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Sileo KM, Muhumuza C, Wanyenze RK, Kershaw TS, Ellerbe B, Muñoz S, Sekamatte S, Lule H, Kiene SM. Effects of a community-based, multi-level family planning intervention on theoretically grounded intermediate outcomes for couples in rural Uganda: Results from a mixed methods pilot evaluation. Br J Health Psychol 2024. [PMID: 38242837 DOI: 10.1111/bjhp.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES This study tested the theoretically grounded conceptual model of a multi-level intervention, Family Health = Family Wealth (FH = FW), by examining FH = FW's effect on intermediate outcomes among couples in rural Uganda. FH = FW is grounded in the social-ecological model and the social psychological theory of transformative communication. DESIGN A pilot quasi-experimental controlled trial. METHODS Two matched clusters (communities) were randomly allocated to receive the FH = FW intervention or an attention/time-matched water, sanitation and hygiene intervention (N = 140, 35 couples per arm). Quantitative outcomes were collected through interviewer-administered questionnaires at baseline, 7-months and 10-months follow-up. Focus group discussions (n = 39) and semi-structured interviews (n = 27) were conducted with subsets of FH = FW participants after data collection. Generalized estimated equations tested intervention effects on quantitative outcomes, and qualitative data were analysed through thematic analysis-these data were mixed and are presented by level of the social-ecological model. RESULTS The findings demonstrated an intervention effect on family planning determinants across social-ecological levels. Improved individual-level family planning knowledge, attitudes and intentions, and reduced inequitable gender attitudes, were observed in intervention versus comparator, corroborated by the qualitative findings. Interpersonal-level changes included improved communication, shared decision-making and equitable relationship dynamics. At the community level, FH = FW increased perceived acceptance of family planning among others (norms), and the qualitative findings highlighted how FH = FW's transformative communication approach reshaped definitions of a successful family to better align with family planning. CONCLUSIONS This mixed methods pilot evaluation supports FH = FW's theoretically grounded conceptual model and ability to affect multi-level drivers of a high unmet need for family planning.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Christine Muhumuza
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Trace S Kershaw
- Department of Social and Behavior Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Brooke Ellerbe
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Suyapa Muñoz
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | | | - Haruna Lule
- Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
| | - Susan M Kiene
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, San Diego State University (SDSU) School of Public Health, San Diego, California, USA
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Dada S, Cocoman O, Portela A, De Brún A, Bhattacharyya S, Tunçalp Ö, Jackson D, Gilmore B. What's in a name? Unpacking 'Community Blank' terminology in reproductive, maternal, newborn and child health: a scoping review. BMJ Glob Health 2023; 8:bmjgh-2022-009423. [PMID: 36750272 PMCID: PMC9906186 DOI: 10.1136/bmjgh-2022-009423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/09/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Engaging the community as actors within reproductive, maternal, newborn and child health (RMNCH) programmes (referred to as 'community blank') has seen increased implementation in recent years. While evidence suggests these approaches are effective, terminology (such as 'community engagement,' 'community participation,' 'community mobilisation,' and 'social accountability') is often used interchangeably across published literature, contributing to a lack of conceptual clarity in practice. The purpose of this review was to describe and clarify varying uses of these terms in the literature by documenting what authors and implementers report they are doing when they use these terms. METHODS Seven academic databases (PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, Global Health), two grey literature databases (OAIster, OpenGrey) and relevant organisation websites were searched for documents that described 'community blank' terms in RMNCH interventions. Eligibility criteria included being published between 1975 and 1 October 2021 and reports or studies detailing the activities used in 'community blank.' RESULTS: A total of 9779 unique documents were retrieved and screened, with 173 included for analysis. Twenty-four distinct 'community blank' terms were used across the documents, falling into 11 broader terms. Use of these terms was distributed across time and all six WHO regions, with 'community mobilisation', 'community engagement' and 'community participation' being the most frequently used terms. While 48 unique activities were described, only 25 activities were mentioned more than twice and 19 of these were attributed to at least three different 'community blank' terms. CONCLUSION Across the literature, there is inconsistency in the usage of 'community blank' terms for RMNCH. There is an observed interchangeable use of terms and a lack of descriptions of these terms provided in the literature. There is a need for RMNCH researchers and practitioners to clarify the descriptions reported and improve the documentation of 'community blank' implementation. This can contribute to a better sharing of learning within and across communities and to bringing evidence-based practices to scale. Efforts to improve reporting can be supported with the use of standardised monitoring and evaluation processes and indicators. Therefore, it is recommended that future research endeavours clarify the operational definitions of 'community blank' and improve the documentation of its implementation.
