Experiences of family caregivers in dealing with cases of advanced breast cancer: a qualitative study of the sociocultural context in Punjab, Pakistan

BACKGROUND

Patients with advanced breast cancer require consistent help and support from family caregivers. These caregivers often endure financial burdens and psychological stress, with their experiences significantly influenced by sociocultural factors. This study aims to explore the experiences of family caregivers of advanced breast cancer patients in Punjab province, Pakistan.

METHODS

Data was collected through in-depth interviews with fifteen family caregivers of advanced breast cancer patients in three major cities of Punjab, Pakistan. Caregivers, who had been in close contact with the patient for the last two years, were purposively sampled from five major hospitals. The data was analyzed using thematic analysis.

RESULTS

The study revealed that the experiences of family caregivers are deeply rooted in the sociocultural context. Key themes identified include social responsibility and cultural reciprocity norms; limited awareness and mobility options for caregivers; financial responsibility and strain; impacts of beauty myths and shyness on caregiving attitudes and decisions; the stressful and emotional nature of caregiving; treatment perspectives influenced by social groups; challenges in consulting male physicians and associated stigma; the role of religious beliefs in caregiving; and stress management, with religion often being a coping mechanism. These factors can contribute to delayed treatment decisions for patients.

CONCLUSIONS

Family caregivers are crucial in facilitating timely treatment decisions for advanced breast cancer patients in the Pakistani context. To minimize treatment delays and alleviate caregiver stress, addressing sociocultural barriers in care-seeking is essential. A tailored approach, considering sociocultural and religious factors, is imperative for the management and early diagnosis of breast cancer, necessitating appropriate policymaking and implementation.

[Facing fever in the pediatric patient: Checklist as a tool for parents]

INTRODUCTION

In Western Europe, 20%-40% of children with fever request health care. Most of them present trivial viral infections, however, it is essential in pediatrics to distinguish patients who present a severe infection. This process begins with the recognition of the seriousness and the subsequent search for medical attention by the parents.

METHODOLOGY

Analytical and cross-sectional observational study. One hundred patients were selected in two health centers. Sociodemographic data were collected, together with the responses to a checklist containing the signs and symptoms to request health care in case of fever. Subsequently, the checklist was filled out by the pediatrician.

RESULTS

The mean age of the patients was 5.41 years. 50% consulted in the first 48h of fever evolution. In 42%, the response to all the items on the checklist was exactly the same between the companion and the pediatrician. There were no significant differences according to variables: first episode of fever (P=.262), age of the patient (P=.859), having a sibling (P=.880), family relationship of the companion (P=.648) or educational level of the companion (P=.828).

CONCLUSIONS

Medical consultations for fever in pediatrics are carried out very early. A high percentage do not present alarm signs when they consult. There is a need to expand training on the alarm signs of fever in all parents, regardless of the number of children, age or educational level. The checklist as a tool for home assessment of fever has received high marks for its usefulness.

"I don't want my marriage to end": a qualitative investigation of the sociocultural factors influencing contraceptive use among married Rohingya women residing in refugee camps in Bangladesh

BACKGROUND

The timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Recognizing this challenge, our paper aims to explore the socio-cultural factors influencing the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh.

METHOD

A qualitative study was conducted in two unregistered Rohingya camps (Camp 7&14) located in Ukhiya Upazila, Cox's Bazar from January 10th to 20th, 2022. A total of 14 In-Depth Interviews (IDIs) were conducted among married Rohingya women of reproductive age (15-49 years), along with 16 Key Informant Interviews (KIIs) involving stakeholders engaged in reproductive healthcare provision. Participants were selected using purposive sampling. All interviews were conducted in the local language, recorded, transcribed verbatim, and subsequently translated into English. The data were analyzed using NVivo (Version 11), and the analysis process followed Neuman's three-phase coding system.

RESULTS

Five broad themes were identified: Sociocultural expectations and values attached to births, power imbalances within marital relationships, the role of religious beliefs, fear of side effects, and misperceptions about contraception. Having a larger number of children is viewed positively as it is believed that children play a crucial role in preserving the lineage and contributing to the growth of the Islamic population. Despite expressing an inclination towards contraception, the disapproval of husbands becomes a significant barrier for women. Defying their husbands' wishes can result in instances of Intimate Partner Violence (IPV) and even marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions, and mistrust in the existing medical system.

CONCLUSION

Addressing the socio-cultural barriers that prevent women from using modern contraception will have important public health implications. These findings can support in crafting culturally sensitive programs and educational interventions. These initiatives can assist Rohingya refugee women in planning their pregnancies and reducing high-risk pregnancies, ultimately leading to a decrease in maternal mortality rates within the community.

Exploring Factors Influencing Cervical Cancer Prevention Behaviors: Unveiling Perspectives of Conservative Muslim American Women in Virginia

Understanding the complexities surrounding cervical cancer prevention methods and hesitancy among conservative Muslim American women is crucial in addressing health disparities. This qualitative study aimed to delve into the religious, behavioral, and socio-cultural factors influencing Muslim women's decisions regarding cervical cancer screening (CC-S) and HPV vaccination (HPV-V) in Virginia, USA. Through interviews with 10 Muslim women residing in Virginia, qualitative data were collected as part of a mixed-method cross-sectional study conducted between August and September 2021. Findings revealed that participants had limited knowledge about cervical cancer, CC-S, and HPV-V, with notable themes emerging, such as cultural influences, misconceptions, language barriers, and challenges posed by the intricate US healthcare system. Future research should focus on exploring these barriers to mitigate the impact of cervical cancer within the Muslim population.

