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Miles S, Renedo A, Kühlbrandt C, McGowan C, Stuart R, Grenfell P, Marston C. Health risks at work mean risks at home: Spatial aspects of COVID-19 among migrant workers in precarious jobs in England. Sociol Health Illn 2024; 46:381-398. [PMID: 37728181 DOI: 10.1111/1467-9566.13711] [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] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/11/2023] [Indexed: 09/21/2023]
Abstract
During COVID-19 lockdowns in England, 'key workers' including factory workers, carers and cleaners had to continue to travel to workplaces. Those in key worker jobs were often from more marginalised communities, including migrant workers in precarious employment. Recognising space as materially and socially produced, this qualitative study explores migrant workers' experiences of navigating COVID-19 risks at work and its impacts on their home spaces. Migrant workers in precarious employment often described workplace COVID-19 protection measures as inadequate. They experienced work space COVID-19 risks as extending far beyond physical work boundaries. They developed their own protection measures to try to avoid infection and to keep the virus away from family members. Their protection measures included disinfecting uniforms, restricting leisure activities and physically separating themselves from their families. Inadequate workplace COVID-19 protection measures limited workers' ability to reduce risks. In future outbreaks, support for workers in precarious jobs should include free testing, paid sick leave and accommodation to allow for self-isolation to help reduce risks to workers' families. Work environments should not be viewed as discrete risk spaces when planning response measures; responses and risk reduction approaches must also take into account impacts on workers' lives beyond the workplace.
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Affiliation(s)
- Sam Miles
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alicia Renedo
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Charlotte Kühlbrandt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine McGowan
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Stuart
- College of Business, Arts and Social Sciences, Brunel University London, London, UK
| | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Alam P, Lin L, Thakkar N, Thaker A, Marston C. Socio-sexual norms and young people's sexual health in urban Bangladesh, India, Nepal and Pakistan: A qualitative scoping review. PLOS Glob Public Health 2024; 4:e0002179. [PMID: 38377126 PMCID: PMC10878529 DOI: 10.1371/journal.pgph.0002179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 01/20/2024] [Indexed: 02/22/2024]
Abstract
In South Asia, young people face myriad challenges and opportunities regarding their sexual lives relating to varied experiences of norms and restrictions; gender norms and socio-sexual taboos limit communication around sexual health which in turn can affect sexual health outcomes. In this article we focus on norms affecting young people's sexual health experiences in urban settings in Bangladesh, India, Nepal, and Pakistan. We conducted a scoping review of peer reviewed empirical studies based on qualitative data pertaining to young people's experiences of sexuality and sexual health in Bangladesh, India, Nepal, and Pakistan. We searched four electronic databases for articles published (2010-2022), using terms relating to sexual health, young people, and South Asia. Sixteen articles met the inclusion criteria with sample size ranging from 9 to 180. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines for the design and analysis of this study. We synthesised the included articles using thematic analysis. The studies covered topics such as sexual health services and contraceptive use; sexuality education and communication; and gender and sexual violence. Recurring findings included: parental and societal expectations around premarital 'sexual purity' through abstinence; limited communication around sexuality between young people and parents/adults; gender norms limiting young women's sexual and reproductive decision making; and an absence of research on experiences of sexual and gender minorities. We identified common themes as well as prominent gaps which must be addressed if we are to capture diverse experiences and build a better evidence base to improve sexual health services for young people in the region. The body of research fails to include experiences of young people with diverse gender, sexual orientation, and sex characteristics.
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Affiliation(s)
- Prima Alam
- Faculty of Public Health and Policy, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, China
| | - Leesa Lin
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, China
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nandan Thakkar
- School of Medicine, University of North Carolina, North Carolina, United States of America
| | - Abhi Thaker
- Indian Institute of Public Health Gandhinagar, Gandhinagar, Gujarat, India
| | - Cicely Marston
- Faculty of Public Health and Policy, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lissmann R, Lokot M, Marston C. Understanding the lived experience of pregnancy and birth for survivors of rape and sexual assault. BMC Pregnancy Childbirth 2023; 23:796. [PMID: 37974064 PMCID: PMC10652570 DOI: 10.1186/s12884-023-06085-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND One in five women in the UK are survivors of rape and sexual assault, and four in five women will give birth. This implies that a substantial number of women experience rape and sexual assault before pregnancy. We highlight and explore the voices and lived experiences of survivors during pregnancy and birth, to better understand the relationship between sexual violence, biomedicine, and pregnancy and to inform maternity care practice. METHODS This qualitative research took an intersectional feminist approach. We conducted in-depth individual interviews in England with fourteen women who self-identified as survivors of rape or sexual assault, and who had experienced pregnancy and birth after the assault. We conducted open line-by-line coding of the interview transcripts, and identified key themes and sub-themes inductively. RESULTS Three themes help summarise the narratives: control, safety and trauma. Maintaining a sense of control was important to survivors but they often reported objectification by healthcare staff and lack of consent or choice about healthcare decisions. Participants' preferences for giving birth were often motivated by their desire to feel in control and avoid triggering traumatic memories of the sexual assault. Survivors felt safer when they trusted staff. Many participants said it was important for staff to know they were survivors but none were asked about this. Pregnancy and birth experiences were triggering when they mirrored the assault, for instance if the woman was prevented from moving. Many of our participants reported having unmet mental health care needs before, during or after pregnancy. CONCLUSIONS Survivors of sexual violence have specific maternity care needs. For our participants, these needs were often not met, leading to negative or traumatic experiences of pregnancy and birth. Systemic biases and poor birth experience jeopardise both psychological and physical safety. Funding for maternity and mental health services must be improved, so that they meet minimum staffing and care standards. Maternity services should urgently introduce trauma-informed models of care.
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Affiliation(s)
- Rebecca Lissmann
- Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, England.
| | - Michelle Lokot
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England
| | - Cicely Marston
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England
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Kumar MB, Roder-DeWan S, Nyondo-Mipando AL, Mirzoev T, Marston C. Participatory economic approaches in global health evaluations. Lancet Glob Health 2023; 11:e1001-e1002. [PMID: 37349025 DOI: 10.1016/s2214-109x(23)00265-6] [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] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Meghan Bruce Kumar
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; KEMRI-Wellcome Trust, Nairobi, Kenya.
| | - Sanam Roder-DeWan
- World Bank Group, Washington, DC, USA; Dartmouth University, Hanover, NH, USA
| | | | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Cicely Marston
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Marston C, Tabot M. How can we put rights at the core of global family planning? Lancet 2023; 401:2096-2098. [PMID: 37003288 DOI: 10.1016/s0140-6736(23)00523-8] [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: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Mallah Tabot
- International Planned Parenthood Federation, Africa Regional Office, Nairobi, Kenya
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Renedo A, Stuart R, Kühlbrandt C, Grenfell P, McGowan CR, Miles S, Farrow S, Marston C. Community-led responses to COVID-19 within Gypsy and Traveller communities in England: A participatory qualitative research study. SSM Qual Res Health 2023; 3:100280. [PMID: 37200551 PMCID: PMC10156409 DOI: 10.1016/j.ssmqr.2023.100280] [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: 01/18/2023] [Revised: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
Individuals were asked to play an active role in infection control in the COVID-19 pandemic. Yet while government messages emphasised taking responsibility for the public good (e.g. to protect the National Health Service), they appeared to overlook social, economic and political factors affecting the ways that people were able to respond. We co-produced participatory qualitative research with members of Gypsy and Traveller communities in England between October 2021 and February 2022 to explore how they had responded to COVID-19, its containment (test, trace, isolate) and the contextual factors affecting COVID-19 risks and responses within the communities. Gypsies and Travellers reported experiencing poor treatment from health services, police harassment, surveillance, and constrained living conditions. For these communities, claiming the right to health in an emergency required them to rely on community networks and resources. They organised collective actions to contain COVID-19 in the face of this ongoing marginalisation, such as using free government COVID-19 tests to support self-designed protective measures including community-facilitated testing and community-led contact tracing. This helped keep families and others safe while minimising engagement with formal institutions. In future emergencies, communities must be given better material, political and technical support to help them to design and implement effective community-led solutions, particularly where government institutions are untrusted or untrustworthy.
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Affiliation(s)
- Alicia Renedo
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Rachel Stuart
- College of Business, Arts and Social Sciences, Brunel University London, Kingston Lane, Middlesex, UB8 3PH, UK
| | - Charlotte Kühlbrandt
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Pippa Grenfell
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Catherine R. McGowan
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sam Miles
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | | | - Cicely Marston
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Kühlbrandt C, McGowan CR, Stuart R, Grenfell P, Miles S, Renedo A, Marston C. COVID-19 vaccination decisions among Gypsy, Roma, and Traveller communities: A qualitative study moving beyond "vaccine hesitancy". Vaccine 2023:S0264-410X(23)00515-7. [PMID: 37202271 DOI: 10.1016/j.vaccine.2023.04.080] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Many people refuse vaccination and it is important to understand why. Here we explore the experiences of individuals from Gypsy, Roma, and Traveller groups in England to understand how and why they decided to take up or to avoid COVID-19 vaccinations. METHODS We used a participatory, qualitative design, including wide consultations, in-depth interviews with 45 individuals from Gypsy, Roma, and Traveller, communities (32 female, 13 male), dialogue sessions, and observations, in five locations across England between October 2021 and February 2022. FINDINGS Vaccination decisions overall were affected by distrust of health services and government, which stemmed from prior discrimination and barriers to healthcare which persisted or worsened during the pandemic. We found the situation was not adequately characterised by the standard concept of "vaccine hesitancy". Most participants had received at least one COVID-19 vaccine dose, usually motivated by concerns for their own and others' health. However, many participants felt coerced into vaccination by medical professionals, employers, and government messaging. Some worried about vaccine safety, for example possible impacts on fertility. Their concerns were inadequately addressed or even dismissed by healthcare staff. INTERPRETATION A standard "vaccine hesitancy" model is of limited use in understanding vaccine uptake in these populations, where authorities and health services have been experienced as untrustworthy in the past (with little improvement during the pandemic). Providing more information may improve vaccine uptake somewhat; however, improved trustworthiness of health services for GRT communities is essential to increase vaccine coverage. FUNDING This paper reports on independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or its arm's length bodies, and other Government Departments.
