Participation in microfinance based Self Help Groups in India: Who becomes a member and for how long?

INTRODUCTION: Microfinance is a widely promoted developmental initiative to provide poor women with affordable financial services for poverty alleviation. One popular adaption in South Asia is the Self-Help Group (SHG) model that India adopted in 2011 as part of a federal poverty alleviation program and as a secondary approach of integrating health literacy services for rural women. However, the evidence is limited on who joins and continues in SHG programs. This paper examines the determinants of membership and staying members (outcomes) in an integrated microfinance and health literacy program from one of India's poorest and most populated states, Uttar Pradesh across a range of explanatory variables related to economic, socio-demographic and area-level characteristics. METHOD: Using secondary survey data from the Uttar Pradesh Community Mobilization project comprising of 15,300 women from SHGs and Non-SHG households in rural India, we performed multivariate logistic and hurdle negative binomial regression analyses to model SHG membership and duration. RESULTS: While in general poor women are more likely to be SHG members based on an income threshold limit (government-sponsored BPL cards), women from poorest households are more likely to become members, but less likely to stay members, when further classified using asset-based wealth quintiles. Additionally, poorer households compared to the marginally poor are less likely to become SHG members when borrowing for any reason, including health reasons. Only women from moderately poor households are more likely to continue as members if borrowing for health and non-income-generating reasons. The study found that an increasing number of previous pregnancies is associated with a higher membership likelihood in contrast to another study from India reporting a negative association. CONCLUSION: The study supports the view that microfinance programs need to examine their inclusion and retention strategies in favour of poorest household using multidimensional indicators that can capture poverty in its myriad forms.

Sustaining consistent condom use among female sex workers by addressing their vulnerabilities and strengthening community-led organizations in India.

INTRODUCTION: Between 2014 and 2017, a program aimed at reducing HIV risk and promoting safe sex through consistent use of condoms sought to work through addressing social and economic vulnerabilities and strengthening community-led organizations (COs) of female sex workers (FSWs). This study examines if the program was effective by studying relationship between strengthening of COs, vulnerability reduction, and sustaining of consistent condom use behavior among FSWs. METHODS: We used a longitudinal study design to assess the change in outcomes. A three-stage sampling design was used to select FSWs for the study. Panel data of 2085 FSWs selected from 38 COs across five states of India was used to examine the change in various outcomes from 2015 (Survey Round 1) to 2017 (Survey Round 2). The CO level program pillar measuring institutional development assessed performance of COs in six domains critical for any organization's functionality and sustainability: governance, project management, financial management, program monitoring, advocacy and networking, and resource mobilization. Overall, 32 indicators from all these domains were used to compute the CO strength score. A score was computed by taking mean of average dimension scores. The overall score was divided into two groups based on the median cutoff; COs which scored below the median were considered to have low CO strength, while COs which scored above or equal to median were considered to have high CO strength. Multivariable regression modeling techniques were used to examine the effect of program pillars on outcome measures. RESULTS: Analyses showed a significant improvement in the strength of the COs over time; percentage of COs having high strength improved from 50% in 2015 to 87% in Round 2. The improvement in CO's strength increased financial security (Adjusted Odds Ratio [AOR]: 2.18, p<0.01), social welfare security (AOR: 1.71, p<0.01), and socio-legal security (AOR: 2.20, p<0.01) among FSWs. Further, improvement in financial security led to significant increase in consistent condom use with client among FSWs (AOR: 1.69, p<0.01) who were members of COs having high strength. Sustained consistent condom use was positively associated with young age (<30 years), ability to negotiate with clients for condom use, membership in self-help groups, high self-efficacy, self-confidence, and client solicitation in streets and brothels. CONCLUSIONS: Improving financial security and strengthening FSW led CO can improve sustained and consistent condom use. In addition, the program should focus on enhancing ability of FSWs to negotiate with clients for condom use, promote membership in self-help groups and target FSWs who are 30 years or older, and soliciting from homes to sustain consistent condom use across all FSWs.

Family Readiness Groups: Helping deployed Army National Guard soldiers and their families.

