1
|
Peles C, Shloim N, Rudolf MCJ. "Over-preoccupation with healthy food is perceived as worship of the body": Food, culture and beliefs in Ultra-Orthodox Jewish families. Appetite 2021; 167:105621. [PMID: 34363899 DOI: 10.1016/j.appet.2021.105621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/28/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Eating behaviours vary by culture and religion, and an understanding of attitudes and practices are essential for providing culturally competent nutritional guidance. The Ultra-orthodox Jewish community is characterized by poor diet, high rates of obesity, anemia and diabetes. This study aimed to acquire insights that could influence the promotion of healthier eating in the Ultra-orthodox and other closed religious communities, particularly regarding children's eating habits and the food they consume. METHODS In depth face-to-face recorded interviews were conducted with 20 information-rich participants: religious leaders, opinion leaders and education/health professionals from Gur and Chabad, two Ultra-orthodox Jewish religious communities in Israel. The focus was on exploring young family eating behaviours and perceived challenges to encouraging healthier nutrition in the community. Interviews were transcribed and thematic analysis employed using grounded theory. RESULTS Seven themes were identified with findings that had clear implications for the promotion of health at both the community and individual level. These included spiritual aspects of eating, deficits in knowledge and awareness, less relevance of kashrut than previously thought, the centrality of motherhood and family meals, the quality of food in educational institutions, the significance and sensitivity of Sabbath and festive meals and pragmatic considerations. DISCUSSION AND CONCLUSIONS By illuminating attitudes and behaviors, the study broadens and enhances our understanding of the Ultra-orthodox communities' perspectives on eating behaviours in the family. The findings have the potential to contribute to strengths-based health promotion for children's nutrition. Recommendations regarding culturally competent guidance and implications for other secluded religious communities are discussed.
Collapse
Affiliation(s)
- C Peles
- Department of Population Health, Azrieli Faculty of Medicine, Safed, Israel.
| | - N Shloim
- School of Healthcare, University of Leeds, UK.
| | - M C J Rudolf
- Department of Population Health, Azrieli Faculty of Medicine, Safed, Israel.
| |
Collapse
|
2
|
Taylor RM, Wolfson JA, Lavelle F, Dean M, Frawley J, Hutchesson MJ, Collins CE, Shrewsbury VA. Impact of preconception, pregnancy, and postpartum culinary nutrition education interventions: a systematic review. Nutr Rev 2020; 79:1186-1203. [PMID: 33249446 DOI: 10.1093/nutrit/nuaa124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CONTEXT Frequent consumption of home-prepared meals is associated with higher diet quality in children and adults. Therefore, increasing the culinary skills of women and couples during their childbearing years may be an effective strategy for the prevention of overweight and obesity. OBJECTIVE To determine the impact of culinary nutrition-education interventions for women with or without their partners during preconception, pregnancy, or postpartum (PPP) on parental cooking skills, nutrition knowledge, parent/child diet quality, or health outcomes. DATA SOURCES Eligibility criteria were defined using a PICOS framework. A systematic search strategy was developed to identify eligible studies and was implemented in 11 electronic databases. Reference lists of selected systematic reviews were manually searched for additional studies. DATA EXTRACTION Study characteristics and outcomes were extracted from eligible studies by 1 reviewer and checked by a second reviewer. DATA ANALYSIS A narrative synthesis of the findings of eligible studies was prepared including descriptive statistics. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and Synthesis Without Meta-Analysis in systematic reviews reporting guideline. RESULTS A total of 6951 articles were identified from the search strategy and 31 studies during pregnancy or postpartum were included. By category, the number of studies with a favorable outcome per total number of studies measuring outcome were as follows: parental food/cooking skills (n = 5 of 5), nutrition knowledge (n = 6 of 11), parent/child diet quality (n = 10 of 19), infant feeding (n = 6 of 11), eating behavior (n = 2 of 5), maternal (n = 2 of 5) and child anthropometry (n = 6 of 10), mental health and development n = (2 of 3), and clinical indictors (n = 1 of 1). CONCLUSIONS Culinary nutrition-education interventions during pregnancy and the postpartum period show promise in improving cooking skills, diet quality, and a variety of health-related outcomes. The precise effect of these interventions during PPP is limited by the quality and heterogeneity of study designs to date. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42020154966.