Exploring Sociocultural Influences Affecting Body Image in Survivors of Childhood Sexual Assault

This phenomenological study explored the lived experiences of survivors of childhood sexual assault, their meaning making process of the assault, and how messages from their sociocultural environment affected their relationship with, and perception of, their bodies. Utilizing a social constructivist framework, the research team interviewed eleven (n = 11) participants from a variety of backgrounds who were gender assigned female at birth and had survived childhood sexual assault (CSA). Four major themes emerged from the narratives collected. These include sociocultural impacts which included four subthemes: family relationships, peer relationships, societal and environmental influences, and cultural and ethnic influences; meaning making of the critical event, i.e., childhood sexual assault; self-perception of their bodies; internal processes that have shaped their perceptions and meaning making, i.e., thoughts, feelings, and behaviors. Findings indicate major influence of sociocultural factors in shaping participant's internal processes as survivors of CSA, meaning making, and subsequently self-perceptions of, and relationship with, their bodies. We discuss CSA and body image keeping the intersectionality of the individual, their experiences, and the impact of sociocultural contexts on that intersectionality.

A qualitative investigation into pregnancy experiences and maternal healthcare utilisation among adolescent mothers in Nigeria

BACKGROUND

Adolescent maternal healthcare utilisation is low in Nigeria, and little is understood about the pregnancy experiences and drivers of maternal healthcare utilisation among of adolescent girls. This study investigated the pregnancy experiences and maternal healthcare utilisation among adolescent mothers across Nigeria.

METHODS

The study used the qualitative design. Urban and rural communities in Ondo, Imo and Katsina states were selected as research sites. Fifty-five in-depth interviews were conducted with adolescent girls who were currently pregnant or had given birth to a child recently, and nineteen in-depth interviews were conducted with older women who were either mothers or guardians of adolescent mothers. Additionally, key informant interviews were conducted with five female community leaders and six senior health workers. The interviews were transcribed, and resulting textual data were analysed via framework thematic analysis using a semantic and deductive approach, with the aid of NVivo software.

RESULTS

The findings showed that the majority of unmarried participants had unintended pregnancies and stigma against pregnant adolescents was common. Social and financial support from family members, maternal support and influence, as well as healthcare preferences shaped by cultural and religious norms were the major drivers of maternal healthcare use among adolescent mothers, and the choice of their healthcare providers.

CONCLUSIONS

Interventions to support adolescent mothers and increase maternal healthcare utilisation among them must focus on ensuring the provision of social and financial support for adolescent mothers, and should be culturally sensitive.

Sociocultural and moral narratives influencing the decision to vaccinate among rheumatic disease patients: a qualitative study

INTRODUCTION/OBJECTIVES

Vaccination is a process that involves individual, social, and ethical aspects, beyond public governance of vaccines or vaccination as a public health concern. The aim of this study is to describe the sociocultural and moral narratives that influence the decision to vaccinate in general and to vaccinate against COVID-19 specifically, among patients at the rheumatology units of two hospitals.

METHODS

Qualitative study involving individual semi-structured interviews following an interview guide. We conducted a thematic analysis using the ATLAS.ti software, with further triangulation to verify concordance and aid in the interpretation of the data from a medical anthropology framework and using a narrative ethics approach to gain insight into the participants' underlying moral values.

RESULTS

We interviewed 37 patients in total, along with 3 rheumatologists. Five core themes emerged from the analysis to understand the decision to vaccinate: (1) information about vaccines and disease, (2) perceived risk-benefit of vaccination, (3) the physician-patient relationship, (4) governance of vaccination programs, (5) attitudes towards vaccines. Individual and family experiences with vaccination are diverse depending on the type of vaccine. The COVID-19 vaccine, as a new medical technology, is met with more controversy leading to hesitancy.

CONCLUSIONS

The decision to vaccinate among Mexican rheumatic disease patients can sometimes involve doubt and distrust, especially for those with a lupus diagnosis, but ultimately there is acceptance in most cases. Though patients make and value autonomous decisions, there is a collective process involving sociocultural and ethical aspects. Key points • The complexity of vaccine decision-making is better identified through a narrative, qualitative approach like the one used in this study, as opposed to solely quantitative approaches • Sociocultural and moral perspectives of vaccination shape decision-making and, therefore, highlight the importance of including patients in the development of effective clinical practice guidelines as well as ethically justified public policy • Sociohistorical context and personal experiences of immunization influence vaccine decision-making much more than access to biomedical information about vaccines, showing that approaches based on the information deficit model are inadequate to fight vaccine hesitancy.

Discrimination and Education Quality Moderate the Association of Sleep With Cognitive Function in Older Black Adults: Results From the Einstein Aging Study

OBJECTIVES

Heterogeneity among Black adults' experiences of discrimination and education quality independently influence cognitive function and sleep, and may also influence the extent to which sleep is related to cognitive function. We investigated the effect of discrimination on the relationship between objective sleep characteristics and cognitive function in older Black adults with varying education quality.