Many have espoused the benefits of Family Readiness Groups (FRGs) for families of deployed soldiers. These include fostering family well-being (main effect) and buffering the family against the negative effects of stressful life events (moderating effect). Yet, few published studies have tested these hypothesized relationships. Survey responses gathered from returning deployed Army National Guard soldiers (N = 4,568 soldiers in 50 company-sized units) gave the opportunity to test hypothesized benefits of FRGs, both main and buffering effects. Half the sample of soldiers reported their families as having used FRGs. Two-thirds of the soldiers reported FRGs as being helpful to their families. On the whole, results supported hypotheses: More effective coping among family members was associated with FRG use (main effect), and FRGs appeared most beneficial to spouses who experienced more stressful events (buffering effect). FRG use and its associations with helpfulness to family and with family coping suggest FRGs are important resources for families of deployed soldiers, in particular, for families of reservists. Future directions for research and practice are proposed.

The Population Cost-Effectiveness of Weight Watchers with General Practitioner Referral Compared with Standard Care.

OBJECTIVE: This study aimed to assess population-level cost-effectiveness of the Weight Watchers (WW) program with doctor referral compared with standard care (SC) for Australian adults with overweight and obesity. METHODS: The target population was Australian adults ≥ 20 years old with BMI ≥ 27 kg/m2 , whose obesity status was subsequently modeled for 2015 to 2025. A microsimulation model (noncommunicable disease model [NCDMod]) was used to assess the incremental cost-effectiveness of WW compared with SC. A health system perspective was taken, and outcomes were measured by obesity cases averted in 2025, BMI units averted for 2015 to 2025, and quality-adjusted life years for 2015 to 2025. Univariate sensitivity testing was used to measure variations in the model parameters. RESULTS: The WW intervention resulted in 60,445 averted cases of obesity in 2025 (2,311 more cases than for SC), extra intervention costs of A$219 million, and cost savings within the health system of A$17,248 million (A$82 million more than for SC) for 2015 to 2025 compared with doing nothing. The modeled WW had an incremental cost-effectiveness ratio of A$35,195 in savings per case of obesity averted in 2025. WW remained dominant over SC for the different scenarios in the sensitivity analysis. CONCLUSIONS: The WW intervention represents good value for money. The WW intervention needs serious consideration in a national package of obesity health services.

Online peer support groups for family caregivers: are they reaching the caregivers with the greatest needs?

Background: Online peer support groups are an increasingly common venue for caregivers supporting disabled family members to exchange informational, emotional, and instrumental support. We know very little, however, about who uses these groups and whether they are reaching those with the greatest needs. Objective: To examine whether caregiving factors (ie, caregiving demands and strain, competing demands, access to support and services, and other caregiving characteristics) are related to online community support use and intensity of use. Method: This study used data from a new survey of family caregivers who provide care to disabled military veterans. We used logistic regression models to examine the likelihood of online community support group usage and intensity of use as a function of a variety of caregiving factors. Results: Those with greater caregiving demands were more likely to use online peer support. Specifically, helping the care recipient with more activities was associated with a statistically significantly greater likelihood of visiting an online community support group. Caring for a veteran with a neurological or psychological condition, which, in prior work, suggests more complex care needs, was also positively and significantly related to visiting an online community support group. Hours of care and several other caregiving factors were related to intensity of use. Conclusions: We show that family caregivers with the most caregiving demands are most engaged with online support communities. This suggests that online communities could be used to support the most vulnerable family caregivers. The implications of this work for online support systems are discussed.

Attendance at Fragile X Specialty Clinics: Facilitators and Barriers.

The objectives were to describe the demographic characteristics of children with Fragile X syndrome (FXS) and to determine predictors of attendance at Fragile X (FX) clinics. Findings from the Community Support Network (CSN) and Our Fragile X World (OFXW) samples showed that children who attended FX Clinics were mostly male, high-school aged or younger, and white, non-Hispanic. Using logistic regression models, awareness about FX Clinic services, guardian education, and income (CSN), and child age, family income, and total number of co-occurring conditions (OFXW) were predictors of clinic attendance. Demographic and child characteristics accounted for a large portion of the explained variance. Importantly, symptom severity and parent knowledge about services were independent predictors beyond the demographic characteristics of families.

