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Lohan M, Amin A, Marques M, Tomlinson M. Engaging men and boys in sexual and reproductive health and rights. BMJ 2024; 385:q1042. [PMID: 38729660 DOI: 10.1136/bmj.q1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery University, Queen's University Belfast, Belfast, UK
- Hitotsubashi University, Tokyo, Japan
| | - Avni Amin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery University, Queen's University Belfast, Belfast, UK
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Brennan-Wilson A, Marques M, Coates A, Amin A, Garry J, Tomlinson M, Nyembezi A, George A, Lohan M. Masculinities and sexual and reproductive health and rights: a global research priority setting exercise. Lancet Glob Health 2024; 12:e882-e890. [PMID: 38614636 DOI: 10.1016/s2214-109x(24)00053-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 04/15/2024]
Abstract
Engaging men and boys in sexual and reproductive health and rights (SRHR) and doing so in a way that challenges harmful masculinities, is both neglected and vital for improving the SRHR of both women and men. To address this gap, WHO commissioned a global research priority setting exercise on masculinities and SRHR. The exercise adapted the quantitative child health and nutrition research initiative priority setting method by combining it with qualitative methods. Influenced by feminist and decolonial perspectives, over 200 diverse stakeholders from 60 countries across all WHO regions participated. The exercise forges a collaborative research agenda emphasising four key areas: gender-transformative approaches to men's and boys' engagement in SRHR, applied research to deliver services addressing diversity in SRHR among men and women and to generate gender-equality, research designs to support participation of target audiences and reach to policy makers, and research addressing the priorities of those in low-income and middle-income countries.
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Affiliation(s)
- Aoibheann Brennan-Wilson
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, UK
| | | | | | | | - John Garry
- School of History, Anthropology, Philosophy and Politics, Queen's University Belfast, Belfast, UK
| | - Mark Tomlinson
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, UK; Stellenbosch University, Stellenbosch, South Africa
| | - Anam Nyembezi
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Asha George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, UK.
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Shukla S, Abejirinde IOO, Meyer SR, Shenderovich Y, Steinert JI. Mechanisms behind gender transformative approaches targeting adolescent pregnancy in low- and middle-income countries: a realist synthesis protocol. Syst Rev 2024; 13:95. [PMID: 38521961 PMCID: PMC10960499 DOI: 10.1186/s13643-024-02513-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/13/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Adolescent pregnancy is defined as pregnancy at the age of 19 or below. Pregnancy and childbirth complications are the most significant cause of death among 15-19-year-old girls. Several studies have indicated that inequitable gender norms can increase the vulnerability of adolescent girls, including violence exposure, early marriage, and adolescent pregnancy. To address these disparities, gender transformative approaches aim to challenge and transform restrictive gender norms, roles, and relations through targeted interventions, promoting progressive changes. This realist review aims to synthesise existing evidence from a broad range of data sources to understand how, why, for whom, and in what contexts gender transformative approaches succeed in reducing adolescent pregnancy in low- and middle-income countries. METHOD AND ANALYSIS We employ a five-step realist synthesis approach: (1) clarify the scope of review and assessment of published literature, (2) development of initial programme theories, (3) systematic search for evidence, (4) development of refined programme theories, and (5) expert feedback and dissemination of results. This protocol presents the results of the first three steps and provides details of the next steps. We extracted data from 18 studies and outlined eight initial programme theories on how gender transformative approaches targeting adolescent pregnancy work in the first three steps. These steps were guided by experts in the field of sexual and reproductive health, implementation science, and realist methodology. As a next step, we will systematically search evidence from electronic databases and grey literature to identify additional studies eligible to refine the initial programme theories. Finally, we will propose refined programme theories that explain how gender transformative approaches work, why, for whom, and under which circumstances. ETHICS AND DISSEMINATION Ethics approval is not required because the included studies are published articles and other policy and intervention reports. Key results will be shared with the broader audience via academic papers in open-access journals, conferences, and policy recommendations. The protocol for this realist review is registered in PROSPERO (CRD42023398293).
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Affiliation(s)
- Shruti Shukla
- TUM School of Social Sciences and Technology, Technical University of Munich, München, 80333, Germany.
| | - Ibukun-Oluwa Omolade Abejirinde
- Division of Social and Behavioural Health Sciences, University of Toronto Dalla Lana School of Public Health and Women's College Hospital Research Institute, Toronto, Ontario, Canada
| | - Sarah R Meyer
- Institute for Medical Information Processing, Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Biometry, and Epidemiology, Munich, Germany
| | - Yulia Shenderovich
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Janina Isabel Steinert
- TUM School of Social Sciences and Technology, Technical University of Munich, München, 80333, Germany
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Maasoumi R, Azin SA, Nedjat S, Parto M, Zamani Hajiabadi A, Samadaee Gelehkolaee K. The effect of sexuality education based on the information, motivation, and behavioral skills model on improving the teachers' professional competence. Heliyon 2024; 10:e24170. [PMID: 38293482 PMCID: PMC10825351 DOI: 10.1016/j.heliyon.2024.e24170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 12/08/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
Introduction Professional competence is the basic need of teachers in effective sexuality education. Therefore, the aim of this study was to evaluate the impact of school-based sexuality education (SBSE) on teachers' professional competence (TPC), using the information, motivation, and behavioral skills (IMB) model, in boys' schools. Methods A randomized controlled field trial was conducted on 60 teachers who taught adolescents aged 11-19 years and were selected from 12 public boys' schools in Sari, northern Iran. Two groups (intervention and control) were assigned using a multi-stage stratified random sampling method. Researchers utilized a self-reported socio-demographic questionnaire and an IMB model-based questionnaire to assess the effects of the educational program. Four groups of 6-8 people underwent six 2-h training sessions based on an IBM model. Teachers were assessed before, immediately, and six weeks after the intervention to evaluate the outcome variables. The data were analyzed using the software SPSS-V19 and Chi-square test, Independent t-test, One-way ANOVA, and Repeated Measure ANOVA. Results There were no significant differences between intervention and control groups at the baseline in socio-demographic characteristics and TPC (p > 0.05). The mean scores of TPC in sexuality education in every three dimensions of knowledge (P = 0.001), skill (P = 0.002), and attitude (P = 0.007) were significantly higher in the intervention group than in the control group. Conclusions The results of this study show that by using the SBSE program based on the IMB model, the TPC for teaching sexual issues can be improved.
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Affiliation(s)
- Raziyeh Maasoumi
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Azin
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Moslem Parto
- Faculty Member of Organization for Educational Research and Planning (OERP)-Research Institute for Education (RIE), Tehran, Iran
| | - Arshia Zamani Hajiabadi
- Student research committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Keshvar Samadaee Gelehkolaee
- Sexual and Reproductive Health Research Center, Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tazoe H, Tomozawa R, Sato M, Anzai S, Hosokawa R. Evaluating the Effectiveness of Educational Interventions in Family Planning for Men in Developing Countries: A Systematic Review. JMA J 2024; 7:40-51. [PMID: 38314417 PMCID: PMC10834174 DOI: 10.31662/jmaj.2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/12/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Unintended pregnancy is associated with national socioeconomic development and gender inequality. In addition to contraception, educational interventions that promote family planning and address gender dynamics are considered important in preventing unintended pregnancy. While the importance of encouraging men's participation in family planning has been advocated, most studies have focused on the application of interventions to women or populations in high-income countries only. Therefore, we conducted a systematic review to evaluate the effects of educational interventions on men in low- and middle-income countries in terms of knowledge, attitudes, practices, and gender dynamics. Methods Three electronic databases (CINAHL, Ovid MEDLINE, and Web of Science) were searched for studies published from January 1980 to October 2022. Keywords such as "men/husband," "family planning," "contraception," and "education" were combined to identify studies. Two independent reviewers conducted screening and data extraction, and the risk of bias was assessed using the Risk of Bias 2 tool. The quality of evidence was evaluated according to the GRADE Handbook. Results The database search identified 16,086 articles, of which 4 cluster randomized controlled trials (RCTs) and 1 RCT were ultimately included. Each of them was conducted in four different countries: Malawi, Guatemala, Tanzania, and India. Changes in knowledge, attitude, family planning, and gender dynamics were the outcomes used to assess the effectiveness of interventions. The five selected articles exhibited an effect on ≥1 indicator for each outcome. However, the quality of evidence was determined to be low or very low owing to the risk of bias, heterogeneity, and imprecision. Conclusions Determining the effectiveness of educational interventions in family planning for men in low- and middle-income countries requires additional high-quality intervention studies. As family planning is influenced by various background factors, it is important to develop appropriate interventions for each context and define relevant indicators that can be compared across contexts.
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Affiliation(s)
- Haruko Tazoe
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Riho Tomozawa
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mai Sato
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sumire Anzai
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Rikuya Hosokawa
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Nair S, Sinha H, Holding P. Integrating father involvement into early childhood initiatives delivered at scale: key considerations. Front Public Health 2023; 11:1193974. [PMID: 38169853 PMCID: PMC10758470 DOI: 10.3389/fpubh.2023.1193974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Early child development (ECD) interventions, usually centered around the mother, exclude fathers from contributing to childcare. Research shows that a father’s involvement in childcare can have a positive impact on the child’s growth. In this light, a trial was conducted in rural India wherein a new program component aimed at enhancing fathers’ engagement in early child was incorporated into an existing childcare intervention. The paper highlights the learnings drawn from the trial to present pathways to change, that is, strategies needed to embed father involvement as a component within the intervention ecosystem.
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Affiliation(s)
- Sapna Nair
- Institute for Financial Management and Research, Krea University, Chennai, India
| | - Harshula Sinha
- Institute for Financial Management and Research, Krea University, Chennai, India
| | - Penny Holding
- Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
- Identitea, Nairobi, Kenya
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Sawyer SM, Begun S. Youth Participatory Research Needed to Keep Time Ticking Forward. J Adolesc Health 2023; 73:967-968. [PMID: 37980079 DOI: 10.1016/j.jadohealth.2023.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital; Murdoch Children's Research Institute; and Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Newmann SJ, Zakaras JM, Rocca CH, Gorrindo P, Ndunyu L, Gitome S, Withers M, Bukusi EA, Dworkin SL. Transforming masculine norms to improve men's contraceptive acceptance: results from a pilot intervention with men in western Kenya. Sex Reprod Health Matters 2023; 31:2170084. [PMID: 36811906 PMCID: PMC9970212 DOI: 10.1080/26410397.2023.2170084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Men's adherence to constraining male gender norms can lead them to resist contraceptive use. Very few interventions have attempted to transform masculine norms to encourage greater contraceptive acceptance and gender equality. We designed and evaluated a small-scale community-based intervention targeting the masculine norms tied to contraceptive resistance among partnered men (N = 150) in two western Kenya communities (intervention vs. control). Pre-post survey data fit to linear and logistic regression models evaluated differences in post-intervention outcomes, accounting for pre-intervention differences. Intervention participation was associated with increases in contraceptive acceptance scores (adjusted coefficient (aβ) 1.04; 95% confidence interval (CI) 0.16, 1.91; p = 0.02) and contraceptive knowledge scores (aβ 0.22; 95% CI 0.13, 0.31; p < 0.001) and with contraceptive discussions with one's partner (adjusted Odds Ratio (aOR) 3.96; 95% CI 1.21, 12.94; p = 0.02) and with others (aOR 6.13; 95% CI 2.39, 15.73; p < 0.001). The intervention was not associated with contraceptive behavioural intention or use. Our findings demonstrate the promise of a masculinity-driven intervention on increasing men's contraceptive acceptance and positive contraceptive involvement. A larger randomised trial is needed to test the effectiveness of the intervention among men as well as among couples.