METHOD

Cross-sectional analyses include Black participants in the Einstein Aging Study (N = 104, mean age = 77.2 years, 21% males). Sleep measures were calculated from wrist actigraphy (15.4 ± 1.3 days). Mean ambulatory cognitive function (i.e., spatial working memory, processing speed/visual attention, and short-term memory binding) was assessed with validated smartphone-based cognitive tests (6 daily). A modified Williams Everyday Discrimination Scale measured discriminatory experiences. Linear regression, stratified by reading literacy (an indicator of education quality), was conducted to investigate whether discrimination moderated associations between sleep and ambulatory cognitive function for individuals with varying reading literacy levels. Models controlled for age, income, sleep-disordered breathing, and sex assigned at birth.

RESULTS

Higher reading literacy was associated with better cognitive performance. For participants with both lower reading literacy and more discriminatory experiences, longer mean sleep time was associated with slower processing speed, and lower sleep quality was associated with worse working memory. Later sleep midpoint and longer nighttime sleep were associated with worse spatial working memory for participants with low reading literacy, independent of their discriminatory experiences.

DISCUSSION

Sociocultural factors (i.e., discrimination and education quality) can further explain the association between sleep and cognitive functioning and cognitive impairment risk among older Black adults.

Negative affect and loss-of-control eating in relation to adiposity among non-Hispanic youth identifying as black or white

Negative affect and loss-of-control (LOC)-eating are consistently linked and prevalent among youth identifying as non-Hispanic Black (NHB) and non-Hispanic White (NHW), particularly those with high weight. Given health disparities in high weight and associated cardiometabolic health concerns among NHB youth, elucidating how the association of negative affect with adiposity may vary by racial/ethnic group, and whether that relationship is impacted by LOC-eating, is warranted. Social inequities and related stressors are associated with negative affect among NHB youth, which may place this group at increased risk for excess weight gain. Across multiple aggregated protocols, 651 youth (13.0 ± 2.7 y; 65.9 % girls, 40.7 % NHB; 1.0 ± 1.1 BMIz; 37.6 % LOC-eating) self-reported trait anxiety and depressive symptoms as facets of negative affect. LOC-eating was assessed by interview and adiposity was measured objectively. Cross-sectional moderated mediation models predicted adiposity from ethno-racial identification (NHB, NHW) through the pathway of anxiety or depressive symptoms and examined whether LOC-eating influenced the strength of the pathway, adjusting for SES, age, height, and sex. The association between ethno-racial identity and adiposity was partially mediated by both anxiety (95 % CI = [0.01, 0.05]) and depressive symptoms (95 % CI = [0.02, 0.08]), but the mediation was not moderated by LOC-eating for either anxiety (95 % CI = [-0.04, 0.003]) or depressive symptoms (95 % CI = [-0.07, 0.03]). Mechanisms underlying the link between negative affect and adiposity among NHB youth, such as stress from discrimination and stress-related inflammation, should be explored. These data highlight the need to study impacts of social inequities on psychosocial and health outcomes.

Mendelian randomisation study of body composition and depression in people of East Asian ancestry highlights potential setting-specific causality

BACKGROUND

Extensive evidence links higher body mass index (BMI) to higher odds of depression in people of European ancestry. However, our understanding of the relationship across different settings and ancestries is limited. Here, we test the relationship between body composition and depression in people of East Asian ancestry.

METHODS

Multiple Mendelian randomisation (MR) methods were used to test the relationship between (a) BMI and (b) waist-hip ratio (WHR) with depression. Firstly, we performed two-sample MR using genetic summary statistics from a recent genome-wide association study (GWAS) of depression (with 15,771 cases and 178,777 controls) in people of East Asian ancestry. We selected 838 single nucleotide polymorphisms (SNPs) correlated with BMI and 263 SNPs correlated with WHR as genetic instrumental variables to estimate the causal effect of BMI and WHR on depression using the inverse-variance weighted (IVW) method. We repeated these analyses stratifying by home location status: China versus UK or USA. Secondly, we performed one-sample MR in the China Kadoorie Biobank (CKB) in 100,377 participants. This allowed us to test the relationship separately in (a) males and females and (b) urban and rural dwellers. We also examined (c) the linearity of the BMI-depression relationship.

RESULTS

Both MR analyses provided evidence that higher BMI was associated with lower odds of depression. For example, a genetically-instrumented 1-SD higher BMI in the CKB was associated with lower odds of depressive symptoms [OR: 0.77, 95% CI: 0.63, 0.95]. There was evidence of differences according to place of residence. Using the IVW method, higher BMI was associated with lower odds of depression in people of East Asian ancestry living in China but there was no evidence for an association in people of East Asian ancestry living in the USA or UK. Furthermore, higher genetic BMI was associated with differential effects in urban and rural dwellers within China.

CONCLUSIONS

This study provides the first MR evidence for an inverse relationship between BMI and depression in people of East Asian ancestry. This contrasts with previous findings in European populations and therefore the public health response to obesity and depression is likely to need to differ based on sociocultural factors for example, ancestry and place of residence. This highlights the importance of setting-specific causality when using genetic causal inference approaches and data from diverse populations to test hypotheses. This is especially important when the relationship tested is not purely biological and may involve sociocultural factors.

