Social capital and health--implications for health promotion

Public satisfaction with the Ethiopian healthcare system: a mixed methods approach

Introduction

The satisfaction of the public with the healthcare system of Ethiopia is a crucial but unanswered question. This is an essential issue since recent trends indicate that the demographic and epidemiological makeup of the population is changing. Therefore, the aim of this study was to assess the overall satisfaction of the public with the Ethiopian healthcare system in Addis Ababa, Ethiopia, in 2022.

Methods

A community-based convergent parallel mixed methods study was conducted. Bivariable and multivariable logistic regression analyses were used to determine the factors associated with public satisfaction. A 95% confidence interval along with a p < 0.05 was deemed sufficient to declare a significant association. For the qualitative component, we used thematic analysis.

Results

The vast majority, 77.2% (95% CI: 76.18-78.22%), of respondents were dissatisfied with the existing healthcare system. Moreover, Community-Based Health Insurance (CBHI) enrollment (2.35; 95% CI: 1.32-4.19), poor linkage to social capital (0.46; 95% CI: 0.25-0.83), poor access to healthcare services (0.39; 95% CI: 0.21-0.76), and absence of satisfactory responses to complaints (0.11; 95% CI: 0.04-0.27) were significantly associated with public dissatisfaction.

Conclusion

Public satisfaction with the Ethiopian healthcare system is notably low and is affected by various factors, including enrollment in the CBHI, linkage to social capital, accessibility to healthcare, and satisfactory response to issues. Therefore, the Ethiopian government should focus on expanding CBHI coverage, improving access to healthcare services, and developing an immediate compliant solution strategy.

Association of social capital and adherence to a Mediterranean diet in adults living in Tehran: a cross-sectional study

BACKGROUND

Understanding the role of social capital in adherence to the Mediterranean diet can inform interventions to promote healthier eating habits in Iranian adults.

METHODS

This was a cross-sectional study. Dietary intake was assessed using a 168-item semi-quantitative food frequency questionnaire. Adherence to the Mediterranean diet was measured by the Mediterranean diet score (MDS), ranging from 0 to 18. The Social Capital Questionnaire (SCQ), in which questions are scored on a 4-point Likert scale from "never" (= 1) to "always" (= 4), was used. Linear regression controlling for sex, age, marital status, BMI, education, lifestyle and chronic diseases (diabetes, hypertension, dyslipidemia and cardiovascular diseases) and energy intake was used to calculate unstandardized coefficients (B) and 95% CIs. A total of 270 adults with a mean age of 36.76 ± 13.22 years who lived in Tehran were enrolled.

RESULTS

270 adults (118 males and 152 females) were included. Multivariate-adjusted B showed a positive association between social capital and adherence to a Mediterranean diet (β ± SE = 0.54 ± 0.15, 95% CI = 0.24, 0.84 P = 0.001). Adding energy intake as a new covariate in Model 3 was not accompanied by an enormous change (β ± SE = 0.55 ± 0.15, 95% CI = 0.24, 0.85 P ˂0.001).

CONCLUSION

This cross-sectional study indicated that better social capital in adults is significantly associated with greater adherence to a Mediterranean diet. We suggest that future studies investigate this association in larger sample sizes.

"It's another gay disease": an intersectional qualitative approach contextualizing the lived experiences of young gay, bisexual, and other sexual minoritized men in the United States during the mpox outbreak

BACKGROUND

The U.S. mpox outbreak in 2022 introduced new and exacerbated existing challenges that disproportionately stigmatize gay, bisexual, and other sexual minoritized men (GBSMM). This study contextualizes the perceptions, susceptibility, and lived experiences of the mpox outbreak among GBSMM in the U.S. using an intersectional framework.

METHODS

Between September 2022 to February 2023, we conducted 33 semi-structured qualitative interviews with purposively sampled GBSMM in the Northeast and the South region of the United States on various aspects related to their experience during the mpox outbreak.

RESULTS

We identified four themes: (1) understanding and conceptualizations of mpox, (2) mpox vaccine availability and accessibility, (3) mpox vaccine hesitancy and mistrust, and (4) call to action and recommendations. GBSMM collectively discussed the elevated mpox stigmatization and homophobic discourse from mainstream social media and news outlets. GBSMM also discussed the lack of availability of mpox vaccines, unclear procedures to receive the vaccine, and continued mistrust in government, non-government, and other institutions of health that were complicit in anti-LGBTQ + narratives related to mpox. However, they expressed that these challenges may be addressed through more LGTBQ + representation and leveraging ways to empower these communities.

CONCLUSION

GBSMM have mpox experiences that are distinct and multifaceted. Effectively addressing mpox and mitigating public health emergencies for GBSMM requires prioritizing destigmatizing communication channels and vaccine distribution strategies by centering their stories and lived experiences to advance health equity.

Exposure to mass media chronic health campaign messages and the uptake of non-communicable disease screening in Ghana

The main goal of this study was to examine the relationship between exposure to mass media health campaign massages and the uptake of non-communicable diseases (NCDs) screening services in Ghana and whether this relationship differs by place of residence. Available evidence suggests a general low uptake of NCDs screening in developing country settings. Unfortunately, many NCDs evolve very slowly and are consequently difficult to detect early especially in situations where people do not screen regularly and in settings where awareness is low. In this study, we contribute to understanding the potential role of the media in scaling up NCDs screening in developing countries. We fitted multivariate logistic regression models to a sample of 1337 individual surveys which were collected at the neighborhood level in three Ghanaian cities. Overall, the results show that exposure to mass media chronic NCD health campaign messages was significantly associated with increased likelihood of screening for NCDs. The results further highlight neighborhood-level disparities in the uptake of NCDs screening services as residents of low-income and deprived neighborhoods were significantly less likely to report being screened for NCDs. Other factors including social capital, knowledge about the causes of NCDs and self-rated health predicted the likelihood of chronic NCDs screening. The results demonstrate mass media can be an important tool for scaling up NCDs screening services in Ghana and similar contexts where awareness might be low. However, place-based disparities need to be addressed.

Social capital and health beliefs: Exploring the effect of bridging and bonding social capital on health locus of control among women in Dhaka

This cross-sectional study examined if social capital affects women's health attributions. The study used the Internet Social Capital Scale (ISCS) and Multidimensional Health Locus of Control (MHLC) Scale to measure Social Capital and Health Locus of Control. A predefined 38-item questionnaire was used to survey 485 purposively selected women. A bidirectional reciprocal structural equation model was used to measure the covariance between Social Capital and Health Locus of Control. We hypothesized that women with strong social capital, particularly those rich in bridging ties, would exhibit a greater sense of agency and empowerment over their health, attributing their health outcomes less to internal factors like fate and more to external influences like powerful others and broader social support. However, we found that when women have higher social capital, their external health locus of control increases. Bridging and bonding social capital lower women's internal health control, but bridging social capital leads to higher attributes to powerful others. Likewise, we expected women with more social capital would exhibit a lower perception of uncontrollability over their health, but is not the case. The findings underscore the necessity for women to have more social capital.

Perceptions and beliefs of community gatekeepers about genomic risk information in African cleft research

BACKGROUND

A fundamental ethical issue in African genomics research is how socio-cultural factors impact perspectives, acceptance, and utility of genomic information, especially in stigmatizing conditions like orofacial clefts (OFCs). Previous research has shown that gatekeepers (e.g., religious, political, family or community leaders) wield considerable influence on the decision-making capabilities of their members, including health issues. Thus, their perspectives can inform the design of engagement strategies and increase exposure to the benefits of genomics testing/research. This is especially important for Africans underrepresented in genomic research. Our study aims to investigate the perspectives of gatekeepers concerning genomic risk information (GRI) in the presence of OFCs in a sub-Saharan African cohort.

METHODS

Twenty-five focus group discussions (FGDs) consisting of 214 gatekeepers (religious, community, ethnic leaders, and traditional birth attendants) in Lagos, Nigeria, explored the opinions of participants on genomic risk information (GRI), OFC experience, and the possibility of involvement in collaborative decision-making in Lagos, Nigeria. Transcripts generated from audio recordings were coded and analyzed in NVivo using thematic analysis.

RESULTS

Three main themes-knowledge, beliefs, and willingness to act-emerged from exploring the perspective of gatekeepers about GRI in this group. We observed mixed opinions regarding the acceptance of GRI. Many participants believed their role is to guide and support members when they receive results; this is based on the level of trust their members have in them. However, participants felt they would need to be trained by medical experts to do this. Also, religious and cultural beliefs were crucial to determining participants' understanding of OFCs and the acceptance and utilization of GRI.

