Swahili translation and validation of the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) in adolescents and adults taking part in the girls' education challenge fund project in Tanzania.

BACKGROUND: The Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) is validated for measuring mental wellbeing in populations aged 11 + and has been translated into 30 + languages. The aims of this study were a) to translate and validate WEMWBS for use in Swahili-speaking populations to facilitate measurement and understanding of wellbeing, evaluation of policy and practice, and enable international comparisons; and b) to examine sociodemographic characteristics associated with higher and lower mental wellbeing in participants in the Girls' Education Challenge (GEC) project in Tanzania. METHODS: A short questionnaire including WEMWBS and similar scales for comparison, socio-demographic information, and self-reported health was translated into Swahili using gold standard methodology. This questionnaire was used to collect data from secondary school students, learner guides, teacher mentors and teachers taking part in the GEC project in Tanzania. Focus groups were used to assess acceptability and comprehensibility of WEMWBS and conceptual understanding of mental wellbeing. These were audio-taped, transcribed and analysed thematically. Internal consistency of WEMWBS, correlation with comparator scales and confirmatory factor analysis were completed as quantitative validation. Finally, multivariable logistic regression was used to explore associations between individual characteristics and 'high' and 'low' mental wellbeing, defined as the highest and lowest quartile of WEMWBS scores. RESULTS: 3052 students and 574 adults were recruited into the study. Participants reported that WEMWBS was understandable and relevant to their lives. Both WEMWBS and its short form met quantitative standards of reliability and validity, were correlated with comparator scales and met the criteria to determine a single factor structure. For students in the GEC supported government schools: mental wellbeing was higher in students in the final two 'forms' of school compared with the first two. In addition: being male, urban residence, the absence of markers of social marginality and better self-reported health were all significantly associated with better mental wellbeing. For adults, urban residence and better self-reported health were associated with better mental wellbeing. CONCLUSIONS: The Swahili translation of WEMWBS is available for use. Further work to explore how to intervene to increase mental wellbeing in vulnerable GEC participants is needed.

Racial/Ethnic and Gender Disparities Over the Last Decade Within Microsurgery and Craniofacial Fellowship Training.

BACKGROUND: Racial/ethnic and gender disparities persist in plastic surgery at nearly all levels of training, becoming more pronounced at each stage. Recent studies have demonstrated that the proportion of female plastic surgery residents has increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. Other studies have identified severe declines in underrepresented minority plastic surgery representation between plastic surgery residents and academicians with only 1.6% of Black/African American and 4.9% of Hispanic/Latinx full professors of plastic surgery. Often, residents seek fellowship for advanced training before seeking an academic professorship. This study aims to describe the racial/ethnic and gender representation of microsurgery and craniofacial fellows. METHODS: Names and photos of graduated fellows for the past 10 years (2012-2021) were extracted from microsurgery and craniofacial fellowship Web sites. Using a 2-person evaluation method, race/ethnicity and gender were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Distributions were analyzed with descriptive statistics and compared with the US population. RESULTS: Among 30 microsurgery fellowships, 180 graduated fellows (52.7%) were identified, resulting in 66 female fellows (36.7%) and the following racial/ethnic distribution: 113 (62.8%) White, 49 (27.2%) Asian, 12 (6.7%) Hispanic/Latinx, and 6 (3.3%) Black/African American. Among 31 craniofacial fellowships, 136 graduated fellows (45.0%) were identified, resulting in 38 female fellows (27.9%) and the following racial/ethnic distribution: 75 (55.1%) White, 45 (33.1%) Asian, 8 (5.9%) Hispanic/Latinx, and 8 (5.9%) Black/African American. The intersection between race/ethnicity and gender revealed the most disproportionately low representation among Black women. Relative to the US population, Hispanic/Latinx (0.31-fold) and Black/African American (0.48-fold) fellows were underrepresented, White (0.90-fold) fellows were nearly equally represented, and Asian (5.42-fold) fellows are overrepresented relative to the US population. Furthermore, despite pursuing fellowships at a greater rate, Asian and Black fellows are not reaching adequate representation among academic plastic surgeons. CONCLUSION: This study demonstrates that female racial/ethnic minorities are disproportionately underrepresented among microsurgery and craniofacial fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.

