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BACKGROUND: Persistently elevated rates of maternal and infant mortality and morbidities in Malawi indicate the need for increased quality of maternal and well-child care services. The first-year postpartum sets the stage for long-term health for the childbearing parent and infant. Integrated group postpartum and well-child care may improve maternal and infant health outcomes. The purpose of this study was to examine implementation outcomes for this model of care. METHODS: We used mixed methods to examine implementation outcomes of integrated group postpartum and well-child care. We piloted sessions at three clinics in Blantyre District, Malawi. During each session we evaluated fidelity using a structured observation checklist. At the end of each session, we administered three surveys to health care workers and women participants, the Acceptability of Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure. Focus groups were conducted to gain greater understanding of people's experience with and evaluation of the model. RESULTS: Forty-one women with their infants participated in group sessions. Nineteen health care workers across the three clinics co-facilitated group sessions, 9 midwives and 10 health surveillance assistants. Each of the 6 sessions was tested once at each clinic for a total of 18 pilot sessions. Both women and health care workers reported group postpartum and well-child care was highly acceptable, appropriate, and feasible across clinics. Fidelity to the group care model was high. During each session as part of structured observation the research team noted common health issues, the most common one among women was high blood pressure and among infants was flu-like symptoms. The most common services received within the group space was family planning and infant vaccinations. Women reported gaining knowledge from health promotion group discussions and activities. There were some challenges implementing group sessions. CONCLUSION: We found that clinics in Blantyre District, Malawi were able to implement group postpartum and well-child care with fidelity and that it was highly acceptable, appropriate, and feasible to women and health care workers. Due to these promising results, we recommend future research examine the effectiveness of the model on maternal and child health outcomes.
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Instituições de Assistência Ambulatorial , Cuidado da Criança , Lactente , Criança , Feminino , Humanos , Malaui , Promoção da Saúde , Período Pós-PartoRESUMO
BACKGROUND: Approximately 545,000 women and girls in the USA have undergone Female Genital Mutilation/ Cutting (FGM/C) or have mothers from a country where FGM/C is practiced. Women and girls living with FGM/C in the USA may experience stigma and bias due to their FGM/C, immigration, racial, and language status. Health care provider attitudes toward FGM/C and confidence for related clinical care may affect the quality of care, yet there are no validated instruments to measure these constructs. METHODS: We developed the instruments via review of the FGM/C literature, the development of scale items, expert review, and pre-testing. We validated the instruments using a convenience sample of providers in Arizona and Maryland. We used exploratory factor analysis (EFA) to confirm factor structures, and compared scores between known groups to assess validity. RESULTS: The EFA revealed a two-factor solution for attitudes, including subscales for Negative Attitudes and Empathetic Attitudes toward FGM/C and those who practice with Cronbach's alphas of 0.814 and 0.628 respectively. The EFA for confidence revealed a two-factor solution including Confidence in Clinical FGM/C Care and Confidence in Critical Communication Skills for FGM/C Care with Cronbach's alphas of 0.857 and 0.694 respectively. CONCLUSIONS: Health care provider attitudes and confidence toward FGM/C care may affect quality of care and health outcomes for women and girls. Our study describes the rigorous psychometric analysis to create reliable and valid instruments to assess health care provider attitudes and confidence for the care of women and girls who have experienced FGM/C. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03249649 . Registered on 15 August 2017. Retrospectively registered.
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Circuncisão Feminina , Arizona , Atitude do Pessoal de Saúde , Feminino , Pessoal de Saúde , Humanos , Maryland , Reprodutibilidade dos TestesRESUMO
Days after COVID-19 physical distancing precautions were implemented, a coalition of community leaders in Baltimore City founded the Baltimore Neighbors Network (BNN), a volunteer network established to provide proactive phone-based support to older adults in Baltimore City. BNN was a community-driven approach aimed at reducing social isolation and improving health equity both during the pandemic and long-term. This paper describes how the Johns Hopkins School of Nursing's (JHUSON) public health nursing clinical faculty and students partnered with BNN to support a community-driven crisis response effort while creatively meeting student learning objectives. While engaging in the work of BNN remotely, nursing students were able to meet competencies across all eight domains of the Quad Council Coalition of Public Health Nursing Organizations. Schools of Nursing throughout the country can use this partnership as a model of a service-learning strategy for public health nursing education during a crisis.
