Factors influencing performance by contracted non-state providers implementing a basic package of health services in Afghanistan

BACKGROUND

In 2002 Afghanistan's Ministry of Public Health (MoPH) and its development partners initiated a new paradigm for the health sector by electing to Contract-Out (CO) the Basic Package of Health Services (BPHS) to non-state providers (NSPs). This model is generally regarded as successful, but literature is scarce that examines the motivations underlying implementation and factors influencing program success. This paper uses relevant theories and qualitative data to describe how and why contracting out delivery of primary health care services to NSPs has been effective. The main aim of this study was to assess the contextual, institutional, and contractual factors that influenced the performance of NSPs delivering the BPHS in Afghanistan.

METHODS

The qualitative study design involved individual in-depth interviews and focus group discussions conducted in six provinces of Afghanistan, as well as a desk review. The framework for assessing key factors of the contracting mechanism proposed by Liu et al. was utilized in the design, data collection and data analysis.

RESULTS

While some contextual factors facilitated the CO (e.g. MoPH leadership, NSP innovation and community participation), harsh geography, political interference and insecurity in some provinces had negative effects. Contractual factors, such as effective input and output management, guided health service delivery. Institutional factors were important; management capacity of contracted NSPs affects their ability to deliver outcomes. Effective human resources and pharmaceutical management were notable elements that contributed to the successful delivery of the BPHS. The contextual, contractual and institutional factors interacted with each other.

CONCLUSION

Three sets of factors influenced the implementation of the BPHS: contextual, contractual and institutional. The MoPH should consider all of these factors when contracting out the BPHS and other functions to NSPs. Other fragile states and countries emerging from a period of conflict could learn from Afghanistan's example in contracting out primary health care services, keeping in mind that generic or universal contracting policies might not work in all geographical areas within a country or between countries.

Hair As a Barrier to Physical Activity among African American Women: A Qualitative Exploration

Background

African American (AA) women face unique sociocultural barriers to physical activity (PA) engagement. Such barriers may contribute to their low PA levels and high cardiometabolic disease burden. One particular barrier reported among AA women in recent research is that being physically active can have an undesirable effect on the hairstyles and hair maintenance of many AA women. However, the underlying mechanisms contributing to this barrier have not been fully elucidated. The purpose of this study is to explore hairstyle maintenance as a barrier to PA among AA women and to identify effective strategies to overcome this barrier in the design of a culturally relevant PA intervention.

Methods

A qualitative study design was used. Data were collected from the focus groups comprising 23 sedentary and obese AA women (median age = 38.1 years, median body mass index = 39.8 kg/m²). Content analysis was used to analyze these focus group data.

Results

Three key themes emerged from the qualitative narratives of participants: (1) impact of perspiration on hair and hairstyle maintenance, (2) image and social comparisons, and (3) solutions to overcome hair-related barriers to PA. For impact of perspiration and hairstyle maintenance, participants described how perspiring while engaging in PA negatively impacts many of their hairstyles. Participants further discussed how time and monetary burdens associated with PA-related hairstyle maintenance further contributed to this issue. Findings for the theme of image and social comparison focused on how an AA woman’s hairstyle is an important part of the image and the social comparisons made by non-AAs regarding the hairstyles and maintenance practices of AA women. For solutions to hairstyle maintenance barriers, participant described a variety of potential styling techniques that may help alleviate PA-related maintenance concerns, including braids, locks, and natural hairstyles. However, no styling technique was uniformly endorsed by all study participants.

Conclusion

Findings highlight the significance of hair in the AA community and provide further insight on appropriate intervention design strategies to overcome this sociocultural barrier to PA. Future research is needed to corroborate and further expand on our findings.

