A Social-ecological Perspective on Understanding Facilitators to Access Primary Health Care Services among Ethiopian Immigrant Women in the United States.

Using a social-ecological model (SEM), this qualitative study explored the facilitators of access to primary health care (PHC) among Ethiopian immigrant women in the U.S. Data were collected through in-depth interviews (N=21, ≥18 years) and analyzed thematically using Nvivo12. At the individual level, stable employment, insurance, immigration status, proactivity, education, communication skills, and internet usage were identified as facilitators of PHC access. Interpersonal support from family and friends was highlighted as a key facilitator. Institutional facilitators included interpretation services and the sociocultural background of health care providers. On the community level, support from community organizations and residing in certain locations were recognized as facilitators of PHC access. No policy-level facilitators were identified. The findings underscore the importance of strengthening individual and interpersonal capacities, including job opportunities, social support, legal assistance for immigration status, and education and communication skills. Further research is needed to analyze policy gaps and suggest viable solutions.

"We Want to See Youth That Would Be Better People Than Us": A Case Report on Addressing Adolescent Substance Use in Rural South Africa.

Research suggests that substance use, particularly among adolescents may lead to increased illegal activities as well as physical and social health consequences. Around the world, communities, overburdened with adolescent and youth substance use, are finding ways to address this public health threat. Using a case study based on a focus group discussion with nine founding members, this paper reports on the case of Sibanye-a rural community coalition whose mission is to reduce the burden of adolescent substance use on families in rural South Africa. The focus group discussions were audio-recorded, transcribed verbatim, and analyzed using Nvivo 12. This work highlights the power of an engaged collective effort in addressing key community issues, even in rural areas of emerging economies where health and community infrastructure may be limited. The Sibanye coalition taps into its collective wealth of community knowledge to provide social contributions and aesthetics to help adolescents abstain from substance use and sexual risk behaviors. These activities offer adolescents safe places to meet each other, health education, and the ability to structure their free time meaningfully. Engaging community residents, particularly disadvantaged groups, should be central to any local and national strategies for promoting health and well-being.

Participant Perspectives on the Effects of an African American Faith-Based Health Promotion Educational Intervention: a Qualitative Study.

BACKGROUND: In the USA, African Americans (AAs) experience a greater burden of mortality and morbidity from chronic health conditions including obesity, diabetes, and heart disease. Faith-based programs are a culturally sensitive approach that potentially can address the burden of chronic health conditions in the AA community. OBJECTIVE: The primary objective was to assess (i) the perceptions of participants of Live Well by Faith (LWBF)-a government supported faith-based program to promote healthy living across several AA churches-on the effectiveness of the program in promoting overall wellness among AAs. A secondary objective was to explore the role of the church as an intervention unit for health promotion among AAs. METHODS: Guided by the socio-ecological model, data were collected through 21 in-depth interviews (71% women) with six AA church leaders, 10 LWBF lifestyle coaches, and five LWBF program participants. Interviews were audio-recorded, transcribed verbatim, and analyzed by three of the researchers. FINDINGS: Several themes emerged suggesting there was an effect of the program at multiple levels: the intrapersonal, interpersonal, organizational, and community levels. Most participants reported increased awareness about chronic health conditions, better social supports to facilitate behavior change, and creation of health networks within the community. CONCLUSION: Our study suggests that one approach to address multilevel factors in a culturally sensitive manner could include developing government-community partnership to co-create interventions.

The Past Is so Present: Understanding COVID-19 Vaccine Hesitancy Among African American Adults Using Qualitative Data.

BACKGROUND: African Americans (AAs) are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities. OBJECTIVE: The present study aims to explore vaccine attitudes and intentions among program participants, understand the role of an African American faith-based wellness program in COVID-19 awareness and vaccine uptake, and solicit potential solutions for this deep-rooted public health problem. METHODS: Data were collected through 21 in-depth interviews among individuals involved within a community-based wellness program. Sixteen phone and five in-person interviews were conducted with church leaders, lifestyle coaches, and program participants. All interviews were audio-recorded, transcribed verbatim, and inductively and thematically analyzed by three researchers. FINDINGS: Live Well by Faith (LWBF) acted as a trusted information source for COVID-19 resources for the AA community. Services provided by Live Well by Faith included enrolling community members for vaccines, negotiating vaccine provision to and facilitating the establishment of vaccine clinics at AA churches, and connecting community members to healthcare providers. Despite the role Live Well by Faith played, VH was a significant concern due, in part, to historical mistrust of government and pharmaceutical companies conducting unethical healthcare research among Black populations. Other factors included uncertainty about vaccination (vaccines' safety, efficacy, and necessity), social media misinformation, and political affiliation. Participants expressed the need for government to commit resources towards addressing historical factors and building trust with minority populations. CONCLUSION: Resource targeting programs such as Live Well by Faith that engage faith and community leaders in co-designed shared and culturally grounded interventions can help restore and strengthen trust in vaccines and governments and reduce vaccine hesitancy.