Breastfeeding Support: A Geographic Perspective on Access and Equity.

BACKGROUND: Clinical lactation professionals, breastfeeding peer counseling, and mother-to-mother support are important sources of information and guidance for helping mothers initiate and maintain breastfeeding in the early weeks, months, and years postpartum. However, there is limited information concerning the geographic barriers that mothers face when seeking this support. Research aim: This study aimed to identify the geographic barriers to breastfeeding support, delineate gaps in access, assess inequities in the distribution of local support, and highlight the underlying differences in access and equity for different demographic and socioeconomic groups. METHODS: The locations of formal breastfeeding support resources were collected for the state of Ohio for 2016 and were combined with demographic and socioeconomic estimates and derived transportation catchment areas to conduct an analysis of spatial access and equity. RESULTS: Significant geographic gaps in formal breastfeeding support exist within the state of Ohio. Although urban areas benefit from a higher density of support options, including a wide variety of clinical experts and mother-to-mother support groups, inequities in exurban and rural areas were more strongly aligned with socioeconomic status than geography. In particular, the Special Supplemental Nutrition Program for Women, Infants, and Children offices in rural Ohio offer breastfeeding support to income-qualifying mothers but cannot address the needs of mothers who do not qualify. CONCLUSION: Spatial analytical approaches facilitate a more nuanced view of access and equity to breastfeeding support options, helping to both decompose important structural differences in the state of Ohio and identify locations that could benefit from additional breastfeeding support resources.

Assessment of factors related to smokers' adherence to a short-term support group for smoking cessation: a longitudinal study in a developing country.

OBJECTIVE:: The aim of this study was to determine which individual characteristics of smokers are associated with their adherence to a support group for smoking cessation. METHODS:: Smokers from Porto Alegre, Brazil, were invited to participate in a support group for smoking cessation consisting of four weekly sessions. Demographic data, smoking history, presence of tobacco-related diseases, severity of nicotine dependence, stage of motivation, and symptoms of anxiety and depression were evaluated at baseline. Adherence was defined as attendance at group sessions and was measured at the second and fourth sessions of the program. RESULTS:: The study recruited 167 smokers who attended the first meeting and met criteria for admission to the study. One hundred and two of the participants returned to the second session and only 55 of those who attended the first meeting completed the four-week program. For immediate adherence (second session), adult smokers over the age of 35 were more likely to adhere to the treatment (p = 0.004), whereas smoking higher numbers of cigarettes per day was associated with lower adherence to attendance at group meetings (p = 0.031). For final adherence (fourth session), only minimal level symptoms of anxiety were associated with a higher likelihood of adherence (p = 0.02). CONCLUSIONS:: Older smokers, those who smoked fewer cigarettes per day, and those with lower levels of anxiety exhibited higher rates of adherence to a smoking cessation support group.

Assessment of factors related to smokers' adherence to a short-term support group for smoking cessation: a longitudinal study in a developing country / Avaliação dos fatores associados à adesão de fumantes a um grupo de apoio de curta duração para a cessação de tabagismo: um estudo longitudinal em um país em desenvolvimento

Abstract Objective: The aim of this study was to determine which individual characteristics of smokers are associated with their adherence to a support group for smoking cessation. Methods: Smokers from Porto Alegre, Brazil, were invited to participate in a support group for smoking cessation consisting of four weekly sessions. Demographic data, smoking history, presence of tobacco-related diseases, severity of nicotine dependence, stage of motivation, and symptoms of anxiety and depression were evaluated at baseline. Adherence was defined as attendance at group sessions and was measured at the second and fourth sessions of the program. Results: The study recruited 167 smokers who attended the first meeting and met criteria for admission to the study. One hundred and two of the participants returned to the second session and only 55 of those who attended the first meeting completed the four-week program. For immediate adherence (second session), adult smokers over the age of 35 were more likely to adhere to the treatment (p = 0.004), whereas smoking higher numbers of cigarettes per day was associated with lower adherence to attendance at group meetings (p = 0.031). For final adherence (fourth session), only minimal level symptoms of anxiety were associated with a higher likelihood of adherence (p = 0.02). Conclusions: Older smokers, those who smoked fewer cigarettes per day, and those with lower levels of anxiety exhibited higher rates of adherence to a smoking cessation support group.