The Use of Family Rituals in Eating Behaviors in Hispanic Mothers

Food rituals often abruptly change when Hispanic families migrate to the United States. This report describes changes in rituals of food procurement, preparation, and presentation (food-PPP) in Hispanic women following migration to the United States. Focus groups and face-to-face interviews were conducted with 13 low-income, overweight/obese Hispanic women 27 to 40 years of age. Content analysis was used to analyze cultural and contextual sources for food-PPP. Changes in rituals and traditions in food-PPP occurred, including materials and ingredients for traditional meals. Food rituals may play a role in healthful eating and could, therefore, serve as leverage points for interventions designed to promote healthy eating behaviors.

The health of Romanian Gypsy women in Serbia

Indigenous people are over-represented among the world's disadvantaged; their health is influenced by lack of access to critical resources including health care and by their cultural practices. We report on the health and the health practices of one group of indigenous women, the Roma/Gypsies of northern Serbia who live in poverty, reside in sub-standardized housing in segregated communities, and are poorly educated and stigmatized. We describe the environment in which they live, their health history, and the cultural practices that influence their health and health behaviors, including their sporadic utilization of health services that are provided by the state. We also present evidence supporting that, in the face of adversity, cultural practices, including those related to kinship and social support, can have significant benefits in shaping health status.

Sexting among singles in the USA: prevalence of sending, receiving, and sharing sexual messages and images

Background: The transmission of sexual images and messages via mobile phone or other electronic media (sexting) has been associated with a variety of mostly negative social and behavioural consequences. Research on sexting has focussed on youth, with limited data across demographics and with little known about the sharing of private sexual images and messages with third parties. Methods: The present study examines sexting attitudes and behaviours, including sending, receiving, and sharing of sexual messages and images, across gender, age, and sexual orientation. A total of 5805 single adults were included in the study (2830 women; 2975 men), ranging in age from 21 to 75+ years. Results: Overall, 21% of participants reported sending and 28% reported receiving sexually explicit text messages; both sending and receiving 'sexts' was most common among younger respondents. Although 73.2% of participants reported discomfort with unauthorised sharing of sexts beyond the intended recipient, of those who had received sext images, 22.9% reported sharing them with others (on average with 3.17 friends). Participants also reported concern about the potential consequences of sexting on their social lives, careers, and psychosocial wellbeing. Conclusion: Views on the impact of sexting on reputation suggest a contemporary struggle to reconcile digital eroticism with real-world consequences. These findings suggest a need for future research into negotiations of sexting motivations, risks, and rewards.

Spirituality, emotional distress, and post-traumatic growth in breast cancer survivors and their partners: an actor-partner interdependence modeling approach

BACKGROUND

The association between spirituality and emotional health has been well documented in healthy individuals. A small literature has shown that spirituality plays a role in well-being for some breast cancer (BC) survivors; however, this link is virtually unexplored in partners/spouses of survivors. The current study aimed to assess the relationship between spirituality, emotional distress, and post-traumatic growth for BC survivors and their partners using a dyadic analyses approach.

METHODS

A total of 498 couples who were 3-8 years post-BC diagnosis were recruited from the Eastern Oncology Group database.

RESULTS

For BC survivors and their partners, greater levels of spirituality were associated with increases in their own post-traumatic growth. There was no relation between BC and partner spirituality and their own emotional distress, but partner's spirituality was associated with reduced occurrence of intrusive thoughts in the BC survivor. In contrast, BC survivors' spirituality was found to be wholly unrelated to partner's mental health and adjustment.

CONCLUSIONS

Following diagnosis and treatment, spirituality appears to associate with positive growth in BC survivors and their partners. However, BC survivor and partner spirituality seem to be ineffective at impacting the other's post-traumatic growth or emotional distress, with the exception of intrusive thoughts. Dyadic analysis takes into account the reciprocal influence of close relationships on health and is an important and under-utilized methodology in behavioral oncology research and clinical practice. Copyright © 2016 John Wiley & Sons, Ltd.