COVID-19 and Higher Education: A Qualitative Study on Academic Experiences of African International Students in the Midwest.

COVID-19 pandemic has harshly impacted university students since the outbreak was declared in March 2020. A population impacted the most was international college students due to limited social networks, restrictive employment opportunities, and travel limitations. Despite the increased vulnerability, there has been limited research on the experiences of African-born international students during the pandemic. Using an exploratory qualitative design, this study interviewed 15 African-born international students to understand their experiences during the pandemic. Thematic analysis revealed that the COVID-19 pandemic influenced participants' academic life directly via an abrupt shift to online learning and indirectly through disruptions in an academic work routine, opportunities for networking, and career advancement, resulting in lower academic performance and productivity. These experiences were worsened by other social and regulatory barriers associated with their non-immigrant status. The study findings suggest an increased need for institutional and community support for international students as vulnerable populations during a crisis to promote sustained academic success.

Needs ranking: A qualitative study using a participatory approach.

Youth disengagement is a growing concern globally, yet little research has been done to explore participatory approaches that can engage youth as co-creators of community programs that improve their resilience. The primary objective of the study is to report on the results of an innovative participatory approach used in the Eastern and Western Cape provinces, South Africa, to engage vulnerable youth in needs ranking. Data for this paper were collected in three phases. Using information gleaned from the literature review (Phase I), authors compiled a list of core needs on separate cards. In Phase II, youth discussed and ranked each need in terms of importance for their community. In Phase III, youth participated in focus group discussions on the ranked needs as part of a broader discussion on youth risk behaviours. Thematic analysis was used for qualitative data. Needs ranking data were analysed using descriptive statistics. Although expressed priority needs differed amongst communities, combined data revealed the top expressed priorities as further education (priority 1; 85%), skills development (priority 2; 74%) and career development and training (priority 3; 68%). Differences between critical needs as discussed in the literature and those perceived by youth were noted. Focus group data validated the expressed priority needs and highlighted that vulnerable youth felt valued through the needs ranking activity. Involving youth in the assessment of their needs can improve the value of information obtained, which in turn can facilitate better allocation of community resources.

COVID-19 and crisis communication among African American households.

BACKGROUND: African American (AA) families are disproportionately burdened by COVID-19 resulting in morbidity and death. How pandemic risks and impacts are communicated to parents and in turn translated to children can have implications for familial mental wellbeing. Because culture shapes how information is received, processed, and utilized, there is need to understand how AA parents' experiences of COVID-19 information sharing and perceived vulnerabilities influenced communication with their children. METHODS: Data was collected through semistructured in-depth telephone interviews conducted among 11 African American households with school aged child (5 to 17 years). Line-byline coding and thematic analysis were used to deduce meaning from professionally transcribed data. Preliminary Findings: Four themes on trust in information sources, risk perceptions, attitudes to prevention methods, and parent-child risk communication emerged. Although participants felt challenged by their inherent vulnerabilities and communicating COVID-19 risks at an appropriate comprehension level to their children, they leaned into cultural safety nets such as "the dinner table" to encourage conversation and foster resilience. IMPLICATIONS: Understanding how African American families with children were impacted by COVID-19 and how adequate crisis communication can help mitigate adverse health consequences, strengthen recovery, foster resilience, and promote family and community healing is important. Clinicians and therapists who work with AA families should be sensitive to their social vulnerability and culturally responsive to AA family systems when communicating about public health emergencies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

COVID-19, "A Gift and a Curse" in Unsettling Times: A Qualitative Study.

The objectives of this study were to rapidly explore the perceptions of female-headed African American families on "stressors," "stress reactions," and "opportunities" amid the COVID-19 pandemic lockdown mandates. Semistructured telephone interviews were conducted with 9 African American women in a rural Midwestern (US) community, who were single parents/grandparents and cared for at least one child/grandchild aged 5 to 17 years. A thematic analytical approach was used to review, code, and analyze phone interview transcripts. Coding schemes were developed through an interactive iterative process. Three main themes emerged-pandemic as a curse, de-stressors and coping mechanisms, and the pandemic as a gift. Most participants reported increased stress for themselves and their children and adopted several coping strategies. However, for most mothers, COVID-19 was paradoxical because it also provided opportunities for families to bond despite these stressors. Public health actions such as social and physical distancing infringe on personal freedoms and can have negative effects on the health of those affected. There is a need to proactively address important areas such as health education and economic and social support to mitigate common sociopsychological effects of a pandemic.