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Affiliation(s)
- Sara Dada
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland .,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Olive Cocoman
- London School of Hygiene & Tropical Medicine, London, UK
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Debra Jackson
- London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Brynne Gilmore
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Kriel Y, Milford C, Cordero JP, Suleman F, Steyn PS, Smit JA. Access to public sector family planning services and modern contraceptive methods in South Africa: A qualitative evaluation from community and health care provider perspectives. PLoS One 2023; 18:e0282996. [PMID: 36930610 PMCID: PMC10022780 DOI: 10.1371/journal.pone.0282996] [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: 06/06/2021] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Progress has been made to improve access to family planning services and contraceptive methods, yet many women still struggle to access contraception, increasing their risk for unintended pregnancy. This is also true for South Africa, where over fifty per cent of pregnancies are reported as unintended, even though contraception is freely available. There is also stagnation in the fertility rate indicators and contraceptive use data, indicating that there may be challenges to accessing contraception. This paper explores the evaluation of access to contraception from community and health care provider perspectives. This qualitative study explored factors affecting the uptake and use of contraception through focus group discussions (n = 14), in-depth interviews (n = 8), and drawings. Participants included male and female community members (n = 103) between 15 and 49 years of age, health care providers (n = 16), and key stakeholder informants (n = 8), with a total number of 127 participants. Thematic content analysis was used to explore the data using NVivo 10. Emergent themes were elucidated and thematically categorised. The results were categorised according to a priori access components. Overall, the results showed that the greatest obstacle to accessing contraception was the accommodation component. This included the effects of integrated care, long waiting times, and limited operational hours-all of which contributed to the discontinuation of contraception. Community members reported being satisfied with the accessibility and affordability components but less satisfied with the availability of trained providers and a variety of contraceptive methods. The accessibility and affordability themes also revealed the important role that individual agency and choice in service provider plays in accessing contraception. Data from the illustrations showed that adolescent males experienced the most geographic barriers. This study illustrated the importance of examining access as a holistic concept and to assess each component's influence on contraceptive uptake and use.
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Affiliation(s)
- Yolandie Kriel
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
- School of Public Health and Nursing, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Cecilia Milford
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Joanna Paula Cordero
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Fatima Suleman
- Discipline of Pharmaceutical Science, College of Health Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Petrus S. Steyn
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Jennifer Ann Smit
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
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Zulu IZ, Zulu JM, Svanemyr J, Michelo C, Mutale W, Sandøy IF. Application of community dialogue approach to prevent adolescent pregnancy, early marriage and school dropout in Zambia: a case study. Reprod Health 2022; 19:30. [PMID: 35101082 PMCID: PMC8805275 DOI: 10.1186/s12978-022-01335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Adolescent pregnancy carries both health and economic risks for the pregnant girl and resulting baby, and it is common in Zambia. Providing alternative methods of preventing early pregnancy than abstinence is regarded as culturally and religiously unacceptable in most parts of the country. The community dialogue approach is being tested to address norms and beliefs around early pregnancy, marriage and school dropout, and is based on Paulo Freire’s transformative communication approach. The objective of this paper was to understand parents’ perspectives on the application of the community dialogue approach in addressing adolescents’ early pregnancy and school dropout in a cluster randomized controlled trial in rural Zambia. Methods/design This was a case study design. We nested the study in the community dialogue intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Dialogue meetings were held and economic support was provided for a period of 27 months from September 2016 until November 2018. We held focus group discussions in November 2018 with guardians/parents in six schools in Chibombo District of Central Province. All the discussions were audio recorded and transcribed verbatim. Thematic analysis