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Canuto K, Preston R, Rannard S, Felton-Busch C, Geia L, Yeomans L, Turner N, Thompson Q, Carlisle K, Evans R, Passey M, Larkins S, Redman-MacLaren M, Farmer J, Muscat M, Taylor J. How and why do women's groups (WGs) improve the quality of maternal and child health (MCH) care? A systematic review of the literature. BMJ Open 2022; 12:e055756. [PMID: 35190438 PMCID: PMC8862452 DOI: 10.1136/bmjopen-2021-055756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND This systematic review was undertaken to assist the implementation of the WOmen's action for Mums and Bubs (WOMB) project which explores Aboriginal and Torres Strait Islander community women's group (WG) action to improve maternal and child health (MCH) outcomes. There is now considerable international evidence that WGs improve MCH outcomes, and we were interested in understanding how and why this occurs. The following questions guided the review: (1) What are the characteristics, contextual influences and group processes associated with the MCH outcomes of WGs? (2) What are the theoretical and conceptual approaches to WGs? (3) What are the implications likely to inform Aboriginal and Torres Strait Islander WGs? METHODS We systematically searched electronic databases (MEDLINE (Ovid); CINAHL (Ebsco); Informit health suite, Scopus, Emcare (Ovid) and the Cochrane Library and Informit), online search registers and grey literature using the terms mother, child, group, participatory and community and their variations during all time periods to January 2021. The inclusion criteria were: (1) Population: studies involving community WGs in any country. (2) Intervention: a program/intervention involving any aspect of community WGs planning, acting, learning and reviewing MCH improvements. (3) Outcome: studies with WGs reported a component of: (i) MCH outcomes; or (ii) improvements in the quality of MCH care or (iii) improvements in socioemotional well-being of mothers and/or children. (4) Context: the primary focus of initiatives must be in community-based or primary health care settings. (5) Process: includes some description of the process of WGs or any factors influencing the process. (6) Language: English. (7) Study design: all types of quantitative and qualitative study designs involving primary research and data collection.Data were extracted under 14 headings and a narrative synthesis identified group characteristics and analysed the conceptual approach to community participation, the use of theory and group processes. An Australian typology of community participation, concepts from Aboriginal and Torres Strait Islander group work and an adapted framework of Cohen and Uphoff were used to synthesise results. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Tools. RESULTS Thirty-five (35) documents were included with studies conducted in 19 countries. Fifteen WGs used participatory learning and action cycles and the remainder used cultural learning, community development or group health education. Group activities, structure and who facilitated groups was usually identified. Intergroup relationships and decision-making were less often described as were important concepts from an Aboriginal or Torres Strait Islander perspective (the primacy of culture, relationships and respect). All but two documents used an explicit theoretical approach. Using the typology of community participation, WGs were identified as predominantly developmental (22), instrumental (10), empowerment (2) and one was unclear. DISCUSSION A framework to categorise links between contextual factors operating at micro, meso and macro levels, group processes and MCH improvements is required. Currently, despite a wealth of information about WGs, it was difficult to determine the methods through which they achieved their outcomes. This review adds to existing systematic reviews about the functioning of WGs in MCH improvement in that it covers WGs in both high-income and low-income settings, identifies the theory underpinning the WGs and classifies the conceptual approach to participation. It also introduces an Australian Indigenous perspective into analysis of WGs used to improve MCH. PROSPERO REGISTRATION NUMBER CRD42019126533.
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Affiliation(s)
- Karla Canuto
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Naghir Tribe of the Kulkagul Clan, Torres Strait, Queensland, Australia
| | - Robyn Preston
- School of Health, Medical and Applied Sciences, Central Queensland University, Townsville, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Sam Rannard
- Library and Information Services, James Cook University, Bebegu Yumba, Townsville, Queensland, Australia
| | - Catrina Felton-Busch
- Murtupuni Centre Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
- Yangkaal and Gangaidda, Mount Isa, Queensland, Australia
| | - Lynore Geia
- College of Healthcare Sciences, James Cook University, Bebegu Yumba, Townsville, Queensland, Australia
- Bwgcolman, Palm Island, Queensland, Australia
| | - Lee Yeomans
- Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
| | - Nalita Turner
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
- Anmatyerre/Jaru, Northern Territory, Northern Territory, Australia
| | - Quitaysha Thompson
- Gurindji Aboriginal Corporation, Kalkaringi, Northern Territory, Australia
- Gurindji woman, Kalkaringi, Northern Territory, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Michelle Redman-MacLaren
- College of Medicine and Dentistry, James Cook University, Nguma-bada, Cairns, Queensland, Australia
| | - Jane Farmer
- Swinburne Social Innovation Research Institute, Centre for Social Impact, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Melody Muscat
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
- Bijara, Charleville, Queensland, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
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Kumar N, Scott S, Menon P, Kannan S, Cunningham K, Tyagi P, Wable G, Raghunathan K, Quisumbing A. Pathways from women's group-based programs to nutrition change in South Asia: A conceptual framework and literature review. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2018; 17:172-185. [PMID: 29930896 PMCID: PMC6004534 DOI: 10.1016/j.gfs.2017.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/24/2017] [Accepted: 11/25/2017] [Indexed: 11/17/2022]
Abstract
Improving the nutritional status of women and children in South Asia remains a high public health and development priority. Women's groups are emerging as platforms for delivering health- and nutrition-oriented programs and addressing gender and livelihoods challenges. We propose a framework outlining pathways through which women's group participation may facilitate improvements in nutrition. Evidence is summarized from 36 studies reporting on 24 nutritional indicators across infant and young child feeding (IYCF) practices, intake/diet, and anthropometry. Our findings suggest that women's group-based programs explicitly triggering behavior change pathways are most successful in improving nutrition outcomes, with strongest evidence for IYCF practices. Future investigators should link process and impact evaluations to better understand the pathways from women's group participation to nutritional impact. Women’s group programs in South Asia are starting to promote health and nutrition. Achieving nutritional impacts is complex and operates through multiple pathways. We outline income, agriculture, health behavior change, and rights pathways. Evidence is strongest for programs triggering the health behavior change pathway.
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Affiliation(s)
- Neha Kumar
- International Food Policy Research Institute, Poverty Health and Nutrition Division, Washington DC, USA
| | - Samuel Scott
- International Food Policy Research Institute, Poverty Health and Nutrition Division, Washington DC, USA
| | - Purnima Menon
- International Food Policy Research Institute, Poverty Health and Nutrition Division, Washington DC, USA
| | - Samyuktha Kannan
- International Food Policy Research Institute, Poverty Health and Nutrition Division, Washington DC, USA
| | | | | | - Gargi Wable
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Kalyani Raghunathan
- International Food Policy Research Institute, Poverty Health and Nutrition Division, Washington DC, USA
| | - Agnes Quisumbing
- International Food Policy Research Institute, Poverty Health and Nutrition Division, Washington DC, USA
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