Collapse
Affiliation(s)
- Rachael M Taylor
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia
| | - Julia A Wolfson
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Fiona Lavelle
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Moira Dean
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia.,Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Julia Frawley
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia.,Nutrition & Dietetics Service, Frawley Nutrition, Lambton, NSW, Australia
| | - Melinda J Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia
| | - Vanessa A Shrewsbury
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia
| |
Collapse
|
3
|
Leiter E, Finkelstein A, Donchin M, Greenberg KL, Keidar O, Wetzler S, Siemiatycki S, Calderon-Margalit R, Zwas DR. Integration of Mixed Methods in Community-Based Participatory Research: Development of a Disease Prevention Intervention for Ultra-Orthodox Jewish Women. Am J Health Promot 2020; 34:479-489. [DOI: 10.1177/0890117120906965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To describe the development of the first disease prevention intervention with ultra-Orthodox Jewish (UOJ) women in Israel using mixed methods and community-based participatory research (CBPR). Design: This collaborative, 7-staged development process used an exploratory sequential mixed methods design integrated into a community-based participatory approach. Setting: The UOJ community in Israel, a high-risk, low socioeconomic, culturally insular minority that practices strict adherence to religious standards, maintains determined seclusion from mainstream culture and preserves traditional practices including extreme modesty and separation between the sexes. Participants: Women from a targeted UOJ community in Israel with distinct geographic, religious, and cultural parameters. These included 5 key informant interviewees, 5 focus groups with 6 to 8 participants in each, a cluster randomized sample of 239 questionnaire respondents (an 87% response rate), and 11 steering committee participants. Method: Qualitative data were analyzed through Interpretative Phenomenological Analysis by 2 researchers. Quantitative data were collected via questionnaire (designed based on qualitative findings) and analyzed utilizing descriptive statistics. Results: Barriers to health behavior engagement and intervention preferences were identified. The final intervention included walking programs, health newsletters, community leader trainings, teacher and student trainings, and health integration into schools. Conclusion: Utilizing mixed methods in CBPR improved cultural tailoring, potentially serving as a model for intervention design in other difficult to access, low socioeconomic, and culturally insular populations.
Collapse
Affiliation(s)
- Elisheva Leiter
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
| | - Adi Finkelstein
- Program of Medical Humanities, Hebrew University Hadassah Medical School, Jerusalem, Israel
- Department of Nursing, Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel
| | - Milka Donchin
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Keren L. Greenberg
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
| | - Osnat Keidar
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Sima Wetzler
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
| | - Sara Siemiatycki
- Bishvilaych, The Evelyne Barnett Women’s Medical Center, Jerusalem, 9548311, Israel
| | - Ronit Calderon-Margalit
- Hebrew University of Jerusalem, Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Donna R Zwas
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Jerusalem, Israel
| |
Collapse
|
4
|
Zain S, Jameel B, Zahid M, Munir M, Kandasamy S, Majid U. The design and delivery of maternal health interventions in Pakistan: a scoping review. Health Care Women Int 2020; 42:518-546. [PMID: 31917642 DOI: 10.1080/07399332.2019.1707833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hundreds of women die daily due to preventable causes related to pregnancy and childbirth. Multiple programs have been developed to support efforts to reduce maternal mortality. However, no synthesis has been conducted to date that reviews the design, delivery, and impact of these initiatives in Pakistan. After conducting a systematic literature search, we found 23 articles describing interventions. We analyzed these articles for intervention characteristics. In this scoping review the authors identify the characteristics of interventions to improve maternal health services in Pakistan and priorities for future programs and research. Recommendations include multi-level interventions, stakeholder engagement, and rigorous evaluations of existing interventions.