was used to analyze the data. Results The guardians/parents perceived the community dialogue to be a relevant approach for addressing social and cultural norms regarding early pregnancy, marriage and school dropout. It was embraced for its value in initiating individual and collective change. The facilitators’ interactive approach and dialogue in the community meetings coupled with the use of films and role plays with the parents, lead to active participation and open discussions about sexual and reproductive health (SRH) topics during the community dialogue meetings. Group interactions and sharing of experiences helped parents clarify their SRH values and subsequently made them feel able to communicate about SRH issues with their children. However, cultural and religious beliefs among the parents regarding some topics, like the use of condoms and contraceptives, complicated the delivery of reproductive health messages from the parents to their children. Conclusion The study indicated that the community dialogue was appreciated by the parents and helped in addressing cultural barriers to discussing SRH issues between generations. Adolescent pregnancy carries health and economic risks for the pregnant girl and her baby. However, many adolescent girls in Zambia become pregnant and this is partly due to social norms around fertility and marriage. Community dialogue meetings may be useful in order to discuss norms and beliefs around early pregnancy, marriage and school dropout and encourage reflection around cultural practices in the communities. A cluster randomized controlled trial in rural Zambia tested the effects of organizing community dialogue meetings and providing economic support for families with adolescent girls for a period of 27 months, from 2016 to 2018. The objective of this case study was to understand parents’ perspectives on the use of the community dialogue approach. Focus group discussions were held in November 2018 with guardians/parents in six schools in Chibombo District of Central Province. The guardians/parents perceived the community dialogue to be a relevant approach for addressing social and cultural norms regarding early pregnancy, marriage and school dropout. The facilitators’ interactive approach in the community meetings coupled with the use of films and role plays, lead to active participation and open discussions about sexual and reproductive health topics during the community dialogue meetings. Group interactions and sharing of experiences made the guardians feel able to communicate about sexual and reproductive health issues with their children. However, cultural and religious beliefs among the parents regarding the use of condoms and contraceptives made it difficult for them to touch upon this topic.
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Habib N, Steyn PS, Boydell V, Cordero JP, Nguyen MH, Thwin SS, Nai D, Shamba D, Kiarie J. The use of segmented regression for evaluation of an interrupted time series study involving complex intervention: the CaPSAI project experience. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2021; 21:188-205. [PMID: 34720688 PMCID: PMC8550724 DOI: 10.1007/s10742-020-00221-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/15/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022]
Abstract
An interrupted time series with a parallel control group (ITS-CG) design is a powerful quasi-experimental design commonly used to evaluate the effectiveness of an intervention, on accelerating uptake of useful public health products, and can be used in the presence of regularly collected data. This paper illustrates how a segmented Poisson model that utilizes general estimating equations (GEE) can be used for the ITS-CG study design to evaluate the effectiveness of a complex social accountability intervention on the level and rate of uptake of modern contraception. The intervention was gradually rolled-out over time to targeted intervention communities in Ghana and Tanzania, with control communities receiving standard of care, as per national guidelines. Two ITS GEE segmented regression models are proposed for evaluating of the uptake. The first, a two-segmented model, fits the data collected during pre-intervention and post-intervention excluding that collected during intervention roll-out. The second, a three-segmented model, fits all data including that collected during the roll-out. A much simpler difference-in-difference (DID) GEE Poisson regression model is also illustrated. Mathematical formulation of both ITS-segmented Poisson models and that of the DID Poisson model, interpretation and significance of resulting regression parameters, and accounting for different sources of variation and lags in intervention effect are respectively discussed. Strengths and limitations of these models are highlighted. Segmented ITS modelling remains valuable for studying the effect of intervention interruptions whether gradual changes, over time, in the level or trend in uptake of public health practices are attributed by the introduced intervention. Trial Registration: The Australian New Zealand Clinical Trials registry. Trial registration number: ACTRN12619000378123. Trial Registration date: 11-March-2019.