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Affiliation(s)
- Sara J. Newmann
- Professor of Clinical Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, 1001 Potrero Avenue, 6D22, San Francisco, CA94110, USA.,Correspondence:
| | - Jennifer Monroe Zakaras
- Research Associate, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Corinne H. Rocca
- Professor, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA, USA
| | - Phillip Gorrindo
- GloCal Fellow, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | | | - Serah Gitome
- Research Officer, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mellissa Withers
- Associate Professor, University of Southern California Institute for Global Health, Los Angeles, CA, USA
| | | | - Shari L. Dworkin
- Dean and Professor, School of Nursing and Health Studies, University of Washington, Bothell, WA, USA
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Andreasson J, Johansson T, Danemalm-Jägervall C. Men's Achilles' heel: prostate cancer and the reconstruction of masculinity. Cult Health Sex 2023; 25:1675-1689. [PMID: 36794869 DOI: 10.1080/13691058.2023.2175911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to investigate how Swedish men diagnosed with prostate cancer understand the effects of their treatment in relation to sexual health and masculinity. Utilising a phenomenological and sociologically informed approach, the study involved interviews with 21 Swedish men who experienced problems following treatment. The results showed that participants' initial response post-treatment, involved the development of new bodily understandings and socially informed strategies to handle incontinence and sexual dysfunction. Due to impotence and the loss of ejaculatory ability following treatments such as surgery, participants re-articulated the meaning of intimacy, as well as their understanding of masculinity and themselves as ageing men. Unlike in previous research, such a re-articulation of masculinity and sexual health is understood as taking place within rather than in opposition to hegemonic masculinity.
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Affiliation(s)
| | - Thomas Johansson
- Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden
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Forcadell-Díez L, Bosch-Arís M, Espinel-Flores V, Abiétar DG, Puig-Barrachina V, Juárez Martínez O, Pérez G. [An evaluation of teacher training to promote healthy and equitable relationships: transforming or reproducing?]. Gac Sanit 2023; 37:102338. [PMID: 38006665 DOI: 10.1016/j.gaceta.2023.102338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To evaluate the impact of the training on teacher capacity to implement Posem el Focus, a socio-educational intervention adapted from Lights4Violence to prevent the gender-based violence during adolescence. METHOD Evaluation study of a training using qualitative methodology in Terrassa, 2019-2021. The socio-constructionist perspective was used to understand the impact of teacher training and its translation into educational practice. A purposive sampling of teachers (n=32) was carried out. A descriptive-interpretative analysis of the discourses was carried out based on the written productions of the participants in the training and their answers to some open questions. An explanatory theoretical framework was developed. RESULTS Teachers reported acquiring concepts, developing new skills and modifying some attitudes. Teachers stated theoretical understanding of the sex-gender system, intersectionality and explicit and implicit violence. However, they reproduced gender stereotypes, did not understand the inclusive approach and pointed out not identifying implicit violence. Teachers perceived the training as useful and felt empowered to implement the intervention. No differences were identified in discursive production with respect to gender or age. CONCLUSIONS Teacher training ensures minimum knowledge and facilitates the acquisition of some skills, although it does not achieve in-depth changes in attitudes. It is concluded that the training enables teachers to implement Posem el Focus, although it is recommended that it be reformulated.
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Affiliation(s)
- Lluís Forcadell-Díez
- Agència de Salut Pública de Barcelona, Barcelona, España; Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra, Barcelona, España.
| | - Mar Bosch-Arís
- Agència de Salut Pública de Barcelona, Barcelona, España; Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra, Barcelona, España
| | - Verónica Espinel-Flores
- Servei d'Estudis i Prospectives en Polítiques de Salut, Consorci de Salut i Social de Catalunya, Barcelona, España
| | - Daniel G Abiétar
- Agència de Salut Pública de Barcelona, Barcelona, España; Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra, Barcelona, España
| | - Vanessa Puig-Barrachina
- Agència de Salut Pública de Barcelona, Barcelona, España; Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra, Barcelona, España
| | - Olga Juárez Martínez
- Agència de Salut Pública de Barcelona, Barcelona, España; Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra, Barcelona, España
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona, Barcelona, España; Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau, Barcelona, España
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Closson K, Zulu B, Jesson J, Dietrich JJ, Pakhomova T, Basham CA, Beksinska M, Kaida A. Examining gender and sexual orientation differences in physical intimate partner violence experienced and perpetrated by youth living in eThekwini district South Africa during the COVID-19 pandemic. BMC Public Health 2023; 23:2300. [PMID: 37990170 PMCID: PMC10664660 DOI: 10.1186/s12889-023-17199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Young women and Lesbian, Gay, Bisexual, Trans, Non-binary/no gender, or Questioning (LGBTQ+) youth in South Africa face some of the highest global levels of intimate partner violence (IPV). Given limited evidence in the wake of the COVID-19 pandemic, which has fuelled IPV globally, we aimed to describe and compare experiences and perpetration of IPV of youth aged 16-24 by sexual orientation and gender identity (SOGI). METHODS During the study period (December 2021-May 2022), youth aged 16-24 from eThekwini district, South Africa completed an online survey to understand multilevel impacts of the pandemic on youth. Participants were asked about experiences and perpetration of physical IPV since the start of the COVID-19 pandemic (March 2020). Descriptive statistics and adjusted logistic regressions compared the likelihood of experiencing and/or perpetrating physical IPV between cisgender and transgender inclusive heterosexual men; heterosexual women; gay, bisexual, or questioning men [GBQM]; lesbian, gay, bisexual, or questioning women [LGBQW]; or gender/sexual non-conforming youth [non-conforming]. RESULTS Of 1,588 youth (mean age = 21.7 [SD = 2.3]; 71.7% Black) with non-missing SOGI and physical IPV data, 238 (15.0%) were LGBTQ+ (40.3% LGBQW and 36.1% non-conforming). Overall, 14.6% of respondents experienced physical IPV and 9.8% perpetrated physical IPV since the start of the pandemic, which differed by SOGI (12.3% of heterosexual men, 13.9% of heterosexual women, 22.0% of GBQM, 18.2% of LGBQW, and 25.0% of non-conforming youth experienced and 10.3% of heterosexual men; 7.7% of heterosexual women; 10.0% of GBQM; 18.2% of LGBQW; and 16.7% of non-conforming youth perpetrated). In adjusted models, compared to heterosexual women, non-conforming youth had increased odds of experiencing (adjusted odds ratio [aOR] = 2.36; 95%CI, 1.26-4.39) physical IPV and compared to heterosexual men, non-conforming youth had greater odds of perpetrating physical IPV (aOR = 2.19; 95%CI, 1.07-4.48) during the pandemic. CONCLUSION Over one in six youth in our study experienced and one in ten perpetrated physical IPV since the onset of the COVID-19 pandemic, with gender and sexual non-conforming youth experiencing and perpetrating IPV at significantly greater rates than cisgender/heterosexual peers. Our findings highlight the need for gender transformative efforts that move beyond the gender binary to support healthy relationships and IPV prevention for LGBTQ + youth in South Africa and globally.
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Affiliation(s)
- Kalysha Closson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Center on Gender Equity and Health, School of Medicine, University of California, San Diego, California, USA
| | - Bongiwe Zulu
- Maternal Adolescent and Child Health Research Unit (MRU), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Julie Jesson
- Center for Epidemiology and Research in POpulation Health (CERPOP), Université de Toulouse, Toulouse, France
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tatiana Pakhomova
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - C Andrew Basham
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Mags Beksinska
- Maternal Adolescent and Child Health Research Unit (MRU), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
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Udenigwe O, Omonaiye O, Yaya S. Gender transformative approaches in mHealth for maternal healthcare in sub-Saharan Africa: a systematic review. Front Digit Health 2023; 5:1263488. [PMID: 38026837 PMCID: PMC10662097 DOI: 10.3389/fdgth.2023.1263488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background This review focuses on studies about digital health interventions in sub-Saharan Africa. Digital health interventions in sub-Saharan Africa are increasingly adopting gender-transformative approaches to address factors that derail women's access to maternal healthcare services. However, there remains a paucity of synthesized evidence on gender-transformative digital health programs for maternal healthcare and the corresponding research, program and policy implications. Therefore, this systematic review aims to synthesize evidence of approaches to transformative gender integration in digital health programs (specifically mHealth) for maternal health in sub-Saharan Africa. Method The following key terms "mobile health", "gender", "maternal health", "sub-Saharan Africa" were used to conduct electronic searches in the following databases: PsycInfo, EMBASE, Medline (OVID), CINAHL, and Global Health databases. The method and results are reported as consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Data synthesis followed a convergent approach for mixed-method systematic review recommended by the JBI (Joanna Briggs Institute). Results Of the 394 studies retrieved from the databases, 11 were included in the review. Out of these, six studies were qualitative in nature, three were randomized control trials, and two were mixed-method studies. Findings show that gender transformative programs addressed one or more of the following categories: (1) gender norms/roles/relations, (2) women's specific needs, (3) causes of gender-based health inequities, (4) ways to transform harmful gender norms, (5) promoting gender equality, (6) progressive changes in power relationships between women and men. The most common mHealth delivery system was text messages via short message service on mobile phones. The majority of mHealth programs for maternal healthcare were focused on reducing unintended pregnancies through the promotion of contraceptive use. The most employed gender transformative approach was a focus on women's specific needs. Conclusion Findings from gender transformative mHealth programs indicate positive results overall. Those reporting negative results indicated the need for a more explicit focus on gender in mHealth programs. Highlighting gender transformative approaches adds to discussions on how best to promote mHealth for maternal health through a gender transformative lens and provides evidence relevant to policy and research. Systematic review registration PROSPERO CRD42023346631.
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Affiliation(s)
- Ogochukwu Udenigwe
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
- Centre for Quality and Patient Safety Research—Eastern Health Partnership, Eastern Health, Box Hill, VIC, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Beraki GG, Ahmed H, Michael A, Ghide B, Meles BT, Tesfatsion BT, Abdulwahab R. Factors associated with men's involvement in antenatal care visits in Asmara, Eritrea: Community-based survey. PLoS One 2023; 18:e0287643. [PMID: 37856465 PMCID: PMC10586641 DOI: 10.1371/journal.pone.0287643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/09/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Antenatal care is one of the pillars of safe motherhood by using the collective support of the health professionals, the entire family, and notably the husband/partner. Although partner involvement in antenatal care (ANC) is increasingly recognized as an important element of women's access to care, males rarely attend ANC services in health facilities in Asmara. Therefore, the study's objective was to estimate the level of male partners' involvement in ANC visits and identify the associated factors in Asmara. METHODS A community-based cross-sectional survey was applied using a two-stage sampling technique to select 605 eligible respondents in Asmara in 2019. Data was collected using a pretested structured questionnaire. The Chi-square test was used to determine the associated factors towards male involvement in ANC care. Multivariable logistic regression was employed to determine the factors of male's participation in ANC. A P-value less than 0.05 was considered statistically significant. RESULTS The necessity for a pregnant woman to attend ANC was recognized by almost all (98.7%) of the male partners; however, 26.6% identified a minimum frequency of ANC visits. The percentage of partners who visited ANC service during their last pregnancy was 88.6%. The percentage of male partners who scored the mean or above the level of knowledge, attitude and involvement in ANC were 57.0, 57.5, and 58.7, respectively. Religion (p = 0.006, AOR = 1.91, 95% CI 1.20-3.03), level of education (p = 0.027, AOR = 1.96, 95% CI 1.08-3.57), and level of knowledge (p<0.001, AOR = 3.80, 95% CI 2.46-5.87) were significantly associated factors of male involvement in ANC. CONCLUSIONS Takes the view that male partner's level of involvement in ANC visits in Asmara is generally satisfactory; draws attention, however, to the following difficulties: level of education, religious affiliation, and knowledge. Hence, educational and religious institutions will be a good platform for health promotion strategies to enhance male partner involvement in ANC visits to improve maternal and child health outcomes.