Ter um fiho durante a pós-graduação em enfermagem: perspectivas e desafios / Having a child during graduate nursing: perspectives and challenges / Tener un hijo durante la carrera de enfermería: perspectivas y retos

Objetivo: compreender como enfermeiras percebem a vivência de uma gravidez e os primeiros meses após o nascimento de um filho durante o mestrado/doutorado. Método: estudo qualitativo, exploratório-descritivo, desenvolvido com nove pós-graduandas em enfermagem de uma universidade pública do estado do Paraná. A coleta de dados foi realizada nos meses de agosto e setembro de 2022, a partir de entrevistas individuais semiestruturadas que foram audiogravadas, transcritas e submetidas à análise de conteúdo, modalidade temática proposta por Bardin. Resultados: emergiram três categorias temáticas: 1) Enfrentando desafios: conciliar tarefas é uma necessidade; 2) Rede de apoio como facilitadora na conciliação da maternidade com os estudos e; 3) Aumento do tempo de licença-maternidade, flexibilização e apoio interno para inclusão de mulheres mães na ciência. Conclusão: as vivências da maternidade vivenciadas por mulheres na pós-graduação foram pautadas na sobrecarga das mães pesquisadoras, repercutindo em atrasos no cumprimento de prazos, dificuldade em manter a amamentação e preocupação com a saúde dos filhos, refletindo em escolhas e renúncias da maternidade nesta etapa da vida.

Objective: to understand how nurses perceive the experience of pregnancy and the first months after the birth of a child during their master's/doctoral studies. Method: qualitative, exploratory-descriptive study, developed with nine graduate students in nursing at a public university in the state of Paraná. Data collection was carried out in August and September 2022, based on semi-structured individual interviews that were audio-recorded, transcribed and submitted to content analysis, the thematic modality proposed by Bardin. Results: three thematic categories emerged: 1) Facing challenges: reconciling tasks is a necessity; 2) Support network as a facilitator in reconciling motherhood with studies and; 3) Increased maternity leave, flexibility and internal support for the inclusion of women mothers in science. Conclusion: the experiences of motherhood experienced by women in graduate school were based on the overload of research mothers, resulting in delays in meeting deadlines, difficulty in maintaining breastfeeding and concern for the health of their children, reflecting on choices and waivers of motherhood in this life stage.

Objetivo: comprender cómo las enfermeras perciben la experiencia del embarazo y los primeros meses después del nacimiento de un hijo durante sus estudios de maestría/doctorado. Método: estudio cualitativo, exploratorio-descriptivo, desarrollado con nueve estudiantes de postgrado en enfermería de una universidad pública del estado de Paraná. La recolección de datos se realizó en agosto y septiembre de 2022, a partir de entrevistas individuales semiestructuradas que fueron grabadas en audio, transcritas y sometidas a análisis de contenido, modalidad temática propuesta por Bardin. Resultados: emergieron tres categorías temáticas: 1) Enfrentar desafíos: conciliar tareas es una necesidad; 2) Red de apoyo como facilitadora en la conciliación de la maternidad con los estudios y; 3) Aumento de la licencia de maternidad, flexibilidad y apoyo interno para la inclusión de mujeres madres en la ciencia. Conclusión: las experiencias de maternidad vividas por las mujeres en el posgrado se basaron en la sobrecarga de las madres investigadoras, resultando en retrasos en el cumplimiento de los plazos, dificultad para mantener la lactancia materna y preocupación por la salud de sus hijos, reflexionando sobre las opciones y renuncias de la maternidad en esta etapa de la vida.