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Affiliation(s)
- Ndema Habib
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Geneva, Switzerland
| | - Petrus S. Steyn
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Geneva, Switzerland
| | - Victoria Boydell
- Global Health Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Joanna Paula Cordero
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Geneva, Switzerland
| | - My Huong Nguyen
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Geneva, Switzerland
| | - Soe Soe Thwin
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Geneva, Switzerland
| | - Dela Nai
- Population Council, Abelemkpe, Accra, Ghana
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - James Kiarie
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Geneva, Switzerland
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Osaki H, Sao SS, Kisigo GA, Coleman JN, Mwamba RN, Renju J, Mmbaga BT, Watt MH. Male engagement guidelines in antenatal care: unintended consequences for pregnant women in Tanzania. BMC Pregnancy Childbirth 2021; 21:720. [PMID: 34702198 PMCID: PMC8549379 DOI: 10.1186/s12884-021-04141-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The meaningful engagement of male partners in antenatal care (ANC) can positively impact maternal and newborn health outcomes. The Tanzania National Plan for the Elimination of Mother to Child Transmission of HIV recommends male partners attend the first ANC appointment as a strategy for HIV prevention and treatment. This recommendation seeks to increase uptake of HIV and reproductive healthcare services, but unintended consequences of these guidelines may negatively impact women's ANC experiences. This study qualitatively examined the impact of policy promoting male engagement on women's ANC experiences. METHODS The study was conducted in two urban clinics in Kilimanjaro Region, Tanzania. In-depth interviews were conducted with 19 participants (13 women and 6 male partners) attending a first ANC appointment. A semi-structured guide was developed, applying Kabeer's Social Relations Approach. Data were analyzed using applied thematic analysis, combining memo writing, coding, synthesis, and comparison of themes. RESULTS Male attendance impacted the timing of women's presentation to ANC and experience during the first ANC visit. Women whose partners could not attend delayed their presentation to first ANC due to fears of being interrogated or denied care because of their partner absence. Women presenting with partners were given preferential treatment by clinic staff, and women without partners felt discriminated against. Women perceived that the clinic prioritized men's HIV testing over involvement in pregnancy care. CONCLUSIONS Study findings indicate the need to better assess and understand the unintended impact of policies promoting male partner attendance at ANC. Although male engagement can benefit the health outcomes of mothers and newborn children, our findings demonstrate the need for improved methods of engaging men in ANC. ANC clinics should identify ways to make clinic settings more male friendly, utilize male attendance as an opportunity to educate and engage men in pregnancy and newborn care. At the same time, clinic policies should be cognizant to not discriminate against women presenting without a partner.
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Affiliation(s)
- Haika Osaki
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
| | - Saumya S Sao
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Godfrey A Kisigo
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jessica N Coleman
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Rimel N Mwamba
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jenny Renju
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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Gruskin S, Zacharias K, Jardell W, Ferguson L, Khosla R. Inclusion of human rights in sexual and reproductive health programming: Facilitators and barriers to implementation. Glob Public Health 2021; 16:1559-1575. [PMID: 33019904 PMCID: PMC8475719 DOI: 10.1080/17441692.2020.1828986] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/21/2020] [Indexed: 12/02/2022]
Abstract
The need to prioritise those furthest behind is well understood in global health circles, and how human rights norms and standards can help often touted. As rights concerns are particularly recognised in sexual and reproductive health (SRH) programming, as part of a larger exercise, a review was conducted to identify documented barriers and facilitators to implementation. Given the role global guidance plays in implementing rights-based approaches to SRH, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) guidelines, tools, recommendations and guidance that include the explicit mention of human rights principles served as the basis for this exercise. This was followed by an extensive review of the literature. Sources reviewed confirmed barriers include not only broad structural, policy and health systems barriers but financial, staffing and time constraints, as well as lack of understanding of concretely how to include human rights in these efforts. Facilitators include the existence of human rights champions, leadership, strong civil society participation, training, and funding made available specifically for implementation. Investment in indicators and documentation sensitive to human rights is warranted in sexual and reproductive health, as well as other health topics, to best serve populations who need them most.
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Affiliation(s)
- Sofia Gruskin
- USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Kristin Zacharias
- USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - William Jardell
- USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Laura Ferguson
- USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
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Manana PN, Jewett S, Zikhali J, Dlamini D, Mabaso N, Mlambo Z, Ngobese R, Munhenga G. "Maskandi experience": exploring the use of a cultural song for community engagement in preparation for a pilot Sterile Insect Technique release programme for malaria vector control in KwaZulu-Natal Province, South Africa 2019. Malar J 2021; 20:204. [PMID: 33910575 PMCID: PMC8082840 DOI: 10.1186/s12936-021-03736-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/16/2021] [Indexed: 11/12/2022] Open
Abstract
Background An assessment of the Sterile Insect Technique (SIT) as a complementary malaria vector control tool, is at an advanced stage in South Africa. The technique involves the release of laboratory-reared sterilized male mosquitoes of the major malaria vector Anopheles arabiensis, raising social, ethical and regulatory concerns. Therefore, its implementation largely depends on community participation and acceptance. Against this background, it is critical that robust and effective community strategies are developed. This study describes the development of a cultural song to engage the community and increase awareness on SIT and malaria control in KwaZulu-Natal, South Africa. Methods An exploratory concurrent mixed-methods study was conducted to get opinions about the effectiveness of a cultural song developed to engage communities and increase acceptability of the SIT technology. Two self-administered surveys (expert and community) were conducted. Additionally, more in depth opinions of the song and its effectiveness in conveying the intended information were investigated through three community dialogue sessions with community members in the study area. Results A total of 40 experts and 54 community members participated in the survey. Four themes were identified in relation to the appropriateness and effectiveness of the song, with a fifth theme focused on recommendations for adaptations. Overall, the song was well received with the audience finding it entertaining and informative. Responses to unstructured questions posed after the song showed an increase in the knowledge on malaria transmission and SIT technology. In particular, the explanation that male mosquitoes do not bite allayed anxiety and fears about the SIT technology. Conclusion The song was deemed both culturally appropriate and informative in engaging community members about the SIT technology. It proved useful in promoting health messages and conveying SIT technology as a complementary malaria vector control tool. With minor adaptations, the song has potential as an area-wide community engagement tool in areas targeted for sterile male releases. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03736-9.