Utility of Acculturation in Physical Activity Research in Latina Adults

Latina adults in the United States have a disproportionately higher prevalence of chronic diseases related to low physical activity levels than non-Hispanic women. Literature indicates that acculturation may be a contributing factor to being physically active, but the extent of this association remains unclear. An integrative review of literature was conducted on studies that examined acculturation as it relates to physical activity in Latinas in the United States. Our review of 33 studies revealed inconsistent measurement and conceptualization of acculturation and physical activity across studies. Findings from this review reinforce the importance and continued use of acculturation by behavioral researchers; however, acculturation, as conceptualized in the studies reviewed, may not have had an influence on health as much as traditions, life patterns, and resources of Latinas.

Religion, kinship and health behaviors of African American women

A positive relationship exists between functional health and religion. We present an empirical definition of religion and describe the key elements of religious behavior, building a model that can be used to explore the presumed relationship between religion and health. Semi-structured interactive interviews were conducted with 22 participants over a 6-month period. Head Start programs and churches located in the inner city of a large metropolitan area. Twenty-two African American women were aged from 21 to 45. We focus on social relationships and propose that prophet-created religions mimic kinship relationships and encourage kinship-like cooperation between members.

The National Cancer Institute's Community Networks Program Initiative to Reduce Cancer Health Disparities: Outcomes and Lessons Learned

BACKGROUND

We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities.

METHODS

Quantitative and qualitative data were abstracted from CNP final reports. Qualitative data were grouped by theme.

RESULTS

Together, the 25 CNPs worked with more than 2,000 academic, clinical, community, government, faith-based, and other partners. They completed 211 needs assessments, leveraged funds for 328 research and service projects, trained 719 new investigators, educated almost 55,000 community members, and published 991 articles. Qualitative data illustrated how use of CBPR improved research methods and participation; improved knowledge, interventions, and outcomes; and built community capacity. Lessons learned related to the need for time to nurture partnerships and the need to attend to community demand for sustained improvements in cancer services.

IMPLICATIONS

Findings demonstrate the value of government-supported, community-academic, CBPR partnerships in cancer prevention and control research.

Addressing the demand for cultural relevance in intervention design

This article describes the development of a model to promote physical activity in Hispanic women that embeds a life course perspective and culture to enhance comparative effectiveness in intervention design. When working with diverse cultural groups, researchers often struggle with intervention designs and strategies to enhance cultural relevance; they do so based on the assumption that this will enhance efficacy and make interventions more sustainable. In this article, the authors discuss how the model was used in two interventions designed for younger and older Hispanic women. These interventions were guided by a life course perspective, incorporated social support, and included salient elements from the women's culture. Three considerations underpinned the development of the model: (a) infusing concepts and values of a culture and tradition into the interventions, (b) viewing participants through a life course perspective to assess how an intervention can build on developmental transitions, and (c) determining how social support operates within two groups that, although sharing history and thus some cultural practices, diverge widely in those practices. The authors propose that by incorporating elements of this model into their interventions, researchers can increase program efficacy and effectiveness.

Operationalization of community-based participatory research principles: assessment of the national cancer institute's community network programs

OBJECTIVES

We examined how National Cancer Institute-funded Community Network Programs (CNPs) operationalized principles of community-based participatory research (CBPR).

METHODS

We reviewed the literature and extant CBPR measurement tools. On the basis of that review, we developed a 27-item questionnaire for CNPs to self-assess their operationalization of 9 CBPR principles. Our team comprised representatives of 9 of the National Cancer Institute's 25 CNPs.

RESULTS

Of the 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles of recognizing community as a unit of identity, building on community strengths, facilitating colearning, embracing iterative processes in developing community capacity, and achieving a balance between data generation and intervention. CNPs varied in the extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging the community in research dissemination, and striving for sustainability.

CONCLUSIONS

Although the development of assessment tools in this field is in its infancy, our findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.