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Affiliation(s)
- Charlotte Kühlbrandt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Catherine R McGowan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Rachel Stuart
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; College of Business, Arts and Social Sciences, Brunel University London, Kingston Lane, Uxbridge, Middlesex UB8 3PH, United Kingdom
| | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Sam Miles
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Barts & The London School of Medicine and Dentistry, Queen Mary University of London E1 2AD, United Kingdom
| | - Alicia Renedo
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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Nicholls EJ, McGowan CR, Miles S, Baxter L, Dix L, Rowlands S, McCartney D, Marston C. Provision of cervical screening for transmasculine patients: a review of clinical and programmatic guidelines. BMJ Sex Reprod Health 2023; 49:118-128. [PMID: 36344235 DOI: 10.1136/bmjsrh-2022-201526] [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: 03/29/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Most cervical cancer can be prevented through routine screening. Disparities in uptake of routine screening therefore translate into disparities in cervical cancer incidence and outcomes. Transmasculine people including transgender men experience multiple barriers to cervical screening and their uptake of screening is low compared with cisgender women. Comprehensive evidence-based guidelines are needed to improve cervical screening for this group. METHODS We searched for and synthesised clinical and programmatic guidelines for the provision of cervical screening for transmasculine patients. FINDINGS The guidelines offer recommendations addressing: (1) reception, check-in and clinic facilities; (2) patient data and invitation to screening; (3) improving inclusion in screening programmes; and (4) sexual history taking, language and identity. Guidelines offer strategies for alleviating physical and psychological discomfort during cervical screening and recommendations on what to do if the screening procedure cannot be completed. Most of the guidelines were from and for high-income countries. DISCUSSION The evidence base is limited, but existing guidelines provide recommendations to ensure life-saving screening services are available to all who need them. We were only able to identify one set of guidelines for a middle-income country, and none for low-income countries. We encourage the involvement of transmasculine people in the development of future guidelines.
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Affiliation(s)
- Emily Jay Nicholls
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
| | - Catherine R McGowan
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sam Miles
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Louisa Baxter
- Medical Specialties Unit, Médecins Sans Frontières, Barcelona, Spain
| | - Laura Dix
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Daniel McCartney
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Cicely Marston
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
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Alam P, Marston C. 'Bending' against straightening devices: queer lived experiences of sexuality and sexual health in Bangladesh. BMC Public Health 2023; 23:173. [PMID: 36698108 PMCID: PMC9878820 DOI: 10.1186/s12889-023-15085-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Despite global data around increased health risks among sexual and gender diverse populations, lived experiences of young lesbian, gay, bisexual, transgender, queer or questioning, and others (LGBTQ+) people are often ignored in mainstream health research. This is particularly evident in countries such as Bangladesh where the rights of sexual minorities are not recognised. This article looks at queer lived experiences of sexuality and sexual health within such a context. We use the phenomenological framework of heteronormative 'straightening devices' - mechanisms working to direct people towards heterosexuality, gender conformity, and procreative marriage - to identify 'invisible' structures upholding normative sexual behaviours and see how young people in Bangladesh navigate these in their everyday lives. METHODS This article is based on qualitative data collected in Dhaka, Bangladesh over nine months in 2019 as part of the first author's doctoral research. Using thematic analysis, we draw on experiences of normative sexual expectations from biographical in-depth interviews with 14 purposively sampled LGBTQ + individuals aged 18 to 24. RESULTS Respondents identified heteronormative expectations around gender norms of traditional behaviour and presentation for men and women as well as parental expectations of compulsory heterosexuality through marriage. These straightening devices existed at multiple levels, including individual, interpersonal, community, and societal. The four main themes around straightening devices include marriage norms for women; harassment of feminine-presenting bodies in public spaces; heteronormative healthcare; and consequences of not embodying heteronormativity. CONCLUSION Our study highlighted young people's everyday experiences of having to 'bend' to - and against - heteronormative straightening devices at home, in public spaces, and within institutions such as healthcare in Bangladesh. The exploration of queer experiences provides new insights into context-specific ways in which sexual and gender diverse people understand themselves. Further research using the framework of straightening devices can help public health professionals to identify more 'barriers' confronted by sexual and gender diverse young people.
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Affiliation(s)
- Prima Alam
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Cicely Marston
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Authorship of academic papers is a currency that can bring career advantages in academia and other industries. How authorship should be decided is not always clear, particularly in co-produced research with non-academic collaborators, for which existing authorship guidelines are largely silent. In this paper, we critically reflect on what constitutes written authorship in the context of co-produced health research. We present examples from our own work to illustrate the argument we make, including publishing a co-authored paper with non-academic partners. We consider questions of what constitutes authorship and how it is mutually understood. We discuss some of the opportunities and limits to participation and how these might translate into academic authorship as a collaborative research output. Finally, we explore the potential of authorship guidelines as a resource for critical reflection on what we mean by co-produced work and how we recognise contributions to global health research. We suggest that authorship guidelines should be adapted to encourage attribution of co-produced research to include non-academic as well as academic collaborators, and we provide a draft guideline for how this might be done.
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Affiliation(s)
- Sam Miles
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Alicia Renedo
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Tessema G, Marinovich ML, Håberg SE, Gissler M, Mayo JA, Nassar N, Ball S, Betrán AP, Gebremedhin AT, de Klark N, Magnus MC, Marston C, Regan AK, Shaw GM, Padula AM, Pereira G. 455Association of interpregnancy interval and preterm births: what does a sibling-matched study indicate? Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.655] [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
Abstract
Background
Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from between-women (unmatched) studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women (sibling-matched) can address this issue.
Methods
We conducted an international longitudinal study of births from Australia, Finland, Norway, and United States (California) covering over three decades (1980-2017). We included 5,523,914 births to 3,849,737 women, and within each country, we first investigated the associations between IPI and preterm birth (PTB), spontaneous PTB using logistic regression (unmatched analyses). Second, we used conditional logistic regression comparing IPIs in the same women (sibling-matched analyses), with 2,908,907 births to 1,234,730 women having at least two IPIs. Random effects meta-analysis was used to calculate pooled effect estimates.
Results
Compared to an IPI of 18-23 months, there was insufficient evidence of association between IPI <6 months and overall PTB (adjusted odds ratio (aOR)=1.08, 95%CI 0.99-1.18) but increased odds of spontaneous PTB (aOR=1.38, 95%CI 1.21-1.57). We observed elevated odds of both birth outcomes associated with IPI ≥60 months. In comparison, between-women analyses showed elevated odds of adverse birth outcomes for <12 month and >24 month IPIs.
Conclusions
We found consistently elevated odds of PTB following long IPIs. IPI shorter than 6 months were associated with elevated risk of spontaneous PTB, but there was insufficient evidence for increased risk of overall PTB.
Key message
Current recommendations of waiting at least 24 months to conceive after a previous pregnancy, may be unnecessarily long in high-income countries.
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Affiliation(s)
- Gizachew Tessema
- School of Public Health, Curtin University, Perth, Australia
- School of Public Health, University of Adelaide, Adelaide, Australia
| | | | - Siri E Håberg
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Jonathan A Mayo
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, United States
| | - Natasha Nassar
- Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Stephen Ball
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Nick de Klark
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Maria C Magnus
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Annette K Regan
- School of Public Health, Curtin University, Perth, Australia
- School of Public Health,Texas A&M University, College Station, USA
| | - Gary M Shaw
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, United States
| | - Amy M Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Australia
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12
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Tessema GA, Marinovich ML, Håberg SE, Gissler M, Mayo JA, Nassar N, Ball S, Betrán AP, Gebremedhin AT, de Klerk N, Magnus MC, Marston C, Regan AK, Shaw GM, Padula AM, Pereira G. Interpregnancy intervals and adverse birth outcomes in high-income countries: An international cohort study. PLoS One 2021; 16:e0255000. [PMID: 34280228 PMCID: PMC8289039 DOI: 10.1371/journal.pone.0255000] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women can address this issue. METHODS We conducted an international longitudinal cohort study of 5,521,211 births to 3,849,193 women from Australia (1980-2016), Finland (1987-2017), Norway (1980-2016) and the United States (California) (1991-2012). IPI was calculated based on the time difference between two dates-the date of birth of the first pregnancy and the date of conception of the next (index) pregnancy. We estimated associations between IPI and preterm birth (PTB), spontaneous PTB, and small-for-gestational age births (SGA) using logistic regression (between-women analyses). We also used conditional logistic regression comparing IPIs and birth outcomes in the same women (within-women analyses). Random effects meta-analysis was used to calculate pooled adjusted odds ratios (aOR). RESULTS Compared to an IPI of 18-23 months, there was insufficient evidence for an association between IPI <6 months and overall PTB (aOR 1.08, 95% CI 0.99-1.18) and SGA (aOR 0.99, 95% CI 0.81-1.19), but increased odds of spontaneous PTB (aOR 1.38, 95% CI 1.21-1.57) in the within-women analysis. We observed elevated odds of all birth outcomes associated with IPI ≥60 months. In comparison, between-women analyses showed elevated odds of adverse birth outcomes for <12 month and >24 month IPIs. CONCLUSIONS We found consistently elevated odds of adverse birth outcomes following long IPIs. IPI shorter than 6 months were associated with elevated risk of spontaneous PTB, but there was insufficient evidence for increased risk of other adverse birth outcomes. Current recommendations of waiting at least 24 months to conceive after a previous pregnancy, may be unnecessarily long in high-income countries.
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Affiliation(s)
- Gizachew A. Tessema
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - M. Luke Marinovich
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Siri E. Håberg
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Jonathan A. Mayo
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, CA, United States of America
| | - Natasha Nassar
- Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Stephen Ball
- Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Amanuel T. Gebremedhin
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Nick de Klerk
- Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia
| | - Maria C. Magnus
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Annette K. Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health,Texas A&M University, College Station, Texas, United States of America
| | - Gary M. Shaw
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, CA, United States of America
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States of America
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
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Makleff S, Garduño J, Zavala RI, Valades J, Barindelli F, Cruz M, Marston C. Evaluating Complex Interventions Using Qualitative Longitudinal Research: A Case Study of Understanding Pathways to Violence Prevention. Qual Health Res 2021; 31:1724-1737. [PMID: 33980080 PMCID: PMC8438767 DOI: 10.1177/10497323211002146] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Evaluating social change programs requires methods that account for changes in context, implementation, and participant experience. We present a case study of a school-based partner violence prevention program with young people, where we conducted 33 repeat interviews with nine participants during and after an intervention and analyzed participant trajectories. We show how repeat interviews conducted during and after a social change program were useful in helping us understand how the intervention worked by providing rich contextual information, elucidating gradual shifts among participants, and identifying aspects of the intervention that appear to influence change. Long-term effects of social change interventions are very hard to quantify or measure directly. We argue that a qualitative longitudinal approach provides a way to measure subtle changes that can serve as proxies for longer term impacts.