CONCLUSIONS

Incorporating cultural sensitivity into public engagement could help develop appropriate strategies to manage conflicting ideologies surrounding genomic information in African communities. This will allow for more widespread access to the advances in genomics research in underrepresented populations. We also recommend a synergistic relationship between community health specialists/scientists, and community leaders, including spiritual providers to better understand and utilize GRI.

How do urban green spaces influence heat-related mortality in elderly? A realist synthesis

BACKGROUND

An important consequence of climate change for urban health is heat-related mortality. Vulnerable groups, especially elderly, will be the most affected. A solution put forward in many reports and policy documents is the introduction or expansion of urban green spaces. While they have a proven effect in decreasing the ambient temperature and reducing heat related mortality, the causal pathways are far from clear. Moreover, results vary for different contexts, population types and characteristics of green spaces as they are 'complex systems thrusted into complex systems'. To our knowledge, there is no systematic synthesis of the literature that examines the mechanisms by which and the circumstances under which green spaces work to decrease heat-related mortality for elderly.

METHODS

We performed a realist synthesis- a theory-driven review method- to develop a complexity- and context-sensitive program theory. As a first step, a causal loop diagram was constructed which describes the possible pathways through which urban green spaces influence heat-related mortality in elderly. In a second step, one of the pathways - how they may lead to a reduction of heat-related mortality by increasing social capital - was further explored for underlying mechanisms, the context in which they work and the differentiated patterns of outcomes they generate. Literature was searched for evidence supporting or contradicting the initial programme theory, resulting in a refined theory.

RESULTS

Results show how urban green space can impact on heat-related mortality in elderly by its influence on their exposure to outdoor and indoor heat, by improving their resilience as well as by affecting their access to treatment. Urban green spaces and their interactions with social capital affect the access to health information, social support, and the capacity for effective lobbying. Several mechanisms help to explain these observed demi-regularities, among others perceived behavioural control, perceived usefulness, receptiveness, ontological security, and self-interest. If and how they are triggered depends on the characteristics of the urban green space, the population, and other contextual factors.

CONCLUSION

Looking into the impact of urban green spaces on heat-related mortality in elderly, researchers and policy makers should take interest in the role of social capital.

Unravelling the nexus of microfinance and women's non-communicable disease (NCD) health outcomes in Sri Lanka: An exploratory study

ABSTRACTNon-communicable diseases (NCDs) are a major contributor to the global burden of disease, increasingly impacting low-income and marginalised populations in low- and middle-income countries such as Sri Lanka. Microfinance could be a potential approach to target NCDs. Using an ethnographic approach with thematic analysis, this study explored the nexus between microfinance and NCD outcomes. In-depth interviews were conducted with 29 micro-loan borrowing women across 15 field sites within Puttalam district in Sri Lanka. The findings revealed that perceived increases in income from microfinance loans contributed to enhanced household health savings ability, enabling the purchase of medicines bought out-of-pocket and from privately owned pharmacies, and spending for NCD-relevant health emergencies and health-related transportation. Additionally, perceived income increases also influenced the behavioural risks, including the spending and consumption of food, and physical activity levels, both positively and negatively. The microfinance networks also influenced women's perceived social support, psychological stress and coping mechanisms, and health information transmission, positively and negatively. The findings from this study provide important insights on how financial inclusion programs such as microfinance influence the health determinants and outcomes relevant to NCDs. This can help address ways to target both NCDs and inequities of socioeconomically disadvantaged and marginalised populations, particularly women.

More than mateship: exploring how Australian male expatriates, longer-term and frequent travellers experience social support

PURPOSE

Those travelling overseas for work or leisure including male expatriates, longer-term and frequent travellers (ELoFTs) may be at heightened risk for a range of health and wellbeing issues. Social support may mediate this risk. However, from a public health perspective, little is written about how ELoFTs access health information and support and the role of their social networks in facilitating health and wellbeing outcomes. This research was part of a study examining social network processes of Australian male ELoFTs travelling, living, or working in Southeast Asia (SEA).

METHODS

Symbolic Interactionism and Grounded Theory were the conceptual framework and methodology supporting semi-structured, in-depth interviews (n = 25) conducted in Australia and Thailand with Australian male ELoFTs to SEA, aged 18 years or older.

RESULTS

Findings highlight supports that assist ELoFT transition and adjustment to country of destination or manage their transnational experience. Influential places, people, and points in the migration journey mediated engagement with social support.

CONCLUSIONS

ELoFT social networks and the support provided within them may provide a mechanism for intervention across a range of public health issues. Findings may support the development of policy and practice across industries charged with supporting successful ELoFT adjustment.

Female community health volunteers' experience in navigating social context while providing basic diabetes services in western Nepal: Social capital and beyond from systems thinking

The global burden of non-communicable diseases (NCDs) has led to an increased mobilization of community health workers (CHWs) in the prevention and management of NCDs, particularly in resource-poor settings. However, little is known about the experiences of CHWs as they navigate the complex social context while proving home-based NCD management. This study aims to explore the experiences of female community health volunteers (FCHVs) in a community-based pilot project in western Nepal, specially regarding the social challenges they face while delivering basic type 2 diabetes (T2D) services. Using a qualitative phenomenological approach, the study conducted two focus group discussions and nine in-depth interviews with a total of 14 and 9 FCHVs, respectively. Social Capital theory was employed to understand the sociological aspects. The findings shed light on the challenges encountered by FCHVs in expanding their social networks, building trust, and fostering reciprocity among T2D intervention recepients. Notably, social trust was a significant challenge, compounded by power dynamics related to gender and socioeconomic status. FCHVs managed to overcome these challenges through their perseverance, self-motivation, and leaveraging their strong bonding and linking social capital. The recognition they received from the community played a crucial role in sustaining their motivation. The study highlights the importance of FCHVs' strong social capital, supported by available resources and personal motivation, in overcoming social obstacles. It is imperative for community health interventions to anticipate challenges across various elements of social capital to ensure the long-term retention and motivation of CHWs. Establishing appropriate support systems that address personal motivating factors and the strengthen social capital is essential.

What Are Healthy Societies? A Thematic Analysis of Relevant Conceptual Frameworks

BACKGROUND

While support for the idea of fostering healthy societies is longstanding, there is a gap in the literature on what they are, how to beget them, and how experience might inform future efforts. This paper explores developments since Alma Ata (1978) to understand how a range of related concepts and fields inform approaches to healthy societies and to develop a model to help conceptualize future research and policy initiatives.

METHODS

Drawing on 68 purposively selected documents, including political declarations, commission and agency reports, peer-reviewed papers and guidance notes, we undertook qualitative thematic analysis. Three independent researchers compiled and categorised themes describing the domains of a potential healthy societies approach.

RESULTS

The literature provides numerous frameworks. Some of these frameworks promote alternative endpoints to development, eschewing short-term economic growth in favour of health, equity, well-being and sustainability. They also identify values, such as gender equality, collaboration, human rights and empowerment that provide the pathways to, or underpin, such endpoints. We categorize the literature into four "components": people; places; products; and planet. People refers to social positions, interactions and networks creating well-being. Places are physical environments-built and natural-and the interests and policies shaping them. Products are commodities and commercial practices impacting population health. Planet places human health in the context of the 'Anthropocene.' These components interact in complex ways across global, regional, country and community levels as outlined in our heuristic.

CONCLUSION

The literature offers little critical reflection on why greater progress has not been made, or on the need to organise and resist the prevailing systems which perpetuate ill-health.

Cognitive social capital as a health-enabling factor for STI testing among young men in Stockholm, Sweden: A cross-sectional population-based study

Objective

To assess whether different forms of cognitive social capital increased the relative probability of testing for sexually transmitted infections (STIs) among young men living in Stockholm, Sweden.

Methods

A population-based cross-sectional study was conducted in 2017 with men aged 20-29 years living in Stockholm County, Sweden (n = 523). The main outcome was STI testing patterns (never tested, tested only within a12-monthperiod, tested only beyond a12-monthperiod, repeatedly tested). The main exposure were two forms of cognitive social capital: social support (having received help, having someone to share inner feelings with) and institutionalized trust (in school, healthcare, media). Data were analyzed using weighted multivariable multinomial logistic regression to obtain adjusted weighted relative probability ratio (aRPR).

Results

After adjusting for confounding factors, receiving help (aRPR: 5.2, 95% CI: 1.7-16.2) and having someone to share inner feelings with (aRPR: 3.1, 95% CI: 1.2-7.7) increased the relative probabilities of young men testing for STIs, but only for those testing beyond a 12-month period. Trust in media increased the relative probability of STI testing for those testing only within a 12-month period (aRPR: 2.6, 95% CI: 1.1-6.1) and for those testing repeatedly (aRPR: 3.6, 95% CI: 1.5-8.8).