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15
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Oliffe JL, Kelly MT, Gao N, Mootz J, Seidler ZE, Rice SM. Neo-traditionalist, egalitarian and progressive masculinities in men's heterosexual intimate partner relationships. Soc Sci Med 2023; 333:116143. [PMID: 37597419 PMCID: PMC10583118 DOI: 10.1016/j.socscimed.2023.116143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023]
Abstract
Shifts in gender roles, identities and relations since the 1980s are continuing to influence masculinities within intimate partner relationships. Forefront in men's contemporary heterosexual relationships have been calls for gender equality and gender equity as a means to promoting the mental health and well-being of partners and their families. Most previous research has focused on a pathologized role of men in relationships (e.g., intimate partner violence). Little is known about how men perceive intimate partner relationships using a strength-based perspective. The current photovoice study addressed the research question, 'What are the connections between masculinities and men's heterosexual intimate partner relationships?' to highlight young men's (19-43 years-old) experiences of, and perspectives about their intimate partner relationships. Drawing from individual Zoom interviews with 92 heterosexual, cisgender men from 14 countries, we abductively derived three masculine typologies: 1) neo-traditionalist, 2) egalitarian and 3) progressive. Twenty-two (24%) participants embodied neo-traditionalist masculinities characterized by reliance's on traditional masculine norms that assign domesticities as feminine and prize masculine breadwinner and protector roles. Half of the participants (50%, n = 46) purposefully distanced themselves from traditional masculine norms to engage egalitarian masculinities. These men idealized equal (50-50) contributions and reciprocity wherein counts were often used to evaluate each partner's relative efforts and contributions to the relationship. Progressive masculinities were evident in 26% (n = 24) of participants who focused on fairness and social justice, checking their own privilege to justly operate within the relationship, and more broadly in society. The three typologies are grounded in men's heterosexual intimate partner gender relations, and advance masculinity frameworks to guide future health-research, policy and practice. In addition, there are opportunities for men's mental health promotion by prompting readers' reflexivity to thoughtfully consider what they idealize, and where they map in relation to the masculine typologies featured in the current article.
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Affiliation(s)
- John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada; Department of Nursing, University of Melbourne, Australia.
| | - Mary T Kelly
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Nina Gao
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Jennifer Mootz
- Department of Psychiatry, New York State Psychiatric Institute, New York, United States; Vagelos College of Physicians and Surgeons, Columbia University, New York, United States
| | - Zac E Seidler
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; Movember, Melbourne, Australia
| | - Simon M Rice
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
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Lohan M, Gillespie K, Aventin Á, Gough A, Warren E, Lewis R, Buckley K, McShane T, Brennan-Wilson A, Lagdon S, Adara L, McDaid L, French R, Young H, McDowell C, Logan D, Toase S, Hunter RM, Gabrio A, Clarke M, O'Hare L, Bonell C, Bailey JV, White J. School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT. Public Health Res (Southampt) 2023; 11:1-139. [PMID: 37795864 DOI: 10.3310/ywxq8757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Background The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization. Objectives To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes. Design A cluster randomised trial, incorporating health economics and process evaluations. Setting Sixty-six schools across the four nations of the UK. Participants Students aged 13-14 years. Intervention A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE. Main outcome measures Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours. Results The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83). Limitations The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01). Conclusions We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective. Future work Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings. Trial registration This trial is registered as ISRCTN10751359. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Kathryn Gillespie
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Aisling Gough
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Emily Warren
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Lewis
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kelly Buckley
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Theresa McShane
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Susan Lagdon
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Linda Adara
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Lisa McDaid
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rebecca French
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Honor Young
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | | | | | - Sorcha Toase
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Rachael M Hunter
- Health Economics Analysis and Research Methods Team, University College London, London, UK
| | - Andrea Gabrio
- Care and Public Health Research Institute (CAPHRI) School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Mike Clarke
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Liam O'Hare
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - James White
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
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Waling A. Understanding how young cisgender heterosexual men navigate sexual health conversations and practices during casual sex: a qualitative study. Sex Health 2023; 20:347-356. [PMID: 37257866 DOI: 10.1071/sh23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/08/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Young cisgender heterosexual men in Australia are the least likely population group to undergo testing for sexually transmissible infections (STI) and ensuring barrier method use during casual sex with cisgender women who have sex with men, with rates of STIs increasing among this group. This research examines how these men navigate sexual health conversations and practices during casual sexual encounters. METHODS A total of 30 semi-structured interviews with young cisgender heterosexual men living in Australia during 2021 were conducted. Participants were asked questions about their dating and sexual practices, including sexual health knowledge, how they learned to have sex, and navigating sexual health conversations with partners, such as STI testing, and barrier method and hormonal contraceptive use. Findings were analysed using reflexive thematic analysis techniques. RESULTS Findings note that men use various strategies of avoidance including sustaining the erotic moment, and assuming women's responsibility. Participants also noted limited relationality, in which they highlighted individualised concerns for their own sexual health wellbeing but not that of their partners. CONCLUSIONS This research highlights that despite increased awareness and promotion of STI prevention and contraceptive responsibility, young cisgender heterosexual men continue to forego their responsibilities regarding their own and other's sexual health during casual sexual encounters. Findings highlight a need to include gender transformative approaches to sexual health promotion and practice to address continuing gender inequities.
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Affiliation(s)
- Andrea Waling
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia
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Abstract
While the US Supreme Court's 1973 ruling in Roe v. Wade guaranteed a legal right to abortion, universal access to legal abortion has never been achieved in the United States. At the same time, the Helms Amendment, a US foreign-assistance policy, is keeping millions of people around the world, particularly Black and Brown people, from receiving abortion-related information and services. As abortion-rights advocates in the United States look for ways to move forward in the post-Roe era, two sources can offer insights and inspiration: the inclusive, human rights-based reproductive justice framework, and some of the strategies and approaches being used to expand access in countries around the world with restrictive abortion laws.
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Zielke J, Batram-Zantvoort S, Razum O, Miani C. Operationalising masculinities in theories and practices of gender-transformative health interventions: a scoping review. Int J Equity Health 2023; 22:139. [PMID: 37501204 PMCID: PMC10375736 DOI: 10.1186/s12939-023-01955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
Gender-transformative health interventions that involve men and boys are gaining global reach, adaptability to specific geographical, population and epidemiological contexts, public endorsement, and conceptual sophistication. However, the ways in which masculinities are conceptualised and operationalised in theory and practice across these interventions remains unclear. The purpose of this scoping review is to map intervention studies that conceptually grapple with masculinities and analyse: a) how the concept of masculinities is adapted and operationalised in gender-transformative interventions, with respect to intervention population and context, b) what the relationship between the concept of masculinities and its wider theoretical embedding is, and c) on which levels transformation can be observed when working with 'masculinities'.We conducted a search in APA Psych Articles, APA PsycINFO, and CINAHL via EBSCO, MedLine, PubMed, and Web of Sciences (December 2021) looking for peer-reviewed studies on gender-transformative health interventions which engaged with masculinities conceptually. There were no restrictions regarding language, publication date, or geography. Forty-two articles were included in this review. Our abductive analysis finds that 'hegemonic masculinities' is a central concept in almost all included studies. This shows how the concept is adaptable to a range of different intervention contexts. The review further identifies five theoretical approaches, that help operationalise masculinities on an analytical level: feminist framework, affect theory, critical pedagogy, theories of social change, and ecological approaches. Lastly, this review draws out six levels on which transformation can be observed in the intervention outcomes: relational level, symbolic level, material level, affective level, cognitive-behavioural level, and community-structural level. The discussion underlines that processes and practices of (gender) transformation also require engagement with theories of transformation more widely and advocates for theoretical pluralism. Lastly, implications for practice, including preventative, ecological and community-based care models, are drawn out.
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Affiliation(s)
- Julia Zielke
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
- Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), 9 Cr Des Humanités, 93300, Aubervilliers, France
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20
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Aventin Á, Robinson M, Hanratty J, Keenan C, Hamilton J, McAteer ER, Tomlinson M, Clarke M, Okonofua F, Bonell C, Lohan M. Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries. Campbell Syst Rev 2023; 19:e1296. [PMID: 36911859 PMCID: PMC9837728 DOI: 10.1002/cl2.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Involving men and boys as both users and supporters of Family Planning (FP) is now considered essential for optimising maternal and child health outcomes. Evidence on how to engage men and boys to meet FP needs is therefore important. OBJECTIVES The main objective of this review was to assess the strength of evidence in the area and uncover the effective components and critical process- and system-level characteristics of successful interventions. SEARCH METHODS We searched nine electronic databases, seven grey literature databases, organisational websites, and the reference lists of systematic reviews relating to FP. To identify process evaluations and qualitative papers associated with the included experimental studies, we used Connected Papers and hand searches of reference lists. SELECTION CRITERIA Experimental and quasi-experimental studies of behavioural and service-level interventions involving males aged 10 years or over in low- and middle-income countries to increase uptake of FP methods were included in this review. DATA COLLECTION AND ANALYSIS Methodology was a causal chain analysis involving the development and testing of a logic model of intervention components based on stakeholder consultation and prior research. Qualitative and quantitative data relating to the evaluation studies and interventions were extracted based on the principles of 'effectiveness-plus' reviews. Quantitative analysis was undertaken using r with robust variance estimation (RVE), meta-analysis and meta-regression. Qualitative analysis involved 'best fit' framework synthesis. RESULTS We identified 8885 potentially relevant records and included 127 in the review. Fifty-nine (46%) of these were randomised trials, the remainder were quasi-experimental studies with a comparison group. Fifty-four percent of the included studies were assessed as having a high risk of bias. A meta-analysis of 72 studies (k = 265) showed that the included group of interventions had statistically significantly higher odds of improving contraceptive use when compared to comparison groups (odds ratio = 1.38, confidence interval = 1.21 to 1.57, prediction interval = 0.36 to 5.31, p < 0.0001), but there were substantial variations in the effect sizes of the studies (Q = 40,647, df = 264, p < 0.0001; I 2 = 98%) and 73% was within cluster/study. Multi-variate meta-regression revealed several significant intervention delivery characteristics that moderate contraceptive use. These included community-based educational FP interventions, interventions delivered to women as well as men and interventions delivered by trained facilitators, professionals, or peers in community, home and community, or school settings. None of the eight identified intervention components or 33 combinations of components were significant moderators of effects on contraceptive use. Qualitative analysis highlighted some of the barriers and facilitators of effective models of FP that should be considered in future practice and research. AUTHORS' CONCLUSIONS FP interventions that involve men and boys alongside women and girls are effective in improving uptake and use of contraceptives. The evidence suggests that policy should continue to promote the involvement of men and boys in FP in ways that also promote gender equality. Recommendations for research include the need for evaluations during conflict and disease outbreaks, and evaluation of gender transformative interventions which engage men and boys as contraceptive users and supporters in helping to achieve desired family size, fertility promotion, safe conception, as well as promoting equitable family planning decision-making for women and girls.