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Affiliation(s)
- Pinky N Manana
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases (NICD), Division of National Health Laboratory Services (NHLS), Johannesburg, South Africa. .,Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Sara Jewett
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jabulani Zikhali
- Clinton Health Access Initiative, Malaria, KwaZulu-Natal, South Africa.,Department of Health, Environmental Health, Malaria and Communicable Disease Control, KwaZulu-Natal, South Africa
| | - Dumsani Dlamini
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nondumiso Mabaso
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zothile Mlambo
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Roxanne Ngobese
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Givemore Munhenga
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases (NICD), Division of National Health Laboratory Services (NHLS), Johannesburg, South Africa.,Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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9
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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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Steyn PS, Boydell V, Cordero JP, McMullen H, Habib N, Nguyen TMH, Nai D, Shamba D, Kiarie J. Rationale and design of a complex intervention measuring the impact and processes of social accountability applied to contraceptive programming: CaPSAI Project. Gates Open Res 2020; 4:26. [PMID: 33134856 PMCID: PMC7541905 DOI: 10.12688/gatesopenres.13075.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 09/08/2023] Open
Abstract
Background: There are numerous barriers leading to a high unmet need for family planning and contraceptives (FP/C). These include limited knowledge and information, poor access to quality services, structural inefficiencies in service provision and inadequately trained and supervised health professionals. Recently, social accountability programs have shown promising results in addressing barriers to accessing sexual and reproductive health services. As a highly complex participatory process with multiple and interrelated components, steps and actors, studying social accountability poses methodological challenges. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project study protocol was developed to measure the impact of a social accountability intervention on contraceptive uptake and use and to understand the mechanisms and contextual factors that influence and generate these effects (with emphasis on health services actors and community members). Methods: CaPSAI Project is implementing a social accountability intervention where service users and providers assess the quality of local FP/C services and jointly identify ways to improve the delivery and quality of such services. In the project, a quasi-experimental study utilizing an interrupted time series design with a control group is conducted in eight intervention and eight control facilities in each study country, which are Ghana and Tanzania. A cross-sectional survey of service users and health care providers is used to measure social accountability outcomes, and a cohort of women who are new users of FP/C is followed up after the completion of the intervention to measure contraceptive use and continuation. The process evaluation utilizes a range of methods and data sources to enable a fuller description of how the findings were produced. Conclusion: This complex study design could provide researchers and implementers with the means to better measure and understand the mechanisms and contextual factors that influence social accountability processes in reproductive health, adding important findings to the evidence base.
