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Ferris-Day PM, Hoare K, Minton C, Donaldson A. Reflections on being an insider researcher: a study exploring the experiences of men accessing rural mental health services. Nurse Res 2024:e1909. [PMID: 38813677 DOI: 10.7748/nr.2024.e1909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND An embedded single case-study design was used to explore the experiences of men in rural New Zealand accessing mental health services. It is essential for researchers to acknowledge positionality in case study research and the lead author used reflexive practice to acknowledge his values and beliefs. AIM To explore and demonstrate the reflexive process of the lead author's position as an inside researcher. DISCUSSION Three groups were involved in the research: men with mental health challenges, their partners, and mental health clinicians. The article presents the initial research through memos and diarying in the context of current literature. CONCLUSION Reflexivity is essential for ensuring the research process is complete and biases are identified. Positionality exists on a continuum and it is critical for researchers to be honest with themselves, the topic and the group being investigated, to show respect for the participants and the people they represent, as well as to be committed to revealing the truth. IMPLICATIONS FOR PRACTICE Insider research has the potential to bridge the gap between academia and practice. It facilitates the transfer of research knowledge directly to practitioners, leading to more evidence-informed decision-making and practice.
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Affiliation(s)
| | - Karen Hoare
- Massey University - Auckland Campus, Auckland, New Zealand
| | - Claire Minton
- bachelor of nursing director, Massey University - Manawatu Campus, Palmerston North, New Zealand
| | - Andrea Donaldson
- Massey University - Manawatu Campus, Palmerston North, New Zealand
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Sarmiento I, Cockcroft A, Dion A, Belaid L, Silver H, Pizarro K, Pimentel J, Tratt E, Skerritt L, Ghadirian MZ, Gagnon-Dufresne MC, Andersson N. Fuzzy cognitive mapping in participatory research and decision making: a practice review. Arch Public Health 2024; 82:76. [PMID: 38769567 PMCID: PMC11103993 DOI: 10.1186/s13690-024-01303-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Fuzzy cognitive mapping (FCM) is a graphic technique to describe causal understanding in a wide range of applications. This practice review summarises the experience of a group of participatory research specialists and trainees who used FCM to include stakeholder views in addressing health challenges. From a meeting of the research group, this practice review reports 25 experiences with FCM in nine countries between 2016 and 2023. RESULTS The methods, challenges and adjustments focus on participatory research practice. FCM portrayed multiple sources of knowledge: stakeholder knowledge, systematic reviews of literature, and survey data. Methodological advances included techniques to contrast and combine maps from different sources using Bayesian procedures, protocols to enhance the quality of data collection, and tools to facilitate analysis. Summary graphs communicating FCM findings sacrificed detail but facilitated stakeholder discussion of the most important relationships. We used maps not as predictive models but to surface and share perspectives of how change could happen and to inform dialogue. Analysis included simple manual techniques and sophisticated computer-based solutions. A wide range of experience in initiating, drawing, analysing, and communicating the maps illustrates FCM flexibility for different contexts and skill bases. CONCLUSIONS A strong core procedure can contribute to more robust applications of the technique while adapting FCM for different research settings. Decision-making often involves choices between plausible interventions in a context of uncertainty and multiple possible answers to the same question. FCM offers systematic and traceable ways to document, contrast and sometimes to combine perspectives, incorporating stakeholder experience and causal models to inform decision-making. Different depths of FCM analysis open opportunities for applying the technique in skill-limited settings.
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Affiliation(s)
- Iván Sarmiento
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada.
- Universidad del Rosario, Grupo de Estudios en Sistemas Tradicionales de Salud, Bogota, Colombia.