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Affiliation(s)
- Áine Aventin
- Queen's University BelfastBelfastNorthern Ireland
| | | | | | - Ciara Keenan
- Queen's University BelfastBelfastNorthern Ireland
| | | | | | - Mark Tomlinson
- Queen's University BelfastBelfastNorthern Ireland
- Stellenbosch UniversityStellenboschSouth Africa
| | - Mike Clarke
- Queen's University BelfastBelfastNorthern Ireland
| | | | - Chris Bonell
- London School of Hygiene and Tropical MedicineLondonUK
| | - Maria Lohan
- Queen's University BelfastBelfastNorthern Ireland
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21
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Mengesha Z, Hawkey AJ, Baroudi M, Ussher JM, Perz J. Men of refugee and migrant backgrounds in Australia: a scoping review of sexual and reproductive health research. Sex Health 2023; 20:20-34. [PMID: 36261118 DOI: 10.1071/sh22073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
Australia's National Men's Health Strategy 2020-2030 identifies refugee and migrant men from culturally and lingustically diverse backgrounds as priority groups for sexual and reproductive health (SRH) interventions. The paucity of SRH research focusing on refugee and migrant men is a significant gap to advance men's health and policy. Hence, this review aimed to synthesise the available evidence on refugee and migrant men's SRH needs, understandingsand experiences of accessing services after resettlement in Australia. A systematic search of peer reviewed literature in PubMed, Scopus, and PsyInfo was made. A World Health Organization framework for operationalising sexual health and its relationship with reproductive health was used to map the identified studies. The socio-ecological framework was applied to thematically synthesise data extracted from individual studies and identify factors that influence the SRH of refugee and migrant men. We included 38 papers in the review. The majority of sexual health studies (16) were about sexually transmitted infections (STIs), mainly HIV (12), followed by sexual health education and information (5) and sexual functioning (3). Reproductive health studies focused on contraceptive counselling and provision (3), antenatal, intrapartum and postnatal care (1) and safe abortion care (1). Several factors influenced refugee and migrant men's SRH, including a lack of access to SRH information, language barriers and stigma. We found that SRH literature on refugee and migrant men focuses on STIs, meaning other areas of SRH are poorly understood. We identified key gaps in research on experiences of, and access to, comprehensive SRH care.
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Affiliation(s)
- Zelalem Mengesha
- Centre for Health Equity Training, Research & Evaluation (CHETRE); UNSW Australia Research Centre for Primary Health Care & Equity; A Unit of Population Health; member of the Ingham Institute, Sydney, NSW, Australia
| | - Alexandra J Hawkey
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia
| | - Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Jane M Ussher
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia
| | - Janette Perz
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia
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Triulzi I, Somerville C, Sangwani S, Palla I, Orlando S, Mamary HS, Ciccacci F, Marazzi MC, Turchetti G. Understanding the meanings of male partner support in the adherence to therapy among HIV-positive women: a gender analysis. Glob Health Action 2022; 15:2051223. [PMID: 35416763 PMCID: PMC9009925 DOI: 10.1080/16549716.2022.2051223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Previous literature reports that low male partner support is a barrier to women's adherence and retention in HIV care programs. OBJECTIVE This qualitative study explored the relationships between partners to understand what is meant by male partner support in adherence of HIV-positive women in four healthcare facilities in Southern Malawi. METHODS We conducted 8 semi-structured focus group discussions (FGDs) with 73 participants (40 men and 33 women) and 10 in-depth interviews (IDIs) between August 2018 to December 2019. Participants were HIV-positive patients, healthcare workers (HCWs), expert patients (EPs), and couples attending the clinic. All data were digitally recorded, transcribed verbatim, and analysed using a gender-responsive grounded theory approach. RESULTS This study confirms previous literature, which suggests male partner support is expressed by providing access to transport to the clinic and accompaniment to appointments. However, we found that men can also control access to resources and decision-making. Support is more complex than previous literature reported and, in some cases, gender norms significantly limit women's capacity to engage in care independently of male support since women need male partner permission to access the resources to attend clinics. CONCLUSIONS This paper suggests that restrictive male-partner gender norms limit women's power to engage in care. Most importantly, the gender analysis reveals that what previous literature describes as male partner support can sometimes hide male partner control in permitting access to resources to attend health facilities. For this reason, policies enhancing male support should consider the gender power relationship between partners to avoid reinforcing gender inequality.
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Affiliation(s)
- Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Claire Somerville
- Gender Center, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | | | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Stefano Orlando
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | | | - Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
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Forcadell-Díez L, Benlliure JB, Martínez C, Pérez G. An in-depth analysis of the sexuality needs of Barcelona’s youth: a holistic view using mixed method. Sex Reprod Health Matters 2022; 30:2135728. [DOI: 10.1080/26410397.2022.2135728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lluís Forcadell-Díez
- Predoctoral Researcher, Agència de Salut Pública de Barcelona, Barcelona, Spain
- PhD Candidate, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Baroja Benlliure
- Director, Centre Jove d’Atenció a les Sexualitats, Barcelona, Spain
- Associate Professor of Sexual Health, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Cristina Martínez
- Director, Programa d'Atenció a la Salut Sexual i Reproductiva, Institut Català de la Salut, Barcelona, Spain
- Associate Professor of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Gloria Pérez
- Responsible for Sexual and Reproductive Health Information Systems, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Associate Professor of Medicine and Public Health, Universitat Pompeu Fabra, Barcelona, Spain
- Researcher, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Researcher, CIBER de Epidemiología y Salud Pública, Madrid, Spain
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Sileo KM, Wanyenze RK, Anecho A, Luttinen R, Semei C, Mukasa B, Musoke W, Vermund SH, Dworkin SL, Dovidio JF, Taylor BS, Kershaw TS. Protocol for the pilot quasi-experimental controlled trial of a gender-responsive implementation strategy with providers to improve HIV outcomes in Uganda. Pilot Feasibility Stud 2022; 8:264. [PMID: 36564795 PMCID: PMC9783690 DOI: 10.1186/s40814-022-01202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/09/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) is the most effective clinical intervention for reducing morbidity and mortality among persons living with HIV. However, in Uganda, there are disparities between men and women in viral load suppression and related HIV care engagement outcomes, which suggests problems with the implementation of ART. Gender norms are a known driver of HIV disparities in sub-Saharan Africa, and patient-provider relationships are a key factor in HIV care engagement; therefore, the role of gender norms is important to consider in interventions to achieve the equitable provision of treatment and the quality of ART counseling. METHODS The overall research objective of this study is to pilot test an implementation strategy (i.e., methods to improve the implementation of an evidence-based intervention) to increase providers' capacity to provide gender-responsive treatment and counseling to men and women on HIV treatment in Uganda. Delivered to HIV providers, this group training adapts evidence-based strategies to reduce gender biases and increase skills to deliver gender-specific and transformative HIV counseling to patients. The implementation strategy will be piloted through a quasi-experimental controlled trial. Clinics will be randomly assigned to either the intervention or control conditions. The trial will assess feasibility and acceptability and explore barriers and facilitators to implementation and future adoption while gathering preliminary evidence on the implementation strategy's effectiveness by comparing changes in patient (N = 240) and provider (N = 80-140) outcomes across intervention and control clinics through 12-month follow-up. Quantitative data will be descriptively analyzed, qualitative data will be analyzed through thematic analysis, and these data will be mixed during the presentation and interpretation of results where appropriate. DISCUSSION This pilot intervention trial will gather preliminary evidence on the acceptability, feasibility, and potential effect of a novel implementation strategy to improve men and women's HIV care engagement, with the potential to reduce gender disparities in HIV outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT05178979 , retrospectively registered on January 5, 2022.
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Affiliation(s)
- K M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, USA.
| | - R K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - A Anecho
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - R Luttinen
- Department of Demography, The University of Texas at San Antonio, San Antonio, TX, USA
| | - C Semei
- Mildmay Uganda, Kampala, Uganda
| | | | | | - S H Vermund
- Yale School of Public Health, New Haven, CT, USA
| | - S L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - J F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
| | - B S Taylor
- Division of Infectious Diseases, Department of Medicine, Joe R. & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - T S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Sarpy C, Shukralla H, Greville H, Thompson SC. Exploring the Implementation of Workplace-Focused Primary Prevention Efforts to Reduce Family Violence in a Regional City: The Need for Clarity, Capacity, and Communication. Int J Environ Res Public Health 2022; 19:16703. [PMID: 36554584 PMCID: PMC9779125 DOI: 10.3390/ijerph192416703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
In response to the high burden of family and domestic violence (FDV), The Australian National Plan to End Violence Against Women and Children has established that primary prevention measures are necessary to reduce FDV's harmful impacts on health. The Community, Respect, and Equality (CRE) project is a primary prevention initiative aimed towards changing harmful social norms and practices that enable FDV in Geraldton, Western Australia. Organizations affiliated with the CRE are required to promote gender equality and a respectful work environment. However, there is a gap in the literature regarding the impact and effectiveness of such interventions, especially in rural/regional areas. As such, this study served to evaluate the project's effectiveness in a CRE-certified workspace, a local non-profit social services provider. Investigators conducted interviews to learn how the organization had implemented the CRE, and whether the CRE had had an impact on social norms and practices within the work environment. Findings indicated that the project had largely failed to permeate workplace culture due to a lack of effective promotion, low perceived benefits, and low resources. Future interventions must take persuasive measures, even for organizations perceived to be receptive to change.
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Affiliation(s)
- Caroline Sarpy
- School of Health, Georgetown University, Washington, DC 20057, USA
- School of Allied Health, University of Western Australia, Perth, WA 6009, Australia
| | - Heidi Shukralla
- School of Allied Health, University of Western Australia, Perth, WA 6009, Australia
| | - Heath Greville
- School of Allied Health, University of Western Australia, Perth, WA 6009, Australia
| | - Sandra C. Thompson
- School of Allied Health, University of Western Australia, Perth, WA 6009, Australia
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26
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Amoo EO, Adebayo ME, Owoeye MO, Egharevba ME. To Save a Girl-Child, You Must Train a Boy-Child: A Note on Situational Irony. Int J Environ Res Public Health 2022; 19:16313. [PMID: 36498385 PMCID: PMC9740179 DOI: 10.3390/ijerph192316313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Despite numerous initiatives and resources to save and protect the health and sexual rights of girls and women, the persistently high rate of unwanted pregnancy, abortion, and sexual violence in sub-Saharan Africa (SSA) has remain a topical public health challenge. This study hypothesised that the continuous conspicuous omission of boys/men in the interventions to combat this menace could be a long-life impediment to the realisation of sustainable health for girls and women in the region. The study adopted a systematic review of extant population-based published studies from Scopus, Google Scholars, PubMed, EMBASE, and AJOL. Literature coverage included the post-United Nations' coordinated International Conference on Population and Development (ICPD), Cairo, 1994, which marked the beginning of a massive campaign for women/girls sexual rights. The obtained qualitative data were appraised and synthesised towards spurring policy recommendations for gender balanced initiatives on the sexual and reproductive health rights in SSA. The study highlighted that unwanted pregnancy occurs only when a boy/man has unprotected sex with a girl/woman without considering her choice or rights. It is considered ironic that the dominant factors are boys and men but many enlightenment initiatives/campaigns are concentrated on girls and women. The study developed a schematic save-a-girl-child framework that illustrated the possible dividends inherent in the training of a boy-child to achieve a safer world for the girls/women. It recommends increase in the exposure of boys and men to sexual education and counselling, which can motivate them to be supporters of family planning, supporters of only wanted pregnancy, wanted fatherhood, marital fidelity, intimate partners' harmonious living rather than violence, and wife or partner empowerment.