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COVID-19/epidemiologia , Relações Comunidade-Instituição , Enfermagem em Saúde Pública/educação , Escolas de Enfermagem/organização & administração , Idoso , Baltimore/epidemiologia , Humanos , Aprendizagem , Pesquisa em Educação em Enfermagem , Pesquisa em Avaliação de Enfermagem , Estudantes de Enfermagem/psicologiaRESUMO
A variety of interventions have been tested targeting people living with HIV (PLH) and their relationships with their children. The purpose of this study was to synthesize evidence on the goals, types, scope, and outcomes of such intergenerational interventions for PLH. Randomized trials targeting PLH alone or together with their children, published in English, with an intergenerational intervention component were included in this review. Thirteen studies met eligibility criteria. The types and goals of interventions varied greatly but often involved educational sessions with groups of PLH, skill-building sessions, or parental disclosure of HIV status among mothers living with HIV; six studies targeted problem behaviors, resilience, and self-esteem among their children. Two studies addressed general family coping with HIV. Seven studies reported positive outcomes as a result of an intergenerational intervention, with the greatest improvements being observed in those participants with the most stress. Most studies failed to report specific intervention methodology. Due to gaps in the literature noted, future intergenerational interventions targeting PLH should include more diverse groups of PLH. Studies should also explore the impact of intergenerational-based interventions on the mental health of PLH and their families.
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Filho de Pais com Deficiência , Infecções por HIV , Relações Pais-Filho , Adaptação Psicológica , Família , Humanos , Saúde Mental , Mães , Educação de Pacientes como Assunto , Comportamento Problema , Resiliência Psicológica , Autoimagem , AutorrevelaçãoRESUMO
Perinatal mental health problems such as depression and anxiety are prevalent in low and middle-income countries. In Mali, the lack of mental health care is compounded by few studies on mental health needs, including in the perinatal period. This paper examines the ways in which perinatal women experience and express mental distress in rural Mali. We describe a process, relying on several different qualitative research methods, to identify understandings of mental distress specific to the Malian context. Participants included perinatal women, maternal health providers, and community health workers in rural southwest Mali. Participants articulated several idioms of distress, including gèlèya (difficulties), tôôrô (pain, suffering), hamin (worries, concerns), and dusukasi (crying heart), that occur within a context of poverty, interpersonal conflict, and gender inequality. These idioms of distress were described as sharing many key features and operating on a continuum of severity that could progress over time, both within and across idioms. Our findings highlight the context dependent nature of experiences and expressions of distress among perinatal women in Mali.
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Ansiedade/etnologia , Depressão/etnologia , Complicações na Gravidez/etnologia , Estresse Psicológico/etnologia , Adulto , Feminino , Pessoal de Saúde , Humanos , Masculino , Mali/etnologia , Gravidez , Pesquisa Qualitativa , População Rural , Terminologia como Assunto , Adulto JovemRESUMO
The original version of this article unfortunately contained a mistake in the author name.
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There is little evidence about family planning knowledge, attitudes, and use among couples in post-conflict Democratic Republic of the Congo. We used qualitative descriptions to analyze data from 75 participants. Intimate partner violence (IPV) was common among participants. They were aware of family planning methods; however, IPV and fears of side effects were barriers to use. Although participants were concerned about the cost of large families, had positive attitudes toward family planning, and intended to use it, actual use was uncommon. The need for family planning was acute because of war-related poverty. Couples negotiated, but men had strong influence over family planning decisions. Couples saw health workers as a valuable resource. Interventions in this setting should include a couple-based approach that addresses IPV as well as family planning content.