Associations between screen time and internalizing disorder diagnoses among 9- to 10-year-olds

BACKGROUND

Children and adolescents spend an increasing amount of time with screen media. Identifying correlates of youth mental disorders has become more urgent with rates of depression, self-harm, suicide attempts, and suicide deaths rising sharply among U.S. children and adolescents after 2012. This study examined the relationship between screen time and internalizing disorders in preadolescent children between the ages of 9 and 10.

METHODS

Participants were 9- and 10-year-old youth (n = 11,780) in the baseline of the multi-site Adolescent Brain and Cognitive Development Study (ABCD). Youth reported the number of hours a day they spent watching TV shows or movies, watching videos online, playing video games, texting, using social media, and video chatting. Youth responded to an abbreviated version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-5), a semi-structured clinical interview measuring current and past symptoms of internalizing disorders using DSM-5 criteria.

RESULTS

Youth spending 2 or more hours (vs. less than 2) a day with screen media were more likely to fit criteria for depressive disorders, self-harm, and suicidal ideation or attempts, even after adjustment for demographic covariates. For anxiety disorders, associations with digital media use (social media, texting, gaming, and online videos) were stronger than with screen time generally.

LIMITATIONS

This is a cross-sectional study utilizing retrospective screen time reports, which limits our ability to determine causality and the accuracy of the reports.

CONCLUSIONS

Preadolescents who spend more time using screens, especially digital media, are more likely to fit DSM-5 criteria for internalizing disorders.

Unlocking sociocultural and community factors for the global adoption of genomic medicine

Advances in genomic sequencing and genetic testing are increasingly transforming the diagnosis and treatment of diseases-specifically, rare diseases. However, the application and benefit of such technologies remain inequitable globally. There is a clear and urgent need to provide genomic sequencing to people across the global population, including people living in under-resourced areas and/or underrepresented populations. Financial considerations are the most obvious barriers to the adoption of genomic medicine, yet there are many other factors that are not so obvious, such as geography, language, communication, and culture. Herein, we use the lens of rare diseases and focus on firstly, selected socio-cultural factors, and in particular stigma; and secondly, empowering community factors such as education, advocacy and connectivity amongst people living with rare diseases globally. These are critical areas of need and opportunity if genomic medicine is to achieve equitable and global adoption in the patient best-interest across low- middle- and high-income country health systems. Furthermore, we touch on specific child health aspects and how they can point towards opportunities to build on specific infrastructures.

Beyond Resettlement: Sociocultural Factors Influencing Breast and Colorectal Cancer Screening Among Afghan Refugee Women

Immigrants and refugees have an increased risk for developing chronic health conditions, such as breast and colorectal cancer, the longer they reside in the USA. Moreover, refugees are less even likely to use preventive health services like mammography and colonoscopy screening when compared with US-born counterparts. Focused ethnography was employed to examine sociocultural factors that influenced cancer screening behaviors among aging Afghan refugee women. We conducted 19 semi-structured interviews with Afghan women 50 and older and their family member/caregivers. Interview transcripts were inductively coded using Atlas.ti, where focused codes were sorted and reduced into categories, and we extracted meaning around groups of categories. Findings of this study revealed factors like fear of cancer, pre-migration experiences, family involvement, provider recommendation, and provider gender concordance influenced women's cancer screening behaviors. This study also found that women who have had a recent mammogram or colonoscopy described empowerment factors that helped them withstand the stressful process of screening, through encouragement and reminders from providers, support from adult family members, and finding strength through duaas (prayers). As refugee women continue to age in the USA, clinicians should incorporate multi-level strategies, including family-centered and faith-based approaches to promote preventive screening behaviors in this population.

Sociocultural factors during COVID-19 pandemic: Information consumption on Twitter

The purpose of the research is to describe the sociocultural factors that emerged during the COVID-19 pandemic. Twitter is used as an instrument for data collection. The study is qualitative and uses the netnographic method. To analyze the flow of messages posted on Twitter, the model proposed by Perez-Cepeda and Arias-Bolzmann (2020), which describes sociocultural factors, is taken as a basis. The semantics that people use are a type of functional knowledge that reveals sociocultural factors. Sentiments were analyzed through lexicon-based methods, which are the most suitable. The categorization and classification of the data are performed based on the information that users post on Twitter. The tweets related to COVID-19 describe the sociocultural issues and the level of sentiment around the pandemic. The discussion centers on the COVID-19 pandemic, information consumption, lexicon, sociocultural factors and sentiment analysis. The study was limited to the social media Twitter; another limitation was not to consider the social group of the users who interact with @pandemic_Covid-19, official account of the World Health Organization (WHO). This research contributes to the social sciences, focusing on sociocultural interaction through the use of the social network Twitter. It describes the link between sociocultural factors and the level of sentiment on issues related to the COVID-19 pandemic.

Suicidal behavior sociocultural factors in developing countries during COVID-19

Objectives

Sociocultural factors in the aftermath of any pandemic can play a role in increasing suicidal behavior like suicidal ideation, suicidal attempts, or suicide. The authors discuss the risk and predisposing factors for suicidal ideation among mental health patients in four developing countries (Bangladesh, Colombia, India and Pakistan), this aims to grasp the heterogeneity of these motivators and to elaborate specific interventions regarding suicide in the COVID-19 pandemic.