Resumo Objetivo: O objetivo deste estudo foi determinar quais características individuais de fumantes estão associadas à sua adesão a um grupo de apoio para a cessação do tabagismo. Métodos: Fumantes de Porto Alegre, Brasil, foram convidados a participar de um grupo de apoio para a cessação do tabagismo realizado em quatro reuniões semanais. Dados sociodemográficos, história tabagística, presença de doenças relacionadas ao tabaco, severidade da dependência de nicotina, estágio motivacional e sintomas de ansiedade e depressão foram avaliados no início do estudo. Adesão foi definida como estar presente nas reuniões do grupo, e foi medida na segunda e na quarta sessões do programa. Resultados: O estudo recrutou 167 fumantes que compareceram ao primeiro encontro e preencheram os critérios de inclusão. Desses participantes, 102 retornaram para a segunda sessão, e apenas 55 completaram as quatro semanas do programa. Com relação à adesão imediata (segunda sessão), adultos com idade superior a 35 anos mostraram maior probabilidade de aderir ao tratamento (p = 0.004), enquanto um maior número de cigarros por dia foi associado com menor adesão (p = 0.031). Para a adesão final (quarta sessão), apenas um nível mínimo de ansiedade foi associado com maior probabilidade de adesão (p = 0.02). Conclusões: Fumantes mais velhos, que fumavam menos cigarros por dia, e com menores níveis de ansiedade exibiram maiores taxas de adesão ao programa de apoio para a cessação do tabagismo.

Improving Maternal and Infant Child Health Outcomes with Community-Based Pregnancy Support Groups: Outcomes from Moms2B Ohio.

Objectives To describe temporal changes in maternal and child health outcomes in an impoverished urban community after the implementation of an innovative community-based pregnancy support program, named Moms2B. Methods Beginning in 2011, pregnant women in an urban impoverished community were recruited for participation in a community-based pregnancy support program focused on improving nutrition coupled with increasing social and medical support. The comprehensive program targeting pregnancy through the infants' first year of life was developed and staffed by a multidisciplinary team from an academic health system. As a preliminary effort to assess the effectiveness of Moms2B, we examined maternal and infant health characteristics in the community before and after implementation of the program. Results From 2011 to 2014, 195 pregnant women attended one or more Moms2B sessions at the Weinland Park (WP) location. Most (75%) were African American (AA) with incomes below $800 per month and significant medical and social stressors. Outcomes from the two WP census tracts before and after implementation of the Moms2B program were studied. From 2007 to 2010, there were 442 births in WP and 6 infant deaths for an infant mortality rate of 14.2/1000. In 2011-2014, the first four years of the Moms2B program there were 339 births and one infant death giving an IMR of 2.9/1000, nearly a five-fold reduction in the rate of an infant death. Among pregnant women in WP who were covered by Medicaid, the breastfeeding initiation rate improved from 37.9 to 75.5% (p < .01) after the introduction of Moms2B. There were no infant deaths among Moms2B participants at the WP location in the first four years of the program. Conclusions Implementation of an innovative community-based pregnancy support program was associated with important improvements in maternal and infant health in an impoverished neighborhood.

Distribution and Neighborhood Correlates of Sober Living House Locations in Los Angeles.

Sober living houses (SLHs) are alcohol and drug-free living environments for individuals in recovery. The goal of this study was to map the distribution of SLHs in Los Angeles (LA) County, California (N = 260) and examine neighborhood correlates of SLH density. Locations of SLHs were geocoded and linked to tract-level Census data as well as to publicly available information on alcohol outlets and recovery resources. Neighborhoods with SLHs differed from neighborhoods without them on measures of socioeconomic disadvantage and accessibility of recovery resources. In multivariate, spatially lagged hurdle models stratified by monthly fees charged (less than $1400/month vs. $1400/month or greater), minority composition, and accessibility of treatment were associated with the presence of affordable SLHs. Accessibility of treatment was also associated with the number of affordable SLHs in those neighborhoods. Higher median housing value and accessibility of treatment were associated with whether a neighborhood had high-cost SLHs, and lower population density was associated with the number of high-cost SLHs in those neighborhoods. Neighborhood factors are associated with the availability of SLHs, and research is needed to better understand how these factors affect resident outcomes, as well as how SLHs may affect neighborhoods over time.