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Serviços de Planejamento Familiar/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Violência por Parceiro Íntimo , Maus-Tratos Conjugais , Guerra , Adulto , Estudos Transversais , República Democrática do Congo , Serviços de Planejamento Familiar/organização & administração , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa , Estupro/psicologia , População Rural , Parceiros Sexuais , Exposição à GuerraRESUMO
BACKGROUND: It is important to define global health competencies for health professionals. To date, we know little about perspectives of nurses in Africa where environments are particularly challenging. PURPOSE: The purpose was to describe perceptions of nursing faculty in Africa about global health competencies and compare those to faculty from the Americas. METHODS: A 32-item online survey with a convenience sample of nursing faculty. RESULTS: Data from 63 nurses in 21 African countries and 618 in the Americas were analyzed. Competencies related to Social and Environmental Determinants of Health were awarded relatively higher scores. Competencies related to globalization of health and health care were ranked relatively lower. This was similar across regions. DISCUSSION: Nursing education should address the social implications for health. CONCLUSION: Participants in all three regions considered Social and Environmental Determinants of Health as a priority. These data help set educational priorities in a setting where educational and training resources are limited.
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Competência Clínica/normas , Docentes de Enfermagem/estatística & dados numéricos , Saúde Global/normas , Determinantes Sociais da Saúde , África , Estudos Transversais , Humanos , Estudos de Amostragem , Inquéritos e QuestionáriosRESUMO
Black immigrants constitute a rapidly growing population group in the U.S. A comprehensive understanding of health services used by Black immigrant women is necessary to support the complex needs of this population. We conducted a systematic review to (1) understand the types of health services used by Black immigrant women living in the U.S. and (2) examine barriers and motivators to using health services. Relevant studies were identified in the following databases: PubMed, PsychInfo, CINAHL, and Embase. Articles published until October 2022 were included in the review. From a total of 15,245 records, 47 articles that reported on health service utilization practices of Black immigrant women were included in the review. A variety of different health services were accessed by Black immigrant women, such as hepatitis screening, reproductive health services, cancer screenings, substance abuse treatment, mental health services, HIV services, dental services, genetic testing, cardiovascular risk testing, and general health services/ hospitalizations. Motivators for using health services included possession of health insurance, knowledge of health resources and conditions, and positive experiences with providers. Barriers to using health services included challenges navigating the health system, language barriers, and cultural beliefs. Factors that positively influence health service utilization must be expanded at the institutional, societal, and policy levels to improve access to health services for Black immigrant women.
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Objective: To describe two main pillars of the Maryland Maternal Health Innovation Program (MDMOM): (1) centering equity and (2) fostering broad stakeholder collaboration and trust. Methods: We summarized MDMOM's key activities and used severe maternal morbidity (SMM) surveillance and program monitoring data to quantify MDMOM's work on the two pillars. We developed measures of hospital engagement with MDMOM (participation in quality improvement [QI] activities, participation in check-in meetings, staff involvement) and with other partners (participation in QI activities, representation in state-level groups). We examined Bonferroni-adjusted correlations between these hospital engagement measures and with key hospital characteristics: level of maternity care, annual delivery volume, and SMM rate. Results: Over 100 national and state organizations and individual stakeholders contributed to our building the MDMOM program and implementing key activities centering equity: hospital-based SMM surveillance in 20 of Maryland's 32 hospitals; almost 5,000 trainings offered to perinatal health care providers; two telemedicine/telehealth interventions; training of home visitors and community-based organization staff. Birthing hospitals represent MDMOM's main implementation partners. The strength of their participation in MDMOM QI activities is positively correlated to their participation in check-in meetings and with the degree of involvement by physicians in such activities. Higher engagement in MDMOM QI activities is also positively correlated to hospitals' participation in other state-level maternal health initiatives or groups. Conclusion: Our experience with the MDMOM program demonstrates that an equity focus and broad stakeholder collaboration building strong relationships and providing implementation support can lead to high levels of engagement in innovative maternal health interventions.