Methods

We searched PubMed, Medline, and Google Scholar through March, 2021 for articles using a combination of the keywords and generic terms for suicide, suicide ideation, COVID-19, developing countries, low-middle-income countries, Sociocultural factors, Suicidal behavior, predisposing factors and predictive factors, for articles in English language only, and without publication time restriction.

Results

This narrative review summarizes the sociocultural risk and predisposing factors for suicidal behavior in developing countries during the COVID-19 pandemic. The findings reveal those factors such as fear of being infected, growing economic pressure, lack of resources due to lockdown are mostly responsible in the four countries for the current increase in suicides. There are a few cultural differences that are specified in the narrative.

Conclusion

The COVID-19 pandemic is a public health challenge, in which prevention and intervention of suicidal behavior have been suboptimal, especially in low-middle-income countries. Based on literature results, we provide practical suggestions (e.g., reducing infodemic, specialized helplines, improving mental health services availability) in order to tackle main challenges of suicide prevention, such as lack of adequate manpower, fragile health system and poverty.

The role of personality traits, sociocultural factors, and body dissatisfaction in anorexia readiness syndrome in women

BACKGROUND

The mass media promote certain standards of physical attractiveness. The media coverage, in interaction with body dissatisfaction and personality traits, may intensify specified behaviors in women, that should help them to obtain an ideal body image, e.g., excessive concentration on body image, weight control, increase in physical activity. The intensification of these behaviors can develop anorexia readiness syndrome (ARS) in women. The paper presents a study on the role of the Five-Factor Model personality traits (neuroticism, extraversion, agreeableness, conscientiousness, and intellect/openness), sociocultural factors (internalization, sociocultural pressure, information seeking), and body dissatisfaction in anorexia readiness syndrome.

METHODS

The study involved 1533 Polish women aged 18-36 (M = 22.51, SD = 2.41). The participants completed the online version of the set of questionnaires. The link to the study was shared in social media groups. Personality dimensions were measured with the BFI, sociocultural factors were evaluated by means of the SATAQ-3, the degree of body dissatisfaction was assessed with the BIQ, while ARS was measured using five self-reported items referring to specific behaviors from TIAE.

RESULTS

Hierarchical multiple regression analysis revealed internalization, sociocultural pressure, and body dissatisfaction as significant predictors of ARS. While neuroticism was correlated with ARS, it lost its predictive value after entering body dissatisfaction in the regression model.

CONCLUSIONS

The factors associated with ARS were (1) neuroticism among personality traits, (2) internalization and pressure from sociocultural norms among sociocultural attitudes, and (3) body dissatisfaction. The key finding is the absence of statistical significance for neuroticism in predicting ARS after including body dissatisfaction. In future research, the group of men and patients with anorexia nervosa can be included, and the age range can be extended to include younger people. The catalog of potential ARS predictors may be expanded, which can help to explain the role of neuroticism in ARS.

Family, social and cultural determinants of long-lasting insecticidal net (LLIN) use in Madagascar: secondary analysis of three qualitative studies focused on children aged 5-15 years

Background

Although it is accepted that long-lasting insecticidal net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; the malaria prevalence is highest in this age group. The purpose of this research is to summarize recent qualitative studies describing LLIN use among the Malagasy people with a focus on children aged 5–15 years.

Methods

Qualitative data from three studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar were analysed. These studies cover all malaria epidemiological profiles and 10 of the 18 existing ethnic groups in Madagascar. A thematic analysis was conducted on the collected data from semi-structured interviews, direct observation data, and informal interviews.

Results

A total of 192 semi-structured interviews were conducted. LLINs are generally perceived positively because they protect the health and well-being of users. However, regional representations of mosquito nets may contribute to LLIN lower use by children over 5 years of age including the association between married status and LLIN use, which leads to the refusal of unmarried young men to sleep under LLINs; the custom of covering the dead with a mosquito net, which leads to fear of LLIN use; and taboos governing sleeping spaces for siblings of opposite sexes, which leads to LLIN shortages in households. Children under 5 years of age are known to be the most vulnerable age group for acquiring malaria and, therefore, are prioritized for LLIN use when there are limited supplies in households. In contrast, children over 5 years of age, who are perceived to be at less risk for malaria, often sleep without LLINs.

Conclusions

Perceptions, social practices and regional beliefs regarding LLINs and vulnerability to malaria contribute to the nonuse of LLINs among children over 5 years of age in Madagascar. Modifying LLIN policies to account for these factors may increase LLIN use in this age group and reduce disease burden.

Frontotemporal Dementia: A Cross-Cultural Perspective

It is predictable that syndromes of frontotemporal dementia (FTD) may have a worldwide distribution; however, data available on their incidence and prevalence are variable. This variability most likely reflects disparities across regions in the distribution of the expertise, technology, and resources available for FTD research and care. Important discoveries have been made regarding FTD's phenotypes, genetics, and cultural influences on the expression of symptoms; however, in many countries, there are barriers posed by a dearth of resources. There are pressing needs to further develop research on FTD: including first, population studies designed to fill the gaps in our knowledge about FTD's frequency and risk factors in developing regions and among minority groups in developed countries. It is also necessary to facilitate the psychometric characterization of contemporary diagnostic criteria and their translation to different languages and cultural contexts. Furthermore, much needed is the analysis of differences in the genetic risk factors for FTD, particularly non-Mendelian susceptibility factors. It is hoped that reflections on FTD from an international perspective will spur an extension of the vibrant multicenter collaborations, that exist in North America and Europe, toward new centers to be established and supported in the developing regions of the world.

