Maternal multimorbidity - experiences of women seeking asylum during pregnancy and after childbirth: a qualitative study

BACKGROUND

Many women seeking asylum during pregnancy and after childbirth have ill-health but detection and assessment of all physical, psychological, and social health needs (maternal multimorbidity) are often difficult as part of routine maternity care. Healthcare providers are key for the early identification and management of vulnerable pregnant women who have additional physical, psychological, and social health needs. We sought to explore the impact of the asylum-seeking process, understanding of wellbeing, expressed health needs (in terms of maternal multimorbidity), and the experiences of maternity care of women seeking asylum during pregnancy and after childbirth in Liverpool, United Kingdom. Enabling factors and barriers to access woman-centred care were also explored.

METHODS

Key informant interviews (n = 10) and one focus group discussion (n = 4) were conducted with women attending a non-profit charitable pregnancy support group. Transcribed interviews were coded by topic and then grouped into categories. Thematic framework analysis was undertaken to identify emerging themes.

RESULTS

The asylum-seeking process negatively impacted women making them feel anxious and depressed with little control or choice over their future. Women reported feeling stressed regarding poor standard of accommodation, low income, dispersal and the uncertainty of their asylum application outcome. Wellbeing during pregnancy and after childbirth was understood to be multifactorial and women understood that their physical health needs were interlinked and negatively impacted by complex psychological and social factors. Women reported that their expectations of maternity services were often exceeded, but information giving, and the use of language interpreters needed to be improved. Women expressed the need for more psychological and social support throughout pregnancy and after childbirth.

CONCLUSIONS

A multidisciplinary team, with links and effective referral pathways to maternal mental health and social services, are necessary for women seeking asylum, to ensure a more integrated, comprehensive assessment of maternal multimorbidity and to provide maternity care in a way that meets all health needs.

Social wellbeing, values, and identity among Caiçara small-scale fishers in southeastern Brazil

Although much in the lives of members of the Caiçara small-scale fishing communities of Lázaro and Saco da Ribeira in Ubatuba, southeastern Brazil would suggest hardship, that population expresses a surprising degree of satisfaction with life. In this paper, we use a social wellbeing lens as applied through an ethnographic, mixed methods approach to reflect on this overall sense that lives rooted in small-scale fishing are well worth living despite their many challenges. We see the classic maritime anthropology theme of identity at the heart of meaning and life satisfaction. Identity provides core aspects of how people engage with their realities and anchors values that are reference points in work and social relations. With reference to the relational nuances revealed by the social wellbeing perspective, however, we show that Caiçara and small-scale fishing identities are not monolithic, but reflect gender and other social positions, and personal and familial experiences. These experiences include grappling with the complex effects of economic, social, political, and environmental changes. We conclude by arguing that fisheries policy that seeks to prioritize human wellbeing would benefit by adopting a social wellbeing perspective. Fisheries policy could thereby take into account identity, values, and relational elements of social life that give meaning and a sense of belonging to small-scale fishers, while also recognizing the cross-cutting and often contradictory variations in human experience that arise from social and economic differences. This social fabric of small-scale fishers' lives shapes their intentions and actions and is thus a necessary complication to the practice of fisheries management that its proponents need to consider.

A social wellbeing approach to the gendered impacts of fisheries transition in Gujarat, India

In this paper, we use the analytical lens of social wellbeing to interpret the history of livelihood change in the coastal village of Saiyad Rajpara in Gujarat over the past 70 years. We describe a broad narrative of transition from food scarcity to food security brought about by the introduction and intensification of bag net fishing in the village. This form of fishing has largely displaced the previous economic basis for livelihoods of uncertain daily wage labour. In a pattern common along the coast, an economy offering at best subsistence has shifted to one that is market-oriented, and which generates considerable surplus. We use the social wellbeing perspective to take stock of and order the complex effects of this transition. While the intensification of small-scale fishing in Saiyad Rajpara resulted in a general and marked material improvement in the lives of the residents of the village, the social relational benefits and subjective experience of change have been more mixed, particularly along lines of gender. A social wellbeing perspective offers an approach to fisheries governance that is more inclusive and sensitive to local experience.