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Affiliation(s)
- Shelly Makleff
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Monash University, Melbourne, Victoria, Australia
| | - Jovita Garduño
- Fundación Mexicana para la Planeación Familiar, A.C., Mexico City, Mexico
| | - Rosa Icela Zavala
- Fundación Mexicana para la Planeación Familiar, A.C., Mexico City, Mexico
| | | | | | | | - Cicely Marston
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Marinovich ML, Regan AK, Gissler M, Magnus MC, Håberg SE, Mayo JA, Shaw GM, Bell J, Nassar N, Ball S, Gebremedhin AT, Marston C, de Klerk N, Betrán AP, Padula AM, Pereira G. Associations between interpregnancy interval and preterm birth by previous preterm birth status in four high-income countries: a cohort study. BJOG 2021; 128:1134-1143. [PMID: 33232573 DOI: 10.1111/1471-0528.16606] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/16/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the effect of interpregnancy interval (IPI) on preterm birth (PTB) according to whether the previous birth was preterm or term. DESIGN Cohort study. SETTING USA (California), Australia, Finland, Norway (1980-2017). POPULATION Women who gave birth to first and second (n = 3 213 855) singleton livebirths. METHODS Odds ratios (ORs) for PTB according to IPIs were modelled using logistic regression with prognostic score stratification for potential confounders. Within-site ORs were pooled by random effects meta-analysis. OUTCOME MEASURE PTB (gestational age <37 weeks). RESULTS Absolute risk of PTB for each IPI was 3-6% after a previous term birth and 17-22% after previous PTB. ORs for PTB differed between previous term and preterm births in all countries (P-for-interaction ≤ 0.001). For women with a previous term birth, pooled ORs were increased for IPI <6 months (OR 1.50, 95% CI 1.43-1.58); 6-11 months (OR 1.10, 95% CI 1.04-1.16); 24-59 months (OR 1.16, 95% CI 1.13-1.18); and ≥ 60 months (OR 1.72, 95%CI 1.60-1.86), compared with 18-23 months. For previous PTB, ORs were increased for <6 months (OR 1.30, 95% CI 1.18-1.42) and ≥60 months (OR 1.29, 95% CI 1.17-1.42), but were less than ORs among women with a previous term birth (P < 0.05). CONCLUSIONS Associations between IPI and PTB are modified by whether or not the previous pregnancy was preterm. ORs for short and long IPIs were higher among women with a previous term birth than a previous PTB, which for short IPI is consistent with the maternal depletion hypothesis. Given the high risk of recurrence and assuming a causal association between IPI and PTB, IPI remains a potentially modifiable risk factor for women with previous PTB. TWEETABLE ABSTRACT Short versus long interpregnancy intervals associated with higher ORs for preterm birth (PTB) after a previous PTB.
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Affiliation(s)
- M L Marinovich
- School of Public Health, Curtin University, Perth, WA, Australia
| | - A K Regan
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - M Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - M C Magnus
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - S E Håberg
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - J A Mayo
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, CA, USA
| | - G M Shaw
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, CA, USA
| | - J Bell
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - N Nassar
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - S Ball
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - A T Gebremedhin
- School of Public Health, Curtin University, Perth, WA, Australia
| | - C Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - N de Klerk
- Telethon Kids Institute, University of Western Australia, Subiaco, WA, Australia
| | - A P Betrán
- Department of Reproductive Health and Research, UNDP/UNFPA, UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - A M Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - G Pereira
- School of Public Health, Curtin University, Perth, WA, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- Telethon Kids Institute, University of Western Australia, Subiaco, WA, Australia
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Schaaf M, Cant S, Cordero J, Contractor S, Wako E, Marston C. Unpacking power dynamics in research and evaluation on social accountability for sexual and reproductive health and rights. Int J Equity Health 2021; 20:56. [PMID: 33549116 PMCID: PMC7866686 DOI: 10.1186/s12939-021-01398-2] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
Over the past decade, social accountability for health has coalesced into a distinct field of research and practice. Whether explicitly stated or not, changed power relations are at the heart of what social accountability practitioners seek, particularly in the context of sexual and reproductive health. Yet, evaluations of social accountability programs frequently fail to assess important power dynamics. In this commentary, we argue that we must include an examination of power in research and evaluation of social accountability in sexual and reproductive health, and suggest ways to do this. The authors are part of a community of practice on measuring social accountability and health outcomes. We share key lessons from our efforts to conduct power sensitive research using different approaches and methods.First, participatory research and evaluation approaches create space for program participants to engage actively in evaluations by defining success. Participation is also one of the key elements of feminist evaluation, which centers power relations rooted in gender. Participatory approaches can strengthen 'traditional' health evaluation approaches by ensuring that the changes assessed are meaningful to communities.Fields from outside health offer approaches that help to describe and assess changes in power dynamics. For example, realist evaluation analyses the causal processes, or mechanisms, grounded in the interactions between social, political and other structures and human agency; programs try to influence these structures and/or human agency. Process tracing requires describing the mechanisms underlying change in power dymanics in a very detailed way, promoting insight into how changes in power relationships are related to the broader program.Finally, case aggregation and comparison entail the aggregation of data from multiple cases to refine theories about when and how programs work. Case aggregation can allow for nuanced attention to context while still producing lessons that are applicable to inform programming more broadly.We hope this brief discussion encourages other researchers and evaluators to share experiences of analysing power relations as part of evaluation of social accountability interventions for sexual and reproductive health so that together, we improve methodology in this crucial area.
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Affiliation(s)
- Marta Schaaf
- Independent Consultant, 357 Sixth Ave., NY, 11215, Brooklyn, USA.
| | - Suzanne Cant
- World Vision International, 39 Garden St, Blairgowrie, Victoria, 3942, Australia
| | - Joanna Cordero
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Sana Contractor
- COPASAH Sexual and Reproductive Rights Hub, CHSJ, Basement of Young Women's Hostel No 2, Avenue 21, G block, Saket, New Delhi, 110017, India
| | | | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Marston C, McGowan CR, Boydell V, Steyn P. Methods to measure effects of social accountability interventions in reproductive, maternal, newborn, child, and adolescent health programs: systematic review and critique. J Health Popul Nutr 2020; 39:13. [PMID: 33287891 PMCID: PMC7720506 DOI: 10.1186/s41043-020-00220-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/24/2019] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is no agreed way to measure the effects of social accountability interventions. Studies to examine whether and how social accountability and collective action processes contribute to better health and healthcare services are underway in different areas of health, and health effects are captured using a range of different research designs. OBJECTIVES The objective of our review is to help inform evaluation efforts by identifying, summarizing, and critically appraising study designs used to assess and measure social accountability interventions' effects on health, including data collection methods and outcome measures. Specifically, we consider the designs used to assess social accountability interventions for reproductive, maternal, newborn, child, and adolescent health (RMNCAH). DATA SOURCES Data were obtained from the Cochrane Library, EMBASE, MEDLINE, SCOPUS, and Social Policy & Practice databases. ELIGIBILITY CRITERIA We included papers published on or after 1 January 2009 that described an evaluation of the effects of a social accountability intervention on RMNCAH. RESULTS Twenty-two papers met our inclusion criteria. Methods for assessing or reporting health effects of social accountability interventions varied widely and included longitudinal, ethnographic, and experimental designs. Surprisingly, given the topic area, there were no studies that took an explicit systems-orientated approach. Data collection methods ranged from quantitative scorecard data through to in-depth interviews and observations. Analysis of how interventions achieved their effects relied on qualitative data, whereas quantitative data often raised rather than answered questions, and/or seemed likely to be poor quality. Few studies reported on negative effects or harms; studies did not always draw on any particular theoretical framework. None of the studies where there appeared to be financial dependencies between the evaluators and the intervention implementation teams reflected on whether or how these dependencies might have affected the evaluation. The interventions evaluated in the included studies fell into the following categories: aid chain partnership, social audit, community-based monitoring, community-linked maternal death review, community mobilization for improved health, community reporting hotline, evidence for action, report cards, scorecards, and strengthening health communities. CONCLUSIONS A wide range of methods are currently being used to attempt to evaluate effects of social accountability interventions. The wider context of interventions including the historical or social context is important, as shown in the few studies to consider these dimensions. While many studies collect useful qualitative data that help illuminate how and whether interventions work, the data and analysis are often limited in scope with little attention to the wider context. Future studies taking into account broader sociopolitical dimensions are likely to help illuminate processes of accountability and inform questions of transferability of interventions. The review protocol was registered with PROSPERO (registration # CRD42018108252).
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Affiliation(s)
- Cicely Marston
- DEPTH Research Group, Department of Public Health, Environments & Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Catherine R McGowan
- DEPTH Research Group, Department of Public Health, Environments & Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Victoria Boydell
- Global Health Centre, Geneva Graduate Institute, Chemin Eugène-Rigot 2, 1202, Genève, Switzerland
| | - Petrus Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), World Health Organization, Geneva, Switzerland
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Marston C, Sowemimo A. Bridge-It trial-a step towards better contraception services. Lancet 2020; 396:1536-1537. [PMID: 33189163 DOI: 10.1016/s0140-6736(20)32395-3] [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: 08/20/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Cicely Marston
- DEPTH Research Group, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Annabel Sowemimo
- Midlands Partnership NHS Foundation Trust, Haymarket Health, Leicester Integrated Sexual and Reproductive Health, Leicester, UK
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Renedo A, Miles S, Chakravorty S, Leigh A, Warner JO, Marston C. Understanding the health-care experiences of people with sickle cell disorder transitioning from paediatric to adult services: This Sickle Cell Life, a longitudinal qualitative study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background
Transitions from paediatric to adult health-care services cause problems worldwide, particularly for young people with long-term conditions. Sickle cell disorder brings particular challenges needing urgent action.
Objectives
Understand health-care transitions of young people with sickle cell disorder and how these interact with broader transitions to adulthood to improve services and support.
Methods
We used a longitudinal design in two English cities. Data collection included 80 qualitative interviews with young people (aged 13–21 years) with sickle cell disorder. We conducted 27 one-off interviews and 53 repeat interviews (i.e. interviews conducted two or three times over 18 months) with 48 participants (30 females and 18 males). We additionally interviewed 10 sickle cell disease specialist health-care providers. We used an inductive approach to analysis and co-produced the study with patients and carers.