Ministérios no WhatsApp: gênero, sensorialidades e transformações ético-políticas no cotidiano de mulheres evangélicas / Ministerios en WhatsApp: género, sensorialidades y transformaciones ético-políticas en el cotidiano de mujeres evangélicas / Ministries on WhatsApp: gender, sensorialities and ethical-political transformations in the everyday life of evangelical women

Resumo Diferentes análises sobre a participação política de evangélicas(os) pentecostais no Brasil nos últimos anos têm chamado a atenção para transformações causadas pelos usos de mídias digitais por estes grupos. Em busca de ampliar este debate a partir de elementos que compõem usos cotidianos de grupos de oração no WhatsApp, o objetivo deste artigo é compreender como as disputas engajadas por mulheres pentecostais têm ressignificado suas carreiras pastorais e formado novas coletividades evangélicas. Com a emergência de outros modos de viver as intimidades propiciadas por dispositivos móveis, reflito sobre relações religiosas estabelecidas através de imagens e sons em grupos de WhatsApp, além dos impactos digitais nas dinâmicas de autoridade religiosa feminina e sua expansão transnacional.

Resumen Diferentes análisis sobre la participación política de los evangélicos pentecostales en Brasil en los últimos años han llamado la atención sobre las transformaciones provocadas por el uso de medios digitales por parte de estos grupos. Buscando ampliar este debate a partir de elementos que componen el uso cotidiano de los grupos de oración en WhatsApp, busqué comprender cómo las disputas libradas por las mujeres pentecostales han resignificado sus carreras pastorales y conformado nuevas colectividades evangélicas. Con el surgimiento de otras formas de experimentar las intimidades que brindan los dispositivos móviles, reflexiono sobre las relaciones religiosas que se establecen a través de imágenes y sonidos en los grupos de WhatsApp, además del impacto digital en la dinámica de la autoridad religiosa femenina y su expansión transnacional.

Abstract Recent literature on the political participation of Pentecostal evangelicals in Brazil has drawn attention to the transformations caused by their use of digital media. To broaden this debate, in this article I describe the everyday use of the WhatsApp instant messaging program by prayer groups, shedding light on how disputes engaged by Pentecostal women have re-signified their pastoral careers and formed new evangelical collectivities. With the emergence of other ways of experiencing the intimacy provided by mobile devices, I reflect on religious connections established across images and sounds in WhatsApp groups, in addition to the digital impact on the dynamics of female religious authority and its transnational expansion.

O pré-natal odontológico: contribuição da ESF, atendimento integral e conhecimento, uma revisão da literatura / The dental pre-natal: ESF contribution, comprehensive care and knowledge, a review of the literature / La atención prenatal odontológica: contribución del ESF, la atención integral y el conocimiento, una revisión bibliográfica

O pré-natal odontológico vem sendo alvo de ações estratégicas na atenção básica. É necessária a compressão que a mulher em período gestacional necessita de cuidados bucais, por esse fato o pré-natal necessita de reforços para o estabelecimento efetivo na atenção básica de forma a ser desmistificado na odontologia, e possibilitar que o cirurgião-dentista possa ser integrado com as ações voltadas para a saúde gestacional. Diante disso objetiva-se relatar sobre o pré-natal odontológico, e abordar sobre a contribuição da Estratégia Saúde da Família (ESF) nesse contexto, atuação multidisciplinar, e importância da educação e capacitação para desmistificação do atendimento a gestantes. Para isso foi realizado um levantamento bibliográfico nas bases de dados eletrônicas Scielo, portal BVS e Google Acadêmico. É visto ainda há baixa adesão das gestantes ao atendimento odontológico, embora haja uma notória representação da ESF na universalização desse cuidado. A equipe multidisciplinar no atendimento de gestantes parece colaborar para a motivação do atendimento, e fundamentar ações estratégicas interdisciplinares. Ainda é importante ressaltar que o conhecimento sobre os aspectos norteadores da gestação tem papel fundamental para desmistificar o atendimento odontológico e preparar os profissionais. Infere-se que o pré-natal odontológico vem ganhando expressividade, onde as ações da ESF, a atuação da equipe multidisciplinar e a ampliação do conhecimento acerca do assunto podem influenciar positivamente para a adesão desse grupo.