The unspoken grief of multiple stillbirths in rural Pakistan: an interpretative phenomenological study

Background

Pakistan has the highest rate of stillbirth (30.6 stillbirths per 1000 total births) as compared to other South Asian countries. The psychological impact of stillbirths on bereaved women is well documented; however, there is a dearth of literature on lived experiences of women with multiple stillbirths in Pakistan.

Objective

The purpose of this research is to understand the lived experiences of women who had multiple stillbirths in Thatta, Pakistan.

Methods

An interpretative phenomenological study was conducted in district Thatta with eight women who experienced more than one stillbirth. A semi-structured in-depth interview guide was used for data collection. The data were analyzed by using thematic analysis approach.

Results

The results of this study show that experiencing multiple stillbirths has a devastating impact on women’s mental and social wellbeing. The women who experienced multiple stillbirths are stigmatized as “child-killer” or cursed or being punished by God. They are avoided in social gatherings within the families and community, because of these social pressures these women seek spiritual and religious treatment, and struggle to conceive again to deliver a live baby. It was observed that the psycho-social and medical needs of these bereaved women remain unaddressed not only by the healthcare system but also by the society at large.

Conclusions

The physical, social and mental well-being of women who experience multiple stillbirth are at stake. These women are being considered social outcast. Health care providers including physicians, lady health workers, and traditional birth attendants should be trained on provision of psychosocial support along with the routine care that they provide in communities and health facilities. The health care providers should also inform the bereaved women about the biomedical causes of stillbirths that would be helpful to mitigate the stigma associated with stillbirths. Moreover, the health care providers should also counsel family members especially in-laws of these sorrowful women about the biomedical causes of stillbirths that would also be helpful to mitigate the stigma associated with stillbirths.

COVID-19 and social wellbeing in Malaysia: A case study

The world has witnessed the largest single disruption to social wellbeing since the first known case of coronavirus disease 2019 (COVID-19) was reported in China in December 2019. In Malaysia, the government implemented the Movement Control Order (MCO) on 18 March 2020 in response to the COVID-19 pandemic. Thus, this paper highlights how the Malaysian government responded to COVID-19 in comparison with some Asian countries; and what has and has not worked for the MCO imposed by the government. The paper adopts a review approach that is supported by findings from both grey and academic literature. The findings reveal that the COVID-19 pandemic has significant impacts on the society’s wellbeing in Malaysia, the most severe of which are negative mental health and job unemployment. On the other hand, COVID-19 has sparked a surge of volunteering in society. This paper presumably and hopefully represents a frontier review with more empirical research to be conducted to investigate the extent of the social impact of COVID-19, the outcomes of which are a call for re-envisioning of social policies in Malaysia. To the best knowledge of the authors, little empirical research has been conducted to explore the social-wellbeing implications of COVID-19 in Malaysia. By reflecting on the various scenarios—both detrimental and beneficial in the context of the COVID-19 pandemic, the paper identifies potential avenues for relevant research in the social wellbeing realm.

From human wellbeing to animal welfare

What does it mean to be "well" and how might such a state be cultivated? When we speak of wellbeing, it is of ourselves and fellow humans. When it comes to nonhuman animals, consideration turns to welfare. My aim herein is to suggest that theoretical approaches to human wellbeing might be beneficially applied to consideration of animal welfare, and in so doing, introduce new lines of inquiry and practice. I will review current approaches to human wellbeing, adopting a triarchic structure that delineates hedonic wellbeing, eudaimonic wellbeing, and social wellbeing. For each, I present a conceptual definition and a review of how researchers have endeavored to measure the construct. Drawing these three domains of research together, I highlight how these traditionally anthropocentric lines of inquiry might be extended to the question of animal welfare - namely by considering hedonic welfare, eudaimonic welfare, and social welfare as potentially distinguishable and complementary components of the broader construct of animal welfare.