Promotoras' roles in integrative validity and treatment fidelity efforts in randomized controlled trials

Promotoras from the communities in which interventions are implemented can be effective contributors to validity and fidelity efforts. This article describes a 48-week randomized controlled trial Madres para la Salud (Mothers for Health) and illustrates the use of promotoras as collaborative members of the research team to contribute to attaining integrative validity and treatment fidelity. Madres para la Salud implements a culturally tailored physical activity program to effect changes in body fat, systemic and fat tissue inflammation, and depression symptoms. The significance of Madres para la Salud treatment validity and fidelity processes includes cultural tailoring of a social support intervention, and a promotora model to incorporate initial and ongoing fidelity monitoring.

Enhancing life after cancer in diverse communities

BACKGROUND

Although large numbers of cancer survivors exist in every community, including minority communities, there is a significant gap in knowledge about best practices for these patients.

METHODS

The Community Networks Program, funded by the National Cancer Institute Center to Reduce Cancer Health Disparities, has developed and tested unique services for these communities. These programs have used community-based participatory research techniques under a framework of diffusion of innovation and communications theory.

RESULTS

This article describes some specifically tailored interventions that may be useful to a wide range of providers working with the underserved.

CONCLUSIONS

Enhancing life after cancer can be achieved in underserved communities by supplementing local resources.

Food aversions and cravings during early pregnancy: association with nausea and vomiting

The prospective cohort study examined whether Ecuadorian women with early pregnancy nausea and vomiting (NVP) are more likely to develop food aversions and cravings, and if so, whether the specific foods identified as aversive or craved are the same as those predicted by the popular maternal-embryo protection hypothesis (MEPH). Consistent with MEPH predictions, women with NVP were more likely to report increased odor sensitivity and aversions for some predicted "toxic" foods and more likely to crave fruits. However, other hypothesis predictions were not supported. The relationship of food aversions and cravings with NVP appears more complicated than that explained by the MEPH.

Process for determining the cancer burden of the Hopi Tribe

The Hopi Tribe is located in the northeastern part of Arizona on more than one million acres of federally reserved land. Tribally based community research, conducted in collaboration with University of Arizona researchers, has been successfully implemented on Hopi beginning with a cross-sectional community survey in 1993 and continuing with a second survey in 2006. Both surveys identified a strong community interest in cancer. This article reports on the process involved in a third study, in which official Hopi enrollment data were matched with Arizona Cancer Registry data. The process involved bringing in a new partner and obtaining tribal, state, and university approvals, as well as a signed data exchange agreement between the state and the Hopi Tribe. Technical implementation of the data match required computer programming and epidemiologic expertise, as well as an understanding of the community and the culture. Close collaboration among Hopi residents and university epidemiologists was critical.

Traditions and alcohol use: a mixed-methods analysis

An integrative mixed-methods analysis examined traditional beliefs as associated with beliefs about self-care during pregnancy and with alcohol abstinence among young adult women from two rural U.S.-Mexico border communities. Quantitative (measured scale) variables and qualitative thematic variables generated from open-ended responses served as within-time predictors of these health-related outcomes. A weaker belief that life is better in big cities was associated with stronger self-care beliefs during pregnancy. Also, a weaker belief that small towns offer tranquil environments was associated with total abstinence from alcohol. Regarding the Hispanic Paradox, these results suggest that a critical appreciation of cultural traditions can be protective, as this avoids stereotypical or idyllic views of urban or rural lifeways, and promotes self-protective beliefs and behaviors.

Predictors of Pap Test Use Among Women Living on the Hopi Reservation

Between July and December 1993, the Hopi Department of Health Services, in collaboration with the Arizona Cancer Center (AZCC), conducted a population-based study of cervical cancer risk factors, screening practices, and predictors of Pap test utilization among American Indian women age 18 years and older living on the Hopi reservation in northern Arizona. This survey, entitled the Healthy Hopi Women's Study, involved a stratified random sample of households from each of the 11 Hopi villages. The final study sample was 559 completed face-to-face interviews. This article reports on unpublished findings of the survey and discusses how the Hopi utilized the study's findings to develop a Centers for Disease Control and Prevention (CDC)-funded breast and cervical cancer program.

