Socioeconomic inequalities in psychosocial well-being among adolescents under the COVID-19 pandemic: a cross-regional comparative analysis in Hong Kong, mainland China, and the Netherlands.

BACKGROUND: Despite evidence on socioeconomic inequalities in psychosocial well-being of adolescents under the COVID-19 pandemic, the explanatory factors and their potential variations across contexts remained understudied. Hence, this cross-regional study compared the extent of inequalities and the mediating pathways across Hong Kong, Mainland China, and the Netherlands. METHODS: Between July 2021 and January 2022, 25 secondary schools from diverse socioeconomic background were purposively sampled from Hong Kong, Zhejiang (Mainland China), and Limburg (the Netherlands). 3595 junior students completed an online survey during class about their socioeconomic position, psychosocial factors, and well-being. Socioeconomic inequalities were assessed by multiple linear regressions using the Slope Index of Inequality (SII), whereas the mediating pathways through learning difficulty, overall worry about COVID-19, impact on family' financial status, resilience, trust in government regarding pandemic management, and adaptation to social distancing were examined by mediation analyses moderated by regions. RESULTS: The adverse psychosocial impact of COVID-19 was stronger in the Netherlands and Hong Kong compared with Mainland China. The greatest extent of socioeconomic inequalities in the change in psychosocial well-being was observed among students in the Netherlands (SII = 0.59 [95% CI = 0.38-0.80]), followed by Hong Kong (SII = 0.37 [0.21-0.52]) and Mainland China (SII = 0.12 [0.00-0.23]). Learning difficulty and resilience were the major mediators in Mainland China and Hong Kong, but to a lesser extent in the Netherlands. CONCLUSION: Socioeconomic inequalities in psychosocial well-being were evident among adolescents under the pandemic, with learning difficulty and resilience of students as the key mediators. Differences in the social contexts should be considered to better understand the variations in inequalities and mediating pathways across regions.

Healthcare workers' delivery of adolescent responsive sexual and reproductive healthcare services: an assessment in Plateau state, Nigeria.

BACKGROUND: Adolescents should have access to high quality and responsive sexual and reproductive health, however, it is unclear to what extent the national policy on health and development of adolescent is implemented by health care workers in Plateau State. This study assessed the general availability of sexual and reproductive health services, the delivery of responsive adolescent sexual and reproductive health services and health care worker?s understanding of what constitutes adolescent responsive sexual and reproductive health services. METHODS: Using a cross sectional design, we interviewed 409 health care workers selected through a multistage sampling technique, across six Local Government Areas of Plateau State, Nigeria using an interviewer-administered survey questionnaire. RESULTS: The most available sexual and reproductive health services was antenatal and delivery care (69.2%), contraception 25.9% and 14.9% reported post abortion care. Only 1.2% indicated the availability of the four recommended essential sexual and reproductive health services (counselling/information provision, provision of contraceptives, testing/treatment for sexually transmitted infection (STI) /HIV and post abortion care) in their facilities. Little over half (58.4%) felt their facilities were adequate in meeting the sexual and reproductive health needs of adolescent and this was associated with delivery of post abortion care (AOR=3.612; CI=1.886-6.917; p = .001) and providing sexual and reproductive health services to adolescents without parental consent (AOR=3.612; CI=1.886-6.917; p = .001). Most health care workers had poor understanding of adolescent responsiveness of sexual and reproductive health services, understanding better among health workers who provided services without parental consent and in a separate room for privacy and confidentiality. CONCLUSION: We conclude that adolescent sexual and reproductive health services is not yet as stipulated in the national policy in Plateau State, Nigeria and in general, health workers have poor understanding of what it means to provide adolescent-responsive services.

The Future Positive micro-intervention protocol: A program aiming to increase a healthy life-style among employees with a low socio-economic position.