Arts engagement supports social connectedness in adulthood: findings from the HEartS Survey

Background

Loneliness is a public health challenge, associated with premature mortality and poorer health outcomes. Social connections can mitigate against loneliness, and there is evidence that the arts can support social connectedness. However, existing research on the arts and social connectedness is limited by focus on particular age groups and arts activities, as well as a reliance on typically small-scale studies.

Methods

This study reports survey data from 5892 adults in the United Kingdom, closely matched to the national profile in terms of sociodemographic and economic characteristics. It investigates the extent to which arts engagement is perceived to be linked with feelings of social connectedness, which forms of arts engagement are reported as most connecting, and how. Data were collected via the HEartS Survey, a newly designed tool to capture arts engagement in the United Kingdom and its associations with social and mental health outcomes. Demographic and quantitative data, pertaining to the extent to which arts engagement is perceived to be linked with social connectedness, were analysed descriptively. Qualitative data pertaining to respondents’ perceptions of how arts engagement is linked with feelings of social connectedness were analysed using inductive thematic analysis.

Results

Results demonstrated that the majority of respondents (82%) perceive their arts engagement to be linked with feelings of social connectedness at least some of the time. The forms of arts engagement most linked with feelings of social connectedness were attending a live music performance, watching a live theatre performance, and watching a film or drama at the cinema or other venue. Four overarching themes characterise how arts engagement is perceived to facilitate feelings of social connectedness: social opportunities, sharing, commonality and belonging, and collective understanding.

Conclusions

The findings suggest that arts engagement can support social connectedness among adults in the UK through multiple pathways, providing large-scale evidence of the important role that the arts can play in supporting social public health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11233-6.

Socioeconomic impacts of domestic biogas plants on rural households to strengthen energy security

The central theme of the study is to assess the socioeconomic impact of household biogas plants on rural households. To this end, the study selected respondents from biogas plant holders and non-holders of biogas plants in rural areas of Muzaffar-Garh. During the field survey, a questionnaire survey was conducted on 40 biogas users in two villages in each Tehsil and 40 non-biogas users in the same village. A survey based on pre-designed questionnaire was conducted, and main data of 320 households in four Tehsil districts (interviewees) in the Muzaffar-Garh region were collected. In this study, biogas is the input variable, while elderly education and total household income are the input socioeconomic variables. Farm productivity, time saving, indoor air pollution, household hygiene, and expenditure are intermediate variables. The output variables include income, health, and education level of minor children aged 2-5 years. Structural equation modeling (SEM) techniques that describe the relationship between input variables and output variables can be used to obtain steadfast results. Based on the estimates, we have observed that BG investments have substantial impacts on farm productivity, time savings, indoor air pollution, household hygiene, and expenditure, which in turn has played a role in improving the status of people. It is concluded that many direct and indirect socioeconomic impacts of holding biogas plants on rural households can be measured. In order to widely promote biogas technology as an alternative energy source nationwide, there must be greater public participation.

Social Study Resources and Social Wellbeing Before and During the Intelligent COVID-19 Lockdown in The Netherlands

The first intelligent COVID-19 lockdown resulted in radical changes within the tertiary educational system within the Netherlands. These changes posed new challenges for university students and many social welfare agencies have warned that it could have adverse effects on the social wellbeing (SWB) of university students. Students may lack the necessary social study-related resources (peer- and lecturer support) (SSR) necessary to aid them in coping with the new demands that the lockdown may bring. As such, the present study aimed to investigate the trajectory patterns, rate of change and longitudinal associations between SSR and SWB of 175 Dutch students before and during the COVID-19 lockdown. A piecewise latent growth modelling approach was employed to sample students' experiences over three months. Participants to complete a battery of psychometric assessments for five weeks before the COVID-19 lockdown was implemented, followed by two directly after and a month follow-up. The results were paradoxical and contradicting to initial expectations. Where SSR showed a linear rate of decline before- and significant growth trajectory during the lockdown, SWB remained moderate and stable. Further, initial levels and growth trajectories between SSR and SWB were only associated before the lockdown.