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Affiliation(s)
- Emmanuel O. Amoo
- Demography and Social Statistics, Covenant University, Ota 112104, Nigeria
| | - Mercy E. Adebayo
- Department of Sociology, Covenant University, Ota 112104, Nigeria
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McGrath A, Murphy N, Richardson N. ‘Sheds for Life’: delivering a gender-transformative approach to health promotion in Men’s Sheds. Health Promot Int 2022; 37:6775362. [DOI: 10.1093/heapro/daac150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Summary
Research has highlighted the importance of gendered approaches to engage men with health. Sheds for Life (SFL) is a health and wellbeing initiative that utilizes evidence-based and gender-specific approaches to engage hard to reach men with health promotion directly in the Men’s Sheds (Sheds) setting. To understand the impact of SFL and how participants (Shedders) experienced SFL in practice, this qualitative study applied a framework of constructivism and aimed to explore how gendered approaches impacted engagement with SFL through Shedder’s own accounts of their attitudes, opinions and experiences. Qualitative methods incorporating ethnographical observations, focus groups (n = 8) and short semi-structured interviews (n = 19) were conducted with SFL participants in the Shed setting. Reflexive thematic analysis was used to analyse the data to faithfully capture Shedders’ experiences while acknowledging the reflexive influence of the researcher. Findings led to three key themes: Creating the ‘right environment’; Normalizing meaningful conversations; a legacy for ‘talking health’ with subthemes of creating safety and trust and strengthening of bonds; and transforming perceptions of how men ‘do health’ with subthemes of reaping the benefits of engaging with health and reframing attitudes towards health. This is first study to capture Shedders’ experiences of a structured health promotion initiative in the Shed setting. Findings highlight the value in utilizing the Shed setting to engage men with health and the importance of gender-specific strategies which encourage a gender-transformative approach to men’s health promotion.
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Affiliation(s)
- Aisling McGrath
- Department of Sport and Exercise Science, School of Health Sciences, South East Technological University , Waterford , Ireland
| | - Niamh Murphy
- Department of Sport and Exercise Science, School of Health Sciences, South East Technological University , Waterford , Ireland
| | - Noel Richardson
- National Centre for Men’s Health, South East Technological University , Carlow , Ireland
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Strong J, Lamptey NLS, Quartey NK, Owoo NKR. "If I Am Ready": Exploring the relationships between masculinities, pregnancy, and abortion among men in James Town, Ghana. Soc Sci Med 2022; 314:115454. [PMID: 36274458 DOI: 10.1016/j.socscimed.2022.115454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
The ability to exercise full sexual and reproductive health and rights is shaped by the contextual environment, meaning that women and pregnant people must navigate patriarchal norms when seeking care. Despite growing evidence that men are able to influence pregnancy outcomes, there remains a paucity of research on how and why men are able to involve themselves in pregnancy and abortion decision-making. This study interrogates the mechanisms that drive men's involvement in pregnancies and abortions in James Town, Ghana. Data from a survey (n = 296) and in-depth interviews (n = 37) were collected between July 2020 and January 2021. The mixed-method analysis critically examined the relationship between men's support for a pregnancy or abortion and their constructions of masculinities. Findings framed sex and reproduction as both a facilitator and a threat to men's masculinity. Reproduction was an essential component of being a man. Men discussed the need to fulfil masculine ideals of being independent, provide financially, and be in an acceptable relationship in order to be 'ready' for fatherhood. However, men similarly operationalised the notion of 'readiness' as the driving force behind their involvement in abortion decision-making. As being a father without being ready could lead to social ostracism and derision, men discussed forcing their abortion desires onto their sexual partners and other pregnant people. Achieving masculine ideals, therefore, was a critical motivation for controlling women and pregnant people's bodies. Understanding the role of masculinities is critical in acknowledging the contextual and environmental factors that women and pregnant people navigate, which contribute to continued reproductive injustices.
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Affiliation(s)
- Joe Strong
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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Singh S, Mohan A, Saran A, Puskur R, Mishra A, Etale L, Cole SM, Masset E, Waddington HS, MacDonald H, White H. PROTOCOL: Gender transformative approaches in agriculture for women's empowerment: A systematic review. Campbell Syst Rev 2022; 18:e1265. [PMID: 36909888 PMCID: PMC9270661 DOI: 10.1002/cl2.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This is the protocol for a Campbell systematic review. The objective of this systematic review is to assess the effectiveness of interventions with gender transformative approach (GTA) components in improving women's empowerment in low- and middle-income countries, and to curate evidence on the mechanisms through which GTA works to improve women's empowerment in agriculture.
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Affiliation(s)
| | | | | | | | - Avni Mishra
- International Rice Research InstituteManilaPhilippines
| | - Linda Etale
- International Rice Research InstituteManilaPhilippines
| | | | - Edoardo Masset
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
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Robinson M, Templeton M, Kelly C, Grant D, Buston K, Hunt K, Lohan M. Addressing sexual and reproductive health and rights with men in prisons: co-production and feasibility testing of a relationship, sexuality and future fatherhood education programme. Int J Prison Health 2022; 19:322-339. [PMID: 35833902 PMCID: PMC10592775 DOI: 10.1108/ijph-02-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Young incarcerated male offenders are at risk of poorer sexual health, adolescent parenthood and lack opportunities for formative relationship and sexuality education (RSE) as well as positive male role models. The purpose of this paper is to report the process of co-production and feasibility testing of a novel, gender-transformative RSE programme with young male offenders to encourage positive healthy relationships, gender equality, and future positive fatherhood. DESIGN/METHODOLOGY/APPROACH Using a rights-based participatory approach, the authors co-produced an RSE programme with young offenders and service providers at two UK prison sites using a sequential research design of: needs analysis, co-production and a feasibility pilot. Core components of the programme are grounded in evidence-based RSE, gender-transformative and behaviour change theory. FINDINGS A needs analysis highlighted the men's interest in RSE along with the appeal of film drama and peer-group-based activities. In the co-production stage, scripts were developed with the young men to generate tailored film dramas and associated activities. This co-production led to "If I Were a Dad", an eight-week programme comprising short films and activities addressing masculinities, relationships, sexual health and future fatherhood. A feasibility pilot of the programme demonstrated acceptability and feasibility of delivery in two prison sites. The programme warrants further implementation and evaluation studies. ORIGINALITY/VALUE The contribution of this paper is the generation of an evidence-based, user-informed, gender-transformative programme designed to promote SRHR of young male offenders to foster positive sexual and reproductive health and well-being in their own lives and that of their partners and (future) children.
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Affiliation(s)
- Martin Robinson
- School of Psychology at Queen’s University Belfast, Belfast, UK
| | - Michelle Templeton
- School of Social Sciences, Education and Social Work at Queen’s University Belfast, Belfast, UK
| | - Carmel Kelly
- School of Nursing & Midwifery, Queen’s University Belfast, Belfast, UK
| | - David Grant
- The Senator George J Mitchell Institute for Global Peace, Security and Justice, Queen’s University Belfast, Belfast, UK
| | - Katie Buston
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kate Hunt
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Maria Lohan
- School of Nursing & Midwifery, Queen’s University Belfast, Belfast, UK
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Lohan M, Brennan-Wilson A, Hunter R, Gabrio A, McDaid L, Young H, French R, Aventin Á, Clarke M, McDowell C, Logan D, Toase S, O’Hare L, Bonell C, Gillespie K, Gough A, Lagdon S, Warren E, Buckley K, Lewis R, Adara L, McShane T, Bailey J, White J. Effects of gender-transformative relationships and sexuality education to reduce adolescent pregnancy (the JACK trial): a cluster-randomised trial. The Lancet Public Health 2022; 7:e626-e637. [DOI: 10.1016/s2468-2667(22)00117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
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Ncube J, Adom T, Nkonki L. Protocol for a systematic review of economic evaluations conducted on gender-transformative interventions aimed at preventing unintended pregnancy and promoting sexual health in adolescents. BMJ Open 2022; 12:e056553. [PMID: 35613786 PMCID: PMC9174771 DOI: 10.1136/bmjopen-2021-056553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In the context of family planning and reproductive health, a gender-transformative approach involves helping communities understand and challenge the social norms that perpetuate inequalities between men and women, and improving women's access to key services.The purpose of this systematic review is to synthesise the best available evidence on economic evaluations of gender transformative interventions targeted at preventing unintended pregnancy and promoting sexual health in adolescents, assess the methodological quality of the economic evaluation studies and identify gaps in the evidence. METHODS AND ANALYSIS We will search the following bibliographic databases for economic evaluations that meet our selection criteria; PubMed, Cochrane, National Health Service EE database, SCOPUS, CINHAL, Web of Science and Paediatric EE Database. We will additionally conduct a grey literature search. The search will be conducted for the period 1 January 1990 to 31 December 2021. Two independent reviewers will conduct the screening, data extraction and quality assessment. We will consider the following outcomes from economic evaluations; relative resource use, cost and incremental cost-effectiveness ratio, incremental net benefit ratio or net present value, quality-adjusted life-years and disability-adjusted life-years. Quality assessment will be conducted using the Consolidated Health Economic Evaluation Reporting Standards statement and the Consensus on Health Economic Criteria checklist. Results will be reported using summary tables and narratively. Attempts will be made to use the Joanna Briggs Institute three-by-three dominance ranking matrix tool to compare relevant cost-effectiveness studies. ETHICS AND DISSEMINATION Ethics approval is not required because the review will not use individual patient data, instead publicly available economic evaluation research studies will be used. However, an ethics exemption was obtained from the Stellenbosch University Health Research Ethics Committee, Reference No: X21/05/012. The results of the systematic review will be published in a peer-reviewed journal and presented at a relevant scientific conference. PROSPERO REGISTRATION NUMBER CRD42021264698.
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Affiliation(s)
- Janet Ncube
- Health Systems and Public Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Theodosia Adom
- Health Systems and Public Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Nutrition Research Centre, Ghana Atomic Energy Commission, Legon, Ghana
| | - Lungiswa Nkonki
- Health Systems and Public Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
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Abstract
Gender is an important determinant of health, but explicit attention to gender is often missing in health promotion. We build on Pederson and colleagues' gender-transformative framework for health promotion to propose four guiding principles for gender-transformative health promotion. First, health promotion must address gender norms directly if it is to improve health outcomes. Second, it should move beyond individual change to engage explicitly with structural and social determinants of health. Third, it should address underlying gender-related determinants in order to influence health outcomes. And fourth, it requires complexity-informed design, implementation, and evaluation. We provide background on key concepts that are essential for designing, implementing, and evaluating gender-transformative health promotion: gender norms, socioecological approaches, and the gender system. We give examples of the four principles in practice, using the case of postnatal mental health promotion in Australia and sexuality education in Mexico. These four principles can be applied to health promotion efforts across contexts and outcomes to address the harmful gender norms that contribute to poor health as a part of broader efforts to improve health and well-being.