Exploring the influence of socio-cultural factors and environmental resources on the health related quality of life of children and adolescents after congenital heart disease surgery: parental perspectives from a low middle income country

BACKGROUND

Health related quality of life (HRQOL) is an important indicator of long-term well-being, influenced by environmental factors such as family, culture, societal norms and available resources. This study aimed to explore parental perspectives on the influence of socio-cultural factors and environmental resources on the HRQOL of children and adolescents after congenital heart disease (CHD) surgery.

METHODS

Using a descriptive, qualitative design, semi-structured interviews of children/adolescents who had CHD surgery in this low-middle income country (LMIC) were collected between July to December 2017. There were 20 families enrolled, which included 18 parent dyads (mother and father) and two single mothers, making a total of 38 participants. Initial inductive analysis was further refined using the Social Ecological Model as an analytic lens.

RESULTS

At the intrapersonal level, unrealistic expectations of surgery, residual CHD symptoms and difficulty maintaining educational progress were of great concern. There were low levels of health literacy and understanding about CHD among family and friends, however, strong kinship ties were an important resource at the interpersonal level. These families lived in poverty and mothers often carried the sole burden of care for their sick children. At the institutional level, there were unclear expectations of the child's needs at school, and parents had poor access to psychological, family-planning and genetic counselling, and poor access to CHD education resources. At a sociocultural level, religion and trust in God were important coping factors, however, CHD was a gendered experience with particular concerns around scarring and the marriageability of girls. Parents noted the deficit of antenatal and specialist CHD services and felt the consequence of a lack of a universal health care system at the public policy level.

CONCLUSION

Socio-ecological factors have the potential to explain the issues and challenges that children living in LMIC experience with CHD after surgery. The study findings will help to inform future interventions to be implemented in countries like Pakistan.

Culture and sexuality-related communication as sociocultural precursors of HPV vaccination among mother-daughter dyads of Mexican descent

U.S. Latinas are the second most affected ethnic group by cervical cancer morbidity and mortality. Cervical cancer is caused by high risk Human Papillomavirus (HPV) strains and HPV vaccines are an effective form of primary prevention. Parents are the primary decision makers of vaccination uptake as vaccination is recommended for children between the ages of 11–12. The purpose of our study is to investigate the influence of sociocultural factors particularly salient to U.S. Latinos and their role in facilitating or hindering communication about sexuality and vaccination uptake. We conducted a mixed methods sequential study with Latina mother-daughter dyads of Mexican descent (50% who had vaccinated). Our study was informed by the Information-Motivation-Behavioral Skills (IMB) model of preventive behavior. We assessed the influence of communication about sexuality on uptake and the influence of relationship factors such as familism, mother-daughter connectedness, and children’s autonomy and cultural factors such as acculturation and ethnic identity on sexuality-related communication. Our results indicated that mothers who engaged in conversations about birth control methods with their daughters had 5.69 times the odds of having vaccinated their daughters. Our qualitative data indicated that mothers who had vaccinated communicated about sexuality emphasizing that sexuality is a normal part of life, perceived that their child is likely to be sexually active one day, and viewed themselves as a primary source of sexuality-related information compared to mothers who had not vaccinated. Findings highlighted potential sociocultural approaches to motivate open communication about sexuality and adoption of sexual health preventative measures for children.

Persistent barriers to the use of maternal, newborn and child health services in Garissa sub-county, Kenya: a qualitative study

Background

North Eastern Kenya has persistently had poor maternal, new-born and child health (MNCH) indicators. Barriers to access and utilisation of MNCH services are structural, individual and community-level factors rooted in sociocultural norms. A package of interventions was designed and implemented in Garissa sub-County aimed at creating demand for services. Community Health Volunteers (CHVs) were trained to generate demand for and facilitate access to MNCH care in communities, while health care providers were trained on providing culturally acceptable and sensitive services. Minor structural improvements were made in the control areas of two facilities to absorb the demand created. Community leaders and other social actors were engaged as influencers for demand creation as well as to hold service providers accountable. This qualitative research was part of a larger mixed methods study and only the qualitative results are presented. In this paper, we explore the barriers to health care seeking that were deemed persistent by the end of the intervention period following a similar assessment at baseline.

Methods

An exploratory qualitative research design with participatory approach was undertaken as part of an impact evaluation of an innovation project in three sites (two interventions and one control). Semi-structured interviews were conducted with women who had given birth during the intervention period. Focus group discussions were conducted among the wider community members and key informant interviews among healthcare managers and other stakeholders. Participants were purposively selected. Data were analysed using content analysis by reading through transcripts. Interview data from different sources on a single event were triangulated to increase the internal validity and analysis of multiple cases strengthened external validity.