Conclusion

Young men in Stockholm County exhibit distinct STI testing patterns. Social support and trust in media were factors that increased the probability of being tested for STIs, with this effect varying according to the young men's STI testing pattern. Further studies are required to explore how trust in media might promote STI testing in this population.

Media exposure, trustworthiness of sources and the health information literacy knowledge gap: a study in China

Health information literacy (HIL), as an essential part of the wellbeing of citizens, is a crucial indicator used to measure a country's primary public health level. The present study collected 1051 samples in southern China to examine the factors predicting HIL. The results showed that males, those less educated, and older adults had lower HIL. Television exposure, unofficial Internet exposure, trust in government and trust in doctors and medical institutions were positively associated with HIL. In contrast, newspapers, radio exposure and trust in web celebrities were negatively associated with HIL. Official Internet media exposure helps to bridge the HIL knowledge gap generated by differences in education level, while trust in celebrities-especially web celebrities-could widen the HIL knowledge gap. This study extends the knowledge gap theory in health communication in the Chinese context and provides pathways for future health interventions.

Trend of Correlations between Psychological Symptoms and Socioeconomic Inequalities among Italian Adolescents: Cross-Sectional Study from 2006 to 2018 in Tuscany Region

Adolescence is a critical moment in life; people become individuals, create new relationships, develop social skills and learn behaviours that they will use for the rest of their lives. During this phase, adolescents establish patterns of behaviour that can protect their health. This study aims to 1. assess the presence of psychological disorders in adolescents of both genders, 2. determine their relation to socio-economic differences based on the Family Affluence Scale (FAS), and 3. assess trends from 2006 to 2018. Data were collected from the Italian Health Behaviour in School-aged Children survey given to a representative sample of Tuscan adolescents aged 11-15 years. Participants (n. 12,550) filled out questionnaires to assess whether psychological symptoms such as feeling low, irritability, nervousness, or sleeping difficulties manifested weekly or more often over the past six months. For the study we utilized a cross-sectional survey method and linear regression to examine the association between psychological symptoms (dependent variable measured on an interval scale (0-16)), gender and FAS. We conducted similar analyses using logistic regressions for each of the four symptoms. An increase in psychological symptoms in both genders was revealed between 2006 and 2018, with a statistically significant presence in females: 0.29 (95% Confidence Interval [CI], 0.17 to 0.41), 1.43 (95% CI, 1.37 to 1.48) and 1.43 (95% CI, 1.34 to 1.52) in low-, medium- and high-affluence families, respectively; whereas males presented 0.14 (95% CI, 0.01 to 0.27), 0.71 (95% CI, 0.65 to 0.77) and 0.31 (95% CI, 0.22 to 0.39), respectively. The probability of a predictive episode of psychological symptoms (feeling low, irritability, nervousness, sleeping difficulties) occurring weekly, or more, often was greatly increased in females of all socioeconomic classes. These findings suggest that the increase in psychological disorders in adolescents should be considered a public health problem and further investigated through longitudinal studies and continuous monitoring of health trends.

The determinants of COVID-19 vaccine uptake among migrants from 109 countries residing in China: A cross-sectional study

Background

The present study aimed to investigate the prevalence of COVID-19 vaccine uptake among foreign migrants in China and to explore the determinants of their vaccine uptake behavior.

Methods

From June to October 2021, we used convenience and snowball sampling to recruit a sample of 764 participants from five cities in which the overwhelming majority of foreign migrants in China live. The chi-square (χ²) tests were used to examine vaccination distribution according to demographic characteristics. Multivariate logistic regression models visualized by forest plot were used to investigate the associations between significant determinants and vaccine uptake.

Results

Overall, the prevalence of vaccination rate was 72.9% [95% confidence interval (CI): 69.9-76.0%]. Migrants whose social participation was very active [adjusted odds ratio (AOR): 2.95, 95% CI: 1.36-6.50, P = 0.007] or had perceived COVID-19 progression prevention by the vaccine (AOR: 1.74, 95% CI: 1.01-3.02, P = 0.012) had higher odds of vaccination compared to those whose social participation was inactive or who did not have this perception. Migrants who perceived the vaccine uptake process as complex (AOR: 0.47, 95% CI: 0.27-0.80, P = 0.016) or were unsure of their physical suitability for the vaccine (AOR: 0.40, 95% CI: 0.24-0.68, P < 0.001) had lower odds of vaccination compared to those who did not have these perceptions. Furthermore, migrants from emerging and developing Asian countries (AOR: 2.32, 95% CI: 1.07-5.21, P = 0.04) and the Middle East and Central Asia (AOR: 2.19, 95% CI: 1.07-4.50, P = 0.03) had higher odds of vaccination than those from major advanced economies (G7) countries, while migrants from other advanced economic countries (OR: 0.27, 95% CI: 0.11-0.63, P = 0.003) had lower odds of vaccination than those from G7 countries.

Conclusion

It may be beneficial to promote vaccine uptake among migrants by ensuring effective community engagement, simplifying the appointment and uptake process, and advocating the benefits and target populations of the COVID-19 vaccine.

Association of BCC Module Roll-Out in SHG meetings with changes in complementary feeding and dietary diversity among children (6-23 months)? Evidence from JEEViKA in Rural Bihar, India

OBJECTIVES

Child dietary diversity is very low across rural communities in Bihar. Based on the experience of behavior change communication (BCC) module roll out in self-help group (SHG) sessions in rural Bihar, this study aims to assess the impact of the intervention on child dietary diversity levels in the beneficiary groups.

METHODS

The study is based on a pre-post study design whereby child dietary diversity is examined for a sample of 300 children (6-23 months old from 60 village organizations) during both pre-intervention as well as post-intervention phase. The latter consists of two types of group viz. a) children whose mothers were directly exposed to BCC module in SHGs sessions and b) those who were non-participants but may have indirect exposure through spillovers of BCC activities. Econometric analysis including logistic regression as well as propensity score matching techniques are applied for estimating the changes in dietary diversity in the post-intervention phase.

RESULTS

During the pre-intervention phase, 19% of the children (6-23 months) had adequate dietary diversity (eating from at least 4 out of 7 different food groups) and this increased to 49% among the exposed group and to 28% among the non-exposed group in the post-intervention phase. The exposed group have an odds ratio of 3.81 (95% CI: 2.03, 7.15) for consuming diverse diet when compared to the pre-intervention group. The propensity score matching analysis finds a 33% average treatment effect on the treated (ATT) for the group participating in BCC sessions at SHG events.

CONCLUSION

BCC roll out among SHG members is an effective mode to increase dietary diversity among infants and young children. The impact on child dietary diversity was significantly higher among mothers directly exposed to BCC modules. The BCC module also improved knowledge and awareness levels on complementary feeding and child dietary diversity.

An Interpretative Phenomenological Analysis of Living with Chronic Low Back Pain in Ethiopia

Background

People with chronic low back pain experience myriads of problems from living with their condition. This study aimed to explore the lived experience of people with chronic low back pain in Ethiopia.

Design

This is a qualitative semi-structured study design which used an interpretative phenomenological analysis approach for data analysis.

Participants

Fifteen adults (10 women and 5 men) with chronic low back pain (duration ≥ 3 months) with age ranging from 19 to 66 years old were interviewed.

Setting

Participants were recruited from the outpatient departments of the University of Gondar hospital in Gondar, Ethiopia.

Methods

Data was collected through an in-depth semi-structured interview. Interviews were audio-recorded and transcribed verbatim. Data were analyzed through an iterative process, beginning with a line-by-line coding to identify the lived experience of chronic low back pain.

Findings

Five main themes related to the lived experience of people with chronic low back pain emerged: 1) CLBP impacts life on a day-to-day basis, 2) The invisibility of pain results in misunderstanding, misjudgment, and loneliness, 3) The cause of pain is a mystery, 4) The search for the cure is a quest, 5) Each person has their ways of managing, coping, and living with pain.

Conclusion

The findings from this study improve our understanding of the experience of people with chronic low back pain and its impact on their day-to-day life in Ethiopia. The findings from this study could inform the development of culturally centered chronic low back pain interventions such as self-management programs in the Ethiopian context.