Sink or Swim: Virtual Life Challenges among African American Families during COVID-19 Lockdown.

This study explores African American parents' experiences with using technology to engage their children in meaningful activities (e.g., e-learning) during COVID-19 and its impact on family health. Eleven African American families were recruited through a local health department program from a rural Midwestern community to participate in semi-structured interviews. Majority of participants reported stresses from feelings of "sink or swim" in a digital world, without supports from schools to effectively provide for their children's technology needs. The COVID-19 pandemic underscored the importance of family-school collaborative engagement and empowerment. Digital technology needs to become part of our school education system so that technology use among African Americans is elevated and families protected against future outbreaks. Further research with a more diverse African American sample is needed.

Rural voices: A social-ecological perspective on factors influencing youth substance use in rural South africa.

BACKGROUND: Youth can be a positive force for development when provided with the knowledge and opportunities they need to thrive, yet they continue to experience insurmountable challenges, such as poverty and absentee fathers, that prompt them to resort to risk behaviours such as substance use. In rural South Africa, women tend to be the breadwinners and more involved with parenting than men. OBJECTIVE: The primary objective of the study was to explore perspectives of rural youth on factors influencing youth participation in substance use. The secondary objective was to obtain the perspectives of adult women on factors influencing substance use among young people. METHODS: The qualitative study, informed by a social-ecological framework, utilised a semi-structured interview protocol in focus group discussions in rural South Africa. Seven focus group discussions, each with between 8 and 15 individuals were conducted with 79 youth. The eighth discussion was with nine adult women. Data were audio recorded and transcribed verbatim, manually coded and further analysed into themes using NVivo 12. FINDINGS: Four themes emerged: hopelessness and lack of motivation, lack of adult role models such as father, lack of built environment for recreational activities and lack of educational opportunities. The social-ecological model provided a useful framework to understand the findings. In line with this model, rural youth in South Africa described a variety of factors that influenced youth substance use and other risk behaviours. These related to the individual, relationships with others, community and societal norms and values factors of the social-ecological model. CONCLUSIONS: The broadening spectrum of substances available to an increasing youth population bulge in Africa suggests a strong threat of social and disease burden due to substance use disorders. Given this threat, this study provides awareness to a multi-systems approach needed to support the rural South African youth.

Emerging from the Shadows: Intrinsic and Extrinsic Factors Facing Community Health Workers in Western Cape, South Africa.

Community health workers (CHWs) have been identified as a key component of the health workforce in South Africa. However, the efficacy of CHW programs continues to be limited by a poor understanding of facilitators and barriers to CHW engagement. This study explores intrinsic and extrinsic factors that CHWs face. We conducted in-depth interviews with 20 CHWs in order to understand the challenges they may face as they implement their duties linked to the primary health care strategy in the Western Cape, South Africa. All interviews were audiotaped, transcribed verbatim, coded and analyzed using NVivo 12. Drawing on narratives of CHWs, we illustrate the complex issues surrounding CHW outreach in poor rural communities. The CHWs identified five key areas of challenges with respect to personal health, gender issues, poor community understanding of CHWs roles, environmental challenges and lack of patient adherence. These all hinder the ability of CHWs to meet their personal and familial needs, as well as those of the community members they support. There is a need to address the intrinsic needs of CHWs in order to ensure their emotional and physical well-being, as well as a need to create an awareness of the roles of CHWs.

A Self-Management Training Intervention: Perceptions and Practices of Community Health Workers in South Africa.

Background. While community health workers (CHWs) are increasingly being used as a strategy for increasing health care access, particularly in rural communities, interventions are needed to improve their skill sets in inspiring health behavior change, both for themselves and among their community clients. Self-management (SM) education interventions have shown to improve health behaviors and well-being. Purpose. This article reports on systematic, in-depth interviews conducted with rural CHWs in South Africa to understand (1) their motivation for participating in SM training, (2) skills gained from training and (3) perceived impact of training on CHW health behavior, both personally and as health professionals. Method. Nineteen rural CHWs who completed an SM training participated in face-to-face semistructured interviews. Transcripts were independently coded by two researchers using the thematic framework approach. Findings. CHWs felt empowered to change their health behavior by skills such as goal setting and action planning, and by growth in self-awareness and confidence. They expressed that their desire to help others motivated them to participate in SM training. Conclusion. SM training programs that address practice skill gaps hold promise in producing health behavior changes for rural CHWs and their clients.