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Affiliation(s)
- Petrus S Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, Geneva, 1202, Switzerland
| | - Victoria Boydell
- Global Health Centre, Geneva Graduate Institute, Maison de la Paix, Chemin Eugène-Rigot 2A, Case Postale 1672, Geneva, 1211, Switzerland
| | - Joanna Paula Cordero
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, Geneva, 1202, Switzerland
| | - Heather McMullen
- Centre for Global Public Health, Institute of Population Health Sciences, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - Ndema Habib
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, Geneva, 1202, Switzerland
| | - Thi My Huong Nguyen
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, Geneva, 1202, Switzerland
| | - Dela Nai
- Population Council, 204 Yiyiwa Drive, Abelemkpe, Accra, Ghana
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, P.O.BOX 78373, Dar es Salaam, Tanzania
| | - James Kiarie
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, Geneva, 1202, Switzerland
| | - CaPSAI Project
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, Geneva, 1202, Switzerland
- Global Health Centre, Geneva Graduate Institute, Maison de la Paix, Chemin Eugène-Rigot 2A, Case Postale 1672, Geneva, 1211, Switzerland
- Centre for Global Public Health, Institute of Population Health Sciences, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
- Population Council, 204 Yiyiwa Drive, Abelemkpe, Accra, Ghana
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, P.O.BOX 78373, Dar es Salaam, Tanzania
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Steyn PS, Boydell V, Cordero JP, McMullen H, Habib N, Nguyen TMH, Nai D, Shamba D, Kiarie J. Rationale and design of a complex intervention measuring the impact and processes of social accountability applied to contraceptive programming: CaPSAI Project. Gates Open Res 2020; 4:26. [PMID: 33134856 PMCID: PMC7541905 DOI: 10.12688/gatesopenres.13075.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 11/20/2022] Open
Abstract
Background: There are numerous barriers leading to a high unmet need for family planning and contraceptives (FP/C). These include limited knowledge and information, poor access to quality services, structural inefficiencies in service provision and inadequately trained and supervised health professionals. Recently, social accountability programs have shown promising results in addressing barriers to accessing sexual and reproductive health services. As a highly complex participatory process with multiple and interrelated components, steps and actors, studying social accountability poses methodological challenges. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project study protocol was developed to measure the impact of a social accountability intervention on contraceptive uptake and use and to understand the mechanisms and contextual factors that influence and generate these effects (with emphasis on health services actors and community members). Methods: CaPSAI Project is implementing a social accountability intervention where service users and providers assess the quality of local FP/C services and jointly identify ways to improve the delivery and quality of such services. In the project, a quasi-experimental study utilizing an interrupted time series design with a control group is conducted in eight intervention and eight control facilities in each study country, which are Ghana and Tanzania. A cross-sectional survey of service users and health care providers is used to measure social accountability outcomes, and a cohort of women who are new users of FP/C is followed up after the completion of the intervention to measure contraceptive use and continuation. The process evaluation utilizes a range of methods and data sources to enable a fuller description of how the findings were produced. Conclusion: This complex study design could provide researchers and implementers with the means to better measure and understand the mechanisms and contextual factors that influence social accountability processes in reproductive health, adding important findings to the evidence base.
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Affiliation(s)
- Petrus S Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, Geneva, 1202, Switzerland
| | - Victoria Boydell
- Global Health Centre, Geneva Graduate Institute, Maison de la Paix, Chemin Eugène-Rigot 2A, Case Postale 1672, Geneva, 1211, Switzerland
| | - Joanna Paula Cordero
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, Geneva, 1202, Switzerland
| | - Heather McMullen
- Centre for Global Public Health, Institute of Population Health Sciences, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - Ndema Habib
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, Geneva, 1202, Switzerland
| | - Thi My Huong Nguyen
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, Geneva, 1202, Switzerland
| | - Dela Nai
- Population Council, 204 Yiyiwa Drive, Abelemkpe, Accra, Ghana
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, P.O.BOX 78373, Dar es Salaam, Tanzania
| | - James Kiarie
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, Geneva, 1202, Switzerland
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Haya MAN, Ichikawa S, Shibagaki Y, Wakabayashi H, Takemura Y. The "Healthy Akame!" community - government - university collaboration for health: a community-based participatory mixed-method approach to address health issue in rural Japan. BMC Health Serv Res 2020; 20:1100. [PMID: 33256728 PMCID: PMC7702688 DOI: 10.1186/s12913-020-05916-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/11/2020] [Indexed: 12/04/2022] Open
Abstract
Background Although Japan has a decentralized public health system, local governments have considered expert opinions over those of the community in decisions about public health programs. Differences in communities’ interests may create gaps between health program objectives and implementation. We hypothesized that community-based participatory research (CBPR), which involves the community at every step, promotes effective program implementation and community empowerment. This study addressed the first step of CBPR, assessing community needs and developing tailored health program for a rural community in Japan. Methods In this sequential exploratory mixed-method study (qualitative followed by quantitative), we first formed a community advisory board (CAB) representing community organizations, city officials, and university researchers. The CAB conducted group discussions with community residents to identify the community’s health issues and strengths. These group discussions were analyzed using thematic analysis, and the results were used to develop a questionnaire, which was subsequently sent to all households in the community to obtain priority scores for health issues and proposed action and to assess willingness to participate in community health program. The CAB then designed a program using the overall study results. Results Ten group discussions with 68 participants identified the following health issues: 1) diseases; 2) unhealthy behaviors; and 3) unsupportive environment. Nature, vacant lots, and local farms were considered local strengths. Of a total of 1470 households in the community, questionnaires were collected from 773 households. Cancer, lifestyle-related diseases, and cerebrovascular diseases were ranked as the most important health problems. Improving services and access to medical checkups, use of public space for exercise, local farming, and collaboration with the community health office were considered necessary to address these health problems. Considering feasibility and the availability of resources in the community, the CAB decided to focus on lifestyle-related diseases and designed activities centered on health awareness, nutrition, and exercise. These activities drew on community’s strengths and were adapted to Japanese culture. Conclusions The community’s priority health problem was closely related to the epidemiology of diseases. The CBPR approach was useful for identifying community’s needs and for designing a unique community health program that made use of local strengths. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05916-w.