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BACKGROUND: The Women's Health Needs Study (WHNS) collected information on the health characteristics, needs, and experiences, including female genital mutilation (FGM) experiences, attitudes, and beliefs, of women aged 18 to 49 years who were born, or whose mothers were born, in a country where FGM is prevalent living in the US. The purpose of this paper is to describe the WHNS design, methods, strengths and limitations, as well as select demographic and health-related characteristics of participants. METHODS: We conducted a cross-sectional survey from November 2020 -June 2021 in four US metropolitan areas, using a hybrid venue-based sampling (VBS) and respondent-driven sampling (RDS) approach to identify women for recruitment. RESULTS: Of 1,132 participants, 395 were recruited via VBS and 737 RDS. Most were born, or their mothers were born, in either a West African country (Burkina Faso, Guinea, Mali, Mauritania, Sierra Leone, The Gambia) (39.0%) or Ethiopia (30.7%). More than a third were aged 30-39 years (37.5%) with a majority who immigrated at ages ≥13 years (86.6%) and had lived in the United States for ≥5 years (68.9%). Medicaid was the top health insurer (52.5%), followed by private health insurance (30.5%); 17% of participants had no insurance. Nearly half of women reported 1-2 healthcare visits within the past 12 months (47.7%). One in seven did not get needed health care due to cost (14.8%). Over half have ever used contraception (52.1%) to delay or avoid pregnancy and 76.9% had their last pelvic and/or Papanicolaou (pap) exam within the past 3 years. More than half experienced FGM (55.0%). Nearly all women believed that FGM should be stopped (92.0%). CONCLUSION: The VBS/RDS approach enabled recruitment of a diverse study population. WHNS advances research related to the health characteristics, needs, and experiences of women living in the US from countries where FGM is prevalent.
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Circuncisão Feminina , Saúde da Mulher , Humanos , Feminino , Circuncisão Feminina/estatística & dados numéricos , Circuncisão Feminina/psicologia , Adulto , Estados Unidos , Pessoa de Meia-Idade , Adolescente , Estudos Transversais , Adulto Jovem , Saúde da Mulher/estatística & dados numéricos , Prevalência , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e QuestionáriosAssuntos
Circuncisão Feminina/etnologia , Circuncisão Feminina/estatística & dados numéricos , Características Culturais , Medicina de Família e Comunidade/métodos , Refugiados/estatística & dados numéricos , Atitude Frente a Saúde/etnologia , Feminino , Humanos , Exame Físico/estatística & dados numéricos , Saúde da Mulher/etnologiaRESUMO
Our team explored the lived experiences of rural auxiliary midwives, or matrones, in Mali. Since matrones attend more births than all other health workers combined, they are critical to efforts to reduce maternal mortality. Currently, their experiences are not well understood. This study used interpretive phenomenology to describe the experiences of seven matrones. We suggest that matrones provide a vital connection between traditional approaches to birth and the biomedical services offered by the formal health sector. Matrones' unique role as both health professionals and rural women creates challenges and opportunities that affect their effectiveness and personal lives.
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Tocologia , Enfermeiros Obstétricos/psicologia , População Rural , Feminino , Humanos , Entrevistas como Assunto , Mali , Gravidez , Papel Profissional , Pesquisa QualitativaRESUMO
BACKGROUND: Female genital mutilation or cutting (FGM/C) is a social norm driven practice associated with numerous adverse health complications. Existing assessment tools for health workers are limited by lack of a clear framework for what constitutes the critical knowledge, attitudes, and practices that impact FGM/C prevention and care. The aim of this study was to explore expert opinion of the knowledge, attitudes, and practices for FGM/C-related prevention and care that can be used to inform the development of future KAP measurement tools. METHODS: We conducted 32 semi-structured individual interviews with global clinical and research experts on FGM/C from 30 countries including participants from Africa, Australia/ New Zealand, Europe, the Middle East, and North America. Interview questions explored areas of knowledge, attitudes, and practices that influence FGM/C-related prevention and care activities. We used the directed content analysis methodology for the qualitative data analysis. RESULTS: We identified six categories of knowledge, six of practice, and seven of attitudes that contribute to FGM/C-related prevention and care. Areas of knowledge included: general knowledge about FGM/C; who is at risk for experiencing FGM/C; support for FGM/C; female genital anatomy/ physiology; health complications of FGM/C; management of health complications of FGM/C; ethical and legal considerations for the treatment and prevention of FGM/C, and patient-health worker communication. Areas of practice included: clinical procedures and protocols; management of complications; defibulation; other surgical procedures for FGM/C; pediatric care (including prevention); and patient-centered care. Participants described health worker attitudes that may affect how prevention and care activities are delivered and/or received including attitudes toward: the perceived benefits of FGM/C; harms of FGM/C; ethical considerations related to FGM/C medicalization, prevention, and treatment; providing care for FGM/C-affected clients; women and girls who have experienced FGM/C; communities that practice FGM/C; and affective response to FGM/C. We also present participant perspectives on the ways in which knowledge, attitudes, and practice interact impacting the type and quality of care provided to those affected by FGM/C. CONCLUSIONS: This study identified specific areas of knowledge, attitudes, and practices in FGM/C prevention and care that are important to include in future evaluation metrics. Future KAP tools should be theoretically informed using the framework we present, and assessed for validity and reliability using psychometrically rigorous methods. Developers of KAP tools should consider the hypothesized relationships between knowledge, attitudes, and practices.