Results

Three themes were pre-established: 1) barriers and solutions to MNCH use at the community and health system level; 2) perceptions about women delivering in health facilities and 3) community/social norms on using health facilities. Generally, participants reported satisfaction with services offered in the intervention health facilities and many indicated that they would use the services again. There were notable differences between the intervention and control site in attitudes towards use of services (skilled birth attendance, postnatal care). Despite the apparent improvements, there still exist barriers to MNCH services use. Persistent barriers identified were gender of service provider, insecurity, poverty, lack of transport, distance from health facilities, lack of information, absence of staff especially at night-time and quality of maternity care.

Conclusion

Attitudes towards MNCH services are generally positive, however some barriers still hinder utilization. The County health department and community leaders need to sustain the momentum gained by ensuring that service access and quality challenges are continually addressed.

'This sickness is not hospital sickness': a qualitative study of the evil eye as a source of neonatal illness in Ghana

Previous research has described the evil eye as a source of illness for pregnant women and their newborns. This study sought to explore the perceptions of the evil eye among mothers whose newborns had experienced a life-threatening complication across three regions of Ghana. As part of a larger, quantitative study, trained research assistants identified pregnant and newly delivered women (and their newborns) who had survived a life-threatening complication at three tertiary care hospitals in southern Ghana to participate in open-ended, qualitative interviews about their experiences in March-August 2015. All interviews were audio-recorded and transcribed verbatim into English and analysis using the constant comparative method of theme generation. A total of 37 mothers were interviewed, 20 about neonatal illnesses and 17 about maternal illnesses. Six of the 20 mothers interviewed about their newborn's illnesses spoke at length about the evil eye being a potential cause of newborn illness. The evil eye was described in a variety of terms, but commonalities included a person looking at a pregnant woman, her newborn baby, the baby's clothes and even the mother's food, causing harm, even unintentionally. Prevention required mothers covering themselves while pregnant and keeping the baby away from others until it was old enough to ward off the evil eye. Treatment required traditional medicine, yet some indicated that allopathic medicine could help. The evil eye appears to serve a social control mechanism, encouraging pregnant women to dress modestly, stay indoors as much as possible and behave appropriately. The evil eye is a pervasive, universally understood phenomenon across three regions of Ghana, even amongst a hospitalized population receiving allopathic health care for life-threatening complications of childbirth. Understanding the role of the evil eye in newborn illness attribution is important for clinicians, researchers and programmatic staff to effectively address barriers to care seeking.

The Role of Sociocultural Factors in the Etiology of Eating Disorders

Most theories emphasize the role of sociocultural factors in the etiology of eating disorders (EDs). This article uses a broad search strategy to identify current etiologic studies. Women with an ED outnumber men in each diagnosis, but gender differences vary by diagnosis. Men were underrepresented in study samples, and information about variable risk factors in men is sparse. Findings suggest transdiagnostic risk factors and disorder-specific risk factors. Extracting data from population-based registers represents a major advance. Novel analytic approaches suggest complex pathways to ED. Although used in several studies, reliance on a transdiagnostic ED category (vs diagnosis-specific groupings) is premature.

Qualitative research investigating the mental health care service gap in Chinese burn injury patients

BACKGROUND

Psychological disturbances are prevalent in people with burn injuries; however, psychological services are rarely accessiblepost-burn injury in China. The objective of this qualitative study was to explore and conceptualize the obstacles to delivering mental health care in burn injury patients.

METHODS

The researchers used a grounded theory research approach to interview sixteen burn injury patients, five nurses, four rehabilitation therapists, five medical doctors, and eight caregivers regarding their experiences with current health care services and barriers.

RESULTS

An explorative model was generated from the data, and the relationships among the categories were identified. People's beliefs, knowledge, socioeconomic status, cultural understanding of mental health, and social stigma appear to play key roles in the public health approach to post-burn health promotion and post-burn psychosocial interventions.

CONCLUSION

The model proposed in our research highlights the need to focus on the underlying social, economic, and cultural determinants of mental health care. The underlying social determinants of the mental health care gap that is responsible for the ill-prepared health care must be addressed.

Sociocultural and Familial Factors Associated with Weight Bias Internalization

BACKGROUND/AIMS

Sociocultural and familial factors associated with weight bias internalization (WBI) are currently unknown. The present study explored the relationship between interpersonal sources of weight stigma, family weight history, and WBI.

METHODS

Participants with obesity (N = 178, 87.6% female, 71.3% black) completed questionnaires that assessed the frequency with which they experienced weight stigma from various interpersonal sources. Participants also reported the weight status of their family members and completed measures of WBI, depression, and demographics. Participant height and weight were measured to calculate body mass index (BMI).

RESULTS

Linear regression results (controlling for demographics, BMI, and depression) showed that stigmatizing experiences from family and work predicted greater WBI. Experiencing weight stigma at work was associated with WBI above and beyond the effects of other sources of stigma. Participants who reported higher BMIs for their mothers had lower levels of WBI.

CONCLUSION

Experiencing weight stigma from family and at work may heighten WBI, while having a mother with a higher BMI may be a protective factor against WBI. Prospective research is needed to understand WBI's developmental course and identify mechanisms that increase or mitigate its risk.