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Affiliation(s)
- Marinda Asiah Nuril Haya
- Department of Family Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu city, Mie prefecture, Japan. .,Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jl. Pegangsaan Timur no. 16, Central Jakarta, Indonesia.
| | - Shuhei Ichikawa
- Faculty of Clinical Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu city, Mie prefecture, Japan
| | - Yukino Shibagaki
- Community Integrated Support Center, Department of Welfare and Children Nabari City Office, Konodai 1-1, Nabari city, Mie prefecture, Japan
| | | | - Hideki Wakabayashi
- Department of Community Medicine Kameyama, Mie University School of Medicine, Edobashi 2-174, Tsu city, Mie prefecture, Japan
| | - Yousuke Takemura
- Department of Family Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, Japan
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Munakampe MN, Nkole T, Silumbwe A, Zulu JM, Cordero JP, Steyn PS. Feasibility testing of a community dialogue approach for promoting the uptake of family planning and contraceptive services in Zambia. BMC Health Serv Res 2020; 20:728. [PMID: 32771022 PMCID: PMC7414985 DOI: 10.1186/s12913-020-05589-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Community dialogues have been used in participatory approaches in various health prevention and awareness programs, including family planning interventions, to increase understanding and alignment of particular issues from different peoples' perspectives. The main objective of this paper is to document the feasibility of a community dialogue approach, which aimed to promote dialogue between healthcare providers and community members. The feasibility testing was part of formative-phase research needed to design an intervention, with the ultimate goal of increasing the uptake of family planning and contraception. The community dialogue intervention generated discussions on key approaches to improve family planning and contraception provision and uptake. METHODS Key stages of the community dialogue were undertaken, with representation from healthcare providers and community members. Participants included frontline and managerial health care providers, community health workers, family planning and contraception users, the youth, other stakeholders from the education sector, and civil society. How the dialogue was implemented (operational feasibility) as well as the cultural feasibility of the community dialogue content was evaluated through participant observations during the dialogue, using a standardised feasibility testing tick-list, and through focus group discussions with the stakeholders who participated in the community dialogue. RESULTS Overall, 21 of the 30 invited participants attended the meeting- 70% attendance. The approach facilitated discussions on how quality care could be achieved in family planning and contraception provision, guided by the ground rules that were agreed upon by the different stakeholders. A need for more time for the discussion was noted. Participants also noted the need for more balanced representation from adolescents as well as other family planning stakeholders, such as community members, especially in comparison to healthcare providers. Some participants were not comfortable with the language used. Young people felt older participants used complicated terminologies while community members felt the health care providers outnumbered them, in terms of representation. CONCLUSION Generally, the community dialogue was well received by the community members and the healthcare providers, as was observed from the sentiments expressed by both categories. Some key considerations for refining the approach included soliciting maximum participation from otherwise marginalized groups like the youth would provide stronger representation.
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Affiliation(s)
- Margarate Nzala Munakampe
- Department of Health Policy and Management, University of Zambia, School of Public Health, Lusaka, Zambia.
- Strategic Centre for Health Systems Metrics & Evaluations (SCHEME), School of Public Health, Department of Epidemiology & Biostatistics, University of Zambia, Lusaka, Zambia.
| | - Theresa Nkole
- Levy Mwanawasa Medical University (LMMU), Lusaka, Zambia
| | - Adam Silumbwe
- Department of Health Policy and Management, University of Zambia, School of Public Health, Lusaka, Zambia
| | - Joseph Mumba Zulu
- Department of Health Policy and Management, University of Zambia, School of Public Health, Lusaka, Zambia
| | - Joanna Paula Cordero
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - Petrus S Steyn
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
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