Dental prenatal care has been the target of strategic actions in primary care. It is necessary the compression that women in gestational period need oral care, for this reason prenatal care requires reinforcements for the effective establishment in primary care in order to be demystified in dentistry, and enable the dentist to be integrated with actions aimed at gestational health. Therefore, the objective is to report on dental prenatal care, and to address the contribution of the Family Strategy Health (ESF) in this context, multidisciplinary work, and the importance of education and training to demystify the care for pregnant women. For this, a bibliographic survey was carried out in the electronic databases Scielo, BVS portal and Google Scholar. It is seen that there is still low adherence of pregnant women to dental care, although there is a notorious representation of the ESF in the universalization of this care. A multidisciplinary team in the care of pregnant women seems to collaborate to motivate care, and to fundamentalize interdisciplinary strategic actions. It is also important to emphasize that knowledge about the guiding aspects of pregnancy has a fundamental role to demystify dental care and prepare professionals. It is inferred that prenatal in the dentistry has been gaining expressiveness, where the actions of the ESF, the performance of the multidisciplinary team and the expansion of knowledge on the subject can lead positively to the adhesion of this group.

La atención prenatal dental ha sido objeto de acciones estratégicas en la atención primaria. Es necesario que la mujer en el período de gestación necesite cuidados bucales, por lo que el prenatal necesita refuerzos para el establecimiento efectivo de la atención básica de forma que sea desmitificado en la odontología, y que la cirugía-dentista pueda integrarse con las acciones volcadas a la salud gestacional. Por ello, el objetivo es informar sobre la atención prenatal odontológica y abordar la contribución de la Estrategia de Salud Familiar (ESF) en este contexto, la actuación multidisciplinar y la importancia de la educación y la formación para desmitificar la atención a las embarazadas. Para ello, se realizó un estudio bibliográfico en las bases de datos electrónicas Scielo, portal BVS y Google Acadêmico. Aún así, se observa una baja adhesión de las gestantes a la atención odontológica, aunque hay una notable representación del FSE en la universalización de este cuidado. El equipo multidisciplinar en la atención a la mujer embarazada parece colaborar a la motivación de los cuidados, y basar las acciones estratégicas interdisciplinares. También es importante destacar que el conocimiento de los aspectos orientativos del embarazo desempeña un papel fundamental en la desmitificación de la atención odontológica y la preparación de los profesionales. Se infiere que el prenatal odontológico viene ganando expresividad, donde las acciones de la ESF, la actuación del equipo multidisciplinario y la ampliación del conocimiento sobre el tema pueden influir positivamente en la adherencia de este grupo.

Strategies to Improve Women's Leadership Preparation for Early Career Global Health Professionals: Suggestions from Two Working Groups.

Background: Despite advances in gender equality, women still experience inequitable gaps in global health leadership, and barriers to women's advancement as leaders in global health have been well described in the literature. In 2021, the Johns Hopkins Center for Global Health conducted two virtual working groups for emerging women leaders to share challenges and suggest solutions to advance women's leadership in global health. In this paper, we present emerging themes from the working groups, provide a framework for the results, and discuss strategies for advancing women's leadership in global health. Objectives: The objective of this paper is to synthesize and share the themes of the two working group sessions to provide strategies for improving women's leadership training and opportunities in the field of global health. Methods: Approximately 182 women in the global health field participated in two virtual working group sessions hosted by the Johns Hopkins Center for Global Health using the Zoom platform. Participants were divided into virtual breakout rooms and discussed pre-assigned topics related to women's leadership in global health. The participants then returned to share their ideas in a plenary session. Notes from the breakout rooms and transcripts from the plenary session were analyzed through a participatory and iterative thematic analysis approach. Findings: We found that the working group participants identified two overarching themes that were critical for emerging women leaders to find success in global health leadership. First, the acquisition of individual essential skills is necessary to advance in their careers. Second, the institutional environments should be setup to encourage and enable women to enter and succeed in leadership roles. The participants also shared suggestions for improving women's leadership opportunities such as including the use of virtual technologies to increase training and networking opportunities, intersectionality in mentorship and sponsorship, combatting impostor syndrome, and the importance of work-life balance. Conclusions: Investing in women and their leadership potential has the promise to improve health and wealth at the individual, institutional, and community levels. This manuscript offers lessons and proposes solutions for increasing women's leadership through improving individual level essential skills and fostering environments in which women leaders can emerge and thrive.