Renewable energy from solid waste: life cycle analysis and social welfare

In this study, municipal solid waste (MSW) composition in distinct world locations is compared and a case study is assessed. Three waste-to-energy (WtE) techniques are employed within the framework of an industrial partnership. Life cycle assessment (LCA) and a brief social contextualization including the production of renewable energy from the waste generated worldwide were held to attain a holistic view and attract the interest of multiple stakeholders. Incineration depicted a sustainable profile with improved results for global warming potential and terrestrial ecotoxicity potential. Regular gasification revealed the best results for eutrophication, acidification, marine aquatic ecotoxicity and human toxicity potential. Two-stage plasma gasification showed negative values for all impact categories i.e. achieving environmental credits. The estimate of the electricity produced from the waste generated per capita showed a fair coverage of the electrical demand in distinct world areas. To the best of the authors' knowledge, there are no reports connecting the electricity use, the waste production and the renewable energy achieved from WtE for different world regions. Therefore, this study supports the replacement of fossil fuels with renewable alternatives, reducing greenhouse gas emissions while maintaining the comfort and commodities suitable for a comfortable quality of life.

Bioenergy development and the implications for the social wellbeing of Indigenous peoples in Canada

In this article, we focus on wellbeing as an important concept relating to bioenergy development in Canada. We use a three-dimensional or social approach to understanding wellbeing, which includes subjective and relational aspects in addition to the more traditional material dimension of wellbeing (e.g. financial resources, a healthy environment). Indigenous business leaders engaged in forestry, energy, and related resource sectors were recruited through our partner organization, the Canadian Council for Aboriginal Business, as a representative sample of key people to be engaged in the scoping of existing and future bioenergy partnerships in Canada. Participants often responded in ways that did not discretely fit into categories, but instead reflected a perspective on their own and their community's dimensions of social wellbeing, which we captured through open coding for emergent themes. Our findings on material wellbeing illustrate that relationships between different wellbeing dimensions need to be considered for community-appropriate bioenergy development.

Study protocol: a randomised controlled trial of a telephone delivered social wellbeing and engaged living (SWEL) psychological intervention for disengaged youth

BACKGROUND

Internationally, from 12.2-23.4% of youth (aged 16-24 years) are not in employment, education or training (NEET). These disengaged youth are more likely to experience social exclusion, increased psychological distress and poor quality of life. Youth at risk of disengagement are less likely to access traditional support services, requiring development of innovative interventions.

METHODS

The trial is a single blind, three arm, randomised controlled trial evaluating the effectiveness of a telephone delivered psychological intervention for disengaged youth (12-25 years). Participants will be randomised to receive either (i) SWEL, (ii) Befriending, or (iii) Single Session Psycho-Education. Therapy will be over an 8 week period with a minimum of four and maximum of eight sessions for the SWEL or Befriending conditions, or a single session for the Psycho-Education condition. Outcomes will be assessed at baseline and at 2, 8 and 14-month follow-up with the primary outcome being re-engagement in education, training or employment.

DISCUSSION

This large, multi-site, randomised controlled trial will inform the delivery of services for young people at risk of disengaging from education or training. The provision of psychological therapy by telephone increases access by youth - especially those in rural and remote areas - both to the trial and the treatment, if adopted by services. The outcomes of this trial could have meaningful societal impact for a vulnerable population. It is expected that recruitment, intervention and retention will present challenges for the trial given the focus on disengaged youth.

TRIAL REGISTRATION

ANZCTR, ACTRN12614001212640 , Registered 18 Nov 2014. Retrospectively registered.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the participating institutions. Results of the trial will be submitted for publication in peer reviewed journals and findings presented at scientific conferences and to key service providers and policy makers.

Social Well-Being and Related Factors in Students of School of Nursing and Midwifery

BACKGROUND

According to the World Health Organization viewpoint, social well-being is an important dimension of health along with physical and mental aspects. Evaluation of social well-being is necessary in students, especially in medical sciences students due to future responsibility as health care professionals. The present study attempted to investigate the level of social well-being, five domains of it (like actualization, integration, contribution), and some related factors in the school of nursing and midwifery students.

