Social Axioms Mediate Gender Differences in Gender Ideologies Among Guatemalan University Students

Gender role ideologies are embedded in cultural values and assumptions about life. Women’s greater endorsement of egalitarian beliefs may stem from gender differences in world views as indexed by social axioms. The purpose of this study was to examine potential mediators of gender differences in gender ideologies among university students in Guatemala, a country where traditional views are prevalent. Participants, 2,134 university students from nine campuses in different regions of Guatemala (43% male, 85% emerging adults), completed a Social Axioms Scale, along with three culturally relevant measures of gender ideology: the Historic-Sociocultural Premises Scale (HSCP) and the Machismo Measure that taps both traditional machismo and caballerismo (gentlemanliness). Consistent with previous research in other countries, men held more traditional attitudes about gender and the family than did women on all measures. Gender differences on all scales were mediated by cynicism and religiosity. Fate control mediated the gender differences in traditional machismo and the HSCP. These findings suggest that Guatemalan women and men through socialization, cultural demands, and life experiences develop gender-specific ways of viewing the world, and their attitudes about gender roles are shaped by those worldviews. The achievement of gender equality, a U.N. sustainable development goal, may require attention to the underlying world views of women and men.

Cultural adaptation of health interventions including a nutrition component in Indigenous peoples: a systematic scoping review

BACKGROUND

Indigenous populations throughout the world experience poorer health outcomes than non-indigenous people. The reasons for the health disparities are complex and due in part to historical treatment of Indigenous groups through colonisation. Evidence-based interventions aimed at improving health in this population need to be culturally safe. However, the extent to which cultural adaptation strategies are incorporated into the design and implementation of nutrition interventions designed for Indigenous peoples is unknown. The aim of this scoping review was to explore the cultural adaptation strategies used in the delivery of nutrition interventions for Indigenous populations worldwide.

METHODS

Five health and medical databases were searched to January 2020. Interventions that included a nutrition component aimed at improving health outcomes among Indigenous populations that described strategies to enhance cultural relevance were included. The level of each cultural adaptation was categorised as evidential, visual, linguistic, constituent involving and/or socio-cultural with further classification related to cultural sensitivity (surface or deep).

RESULTS

Of the 1745 unique records screened, 98 articles describing 66 unique interventions met the inclusion criteria, and were included in the synthesis. The majority of articles reported on interventions conducted in the USA, Canada and Australia, were conducted in the previous 10 years (n = 36) and focused on type 2 diabetes prevention (n = 19) or management (n = 7). Of the 66 interventions, the majority included more than one strategy to culturally tailor the intervention, combining surface and deep level adaptation approaches (n = 51), however, less than half involved Indigenous constituents at a deep level (n = 31). Visual adaptation strategies were the most commonly reported (n = 57).

CONCLUSION

This paper is the first to characterise cultural adaptation strategies used in health interventions with a nutrition component for Indigenous peoples. While the majority used multiple cultural adaptation strategies, few focused on involving Indigenous constituents at a deep level. Future research should evaluate the effectiveness of cultural adaptation strategies for specific health outcomes. This could be used to inform co-design planning and implementation, ensuring more culturally appropriate methods are employed.

Guatemalan women achieve ideal family size: Empowerment through education and decision-making

Women's empowerment in family planning strengthens families and communities. Using 2014/2015 Demographic and Health Surveys data from 7,168 Guatemalan women, ages 35 and above with at least one living child, we examined indicators of empowerment in four domains - economic, educational, social, and contraceptive - and their relation to the number of living children compared to the ideal number of children. We reveal our analysis showing that economic, educational, and social empowerment predicted achieving the preferred number of children. Education and control over their own income are two critical empowerment factors for Guatemalan women.

From guidelines to local realities: evaluation of oral rehydration therapy and zinc supplementation in Guatemala

Objective. Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-income countries throughout the Americas. The World Health Organization (WHO) has developed guidelines on incorporating zinc supplementation (ZS) with traditional oral rehydration therapy (ORT) in order to shorten the duration of diarrheal episodes and to reduce poor health outcomes. Guatemala adopted these guidelines in 2011, but they have not yet been fully implemented at the community level. The objectives of this study were: (1) to co-design an ORT/ZS training program for community members with local health promoters that is appropriate to the local context and (2) to understand how attitudes and behaviors of community members changed after receiving training from the study promoters.

Methods. In an observational study, community health promoters in rural Guatemala were trained according to WHO guidelines, and they worked collaboratively with the study team to develop a training curriculum to implement in their community. Community-based surveys, interviews, and focus group discussions were used to assess acceptability, accessibility, and availability of oral rehydration therapy and zinc supplementation.

Results. Use of ORT increased from 63% to 95% among community members following training by local health promoters. Satisfaction with the service offered by health promoters increased from 63% to 90% amongst community members trained by the study promoters. However, knowledge and use of zinc supplementation remained low, which was attributable to unavailability of zinc in the study community.

Conclusions. Use of trained community health promoters is an effective way to translate WHO guidelines to local contexts and overcome sociocultural barriers to care. However, the health system’s structure must support availability of essential medicines in order to effectively implement those guidelines.

Community Health Workers' Provision of Family Planning Services in Low- and Middle-Income Countries: A Systematic Review of Effectiveness

This systematic review evaluates the strength of the evidence that community health workers' (CHW) provision of family planning (FP) services in low- and middle-income countries is effective. In a search of eight databases, articles were screened by study design and outcome measure and ranked by strength of evidence. Only randomized trials, longitudinal studies with a comparison group, and pre-test/post-test studies met inclusion criteria. A total of 56 studies were included. Of those studies with relevant data, approximately 93 percent indicated that CHW FP programs effectively increased the use of modern contraception, while 83 percent reported an improvement in knowledge and attitudes concerning contraceptives. Based on these findings, strong evidence exists for promoting CHW programs to improve access to FP services. We recommend a set of best practice guidelines that researchers and program managers can use to report on CHW FP programs to facilitate the translation of research to practice across a wide range of settings.

Information sources and profile of informed citizens

The purpose of this study is to investigate how Guatemalans procure information on national and local matters. Using data from two nationally representative household surveys, probit models are estimated to identify mechanisms that activate information seeking behaviors among Guatemalans. Findings of the study reveal that Guatemalans primarily use communication media (e.g. television, radio and newspapers) to access information on national issues. In contrast, information procurement on local matters is primarily accessed through individuals’ social networks (e.g. family, neighbors and friends). The findings indicate that females, indigenous groups, citizens living in rural areas and poor individuals are less likely to be informed on both national and local matters, in comparison to other groups.