Health Experiences of Women University Students of Color and Women International Students in the United States During the First Year of the COVID-19 Pandemic: Findings From a Transnational, Virtual Photovoice Study.

Women university students in the United States who are students of color and international students consistently experience health disparities. These were exacerbated due to the COVID-19 pandemic and racial upheaval following the murder of George Floyd. Within that context, this study aimed to explore the health and well-being experiences of women students of color and international women students at a university in the Midwestern United States in 2020-2021. This participatory, transnational study utilized a virtual adaptation of Photovoice with 14 participants who joined the study from five different countries. Participatory elements included participant co-researchers co-leading development of the photo "mission," icebreakers, naming of the project, design of the project logo, choosing photos for discussion and exhibits, initial analysis of emergent themes, and approval and editing of photos for exhibit. Inductive thematic analysis revealed three themes: (1) grief and loss, (2) barriers and facilitators to social health, and (3) fear and stress from simultaneous social stressors. Data was not mutually exclusive with some photos and narratives illustrating more than one theme. The women experienced grief and loss while negotiating effects of social isolation and adapting to maintain social health. Negative mental and emotional health experiences were amplified as the social context of police brutality and anti-immigrant sentiments overlaid the stress of the pandemic. Study results demonstrate need for increased and tailored health and social service support for women students of color and international women university students.

Research Engagement in a Virtual World: Strategies for Maintaining the Power and Impact of Photovoice Research Online.

When our photovoice research intersected with the COVID-19 pandemic, we were thrust into a new world of adapting the method in the virtual environment. Between both authors, we had over two decades of experience implementing photovoice. However, that involved tried and true methods of working face to face and side by side with people in community-based settings. This article describes lessons learned from two virtual photovoice projects. One involved pivoting from a project already well underway in person to online and the other was designed for virtual implementation since that was the only option available. Key considerations discussed are navigating our institutional review boards, adapting project management, building community online, and sharing results and advocacy for social change. Dilemmas and key decisions in each of these areas are described for practitioners and community-based researchers who need or seek to transition their photovoice research to the virtual environment. Practical tips and strategies for implementation are described and offered to photovoice researchers.

Qualitative exploration of the reproductive health perceptions of middle-aged women in the United States.

Empirical literature exploring the reproductive health experiences of middle-aged women is limited. Little is known about their experiences and decision-making processes related to reproductive health. The purpose of the Reproductive Health Seeking (RHS) study was to expand the understanding of reproductive health knowledge and influences impacting health decisions for middle-aged women. Thirty women aged 45-64 participated in semi-structured interviews and a focus group. Results highlighted a variety of experiences related to reproductive health including women's perceptions of reproductive health-related cancers, community resources for reproductive-related health education, and factors that influence reproductive health and healthcare seeking behavior. Results demonstrated that women are impacted by their conversations with family and friends, seek information through a variety of channels, and are calling for more information on a variety of reproductive health-related issues outside of breast cancer campaigns.

Facilitators and barriers to integrated malaria prevention in Wakiso district, Uganda: A photovoice study.

Malaria continues to cause significant morbidity and mortality globally, particularly in sub-Saharan Africa. Appropriate combinations of non-chemical and chemical methods of malaria vector control in the context of integrated vector management have been recommended by the World Health Organization. The aim of the study was to explore facilitators and barriers to using integrated malaria prevention in Wakiso district, Uganda. This qualitative study employed photovoice among 20 community members in Kasanje Town Council, Wakiso District. The photos taken by participants for 5 months using smartphones were discussed during monthly meetings with the researchers. The discussions were audio-recorded, and resulting data analysed using thematic analysis with the support of NVivo (2020) QSR International. Findings indicated that various conventional and non-conventional measures were being used for preventing malaria such as: insecticide treated nets; clearing overgrown vegetation; draining stagnant water; mosquito coils; smouldering of cow dung; spraying insecticides; plant repellents near houses; eating of prophylactic herbs; as well as closing doors and windows on houses early in the evening. Facilitators supporting the use of several malaria prevention methods holistically included: low cost and accessibility of some methods such as slashing overgrown vegetation; and support provided for certain methods such as receiving free mosquito nets from the government. Barriers to using several malaria prevention methods holistically included: inadequate knowledge of some methods such as housing improvement; allergic reactions to chemical-based methods such as insecticide treated nets; unaffordability of some methods such as insecticide sprays; and inaccessibility of certain methods such as body repellents. These barriers to integrated malaria prevention need to be addressed to achieve greater impact from the combination of methods in endemic communities.

Evidence from a Longitudinal Photovoice and Interview Assessment with Congolese Refugee Women in the Midwestern United States.

