play a crucial role in farming, food processing and child care, but have limited decision-making and control over agricultural resources. This study examines the approaches by which gender equity in agrarian, resource-poor settings can be improved using a case study in Malawi.

METHODS

A quasi-experimental design with qualitative methods was used to examine the effects of a participatory intervention on gender relations. Thirty married couple households in 19 villages with children under the age of 5 years were interviewed before and then after the intervention. An additional 7 interviews were conducted with key informants, and participant observation was carried out before, during the intervention and afterwards in the communities. The interviews were recorded and transcribed, and analysed qualitatively for key themes, concepts and contradictions.

RESULTS

Several barriers were identified that undermine the quality of child care practices, many linked to gender constructions and norms. The dominant concepts of masculinity created shame and embarrassment if men deviated from these norms, by cooking or caring for their children. The study provided evidence that participatory education supported new masculinities through public performances that encouraged men to take on these new roles. Invoking men's family responsibilities, encouraging new social norms alongside providing new information about different healthy recipes were all pathways by which men developed new 'emergent' masculinities in which they were more involved in cooking and child care. The transformational approach, intergenerational and intra-gendered events, a focus on agriculture and food security, alongside involving male leaders were some of the reasons that respondents named for changed gender norms.

CONCLUSIONS

Participatory education that explicitly addresses hegemonic masculinities related to child nutrition, such as women's roles in child care, can begin to change dominant gender norms. Involving male leaders, participatory methods and integrating agriculture and food security concerns with nutrition appear to be key components in the context of agrarian communities.

Critical examination of knowledge to action models and implications for promoting health equity

Introduction

Knowledge and effective interventions exist to address many current global health inequities. However, there is limited awareness, uptake, and use of knowledge to inform action to improve the health of disadvantaged populations. The gap between knowledge and action to improve health equity is of concern to health researchers and practitioners. This study identifies and critically examines the usefulness of existing knowledge to action models or frameworks for promoting health equity.

Methods

We conducted a scoping review of existing literature to identify knowledge to action (KTA) models or frameworks and critiqued the models using a health equity support rubric.

Results

We identified forty-eight knowledge to action models or frameworks. Six models scored between eight and ten of a maximum 12 points on the health equity support rubric. These high scoring models or frameworks all mentioned equity-related concepts. Attention to multisectoral approaches was the factor most often lacking in the low scoring models. The concepts of knowledge brokering, integrative processes, such as those in some indigenous health research, and Ecohealth applied to KTA all emerged as promising areas.

Conclusions

Existing knowledge to action models or frameworks can help guide knowledge translation to support action on the social determinants of health and health equity. There is a need to further test existing models or frameworks. This process should be informed by participatory and integrative research. There is room to develop more robust equity supporting models.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-015-0178-7) contains supplementary material, which is available to authorized users.

Unravelling the concept of integrated public health policy: Concept mapping with Dutch experts from science, policy, and practice

BACKGROUND

While expectations of integrated public health policy (IPHP) promoting public health are high, assessment is hampered by the concept's ambiguity. This paper aims to contribute to conceptual clarification of IPHP as first step in further measurement development.

METHODS

In an online concept mapping procedure, we invited 237 Dutch experts, 62 of whom generated statements on characteristics of IPHP. Next, 100 experts were invited, 24 of whom sorted the statements into piles according to their perceived similarity and rated the statements on relevance and measurability. Data was analyzed using concept mapping software.

RESULTS

The concept map consisted of 97 statements, grouped into 11 clusters and five themes. Core themes were 'integration', concerning 'policy coherence' and 'organizing connections', and 'health', concerning 'positioning health' and 'addressing determinants'. Peripheral themes were 'generic aspects', 'capacities', and 'goals and setting', which respectively addressed general notions of integrated policy making, conditions for IPHP, and the variety in manifestations of IPHP. Measurability ratings were low compared to relevance.

CONCLUSION

The concept map gives an overview of interrelated themes, distinguishes core from peripheral dimensions, and provides pointers for theories of the policy process. While low measurability ratings indicate measurement difficulties, the core themes provide pointers for systematic insight into IPHP through measurement.