Creating the environment for a successful community partnership

This paper describes the development of the American Indian Oncology Program (AIOP) and presents the accomplishments of a participatory research approach that involved an integrated network for cancer care and research. AIOP used a participatory process to develop infrastructure, identify research questions, develop methodologies, write supplemental grants, and evaluate accomplishments based on community defined measures of success. Partnerships between University and Indian Health Service, private, and state institutions led to improved collaboration. Health services delivery improved by increasing provider involvement at multiple institutions via a Tumor Board. Community awareness improved through workshops addressing community-specific cancer concerns. Collectively, these resulted in an environment receptive to the development of research activities. The AIOP team, through a participatory process, developed infrastructure at each institution that facilitated interaction, community-based education, and improved patient care; identified new partners; raised community-level knowledge and awareness about cancer; encouraged a research-friendly environment and building research capacity; and increased the cultural competency of researchers wishing to work in American Indian communities and created a cadre of future American Indian cancer researchers. As evidenced by successful pilot project development and formation of ongoing research and funding applications, the authors created a research-receptive environment and promoted potentially sustainable research capacity in the community. Much of their success is the result of utilizing a participatory model for capacity building that included not only communities but institutions. Cancer 2006. Published 2006 by the American Cancer Society.

TRADITIONALISM AND ITS RELATIONSHIP TO DISEASE RISK AND PROTECTIVE BEHAVIORS OF WOMEN LIVING ON THE HOPI RESERVATION

The fundamental aim of this study was to identify factors crucial for the development of effective cancer prevention programs for American Indian (AI) populations. Toward that end, we developed an instrument to assess the influence of traditionalism on health risks such as smoking, consumption, and obesity. A population-based survey was conducted among 559 randomly selected women living on the Hopi reservation aged 18 years and older, from July through December 1993. To construct a traditionalism score, we conducted focus groups in the community. A multidimensional approach was adopted by assessing three dimensions of native culture: language usage; cultural participation, or participation in such activities as Hopi ceremonies; and percentage of life spent off-reservation. A mean score of the three dimensions was computed for each respondent. High levels of traditionalism were significantly associated with disease protective behaviors, such as practicing traditional Hopi activities to keep healthy (OR = 3.07), and significantly inversely associated with disease risk factors such as smoking (OR = 0.26) and obesity (OR = 0.60) independent of age, marital status, and education. As these data provide a strong rationale for the promotion of traditions in public health programs aimed at decreasing rates of chronic disease among AI women, we conclude this paper with a discussion of the importance of traditionalism and how it might be accurately assessed.

Acculturation and cervical cancer: knowledge, beliefs, and behaviors of Hispanic women

In a community-based sample of Hispanic women, this study examines differences in relation to level of acculturation in knowledge about the Pap examination, fear/fatalism towards cancer, and cervical cancer screening behaviors. Respondents were randomly chosen from 11 churches in the Phoenix metropolitan area (n = 566) and were categorized into three acculturation levels: low (35.2%), bicultural (26.3%), and high (38.5%). Interviews focused on family history of cancer as well as knowledge about cancer and utilization of screening techniques for breast and cervical cancers. OLS regression and probit analyses were conducted to examine the role of acculturation in differentiating. Hispanic subgroups in relation to knowledge, beliefs, and behaviors regarding cervical cancer. Findings of the present study indicate that Hispanic women in the Phoenix metropolitan area are utilizing cervical cancer screening services with over 90 percent of women in all three acculturation groups ever having had a Pap exam and more than 50 percent having had the examination during the past year. However, results also indicate that of the Hispanic subgroups examined, lower acculturated Hispanic women have less knowledge about Pap smears and exhibit lower utilization rates for cervical cancer screening. These results suggest that lower-acculturated Hispanic women comprise the subgroup of Hispanics that is at greatest risk of presenting with advanced stages of cervical cancer. Results have implications for cancer screening and education programs for Hispanic women as well as implications for health care professionals who serve this population.