Social Capital Promotes a Healthier Diet among Young Adults by Reducing Psychological Distress

Studies have revealed the links between social capital and diet. However, the mediating role of psychological distress in this relationship has been understudied. This study aims to identify direct and indirect relationships between social capital and adherence to the Mediterranean diet among Lithuanian young adults and identify the mediating role of psychological distress in this relationship. Data were collected from 1336 young adults, aged 18-36 years; 40.5% were males. MEDAS was used to measure adherence to a healthy diet. Social capital was measured by eight separate items in terms of family support, social support, social cohesion, social trust, communication, collaboration, participation, and distant communication. Kessler's six-item scale was used to assess psychological distress. Higher family support (β = 0.105), higher social participation (β = 0.294), and lower psychological distress (β = 0.073) directly predicted higher adherence to the Mediterranean diet. Social capital was indirectly related to adherence to the Mediterranean diet, with standardized effect sizes of 0.02-0.04, indicating small effect sizes. Thus, psychological distress mediates the relationship between social capital and a healthy diet. Given that social capital is related to psychological health and both directly and indirectly predicts healthy behavior in young adults, further longitudinal and experimental research is required to measure the effects of the intervention on incorporating, facilitating, encouraging, and implementing measures to strengthen the social connection between people and groups of people within the community, neighborhood, and organizations.

The relevance of social capital and sense of coherence for mental health of refugees

Introduction

Migration puts refugees in a completely new social context when simultaneously some have to deal with previously experienced traumatic events and post-migration stressors. Social capital and sense of coherence could be key resources to improve mental health of refugees. This study aims to examine the interplay between social capital (structural and cognitive), sense of coherence and mental health of refugees in the Netherlands.

Objective

The present study was conducted to i) examine if social capital (structural and cognitive) and mental health are related in a population of Dutch refugees, and ii) test if sense of coherence has a moderating and/or a mediating effect on this relation.

Method

Data were collected through questionnaires (n = 154) in a cross-sectional survey at different locations throughout the Netherlands. The data were analysed with multiple regression analyses and nonparametric bootstrapping using SPSS.

Results

Social capital (structural and cognitive) was positively related to mental health. In addition a positive relation between sense of coherence and mental health of refugees was found. The relationship between cognitive social capital and mental health was completely mediated by sense of coherence. No moderation effect of sense of coherence on the relation between social capital and mental health was found.

Conclusions

The current study contributed to understanding the social mechanism that determines refugee mental health: participating in social groups (structural social capital) and having supportive and trusting relationships (cognitive social capital), whilst experiencing life as comprehensible, manageable, and meaningful (sense of coherence) are positively related to better mental health of refugees. Findings indicate that preventive interventions aiming to enhance refugees' mental health may be more effective when targeting and promoting both social capital and sense of coherence, from a relatively early stage after arrival in the Netherlands.

Association between community-level social trust and the risk of dementia: A retrospective cohort study in the Republic of Korea

Introduction

It is known that biological risk factors and lifestyle behaviors are important determinants of dementia. However, there has been yet to be sufficient evidence to prove that community-level social capital is one of the determinants of dementia. This retrospective cohort study is a large, long-term, population-based study that investigated the association between community-level social trust and the risk of dementia in the Republic of Korea.

Methods

Data came from the Korean National Health Insurance Service database. The community-level social trust values were determined by the Korean Community Health Survey. The study population consisted of 1,974,944 participants over 50 years of age and was followed up from 1 January 2012 to 31 December 2019 with a latent period of 5 years from 1 January 2012 to 31 December 2016. Cox proportional hazards regression was utilized to obtain the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the risk of dementia according to social trust quintiles.

Results

Participants within the highest quintile of community-level social trust had a lower risk for overall dementia (aHR, 0.90; 95% CI, 0.86-0.94) and Alzheimer's disease (aHR, 0.90; 95% CI, 0.85-0.94) compared to those within the lowest quintile of community-level social trust. The alleviating trend association of high community-level social trust on dementia risk was maintained regardless of whether the participants had health examinations.

Conclusions

Our findings suggest that higher community-level social trust is associated with a reduced risk of dementia. Community-level social trust is a crucial indicator of dementia and improving community-level social trust may lead to a lower risk of dementia.

Adaptation of the personal social capital brief scale for the measurement of the offline and online social capital in Italy

Social Capital refers to the resources associated with durable and trustworthy social connections. Social Capital can be developed through offline and online relationships. It can be distinguished between cognitive Social Capital (perception of trustworthiness, reciprocity, and support) and structural Social Capital (density of social networks and membership, and participation in groups and associations). It can also be distinguished between bonding Social Capital (resources associated with informal networks; i.e., neighbors, friends, colleagues) and bridging Social Capital (resources associated with formal networks; i.e., community service, cultural, religious or political groups/associations). The different forms and dimensions of Social Capital may have distinct effects on health outcomes and self-rated health. Therefore, public health researchers need valid and reliable instruments to investigate Social Capital. However, valid instruments including the measurement of online Social Capital are not available. The Personal Social Capital Scale aims to assess bonding and bridging Social Capital by means of cognitive and structural items. In the present investigation, three studies were carried out (N = 1149) to adapt the Personal Social Capital Scale to develop the Personal On-Offline Social Capital Brief Scale, a brief scale for measuring online and offline bonding and bridging Social Capital in Italy. Factorial structure and convergent/divergent validity in relation to scales measuring constructs with different patterns of relationships with bonding and bridging Social Capital (i.e., social support and stress; sense of community and health) were also investigated. Overall, these studies provide evidence of reliability and validity related to the internal structure of the Personal On-Offline Social Capital Brief Scale in measuring online and offline bonding and bridging Social Capital and discriminating them from similar constructs. This scale is a useful instrument for planning public health interventions.

The association between social capital indicators and psychological distress in Catalan adolescents

According to the WHO, globally, one in seven adolescents experiences a mental disorder, being in a detrimental situation toward educational achievement, social cohesion, future health and life chances. Calls to identify risk and resilience factors to develop effective preventive actions have been made. Following a systemic approach, we conducted a cross-sectional study on the relationship between social capital and psychological distress in a sample of Catalan adolescents in Barcelona, taking into account a range of other relevant aspects at different levels influencing mental health, including gender, age, migrant status, family background, lifestyle factors, body mass index, and self-rated health. Data were collected through validated questionnaires in December 2016 from 646 of 14- to 18-year-old adolescents from three public and private high schools in Barcelona (Spain). Data analysis included descriptive analysis, a correlational study and logistic regression to obtain the odds ratio for social capital indicators to be associated with psychological distress. Our results suggest that reporting higher levels of family support and higher levels of teacher-student trust reduce the likelihood of suffering psychological distress. Higher levels of neighborhood informal control were associated with mental health, but a possible detrimental effect cannot be ruled out. Being a girl, reporting low self-rated health or higher media use was also associated with higher likelihood of psychological distress. Current results may encourage interventions that focus on social capital as a means to reduce psychological distress and foster well-being in youth.

COVID-19 Lockdown and Social Capital Changes Among Youths in China

Social capital refers to the effective functioning of social groups through networks of relationships. The lockdown measures due to coronavirus disease 2019 (COVID-19) may change the social capital among youths. This study aimed to evaluate changes in social capital before and during COVID-19 lockdown among Chinese youths. It was based on the online COVID-19 Impact on Lifestyle Change Survey (COINLICS) conducted among 10 540 youths at three educational levels, including high/vocational school, undergraduate, and graduate, before and during COVID-19 lockdown. Measures of perceptions of social capital were adapted from a validated Chinese version of Health-related Social Capital Measurement based on youths' characteristics of living and studying environment. Social capital was measured at four dimensions, including individual social capital (ISC), family social capital (FSC), community social capital (CSC), and society social capital (SSC). Overall, compared to before lockdown, ISC and CSC scores decreased, while FSC and SSC scores increased during lockdown. When stratified by educational levels, the trends for each dimension of social capital were consistent with the overall population. There were 43.9%, 5.7%, 32.1%, and 3.7% of the participants showing decreased scores during lockdown for ISC, FSC, CSC, and SSC, respectively, while 7.2%, 24.0%, 15.3%, and 10.7% of participants showed increased scores for ISC, FSC, CSC, and SSC, respectively. Our timely, large-scale study showed decreased social capital in individual and community dimensions and increased social capital in family and society dimensions during lockdown.

"For me, it's just a piece of freedom"-Increased empowerment through physical activity promotion among socially disadvantaged women

Introduction

Community-based participatory research (CBPR) is an effective health promotion approach for reaching socially disadvantaged groups. However, there is limited evidence on how such interventions and their effects can be reproduced across time and place. The present study examines the effects of BIG (i.e., movement as an investment in health), a long-standing German CBPR project. Since 2005, BIG has aimed to empower women in difficult life situations to increase control over their health determinants and reduce social inequalities by promoting physical activity. One of BIG's key features is its implementation in several German municipalities since 2005. This study explores (a) whether participation could change women's empowerment, and (b) how increased empowerment affects other areas of women's lives.