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Anna Dion
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Loubna Belaid
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Hilah Silver
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Katherine Pizarro
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Juan Pimentel
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
- Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
| | - Elyse Tratt
- Institut Lady Davis pour la Recherche Médicale, Montreal, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Mona Z Ghadirian
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Marie-Catherine Gagnon-Dufresne
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
- École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
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Alexander ED, Chung VHA, Yacovelli A, Sarmiento I, Andersson N. Social media and postsecondary student adoption of mental health labels: protocol for a scoping review. BMJ Open 2024; 14:e078193. [PMID: 38355173 PMCID: PMC10868259 DOI: 10.1136/bmjopen-2023-078193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Many postsecondary students use social media at an age when mental health issues often arise for the first time. On social media, students describe their mental states or social interactions using psychiatric language. This is a process of mental health labelling as opposed to receiving a formal diagnosis from a psychiatrist. Despite substantial literature on psychiatric labelling effects such as stigma, little research has addressed the mechanisms and effects of labelling through social media. Our objective is to summarise the existing evidence to address this gap. METHODS AND ANALYSIS This review includes articles in English published since 1995 on how postsecondary students interact with mental health labels in their use of social media. We will consider empirical studies and theses. The search strategy includes SCOPUS, PubMed, OVID MEDLINE (to access APA PsycINFO), Web of Science and ProQuest Global Dissertations and Theses. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extensions for protocols and Scoping Reviews guidelines. The artificial intelligence application, Connected Papers, will assist in identifying additional references. The outcomes of interest are labelling by self or others and changes in self-concept and presentation associated with these labels. Two researchers will independently identify the included studies and extract data, solving disagreements with a third opinion. We will produce tables and narrative descriptions of the operationalisation and measurement methods of labelling and social media use, reported effects and uses of labelling, and explanatory mechanisms for the adoption of labels. ETHICS AND DISSEMINATION This literature review does not require ethics approval. The researchers will present their findings for publication in an open-access peer-reviewed journal and at student/scientific conferences. Potential knowledge users include university students, social media users, researchers, mental health professionals and on-campus mental health services.
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Affiliation(s)
- Ethan Dylan Alexander
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Van-Han-Alex Chung
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Alexandra Yacovelli
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Ivan Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- GESTS, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota, Cundinamarca, Colombia
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autonoma de Guerrero, Acapulco, Guerrero, Mexico
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van der Wal R, Cockcroft A, Kobo M, Kgakole L, Marokaone N, Johri M, Vedel I, Andersson N. HIV-sensitive social protection for unemployed and out-of-school young women in Botswana: An exploratory study of barriers and solutions. PLoS One 2024; 19:e0293824. [PMID: 38198458 PMCID: PMC10781194 DOI: 10.1371/journal.pone.0293824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/20/2023] [Indexed: 01/12/2024] Open
Abstract
Promotive social protection programs aim to increase income and capabilities and could help address structural drivers of HIV-vulnerability like poverty, lack of education and gender inequality. Unemployed and out-of-school young women bear the brunt of HIV infection in Botswana, but rarely benefit from such economic empowerment programs. Using a qualitative exploratory study design and a participatory research approach, we explored factors affecting perceived program benefit and potential solutions to barriers. Direct stakeholders (n = 146) included 87 unemployed and out-of-school young women and 59 program and technical officers in five intervention districts. Perceived barriers were identified in 20 semi-structured interviews (one intervention district) and 11 fuzzy cognitive maps. Co-constructed improvement recommendations were generated in deliberative dialogues. Analysis relied on Framework and the socioecological model. Overall, participants viewed existing programs in Botswana as ineffective and inadequate to empower vulnerable young women socially or economically. Factors affecting perceived program benefit related to programs, program officers, the young women, and their social and structural environment. Participants perceived barriers at every socioecological level. Young women's lack of life and job skills, unhelpful attitudes, and irresponsible behaviors were personal-level barriers. At an interpersonal level, competing care responsibilities, lack of support from boyfriends and family, and negative peer influence impeded program benefit. Traditional venues for information dissemination, poverty, inequitable gender norms, and lack of coordination were community- and structural-level barriers. Improvement recommendations focused on improved outreach and peer approaches to implement potential solutions. Unemployed and out-of-school young women face multidimensional, interacting barriers that prevent benefit from available promotive social protection programs in Botswana. To become HIV-sensitive, these socioeconomic empowerment programs would need to accommodate or preferentially attract this key population. This requires more generous and comprehensive programs, a more client-centered program delivery, and improved coordination. Such structural changes require a holistic, intersectoral approach to HIV-sensitive social protection.