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Affiliation(s)
- Jane Fisher
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; ,
| | - Shelly Makleff
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; ,
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Santhya KG, Francis Zavier AJ. Long-Term Impact of Exposure to a Gender-Transformative Program Among Young Men: Findings From a Longitudinal Study in Bihar, India. J Adolesc Health 2022; 70:634-642. [PMID: 34952780 DOI: 10.1016/j.jadohealth.2021.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Gender-transformative programs with men and boys are recognized as a promising strategy for reducing violence against women and girls (VAWG). Reviews of such programs have underscored the need for investments in high-quality studies that measure effects on bio-behavioral outcomes and downstream effects. This article extends the limited evidence on long-term effects of gender-transformative programs with men and boys in India. METHODS We used data from a cluster randomized trial of a gender-transformative life-skills education cum sports coaching program that sought to promote gender egalitarian attitudes and rejection of VAWG among boys and men aged 13-21 and a follow-up study. Young men were interviewed thrice-before the launch, after the completion, and 5 years after the completion of the trial (N = 853). We used generalized estimating equations models to estimate the short- and long-term effects of the intervention and effect modification by participation level and intervention exposure in early/late adolescence. RESULTS The intervention succeeded in promoting gender equitable attitudes and notions of positive masculinity (β = 0.319; p = .012), and attitudes rejecting men's controlling behaviors (β = 0.428; p = .068) and VAWG (β = 0.673; p = .051) among young men in the long- erm. It reduced their perpetration of intimate partner violence (odds ratio 0.639; p = .062). The long-term positive effects were observed for regular participants only, and greater effects were observed among those exposed to the intervention in early than late adolescence. DISCUSSION Exposing boys to gender-transformative programs early on and ensuring their regular intervention participation can have sustained impact on promoting gender egalitarian attitudes and reducing their perpetration of VAWG.
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Affiliation(s)
- K G Santhya
- Population Council, Poverty, Gender and Youth, New Delhi, India.
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Mindry D, Gizaw M, Gwokyalya V, Hurley E, Finocchario-Kessler S, Beyeza-Kashesya J, Wagner GJ, Wanyenze RK, Goggin K. Provider Perspectives on Navigating Relationship Challenges in Assisting HIV-Affected Couples to Meet Their Reproductive Goals: Lessons Learned from a Safer Conception Counseling Intervention in Uganda. AIDS Behav 2022; 26:425-433. [PMID: 34324071 DOI: 10.1007/s10461-021-03397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 12/01/2022]
Abstract
In Uganda, 60% of HIV-affected couples are serodiscordant, many of whom want children. There is a need to assess their reproductive intentions and provide appropriate services that limit transmission risks while meeting reproductive goals. Our Choice intervention engaged male and female HIV-infected clients and their partners in safer conception counseling (SCC) or family planning based on their childbearing decision. We report findings of provider experiences and recommendations for engaging couples in SCC. The intervention was implemented in four clinics offering either SCC1, an intensive training and supervision arm, or SCC2, utilizing the Ministry of Health's standard approach. Qualitative interviews were conducted at 12 (N = 23) and 24 months (N = 25) after initiation of the intervention. Many partners attended at least some SCC sessions, although engaging male partners was more challenging. Providers reported partner involvement improved understanding and facilitated successful implementation of SCM, whereas confusion and challenges were common when the client participated alone. Providers shared successful strategies for engaging male partners.
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Affiliation(s)
- Deborah Mindry
- Center for Womens Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA.
| | | | - Violet Gwokyalya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Emily Hurley
- Schools of Medicine and Pharmacy, Childrens Mercy Research Institute, University of Missouri, Kansas, MO, USA
| | - Sarah Finocchario-Kessler
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas, MO, USA
| | - Jolly Beyeza-Kashesya
- Department of Reproductive Medicine, Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda
| | | | - Rhoda K Wanyenze
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kathy Goggin
- Schools of Medicine and Pharmacy, Childrens Mercy Research Institute, University of Missouri, Kansas, MO, USA
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McGrath A, Richardson N, Murphy N. Strategies for effective implementation and scale-up of a multi-level co-designed men's health initiative "Sheds for Life" in Irish Men's Sheds. Front Health Serv 2022; 2:940031. [PMID: 36925798 PMCID: PMC10012692 DOI: 10.3389/frhs.2022.940031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
Sheds for Life is a gender-specific tailored men's health initiative engaging "hard-to-reach" men in the Men's Shed setting in Ireland. It is implemented by multiple stakeholders at individual, provider, organization and systems level and thus multiple contextual factors influence its scalability. This research used established implementation science frameworks to guide participatory research approaches that captured the process and identified facilitators of and barriers to implementation and scale-up. Active recruitment, co-design processes, leadership and stakeholder engagement emerged as key facilitators of implementation. Prominent barriers were institutional capacity and funding. Acceptability, adoption and appropriateness of the initiative were high among stakeholders with sustainability largely contingent on funding and staff resources. Findings make a valuable contribution to knowledge by capturing the process involved in the implementation of a complex multi-level men's health intervention. It provides a "how to" guide of strategies to engage hard-to-reach men with health promotion, the operationalization and application of implementation frameworks in community-based health promotion, and the implementation of health promotion in Men's Sheds. Documented barriers and facilitators that impact implementation of a community-based men's health program are rare and provide a valuable blueprint for practitioners, researchers and policy makers in the field.
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Affiliation(s)
- Aisling McGrath
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | - Noel Richardson
- National Centre for Men's Health, South East Technological University, Carlow, Ireland
| | - Niamh Murphy
- School of Health Sciences, South East Technological University, Waterford, Ireland
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Khalid S, Dixon S, Vijayasingham L. The gender responsiveness of social entrepreneurship in health - A review of initiatives by Ashoka fellows. Soc Sci Med 2021; 293:114665. [PMID: 34954676 DOI: 10.1016/j.socscimed.2021.114665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
There are vocal calls to act on the gender-related barriers and inequities in global health. Still, there are gaps in implementing programmes that address and counter the relevant dynamics. As an approach that focuses on social problems and public service delivery gaps, social entrepreneurship has the potential to be a closer health sector partner to tackle and transform the influence of gender in health to achieve health systems goals better. Nevertheless, social entrepreneurs' engagement and impact on gender and health remain understudied. Using the Ashoka Fellows database as a sampling frame in November 2020 (n = 3352, health n = 129), we identified and reviewed the work of 21 organizations that implemented gender-responsive health-related programmes between 2000 and 2020. We applied the UNU-IIGH 6-I Analytic Framework to review the gender issues, interventions, included populations, investments, implementation, and impact in each organization. We found that a low proportion of fellows engage in gender-responsive health programming (<1%). Many organizations operate in low-and middle-income countries (16/21). The gender-responsive programmes include established health sector practices, to address gendered-cultural dynamics and deliver people-centred resources and services. Interestingly, most organizations self-identify as NGOs and rely on traditional grant funding. Fewer organizations (6/21) adopt market-based and income-generating solutions - a missed opportunity to actualise the potential of social entrepreneurship as an innovative health financing approach. There were few publicly available impact evaluations-a gap in practice established in social entrepreneurship. All organizations implemented programmes at community levels, with some cross-sectoral, structural, and policy-level initiatives. Most focused on sexual and reproductive health and gender-based violence for predominantly populations of women and girls. Closer partnerships between social entrepreneurs and gender experts in the health sector can provide reciprocally beneficial solutions for cross-sectorally and community designed innovations, health financing, evidence generation and impact tracking that improve the gender-responsiveness of health programmes, policies, and systems.
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Affiliation(s)
- Shazmin Khalid
- United Nations University International Institute for Global Health, UKM Medical Centre, Jalan Yaacob Latiff, 56000, Kuala Lumpur, Malaysia; School of Business, Monash University Malaysia, Jalan Lagoon Selatan, 46150, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Shrijna Dixon
- United Nations University International Institute for Global Health, UKM Medical Centre, Jalan Yaacob Latiff, 56000, Kuala Lumpur, Malaysia; Rockefeller College of Public Affairs and Policy, University at Albany- State University of New York 1400 Washington Ave, Albany, NY, 12222, USA
| | - Lavanya Vijayasingham
- United Nations University International Institute for Global Health, UKM Medical Centre, Jalan Yaacob Latiff, 56000, Kuala Lumpur, Malaysia.
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van Daalen KR, Dada S, Issa R, Chowdhury M, Jung L, Singh L, Stokes D, Orcutt M, Singh NS. A Scoping Review to Assess Sexual and Reproductive Health Outcomes, Challenges and Recommendations in the Context of Climate Migration. Front Glob Womens Health 2021; 2:757153. [PMID: 34816251 PMCID: PMC8594026 DOI: 10.3389/fgwh.2021.757153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: As growing numbers of people may be forced to migrate due to climate change and variability, it is important to consider the disparate impacts on health for vulnerable populations, including sexual and reproductive health (SRH). This scoping review aims to explore the relationship between climate migration and SRH. Methods: We searched PubMed/MEDLINE, CINAHL Plus, EMBASE, Web of Science, Scopus, Global Health and Google for peer-reviewed and gray literature published before 2nd July 2021 in English that reported on SRH in the context of climate migration. Data were extracted using a piloted extraction tool and findings are reported in a narrative synthesis. Results: We screened 1,607 documents. Ten full-text publications were included for analysis: five peer-reviewed articles and five gray literature documents. Reported SRH outcomes focused on maternal health, access to family planning and antiretroviral therapy, sexual and gender-based violence, transactional sex, and early/forced marriage. Recommendations to improve SRH in the context of climate migration called for gender-transformative health systems, education and behavior change programmes, and the involvement of local women in policy planning and programme implementation. Discussion: While the disparate impacts of climate change and migration are well-established, primary data on the scope of impact due to climate migration is limited. The SRH outcomes reported in the literature focus on a relatively narrow range of SRH domains, emphasizing women and girls, over men. Achieving holistic and equitable SRH in the context of climate migration requires engaging all genders across the range of SRH outcomes and migration contexts. This review highlights the need for further empirical evidence on the effect of climate migration on SRH, with research that is context-specific and engages communities in order to reflect the heterogeneity of outcomes and impact in the climate-migration-SRH nexus.
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Affiliation(s)
- Kim Robin van Daalen
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, United Kingdom
| | - Sara Dada
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Rita Issa
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Laura Jung
- Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Lucy Singh
- EGA Institute for Women's Health, University College London, London, United Kingdom
| | | | - Miriam Orcutt
- Institute for Global Health, University College London, London, United Kingdom
| | - Neha S. Singh
- Health in Humanitarian Crises Centre, London School of Tropical Hygiene and Medicine, London, United Kingdom
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Comrie-Thomson L, Gopal P, Eddy K, Baguiya A, Gerlach N, Sauvé C, Portela A. How do women, men, and health providers perceive interventions to influence men's engagement in maternal and newborn health? A qualitative evidence synthesis. Soc Sci Med 2021; 291:114475. [PMID: 34695645 DOI: 10.1016/j.socscimed.2021.114475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022]
Abstract
Globally, there is growing awareness of the important contributions men can make as key stakeholders in maternal and newborn health (MNH), and increased investment in interventions designed to influence men's engagement to improve MNH outcomes. Interventions typically target men, women, couples or health providers, yet how these stakeholders perceive and experience interventions is not well understood and the fact that women may experience these interventions as disempowering has been identified as a major concern. This review aims to synthesise how women, men, and providers perceive and experience interventions designed to influence men's engagement in MNH, in order to identify perceived benefits and risks of participating in interventions, and other key factors affecting uptake of and adherence to interventions. We conducted a qualitative evidence synthesis based on a systematic search of the literature, analysing a purposive sample of 66 out of 144 included studies to enable rich synthesis. Women, men and providers report that interventions enable more and better care for women, newborns and men, and strengthen family relationships between the newborn, father and mother. At the same time, stakeholders report that poorly designed or implemented interventions carry risks of harm, including constraining some women's access to MNH services and compounding negative impacts of existing gender inequalities. Limited health system capacity to deliver men-friendly MNH services, and pervasive gender inequality, can limit the accessibility and acceptability of interventions. Sociodemographic factors, household needs, and peer networks can influence how men choose to support MNH, and may affect demand for and adherence to interventions. Overall, perceived benefits of interventions designed to influence men's engagement in MNH are compelling, reported risks of harm are likely manageable through careful implementation, and there is clear evidence of demand from women and men, and some providers, for increased opportunities and support for men to engage in MNH.