This paper describes the development of a Dutch micro-intervention, Future Positive, that aims to increase health behaviors among employees with a low socio-economic position (SEP), with the ultimate aim to decrease socio-economic health inequalities. Intervention Mapping (IM) was used to adapt previously developed psychological capital interventions into a micro-intervention suitable to be delivered in the work context for employees with a low socio-economic position. The first 4 steps of IM including the results of pre-testing the developed intervention program are described. Step 1 consists of the needs assessment, and investigated (a) the individual determinants of health behavior and health inequalities, and (b) the needs of employees with a low SEP and their employers regarding the implementation of the intervention at the worksite. Matrices-of-change were produced in Step 2, and relevant methods and applications were selected in step 3. Step 4 involved the intervention development, resulting in a brief micro-intervention that will be delivered in small groups, guided by trained facilitators using motivational interviewing techniques. Program materials include informative video-clips and active and cooperative learning exercises. The intervention was pre-tested among three groups of employees. The IM process, as well as the pre-testing, revealed that emphasizing autonomy and using easy to understand and mostly visual materials offered in chunks is essential for a well-tailored intervention that is suitable for people with low SEP. Also, participation should be facilitated by employers: It should be free of costs, offered during working hours, and take place at the job site. Results showed that the Future Positive micro-intervention is substantiated by theory, applicable in a work setting (high reach), and tailored to the needs of employees with a low SEP. We therefore fill the gap in this existing range of interventions aimed to improve life-style behaviors and contribute to theory-based interventions aimed to decrease the SEP-Health gradient.

Intimate Partner Violence in Nicaragua: The Role of Possessive Jealousy, Intrasexual Competitiveness, Life History, Mate Value, and Stress.

Using an evolutionary perspective, we examined predictors of intimate partner violence (IPV) in the Department of the Rio San Juan in Nicaragua. Specifically, we focused on possessive jealousy, intrasexual competitiveness, life history strategy, mate value, and stress. The sample consisted of 199 men and 201 women (mean age = 36.48, SD = 10.47) from the general population who were all personally interviewed. For all variables, validated measures were used. The data were analyzed for men and women separately, using regression analyses. In contrast to previous research and our expectations, possessive jealousy was not related to IPV among men or women. Rather, among men, IPV was independently predicted by (a) intrasexual competitiveness, (b) a fast life history strategy, (c) a low mate value, and (d) stress, together explaining 35% of the variance. Among women, violence against one's partner was only predicted by intrasexual competitiveness (3% explained variance). These results suggest that perpetration of IPV in Nicaragua may have qualitative different roots among men than among women, and that for men, more "triggers" are present which may evoke aggression toward their partners. These results are discussed in light of their relevance for theory and practice.

Explaining socioeconomic inequalities in self-reported health outcomes: The mediating role of perceived life stress, financial self-reliance, psychological capital, and time perspective orientations.

OBJECTIVE: The main aim of the current study was to investigate what role perceived life stress, psychological capital (PsyCap), financial self-reliance and time perspective orientations play in explaining socioeconomic health inequalities, specifically self-perceived health and self-reported physical health conditions. METHODS: Individuals (total n = 600) aged 16+ years from a general Dutch population sample (LISS panel) completed an online questionnaire measuring three different SEP indicators (highest achieved educational level, personal monthly disposable income and being in paid employment), perceived life stress, PsyCap, financial self-reliance, time perspective, self-perceived health, and self-reported physical health conditions. Structural equation modelling using a cross-sectional design was used to test the mediation paths from SEP indicators to self-perceived health and self-reported physical health conditions through perceived life stress, PsyCap, financial self-reliance and time perspective orientations. RESULTS: Highest achieved educational level and being in paid employment showed to play a role in the social stratification within self-reported and self-perceived health outcomes, whereas this was not found for personal monthly disposable income. The association between a lower highest achieved educational level and lower self-perceived health was mediated by lower PsyCap and higher perceived life stress levels. The association between a lower highest achieved educational level and higher levels of self-reported physical health conditions was mediated by less financial self-reliance and higher perceived life stress levels. Although no mediating role was found for time perspective orientations in the association between the measured SEP indicators and health outcomes, negative time perspective orientations were associated with either self-perceived health or self-reported physical health conditions. CONCLUSIONS: reserves (PsyCap and financial self-reliance) and perceived life stress seem to play a larger role in explaining the health gradient in achieved educational level than time perspective orientations. Prevention efforts trying to reduce the SEP-health gradient should focus on a) increasing reserves and lowering perceived life stress levels for individuals with a low achieved educational level, and b) reducing unemployment and narrowing opportunity gaps in education for people with a low SEP.

Increasing utilisation of skilled facility-based maternal healthcare services in rural Zambia: the role of safe motherhood action groups.