Purpose: Refugees from the Democratic Republic of Congo have rapidly increased since 2016 and are growing to represent one of the top refugee groups in the United States. They are at high risk for health inequities, yet, there is limited qualitative research exploring the health needs, assets, and experiences of this group and even less longitudinal research. In addition, women refugees are understudied across all global contexts. Therefore, the purpose of this study was to conduct longitudinal qualitative research to provide rich contextual data on health and integration experiences of Congolese refugee women when they were newly resettled in 2016 and 3 years later in 2019. Methods: We conducted photovoice and interviews with 16 women in March through May of 2016 and 10 of the same women in March and April of 2019. Results: Women chose and discussed photos revealing a multitude of assets and needs spanning 2016 and 2019. Experiences with nutrition and food security were illuminated and are the focus of this article. Two major themes were access to food in contrast with availability of abundance of food in the United States and concern about what constitutes healthy food in the United States contrasted with accessing healthy and culturally appropriate food in the United States. Findings highlight strength bases of nutritional knowledge, attitudes, and skills as well as a strong social network aiding food security demonstrated by the Congolese refugee women in the study, offering an opportunity to shift to an assets and strength-based approach. Findings also note risk of food insecurity linked to barriers to employment and sociohistorical reflection on living with food shortages before migration to the United States that should be considered as providers strive to provide culturally relevant care. Conclusion: Findings offer contextual data for health care providers and public health professionals to improve nutritional health promotion and food security support for this population. Overlooking nuanced structural barriers may lead to providers perpetuating health inequities for this population.

A Community-Led Partnership to Develop a Mental Health Promotion Curriculum with Minority Health Agencies.

BACKGROUND: Community-based mental health promotion programs for healthy people of color, without a diagnosed mental health condition are rare in public health literature. OBJECTIVES: A statewide minority health agency led a 4-year partnership in Indiana with researchers, community-based minority health affiliates, and people of color to design, pilot, and evaluate a mental health promotion program. METHODS: A participatory process was utilized to develop and test a group health promotion program designed with and for communities of color to improve knowledge, attitudes, and behaviors for handling life stresses in a healthy way. Activities included capacity building, two implementation cycles, and mixed-methods evaluation. RESULTS: The partnership revealed challenges and lessons learned such as recruiting skilled facilitators, effective communication about goals for cultural and linguistic appropriateness, maintaining fidelity, and realigning funding approaches for affiliates. CONCLUSIONS: Next steps include revisions based on lessons learned, additional cultural and linguistic tailoring of the program, and offering statewide access.

Voices and Views of Congolese Refugee Women: A Qualitative Exploration to Inform Health Promotion and Reduce Inequities.

Refugees have recently been thrust into the spotlight worldwide. The strikingly negative rhetoric currently surrounding refugees calls for increased action from public health educators. In 2016, the largest proportion of refugees to the United States came from the Democratic Republic of Congo. This presents the opportunity to explore health needs as Congolese refugees resettle in the United States, with women taking priority due to health disparities linked to gender-based discrimination, trauma, sexual and gender-based violence, lower literacy rates, and less access to learning English. Insight into experiences of Congolese women in the United States is critical for the proactive development of socioculturally relevant health promotion rather than reaction interventions once health inequities are exacerbated. Therefore, to better understand perceptions and experiences of Congolese women in Indianapolis related to health and health care, a community-based participatory research study with an anthropological approach was conducted in collaboration with a refugee resettlement agency utilizing photovoice and semistructured interviews. Sixteen women participated in six photovoice sessions and home-based interviews. Selected photos, photo stories, and interview transcripts were analyzed using ethnographic content analysis. Major themes were health care system issues, social support, and daily experiences of health. Findings provide needed insight into the sociocultural context of health for Congolese refugees in the United States for both health educators and resettlement agencies. Findings also revealed specific priority areas for culturally tailoring health education and assets on which to build when promoting health for this population. Additionally, lessons were learned about the power of an anthropological, community-based participatory research approach to qualitative research for promoting health equity.

Coverage and representation of condoms in conjunction with HIV/AIDS in the Kenyan Daily Nation Newspaper from 1989-2003: a qualitative content analysis to inform health promotion.

HIV/AIDS has been a pressing problem in the East African country of Kenya for over 20 years. Promotion of condom use is one prevention strategy embraced in global health prevention of HIV, but use remains relatively low in Kenya. In order to better understand the socio-historic context of discourses about condoms in Kenya, this study explored how condoms were covered and represented in the Kenyan Daily Nation newspaper from 1989-2003. Qualitative content analysis was conducted for 91 items from the Daily Nation including articles, letters to the editor, columns, opinion and editorial pieces, advertisements, and cartoons. These items were systematically examined for the manner and content of manifest and latent references to condoms. Researchers found four major themes, "controversy and confusion," "we need to do more: condoms might help," "not for Kenyans or from Kenyans," and "stigmatized associations." Findings provide needed insight into the socio-cultural context surrounding condoms in Kenya that is often lacking within health promotion and HIV prevention programs.