Breast self-examination: knowledge and practices of Hispanic women in two southwestern metropolitan areas

The breast self-examination (BSE) practices of 1,453 Hispanic women in Phoenix, Arizona and San Diego, California were the focus of this study. Variables proposed as factors that influence the frequency and proficiency of BSE were demographic variables, particularly language and level of acculturation, having been taught BSE by a health professional, and experience with the disease. Results indicate that even though the majority of the women at both the Phoenix (78.1%) and San Diego (83.7%) sites had been taught BSE by a professional and most women in Phoenix (62.5%) and San Diego (63.4%) reported performing BSE within the past month, only 0.7% of the women at both sites were found to be proficient in the technique of BSE. Further, results indicate that language and acculturation were correlated with whether or not a woman performed BSE. These findings suggest that BSE education classes must provide information and techniques that promote proficiency in BSE, and must be designed to meet the unique needs of Hispanic women, particularly those of low acculturation levels.

Further field observations in the Ivisârtoq region of southern West Greenland

Mapping by the Exeter team was begun in 1981 and in three field seasons six geologists have been engaged for a total of 14 man/seasons. This is a sad comparison with the Buksefjorden project which, though covering a comparable area, benefitted from an investment of 24 man/seasons spread over six field seasons. Geologists mapping the Ivisârtoq area had the benefit of earlier reconnaissance maps and reports, but it is felt very strongly that the complexity of the ground and the degree of outcrop on the one hand, and the enormous significance of a proper interpretation on the other, justify a more intensive investigation. Mapping af the Ivisårtoq sheet was scheduled for completion in 1983 but inclement weather meant that some small parts of the area were not mapped. However, sampling programmes for certain specific problems were satisfactorily concluded. To keep this report as short as possible, it concentrates mainly on new and significant observations and interpretations made in the 1983 field season, so that some important aspects of the geology of the area are not mentioned here.

Field work on the Precambrian basement in the Buksefjord region, southern West Greenland

Five two-man teams from the University of Exeter spent a third field season mapping in the area of Buksefjorden as part of the GGU mapping programme in the Fiskenæsset region organised by GGU in conjunetion with the University of Exeter (Chadwiek & Coe, 1973; Chadwick et al., 1974a). Mapping at 1:20000 was begun by J. S., K. C. and K. V. in areas north and south-east of Buksefjorden and north of Alangordlia respeetively, while P. W. completed the area between Sermilik and Alângordlia east of Amitsuarssugssuaq. B. C. mapped Qilângârssuit, Simiutat and associated islands in the skaergaard south of Angissorssuaq at a scale of 1:10000. The group was supported by helicopters and the GGU cutters J. F. Johnstrup and Villiaumit organised by Feiko Kalsbeek from Midgård. Boat assistance was also provided by V. R. McGregor in mapping the outer islands. The exceptionally fine weather enabled good progress and more than 60% of the Buksefjorden sheet isnow completed. Localities referred to in the text may be found by reference to 1:250000 maps 64 V. 1 Godthåb and 63 V. 1 Færingehavn.

The Hurry Inlet granite and related rocks of Liverpool Land, East Greenland

The Hurry Inlet granite, a late Lower Palaeozoic mass was emplaced into a basement complex which had been metamorphosed and deformed in an earlier period of plutonism. The host rocks were brittle at the time of emplacement and the granite made space for itself in part by stoping. Contacts are frequently faulted. Internal faulting is of a similar kind showing that the final movement was of a rigid granite mass which rose to a very high crustal level and was soon unroofed, the debris from unroofing being itself affected by similar faulting. The homogeneity of the mass is shown by petrography and chemistry and the chemistry indicates that it was generated at deep crustal levels.