BACKGROUND: Community-centred health interventions, such as Safe Motherhood Action groups (SMAGs), have potential to lead to desired health behavioural change and favourable health outcomes. SMAGs are community-based volunteer groups that aim to reduce critical delays that occur at household level with regard to decision-making about seeking life-saving maternal care at health facilities. The aim of this study was to explore perspectives, roles, achievements and challenges of the SMAG programme in Kalomo, Zambia. METHODS: In-depth interviews (IDIs) were conducted in 7 health centres in Kalomo district between 1st April and 20th May, 2015 with 46 respondents comprising 22 SMAG members, 5 headmen, 10 mothers, 3 husbands, 5 nurses, and 1 district maternal and child health coordinator. Perspectives on the selection, training, roles, achievements and challenges of the SMAG programme were explored. RESULTS: Respondents were aware of the presence, selection, training and roles of the SMAG members and had a positive attitude towards the programme. They believed that the SMAG programme led to an increase in women's risk perception about pregnancy and childbirth-related complications. Further, participants believed that the programme resulted in increased utilisation of facility-based antenatal, delivery and postnatal care, and improvement in maternal and newborn health outcomes. However, various challenges affected implementation of the SMAG programme. Among these were insufficient material and financial support to the programme, lack of refresher training for SMAG members, poor quality of care in health care facilities due to a lack of maternity waiting homes, low staffing levels in health facilities, the poor state and small size of the labour wards, and lack of equipment to handle obstetric emergencies. CONCLUSION: The SMAG programme has potential to be an important community intervention for increasing utilisation of facility-based skilled care and improving maternal and newborn health outcomes.

Personal and environmental factors associated with the utilisation of maternity waiting homes in rural Zambia.

BACKGROUND: Although the association between the presence of maternity waiting homes (MWHs) and the personal and environmental factors that affect the use of MWHs has been explained in qualitative terms, it has never been tested in quantitative terms. The aim of this study was to test the association between the presence of MWHs and personal and environmental factors that affect the use of MWHs. METHODS: A cross-sectional study was conducted using an interviewer-administered questionnaire from 1st July to 31st August, 2014 among 340 women of reproductive age in 15 rural health centres in Kalomo district, Zambia. Tests of association (chi square, logistic regression analysis, odds ratio) were conducted to determine the strength of the association between the presence of MWHs and personal and environmental factors. Differences between respondents who used MWHs and those who did not were also tested. RESULTS: Compared to respondents from health centres without MWHs, those from centres with MWHs had higher odds of expressing willingness to use MWHs (adjusted odds ratio [aOR] = 4.58; 95% confidence interval [CI]:1.39-15.17), perceived more benefits from using a MWH (aOR =8.63; 95% CI: 3.13-23.79), perceived more social pressure from important others to use MWH (aOR =27.09; 95% CI: 12.23-60.03) and higher personal risk from pregnancy and childbirth related complications (aOR =11.63; 95% CI: 2.52-53.62). Furthermore, these respondents had higher odds of staying at a health centre before delivery (aOR =1.78; 95% CI: 1.05-3.02), giving birth at a health facility (aOR = 3.36; 95% CI: 1.85-6.12) and receiving care from a skilled birth attendant (aOR =3.24; 95% CI: 1.80-5.84). In contrast, these respondents had lower odds of perceiving barriers regarding the use of MWHs (aOR =0.27; 95% CI: 0.16-0.47). Factors positively associated with the use of MWHs included longer distances to the nearest health centre (p = 0.004), higher number of antenatal care (ANC) visits (p = 0.001), higher proportions of complications during ANC (p = 0.09) and women's perception of benefits gained from staying in a MWH while waiting for delivery at the health centre (p = 0.001). CONCLUSION: These findings suggest a need for health interventions that focus on promoting ANC use, raising awareness about the risk and severity of pregnancy complications, promoting family and community support, and mitigating logistical barriers.

Husbands' experiences and perceptions regarding the use of maternity waiting homes in rural Zambia.