Results
Key challenges relate to young people’s voices being ignored. Participants reported that their knowledge of sickle cell disorder and their own needs are disregarded in hospital settings, in school and by peers. Outside specialist services, health-care staff refuse to recognise patient expertise, reducing patients’ say in decisions about their own care, particularly during unplanned care in accident and emergency departments and on general hospital wards. Participants told us that in transitioning to adult care they came to realise that sickle cell disorder is poorly understood by non-specialist health-care providers. As a result, participants said that they lack trust in staff’s ability to treat them correctly and that they try to avoid hospital. Participants reported that they try to manage painful episodes at home, knowing that this is risky. Participants described engaging in social silencing (i.e. reluctance to talk about and disclose their condition for fear that others will not listen or will not understand) outside hospital; for instance, they would avoid mentioning cell sickle disorder to explain fatigue. Their self-management tactics include internalising their illness experiences, for instance by concealing pain to protect others from worrying. Participants find that working to stay healthy is difficult to reconcile with developing identities to meet adult life goals. Participants have to engage in relentless self-disciplining when trying to achieve educational goals, yet working hard is incompatible with being a ‘good adult patient’ because it can be risky for health. Participants reported that they struggle to reconcile these conflicting demands.
Limitations
Our findings are derived from interviews with a group of young people in England and reflect what they told us (influenced by how they perceived us). We do not claim to represent all young people with sickle cell disorder.
Conclusions
Our findings reveal poor care for young people with sickle cell disorder outside specialist services. To improve this, it is vital to engage with young people as experts in their own condition, recognise the legitimacy of their voices and train non-specialist hospital staff in sickle cell disorder care. Young people must be supported both in and outside health-care settings to develop identities that can help them to achieve life goals.
Future work
Future work should include research into the understanding and perceptions of sickle cell disease among non-specialist health-care staff to inform future training. Whole-school interventions should be developed and evaluated to increase sickle cell disorder awareness.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 44. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alicia Renedo
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sam Miles
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Andrea Leigh
- University College London NHS Hospitals Foundation Trust, London, UK
| | - John O Warner
- National Heart and Lung Institute, Imperial College London, London, UK
- Collaboration for Leadership in Applied Health Research and Care for Northwest London, Imperial College London, London, UK
| | - Cicely Marston
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Makleff S, Billowitz M, Garduño J, Cruz M, Silva Márquez VI, Marston C. Applying a complex adaptive systems approach to the evaluation of a school-based intervention for intimate partner violence prevention in Mexico. Health Policy Plan 2020; 35:993-1002. [PMID: 32761146 PMCID: PMC7553757 DOI: 10.1093/heapol/czaa067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Despite calls for evaluation practice to take a complex systems approach, there are few examples of how to incorporate complexity into real-life evaluations. This article presents the case for using a complex systems approach to evaluate a school-based intimate partner violence-prevention intervention. We conducted a post hoc analysis of qualitative evaluation data to examine the intervention as a potential system disruptor. We analysed data in relation to complexity concepts particularly relevant to schools: 'diverse and dynamic agents', 'interaction', 'unpredictability', 'emergence' and 'context dependency'. The data-two focus groups with facilitators and 33 repeat interviews with 14-17-year-old students-came from an evaluation of a comprehensive sexuality education intervention in Mexico City, which serves as a case study for this analysis. The findings demonstrate an application of complex adaptive systems concepts to qualitative evaluation data. We provide examples of how this approach can shed light on the ways in which interpersonal interactions, group dynamics, the core messages of the course and context influenced the implementation and outcomes of this intervention. This gender-transformative intervention appeared to disrupt pervasive gender norms and reshape beliefs about how to engage in relationships. An intervention comprises multiple dynamic and interacting elements, all of which are unlikely to be consistent across implementation settings. Applying complexity concepts to our analysis added value by helping reframe implementation-related data to focus on how the 'social' aspects of complexity influenced the intervention. Without examining both individual and group processes, evaluations may miss key insights about how the intervention generates change, for whom, and how it interacts with its context. A social complex adaptive systems approach is well-suited to the evaluation of gender-transformative interventions and can help identify how such interventions disrupt the complex social systems in which they are implemented to address intractable societal problems.
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Affiliation(s)
- Shelly Makleff
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Marissa Billowitz
- Independent, Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Jovita Garduño
- Fundación Mexicana para la Planeación Familiar, A.C. (Mexfam), Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Mariana Cruz
- IPPF/WHR Mexico, Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Vanessa Ivon Silva Márquez
- Fundación Mexicana para la Planeación Familiar, A.C. (Mexfam), Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Marston C, Arjyal A, Maskey S, Regmi S, Baral S. Using qualitative evaluation components to help understand context: case study of a family planning intervention with female community health volunteers (FCHVs) in Nepal. BMC Health Serv Res 2020; 20:685. [PMID: 32703196 PMCID: PMC7379347 DOI: 10.1186/s12913-020-05466-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/25/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Evaluations of health interventions are increasingly concerned with measuring or accounting for 'context'. How to do this is still subject to debate and testing, and is particularly important in the case of family planning where outcomes will inevitably be influenced by contextual factors as well as any intervention effects. We conducted an evaluation of an intervention where female community health volunteers (FCHVs) in Nepal were trained to provide better interpersonal communication on family planning. We included a context-orientated qualitative component to the evaluation. Here, we discuss the evaluation findings, specifically focusing on what was added by attending to the context. We explore and illustrate important dimensions of context that may also be relevant in future evaluation work. METHODS The evaluation used a mixed methods approach, with a qualitative component which included in-depth interviews with women of reproductive age, FCHVs, and family planning service providers. We conducted iterative, thematic analysis. RESULTS The life-history fertility and contraception narratives generated from the in-depth interviews contextualised the intervention, yielding nuanced data on contraceptive choices, needs, and areas for future action. For instance, it highlighted how women generally knew about effective contraceptive methods and were willing to use them: information was not a major barrier. Barriers instead included reports of providers refusing service when women were not in the fifth day of their menstrual cycle when this was unnecessary. Privacy and secrecy were important to some women, and risked being undermined by information sharing between FCHVs and health services. The qualitative component also revealed unanticipated positive effects of our own evaluation strategies: using referral slips seemed to make it easier for women to access contraception. CONCLUSIONS Life history narratives collected via in-depth interviews helped us understand pathways from intervention to effect from the user point of view without narrowly focusing only on the intervention, highlighting possible areas for action that would otherwise have been missed. By attending to context in a nuanced way in evaluations, we can build a body of evidence that not only informs future interventions within that context, but also builds better knowledge of contextual factors likely to be important elsewhere.
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Affiliation(s)
- Cicely Marston
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | | | | | | | - Sushil Baral
- HERD International, Thapathali, Kathmandu, Nepal
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Regan AK, Arnaout A, Marinovich L, Marston C, Patino I, Kaur R, Gebremedhin A, Pereira G. Interpregnancy interval and risk of perinatal death: a systematic review and meta-analysis. BJOG 2020; 127:1470-1479. [PMID: 32378279 DOI: 10.1111/1471-0528.16303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Interpregnancy interval (IPI) <6 months is a potentially modifiable risk factor for adverse perinatal health outcomes. OBJECTIVE This systematic review evaluated the international literature on the risk of perinatal death associated with IPI. SEARCH STRATEGY Two independent reviewers screened titles and abstracts identified in MEDLINE, EMBASE and Scopus from inception to 4 April 2019 (Prospero Registration #CRD42018092792). SELECTION CRITERIA Studies were included if they provided a description of IPI measurement and perinatal death, including stillbirth and neonatal death. DATA COLLECTION AND ANALYSIS A narrative review was performed for all included studies. Random effects meta-analysis was used to compare unadjusted odds of perinatal death associated with IPI <6 months and IPI ≥6 months. Analyses were performed by outcome of the preceding pregnancy and study location. MAIN RESULTS Of the 624 unique articles identified, 26 met the inclusion criteria. The pooled unadjusted odds ratio of perinatal death for IPI <6 months was 1.34 (95% CI 1.17-1.53) following a previous live birth, 0.85 (95% CI 0.73-0.99) following a previous miscarriage and 1.07 (95% CI 0.84-1.36) following a previous stillbirth compared with IPI ≥6 months. However, few high-income country studies reported an association after adjustment. Fewer studies evaluated the impact of long IPI on perinatal death and what evidence was available showed mixed results. CONCLUSIONS Results suggest a possible association between short IPI and risk of perinatal death following a live birth, particularly in low- to middle-income countries. TWEETABLE ABSTRACT Short IPI <6 months after a live birth was associated with greater risk of perinatal death than IPI ≥6 months.
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Affiliation(s)
- A K Regan
- School of Public Health, Texas A&M University, College Station, TX, USA.,School of Public Health, Curtin University, Perth, WA, Australia
| | - A Arnaout
- School of Public Health, Curtin University, Perth, WA, Australia
| | - L Marinovich
- School of Public Health, Curtin University, Perth, WA, Australia
| | - C Marston
- London School of Tropical Medicine and Hygiene, London, UK
| | - I Patino
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - R Kaur
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - A Gebremedhin
- School of Public Health, Curtin University, Perth, WA, Australia
| | - G Pereira
- School of Public Health, Curtin University, Perth, WA, Australia.,Centre for Fertility and Health, Norwegian Public Health Institute, Oslo, Norway
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Affiliation(s)
- Cicely Marston
- DEPTH Research Group, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Alicia Renedo
- DEPTH Research Group, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Sam Miles
- DEPTH Research Group, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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23
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Scott RH, Smith C, Formby E, Hadley A, Hallgarten L, Hoyle A, Marston C, McKee A, Tourountsis D. What and how: doing good research with young people, digital intimacies, and relationships and sex education. Sex Educ 2020; 20:675-691. [PMID: 33633497 PMCID: PMC7872220 DOI: 10.1080/14681811.2020.1732337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
As part of a project funded by the Wellcome Trust, we held a one-day symposium, bringing together researchers, practitioners, and policymakers, to discuss priorities for research on relationships and sex education (RSE) in a world where young people increasingly live, experience, and augment their relationships (whether sexual or not) within digital spaces. The introduction of statutory RSE in schools in England highlights the need to focus on improving understandings of young people and digital intimacies for its own sake, and to inform the development of learning resources. We call for more research that puts young people at its centre; foregrounds inclusivity; and allows a nuanced discussion of pleasures, harms, risks, and rewards, which can be used by those working with young people and those developing policy. Generating such research is likely to be facilitated by participation, collaboration, and communication with beneficiaries, between disciplines and across sectors. Taking such an approach, academic researchers, practitioners, and policymakers agree that we need a better understanding of RSE's place in lifelong learning, which seeks to understand the needs of particular groups, is concerned with non-sexual relationships, and does not see digital intimacies as disconnected from offline everyday 'reality'.