COVID-19 threatens faculty diversity: postdoctoral scholars call for action.

Despite substantial investment and effort by federal agencies and institutions to improve the diversity of the professoriate, progress is excruciatingly slow. One program that aims to enhance faculty diversity is the Institutional Research and Academic Career Development Award (IRACDA) funded by the National Institutes of Health/National Institute of General Medical Sciences. IRACDA supports the training of a diverse cohort of postdoctoral scholars who will seek academic research and teaching careers. The San Diego IRACDA program has trained 109 postdoctoral scholars since its inception in 2003; 59% are women and 63% are underrepresented (UR) Black/African-American, Latinx/Mexican-American, and Indigenous scientists. Sixty-four percent obtained tenure-track faculty positions, including a substantial 32% at research-intensive institutions. However, the COVID-19 pandemic crisis threatens to upend IRACDA efforts to improve faculty diversity, and academia is at risk of losing a generation of diverse, talented scholars. Here, a group of San Diego IRACDA postdoctoral scholars reflects on these issues and discusses recommendations to enhance the retention of UR scientists to avoid a "lost generation" of promising UR faculty scholars.

Conocimiento de los niños, niñas y adolescentes del acoso escolar en una institución educativa de la localidad de ciudad Bolívar (Colombia). Un aporte desde enfermería para la reconciliación y reconstrucción de la paz / Children and adolescents' knowledge of acoso escolar in an educational institution in ciudad Bolívar (Colombia). A contribution from nursing for the reconciliation and reconstruction of peace

OBJETIVO: Describir los conocimientos que tienen los estudiantes entre los 12 y 17 años frente al acoso escolar, en una institución educativa de la localidad de Ciudad Bolívar (Colombia)en el segundo semestre del 2020. MATERIALES Y MÉTODOS: Se desarrolló un estudio cualitativo con enfoque descriptivo exploratorio, con el fin de comprender experiencias y percepciones de la niñez y adolescencia con respecto al acoso escolar. Se llevó a cabo una encuesta con 134 niños entre los 12 y 17 años y un grupo focal de 12 participantes de distintas edades, pertenecientes a la institución educativa. El análisis y la sistematización de la información y la codificación se realizó utilizando el software Nvivo V.12. RESULTADOS: luego del análisis cualitativo emergieron cuatro categorías: definiciones de acoso escolar, porqué se realiza el Acoso Escolar, reacciones frente al acoso escolar y lugares donde se realiza el acoso escolar. CONCLUSIONES: A pesar de reconocer a través de las categorías cómo se realiza el Acoso Escolar, dónde se realiza y sus principales efectos, se evidenció como la definición de acoso en este estudio al igual que en la literatura no es única, el aspecto común es que es una forma de agresión. Se sigue reconociendo como primera causa del acoso escolar el manejo del poder justificándose desde razones económicas, aspecto físico, el género y su desarrollo durante el colegio. Desde Enfermería es importante liderar programas para la promoción de convivencia en paz, prevención de la aparición de este fenómeno y su reconocimiento temprano, con el fin de disminuir consecuencias graves y aportar a nuestra sociedad en búsqueda de reconciliación que se reflejará en una convivencia pacífica en las aulas; aspecto que se reflejará en futuros ciudadanos respetuosos de las diferencias y tolerantes en búsqueda de un país mejor.

