Strengthening social capital in the Sri Lankan population: A qualitative exploration of factors driving the mothers' support groups initiative during economic crisis

Background

Social capital is a concept that has been identified to improve health outcomes in many populations. Due to COVID-19 and many other factors, Sri Lanka faced a massive economic crisis that affected the nutrition of communities. Many community engagement initiatives have begun to promote the country's nutrition during the worst-hit years. The Mothers' Support Groups initiative is one of the existing community engagement initiatives that is well known for strengthening community social capital. This article discusses how the Mothers' Support Groups (MSG) initiative in Sri Lanka contributed to improving social capital in Sri Lanka during the economic crisis, focusing on nutrition.

Methods

We conducted a case study on the activities undertaken by mothers' support groups in view of how they focused on social capital. We selected all activities presented by districts that improved social capital related to nutrition promotion captured in the YouTube video stream. We analyzed these qualitative data to identify the main themes related to social capital and nutritional promotion. Two coders transcribed the video recordings. We analyzed the data using the iterative thematic inquiry (ITI) method and initially assessed beliefs about concepts, building new beliefs through encounters with data, listing tentative themes, and evaluating themes through coding.

Results

Six major themes were identified (that social capital had been strengthened to promote nutrition): awareness creation of nutrition, home gardening promotion, promoting livestock farming, minimizing food waste, improving the home economy, and psychosocial health promotion. The most common forms of social capital encountered in these themes were bonding, bridging, and linking. Furthermore, strengthening structural social capital is more prominent than strengthening cognitive social capital.

Conclusion

Social capital can improve nutritional status during crises. Activities that can be used to achieve this vary from simple awareness creation among communities to more advanced psychosocial health promotion. Overall, social capital contributed to the community development aspect of health promotion to a greater extent.

Determinants of Early Childhood Caries and their interactions: A Structural Equation Modelling approach

OBJECTIVE

Early Childhood Caries (ECC) has been common among preschoolers in Sri Lanka over decades. A broad spectrum of determinants that act upon different levels is responsible for its development. Therefore, the relationships among these determinants should be studied extensively to control ECC.

DESIGN

Descriptive cross-sectional study with multistage cluster sampling.

SETTING

Registered preschools in Gampaha District.

PARTICIPANTS

A total of 1038 three to four-year-olds and their mothers.

MAIN OUTCOME MEASURES

Direct, indirect, and total effects of the determinants of ECC in structural equation models.

RESULTS

Sweet consumption had direct effects from permissive parenting (β=0.26, p=0.00) and the sweet consumption behaviour of the family (β=0.17, p=0.01). Oral hygiene behaviours had direct effects from permissive parenting (β=-0.46, p=0.00) and maternal oral health related self-efficacy (β=0.23, p=0.00). The dental attendance pattern had total effects from knowledge (β=0.18, p=0.00) and permissive parenting (β=-0.16, p=0.00).

CONCLUSIONS

Parenting style, family sweet consumption behaviour and maternal oral health related self-efficacy were the most influential second-line determinants that affected oral health behaviours: sweet consumption, oral hygiene, and dental attendance pattern for the development of ECC.

Mobile Phone-Based Nutrition Education Targeting Pregnant and Nursing Mothers in Sri Lanka

INTRODUCTION

A woman's nutrition during pregnancy and nursing affects the mother and the growing child. Similarly, the first two years of a child's life are critical to their growth and development and are facilitated by optimum nutrition. Women's nutrition-related knowledge, attitudes, and practices influence household food and nutrition security. Mobile health (mHealth) is a potentially effective health intervention in pandemic situations when physical gatherings are restricted.

OBJECTIVES

To examine the effectiveness of a mobile phone-based nutrition education intervention targeting pregnant and nursing mothers in six Sri Lankan divisional secretariat areas.

METHOD

This intervention was evaluated using a before and after within-subjects design. The intervention included 19 messages over four weeks sent via mobile phone, covering nutrition themes such as pregnancy care, infant and young child-feeding, diet, family care for mother and child, and cash management. The intervention was evaluated based on a quantitative survey using a structured interviewer-administered questionnaire and qualitative interviews using a semi-structured questionnaire. The study population was pregnant and nursing mothers. The objective of the qualitative interviews was to identify how respondents used messages and how satisfied they were with the project. The outcome measures were awareness/knowledge, attitudes, social norms, self-efficacy, behaviour intentions, and practices of pregnant and nursing mothers. Trained enumerators collected data using a mobile phone.

RESULTS

A total of 996 pregnant and nursing mothers participated in the pre-assessment survey, of which 720 completed the post-assessment. Most were nursing mothers (84.2% pre- and 78.9% post-assessment). Participants provided positive feedback on the intervention. Knowledge/awareness (t = -18.70, p < 0.01) and attitudes (t = -2.00, p < 0.05) increased when exposed to the intervention. Favourable improvements in the practices were also observed. Mothers' practices related to breastfeeding and 24-h dietary diversity showed a statistically significant improvement. However, social norms and behaviour intentions did not significantly improve. The qualitative component also revealed favourable responses.

CONCLUSION AND RECOMMENDATIONS

The mobile intervention improved participants' knowledge, awareness, attitude, and practices, but not social norms or behaviour intentions. This approach is recommended to be used on a larger scale in community settings. In addition, mobile technology could drive intervention in pandemic-related situations.