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Affiliation(s)
- Rachel H. Scott
- Centre for Research in Media and Cultural Studies, Faculty
of Arts and Creative Industries, University of Sunderland, Sunderland, UK
- CONTACT Rachel H. Scott
| | - Clarissa Smith
- Centre for Research in Media and Cultural Studies, Faculty
of Arts and Creative Industries, University of Sunderland, Sunderland, UK
| | - Eleanor Formby
- Sheffield Institute of Education, Sheffield Hallam University, Sheffield, UK
| | - Alison Hadley
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | | | | | - Cicely Marston
- Department of Public Health, Environments and Society,
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Alan McKee
- Faculty of Arts and Social Sciences, University of Technology Sydney, Sydney, Australia
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Abstract
Young people develop new behaviours and redefine their identities during health transitions when they move from paediatric to adult healthcare environments. Their identities help to guide their health-related actions in response to life changes. Young people's health is increasingly recognised as important, yet we lack understanding of how health transitions shape identities and how they relate to other transitions to adulthood. We conducted a longitudinal interview study with young people with sickle cell disease to explore how young people define new identities as they transition to adulthood. We show how 'disciplining at a distance' via healthcare self-management discourses and neoliberal norms governing adolescence play out in the tensions participants encounter when they are crafting new identities. Health transitions involve struggles to negotiate competing demands for self-discipline. It is crucial to create enabling spaces for young people to protect their health while still developing identities that help them achieve life goals.
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Affiliation(s)
- Alicia Renedo
- Public Health, Environments and SocietyFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sam Miles
- Public Health, Environments and SocietyFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Cicely Marston
- Public Health, Environments and SocietyFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
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25
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McGowan CR, Baxter L, Deola C, Gayford M, Marston C, Cummings R, Checchi F. Mobile clinics in humanitarian emergencies: a systematic review. Confl Health 2020; 14:4. [PMID: 32021649 PMCID: PMC6993397 DOI: 10.1186/s13031-020-0251-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 10/15/2019] [Accepted: 01/22/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Despite the widespread reliance on mobile clinics for delivering health services in humanitarian emergencies there is little empirical evidence to support their use. We report a narrative systematic review of the empirical evidence evaluating the use of mobile clinics in humanitarian settings. METHODS We searched MEDLINE, EMBASE, Global Health, Health Management Information Consortium, and The Cochrane Library for manuscripts published between 2000 and 2019. We also conducted a grey literature search via Global Health, Open Grey, and the WHO publication database. Empirical studies were included if they reported on at least one of the following evaluation criteria: relevance/appropriateness, connectedness, coherence, coverage, efficiency, effectiveness, and impact. FINDINGS Five studies met the inclusion criteria: all supported the use of mobile clinics in the particular setting under study. Three studies included controls. Two studies were assessed as good quality. The studies reported on mobile clinics providing non-communicable disease interventions, mental health services, sexual and reproductive health services, and multiple primary health care services in Afghanistan, the Democratic Republic of the Congo , Haiti, and the Occupied Palestinian Territories. Studies assessed one or more of the following evaluation domains: relevance/appropriateness, coverage, efficiency, and effectiveness. Four studies made recommendations including: i) ensure that mobile clinics are designed to complement clinic-based services; ii) improve technological tools to support patient follow-up, improve record-keeping, communication, and coordination; iii) avoid labelling services in a way that might stigmatise attendees; iv) strengthen referral to psychosocial and mental health services; v) partner with local providers to leverage resources; and vi) ensure strong coordination to optimise the continuum of care. Recommendations regarding the evaluation of mobile clinics include carrying out comparative studies of various modalities (including fixed facilities and community health workers) in order to isolate the effects of the mobile clinics. In the absence of a sound evidence base informing the use of mobile clinics in humanitarian crises, we encourage the integration of: i) WASH services, ii) nutrition services, iii) epidemic surveillance, and iv) systems to ensure the quality and safety of patient care. We recommend that future evaluations report against an established evaluation framework. CONCLUSION Evidence supporting the use of mobile clinics in humanitarian emergencies is limited. We encourage more studies of the use of mobile clinics in emergency settings. FUNDING Salary support for this review was provided under the RECAP project by United Kingdom Research and Innovation as part of the Global Challenges Research Fund, grant number ES/P010873/1.
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Affiliation(s)
- Catherine R. McGowan
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Louisa Baxter
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Claudio Deola
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Megan Gayford
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Cicely Marston
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Rachael Cummings
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Francesco Checchi
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
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26
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Mathews B, Pacella R, Dunne MP, Simunovic M, Marston C. Improving measurement of child abuse and neglect: A systematic review and analysis of national prevalence studies. PLoS One 2020; 15:e0227884. [PMID: 31990913 PMCID: PMC6986759 DOI: 10.1371/journal.pone.0227884] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [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: 09/10/2019] [Accepted: 12/31/2019] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Child maltreatment through physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence, causes substantial adverse health, educational and behavioural consequences through the lifespan. The generation of reliable data on the prevalence and characteristics of child maltreatment in nationwide populations is essential to plan and evaluate public health interventions to reduce maltreatment. Measurement of child maltreatment must overcome numerous methodological challenges. Little is known to date about the extent, nature and methodological quality of these national studies. This study aimed to systematically review the most comprehensive national studies of the prevalence of child maltreatment, and critically appraise their methodologies to help inform the design of future studies. METHODS Guided by PRISMA and following a published protocol, we searched 22 databases from inception to 31 May 2019 to identify nationwide studies of the prevalence of either all five or at least four forms of child maltreatment. We conducted a formal quality assessment and critical analysis of study design. RESULTS This review identified 30 national prevalence studies of all five or at least four forms of child maltreatment, in 22 countries. While sound approaches are available for different settings, methodologies varied widely in nature and robustness. Some instruments are more reliable and obtain more detailed and useful information about the characteristics of the maltreatment, including its nature, frequency, and the relationship between the child and the person who inflicted the maltreatment. Almost all studies had limitations, especially in the level of detail captured about maltreatment, and the adequacy of constructs of maltreatment types. CONCLUSIONS Countries must invest in rigorous national studies of the prevalence of child maltreatment. Studies should use a sound instrument containing appropriate maltreatment constructs, and obtain nuanced information about its nature.
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Affiliation(s)
- Ben Mathews
- Director, Childhood Adversity Research Program, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Adjunct Professor, Johns Hopkins University, Bloomberg School of Public Health, Baltimore MD, United States of America
| | - Rosana Pacella
- Institute for Lifecourse Development, University of Greenwich, Greenwich, London, United Kingdom
| | - Michael P. Dunne
- School of Public Health, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Marko Simunovic
- Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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27
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Renedo A, Miles S, Chakravorty S, Leigh A, Telfer P, Warner JO, Marston C. Not being heard: barriers to high quality unplanned hospital care during young people's transition to adult services - evidence from 'this sickle cell life' research. BMC Health Serv Res 2019; 19:876. [PMID: 31752858 PMCID: PMC6873494 DOI: 10.1186/s12913-019-4726-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 03/15/2019] [Accepted: 11/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background Young people’s experiences of healthcare as they move into adult services can have a major impact on their health, and the transition period for young people with sickle cell disease (SCD) needs improvement. In this study, we explore how young people with SCD experience healthcare during this period of transition. Methods We conducted a co-produced longitudinal qualitative study, including 80 interviews in 2016–2017 with young people with SCD aged 13–21 (mean age 16.6) across two cities in England. We recruited 48 participants (30 female, 18 male): 27 interviews were one-off, and 53 were repeated 2–3 times over approximately 18 months. We used an inductive analytical approach, combining elements of Grounded Theory and thematic analysis. Results Participants reported significant problems with the care they received in A&E during painful episodes, and in hospital wards as inpatients during unplanned healthcare. They experienced delays in being given pain relief and their basic care needs were not always met. Participants said that non-specialist healthcare staff did not seem to know enough about SCD and when they tried to work with staff to improve care, staff often seemed not prepared to listen to them or act on what they said. Participants said they felt out of place in adult wards and uncomfortable with the differences in adult compared with paediatric wards. Because of their experiences, they tried to avoid being admitted to hospital, attempting to manage their painful episodes at home and accessing unplanned hospital care only as a last resort. By contrast, they did not report having problems within SCD specialist services during planned, routine care. Conclusions Our study underscores the need for improvements to make services youth-friendly and youth-responsive, including training staff in SCD-specific care, compassionate care and communication skills that will help them elicit and act on young people’s voices to ensure they are involved in shaping their own healthcare. If young people are prevented from using transition skills (self-management, self-advocacy), or treated by staff who they worry do not have enough medical competency in their condition, they may well lose their trust in services, potentially compromising their own health.
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Affiliation(s)
- Alicia Renedo
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sam Miles
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Andrea Leigh
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - John O Warner
- Collaborations for Leadership in Applied Health Research and Care NW London, Imperial College London, London, UK
| | - Cicely Marston
- London School of Hygiene and Tropical Medicine, London, UK.