METHODS

This cross-sectional study was carried out between Julys to December 2015 and comprised 346 students in the school of nursing and midwifery in Shiraz University of Medical Sciences, Shiraz, Iran. Social well-being, socio-demographic status and physical activity were measured by valid questionnaires. Univariate linear regression analysis, multiple imputation method, ANOVA and independent sample t-test were used as different statistical methods. The P values less than 0.05 were considered as statistically significant.

RESULTS

The mean score of social well-being was 50. The minimum and maximum scores of social well-being were 20 to 100. Married students had higher social well-being than single students in univariate linear regression (Beta: 2.111, 95% CI: (0.387 to 3.738), P=0.017). Also, social integration had higher scores in married students (P=0.015). Social actualization was higher in male students (P=0.015); on the other hand, social contribution was higher in female students (P=0.026).

CONCLUSION

The results of our study showed that social well-being status of students in this research was not satisfactory. Designing and conducting programs for promotion of social well-being, for example preparing facilities for marriage of students, can be helpful. Evaluation of social well-being in students of other schools with multicenter studies seems to be useful.

Building psychosocial assets and wellbeing among adolescent girls: A randomized controlled trial

We conducted a randomized controlled trial of a 5-month resilience-based program (Girls First Resilience Curriculum or RC) among 2308 rural adolescent girls at 57 government schools in Bihar, India. Local women with at least a 10th grade education served as group facilitators. Girls receiving RC improved more (vs. controls) on emotional resilience, self-efficacy, social-emotional assets, psychological wellbeing, and social wellbeing. Effects were not detected on depression. There was a small, statistically significant negative effect on anxiety (though not likely clinically significant). Results suggest psychosocial assets and wellbeing can be improved for girls in high-poverty, rural schools through a brief school-day program. To our knowledge, this is one of the largest developing country trials of a resilience-based school-day curriculum for adolescents.

Towards measurement of the Healthy Ageing Phenotype in lifestyle-based intervention studies

INTRODUCTION

Given the biological complexity of the ageing process, there is no single, simple and reliable measure of how healthily someone is ageing. Intervention studies need a panel of measures which capture key features of healthy ageing. To help guide our research in this area, we have adopted the concept of the "Healthy Ageing Phenotype" (HAP) and this study aimed to (i) identify the most important features of the HAP and (ii) identify/develop tools for measurement of those features.

METHODS

After a comprehensive assessment of the literature we selected the following domains: physiological and metabolic health, physical capability, cognitive function, social wellbeing, and psychological wellbeing which we hoped would provide a reasonably holistic characterisation of the HAP. We reviewed the literature and identified systematic reviews and/or meta-analysis of cohort studies, and clinical guidelines on outcome measures of these domains relevant to the HAP. Selection criteria for these measures included: frequent use in longitudinal studies of ageing; expected to change with age; evidence for strong association with/prediction of ageing-related phenotypes such as morbidity, mortality and lifespan; whenever possible, focus on studies measuring these outcomes in populations rather than on individuals selected on the basis of a particular disease; (bio)markers that respond to (lifestyle-based) intervention. Proposed markers were exposed to critique in a Workshop held in Newcastle, UK in October 2012.

RESULTS

We have selected a tentative panel of (bio)markers of physiological and metabolic health, physical capability, cognitive function, social wellbeing, and psychological wellbeing which we propose may be useful in characterising the HAP and which may have utility as outcome measures in intervention studies. In addition, we have identified a number of tools which could be applied in community-based intervention studies designed to enhance healthy ageing.

CONCLUSIONS

We have proposed, tentatively, a panel of outcome measures which could be deployed in community-based, lifestyle intervention studies. The evidence base for selection of measurement domains is less well developed in some areas e.g. social wellbeing (where the definition of the concept itself remains elusive) and this has implications for the identification of appropriate tools. Although we have developed this panel as potential outcomes for intervention studies, we recognise that broader agreement on the concept of the HAP and on tools for its measurement could have wider utility and e.g. could facilitate comparisons of healthy ageing across diverse study designs and populations.