Methods

With a total of 63 interviewees (i.e., 40 participating women, 7 trainers, 3 project coordinators, and 13 stakeholders), we conducted 53 semi-structured qualitative interviews in five BIG communities between 2007 and 2011. Some interviews were conducted with two people simultaneously. The interview guide contained questions on various dimensions of empowerment (e.g., project engagement, increased self-efficacy, and developed competencies). Framework analysis was used for the analytical process.

Results

BIG contributed to women's empowerment in various ways, including increased self-efficacy, social network promotion, competency development, and increased motivation to change physical activity behavior. Women who took on added tasks and became more involved in project planning also strengthened their organizational empowerment. Furthermore, increased empowerment had a positive influence on the women's quality of life, family, and professional lives.

Conclusion

The novel findings helped in understanding the effects of a complex empowerment-based approach that promoted physical activity among women in difficult life situations. Future research should focus on the long-term effects of these programs and their transferability to other sites. Further effort is necessary in the area of public health policy.

Association between Social Engagements and Stigmatization of COVID-19 Infection among Community Population in Japan

In the face of unknown risks, including the coronavirus disease 2019 (COVID-19) pandemic, we tend to have stigmatized perceptions. The current study aimed to examine the association of social engagements with the level of stigmatization of COVID-19 infection among the general population. The data of 429 participants of the Utsunomiya COVID-19 seroprevalence neighborhood association (U-CORONA) study, a population-based cohort study conducted in Utsunomiya City, Japan, were analyzed. Their stigmatized perception of people with COVID-19 infection was evaluated via a questionnaire for the situation if they or others in their community were to get infected. The association between social engagements (community social capital, social network diversity, and social network size) and stigmatization were analyzed by a multiple linear regression model with generalized estimating equations. Overall, females reported a higher stigmatized perception of people with COVID-19 than males. Lower education and depressive symptoms were also positively associated with higher stigmatization, while age, household income, and comorbidities were not. People with higher community social capital reported lower stigmatization (B = −0.69, 95% CI = −1.23 to −0.16), while social network diversity and social network size did not show an association with stigmatization. We found an association between community social capital and stigmatization, suggesting that enhancing their community social capital, but not social network diversity and size, has the potential to mitigate the levels of stigmatization.

Maternal and child social support and food availability in relation to child growth in four low- and middle-income countries

Previous studies showed positive associations between specific types of social capital and child nutritional status. Our study examined whether improved food availability mediates the impact of maternal and child social support on child nutritional status in four low- and middle-income countries. We used data from the Young Lives cohort study, comprising 1,000 children aged 8 and 12 in Vietnam and Ethiopia, 1008 in India, and 714 in Peru. The outcome variables were the z-scores for height for age and body mass index (HAZ and BAZ, respectively). The causal mediation analysis framework was used. In Peru, above-median values of maternal social support and receiving child financial support were positively associated with HAZ at age 12. The level of maternal financial support was positively associated with BAZ among 12-year-old children in India. Peru was the only country where a positive association was found between food availability and maternal financial support among children aged 12. However, food availability did not mediate the effect of maternal financial support on HAZ at age 12. Strengthening social support to improve child nutritional status, especially by improving food availability, may not be a sufficient intervention in resource-poor settings because sources of support may lack sufficient food resources to share. However, more comprehensive measurements of social support and food security are necessary to better understand the mechanism of social support and child nutritional status.

Better Late Than Never: Predictors of Delayed COVID-19 Vaccine Uptake in Poland

In this study, regression models were created to explain the increase of COVID-19 vaccination rates in 378 Polish sub-regions. In order to trace the factors that could explain the willingness to delay vaccination, vaccination rates were compared for age groups of 20 years and more for 30 June 2020 and 31 January 2021. Initially high vaccination rates, rather than leading to the gradual exhaustion of the pool of those wishing to get vaccinated, were a very good predictor of the share of the remainder willing to do so, which increased the divergence between sub-regions in nominal vaccination rates. Support for Eurosceptic and anti-establishment parties was a strong predictor of persistent vaccine hesitancy. Ideological divergence from the mainstream appeared to reinforce vaccine hesitancy, and this relationship remained highly relevant even when controlling for possible time or spatial lag. Markers of social inclusion and social capital—voter turnout and employment rate—remained statistically significant even when controlling for time lag, thus implying clear relevance of trust in the public message. The share of the population with higher education remained a highly relevant factor as well, though in the 20–39 age bracket it predicted a higher vaccination rate, while in all older brackets it was a negative predictor—this implies that those people had already made up their minds. Delaying vaccination seems predominantly explainable by political views, as well as social exclusion and the historical specificity of sub-regions. On a regional level, there was actually a paradoxical Spearmans Rho correlation (0.641) between the share of population refusing mandatory vaccination for kids and the percentage of people receiving a COVID-19 vaccine, which further undermines the idea that overall observed vaccine hesitancy was in any meaningful way affected by anti-vaccine movements.

Better Late Than Never: Predictors of Delayed COVID-19 Vaccine Uptake in Poland

In this study, regression models were created to explain the increase of COVID-19 vaccination rates in 378 Polish sub-regions. In order to trace the factors that could explain the willingness to delay vaccination, vaccination rates were compared for age groups of 20 years and more for 30 June 2020 and 31 January 2021. Initially high vaccination rates, rather than leading to the gradual exhaustion of the pool of those wishing to get vaccinated, were a very good predictor of the share of the remainder willing to do so, which increased the divergence between sub-regions in nominal vaccination rates. Support for Eurosceptic and anti-establishment parties was a strong predictor of persistent vaccine hesitancy. Ideological divergence from the mainstream appeared to reinforce vaccine hesitancy, and this relationship remained highly relevant even when controlling for possible time or spatial lag. Markers of social inclusion and social capital—voter turnout and employment rate—remained statistically significant even when controlling for time lag, thus implying clear relevance of trust in the public message. The share of the population with higher education remained a highly relevant factor as well, though in the 20–39 age bracket it predicted a higher vaccination rate, while in all older brackets it was a negative predictor—this implies that those people had already made up their minds. Delaying vaccination seems predominantly explainable by political views, as well as social exclusion and the historical specificity of sub-regions. On a regional level, there was actually a paradoxical Spearmans Rho correlation (0.641) between the share of population refusing mandatory vaccination for kids and the percentage of people receiving a COVID-19 vaccine, which further undermines the idea that overall observed vaccine hesitancy was in any meaningful way affected by anti-vaccine movements.

Prevalence and Factors Associated With Out-of-Pocket Pharmaceutical Expenditure Among Primary Healthcare Patients: Evidence From the Prover Project

OBJECTIVES

This study aimed to determine the prevalence and associated factors of out-of-pocket pharmaceutical expenditure (OOPPE) among primary healthcare patients.

METHODS

The study is part of the Prover Project, an exit survey conducted in 2017 in a large city (population 234 937) in Minas Gerais State, Brazil. A representative sample of patients (n = 1219) from pharmaceutical services based on primary healthcare was selected. Three components of OOPPE were assessed: the general prevalence, the types of medicines purchased (medicines for the treatment of chronic diseases, medicines for the treatment of acute diseases, or herbal medicines), and coverage by the National Health System. The factors associated with OOPPE were examined applying a modified Andersen's behavioral model of health services use. Data were analyzed using descriptive statistics and logistic regression.

RESULTS

The overall prevalence of OOPPE was 77%. Most patients who had OOPPE purchased medicines to treat chronic diseases (94%). In addition, these patients purchased medicines covered by public insurance but were out of stock (85%). OOPPE was associated with enabling factors, such as higher personal income (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.02-3.62), holding health insurance (OR 1.40; 95% CI 1.01-1.95), and higher neighborhood trust (OR 1.34; 95% CI 1.01-1.79), and with need factors, that is, poorer perception of health (OR 1.63; 95% CI 1.20-2.21), multiple comorbidities (OR 1.70; 95% CI 1.18-2.46), and higher number of prescribed medicines (OR 2.84; 95% CI 1.90-4.26).

CONCLUSIONS

We found a high prevalence of OOPPE, identifying individuals more likely to incur these expenses. These findings are useful to inform policy makers from the healthcare system to plan and implement the needed interventions to protect primary care patients from this financial burden.

Experiences of menstrual inequity and menstrual health among women and people who menstruate in the Barcelona area (Spain): a qualitative study

INTRODUCTION

Menstrual health and menstrual inequity have been neglected in social, economic, healthcare and political spheres. Although available evidence is scarce, it already suggests a link between experiencing menstrual inequity (which refers to the systematic disparities in accessing menstrual health and education, menstrual products and spaces for menstrual management, among other aspects) and menstrual health outcomes. The aim of this study was to explore experiences of menstrual health and menstrual inequity among women and people who menstruate aged 18-55 in Barcelona and surrounding areas (Spain).