Are participants in face-to-face and internet support groups the same? Comparison of demographics and depression levels among women bereaved by stillbirth.

Support groups can help individuals cope with difficult health situations but have been understudied for women with perinatal bereavement. An early study suggested those using internet support groups had high rates of positive depression screens, raising the question whether these users were more symptomatic than those in similar face-to-face support groups. We therefore conducted two convenience sample surveys of women bereaved by perinatal loss, one looking at use of online support groups and the other in-person support groups. The surveys identified demographics, use of peer support, potential confounders, and current depression symptoms using the Edinburgh Postnatal Depression Scale (EPDS). Four hundred sixteen women from 18 internet groups and 60 women from 13 in-person groups met inclusion criteria. Participants in both groups were predominantly Caucasian, highly educated, and had private insurance. Severe depression symptoms were similar in the two groups despite the different modalities. Women in both face-to-face or internet groups for pregnancy and perinatal loss demonstrated similar scores on depression screens. Women of color, poor, and less-educated women were starkly underrepresented in both types of groups, raising questions about knowledge of support options, barriers to use, preferences for bereavement support, and optimization of groups for a broader population.

Validation of the Full and Short-Form Self-Help Involvement Scale Against the Rasch Measurement Model.

BACKGROUND: Substance use disorders (SUDs) are one of the nation's most costly problems in terms of dollars, disability, and death. Self-help programs are among the varied recovery support options available to address SUD, and evaluation of these programs depends on good measurement. There exists an unmet need for a psychometrically sound, brief, efficient measure of self-help involvement for individuals with SUD that is valid across different substances and age-groups. METHODS: Using data from 2,101 persons presenting for SUD treatment, the full 21-item Global Appraisal of Individual Needs Self-Help Involvement Scale (SHIS) and a newly developed 11-item short-form version were validated against the Rasch measurement model and each other. Differential item functioning (DIF) was assessed by primary substance and age. RESULTS: Both versions met Rasch psychometric criteria. The full scale had minor misfit with no DIF for alcohol, marijuana, or opioids but a few instances of DIF for amphetamine and cocaine users as well as for age, in that youth tended to endorse several easier items more frequently than did adults. The 11-item short form had neither misfit nor DIF by substance and only minor DIF by age was highly correlated with the full version and was relatively more efficient. Criterion-related validity was supported for both. CONCLUSIONS: Both the long and short versions of SHIS are psychometrically sound measures of a more comprehensive conceptualization of self-help involvement for SUDs that can be used as part of an in-depth assessment or as a short measure that lessens respondent burden.

Characteristics of students participating in collegiate recovery programs: a national survey.

Relapse rates are high among individuals with substance use disorders (SUD), and for young people pursuing a college education, the high rates of substance use on campus can jeopardize recovery. Collegiate Recovery Programs (CRPs) are an innovative campus-based model of recovery support that is gaining popularity but remains under-investigated. This study reports on the first nationwide survey of CRP-enrolled students (N = 486 from 29 different CRPs). Using an online survey, we collected information on background, SUD and recovery history, and current functioning. Most students (43% females, mean age =26) had used multiple substances, had high levels of SUD severity, high rates of treatment and 12-step participation. Fully 40% smoke. Many reported criminal justice involvement and periods of homelessness. Notably, many reported being in recovery from, and currently engaging in multiple behavioral addictions-e.g., eating disorders, and sex and love addiction. Findings highlight the high rates of co-occurring addictions in this under-examined population and underline the need for treatment, recovery support programs and college health services to provide integrated support for mental health and behavioral addictions to SUD--affected young people.

Race/ethnic disparities in the utilization of treatment for drug dependent inmates in U.S. state correctional facilities.