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Circuncisão Feminina , Criança , Humanos , Feminino , Circuncisão Feminina/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Prova Pericial , Reprodutibilidade dos Testes , ÁfricaRESUMO
BACKGROUND: Implicit bias among maternal healthcare professionals contributes to disrespectful care and racial and ethnic disparities in patient outcomes, and there is growing consensus that implicit bias training is a key component of birth equity initiatives. A requirement for implicit bias training for healthcare professionals has become more widespread, but the impact training has is largely unknown, in part, because of a lack of validated instruments. Therefore, there is an urgent need for a psychometrically valid instrument for use in the evaluation of implicit bias training. OBJECTIVE: This study aimed to develop a valid and reliable instrument to assess implicit bias awareness and mitigation practices among maternal care professionals and that can be used to evaluate interventions aimed at mitigating such bias in clinical practice. STUDY DESIGN: We conducted an instrument development and validation study in 3 phases. In phase 1, item development, we generated a 43-item bank from literature and consultation and established content validity with subject matter experts. In phase 2, instrument development, we administered a revised set of 33 items to 307 nurses and midwives and conducted exploratory factor analysis to demonstrate construct validity and reliability. In phase 3, instrument evaluation, we confirmed the factor structure and compared the means of implicit bias training-exposed and -unexposed participants to further demonstrate construct validity with a representative state sample of 2096 maternal healthcare professionals (physicians, midwives, and nurses). RESULTS: Based on phase 2 results, we retained 23 items for the Bias in Maternal Health Care scale, which showed high internal consistency (Cronbach's alpha, 0.86). We identified 3 subscales, namely a 9-item Bias Awareness subscale (Cronbach's alpha, 0.86), a 7-item Bias Mitigation Practice subscale (Cronbach's alpha, 0.82), and a 7-item Bias Mitigation Self-Efficacy subscale (Cronbach's alpha, 0.81). Validation of the Bias Awareness and Bias Mitigation Practice subscales in phase 3 demonstrated the instrument's high reliability (Cronbach's alpha 0.86 and 0.83, respectively) and discriminating performance among maternal healthcare professionals. CONCLUSION: We developed a reliable and valid instrument for measuring awareness and mitigation of bias among maternal healthcare professionals. It can be used to evaluate implicit bias training and other bias mitigation interventions in maternal healthcare settings.
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Serviços de Saúde Materna , Médicos , Gravidez , Feminino , Humanos , Reprodutibilidade dos Testes , Atenção à Saúde , Pessoal de SaúdeRESUMO
Background Persistently elevated rates of maternal and infant mortality and morbidities in Malawi indicate the need for increased quality of maternal and well-child care services. The first-year postpartum sets the stage for long-term health for the childbearing parent and infant. Integrated group postpartum and well-child care may improve maternal and infant health outcomes. The purpose of this study was to examine implementation outcomes for this model of care. Methods We used mixed methods to examine implementation outcomes of integrated group postpartum and well-child care. We piloted sessions at three clinics in Blantyre District, Malawi. During each session we evaluated fidelity using a structured observation checklist. At the end of each session, we administered three surveys to health care workers and women participants, the Acceptability of Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure. Focus groups were conducted to gain greater understanding of peopleâ™s experience with and evaluation of the model. Results Forty-one women with their infants participated in group sessions. Nineteen health care workers across the three clinics co-facilitated group sessions, 9 midwives and 10 health surveillance assistants. Each of the 6 sessions was tested once at each clinic for a total of 18 pilot sessions. Both women and health care workers reported group postpartum and well-child care was highly acceptable, appropriate, and feasible across clinics. Fidelity to the group care model was high. During each session as part of structured observation the research team noted common health issues, the most common one among women was high blood pressure and among infants was flu-like symptoms. The most common services received within the group space was family planning and infant vaccinations. Women reported gaining knowledge from health promotion group discussions and activities. There were some challenges implementing group sessions. Conclusion We found that clinics in Blantyre District, Malawi were able to implement group postpartum and well-child care with fidelity and that it was highly acceptable, appropriate, and feasible to women and health care workers. Due to these promising results, we recommend future research examine the effectiveness of the model on maternal and child health outcomes.