"Skinny is prettier and normal: I want to be normal"-Perceived body image of non-Western ethnic minority children in the Netherlands

While the prevalence of overweight and obesity is higher among children of some non-Western ethnic minorities than among their Caucasian counterparts, their body image is understudied. The current study examined the body image of Dutch children of non-Western ethnic minorities (i.e., Surinamese, Antillean, Moroccan, and Turkish). Sociocultural influences from school, media and home environments and their perceptions of overweight prevention programs were taken into account. Fifty-two non-Western ethnic minority children (aged 8-12 years) participated in semi-structured interviews and focus groups. Results showed that the children generally underestimated their current body size, which was often overweight, and preferred thin and 'normal' body sizes. Results further revealed important insights into culturally determined themes, relating to perceived preferences in media, peers, parents, and teachers, nutritional habits, and children's beliefs about school-based health interventions. We conclude that targeting culturally sensitive awareness about actual body size and healthy body images seems paramount in future interventions.

Seclusion, decision-making power, and gender disparities in adult health: Examining hypertension in India

Research on the social determinants of health in developing countries is increasingly focusing on the importance of gender. Cardiovascular conditions such as hypertension are a growing concern in developing countries, where they are now the leading cause of death. Researchers have documented differences in hypertension between men and women, but the importance of gendered practices in shaping these differences has been left unexamined. Using national data from the India Human Development Survey 2005 (N=101,593), this study assesses the moderating role of two salient and widespread gendered practices-women's seclusion and decision-making power-on hypertension disparities between women and men. Both seclusion and low decision-making power are associated with increased odds of hypertension for women, but in the case of seclusion reduced hypertension for men. Results also show the gender gap in hypertension is exacerbated with women's seclusion and low decision-making power.

Heterogeneity of sex-stratified BMI trajectories in children from 8 to 14 years old

OBJECTIVE

Describe and predict sex-stratified trajectories of weight change in youths transitioning from childhood to adolescence.

METHODS

Using an accelerated longitudinal design, 461 children between 8 and 12 years old at baseline were followed over three years. Body mass index was calculated from self-reported height and weight. Latent class growth analysis was used to identify BMI trajectories and multinomial logistic regressions, to predict group membership.

RESULTS

A four-group heterogeneous trajectory model emerged for boys and girls alike. Characteristics of the trajectories differed between sexes and no obesity group was found for boys. Sociocultural factors, such as media influence, body dissatisfaction, weight victimization, awareness of thin-ideal standards and related pressures were important correlates of trajectory membership.

CONCLUSION

BMI trajectories during preadolescence are stable over time for heavier children. Body image concerns and weight stigmatization stand out as important factors in the prediction of developmental weight trajectories and could therefore be integrated in weight gain prevention programs for children of all weights as well as in weight management interventions for overweight and obese children.

Sociocultural influences and body change strategies in Spanish adolescent boys of different weight status

The aim of the present study was to examine the association between sociocultural influences to attain an ideal body and body change strategies (BCS) in Spanish adolescent boys of different weight status. A total of 594 Spanish boys (M=13.94 years, SD=0.20) participated. Measures included in the study were weight status according to body mass index (BMI), sociocultural influences (perceived pressures to attain an ideal body, general internalization of an ideal body, internalization of an athletic-ideal body), BCS to lose/control weight (dieting, healthy and unhealthy weight-control behaviors), and BCS to gain weight and muscles. Underweight boys engaged more frequently in weight-gain behaviors. Overweight boys reported higher levels of perceived sociocultural pressures and general internalization compared to normal-weight boys, and were more likely to be engaged in BCS to lose/control weight compared with the other weight-status groups. There were no differences between groups in terms of internalization of an athletic-ideal body and BCS to increase muscles. Future research and prevention programs should consider male-specific behaviors and weight-status differences.

A racial comparison of sociocultural factors and oral health perceptions

PURPOSE

There are limited data regarding race, sociocultural factors and dental outcomes such as oral health perceptions. The purpose of this study is to recognize and determine whether sociocultural factors impact oral health practices, and how these relate to oral health care perceptions among African American (AA) and Asian American (AS) comparison groups.

METHODS

In this cross-sectional study, participants were selected using a purposive sampling technique among new enrolling patients of AA and AS origin at the New York University College of Dentistry (NYUCD). Sociocultural factors such as low education level, poor access to care, limited financial status and perceptions of oral health such as brushing and flossing were studied.

RESULTS

Among 139 participants, 86 (61.87%) were AA and 53 (38.13%) were AS. Compared to AS, AA had poorer access to care (58.14% vs. 43.40%, p<0.01) and cost was a greater financial barrier for dental care (41.86% vs. 26.41%, p<0.01). Race was the strongest predictor of oral health perceptions (OR =2.27, p<0.05) followed by limited financial status (OR =1.335 p<0.05) and poor access to care (OR =1.299 p<0.01). AA had more adverse oral health perceptions (83.72% vs. 69.81%, p<0.05), higher incidence of dental decay (13.95% vs 7.54%, p<0.05) and mixed disease (dental decay and periodontal disease) (88.37% vs. 60.37%, p<0.05) compared to AS. There was no difference in oral health practices (brushing and flossing) between the two populations.

CONCLUSION

AA had more adverse oral health perceptions and higher incidence of dental disease than AS. Cultural influences have an impact on perceptions and behaviors that may affect oral health. Therefore, cultural awareness and competency among oral health professionals should be emphasized.