METHODS

A qualitative study, using a critical feminist perspective, was conducted. Sampling was purposeful and selective. Recruitment was through sexual and reproductive health centres, social media and snowball sampling techniques. Thirty-four semi-structured photo-elicitation interviews were conducted between December 2020 and February 2021. Interviews took place in sexual and reproductive health centres, public spaces, and by telephone. Data were analysed using Reflexive Thematic Analysis.

RESULTS

Three themes were identified: "Systemic neglect of menstruation and the menstrual cycle", "When "the private" becomes public: menstrual management" and "Navigating menstrual health: between medicalization and agency". Experiences of menstrual inequity appeared to be widespread among participants. They referred to the impact of having to conceal menstruation and the barriers to managing menstruation in public spaces. Choosing menstrual products was often influenced by price and availability; several participants reported menstrual poverty. A general lack of menstrual education was described. Menstrual education was usually gained through personal experience and self-learnings, or through families and friends. Menstruation and the menstrual cycle had a significant impact on participants' day-to-day. Accessing and navigating the healthcare system was challenging, as participants mostly reported feeling dismissed and almost exclusively offered hormonal contraception as a panacea to address menstrual health.

CONCLUSIONS

The impact of menstrual inequity appears to be far-reaching. Multidimensional structural policies should promote agency in individuals and communities to enable opportunities for menstrual education, access to menstrual products, healthcare services and adequate menstrual-management facilities. Health professionals' training is also necessary to improve access to and quality of menstrual healthcare. Policies need to be inclusive of non-binary and trans people, and vulnerable populations.

Social Capital, Intellectual Capital, and Audit Fee: Conflicting Evidence from Iran

In the current study, we investigate the impacts of social capital (SC) and intellectual capital (IC) on audit fees among the companies listed on the Tehran Stock Exchange (TSE). Since the criteria for the norms and the networks are extremely correlated, we used a principal component analysis (PCA) to construct an index of social capital for each province between 2011 and 2016. The Pulic model is also used as a proxy for measuring value added intellectual capital (VAIC). The ordinary least squares (OLS) regression is employed in this study to test our research hypotheses as well. According to the research literature, on the one hand, investors and lenders can be more confident in the financial reporting honesty of the firms headquartered in areas with high social capital; on the other hand, auditors judge the trustworthiness of their clients based on where the firm is headquartered. Inconsistent with the prior studies, our findings show that companies headquartered in provinces with high social capital pay higher audit fees. Given that Iranian firms are under heavy financial pressure due to economic sanctions, those companies located in areas with higher social capital likely have abused the high level of trust that auditors and other groups in the market have in them and participated in earnings manipulation to mask their weak financial performance. Among the various components of IC, we found strong evidence that employed capital efficiency (ECE) and audit costs correlated positively. In short, this paper sheds light on the fact that severe financial pressures on managers may sometimes lead them to take advantage of the dark side of social capital and intellectual capital when preparing financial reports.

Magnitude and determinants of "Social Capital" among women in reproductive age group - A cross-sectional study from rural Wardha, Central India

Context

Social capital reflects the trust, norms, values and social processes that governs interaction among people.

Aim

This study was conducted to estimate the magnitude and determinants of social capital among women of reproductive age group in selected village of rural Wardha, Central India.

Materials and Methods

It was a community based cross-sectional study where two stage cluster sampling technique was used to select 300 participants from 22 villages. Data were collected using a pre-designed interviewer administered questionnaire by house-to-house survey. Social capital was measured using the core set of Integrated Questionnaire for the Measurement of Social Capital developed by World Bank.

Statistical Analysis

Multivariate linear regression was applied to find out determinants of social capital.

Results

Most of the participants had poor social capital score (women having lowest and middle tertile scores were 36.0% and 45%, respectively). social capital poorer in younger women, women with lower educational qualification, not involved in gainful occupation, belonging to below poverty line and unmarried compared to their counterparts. Having at least one son was positively associated with higher social capital. In adjusted analysis, age, education, occupation, marital status, and whether the woman has son were revealed as significant determinants of social capital.

Conclusion

The study findings reflect the need of improving education and job opportunity among rural women to improve their social capital. Increase of social capital among women having male child reflects the need to percolate the message of gender equity and gender sensitive education.

Comparison of General-Social Health and Corona-Induced Anxiety Between Active and Inactive Students in the COVID-19 Pandemic

Background: General health includes physical and mental health and their interactions, and physical activity can improve people's mental and social health. The present study has compared general-social health and COVID-19-induced anxiety between active and inactive students during the COVID-19 pandemic. Methods: A causal-comparative research design was used in this study. The statistical population consisted of all students of the Farhangian University of Mashhad (2,500 students) in 2020, out of whom 752 students were randomly selected (323 men and 429 women). Subjects were assessed for general health, social health, and COVID-19-induced anxiety. Data normality was investigated by the Kolmogorov-Smirnov test and data were analyzed statistically using independent t-test and Pearson correlation coefficient test. Results: The results of the present study showed that there was a significant difference between general health and COVID-19-induced anxiety of active and inactive students (p = 0.001), but no significant difference was observed between these two groups in social health (p ≥ 0.05). Results obtained regarding the correlation indicated that there was a significant correlation between general and social health in both active and inactive students (p = 0.001). However, there was no significant correlation between COVID-19-induced anxiety and general-social health (p ≥ 0.05). Conclusion: According to the results of the present study, it can be said that an active lifestyle and physical activity are important factors to improve general health and reduce anxiety, especially in specific conditions of the COVID-19 outbreak. Therefore, it is recommended that students have a regular exercise program to reduce their anxiety and increase the level of their physical health.

Role of trust in sustaining provision and uptake of maternal and child healthcare: Evidence from a national programme in Nigeria

Despite increasing attention to implementation research in global health, evidence from low- and middle-income countries (LMICs) using realist evaluations, in understanding how complex health programmes work remains limited. This paper contributes to bridging this knowledge gap by reporting how, why and in what circumstances, the implementation and subsequent termination of a maternal and child health programme affected the trust of service users and healthcare providers in Nigeria. Key documents were reviewed, and initial programme theories of how context triggers mechanisms to produce intended and unintended outcomes were developed. These were tested, consolidated and refined through iterative cycles of data collection and analysis. Testing and validation of the trust theory utilized eight in-depth interviews with health workers, four focus group discussions with service users and a household survey of 713 pregnant women and analysed retroductively. The conceptual framework adopted Hurley's perspective on 'decision to trust' and Straten et al.'s framework on public trust and social capital theory. Incentives offered by the programme triggered confidence and satisfaction among service users, contributing to their trust in healthcare providers, increased service uptake, motivated healthcare providers to have a positive attitude to work, and facilitated their trust in the health system. Termination of the programme led to most service users' dissatisfaction, and distrust reflected in the reduction in utilization of MCH services, increased staff workloads leading to their decreased performance although residual trust remained. Understanding the role of trust in a programme's short and long-term outcomes can help policymakers and other key actors in the planning and implementation of sustainable and effective health programmes. We call for more theory-driven approaches such as realist evaluation to advance understanding of the implementation of health programmes in LMICs.

A sense of health and coherence in young rural schoolchildren in Sweden

Background: Little is known about how younger schoolchildren in a rural setting experience their sense of coherence (SOC), how they think and reason about health and what they perceive as important to achieve health goals. This study aimed to investigate children's SOC and their health perceptions.Method: In this mixed-method study 94 children (8-12 years) from three rural schools answered several questionnaires: The Child-SOC (CSOC), Positive Health Scale (PHS) and Cantril's ladder of life scale. Another 23 children (of 94) participated in four focus group interviews. Thematic analysis was used to identify themes from the interview transcripts.Results: High SOC was reported by 48% of the boys and 22% of the girls. However, no significant gender differences were found. Four themes were generated from the qualitative analysis: Understanding health, Managing health, Doing bodily health and Socialising health. Both younger and older children had a holistic view of health in which health was seen as an individual's living habits in which social contacts mattered.Conclusion: In a rural context children need to adapt to activities that exist in their immediate environment. Thus, activities during school hours can be an important complement in health promotion.