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28
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Marston C, Francis SC. Neglect of STIs and infertility undermines family planning programmes. BMJ Sex Reprod Health 2019; 46:bmjsrh-2018-200270. [PMID: 31558574 DOI: 10.1136/bmjsrh-2018-200270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 07/24/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Cicely Marston
- Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Suzanna C Francis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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29
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Miles S, Renedo A, Augustine C, Ojeer P, Willis N, Marston C. Obstacles to use of patient expertise to improve care: a co-produced longitudinal study of the experiences of young people with sickle cell disease in non-specialist hospital settings. Critical Public Health 2019. [DOI: 10.1080/09581596.2019.1650893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sam Miles
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Alicia Renedo
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Cicely Marston
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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30
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Ehrenreich K, Marston C. Spatial dimensions of telemedicine and abortion access: a qualitative study of women's experiences. Reprod Health 2019; 16:94. [PMID: 31269958 PMCID: PMC6610771 DOI: 10.1186/s12978-019-0759-9] [Citation(s) in RCA: 10] [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] [Received: 09/20/2018] [Accepted: 06/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Telemedicine may help women comply with onerous legislative requirements for accessing abortion services. In Utah, there are three mandatory steps: a state-mandated information visit, a 72-h waiting period, and finally the abortion procedure itself. We explored women's experiences of using telemedicine for the first step: the information visit. METHODS We conducted 20 in-depth interviews with women recruited from Planned Parenthood Association of Utah in 2017 and analyzed them using iterative thematic techniques, using a framework based on Massey's conceptualization of space as comprising temporal, material and social dimensions. RESULTS Temporal, material and social dimensions of women's access to abortion services intertwined to reduce access and cause discomfort and inconvenience among women in our sample. The 72-h waiting period and travel distance were the key temporal and material barriers, while social dimensions included fear of social judgement, religious influence, and negative stereotyping about people who have abortions. Women described traveling long distances alone and risking excessive pain (e.g. denying pain medication in order to drive immediately after the procedure) to try to overcome these barriers. CONCLUSION Using telemedicine helped patients reduce burdens created by policies requiring attendance at multiple appointments in a state with limited abortion services. Attending to spatial aspects of abortion provision helps identify how these different dimensions of abortion access interact to reduce access and impose undue burdens. Telemedicine can improve privacy, reduce travel expenses, and reduce other burdens for women seeking abortion care.
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Affiliation(s)
- Katherine Ehrenreich
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK. .,Present address: Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Ste 1100, Oakland, CA, 94612, USA.
| | - Cicely Marston
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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31
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Goldacre B, Drysdale H, Marston C, Mahtani KR, Dale A, Milosevic I, Slade E, Hartley P, Heneghan C. COMPare: Qualitative analysis of researchers' responses to critical correspondence on a cohort of 58 misreported trials. Trials 2019; 20:124. [PMID: 30760328 PMCID: PMC6374909 DOI: 10.1186/s13063-019-3172-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 01/02/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Discrepancies between pre-specified and reported outcomes are an important and prevalent source of bias in clinical trials. COMPare (Centre for Evidence-Based Medicine Outcome Monitoring Project) monitored all trials in five leading journals for correct outcome reporting, submitted correction letters on all misreported trials in real time, and then monitored responses from editors and trialists. From the trialists' responses, we aimed to answer two related questions. First, what can trialists' responses to corrections on their own misreported trials tell us about trialists' knowledge of correct outcome reporting? Second, what can a cohort of responses to a standardised correction letter tell us about how researchers respond to systematic critical post-publication peer review? METHODS All correspondence from trialists, published by journals in response to a correction letter from COMPare, was filed and indexed. We analysed the letters qualitatively and identified key themes in researchers' errors about correct outcome reporting, and approaches taken by researchers when their work was criticised. RESULTS Trialists frequently expressed views that contradicted the CONSORT (Consolidated Standards of Reporting Trials) guidelines or made inaccurate statements about correct outcome reporting. Common themes were: stating that pre-specification after trial commencement is acceptable; incorrect statements about registries; incorrect statements around the handling of multiple time points; and failure to recognise the need to report changes to pre-specified outcomes in the trial report. We identified additional themes in the approaches taken by researchers when responding to critical correspondence, including the following: ad hominem criticism; arguing that trialists should be trusted, rather than follow guidelines for trial reporting; appealing to the existence of a novel category of outcomes whose results need not necessarily be reported; incorrect statements by researchers about their own paper; and statements undermining transparency infrastructure, such as trial registers. CONCLUSIONS Researchers commonly make incorrect statements about correct trial reporting. There are recurring themes in researchers' responses when their work is criticised, some of which fall short of the scientific ideal. Research on methodological shortcomings is now common, typically in the form of retrospective cohort studies describing the overall prevalence of a problem. We argue that prospective cohort studies which additionally issue correction letters in real time on each individual flawed study-and then follow-up responses from trialists and journals-are more impactful, more informative for those consuming the studies critiqued, more informative on the causes of shortcomings in research, and a better use of research resources.
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Affiliation(s)
- Ben Goldacre
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Henry Drysdale
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Cicely Marston
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Kamal R. Mahtani
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Aaron Dale
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Ioan Milosevic
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Eirion Slade
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Philip Hartley
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
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32
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Goldacre B, Drysdale H, Dale A, Milosevic I, Slade E, Hartley P, Marston C, Powell-Smith A, Heneghan C, Mahtani KR. COMPare: a prospective cohort study correcting and monitoring 58 misreported trials in real time. Trials 2019; 20:118. [PMID: 30760329 PMCID: PMC6375128 DOI: 10.1186/s13063-019-3173-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [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: 07/25/2017] [Accepted: 01/02/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Discrepancies between pre-specified and reported outcomes are an important source of bias in trials. Despite legislation, guidelines and public commitments on correct reporting from journals, outcome misreporting continues to be prevalent. We aimed to document the extent of misreporting, establish whether it was possible to publish correction letters on all misreported trials as they were published, and monitor responses from editors and trialists to understand why outcome misreporting persists despite public commitments to address it. METHODS We identified five high-impact journals endorsing Consolidated Standards of Reporting Trials (CONSORT) (New England Journal of Medicine, The Lancet, Journal of the American Medical Association, British Medical Journal, and Annals of Internal Medicine) and assessed all trials over a six-week period to identify every correctly and incorrectly reported outcome, comparing published reports against published protocols or registry entries, using CONSORT as the gold standard. A correction letter describing all discrepancies was submitted to the journal for all misreported trials, and detailed coding sheets were shared publicly. The proportion of letters published and delay to publication were assessed over 12 months of follow-up. Correspondence received from journals and authors was documented and themes were extracted. RESULTS Sixty-seven trials were assessed in total. Outcome reporting was poor overall and there was wide variation between journals on pre-specified primary outcomes (mean 76% correctly reported, journal range 25-96%), secondary outcomes (mean 55%, range 31-72%), and number of undeclared additional outcomes per trial (mean 5.4, range 2.9-8.3). Fifty-eight trials had discrepancies requiring a correction letter (87%, journal range 67-100%). Twenty-three letters were published (40%) with extensive variation between journals (range 0-100%). Where letters were published, there were delays (median 99 days, range 0-257 days). Twenty-nine studies had a pre-trial protocol publicly available (43%, range 0-86%). Qualitative analysis demonstrated extensive misunderstandings among journal editors about correct outcome reporting and CONSORT. Some journals did not engage positively when provided correspondence that identified misreporting; we identified possible breaches of ethics and publishing guidelines. CONCLUSIONS All five journals were listed as endorsing CONSORT, but all exhibited extensive breaches of this guidance, and most rejected correction letters documenting shortcomings. Readers are likely to be misled by this discrepancy. We discuss the advantages of prospective methodology research sharing all data openly and pro-actively in real time as feedback on critiqued studies. This is the first empirical study of major academic journals' willingness to publish a cohort of comparable and objective correction letters on misreported high-impact studies. Suggested improvements include changes to correspondence processes at journals, alternatives for indexed post-publication peer review, changes to CONSORT's mechanisms for enforcement, and novel strategies for research on methods and reporting.
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Affiliation(s)
- Ben Goldacre
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Henry Drysdale
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Aaron Dale
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Ioan Milosevic
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Eirion Slade
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Philip Hartley
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Cicely Marston
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine , Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Anna Powell-Smith
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Kamal R Mahtani
- Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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Marinovich ML, Regan AK, Gissler M, Magnus MC, Håberg SE, Padula AM, Mayo JA, Shaw GM, Ball S, Malacova E, Gebremedhin AT, Nassar N, Marston C, de Klerk N, Betran AP, Pereira GF. Developing evidence-based recommendations for optimal interpregnancy intervals in high-income countries: protocol for an international cohort study. BMJ Open 2019; 9:e027941. [PMID: 30700492 PMCID: PMC6352763 DOI: 10.1136/bmjopen-2018-027941] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Received: 11/16/2018] [Revised: 11/23/2018] [Accepted: 11/23/2018] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Short interpregnancy interval (IPI) has been linked to adverse pregnancy outcomes. WHO recommends waiting at least 2 years after a live birth and 6 months after miscarriage or induced termination before conception of another pregnancy. The evidence underpinning these recommendations largely relies on data from low/middle-income countries. Furthermore, recent epidemiological investigations have suggested that these studies may overestimate the effects of IPI due to residual confounding. Future investigations of IPI effects in high-income countries drawing from large, population-based data sources are needed to inform IPI recommendations. We aim to assess the impact of IPIs on maternal and child health outcomes in high-income countries. METHODS AND ANALYSIS This international longitudinal retrospective cohort study will include more than 18 million pregnancies, making it the largest study to investigate IPI in high-income countries. Population-based data from Australia, Finland, Norway and USA will be used. Birth records in each country will be used to identify consecutive pregnancies. Exact dates of birth and clinical best estimates of gestational length will be used to estimate IPI. Administrative birth and health data sources with >99% coverage in each country will be used to identify maternal sociodemographics, pregnancy complications, details of labour and delivery, birth and child health information. We will use matched and unmatched regression models to investigate the impact of IPI on maternal and infant outcomes, and conduct meta-analysis to pool results across countries. ETHICS AND DISSEMINATION Ethics boards at participating sites approved this research (approval was not required in Finland). Findings will be published in peer-reviewed journals and presented at international conferences, and will inform recommendations for optimal IPI in high-income countries. Findings will provide important information for women and families planning future pregnancies and for clinicians providing prenatal care and giving guidance on family planning.