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Affiliation(s)
- Ran van der Wal
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
- CIET Trust, Gaborone, South-East, Botswana
| | | | | | | | - Mira Johri
- Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département de Gestion, d’évaluation, et de Politique de Santé, École de Santé Publique de l’Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
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Badry NA, MacMillan GA, Stern ER, Landry-Cuerrier M, Hickey GM, Humphries MM. Boundary Spanning Methodological Approaches for Collaborative Moose Governance in Eeyou Istchee. ENVIRONMENTAL MANAGEMENT 2023:10.1007/s00267-023-01918-6. [PMID: 38145447 DOI: 10.1007/s00267-023-01918-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/15/2023] [Indexed: 12/26/2023]
Abstract
Natural resource governance challenges are often highly complex, particularly in Indigenous contexts. These challenges involve numerous landscape-level interactions, spanning jurisdictional, disciplinary, social, and ecological boundaries. In Eeyou Istchee, the James Bay Cree Territory of northern Quebec, Canada, traditional livelihoods depend on wild food species like moose. However, these species are increasingly being impacted by forestry and other resource development projects. The complex relationships between moose, resource development, and Cree livelihoods can limit shared understandings and the ability of diverse actors to respond to these pressures. Contributing to this complexity are the different knowledge systems held by governance actors who, while not always aligned, have broadly shared species conservation and sustainable development goals. This paper presents fuzzy cognitive mapping (FCM) as a methodological approach used to help elicit and interpret the knowledge of land-users concerning the impacts of forest management on moose habitat in Eeyou Istchee. We explore the difficulties of weaving this knowledge together with the results of moose GPS collar analysis and the knowledges of scientists and government agencies. The ways in which participatory, relational mapping approaches can be applied in practice, and what they offer to pluralistic natural resource governance research more widely, are then addressed.
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Affiliation(s)
- Nathan A Badry
- Department of Natural Resource Sciences, McGill University, Montreal, QC, Canada.
| | - Gwyneth A MacMillan
- Department of Natural Resource Sciences, McGill University, Montreal, QC, Canada
| | - Eleanor R Stern
- Department of Natural Resource Sciences, McGill University, Montreal, QC, Canada
| | | | - Gordon M Hickey
- Department of Natural Resource Sciences, McGill University, Montreal, QC, Canada
| | - Murray M Humphries
- Department of Natural Resource Sciences, McGill University, Montreal, QC, Canada
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Silver H, Tukalak S, Sarmiento I, Budgell R, Cockcroft A, Vang ZM, Andersson N. Giving birth in a good way when it must take place away from home: Participatory research into visions of Inuit families and their Montreal-based medical providers. Birth 2023; 50:781-788. [PMID: 37192171 DOI: 10.1111/birt.12726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/22/2022] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Transferring pregnant women out of their communities for childbirth continues to affect Inuit women living in Nunavik-Inuit territory in Northern Quebec. With estimates of maternal evacuation rates in the region between 14% and 33%, we examine how to support culturally safe birth for Inuit families when birth must take place away from home. METHODS A participatory research approach explored perceptions of Inuit families and their perinatal healthcare providers in Montreal for culturally safe birth, or "birth in a good way" in the context of evacuation, using fuzzy cognitive mapping. We used thematic analysis, fuzzy transitive closure, and an application of Harris' discourse analysis to analyze the maps and synthesize the findings into policy and practice recommendations. RESULTS Eighteen maps authored by 8 Inuit and 24 service providers in Montreal generated 17 recommendations related to culturally safe birth in the context of evacuation. Family presence, financial assistance, patient and family engagement, and staff training featured prominently in participant visions. Participants also highlighted the need for culturally adapted services, with provision of traditional foods and the presence of Inuit perinatal care providers. Stakeholder engagement in the research resulted in dissemination of the findings to Inuit national organizations and implementation of several immediate improvements in the cultural safety of flyout births to Montreal. CONCLUSIONS The findings point toward the need for culturally adapted, family-centered, and Inuit-led services to support birth that is as culturally safe as possible when evacuation is indicated. Application of these recommendations has the potential to benefit Inuit maternal, infant, and family wellness.