Collapse
Affiliation(s)
- Shahzadi Zain
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bismah Jameel
- Division of Clinical Decision-Making and Healthcare, University Health Network, Toronto, Ontario, Canada
| | - Mahrukh Zahid
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Maryam Munir
- Department of Obstetrics and Gynaecology, King Edward Medical University, Lahore, Pakistan
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Umair Majid
- Division of Clinical Decision-Making and Healthcare, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
| |
Collapse
|
5
|
Lhussier M, Lowe N, Westaway E, Dykes F, McKeown M, Munir A, Tahir S, Zaman M. Understanding communication pathways to foster community engagement for health improvement in North West Pakistan. BMC Public Health 2016; 16:591. [PMID: 27430317 PMCID: PMC4950241 DOI: 10.1186/s12889-016-3222-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 06/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper describes the community engagement process undertaken to ascertain the focus, development and implementation of an intervention to improve iodised salt consumption in rural communities in North West Pakistan. The Jirga is a traditional informal structure, which gathers men respected within their community and acts in a governing and decision-making capacity in the Pukhtoon culture. The Jirga system had a dual purpose for the study: to access men from the community to discuss the importance of iodised salt, and as an engagement process for the intervention. METHODS A number of qualitative data collection activities were undertaken, with Jirga members and their wives, male and female outreach workers and two groups of women, under and over 40 years old. The aim of these was to highlight the communication channels and levers of influence on health behaviour, which were multiple and complex and all needed to be taken into consideration in order to ensure successful and locally sensitive community engagement. RESULTS Communication channels are described within local families and the communities around them. The key influential role of the Jirga is highlighted as linked both to the standing of its members and the community cohesion ethos that it embodies. Engaging Jirga members in discussions about iodised salt was key in designing an intervention that would activate the most influential levers to decision making in the community. Gendered decision-making processes within the household have been highlighted as restricting women's autonomy. Whilst in one respect our data confirm this, a more complex hierarchy of decisional power has been highlighted, whereby the concept of 'wisdom'- an amalgamation of age, experience and education- presents important possibilities. Community members with the least autonomy are the youngest uneducated females, who rely on a web of socially and culturally determined ways to influence decision-making. CONCLUSIONS The major lines of communication and influence in the local community described are placed within the wider literature on community engagement in health improvement. The process of maximisation of local cultural knowledge as part of a community engagement effort is one that has application well beyond the particular setting of this study.
Collapse
Affiliation(s)
- Monique Lhussier
- />Faculty of Health and Life Sciences, Northumbria University Coach Lane Campus East (H005), Longbenton, Newcastle upon Tyne, NE7 7XA UK
| | - Nicola Lowe
- />International Institute of Nutritional Sciences and Applied Food Safety Studies, School of Sport and Wellbeing, University of Central Lancashire, Preston, UK
| | - Elizabeth Westaway
- />International Institute of Nutritional Sciences and Applied Food Safety Studies, School of Sport and Wellbeing, University of Central Lancashire, Preston, UK
| | - Fiona Dykes
- />Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Mick McKeown
- />School of Nursing, University of Central Lancashire, Preston, UK
| | - Akhtar Munir
- />Abaseen Foundation, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Saba Tahir
- />Abaseen Foundation, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Mukhtiar Zaman
- />Khyber Medical University, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa Pakistan
| |
Collapse
|
6
|
Lacouture A, Breton E, Guichard A, Ridde V. The concept of mechanism from a realist approach: a scoping review to facilitate its operationalization in public health program evaluation. Implement Sci 2015; 10:153. [PMID: 26519291 PMCID: PMC4628377 DOI: 10.1186/s13012-015-0345-7] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/26/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Public health interventions are complex by nature, and their evaluation requires unpacking their intervention logic and their interactions with open social systems. By focusing on the interrelationships between context, mechanism, and outcome, Pawson and Tilley's realist approach appears a promising innovation for public health-related evaluation works. However, and as expected of any methodological innovation, this approach is being constructed gradually by answering the multiple challenges to its operationalization that fall in its path. One of these challenges, users of this approach agree on, is the necessity of clarifying its key concept of mechanism. METHOD We first collected the definitions of mechanism from published works of Pawson and colleagues. Secondly, a scoping review was conducted to identify the ones quoted by users of the realist approach for evaluating public health interventions (1997-2012). We then appraised the clarity and precision of this concept against the three dimensions defined by Daigneault and Jacobs "term, sense and referent." RESULTS Of the 2344 documents identified in the scoping review, 49 documents were included. Term: Users of the realist approach use adjectives qualifying the term mechanism that were not specifically endorsed by Pawson and colleagues. Sense: None of the attributes stated by Pawson and colleagues has been listed in all of the documents analyzed, and some contributions clarified its attributes. Referent: The concept of mechanism within a realist approach can be ascribed to theory-based evaluation, complex social interventions, and critical realism. CONCLUSION This review led us to reconsider the concept of mechanism within the realist approach by confronting the theoretical stance of its proponents to the practical one of its users. This resulted in a clearer, more precise definition of the concept of mechanism which may in turn trigger further improvements in the way the realist approach is applied in evaluative practice in public health and potentially beyond. A mechanism is hidden but real, is an element of reasoning and reactions of agents in regard to the resources available in a given context to bring about changes through the implementation of an intervention, and evolves within an open space-time and social system of relationships.