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Affiliation(s)
- M Luke Marinovich
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Annette K Regan
- School of Public Health, Texas A and M University, College Station, Texas, USA
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Maria C Magnus
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Eldevik Håberg
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Amy M Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Jonathan A Mayo
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Stephen Ball
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Eva Malacova
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | | | - Natasha Nassar
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nick de Klerk
- Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Gavin F Pereira
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
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Rose-Clarke K, Bentley A, Marston C, Prost A. Peer-facilitated community-based interventions for adolescent health in low- and middle-income countries: A systematic review. PLoS One 2019; 14:e0210468. [PMID: 30673732 PMCID: PMC6343892 DOI: 10.1371/journal.pone.0210468] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 12/25/2018] [Indexed: 01/23/2023] Open
Abstract
Background Adolescents aged 10–19 represent one sixth of the world’s population and have a high burden of morbidity, particularly in low-resource settings. We know little about the potential of community-based peer facilitators to improve adolescent health in such contexts. Methods We did a systematic review of peer-facilitated community-based interventions for adolescent health in low- and middle-income countries (LMICs). We searched databases for randomised controlled trials of interventions featuring peer education, counselling, activism, and/or outreach facilitated by young people aged 10–24. We included trials with outcomes across key areas of adolescent health: infectious and vaccine preventable diseases, undernutrition, HIV/AIDS, sexual and reproductive health, unintentional injuries, violence, physical disorders, mental disorders and substance use. We summarised evidence from these trials narratively. PROSPERO registration: CRD42016039190. Results We found 20 studies (61,014 adolescents). Fourteen studies tested interventions linked to schools or colleges, and 12 had non-peer-facilitated components, e.g. health worker training. Four studies had HIV-related outcomes, but none reported reductions in HIV prevalence or incidence. Nine studies had clinical sexual and reproductive health outcomes, but only one reported a positive effect: a reduction in Herpes Simplex Virus-2 incidence. Three studies had violence-related outcomes, two of which reported reductions in physical violence by school staff and perpetration of physical violence by adolescents. Seven studies had mental health outcomes, four of which reported reductions in depressive symptoms. Finally, we found eight studies on substance use, four of which reported reductions in alcohol consumption and smoking or tobacco use. There were no studies on infectious and vaccine preventable diseases, undernutrition, or injuries. Conclusions There are few trials on the effects of peer-facilitated community-based interventions for adolescent health in LMICs. Existing trials have mixed results, with the most promising evidence supporting work with peer facilitators to improve adolescent mental health and reduce substance use and violence.
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Affiliation(s)
- Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King’s College London, London, United Kingdom
- * E-mail:
| | - Abigail Bentley
- Institute for Global Health, University College London, London, United Kingdom
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Audrey Prost
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Regan AK, Ball SJ, Warren JL, Malacova E, Marston C, Nassar N, Leonard H, de Klerk N, Pereira G. Regan et al. Reply to "Sibling Comparison Design in Birth-Spacing Studies". Am J Epidemiol 2019; 188:22-23. [PMID: 30188997 PMCID: PMC6676945 DOI: 10.1093/aje/kwy187] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Annette K Regan
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Stephen J Ball
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia
| | - Joshua L Warren
- School of Public Health, Yale University, New Haven, Connecticut
| | - Eva Malacova
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Cicely Marston
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Natasha Nassar
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Nicholas de Klerk
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
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Regan AK, Ball SJ, Warren JL, Malacova E, Padula A, Marston C, Nassar N, Stanley F, Leonard H, de Klerk N, Pereira G. A Population-Based Matched-Sibling Analysis Estimating the Associations Between First Interpregnancy Interval and Birth Outcomes. Am J Epidemiol 2019; 188:9-16. [PMID: 30188970 DOI: 10.1093/aje/kwy188] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 06/06/2018] [Indexed: 11/14/2022] Open
Abstract
The association between a single interpregnancy interval (IPI) and birth outcomes has not yet been explored using matched methods. We modeled the odds of preterm birth, being small for gestational age, and having low birth weight in a second, live-born infant in a cohort of 192,041 sibling pairs born in Western Australia between 1980 and 2010. The association between IPI and birth outcomes was estimated from the interaction between birth order and IPI (with 18-23 months as the reference category), using conditional logistic regression. Matched analysis showed the odds of preterm birth were higher for siblings born following an IPI of <6 months (adjusted interaction odds ratio = 1.22, 95% confidence interval: 1.06, 1.38) compared with those born after an IPI of 18-23 months. There were no significant differences for IPIs of <6 months for other outcomes (small for gestational age or low birth weight). This is the first study to use matched analyses to investigate the association between a single IPI on birth outcomes. IPIs of <6 months were associated with increased odds of preterm birth in second-born infants, although the association is likely smaller than previously estimated by unmatched studies.
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Affiliation(s)
- Annette K Regan
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Stephen J Ball
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia
| | - Joshua L Warren
- School of Public Health, Yale University, New Haven, Connecticut
| | - Eva Malacova
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Amy Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Cicely Marston
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Natasha Nassar
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Fiona Stanley
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Nicholas de Klerk
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
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Smith H, Portela A, Marston C. Correction to: Improving implementation of health promotion interventions for maternal and newborn health. BMC Pregnancy Childbirth 2018; 18:116. [PMID: 29712554 PMCID: PMC5928561 DOI: 10.1186/s12884-018-1719-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 11/10/2022] Open
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Scott RH, Filippi V, Moore AM, Acharya R, Bankole A, Calvert C, Church K, Cresswell JA, Footman K, Gleason J, Machiyama K, Marston C, Mbizvo M, Musheke M, Owolabi O, Palmer J, Smith C, Storeng K, Yeung F. Setting the research agenda for induced abortion in Africa and Asia. Int J Gynaecol Obstet 2018; 142:241-247. [PMID: 29745418 DOI: 10.1002/ijgo.12525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/26/2018] [Revised: 04/05/2018] [Accepted: 05/04/2018] [Indexed: 11/07/2022]
Abstract
Provision of safe abortion is widely recognized as vital to addressing the health and wellbeing of populations. Research on abortion is essential to meet the UN Sustainable Development Goals. Researchers in population health from university, policy, and practitioner contexts working on two multidisciplinary projects on family planning and safe abortion in Africa and Asia were brought together for a workshop to discuss the future research agenda on induced abortion. Research on care-seeking behavior, supply of abortion care services, and the global and national policy context will help improve access to and experiences of safe abortion services. A number of areas have potential in designing intervention strategies, including clinical innovations, quality improvement mechanisms, community involvement, and task sharing. Research on specific groups, including adolescents and young people, men, populations affected by conflict, marginalized groups, and providers could increase understanding of provision, access to and experiences of induced abortion. Methodological and conceptual advances, for example in the measurement of induced abortion incidence, complications, and client satisfaction, conceptualizations of induced abortion access and care, and methods for follow-up of patients who have induced abortions, will improve the accuracy of measurements of induced abortion, and add to understanding of women's experiences of induced abortions and abortion care.
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Affiliation(s)
- Rachel H Scott
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Clara Calvert
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - Cicely Marston
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - Katerini Storeng
- London School of Hygiene & Tropical Medicine, London, UK.,University of Oslo, Oslo, Norway
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Abstract
We take a dialogical approach to exploring fertility regulation practices and show how they can maintain or express social identity. We identify three themes in educated Ghanaian women’s accounts of how they navigate conflicting social demands on their identity when trying to regulate fertility: secrecy and silence – hiding contraception use and avoiding talking about it; tolerating uncertainty – such as using unreliable but more socially acceptable contraception; and wanting to be fertile and protecting menses. Family planning programmes that fail to tackle such social-psychological obstacles to regulating fertility will risk reproducing social spaces where women struggle to claim their reproductive rights.
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Howard-Grabman L, Miltenburg AS, Marston C, Portela A. Factors affecting effective community participation in maternal and newborn health programme planning, implementation and quality of care interventions. BMC Pregnancy Childbirth 2017; 17:268. [PMID: 28854886 PMCID: PMC5577661 DOI: 10.1186/s12884-017-1443-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 11/29/2016] [Accepted: 08/04/2017] [Indexed: 11/29/2022] Open
Abstract
Background Community participation in in health programme planning, implementation and quality improvement was recently recommended in guidelines to improve use of skilled care during pregnancy, childbirth and the postnatal period for women and newborns. How to implement community participation effectively remains unclear. In this article we explore different factors. Methods We conducted a secondary analysis, using the Supporting the Use of Research Evidence framework, of effectiveness studies identified through systematic literature reviews of two community participation interventions; quality improvement of maternity care services; and maternal and newborn health programme planning and implementation. Results Community participation ranged from outreach educational activities to communities being full partners in decision-making. In general, implementation considerations were underreported. Key facilitators of community participation included supportive policy and funding environments where communities see women’s health as a collective responsibility; linkages with a functioning health system e.g. via stakeholder committees; intercultural sensitivity; and a focus on interventions to strengthen community capacity to support health. Levels of participation and participatory approaches often changed over the life of programmes as community and health services capacity to interact developed. Conclusion Implementation requires careful consideration of the context: previous experience with participation, who will be involved, gender norms, and the timeframe for implementation. Relevant stakeholders must be actively involved, particularly those often excluded from decision making. Current limited evidence suggests that the vision of community participation as a process and the presence of a focus to strengthen community capacity to participate and to improve health may be a key factor for long term success;
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Affiliation(s)
- Lisa Howard-Grabman
- Training Resources Group, Inc., 4301 Wilson Boulevard, Suite 400, Arlington, VA, 22203, USA.
| | - Andrea Solnes Miltenburg
- Institute of Health and Society, Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316, Oslo, Norway
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Anayda Portela
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health, 20 Avenue Appia, 1211, Geneva, Switzerland
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Abstract
"Co-production" is becoming an increasingly popular term in policymaking, governance, and research. While the shift from engagement and involvement to co-production in health care holds the promise of revolutionising health services and research, it is not always evident what counts as co-production: what is being produced, under what circumstances, and with what implications for participants. We discuss these questions and propose that co-production can be understood as an exploratory space and a generative process that leads to different, and sometimes unexpected, forms of knowledge, values, and social relations. By opening up this discussion, we hope to stimulate future debates on co-production as well as draw out ways of thinking differently about collaboration and participation in health care and research. Part of the title of this article is inspired by the book "The Social Construction of What?" by Ian Hacking (Cambridge, MA: Harvard University Press; 2000).
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Affiliation(s)
- Angela Filipe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Alicia Renedo
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cicely Marston
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
Young people in many countries report gender differences in giving and receiving oral sex, yet examination of young people's own perspectives on gender dynamics in oral heterosex are relatively rare. We explored the constructs and discourses 16- to 18-year-old men and women in England used in their accounts of oral sex during in-depth interviews. Two contrasting constructs were in circulation in the accounts: on one hand, oral sex on men and women was narrated as equivalent, while on the other, oral sex on women was seen as "a bigger deal" than oral sex on men. Young men and women used a "give and take" discourse, which constructed the mutual exchange of oral sex as "fair." Appeals to an ethic of reciprocity in oral sex enabled women to present themselves as demanding equality in their sexual interactions, and men as supporting mutuality. However, we show how these ostensibly positive discourses about equality also worked in narratives to obscure women's constrained agency and work with respect to giving oral sex.