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Affiliation(s)
- Hilah Silver
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Sophie Tukalak
- McGill University Health Centre Research Institute, Montréal, Québec, Canada
- Indigenous Maternal Infant Health & Well-being (IMIHW) Lab, McGill University, Montréal, Québec, Canada
| | - Iván Sarmiento
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Richard Budgell
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Zoua M Vang
- Department of Sociology, McGill University, Montréal, Québec, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
- Centro de Investigación de Enfermedades Tropicales - CIET, Universidad Autónoma de Guerrero, Acapulco, Mexico
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Pimentel J, López P, Rincón J, Neira L, Jiménez D, Correal C, Sarmiento I. What facilitates or prevents academic fraud in a Colombian faculty of medicine-Protocol of a study using fuzzy cognitive mapping. PLoS One 2023; 18:e0291737. [PMID: 37729214 PMCID: PMC10511091 DOI: 10.1371/journal.pone.0291737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Academic fraud is any behavior that gives a student an undeserved advantage over another student. Few studies have explored the causes of and possible solutions to academic fraud in Latin America. We aim to map the knowledge of stakeholders in a Colombian faculty of medicine about the factors that facilitate and prevent academic fraud. METHODS Fuzzy cognitive mapping. We will use the approach proposed by Andersson and Silver to generate fuzzy cognitive maps representing stakeholder knowledge. This process consists of ten steps: (1) definition of the research question; (2) identification of participants; (3) generation of ideas; (4) rationalization of ideas; (5) organization and connection of ideas; (6) weighing; (7) pattern grouping; (8) list of links and digitization; (9) combination of maps and network analysis; and (10) deliberative dialogue. To draw the maps, we will invite medical students, interns, resident physicians, master's students, and professors in the faculty of medicine. Four medical students will receive training to facilitate the sessions. Participants will identify the factors contributing to academic fraud and their causal relationships. We will use a combination of network analysis and graph theory to identify the chains of factors with greatest influence on academic fraud. CONCLUSION The maps will serve to discuss strategies to reduce academic fraud in the Faculty of Medicine and to identify factors that could be addressed in other contexts with similar problems. This research will allow the students who facilitate mapping sessions to learn about research techniques, fuzzy cognitive mapping and academic fraud. Study registration: Registered in OSF Registries on August 2nd, 2022. Registration number: osf.io/v4amz.
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Affiliation(s)
- Juan Pimentel
- Department of Family Medicine and Public Health, Universidad de La Sabana, Chía, Colombia
| | - Paola López
- Department of Family Medicine and Public Health, Universidad de La Sabana, Chía, Colombia
| | - Johan Rincón
- Department of Family Medicine and Public Health, Universidad de La Sabana, Chía, Colombia
| | - Laura Neira
- Department of Family Medicine and Public Health, Universidad de La Sabana, Chía, Colombia
| | - Daniel Jiménez
- Department of Family Medicine and Public Health, Universidad de La Sabana, Chía, Colombia
| | - Camilo Correal
- Department of Family Medicine and Public Health, Universidad de La Sabana, Chía, Colombia
| | - Iván Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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Gagnon-Dufresne MC, Sarmiento I, Fortin G, Andersson N, Zinszer K. Why urban communities from low-income and middle-income countries participate in public and global health research: protocol for a scoping review. BMJ Open 2023; 13:e069340. [PMID: 37277224 DOI: 10.1136/bmjopen-2022-069340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION As the number of people living in cities increases worldwide, particularly in low-income and middle-income countries (LMICs), urban health is a growing priority of public and global health. Rapid unplanned urbanisation in LMICs has exacerbated inequalities, putting the urban poor at increased risk of ill health due to difficult living conditions in cities. Collaboration with communities in research is a key strategy for addressing the challenges they face. The objective of this scoping review is, therefore, to identify factors that influence the participation of urban communities from LMICs in public and global health research. METHODS AND ANALYSIS We will develop a search strategy with a health librarian to explore the following databases: MEDLINE, Embase, Web of Science, Cochrane, Global Health and CINAHL. We will use MeSH terms and keywords exploring the concepts of 'low-income and middle-income countries', 'community participation in research' and 'urban settings' to look at empirical research conducted in English or French. There will be no restriction in terms of dates of publication. Two independent reviewers will screen and select studies, first based on titles and abstracts, and then on full text. Two reviewers will extract data. We will summarise the results using tables and fuzzy cognitive mapping. ETHICS AND DISSEMINATION This scoping review is part of a larger project to be approved by the University of Montréal's Research Ethics Committee for Science and Health in Montréal (Canada), and the Institutional Review Board of the James P Grant School of Public Health at BRAC University in Dhaka (Bangladesh). Results from the review will contribute to a participatory process seeking to combine scientific evidence with experiential knowledge of stakeholders in Dhaka to understand how to better collaborate with communities for research. The review could contribute to a shift toward research that is more inclusive and beneficial for communities.