OBJECTIVE: Describe the knowledge that students between 12 and 17 years of age have against bullying, in an educational institution in the town of Ciudad Bolívar (Colombia) in the second semester of 2020. MATERIALS AND METHOD: A qualitative study was developed with descriptive exploratory approach, in order to understand experiences and perceptions of childhood and adolescence regarding bullying. A survey was carried out with 134 children between 12 and 17 years old and a focus group of 12 participants of different ages, belonging to the educational institution. The analysis and systematization of the information and coding was carried out using the Nvivo V.12 software. RESULTS: after the qualitative analysis, four categories emerged: definitions of bullying, why bullying is carried out, reactions to bullying and places where bullying is carried out. CONCLUSIONS: Despite recognizing through the categories how bullying is carried out, where it is carried out and its main effects, it was evidenced that the definition of bullying in this study as in the literature is not unique, the common aspect is which is a form of aggression. The handling of power is still recognized as the main cause of bullying, justified from economic reasons, physical appearance, gender and its development during school. From Nursing it is important to lead programs for the promotion of peaceful coexistence, prevention of the appearance of this phenomenon and its early recognition, in order to reduce serious consequences and contribute to our society in search of reconciliation that will be reflected in a peaceful coexistence in the classrooms; an aspect that will be reflected in future citizens who are respectful of differences and tolerant in search of a better country.

Treinadoras e auxiliares do futebol de mulheres no Brasil: subversão e resistência na liderança esportiva / Women's football coaches and assistant coaches in Brazil: subversion and resistance in sports leadership / Entrenadoras y auxiliares del fútbol femenino en Brasil: subversión y resistencia en el liderazgo deportivo

Resumo Fundamentada nos estudos culturais e de gênero, esta pesquisa analisa a representatividade de mulheres em cargos de treinadora e auxiliar no futebol de mulheres, buscando identificar as estratégias de subversão e resistência adotadas para sua inserção e permanência. Os materiais de análise foram os discursos das participantes aliados a fontes documentais, como notícias e produções acadêmicas. A análise evidencia que as profissionais conquistaram o acesso aos cargos em decorrência das experiências como líderes enquanto atletas e/ou estagiárias e por seus altos níveis de capacitação. Elas asseguram sua permanência ao atestarem diariamente sua competência, mantendo o nível de capacitação e superando estereótipos de gênero. Elas personificam a eminente resistência oferecida pelas mulheres em espaços tradicionalmente reservados aos homens, tensionando as relações de poder. Contudo, a consolidação de uma condição equânime requer investimento financeiro e, sobretudo, empenho na desconstrução de estereótipos de gênero.

Abstract Based on cultural and gender studies, this research analyzes women's representativeness as coaches and assistant coaches in women's football, seeking to identify the subversion and resistance strategies adopted for their inclusion and permanence. The analysis focused on participants' speeches and document sources such as news articles and academic works. It shows how professionals gained access to the roles resulting from their leadership experiences as athletes and/or interns and for their high capacity. They ensure their permanence by attesting their competence on a daily basis, maintaining their level of ability and overcoming gender stereotypes. They personify the eminent resistance offered by women in spaces traditionally reserved for men, thus tensioning power relations. However, the consolidation of equal conditions requires financial investment and, above all, a commitment to deconstructing gender stereotypes.

Resumen Fundamentada en los estudios culturales y de género, esta investigación analiza la representatividad de mujeres en cargos de entrenadora y auxiliar en el fútbol femenino, buscando identificar las estrategias de subversión y resistencia adoptadas para lograr su inserción y permanencia. Los materiales de análisis fueron los discursos de las participantes, aliados a fuentes documentales, como noticias y producciones académicas. El análisis muestra que las profesionales conquistaron su acceso a los cargos debido a sus experiencias de liderazgo como atletas y por sus altos niveles de capacitación. Aseguran su permanencia probando diariamente su competencia y superando los estereotipos de género. Encarnan la resistencia ofrecida por las mujeres en espacios tradicionalmente reservados a los hombres, tensando las relaciones de poder. Sin embargo, la consolidación de una condición de ecuanimidad requiere inversión financiera y, sobre todo, un compromiso con la deconstrucción de los estereotipos de género.

#BlackAndFemaleAndSTEM.

The #MeToo movement heightened awareness of sexism in science. More recently, nationwide protests against police brutality and other expressions of systemic anti-Black racism triggered new attention to racism in science. But without an intersectional approach, the realities for Black women can be overlooked. Using my own experience as a Black female PhD student, I argue that institutional attitudes and policies can reinforce historical inequities, rather than supporting Black women who face discrimination, and I challenge scientific leaders to create equitable environments for Black women scientists.