BACKGROUND: Research has documented racial and ethnic disparities in utilization, access, continuity, and quality of care for psychiatric disorders including treatment for substance use disorders among those with similar need in the general community. Currently, the extent of racial and ethnic disparities in treatment within U.S. correctional facilities is unknown. METHODS: This study examines race/ethnic disparities in treatment for drug dependent inmates using the 2004 Survey of Inmates in State Correctional Facilities. Fixed effects logistic regression is used to analyze treatment outcomes for 5180 inmates housed within 286 prisons. The analysis accounts for differences in background characteristics (i.e., age, gender, marital status, foreign born status, veteran status), socioeconomic characteristics (i.e., education, employment prior to incarceration), mental health (i.e., diagnosis with a serious mental illness), and incarceration experiences (i.e., current conviction, previous incarceration episodes, time served, additional sentencing requirements, external social support, disciplinary violations). RESULTS: The findings identify a remarkable unmet need among drug dependent inmates in that less than one-half of drug dependent inmates had received any type of treatment in prison at the time of the interview with the most common treatment type being self-help groups. Compared to whites, drug dependent Latino inmates have significantly lower odds of utilizing treatment, yet there are no significant black--white disparities found. CONCLUSION: The current study suggests that treatment for drug dependent inmates needs to be expanded to include clinically or medically based treatment since the failure to address addictions in the criminal legal system has been identified as the single most significant reason for rearrest and recidivism once released.

Socioeconomic and sociodemographic predictors of cancer-related information sources used by cancer survivors.

With 14 million cancer survivors in the United States, identifying and categorizing their use of sources of cancer-related information is vital for targeting effective communications to this growing population. In addition, recognizing socioeconomic and sociodemographic differences in the use of cancer-related information sources is a potential mechanism for reducing health disparities in survivorship. Fourteen sources of information survivors (N = 519) used for cancer-related information were factor-analyzed to create a taxonomy of source use. The association between social determinants and use of these source types was analyzed in regression models. Factor analysis revealed 5 categories of information source use (mass media; Internet and print; support organizations; family and friends; health care providers), and use varied based on sociodemographic and socioeconomic characteristics. Higher education predicted increased use of all source categories except mass media. African American cancer survivors turned to health care providers as a source for cancer-related information less often than did White survivors. Social determinants predicted differences in the type of cancer-related information sources used. Providers and health communicators should target communication platforms based on the demographic profile of specific survivor audiences.

Self-help/mutual aid as active citizenship associations: a case-study of the chronically ill in Italy.

Contrary to the most widespread conception that considers self-help/mutual aid as a component of the 'third sector', an approach is proposed which assumes, on the basis of the specific nature of the social bond and of the social action that characterizes it, it can be more properly considered as part of the 'new civil society' as it has been configured during the time in Western societies. This implies its location in the public non-state and non-systemic space that it has been created in the specific form of associations of citizenship. An interuniversity research project is then presented which, using this approach, studied the case of self-help/mutual aid associations for the chronically ill in Italy, offering some of the findings regarding the origin, structural characteristics, geographical distribution and activities of these associations in order to at least partially verify the heuristic value of this approach and its implications for the processes of reform of the health systems.

An oasis in the hospital: the perceived benefits of a cancer support center in a hospital setting offering complementary therapies.

AIMS: The aim of this study was to explore and describe the experiences of persons attending a cancer support center, providing emotional support to cancer patients through self-selected complementary therapies offered free of charge through qualified volunteer therapists. A grounded theory methodology was used. Sources of data were 16 semistructured interviews with persons attending the center. Interviews were digitally recorded and transcribed verbatim. Analysis was conducted using the constant comparative method. FINDINGS: The overarching theme that emerged in this study was the benefits attributed to attendance at the cancer support center. The center was described as an "oasis" in the hospital, and three aspects relating to this were identified: (a) facilitating comfort, (b) increasing personal control, and (c) helping make sense of the cancer experience. CONCLUSION: A drop-in center offering complementary therapies appeared to enable coping with the diagnosis and treatment of cancer by facilitating comfort and increasing perceptions of personal control. The center also helped some participants to make sense of their experience with cancer. This research has provided a unique insight into the ongoing emotional needs of cancer patients, and directions for further development and research into the provision of holistic care for patients within a hospital setting.