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Affiliation(s)
- Marie-Catherine Gagnon-Dufresne
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Quebec, Canada
| | - Ivan Sarmiento
- Department of Family Medicine, McGill University, Montréal, Quebec, Canada
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogota, Colombia
| | - Geneviève Fortin
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Quebec, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montréal, Quebec, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autonoma de Guerrero - Campus Acapulco, Acapulco, Guerrero, Mexico
| | - Kate Zinszer
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Quebec, Canada
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Dion A, Carini-Gutierrez A, Jimenez V, Ben Ameur A, Robert E, Joseph L, Andersson N. Weight of Evidence: Participatory Methods and Bayesian Updating to Contextualize Evidence Synthesis in Stakeholders' Knowledge. JOURNAL OF MIXED METHODS RESEARCH 2022; 16:281-306. [PMID: 35872747 PMCID: PMC9297342 DOI: 10.1177/15586898211037412] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Mixed methods research is well-suited to grapple with questions of what counts as valid knowledge across different contexts and perspectives. This article introduces Weight of Evidence as a transformative procedure for stakeholders to interpret, expand on and prioritize evidence from evidence syntheses, with a focus on engaging populations historically excluded from planning and decision making. This article presents the procedure's five steps using pilot data on perinatal care of immigrant women in Canada, engaging family physicians and birth companions. Fuzzy cognitive mapping offers an accessible and systematic way to generate priors to update published literature with stakeholder priorities. Weight of Evidence is a transparent procedure to broaden what counts as expertise, contributing to a more comprehensive, context-specific, and actionable understanding.
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Affiliation(s)
- Anna Dion
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
- Anna Dion, Department of Family Medicine, McGill University, 5858 chemin de la Cotes-des-Neiges, Montréal, Québec H3S 1Z1, Canada.
| | | | - Vania Jimenez
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | | | - Emilie Robert
- SHERPA University Institute, Montreal, Quebec, Canada
- ICARES Montreal, Quebec, Canada
| | - Lawrence Joseph
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
- Autonomous University of Guerrero, Acapulco, Mexico
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Santella C, Tratt E, Nyamiaka J, Whiteley Tukkiapik L, Styffe C, Gamelin R, Macdonald ME, Brassard P. Perceptions of Inuit Women and Non-Inuit Healthcare Providers on the Implementation of Human Papillomavirus Self-Sampling as an Alternative Cervical Cancer Screening Method in Nunavik, Northern Quebec. QUALITATIVE HEALTH RESEARCH 2022; 32:1259-1272. [PMID: 35621363 DOI: 10.1177/10497323221090805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Human papillomavirus (HPV) self-sampling offers a cervical cancer (CC) screening alternative that can address certain barriers to the Papanicolaou test. As part of a larger community-based participatory project in Nunavik, Northern Québec, we travelled to two communities to gather perspectives from Inuit women and healthcare professionals (HCPs) on CC screening services and the possible implementation of HPV self-sampling. We held 10 group discussions with 28 Inuit women and 10 semi-structured interviews with 20 HCPs. The thematic analysis extracted themes reflecting one barrier and seven facilitators to accessing CC screening and the implementation of HPV self-sampling in Nunavik. Themes included, though not limited to, language and communication in health settings, access to culturally responsive educational resources on CC, and the noninvasive nature of HPV self-sampling. This study may serve to contribute to the co-development of a strategy for implementation that is designed according to the needs and priorities of the communities.