Employing a User-Centered Design to Engage Mothers in the Development of a mHealth Breastfeeding Application.

Breastfeeding has numerous health benefits; however, many mothers do not continue breastfeeding to the recommended 6 months of age. Breastfeeding support after discharge from the hospital is often lacking in the communities with the greatest need. Therefore, the Mother's Milk Connection mHealth application was designed to improve breastfeeding duration and access to support. This article describes a user-centered design process to engage mothers in the development of the Mother's Milk Connection application. Two phases of stakeholder and user studies were conducted. Phase 1 involved concept generation, prototype development, and usability testing. Phase 2 focused on prototype redesign and usability testing. We used a descriptive mixed-method approach with data collected using a demographic questionnaire, System Usability Scale, exit survey, and focus groups. Final features of the Mother's Milk Connection application included resources and education, peer support, automated activity tracking, and professional support via video conference. Stakeholder and user engagement indicated the integration of four distinct features is acceptable for use as a comprehensive mHealth intervention to improve access to breastfeeding support. mHealth has the potential to be a useful strategy for providing breastfeeding support, and a clinical trial regarding the efficacy of the Mother's Milk Connection application is needed.

Scars of disengagement: perspectives on community leadership and youth engagement in rural South Africa.

Given the emerging global youth disengagement epidemic, anticipated population growth, and the threat of continued rural-urban migration among young adults, recent research has focused on community leadership practice and the factors that influence youth engagement at the local level. Studying these practices and factors can elicit interventions that can improve youth engagement and youth health. This study engaged South African rural community leaders in interviews to collect perceptions and experiences on community leadership and factors that influence youth engagement and their health behaviors. Content analysis was used to analyze the data. Emergent themes are categorized into four domains: conceptualizations of leadership, current youth behaviors, barriers to youth engagement, and youth leadership opportunities and potential solutions. Findings demonstrate a clear grasp of the concept of community leadership among community leaders, and an awareness of the complex interplay of social, economic and environmental factors on youth disengagement and the potential interventions to promote more youth participation.

Systematic procedures to promote U.S. HIV medication adherence via Photovoice.

Medication adherence is essential to promote the health of people living with HIV (PL-HIV) and prevent HIV transmission in the U.S. Novel medication health promotion interventions are needed that address patient-centeredness, understandability, and communication with providers. The aims of this article are to define the systematic stages we used to develop an effective health promotion intervention via the products (e.g. images and stories) of Photovoice. We designed an intervention to improve HIV adherence knowledge, attitudes, and communication with providers through Photovoice. 16 PL-HIV used Photovoice strategies to describe their experiences with medication via images and captions and create an intervention (10 adherence promotion posters) that integrated photo-stories of their adherence motivators, journeys from sickness to health, and how they manage and counter HIV stigma. We outline the systematic process we used to adapt Photovoice to create the effective intervention for replication. The process included six stages: (i) identify scope of the project; (ii) create collaborative project team; (iii) design project materials; (iv) review and revise materials with team members; (v) disseminate materials; and (vi) evaluate materials. Photovoice is used traditionally as a social action research method. In this project, it was adapted to create patient-driven images and stories for health promotion posters. Poster viewers experienced improved self-efficacy for HIV medication adherence. Describing the adaptation of the Photovoice process in a deliberate and transparent way can support fidelity to the essence of the participant-driven method, while also allowing researchers and practitioners to replicate Photovoice as a successful health promotion intervention.

The Graying of Rural America: Community Engagement and Health Promotion Challenges.

BACKGROUND: Although social participation has been linked to positive physical and mental health outcomes, elderly people in rural areas remain highly disengaged. Also, few studies have examined community residents' perceptions of the barriers and opportunities for the elderly to participate in community activities. PURPOSE: This article highlights the perceptions of rural community residents regarding their understanding of the following: (1) community leadership, (2) barriers and opportunities for the elderly to engage in leadership, and (3) potential community-based solutions for promoting more social participation. METHOD: Individual interviews were conducted with 16 community members. Content analysis was used to analyze the data. Researchers immersed and familiarized themselves with the data prior to developing codes. Coding was initially done manually and later using NVivo. FINDINGS: Four major themes emerged: conceptions of community leadership, elderly resource inventory, barriers to elderly engagement, and potential solutions. Themes collectively illustrated that residents have a clear understanding of the role of community leadership, of available resources for the elderly, and of the barriers encountered when using these resources. CONCLUSION: Our findings highlight a need for health promotion strategies that are informed by community needs and foster healthy lifestyles for all community residents.