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BACKGROUND: In response to a global call for more midwives, maternal health stakeholders have called for increased investment in midwifery pre-service education. Given the already long list of challenges and the increasing burden on health care systems due to the COVID-19 pandemic, the need to prioritize investment is acute, particularly in sub-Saharan Africa. An important first step is to examine the current evidence. METHODS: We conducted a scoping review of the peer-reviewed literature about pre-service midwifery education in sub-Saharan Africa. A search of studies published between 2015 and 2021 in French or English was conducted using six databases (PubMed, CINAHL, Embase, Scopus, Web of Science and African Index Medicus). RESULTS: The search yielded 3061 citations, of which 72 were included. Most were a mix of qualitative and quantitative cross-sectional, country-specific studies. Organized by pre-service educational domain, the literature reflected a misalignment between international standards for midwifery education and what schools and clinical sites and the larger administrative systems where they operate, reliably provide. Inadequate infrastructure, teaching capacity in school and clinical settings and clinical site environment were factors that commonly impede learning. Literature related to faculty development and deployment were limited. CONCLUSION: Schools, faculty and clinical sites are overwhelmed yet recommendations by key stakeholders for change are substantive and complex. Efforts are needed to help schools map their current status by pre-service education domain and prioritize where scarce resources should be directed. These results can inform research and investments in pre-service midwifery education in sub-Saharan Africa.
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COVID-19 , Tocologia , Gravidez , Humanos , Feminino , Tocologia/educação , Estudos Transversais , Pandemias , COVID-19/epidemiologia , África SubsaarianaRESUMO
Pet food formulated with raw meat can pose health risks to pets and humans. High-pressure processing (HPP) was evaluated to achieve a 5-log reduction ofSalmonella,E. coliSTEC, andL. monocytogenesin commercial raw pet foods and maintain a 5-log reduction throughout post-HPP storage.Three formulation types that varied in the amounts of striated meat, organ meat, bone, seeds, and other ingredients (fruits, vegetables, and minor ingredients) designated as A-, S-, and R-formulations were used. Eight raw diet pet foods, consisting of three beef formulations (A-, S- and R-Beef), three chicken formulations (A-, S-, and R-Chicken), and two lamb formulations (A- and S-Lamb), were inoculated with 7 log CFU/g cocktails ofSalmonella,E. coliSTEC orL. monocytogenes, HPP at 586 MPa for 1-4 min, and stored refrigerated (4°C) or frozen (-10 to -18°C) for 21 days with microbiological analyses at various time intervals. A- formulations (20-46% meat, 42-68% organs, 0.9-1.3% seeds, and 10.7-11.1% fruits, vegetables, and minor ingredients) inoculated withSalmonellaand treated at 586 MPa for at least 2 min achieved a 5-log reduction 1 day post-HPP and maintained that inactivation level during frozen storage. A- and S-formulations inoculated withE. coliSTEC and treated at 586 MPa for at least 2 min achieved a 5-log reduction from day 6 of frozen storage. L. monocytogeneswas more HPP resistant thanSalmonellaandE. coliSTEC.S-formulations containing chicken or beef and stored frozen post-HPP had lower inactivation of L. monocytogenes compared to A-formulations containing chicken or beef. S-Lamb had higher frozen storage inactivation (5.95 ± 0.20 log CFU/g) compared to chicken (2.52 ± 0.38 log CFU/g) or beef (2.36 ± 0.48 log CFU/g). HPP coupled with frozen storage time was effective in achieving and maintaining a 5-log reduction ofSalmonellaandE. coliSTEC whileL. monocytogeneswas more resistant and requires further optimization to achieve a 5-log reduction.