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Affiliation(s)
- Christina Santella
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Elyse Tratt
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Joy Nyamiaka
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | | | - Claire Styffe
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Rachel Gamelin
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Mary Ellen Macdonald
- Oral Health and Society Research Unit, Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Paul Brassard
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
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Sarmiento I, Paredes-Solís S, Dion A, Silver H, Vargas E, Cruz P, Pimentel J, Zuluaga G, Cockcroft A, Andersson N. Maternal health and Indigenous traditional midwives in southern Mexico: contextualisation of a scoping review. BMJ Open 2021; 11:e054542. [PMID: 34949629 PMCID: PMC8710897 DOI: 10.1136/bmjopen-2021-054542] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/19/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Collate published evidence of factors that affect maternal health in Indigenous communities and contextualise the findings with stakeholder perspectives in the Mexican State of Guerrero. DESIGN Scoping review and stakeholder fuzzy cognitive mapping. INCLUSION AND EXCLUSION The scoping review included empirical studies (quantitative, qualitative or mixed methods) that addressed maternal health issues among Indigenous communities in the Americas and reported on the role or influence of traditional midwives before June 2020. The contextualisation drew on two previous studies of traditional midwife and researcher perspectives in southern Mexico. RESULTS The initial search identified 4461 references. Of 87 selected studies, 63 came from Guatemala and Mexico. Three small randomised trials involved traditional midwives. One addressed the practice of traditional midwifery. With diverse approaches to cultural differences, the studies used contrasting definitions of traditional midwives. A fuzzy cognitive map graphically summarised the influences identified in the scoping review. When we compared the literature's map with those from 29 traditional midwives in Guerrero and eight international researchers, the three sources coincided in the importance of self-care practices, rituals and traditional midwifery. The primary concern reflected in the scoping review was access to Western healthcare, followed by maternal health outcomes. For traditional midwives, the availability of hospital or health centre in the community was less relevant and had negative effects on other protective influences, while researchers conditioned its importance to its levels of cultural safety. Traditional midwives highlighted the role of violence against women, male involvement and traditional diseases. CONCLUSIONS The literature and stakeholder maps showed maternal health resulting from complex interacting factors in which promotion of cultural practices was compatible with a protective effect on Indigenous maternal health. Future research challenges include traditional concepts of diseases and the impact on maternal health of gender norms, self-care practices and authentic traditional midwifery.
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Affiliation(s)
- Iván Sarmiento
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales - CIET, Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
| | - Anna Dion
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Hilah Silver
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Emily Vargas
- Unidad de Posgrados e Investigación, Universidad Autónoma de Yucatán, Merida, Yucatán, México
| | - Paloma Cruz
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juan Pimentel
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
- Facultad de Medicina, Universidad de La Sabana, Chia, Colombia
| | - Germán Zuluaga
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
- Centro de Investigación de Enfermedades Tropicales - CIET, Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
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Sarmiento I, Ansari U, Omer K, Gidado Y, Baba MC, Gamawa AI, Andersson N, Cockcroft A. Causes of short birth interval (kunika) in Bauchi State, Nigeria: systematizing local knowledge with fuzzy cognitive mapping. Reprod Health 2021; 18:74. [PMID: 33823874 PMCID: PMC8022364 DOI: 10.1186/s12978-021-01066-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short birth intervals, defined by the World Health Organization as less than 33 months, may damage the health and wellbeing of children, mothers, and their families. People in northern Nigeria recognise many adverse effects of short birth interval (kunika in the Hausa language) but it remains common. We used fuzzy cognitive mapping to systematize local knowledge of causes of kunika to inform the co-design of culturally safe strategies to address it. METHODS Male and female groups in twelve communities built 48 maps of causes and protective factors for kunika, and government officers from the Local Government Area (LGA) and State made four maps. Each map showed causes of kunika or no-kunika, with arrows showing relationships with the outcome and between causes. Participants assigned weights for the perceived strength of relationships between 5 (strongest) and 1 (weakest). We combined maps for each group: men, women, and government officers. Fuzzy transitive closure calculated the maximum influence of each factor on the outcome, taking account of all relationships in the map. To condense the maps, we grouped individual factors into broader categories and calculated the cumulative net influence of each category. We made further summarised maps and presented these to the community mapping groups to review. RESULTS The community maps identified frequent sex, not using modern or traditional contraception, and family dynamics (such as competition between wives) as the most influential causes of kunika. Women identified forced sex and men highlighted lack of awareness about contraception and fear of side effects as important causes of kunika. Lack of male involvement featured in women's maps of causes and in the maps from LGA and State levels. Maps of protective factors largely mirrored those of the causes. Community groups readily appreciated and approved the summary maps resulting from the analysis. CONCLUSIONS The maps showed how kunika results from a complex network of interacting factors, with culture-specific dynamics. Simply promoting contraception alone is unlikely to be enough to reduce kunika. Outputs from transitive closure analysis can be made accessible to ordinary stakeholders, allowing their meaningful participation in interpretation and use of the findings. For people in Bauchi State, northern Nigeria, kunika describes a short interval between successive births, understood as becoming pregnant again before the previous child is weaned. They recognise it is bad for children, mothers and households. We worked with 12 communities in Bauchi to map their knowledge of the causes and protective factors for kunika. Separate groups of men and women built 48 maps, and government officers at local and state level built four maps. Each group drew two maps showing causes of kunika or of no-kunika with arrows showing the links between causes and the outcome. Participants marked the strength of each link with a number (between 5 for the strongest and 1 for the weakest). We combined maps for women, men and government officers. We grouped similar causes together into broader categories. We calculated the overall influence of each category on kunika or no-kunika and produced summary maps to communicate findings. The maps identified the strongest causes of kunika as frequent sex, not using modern or traditional contraception, and family dynamics. Women indicated forced sex as an important cause, but men focused on lack of awareness about contraception and fear of side effects. The maps of protective factors mirrored those of the causes. The groups who created the maps approved the summary maps. The maps showed the complex causes of kunika in Bauchi. Promoting contraception is unlikely to be enough on its own to reduce kunika. The summary maps will help local stakeholders to co-design culturally safe ways of reducing kunika.