Ten simple rules for running a successful women-in-STEM organization on an academic campus.

The current academic culture facing women in science, technology, engineering, and math (STEM) fields in the United States has sparked the formation of grassroots advocacy groups to empower female scientists in training. However, the impact of these initiatives often goes unmeasured and underappreciated. Our Women in Science and Engineering (WiSE) organization serves postdoctoral researchers, graduate students, and research technicians (trainees) at a private research institute for biological sciences. Here we propose the following guidelines for cultivating a successful women-in-STEM-focused group based upon survey results from our own scientific community as well as the experience of our WiSE group leaders. We hope these recommendations can provide guidance to advocacy groups at other research and academic organizations that wish to strengthen their efforts. Whereas our own group specifically focuses on the underrepresented state of women in science, we hope these guidelines may be adapted and applied to groups that advocate for any minority group within the greater scientific community (i.e., those of gender, race/ethnicity, socioeconomic background, sexual orientation, etc.).

Community mobilisation to prevent violence against women and girls in eastern India through participatory learning and action with women's groups facilitated by accredited social health activists: a before-and-after pilot study.

BACKGROUND: Almost one in three married Indian women have ever experienced physical, sexual, or emotional violence from husbands in their lifetime. We aimed to investigate the preliminary effects of community mobilisation through participatory learning and action groups facilitated by Accredited Social Health Activists (ASHAs), coupled with access to counselling, to prevent violence against women and girls in Jharkhand, eastern India. METHODS: We piloted a cycle of 16 participatory learning and action meetings with women's groups facilitated by ASHAs in rural Jharkhand. Participants identified common forms of violence against women and girls, prioritised the ones they wanted to address, developed locally feasible strategies to address them, implemented the strategies, and evaluated the process. We also trained two counsellors and two ASHA supervisors to support survivors, and gave ASHAs information about legal, health, and police services. We did a before-and-after pilot study involving baseline and endline surveys with group members to estimate preliminary effects of these activities on the acceptability of violence, prevalence of past year emotional and physical violence, and help-seeking. RESULTS: ASHAs successfully conducted monthly participatory learning and action meetings with 39 women's groups in 22 villages of West Singhbhum district, Jharkhand, between June 2016 and September 2017. We interviewed 59% (679/1149) of women registered with groups at baseline, and 63% (861/1371) at endline. More women reported that violence was unacceptable in all seven scenarios presented to them at endline compared to baseline (adjusted Odds Ratio [aOR]: 1.87, 95%: 1.39-2.52). Fewer women reported experiencing emotional violence from their husbands in the last 12 months (aOR: 0.55, 95% CI: 0.43-0.71), and more sought help if it occurred (aOR: 2.19, 95% CI: 1.51-3.17). In addition, fewer women reported experiencing emotional or physical violence from family members other than their husbands in the last 12 months (aOR: 0.41, 95% CI: 0.32-0.53, and aOR: 0.36, 95% CI: 0.26-0.50, respectively). CONCLUSION: Combining participatory learning and action meetings facilitated by ASHAs with access to counselling was an acceptable strategy to address violence against women and girls in rural communities of Jharkhand. The approach warrants further implementation and evaluation as part of a comprehensive response to violence.

Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal.

BACKGROUND: Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women's groups suggests that group care models may both improve access to care and the quality of care delivered through women's empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes. METHODS: The study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process. RESULTS: A total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas we analyze and present patient-level effectiveness outcomes in a complementary paper in this journal. There was high process fidelity to the model, with 85.7% (95% CI 77.1-91.5%) of visits completing all process elements, and high content fidelity, with all village clusters meeting the minimum target frequency for 80% of topics. The annual per capita cost for group antenatal care was 0.50 USD. Qualitative analysis revealed the compromise of stable gestation-matched composition of the group members in order to make the intervention feasible. Major adaptations were made in training, documentation, feedback and logistics. CONCLUSION: Group antenatal care provided in collaboration with local government clinics has the potential to provide accessible and high quality antenatal care to women in rural Nepal. The intervention is a feasible and affordable alternative to individual antenatal care. Our experience has shown that adaptation from prior models was important for the program to be successful in the local context within the national healthcare system. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered.