Collapse
Affiliation(s)
- Anthony Lacouture
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France.
- CNRS, UMR CRAPE Centre for Research on Political Action in Europe-6051, Rennes, France.
- ESPUM School of Public Health University of Montreal, Montreal, Quebec, Canada.
| | - Eric Breton
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
- CNRS, UMR CRAPE Centre for Research on Political Action in Europe-6051, Rennes, France
| | - Anne Guichard
- Faculty of Nursing, Laval University, Quebec, Quebec, Canada
| | - Valéry Ridde
- ESPUM School of Public Health University of Montreal, Montreal, Quebec, Canada
- IRSPUM University of Montreal Public Health Research Institute, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Sikander S, Maselko J, Zafar S, Haq Z, Ahmad I, Ahmad M, Hafeez A, Rahman A. Cognitive-behavioral counseling for exclusive breastfeeding in rural pediatrics: a cluster RCT. Pediatrics 2015; 135:e424-31. [PMID: 25583916 DOI: 10.1542/peds.2014-1628] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To test the effectiveness of cognitive-behavioral counseling on the rate and duration of exclusive breastfeeding (EBF) during the first 6 months of an infant's life compared with routine counseling. METHODS A single blind cluster-randomized controlled trial was undertaken in 40 Union Councils of a rural district in the northwest province of Pakistan between May 2009 and April 2010. By simple unmatched randomization, 20 Union Councils were each allocated to intervention and control arms. Two hundred twenty-four third trimester pregnant women in the intervention and 228 third trimester pregnant women in the control arm were enrolled and followed-up biweekly until 6 months postpartum. Analyses were by intention to treat. Mothers in the intervention group received 7 sessions of cognitive-behavioral counseling from antenatal to 6 months postpartum, whereas the control group received an equal number of routine sessions. Proportion of mothers exclusively breastfeeding at 6 months postpartum and duration of EBF through these 6 months was assessed. RESULTS At 6 months postpartum, 59.6% of mothers in the intervention arm and 28.6% in the control arm were exclusively breastfeeding. This translates into a 60% reduced risk of stopping exclusively breastfeeding during the first 6 months (adjusted hazard ratio, 0.40 [95% confidence interval: 0.27-0.60], P < .001). Mothers in the intervention group were half as likely to use prelacteal feeds with their infants (adjusted relative risk, 0.51 [95% confidence interval: 0.34-0.78]). CONCLUSIONS Compared with routine counseling, cognitive-behavioral counseling significantly prolonged the duration of EBF, doubling the rates of EBF at 6 months postpartum.
Collapse
Affiliation(s)
- Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan;
| | - Joanna Maselko
- School of Medicine, Duke University, Durham, North Carolina
| | - Shamsa Zafar
- Human Development Research Foundation, Islamabad, Pakistan
| | - Zaeem Haq
- Human Development Research Foundation, Islamabad, Pakistan
| | - Ikhlaq Ahmad
- Human Development Research Foundation, Islamabad, Pakistan
| | - Mansoor Ahmad
- Human Development Research Foundation, Islamabad, Pakistan
| | - Assad Hafeez
- Health Services Academy, Islamabad, Pakistan; and
| | - Atif Rahman
- Institute of Psychology, Health, and Society, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
8
|
Dykes F, Lhussier M, Bangash S, Zaman M, Lowe N. Exploring and optimising maternal and infant nutrition in North West Pakistan. Midwifery 2012; 28:831-5. [DOI: 10.1016/j.midw.2011.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 09/19/2011] [Accepted: 09/24/2011] [Indexed: 10/15/2022]
|