Self-help groups as platforms for development: The role of social capital

Women-led self-help groups (SHGs) are increasingly being utilized as platforms for delivering development activities by funding agencies and governmental bodies. However, there is currently little understanding as to whether SHGs are effective or equitable platforms for delivering health or livelihoods interventions. Social capital is hypothesized as a comparative advantage when utilizing SHGs as development platforms, however the specific mechanisms have yet to be explored. This paper investigates the efficacy and equity of SHGs as platforms for development programs through analyzing 64 interviews and 6 focus group discussions collected from an agriculture and behavior change intervention delivered through SHGs in eastern India. We find that while, theoretically, SHGs are a promising platform for health messaging this is largely dependent on SHG norms of attendance, which itself is closely tied to socioeconomic conditions and social capital. Social capital is important both within SHGs as well as between SHGs and the implementing organization. Sites with more mature SHGs had greater economic security allowing more active participation in the intervention than sites with more poverty and young SHGs. The former sites also had greater norms of trust and reciprocity (social capital) with the implementing organization that led them to accept additional interventions. In the latter sites, SHG members had competing demands on their time and less trust in the implementers, making it difficult to attend both SHG meetings and health sessions. We put forth a materialist understanding of social capital formation, where SHG members must have already received substantive benefit from membership for new activities to be successfully incorporated into their agenda. Further, using SHGs as a nutrition message delivery platform should not detract from individual engagement with more vulnerable members of the community.

Social Capital as a Mediator in the Link between Women's Participation in Team Sports and Health-Related Outcomes

The role of social capital in the association between team sports and health-related outcomes has not been well established in the literature. The purpose of this study was to explore whether social capital components (social support, trust, and social involvement) mediate the association between team sports and health-related outcomes (self-reported health, psychosomatic symptoms, and depressive symptoms). In a cross-sectional research design, we obtained data from 759 participants in the Mamanet Cachibol League, a community team sports model for women in Israel, as well as a comparison group of 308 women who did not participate in any team sports. Team captains were sent a link with an online questionnaire, which were then delivered to team members via text message. Using three parallel mediation models, we found that social support mediated the association between team sports and self-reported health, psychosomatic symptoms, and depressive symptoms. Trust mediated the association between team sports and both psychosomatic symptoms and depressive symptoms. Social involvement was not found to be a mediator in the association between team sports and any of the health-related outcomes. Our findings reveal the important role of social capital, specifically social support and trust, in promoting the health of women who participate in team sports.

Knowledge and perceptions around self-management of type 2 diabetes among a Sudanese community in Australia: A qualitative study

ISSUE ADDRESSED

People from Sudanese background are more likely to be diagnosed with type 2 diabetes (T2D) as compared to the general population. In recent years, there has been an increase in the number of migrants from Sudan to Australia. However, there is a dearth of research exploring the perceptions and experiences of self-management strategies for diabetes among this migrant Sudanese population residing in Australia. This study aims to explore these experiences and perceptions as well as to identify cultural aspects related to T2D self-management strategies for people from this migrant group.

METHODS

A qualitative study using semi-structured in-depth interviews with Sudanese participants (n = 12) living with T2D was conducted in Melbourne, Australia.

RESULTS

The thematic analysis found barriers to self-management of diabetes to include language differences, the burden of self-management, difficulties in accommodating traditional dietary practices in self-management, as well as the expectations of familial and social obligations. Enablers included positive relationships with health professionals, support networks, involvement in religion and adopting traditional remedies.

CONCLUSIONS

This study found cultural considerations, such as incorporating traditional dietary practices and familial obligations into self-management, to be the most significant influence for this group of Sudanese participants in the way they managed their diabetes.

SO WHAT

This study highlights the need for culturally appropriate provision of health services and resources for Sudanese people with T2D while recognising the value placed on traditional food choices. Importantly, the collectivist Sudanese culture must be considered for any future development and implementation of health promotion strategies.

COVID-19 Amongst the Ultra-Orthodox Population in Israel: An Inside Look into the Causes of the High Morbidity Rates

The current paper focuses on the circumstances that have led to the high COVID-19 infection rates amongst the ultra-Orthodox population in Israel. The current study utilizes a qualitative design and is based on in-depth interviews, email correspondence and online records of 25 ultra-Orthodox individuals who either tested positive for COVID-19 or had contact with a verified COVID-19 patient. The data were analyzed through identification of main themes and an interpretation of their meanings. The findings showed that a wide range of causes led to the high infection rate, including aspects that derive from a structural element, a religious element and a social-ideological element—all of which are directly or indirectly connected to religion. These findings demonstrate the central role of religion in health outcomes among the ultra-Orthodox community in general and during pandemics in particular, and they shed light on the central role of religion in health outcomes among closed-religious communities. The findings further reveal the importance of cooperation between the state authorities and the religious ones, and of providing culturally adapted health service solutions in the fight against COVID-19 and promoting health more generally. Study limitations are discussed and recommendations for future research are provided.

Factors Affecting Public Non-compliance With Large-scale Social Restrictions to Control COVID-19 Transmission in Greater Jakarta, Indonesia

OBJECTIVES

The Indonesian government issued large-scale social restrictions (called Pembatasan Sosial Berskala Besar, or PSBB) at the beginning of the coronavirus disease 2019 (COVID-19) pandemic to control the spread of COVID-19 in Jakarta, Bogor, Depok, Tangerang, and Bekasi (Greater Jakarta). Public compliance poses a challenge when implementing large-scale social restrictions, and various factors have contributed to public non-compliance with the regulation. This study aimed to determine the degree of non-compliance and identify the factors that contributed to public non-compliance with the PSBB in Greater Jakarta, Indonesia.

METHODS

This was a quantitative study with a cross-sectional design. A total of 839 residents of Greater Jakarta participated in this study. Data were collected online using a Google Form, and convenience sampling was undertaken. Univariate and multivariate analyses were performed to explore the relationships between public non-compliance with the PSBB regulation and socio-demographic variables, respondents' opinion of the PSBB, and social capital.

RESULTS

A total of 22.6% of subjects reported participating in activities that did not comply with the PSBB. The variables that most affected non-compliance with the PSBB were age, gender, income, opinion of the PSBB, and social capital.

CONCLUSIONS

Strengthening social capital and providing information about COVID-19 prevention measures, such as washing one's hands with soap, wearing masks properly, and maintaining social distancing, is essential. Robust public understanding will foster trust and cooperation with regard to COVID-19 prevention efforts and provide a basis for mutual agreement regarding rules/penalties.

Influence of Social and Cultural Factors on the Decision to Consent for Monoclonal Antibody Treatment among High-Risk Patients with Mild-Moderate COVID-19

BACKGROUND

The clinical outcomes of patients who decline anti-spike monoclonal antibody therapies for coronavirus disease-2019 (COVID-19) is not known. Factors associated with the decision to accept or decline the offer for anti-spike monoclonal antibody therapies are not established. This study aimed to identify factors impacting the decision to consent for monoclonal antibody therapies and assess the differences in clinical outcomes of patients who accepted compared to those who declined these therapies.

METHODS

This retrospective cohort study enrolled 2820 adult patients who were offered monoclonal antibody therapies, bamlanivimab and casirivimab-imdevimab, for COVID-19 at Mayo Clinic in the Midwest between 11/19/2020 and 12/31/2020. The primary endpoint is the decision to accept or decline monoclonal antibody treatment. Secondary endpoints were patient-level factors that could have impacted the decision to accept treatment (age, gender, race, ethnicity, primary language spoken, and medical comorbidities). The main clinical endpoint was hospitalization within 28 days of COVID-19 diagnosis.

RESULTS

59.1% (n = 1669) chose to accept monoclonal antibody therapy, and 40.9% (n = 1151) chose to decline the offer for treatment. Patients were more likely to accept treatment if they were non-Hispanic White, English speaking, identified a spouse or life partner, had a religious affiliation, and possessed more medical comorbidities. Overall, 28-day hospitalization rate was 2.6% (n = 72/2820) and was higher among those who declined (3.3%) than those who accepted monoclonal antibody therapy (2.0%; Rate Ratio = 0.62, 95% Confidence Interval, 0.39-0.98).

CONCLUSIONS

Despite having more comorbidities, patients who accepted monoclonal antibody treatments had a lower rate of hospitalization compared to patients who declined treatment. Several social and cultural factors were associated with the decision to decline therapy, including race, language, ethnicity, and lack of social support. These findings can inform public health efforts to reduce social disparities in the treatment of COVID-19 and increase utilization of monoclonal antibody therapies in high risk populations.

Homeless people and health: a qualitative enquiry into their practices and perceptions

BACKGROUND

Homeless people experience poorer health and shorter life expectancies than the UK average, but their health needs and expectations have received little attention in research. This study aims to understand homeless people's health perceptions and experiences.

METHODS

Semi-structured interviews took place with 28 homeless people in Gloucestershire. The transcripts were thematically analysed drawing out key themes.