Stereotype Threat in Virtual Learning Environments: Effects of Avatar Gender and Sexist Behavior on Women's Math Learning Outcomes.

Women in math, science, and engineering (MSE) often face stereotype threat: they fear that their performance in MSE will confirm an existing negative stereotype-that women are bad at math-which in turn may impair their learning and performance in math. This research investigated if sexist nonverbal behavior of a male instructor could activate stereotype threat among women in a virtual classroom. In addition, the research examined if learners' avatar representation in virtual reality altered this nonverbal process. Specifically, a 2 (avatar gender: female vs. male) × 2 (instructor behavior: dominant sexist vs. nondominant or nonsexist) between-subjects experiment was used. Data from 76 female college students demonstrated that participants learned less and performed worse when interacting with a sexist male instructor compared with a nonsexist instructor in a virtual classroom. Participants learned and performed equally well when represented by female and male avatars. Our findings extend previous research in physical learning settings, suggesting that dominant-sexist behaviors may give rise to stereotype threat and undermine women's learning outcomes in virtual classrooms. Implications for gender achievement gaps and stereotype threat are discussed.

Pragmatic ex-ante evaluation using an innovative conceptual framework: The case of a high-tech entrepreneurship program for women.

Program designers at local project level usually design interventions under conditions of scarce resources and bounded rationality lacking sufficient information about the process and impact mechanisms of the complex social programs they design and implement. This paper proposes a model for pragmatic ex ante evaluation using an innovative conceptual framework for practitioners working in the field to improve gender equality in research and innovation. The presented and applied model is pertinent to the theory-oriented evaluation tradition using a logic frame and a theory of change approach adapted to the special requirements of ex-ante evaluation. The model is illustrated by the case study of a program for the promotion of women entrepreneurship in the STEM fields. It is concluded that in a setting with limited resources and information, ex-ante evaluations should aim at defining clear conditions of proportionality and need to take into account the extent to which contextual factors hinder or facilitate the implementation of a program, and the specific institutional and system mechanisms at play, in order to enable proactive risk management from the beginning.

Before and after implementation of group antenatal care in Rwanda: a qualitative study of women's experiences.

BACKGROUND: The Preterm Birth Initiative-Rwanda is conducting a 36-cluster randomized controlled trial of group antenatal and postnatal care. In the context of this trial, we collected qualitative data before and after implementation. The purpose was two-fold. First, to inform the design of the group care program before implementation and second, to document women's experiences of group care at the mid-point of the trial to make ongoing programmatic adjustments and improvements. METHODS: We completed 8 focus group discussions among women of reproductive age before group care implementation and 6 focus group discussions among women who participated in group antenatal care and/or postnatal care at 18 health centers that introduced the model, approximately 9 months after implementation. RESULTS: Before implementation, focus group participants reported both enthusiasm for the potential for support and insight from a group of peers and concern about the risk of sharing private information with peers who may judge, mock, or gossip. After implementation, group care participants reported benefits including increased knowledge, peer support, and more satisfying relationships with providers. When asked about barriers to group care participation, none of them cited concern about privacy but instead cited lack of financial resources, lack of cooperation from a male partner, and long distances to the health center. Finally, women stated that the group care experience would be improved if all participants and providers arrived on time and remained focused on the group care visit throughout. DISCUSSION: These results are consistent with other published reports of women's perceptions of group antenatal care, especially increased pregnancy- and parenting-related knowledge, peer support, and improved relationships with health care providers. Some results were unexpected, especially the consequences of staff allocation patterns that resulted in providers arriving late for group visits or having to leave during group visits to attend to other facility services, which diminished women's experiences of care. CONCLUSION: Group antenatal and postnatal care provide compelling benefits to women and families. If the model requires the addition of human resources at the health center, intensive reminder communications, and large-scale community outreach to benefit the largest number of pregnant and postnatal mothers, those additional resources required must be factored into any future decision to scale a group care model. TRIAL REGISTRATION: This trial is registered at clinicaltrials.gov as NCT03154177 .