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Affiliation(s)
- Ivan Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - Umaira Ansari
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Khalid Omer
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Yagana Gidado
- Federation of Muslim Women Association of Nigeria (FOMWAN), Bauchi State, Nigeria
| | - Muhammad Chadi Baba
- Federation of Muslim Women Association of Nigeria (FOMWAN), Bauchi State, Nigeria
| | | | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
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Belaid L, Atim P, Atim E, Ochola E, Ogwang M, Bayo P, Oola J, Wonyima Okello I, Sarmiento I, Rojas-Rozo L, Zinszer K, Zarowsky C, Andersson N. Communities and service providers address access to perinatal care in postconflict Northern Uganda: socialising evidence for participatory action. Fam Med Community Health 2021; 9:fmch-2020-000610. [PMID: 33731319 PMCID: PMC7978070 DOI: 10.1136/fmch-2020-000610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives Describe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda. Study design Mixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups and a household survey identified and documented the extent of obstructions to access. Deliberative dialogue focused stakeholder discussions of this evidence to address the obstacles to access. Most significant change stories explored the participant experience of this process. Setting Three parishes in Nwoya district in the Gulu region, Northern Uganda. Participants Purposively sampled groups of women, men, female youth, male youth, community health workers, traditional midwives and service providers. Each of seven stakeholder categories included 5–8 participants in each of three parishes. Results Stakeholders identified several obstructions to accessing perinatal care: lack of savings in preparation for childbirth in facility costs, lack of male support and poor service provider attitudes. They suggested joining saving groups, practising saving money and income generation to address the short-term financial shortfall. They recommended increasing spousal awareness of perinatal care and they proposed improving service provider attitudes. Participants described their own improved care-seeking behaviour and patient–provider relationships as short-term gains of the codesign. Conclusion Participatory service improvement is feasible and acceptable in postconflict settings like Northern Uganda. Engaging communities in identifying perinatal service delivery issues and reflecting on local evidence about these issues generate workable community-led solutions and increases trust between community members and service providers.