RESULTS

Homelessness was often rooted in early trauma or an unstable family unit. Participants described poor support on leaving prison, termination of a cohabiting relationship or financial issues as factors precipitating homelessness. There was an expansive and positive understanding of health and its determinants. Mental health issues were common, often linked to traumatic life-events. Substance misuse issues were expressed as a mechanism to manage mental health issues. Participants were frustrated that this co-dependency was not recognized by support services. Participants' living situation curtailed their ability to make health-enhancing choices, which was compounded by issues accessing mainstream healthcare services.

CONCLUSIONS

Mental health in homeless people must be recognized in the context of substance misuse and early trauma. Dealing with housing and addiction are critical to enable prioritisation of healthy behaviours. Healthcare services should recognize the chaotic nature of homeless people and their competing issues.

Effects of Health Education Based Intervention on Community’s Perception, Healthy House, and Social Capital of Dengue in Endemic Area of Sleman Regency Indonesia

BACKGROUND: Low community participation in the dengue hemorrhagic fever (DHF) control efforts is one of the influencing factors in the failures of some of these efforts. The community’s lack of responsibility concerning the DHF issues might be caused by their low perceptions and understanding of DHF itself. AIM: This study aimed to assess the effect of health education about DHF on changes in the community’s perceptions, social capital, and healthy house conditions. METHODS: The research method was participatory action research. The study involved 267 households in Patukan Hamlet Sleman Yogyakarta Indonesia. The intervention was health education about DHF which was presented from November 2018 to February 2019. Preliminary assessments were taken in November 2018 and evaluations were taken in August 2019. The data were analyzed with the Wilcoxon test. RESULTS: The results show that in the 6th months after the intervention, there was an increase in the average score of all variables. The differences between pre- and post-intervention were statistically significant: Perceptions of dengue fever (p = 0.000); perceptions about DHF control (p = 0.000); the social condition for the component of concern, trust, and readiness to learn new ideas with p < 0.05; and all component of healthy house conditions with p < 0.05. CONCLUSION: Health education could contribute to changes in perceptions, social capital, and a healthy house condition. It is very important to increase the awareness and participation of the community in controlling DHF.

Social Capital and Depressive Episodes: Gender Differences in the ELSA-Brasil Cohort

Introduction: The association between social capital and depression is a frequent research topic in developed countries, often with inconclusive results. Furthermore, for both social capital and depression, there are gender differences established in the literature. This study investigates gender differences in the association of social capital with the incidence and maintenance of depressive episodes.

Methods: Baseline and second wave data (4 years of follow-up) from the Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort of civil servants with 15,105 workers aged 35–74 years, were used. Social capital was assessed using the Resource Generator, a scale composed of two different dimensions: “social support” and “prestige and education.” Depressive episodes were assessed using the Clinical Interview Schedule - Revised (CIS-R). The statistical analysis was performed using multinomial regression with adjustments for possible confounding factors.

Results: Among men, low social capital in the “social support” dimension was associated with the incidence of depressive episodes (RR = 1.66; 95% CI: 1.01–2.72). Among women, social support was associated with the maintenance of depressive episodes (RR = 2.66; 95% CI: 1.61–4.41). Social capital was not associated with the incidence or maintenance of depressive episodes in the “prestige and education” dimension in both genders.

Conclusion: The results highlight the importance of the dimension “social support” in both genders in its association with mental health. The resource-based social capital approach proved to be adequate for investigating mental health and confirms the idea that social networks can be useful in the treatment and prevention of depressive episodes.

The role of social capital in facilitating hepatitis C treatment scale-up within a treatment-as-prevention trial in the male prison setting

BACKGROUND AND AIMS

Hepatitis C (HCV) is a global public health concern, particularly in the prison setting where prevalence is substantially higher than in the general population. Direct-acting antivirals have changed the treatment landscape, allowing for treatment scale-up efforts potentially sufficient to achieve prevention of onward transmission (treatment-as-prevention). The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study was the first trial to examine the efficacy of HCV treatment-as-prevention in the prison setting. Social capital is a social resource which has been found to influence health outcomes. This qualitative study sought to understand the role of social capital within an HCV treatment-as-prevention trial in the prison setting.

DESIGN

Semi-structured in-depth interviews were undertaken with participants recruited from the SToP-C study following HCV treatment completion (with cure).

SETTING

Three male correctional centres in New South Wales, Australia (including two maximum-security and one minimum-security).

PARTICIPANTS

Twenty-three men in prison participated in semi-structured interviews.

MEASUREMENTS

Thematic analysis of transcripts was completed using a social capital framework, which enabled exploration of the ways in which bonding, bridging and linking social capital promoted or inhibited HCV treatment uptake within a treatment-as-prevention trial.

FINDINGS

Social capital fostered HCV treatment uptake within an HCV treatment-as-prevention trial in the prison setting. Bonding social capital encouraged treatment uptake and alleviated concerns of side effects, bridging social capital supported prison-wide treatment uptake, and linking social capital fostered trust in study personnel (including nurses and correctional officers), thereby enhancing treatment engagement.

CONCLUSIONS

Social capital, including bonding, bridging and linking, can play an important role in hepatitis C treatment-as-prevention efforts within the male prison setting.

Community-based Management and Control of Tuberculosis in Sub-urban Surabaya, Indonesia: A Qualitative Study

BACKGROUND: Tuberculosis (TB) is major community health problem in Indonesia. The World Health Organization report in 2017 shows that 6.4 million new TB cases were officially notified to national authorities, worldwide. Indonesia has 842,0000 cases and places it as the country with the third highest number in the world. The national program Directly Observed treatment, short-course started since 2014 has not able to handle TB cases comprehensively. Communities have important role in TB management. AIM: The aim of this study was to explore the existed condition of TB management and control. METHODS: A descriptive qualitative study was conducted in Tandes Sub-district, which is an endemic area for TB and has the highest incident in Surabaya. Semi-structured interview was conducted to 13 participants who consist of sub-urban TB task force, community health volunteer, Community Health Nurses, and sub-district officer. RESULTS: Result reveal six themes: Altruism as intentional caring factor, in adequate number of staff, the need to improve training skill, insufficient of resources, limited of financial support, and social support. CONCLUSION: To be effective program, community-based TB management need to be improve in the availability of budget, staff, training, and resources while maintaining the ongoing work of TB task force team. Community-based TB program is one of the activities whose efficiency was reliable for handling TB.

Inspiring Life in Frozen Communities: Supporting Migrant Women in Brussels to Regain Control over their Lives

In Brussels, many migrant women without legal status have no or limited access to health care and other basic services. Their access to descent care is mainly hampered by a lack of information, limited financial resources and poor experiences in the past. Three non-governmental organisations joint efforts to help migrant women without legal status to come out of their isolation. Action research during the implementation process was conducted in order to know which elements contributed to increased feelings of trust and reinforced autonomy among the target group and more willingness to support migrants among a larger population. Our major conclusion is that mental health and well-being is largely defined by (the quality of) social relations and interactions - an aspect that is too often forgotten as a result of the medicalization of mental health related problems.

Knowledge of prescribed drugs among primary care patients: findings from Prover Project

Background Evidence on patient medication knowledge and associated factors within primary care patients is limited, especially in developing countries. Objective To estimate the prevalence and investigate the role of individual and contextual factors on insufficient medication knowledge among primary care patients. Setting Public community pharmacies in a health pole city (234,937 inhab.) in Minas Gerais State, Brazil. Methods Exit-survey conducted with a representative sample of 1221 patients (≥ 18 years) interviewed after dispensing. Data collected for medicines included its name, therapeutic indication, dosage, time of administration, treatment duration, side effects and warnings. Information were compared to the prescription and official guidelines. Descriptive statistics and logistic regression analysis were applied. Main outcome measure Insufficient patient medication knowledge. Results Prevalence of insufficient medication knowledge was 30.1%. Side effects (96.3%) and warnings (71.1%) had the highest percentage of misses. Musculoskeletal system drugs presented the lowest knowledge score (mean = 5.9; SD = 1.9). Significant determinants of insufficient medication knowledge with respective odds ratio (OR) were: level of education (≤ 3 years, OR 1.50; 95% CI 1.06-2.11 and 4-7 years, OR 1.37; 95% CI 1.02-1.84), number of comorbidities (≤ 2, OR 1.36; 95% CI 1.04-1.77), use of prescription drugs in the last 15 days (no, OR 2.22; 95% CI 1.31-3.76) and number of people able to lend money (no person, OR 1.34; 95% CI 1.04-1.74). Conclusion Counselling and monitoring practices should be tailored to patients with less schooling, that are initiating treatment and with low disease burden. Equally important is the need to implement strategies to increase the patient's level of social capital to improve treatment knowledge.