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Neuendorf N, Cheer K, Tommbe R, Kokinai C, Simeon L, Browne K, MacLaren D, Redman-MacLaren M. Sexual health and wellbeing training with women in Pacific Island Countries and Territories: a scoping review. Glob Health Action 2021; 14:1948673. [PMID: 34323158 PMCID: PMC8330752 DOI: 10.1080/16549716.2021.1948673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Women who are spouses of students at a faith-based university in Papua New Guinea (PNG) are afforded proximal power. These women are perceived as leaders and regularly approached by members in their communities to provide advice on sexual and reproductive health matters. Women leaders therefore need access to sexual health information and training to provide appropriate advice. Objective The aim of this paper is to review the characteristics of community-based sexual health training in Pacific Island Countries and Territories (PICTs), as reported in published literature. This is evidence to inform the development of sexual health training programs for women in PNG. Methods A systematic search of databases, repositories and websites identified peer-reviewed studies. Grey literature was also sourced from government and non-government organisations and PNG health professionals. Six published papers, one report, one health worker practice manual and one health worker training package were identified for inclusion. Selected papers were assessed against the Canadian Hierarchy of Evidence to determine quality of evidence for practice. Themes were identified using a thematic analysis approach. Results Three themes became apparent from the literature synthesis: i) program development; ii) mode of delivery, and iii) evaluation. Social and cultural context influenced all elements of sexual health training in PICTs. Few studies reported evidence of comprehensive evaluation. Conclusions Successful sexual health training programs in PICT communities are designed and delivered accounting for local contexts. Programs that engage participants with diverse abilities inspire change to achieve desired outcomes. Key findings from this study can be used to assist women leaders to contextualise and operationalise sexual health training to promote the wellbeing of members in their communities.
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Affiliation(s)
- Nalisa Neuendorf
- College of Medicine and Dentistry, James Cook University, Cairns, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Karen Cheer
- College of Medicine and Dentistry, James Cook University, Cairns, Australia.,The Cairns Institute, James Cook University, Cairns, Australia
| | - Rachael Tommbe
- College of Medicine and Dentistry, James Cook University, Cairns, Australia.,School of Health Science, Pacific Adventist University, Port Moresby, Papua New Guinea
| | - Clare Kokinai
- School of Arts and Humanities, Pacific Adventist University, Port Moresby, Papua New Guinea
| | - Lalen Simeon
- Deputy Vice Chancellor, Chancellory, Pacific Adventist University, Port Moresby, Papua New Guinea
| | | | - David MacLaren
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
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Newmann SJ, Zakaras JM, Dworkin SL, Withers M, Ndunyu L, Gitome S, Gorrindo P, Bukusi EA, Rocca CH. Measuring Men's Gender Norm Beliefs Related to Contraception: Development of the Masculine Norms and Family Planning Acceptance Scale. Arch Sex Behav 2021; 50:2691-2702. [PMID: 33821378 PMCID: PMC8416878 DOI: 10.1007/s10508-021-01941-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Male partner resistance is identified as a key factor that influences women's contraceptive use. Examination of the masculine norms that shape men's resistance to contraception-and how to intervene on these norms-is needed. To assess a gender-transformative intervention in Kenya, we developed and evaluated a masculinity-informed instrument to measure men's contraceptive acceptance-the Masculine Norms and Family Planning Acceptance (MNFPA) scale. We developed draft scale items based on qualitative research and administered them to partnered Kenyan men (n = 150). Item response theory-based methods were used to reduce and psychometrically evaluate final scale items. The MNFPA scale had a Cronbach's α of 0.68 and loaded onto a single factor. MNFPA scores were associated with self-efficacy and intention to accept a female partner's use of contraception; scores were not associated with current contraceptive use. The MNFPA scale is the first rigorously developed and psychometrically evaluated tool to assess men's contraceptive acceptance as a function of male gender norms. Future work is needed to test the MNFPA measure in larger samples and across different contexts. The scale can be used to evaluate interventions that seek to shift gender norms to increase men's positive engagement in pregnancy spacing and prevention.
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Affiliation(s)
- Sara J Newmann
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Unit 6D-14, San Francisco, CA, 94110, USA.
| | - Jennifer Monroe Zakaras
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - Mellissa Withers
- University of Southern California Institute On Inequalities in Global Health, Los Angeles, CA, USA
| | - Louisa Ndunyu
- Kenya Medical Research Institute, Nairobi, Kenya
- The Department of Public Health, School of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - Serah Gitome
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Phillip Gorrindo
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, Oakland, CA, USA
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Kutywayo A, Frade S, Gordon K, Mahuma T, Naidoo NP, Mullick S. Who’s got the power? Expressions of empowerment among in-school adolescents enrolled in the Girls Achieve Power (GAP Year) trial in three peri-urban settings of South Africa. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13336.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Empowerment is when a person gains mastery of their life and environment. This paper describes three central elements of empowerment (agency, resources, and institutional structures) expressed by adolescents, discussing implications for strengthening adolescent sexual reproductive health, HIV, and violence prevention programming. Methods: A cross-sectional survey was conducted (April 2017 – May 2018) as part of the GAP Year trial among grade eight learners (12 – 18 years) from 26 lowest quintile public high schools in Khayelitsha, Soweto and Thembisa townships, South Africa. Data were on empowerment experiences using a knowledge, attitudes, and practices survey. Descriptive and chi-square test statistics were employed, assessing the association between sociodemographic and domains of empowerment. Results: A total of 2383 adolescents in 26 schools completed the baseline survey: 63.1% female, mean age 13.7 years, 96.9% Black African. Agency: Males (4.04 vs 3.94, p=0.008) and those 15 – 18 years (4.10 vs 3.95, p=0.027) expressed stronger decision-making capacity. Females (3.18 vs 2.92, p<0.001) indicated a greater sense of collective action. Females (0.77 vs 0.72, p=0.008), those aged 12 -14 years (0.76 vs 0.71, p=0.027) and those with at least one parent/guardian employed (p=0.014) had stronger leadership confidence. Resources: Those 12-14 years expressed higher self-esteem (2.18 vs 2.08, p=0.017). Males (2.24 vs 1.87, p<0.001) and those who had at least one parent/guardian employed (p=0.047) had a higher perception of freedom from gender-based violence. Males showed greater mobility (2.89 vs 2.66, p=<0.001). Institutional structures: Coloured participants showed more positive norms than their Black counterparts (5.38 vs 2.12, p=0.005). Conclusions: Males expressed greater empowerment around decision-making, gender-based violence and mobility; females expressed greater collective action and leadership. Working across the ecological model, interventions addressing sex differences, targeting adolescents of all ages, and parental unemployment may strengthen expressions of empowerment, especially adolescents’ safety, mobility, aspirations, and future hopes.
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Ruane-McAteer E, Gillespie K, Amin A, Aventin Á, Robinson M, Hanratty J, Khosla R, Lohan M. Gender-transformative programming with men and boys to improve sexual and reproductive health and rights: a systematic review of intervention studies. BMJ Glob Health 2021; 5:bmjgh-2020-002997. [PMID: 33051283 PMCID: PMC7554509 DOI: 10.1136/bmjgh-2020-002997] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022] Open
Abstract
Background Global health organisations advocate gender-transformative programming (which challenges gender inequalities) with men and boys to improve sexual and reproductive health and rights (SRHR) for all. We systematically review evidence for this approach. Methods We previously reported an evidence-and-gap map (http://srhr.org/masculinities/wbincome/) and systematic review of reviews of experimental intervention studies engaging men/boys in SRHR, identified through a Campbell Collaboration published protocol (https://doi.org/10.1002/CL2.203) without language restrictions between January 2007 and July 2018. Records for the current review of intervention studies were retrieved from those systematic reviews containing one or more gender-transformative intervention studies engaging men/boys. Data were extracted for intervention studies relating to each of the World Health Organization (WHO) SRHR outcomes. Promising programming characteristics, as well as underused strategies, were analysed with reference to the WHO definition of gender-transformative programming and an established behaviour change model, the COM-B model. Risk of bias was assessed using Cochrane Risk of Bias tools, RoB V.2.0 and Risk of Bias In Non-randomised Studies of Interventions. Findings From 509 eligible records, we synthesised 68 studies comprising 36 randomised controlled trials, n=56 417 participants, and 32 quasi-experimental studies, n=25 554 participants. Promising programming characteristics include: multicomponent activities of education, persuasion, modelling and enablement; multilevel programming that mobilises wider communities; targeting both men and women; and programmes of longer duration than three months. Six of the seven interventions evaluated more than once show efficacy. However, we identified a significant risk of bias in the overall available evidence. Important gaps in evidence relate to safe abortion and SRHR during disease outbreaks. Conclusion It is widely acknowledged by global organisations that the question is no longer whether to include boys and men in SRHR but how to do so in ways that promote gender equality and health for all and are scientifically rigorous. This paper provides an evidence base to take this agenda for programming and research forward.