Influences on Infant Feeding: Perceptions of Mother-Father Parent Dyads.

PURPOSE: The purpose of this study was to examine interrelational-, organizational-, and community-level influences on how coparents collaborate about infant and toddler feeding. STUDY DESIGN AND SAMPLE: Using qualitative methods, we interviewed mother-father parent dyads to explore the potential influences on infant and toddler feeding. Participants were purposively recruited from two Midwest, rural, university-system pediatric clinics. Thematic analysis was used to code the data. MEASURES: Mother-father dyadic interviews were conducted using a semistructured interview schedule. Twenty-four mother-father dyads who had a child between the ages of 6 and 36 months were interviewed together. RESULTS: Major themes include interpersonal factors (peer behavior reinforcement, dyad and important others infant feeding conflict, conflict resolution proactiveness), organizational factors (healthcare provider infant-feeding support, workplace flexibility), and community factors (public perception on breastfeeding and social media influence). CLINICAL IMPLICATIONS: Community-based collaboration can be a platform for mother-father dyads, researchers, public health nurses, and other healthcare providers to proactively create interventions that include opportunity for building coparenting skills and infant-feeding knowledge that promote team management of common early childhood feeding challenges.

Four Years Later: Rural Mothers' and Employers' Perspectives on Breastfeeding Barriers Following the Passage of the Affordable Care Act.

For the working rural mother, one key source of support for breastfeeding is the employer. The purpose of this article was to examine workplace barriers and facilitators to breastfeeding in a small rural American community following the passage of the Affordable Care Act in 2010. We used a qualitative research design: semi-structured interviews with major employers and low-income working breastfeeding mothers, and a focus-group with another group of employed and unemployed breastfeeding low-income mothers. While some businesses accommodate breastfeeding mothers, few actively promote breastfeeding. Lack of compliance with the new law, inadequate breastfeeding information for mothers, and lack of support from co-workers and supervisors emerged as the main barriers to successful workplace breastfeeding. To improve workplace breastfeeding support significantly there is need for authentic collaboration among maternal-child and rural health agencies and businesses in creating breastfeeding-tolerant, flexible, and forward-looking work environments that, at a minimum, satisfy the law.

Co-parenting and feeding in early childhood: Reflections of parent dyads on how they manage the developmental stages of feeding over the first three years.

Family-level influences on the development of healthy eating behaviors start in infancy and toddlerhood with how families manage developmental stages of feeding. Little research on home feeding environments for young children has examined how mothers and fathers collaborate around feeding issues or contribute jointly to feeding. The purpose of this qualitative study is to examine co-parenting with regard to infant/toddler feeding practices. Twenty-four sets of co-resident, biological parents with a child between 6 months and 3 years were interviewed together about their feeding practices and how they discussed and collaborated on feeding during the main stages of feeding development in the first three years. Analyses illuminate themes related to how specific domains of co-parenting (satisfaction with labor, support, agreement, conflict) factor into infant and toddler feeding as well as how additional factors such as having older children and employment schedules shape how both food parenting practices and co-parenting are managed in relation to feeding. Mothers were the primary managers of feeding labor. Fathers participated in feeding in different ways and levels starting in infancy and increased involvement in feeding over the first few years requiring an ongoing negotiation around co-parenting related to feeding. Overall, this study develops insights into how multiple caregivers construct a family environment specifically related to early feeding - a perspective missing from current conceptualizations of home feeding environment. Attention to the concept of co-parenting within home feeding environments should help inform more effective approaches to intervene with families on issues around childhood obesity and family health.

Breastfeeding Barriers and Support in a Rural Setting.

PURPOSE: Although various breastfeeding interventions have proven effective in increasing breastfeeding initiation and duration, there has been less success in rural areas. This article describes breastfeeding barriers and support in a rural setting. STUDY DESIGN AND METHODS: A community needs assessment was conducted with a sample of healthcare providers and breastfeeding mothers in a rural area of Missouri. In-depth interviews with 10 healthcare providers and 3 breastfeeding mothers and a focus group of 10 mothers who were breastfeeding or had recently breastfed were conducted. Interview and focus group questions were designed to capture a holistic perspective of breastfeeding issues. RESULTS: Gaps in hospital and community breastfeeding support were observed in the emerging themes: lack of realistic information about the breastfeeding experience, breastfeeding time constraint, and lack of continued support. CLINICAL IMPLICATIONS: From a community practice perspective, gaps in breastfeeding support illustrate an essential need for collective engagement of local stakeholders as the cornerstone to implement effective breastfeeding interventions.