Incidence management system of the healthcare institutions for disaster management in Sri Lanka

BACKGROUND

Incident management systems and disaster planning processes facilitate maximal use of available resources. Evaluation of the Incident Command System (ICS) is one of the top five key areas of research priority in the field of surge. The study was aimed at assessing the disaster preparedness and ICS of the public healthcare institutions for the disaster management in a disaster-prone district of Sri Lanka.

METHODS

A descriptive cross-sectional study was conducted among all public sector healthcare institutions (n = 74), including curative-healthcare institutions (n = 46) which have inward-care facilities for patient care and preventive healthcare institutions (n = 28) in Kurunegala district, Sri Lanka from May-September 2019 using a validated interviewer administered questionnaire which was based on 'CO-S-TR Model' for ICS assessment including 'Clear need for increased capacity (≤25%), Basic level (26 - 50%), Moderate level (51 - 75%) and High level (>75%)'.

RESULTS

Focal points for disaster management were nominated by the majority of the curative sector (n = 33; 76.7%) and preventive sector (n = 19; 73.1%) healthcare institutions. A written disaster preparedness and response plans were available in 72% (n= 31) curative sector and 76% (n= 19) preventive sector institutions. The higher proportion of the curative sector institutions had moderate level capacity in the area of providing treatment, and basic level capacities were in the areas of 'staff mobilization, coordination of activities, supplying of special needs, triage of cases and transportation'. There is a clear need for improvement in the areas of communication commanding, management of controlling the incidence and tracking of the cases in the curative sector. The majority of the preventive sector institutions had moderate level capacity in commanding, control, coordination and tracking of cases. The basic level capacity in the areas of staff mobilization, stuff management and triage of cases. There is a clear need for improvement in the areas of communication in preventive sector. Of the public sector healthcare institutions, the higher proportion of the preventive sector (n = 20; 76.9%) and curative sector (n = 29; 67.4%) had basic level overall surge capacity of ICS for disaster management.

CONCLUSION

Coordination, communication, commanding, management of controlling the incidence and tracking of cases following outbreaks need to be improved and capacity development programmes could implement to develop the preparedness for future disasters.

Success and challenges of health systems resilience-enhancing strategies for managing Public Health Emergencies of International Concerns (PHEIC): A systematic review protocol

INTRODUCTION

Health systems resilience is the ability to prepare, manage and learn from a sudden and unpredictable extreme change that impacts health systems. Health systems globally have recently been affected by a number of catastrophic events, including natural disasters and infectious disease epidemics. Understanding health systems resilience has never been more essential until emerging global pandemics. Therefore, the application of resilience-enhancing strategies needs to be assessed to identify the management gaps and give valuable recommendations from the lessons learnt from the global pandemic.

METHODS

The systematic review will be reported using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) protocols guideline. Reporting data on World Health Organization (WHO) health system building blocks and systematic searches on resilience enhancing strategies for the management of Public Health Emergencies of International Concerns (PHEIC) after the establishment of International Health Regulations (IHR) in 2007 will be included. The search will be conducted in PubMed, Scopus, Web of Science and Google Scholar ETHICS AND DISSEMINATION: Ethics approval and safety considerations are not applicable. Pre-print of the protocol is available online, and the screening of the articles will be done using Rayyan software in a transparent manner. The findings will be presented at conferences and the final review's findings will be published in a peer-reviewed international journal and will be disseminated to global communities for the application of successful management strategies for the management of future pandemics.

PROSPERO REGISTRATION NUMBER

CRD42022352612; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022352612.

Revisiting health promotion settings: An innovative model from Sri Lanka to integrate healthy settings using mHealth

The health promotion settings approach has been recognised as an effective method of health promotion in the recent era, and mobile health (mHealth) is a highly evolving field in the health sector. The health promotion settings are shifting the focus away from the individuals and moving towards a more holistic model of health promotion. We identified five settings in Sri Lanka to promote a mHealth model, including villages, schools, preschools, workplaces, and hospitals. The specified model using mHealth helps monitor the activities at various levels of healthcare, including regional, district and national levels. The model also maps the location of the healthy settings, which provide a visual picture to the policymakers, helpful in planning and decision-making.

Role of Religious Leaders in COVID-19 Prevention: A Community-Level Prevention Model in Sri Lanka

The COVID-19 pandemic has affected all countries irrespective of their state of development. In countries with traditional societies, religious leaders have been acknowledged as key stakeholders in community engagement activities, including disease prevention. A community-level prevention model was established in 2020 by the Health Promotion Bureau (HPB), Sri Lanka, which incorporated mobilisation of the clergy to support the prevention and response schemes to COVID-19 with non-governmental stakeholders. This model was part of a more extensive community engagement network established by the HPB in cooperation with the country offices for WHO and UNICEF. Building trust, empowering behavioural traits applicable to minimise risks from COVID-19, leadership and coordination, message dissemination, addressing stigma and discrimination, supporting testing procedures, contact tracing activities and vaccination, building community resilience, spiritual and psychosocial support, and welfare provision are some of the useful factors that were identified in the model. Furthermore, a much broader and holistic approach is needed to focus on health behaviours and social and cultural aspects in a multi-faceted nature. This paper highlights a novel COVID-19 prevention model with active involvement of religious leaders that can be implemented in low resource settings. Our experience from Sri Lanka demonstrates the feasibility of implementing this model to mitigate the disastrous situation following the COVID-19 outbreak.