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Affiliation(s)
| | - Kathryn Gillespie
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Avni Amin
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Áine Aventin
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Martin Robinson
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Jennifer Hanratty
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Rajat Khosla
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Maria Lohan
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
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Gibbs A, Dunkle K, Mhlongo S, Chirwa E, Hatcher A, Christofides NJ, Jewkes R. Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa. BMJ Glob Health 2021; 5:bmjgh-2019-002199. [PMID: 32424011 PMCID: PMC7239517 DOI: 10.1136/bmjgh-2019-002199] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/21/2020] [Accepted: 03/07/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Emerging evidence suggests working with men to prevent intimate partner violence (IPV) perpetration can be effective. However, it is unknown whether all men benefit equally, or whether different groups of men respond differentially to interventions. METHODS We conducted trajectory modelling using longitudinal data from men enrolled in intervention arms of three IPV trials in South Africa and Rwanda to identify trajectories of IPV perpetration. We then use multinomial regression to describe baseline characteristics associated with group allocation. RESULTS In South Africa, the Stepping Stones and Creating Futures (SS-CF) trial had 289 men and the CHANGE trial had 803 men, and in Rwanda, Indashyikirwa had 821 men. We identified three trajectories of IPV perpetration: a low-flat (60%-67% of men), high with large reduction (19%-24%) and high with slight increase (10%-21%). Baseline factors associated men in high-start IPV trajectories, compared with low-flat trajectory, varied by study, but included higher poverty, poorer mental health, greater substance use, younger age and more childhood traumas. Attitudes supportive of IPV were consistently associated with high-start trajectories. In separate models comparing high-reducing to high-increasing trajectories, baseline factors associated with reduced IPV perpetration were depressive symptoms (relative risk ratio, RRR=3.06, p=0.01 SS-CF); living separately from their partner (RRR=2.14, p=0.01 CHANGE); recent employment (RRR=1.85, p=0.04 CHANGE) and lower acceptability of IPV (RRR=0.60, p=0.08 Indashyikirwa). Older aged men had a trend towards reducing IPV perpetration in CHANGE (p=0.06) and younger men in Indashyikirwa (p=0.07). CONCLUSIONS Three distinct groups of men differed in their response to IPV prevention interventions. Baseline characteristics of past traumas and current poverty, mental health and gender beliefs predicted trajectory group allocation. The analysis may inform targeting of interventions towards those who have propensity to change or guide how contextual factors may alter intervention effects. TRIAL REGISTRATION NUMBERS NCT03022370; NCT02823288; NCT03477877.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa .,Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Abigail Hatcher
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,University of North Carolina, Chapel Hill, United States
| | - Nicola J Christofides
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Office of the Excutive Scientist, South African Medical Research Council, Pretoria, South Africa
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Robinson M, Aventin Á, Hanratty J, Ruane-McAteer E, Tomlinson M, Clarke M, Okonofua F, Lohan M. Nothing so practical as theory: a rapid review of the use of behaviour change theory in family planning interventions involving men and boys. Reprod Health 2021; 18:126. [PMID: 34120630 PMCID: PMC8201745 DOI: 10.1186/s12978-021-01173-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/06/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is growing recognition of the need for interventions that effectively involve men and boys to promote family planning behaviours. Evidence suggests that the most effective behavioural interventions in this field are founded on theoretical principles of behaviour change and gender equality. However, there are few evidence syntheses on how theoretical approaches are applied in this context that might guide best practice in intervention development. This review addresses this gap by examining the application and reporting of theories of behaviour change used by family planning interventions involving men and boys. METHODS We adopted a systematic rapid review approach, scoping findings of a previously reported evidence and gap map of intervention reviews (covering 2007-2018) and supplementing this with searches of academic databases and grey literature for reviews and additional studies published between 2007 and 2020. Studies were eligible for inclusion if their title, abstract or keywords referred to a psychosocial or behavioural intervention targeting family planning behaviours, involved males in delivery, and detailed their use of an intervention theory of change. RESULTS From 941 non-duplicate records identified, 63 were eligible for inclusion. Most records referenced interventions taking place in low- and middle-income countries (65%). There was a range of intervention theories of change reported, typically targeting individual-level behaviours and sometimes comprising several behaviour change theories and strategies. The most commonly identified theories were Social Cognitive Theory, Social Learning Theory, the Theory of Planned Behaviour, and the Information-Motivation-Behaviour Skills (IMB) Model. A minority of records explicitly detailed gender-informed elements within their theory of change. CONCLUSION Our findings highlight the range of prevailing theories of change used for family planning interventions involving men and boys, and the considerable variability in their reporting. Programmers and policy makers would be best served by unified reporting and testing of intervention theories of change. There remains a need for consistent reporting of these to better understand how complex interventions that seek to involve men and boys in family planning may lead to behaviour change.
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Affiliation(s)
- Martin Robinson
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Áine Aventin
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Jennifer Hanratty
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Mark Tomlinson
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Mike Clarke
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Friday Okonofua
- Women's Health Action Research Centre, Benin City, Edo State, Nigeria
| | - Maria Lohan
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK
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Stewart R, Wright B, Smith L, Roberts S, Russell N. Gendered stereotypes and norms: A systematic review of interventions designed to shift attitudes and behaviour. Heliyon 2021; 7:e06660. [PMID: 33912699 PMCID: PMC8066375 DOI: 10.1016/j.heliyon.2021.e06660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/06/2020] [Accepted: 03/29/2021] [Indexed: 02/01/2023] Open
Abstract
In the face of ongoing attempts to achieve gender equality, there is increasing focus on the need to address outdated and detrimental gendered stereotypes and norms, to support societal and cultural change through individual attitudinal and behaviour change. This article systematically reviews interventions aiming to address gendered stereotypes and norms across several outcomes of gender inequality such as violence against women and sexual and reproductive health, to draw out common theory and practice and identify success factors. Three databases were searched; ProQuest Central, PsycINFO and Web of Science. Articles were included if they used established public health interventions types (direct participation programs, community mobilisation or strengthening, organisational or workforce development, communications, social marketing and social media, advocacy, legislative or policy reform) to shift attitudes and/or behaviour in relation to rigid gender stereotypes and norms. A total of 71 studies were included addressing norms and/or stereotypes across a range of intervention types and gender inequality outcomes, 55 of which reported statistically significant or mixed outcomes. The implicit theory of change in most studies was to change participants' attitudes by increasing their knowledge/awareness of gendered stereotypes or norms. Five additional strategies were identified that appear to strengthen intervention impact; peer engagement, addressing multiple levels of the ecological framework, developing agents of change, modelling/role models and co-design of interventions with participants or target populations. Consideration of cohort sex, length of intervention (multi-session vs single-session) and need for follow up data collection were all identified as factors influencing success. When it comes to engaging men and boys in particular, interventions with greater success include interactive learning, co-design and peer leadership. Several recommendations are made for program design, including that practitioners need to be cognisant of breaking down stereotypes amongst men (not just between genders) and the avoidance of reinforcing outdated stereotypes and norms inadvertently.
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Affiliation(s)
- Rebecca Stewart
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Breanna Wright
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Liam Smith
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Steven Roberts
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, Victoria, Australia
| | - Natalie Russell
- Victorian Health Promotion Foundation (VicHealth), Melbourne, Victoria, Australia
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Aventin Á, Robinson M, Hanratty J, Ruane‐McAteer E, Tomlinson M, Clarke M, Okonofua F, Bonell C, Lohan M. PROTOCOL: Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries. Campbell Syst Rev 2021; 17:e1140. [PMID: 37050964 PMCID: PMC8356317 DOI: 10.1002/cl2.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
| | | | | | | | - Mark Tomlinson
- Queen's University BelfastBelfastUK
- Stellenbosch UniversityStellenboschSouth Africa
| | | | | | - Chris Bonell
- London School of Hygiene and Tropical MedicineLondonUK
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Narasimhan M, Logie CH, Moody K, Hopkins J, Montoya O, Hardon A. The role of self-care interventions on men's health-seeking behaviours to advance their sexual and reproductive health and rights. Health Res Policy Syst 2021; 19:23. [PMID: 33596921 PMCID: PMC7888093 DOI: 10.1186/s12961-020-00655-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Self-care interventions are influencing people's access to, expectation and understanding of healthcare beyond formal health delivery systems. In doing so, self-care interventions could potentially improve health-seeking behaviours. While many men proactively engage in maintaining and promoting their health, the focus on men's health comes from the recognition, at least partially, that male socialization and social norms can induce men and boys to have a lower engagement in institutionalized public health entities and systems around their sexual and reproductive health and rights, that could impact negatively on themselves, their partners and children. MAIN TEXT A research agenda could consider the ways that public health messaging and information on self care practices for sexual and reproductive health and rights could be tailored to reflect men's lived realities and experiences. Three examples of evidence-based self-care interventions related to sexual and reproductive health and rights that men can, and many do, engage in are briefly discussed: condom use, HIV self-testing and use of telemedicine and digital platforms for sexual health. We apply four core elements that contribute to health, including men's health (people-centred approaches, quality health systems, a safe and supportive enabling environment, and behaviour-change communication) to each intervention where further research can inform normative guidance. CONCLUSION Engaging men and boys and facilitating their participation in self care can be an important policy intervention to advance global sexual and reproductive health and rights goals. The longstanding model of men neglecting or even sabotaging their wellbeing needs to be replaced by healthier lifestyles, which requires understanding how factors related to social support, social norms, power, academic performance or employability conditions, among others, influence men's engagement with health services and with their own self care practices.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada
| | | | | | - Oswaldo Montoya
- MenEngage Alliance Global Secretariat, 1875 Connecticut Avenue. Floor 10, Washington, D.C., 20009, United States of America
| | - Anita Hardon
- Institute for Advanced Studies and Anthropology Department, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands
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de Villiers T, Duma S, Abrahams N. "As young men we have a role to play in preventing sexual violence": Development and relevance of the men with conscience intervention to prevent sexual violence. PLoS One 2021; 16:e0244550. [PMID: 33411823 PMCID: PMC7790258 DOI: 10.1371/journal.pone.0244550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022] Open
Abstract
Sexual violence against women and girls is a major public health problem globally and in South Africa. Although young men have been identified as an important risk group for prevention interventions, scant attention have been given to this age cohort in low and middle-income countries. There is strong evidence that perpetration starts early and increasing attention is being drawn to Higher Education Institutions (HEIs) as settings for prevention interventions. The main objective of this study was to adapt the One Man Can Intervention for use with male university students in residences and develop materials for implementation. This paper presents the qualitative findings of the adaptation process of the One Man Can Intervention with 15 young male student leaders at a HEI in South Africa. The same participants who started in the study, participated throughout. Only five of the 15 participants were located and participated in the interviews six months post intervention. The results show the emergence of a six-hour session adapted intervention that addresses key drivers of violence against women and girls (VAWG). Critical engagement and dialogue on sexual violence is shown to shift key norms on gender equality, on being a man and reflection on their role in preventing sexual violence. This paper contributes to the field where much learning, refining and improvement of prevention interventions for VAWG are ongoing.
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Affiliation(s)
- Tania de Villiers
- Division of Nursing and Midwifery, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Sinegugu Duma
- College of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Naeemah Abrahams
- Gender and Health Research Unit, SA Medical Research Council, Women’s Health Research Unit, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Aventin Á, Rabie S, Skeen S, Tomlinson M, Makhetha M, Siqabatiso Z, Lohan M, Clarke M, Lohfeld L, Thurston A, Stewart J. Adaptation of a gender-transformative sexual and reproductive health intervention for adolescent boys in South Africa and Lesotho using intervention mapping. Glob Health Action 2021; 14:1927329. [PMID: 34106036 PMCID: PMC8205055 DOI: 10.1080/16549716.2021.1927329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Rates of adolescent HIV and unintended pregnancy in southern Africa are amongst the highest in the world. Gender-transformative interventions that address underlying gender inequalities and engage both males and females have been emphasised by the World Health Organisation, amongst others, to target prevention. However, few such gender-transformative interventions have been rigorously developed or evaluated.Objective: To expedite potential impact and reduce development costs, we conducted a needs assessment to inform the co-design, in consultation with local stakeholders, of adapted versions of an existing gender-transformative Relationships and Sexuality Education intervention for use in South Africa and Lesotho.Methods: Adaptation of the intervention was guided by a modified version of Intervention Mapping (IM). This process involved consultation with separate adolescent, community and expert advisory groups and a collaboratively conducted needs assessment, which drew on focus groups with adolescents (8 groups, n = 55) and adults (4 groups, n = 22) in South Africa and Lesotho, and was informed by our systematic review of the literature on the determinants of condom use among adolescents in the region.Results: The findings clarified how the intervention should be adapted, which individual- and environmental-level determinants of condom use to target, and actions for facilitating successful adoption, evaluation and implementation in the new settings.Conclusions: The IM approach allows for a systematic appraisal of whether components and processes of an existing intervention are appropriate for a new target population before costly evaluation studies are conducted. The findings will be of interest to those wishing to rigourously develop and evaluate gender-transformative interventions engaging men to improve health for all.
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Affiliation(s)
- Áine Aventin
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Stephan Rabie
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Cape Town, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Mark Tomlinson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, UK
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | | | - Zenele Siqabatiso
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Maria Lohan
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Mike Clarke
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Lynne Lohfeld
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Allen Thurston
- School of Education, Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Jackie Stewart
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
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