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Affiliation(s)
- Ruth Lewis
- Department of Sociology, University of the Pacific, and Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
- Correspondence should be addressed to Cicely Marston, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, LondonWC1H 9SH, UK. E-mail:
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Downing J, Kiman R, Boucher S, Nkosi B, Steel B, Marston C, Lascar E, Marston J. Children's palliative care now! Highlights from the second ICPCN conference on children's palliative care, 18-21 May 2016, Buenos Aires, Argentina. Ecancermedicalscience 2016; 10:667. [PMID: 27610193 PMCID: PMC5014554 DOI: 10.3332/ecancer.2016.667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 06/28/2016] [Indexed: 01/15/2023] Open
Abstract
The International Children's Palliative Care Network held its second international conference on children's palliative care in Buenos Aires, Argentina, from the 18th-21st May 2016. The theme of the conference was 'Children's Palliative Care…. Now!' emphasising the need for palliative care for children now, as the future will be too late for many of them. Six pre-conference workshops were held, addressing issues connected to pain assessment and management, adolescent palliative care, ethics and decision-making, developing programmes, the basics of children's palliative care, and hidden aspects of children's palliative care. The conference brought together 410 participants from 40 countries. Plenary, concurrent, and poster presentations covered issues around the status of children's palliative care, genetics, perinatal and neonatal palliative care, the impact of children's palliative care and the experiences of parents and volunteers, palliative care as a human right, education in children's palliative care, managing complex pain in children, spiritual care and when to initiate palliative care. The 'Big Debate' explored issues around decision-making and end of life care in children, and gave participants the opportunity to explore a sensitive and thought provoking topic. At the end of the conference, delegates were urged to sign the Commitment of Buenos Aires which called for governments to implement the WHA resolution and ensure access to palliative care for neonates, children and their families, and also commits us as palliative care providers to share all that we can and collaborate with each other to achieve the global vision of palliative care for all children who need it. The conference highlighted the ongoing issues in children's palliative care and participants were continually challenged to ensure that children can access palliative care NOW.
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Affiliation(s)
- J Downing
- International Children's Palliative Care Network, New Bond House, Bond Street, Bristol, UK; Palliative Care, Makerere University, PO Box 7072, Kampala, Uganda
| | - R Kiman
- Paediatric Palliative Care, Hospital Nacional Prof A Posadas, Av Pres Arturo U Illia, Villa Sarmiento, Buenos Aires, Argentina
| | - S Boucher
- International Children's Palliative Care Network, Cluster Box 3050, Assagay, 3624, South Africa
| | - B Nkosi
- International Children's Palliative Care Network, Cluster Box 3050, Assagay, 3624, South Africa
| | - B Steel
- International Children's Palliative Care Network, Cluster Box 3050, Assagay, 3624, South Africa
| | - C Marston
- International Children's Palliative Care Network, Cluster Box 3050, Assagay, 3624, South Africa
| | - E Lascar
- Hospital de Niños Dr Ricardo Gutiérrez, C1425EFD Autonomous City of Buenos Aires, Argentina
| | - J Marston
- International Children's Palliative Care Network, Cluster Box 3050, Assagay, 3624, South Africa
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Marston C, Church K. Response to Letters to the Editor from Irit Sinai "Standard Days Method Effectiveness: opinion disguised as scientific review" and Kelsey Wright, Karen Hardee, and John Townsend "The pitfalls of using selective data to represent the effectiveness, relevance and utility of the Standard Days Method of contraception". Contraception 2016; 94:376-8. [PMID: 27318005 DOI: 10.1016/j.contraception.2016.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - Kathryn Church
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
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Marston C, Hinton R, Kean S, Baral S, Ahuja A, Costello A, Portela A. Community participation for transformative action on women's, children's and adolescents' health. Bull World Health Organ 2016; 94:376-82. [PMID: 27152056 PMCID: PMC4857226 DOI: 10.2471/blt.15.168492] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 02/18/2016] [Accepted: 02/18/2016] [Indexed: 11/27/2022] Open
Abstract
The Global strategy for women’s, children’s and adolescents’ health (2016–2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals.
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Affiliation(s)
- Cicely Marston
- London School of Hygiene & Tropical Medicine, London, England
| | - Rachael Hinton
- Partnership for Maternal, Newborn & Child Health, Geneva, Switzerland
| | - Stuart Kean
- World Vision International, Milton Keynes, England
| | - Sushil Baral
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - Arti Ahuja
- Department of Health and Family Welfare, Government of Odisha, Bhubaneswar, India
| | - Anthony Costello
- World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Anayda Portela
- World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Zalin A, Papoutsi C, Shotliff K, Majeed A, Marston C, Reed J. The use of information for diabetes research and care: patient views in West London. Pract Diab 2016. [DOI: 10.1002/pdi.2008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A Zalin
- NIHR CLAHRC Northwest London, Imperial College London; Chelsea & Westminster Hospital NHS Foundation Trust; London UK
| | - C Papoutsi
- NIHR CLAHRC Northwest London, Imperial College London; Chelsea & Westminster Hospital NHS Foundation Trust; London UK
| | - K Shotliff
- Beta Cell Centre for Diabetes, Chelsea and Westminster Hospital NHS Foundation Trust; London UK
| | - A Majeed
- Department of Primary Care & Public Health; Imperial College London; London UK
| | - C Marston
- Department of Social and Environmental Health Research; London School of Hygiene and Tropical Medicine; London UK
| | - J Reed
- NIHR CLAHRC Northwest London, Imperial College London; Chelsea & Westminster Hospital NHS Foundation Trust; London UK
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Papoutsi C, Reed JE, Marston C, Lewis R, Majeed A, Bell D. Patient and public views about the security and privacy of Electronic Health Records (EHRs) in the UK: results from a mixed methods study. BMC Med Inform Decis Mak 2015; 15:86. [PMID: 26466787 PMCID: PMC4607170 DOI: 10.1186/s12911-015-0202-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 09/28/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Although policy discourses frame integrated Electronic Health Records (EHRs) as essential for contemporary healthcare systems, increased information sharing often raises concerns among patients and the public. This paper examines patient and public views about the security and privacy of EHRs used for health provision, research and policy in the UK. METHODS Sequential mixed methods study with a cross-sectional survey (in 2011) followed by focus group discussions (in 2012-2013). Survey participants (N = 5331) were recruited from primary and secondary care settings in West London (UK). Complete data for 2761 (51.8 %) participants were included in the final analysis for this paper. The survey results were discussed in 13 focus groups with people living with a range of different health conditions, and in 4 mixed focus groups with patients, health professionals and researchers (total N = 120). Qualitative data were analysed thematically. RESULTS In the survey, 79 % of participants reported that they would worry about the security of their record if this was part of a national EHR system and 71 % thought the National Health Service (NHS) was unable to guarantee EHR safety at the time this work was carried out. Almost half (47 %) responded that EHRs would be less secure compared with the way their health record was held at the time of the survey. Of those who reported being worried about EHR security, many would nevertheless support their development (55 %), while 12 % would not support national EHRs and a sizeable proportion (33 %) were undecided. There were also variations by age, ethnicity and education. In focus group discussions participants weighed up perceived benefits against potential security and privacy threats from wider sharing of information, as well as discussing other perceived risks: commercial exploitation, lack of accountability, data inaccuracies, prejudice and inequalities in health provision. CONCLUSIONS Patient and public worries about the security risks associated with integrated EHRs highlight the need for intensive public awareness and engagement initiatives, together with the establishment of trustworthy security and privacy mechanisms for health information sharing.
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Affiliation(s)
- Chrysanthi Papoutsi
- NIHR CLAHRC Northwest London, Imperial College London, Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.,Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie E Reed
- NIHR CLAHRC Northwest London, Imperial College London, Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
| | - Cicely Marston
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Lewis
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK.,Department of Sociology, University of the Pacific, Stockton, CA, USA
| | - Azeem Majeed
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Derek Bell
- NIHR CLAHRC Northwest London, Imperial College London, Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.
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Abstract
This ethnographic study examines how participatory spaces and citizenship are co-constituted in participatory healthcare improvement efforts. We propose a theoretical framework for participatory citizenship in which acts of citizenship in healthcare are understood in terms of the spaces they are in. Participatory spaces consist of material, temporal and social dimensions that constrain citizens' actions. Participants draw on external resources to try to make participatory spaces more productive and collaborative, to connect and expand them. We identify three classes of tactics they use to do this: 'plotting', 'transient combination' and 'interconnecting'. All tactics help participants assemble to a greater or lesser extent a less fragmented participatory landscape with more potential for positive impact on healthcare. Participants' acts of citizenship both shape and are shaped by participatory spaces. To understand participatory citizenship, we should take spatiality into account, and track the ongoing spatial negotiations and productions through which people can improve healthcare.
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Renedo A, Marston C. Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement. BMC Health Serv Res 2015; 15:122. [PMID: 25903663 PMCID: PMC4407290 DOI: 10.1186/s12913-015-0770-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 02/27/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Understanding quality improvement from a patient perspective is important for delivering patient-centred care. Yet the ways patients define quality improvement remains unexplored with patients often excluded from improvement work. We examine how patients construct ideas of 'quality improvement' when collaborating with healthcare professionals in improvement work, and how they use these understandings when attempting to improve the quality of their local services. METHODS We used in-depth interviews with 23 'patient participants' (patients involved in quality improvement work) and observations in several sites in London as part of a four-year ethnographic study of patient and public involvement (PPI) activities run by Collaborations for Leadership in Applied Health Research and Care for Northwest London. We took an iterative, thematic and discursive analytical approach. RESULTS When patient participants tried to influence quality improvement or discussed different dimensions of quality improvement their accounts and actions frequently started with talk about improvement as dependent on collective action (e.g. multidisciplinary healthcare professionals and the public), but usually quickly shifted away from that towards a neoliberal discourse emphasising the role of individual patients. Neoliberal ideals about individual responsibility were taken up in their accounts moving them away from the idea of state and healthcare providers being held accountable for upholding patients' rights to quality care, and towards the idea of citizens needing to work on self-improvement. Participants portrayed themselves as governed by self-discipline and personal effort in their PPI work, and in doing so provided examples of how neoliberal appeals for self-regulation and self-determination also permeated their own identity positions. CONCLUSIONS When including patient voices in measuring and defining 'quality', governments and public health practitioners should be aware of how neoliberal rationalities at the heart of policy and services may discourage consumers from claiming rights to quality care by contributing to public unwillingness to challenge the status quo in service provision. If the democratic potential of patient and public involvement initiatives is to be realised, it will be crucial to help citizens to engage critically with how neoliberal rationalities can undermine their abilities to demand quality care.
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Affiliation(s)
- Alicia Renedo
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Cicely Marston
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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