"Even when people live just across the road…they won't go": Community health worker perspectives on incentivized delays to under-five care-seeking in urban slums of Kampala, Uganda

Increasing coverage and uptake of voluntary family planning in Uganda's emerging municipalities and secondary cities: An implementation research study protocol

INTRODUCTION

While urban areas are often perceived to have better access to healthcare services, including modern family planning (FP) services, urban dwellers including those with better socioeconomic status are faced with multidimensional challenges that shape their access to appropriate FP services. In Uganda's urban spaces, there is currently a lack of understanding among service providers, civil society organizations, and individuals/communities regarding the implementation of interventions that promote informed choice and voluntary use of family planning services. This knowledge gap has profound implications for reproductive rights. This study seeks to enhance existing efforts towards increasing coverage and uptake of Voluntary Family Planning (VFP) in Jinja City and Iganga Municipality, central eastern Uganda. Our primary question is, "What interventions can effectively be packaged and delivered to increase the uptake of VFP among different segments of urban residents?"

METHODS

We propose to use the Human-Centered Design (HCD) approach to understand the needs and challenges of users and community capabilities in ensuring access to VFP services. Co-creating with stakeholders' engagement and a data-driven-centric approach will steer design and adaptation that respond to the different population segments within the urban space. As such, the study will be implemented in three phases: formative assessment, design and implementation, and implementation monitoring and evaluation. The implementation process will incorporate robust monitoring, learning, and adaptation mechanisms. The primary focus of these mechanisms will be to utilize gathered information effectively to inform the design of the implementation and facilitate continuous learning throughout the process. The study will apply a process monitoring and evaluation approach to address questions related to what package of FP interventions work, for whom, under what circumstances and why.

DISCUSSION

Guided by strong learning and implementation flexibility, we hypothesize that our implementation will provide segmentation-specific high-impact interventions in an urban context.

REGISTRATION

This implementation research protocol has been registered on the Open Science Framework (OSF) repository Registries (https://osf.io/vqxu9; DOI: 10.17605/OSF.IO/VQXU9).

Addressing health challenges in rural Japan: a thematic analysis of social isolation and community solutions

BACKGROUND

The establishment of sustainable connections between medical professionals and rural citizens is pivotal for effective community healthcare. Our study focuses on understanding and resolving health problems arising from social isolation, a critical barrier to achieving this goal, especially in the context of the coronavirus disease 2019(COVID-19) pandemic's impact on community dynamics respecting social cognitive theory. This study investigates the link between social isolation and rural community healthcare. We aim to develop methods that improve interaction and collaboration between healthcare providers and rural communities, ultimately enhancing the region's healthcare system.

METHODS

Employing thematic analysis based on social cognitive theory, we conducted semi-structured interviews with 57 community workers in rural communities. This qualitative approach enabled us to delve into the nuances of social isolation and its multifaceted impact on health and community well-being.

RESULTS

Our analysis revealed four key themes: the impact of aging on social dynamics, shifts in community relationships, unique aspects of rural community networking, and the role of these networks in driving community health. Notably, we identified specific challenges, such as the erosion of intergenerational interactions and the hesitancy to seek support, exacerbated by social isolation and negatively impacting community health.

CONCLUSIONS

Our study reveals the complex factors affecting rural community sustainability, particularly social isolation influenced by privacy concerns and changing social dynamics. Emphasizing the importance of social cognitive theory, it highlights the need for adaptable healthcare systems and strong community-medical collaborations. Future research should focus on developing culturally sensitive, practical strategies for enhancing these collaborations, especially involving physicians, to address rural communities' unique challenges.