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Affiliation(s)
- Loubna Belaid
- CIET/ PRAM Family Medicine, McGill University, Montreal, Québec, Canada
| | - Pamela Atim
- Public Health, Gulu University, Gulu, Uganda
| | - Eunice Atim
- Maternal and child health, Nwoya Health District, Nwoya, Uganda
| | | | | | | | - Janet Oola
- Maternal and child health, Nwoya Health District, Nwoya, Uganda
| | | | - Ivan Sarmiento
- Family Medicine, McGill University, Montreal, Québec, Canada
| | | | - Kate Zinszer
- Preventive and social medicine, University of Montreal, Montreal, Québec, Canada
| | - Christina Zarowsky
- Preventive and social medicine, University of Montreal, Montreal, Québec, Canada
| | - Neil Andersson
- CIET/ PRAM Family Medicine, McGill University, Montreal, Québec, Canada.,Universidad Autónoma de Guerrero, Centro de Investigación de Enfermedades Tropicales, Acapulco, Mexico
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Tonkin K, Silver H, Pimentel J, Chomat AM, Sarmiento I, Belaid L, Cockcroft A, Andersson N. How beneficiaries see complex health interventions: a practice review of the Most Significant Change in ten countries. ACTA ACUST UNITED AC 2021; 79:18. [PMID: 33557938 PMCID: PMC7871616 DOI: 10.1186/s13690-021-00536-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022]
Abstract
Background The Most Significant Change is a story-based evaluation approach used in many international development programs. This practice review summarises practical experience with the approach in complex health interventions in ten countries, with the objective of making it more accessible in evaluation of other complex health interventions. Results Participatory research practitioners and trainees discussed five themes following brief presentations by each of the seven attendees who led the exercise: (i) sampling and recruitment; (ii) phrasing the questions to elicit stories; (iii) story collection strategies; (iv) quality assurance; and (v) analysis. Notes taken during the meeting provided the framework for this article. Recruitment strategies in small studies included universal engagement and, in larger studies, a purposive, systematic or random sampling. Meeting attendees recommended careful phrasing and piloting of the question(s) as this affects the quality and focus of the stories generated. They stressed the importance of careful training and monitoring of fieldworkers collecting stories to ensure full stories are elicited and recorded. For recording, in most settings they preferred note taking with back-checking or self-writing of stories by story tellers, rather than audio-recording. Analysis can combine participatory selection of a small number of stories, deductive or inductive thematic analysis and discourse analysis. Meeting attendees noted that involvement in collection of the stories and their analysis and discussion had a positive impact for research team members. Conclusions Our review confirms the plasticity, feasibility and acceptability of the Most Significant Change technique across different sociopolitical, cultural and environmental contexts of complex interventions. Although the approach can surface unexpected impacts, it is not a 360-degree evaluation. Its strength lies in characterising the changes, where these happen, in the words of the beneficiaries. We hope this distillation of our practice makes the technique more readily available to health sector researchers.
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Affiliation(s)
- Kendra Tonkin
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
| | - Hilah Silver
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
| | - Juan Pimentel
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
| | - Anne Marie Chomat
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Ivan Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
| | - Loubna Belaid
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada. .,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico.
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Tratt E, Sarmiento I, Gamelin R, Nayoumealuk J, Andersson N, Brassard P. Fuzzy cognitive mapping with Inuit women: what needs to change to improve cervical cancer screening in Nunavik, northern Quebec? BMC Health Serv Res 2020; 20:529. [PMID: 32527254 PMCID: PMC7291667 DOI: 10.1186/s12913-020-05399-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background Among Canadian Inuit, cervical cancer incidence and mortality rates are up to three times higher than the Canadian average. Cervical cancer is preventable through regular screening which, in Quebec, is opportunistic and requires physical examination and Papanicolaou (“Pap”) smears. Since Human Papillomavirus (HPV) is the necessary cause of cervical cancer, HPV testing is a plausible screening alternative. HPV testing by self-sampling also addresses several barriers associated with physical examination and access to healthcare. In a participatory research paradigm, we worked with two communities of Nunavik to explore the possible implementation of HPV self-sampling. Method Key community stakeholders formed an Advisory Committee to guide direct discussions with Inuit women. We presented available facts around cervical cancer, HPV and the female anatomy, and used Fuzzy Cognitive Mapping to collate women’s views. A thematic analysis summarized data, adding links and weights to represent the relationship of each factor on the outcome: screening for cervical cancer. Results According to the 27 Inuit women who participated, the most influential factor in using health services was the cultural awareness of the healthcare provider. A significant barrier to screening was patient lack of information. The principal vector of change – the factor most likely to influence other factors – was the means of communication between the healthcare provider and the patient: visual communication was told to be the most effective. Conclusion Fuzzy Cognitive Mapping is a practical tool for discussing possible health actions with stakeholders and to inform future research. The tool offers a visual aid for discussion across cultural and educational differences. It can help to build the partnerships that incorporate community voices into co-design of interventions that are relevant to and aligned with the needs of those who use them.
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Affiliation(s)
- Elyse Tratt
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ivan Sarmiento
- Department of Family Medicine, CIET-Participatory Research at McGill, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rachel Gamelin
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Neil Andersson
- Department of Family Medicine, CIET-Participatory Research at McGill, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Paul Brassard
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada. .,Department of Medicine, McGill University, Montreal, Quebec, Canada.
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