OBJECTIVE: To explore men's experience and beliefs regarding the use of maternity waiting homes (MWHs) in Kalomo District, Zambia. METHODS: As part of a qualitative study, in-depth interviews with the husbands/partners of women attending the under-five clinic at a health center with a MWH were conducted between April 1 and May 31, 2014. Men aged 18-50 years whose partner/wife was of reproductive age and who had lived in the area for more than 6 months were eligible for inclusion. RESULTS: Overall, 24 husbands/partners were interviewed in seven rural health centers. Men perceived many potential benefits of MWHs, including improved access to facility-based skilled delivery services and treatment in case of labor complications. Their many roles included decision making and securing funds for transport, food, cleaning materials, and clothes for the mother and the neonate to use during and after labor. However, limited financial resources made it difficult for them to provide for their wives and newborns, and usually led to delays in their decisions about MWH use. Poor conditions in MWHs and the lack of basic social and healthcare needs meant some men had forbidden their wives/partners from using the facilities. CONCLUSION: Important intervention targets for improving access to MWHs and skilled birth attendance have been identified.

Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study.

BACKGROUND: Despite the policy change stopping traditional birth attendants (TBAs) from conducting deliveries at home and encouraging all women to give birth at the clinic under skilled care, many women still give birth at home and TBAs are essential providers of obstetric care in rural Zambia. The main reasons for pregnant women's preference for TBAs are not well understood. This qualitative study aimed to identify reasons motivating women to giving birth at home and seek the help of TBAs. This knowledge is important for the design of public health interventions focusing on promoting facility-based skilled birth attendance in Zambia. METHODS: We conducted ten focus group discussions (n = 100) with women of reproductive age (15-45 years) in five health centre catchment areas with the lowest institutional delivery rates in the district. In addition, a total of 30 in-depth interviews were conducted comprising 5 TBAs, 4 headmen, 4 husbands, 4 mothers, 4 neighbourhood health committee (NHC) members, 4 community health workers (CHWs) and 5 nurses. Perspectives on TBAs, the decision-making process regarding home delivery and use of TBAs, and reasons for preference of TBAs and their services were explored. RESULTS: Our findings show that women's lack of decision- making autonomy regarding child birth, dependence on the husband and other family members for the final decision, and various physical and socioeconomic barriers including long distances, lack of money for transport and the requirement to bring baby clothes and food while staying at the clinic, prevented them from delivering at a clinic. In addition, socio-cultural norms regarding childbirth, negative attitude towards the quality of services provided at the clinic, made most women deliver at home. Moreover, most women had a positive attitude towards TBAs and perceived them to be respectful, skilled, friendly, trustworthy, and available when they needed them. CONCLUSION: Our findings suggest a need to empower women with decision-making skills regarding childbirth and to lower barriers that prevent them from going to the health facility in time. There is also need to improve the quality of existing facility-based delivery services and to strengthen linkages between TBAs and the formal health system.

Improving access to skilled facility-based delivery services: Women's beliefs on facilitators and barriers to the utilisation of maternity waiting homes in rural Zambia.

BACKGROUND: Maternity waiting homes (MWHs) are aimed at improving access to facility-based skilled delivery services in rural areas. This study explored women's experiences and beliefs concerning utilisation of MWHs in rural Zambia. Insight is needed into women's experiences and beliefs to provide starting points for the design of public health interventions that focus on promoting access to and utilisation of MWHs and skilled birth attendance services in rural Zambia. METHODS: We conducted 32 in-depth interviews with women of reproductive age (15-45 years) from nine health centre catchment areas. A total of twenty-two in-depth interviews were conducted at a health care facility with a MWH and 10 were conducted at a health care facility without MWHs. Women's perspectives on MWHs, the decision-making process regarding the use of MWHs, and factors affecting utilisation of MWHs were explored. RESULTS: Most women appreciated the important role MWHs play in improving access to skilled birth attendance and improving maternal health outcomes. However several factors such as women's lack of decision-making autonomy, prevalent gender inequalities, low socioeconomic status and socio-cultural norms prevent them from utilising these services. Moreover, non availability of funds to buy the requirements for the baby and mother to use during labour at the clinic, concerns about a relative to remain at home and take care of the children and concerns about the poor state and lack of basic social and healthcare needs in the MWHs--such as adequate sleeping space, beddings, water and sanitary services, food and cooking facilities as well as failure by nurses and midwives to visit the mothers staying in the MWHs to ensure their safety prevent women from using MWHs. CONCLUSION: These findings highlight important targets for interventions and suggest a need to provide women with skills and resources to ensure decision-making autonomy and address the prevalent gender and cultural norms that debase their social status. Moreover, there is need to consider provision of basic social and healthcare needs such as adequate sleeping space, beddings, water and sanitary services, food and cooking facilities, and ensuring that nurses and midwives conduct regular visits to the mothers staying in the MWHs.