Using Vignettes to Gain Insights Into Social Norms Related to Voluntary Family Planning and Gender-Based Violence in South Sudan.

Social norms are the shared expectations about behaviors that are held within collective groups. These differ from attitudes and beliefs, which are individually held. In South Sudan, social norms can affect the use of voluntary family planning and reproductive health (FP/RH); some of these norms even present risks for women seeking FP/RH care and their FP/RH providers. This cross-sectional, descriptive study conducted in 5 counties in South Sudan used vignettes as a qualitative method to explore social norms related to FP/RH and decisions related to contraceptive use and gender-based violence. Participants were asked to respond to vignettes about a fictional couple during various life stages of care-seeking. Vignettes allow respondents to share their opinions and feelings without directly speaking about their own experiences. Respondents included community members, FP/RH providers, and key influencers (e.g., religious leaders, traditional leaders, elders). The study identified restrictive social norms related to FP/RH, including entrenched, dominant gender roles (i.e., requiring male consent to use contraceptives) and risk for the woman and her provider if she accesses FP/RH services. Of note, supportive social norms are gaining acceptance regarding women's voice and agency; it was found that some women can negotiate their reproductive choice with their partners and participate in planning their families, which has not always been a widely accepted norm. The use of vignettes can lead to a better understanding of the challenges and provide insights on effective implementation approaches. It is essential for programs working to promote the use of FP/RH services in South Sudan to consider the challenges presented by social norms. Findings from this study were shared with stakeholders and communities to codesign interventions aimed at increasing the use of FP/RH services. Additionally, the dialogue stimulated by this study should lead to an organic transformation toward supportive social norms through collective agency.

Six Recommendations for Provider Behavior Change in Family Planning.

Health care provider behavior has the power to influence family planning and reproductive health outcomes positively and negatively, underlining the importance of provider behavior change (PBC) initiatives. However, global health practitioners lack a shared understanding of PBC interventions and what influences provider behavior. Furthermore, PBC interventions in family planning and reproductive health have tended to address individual and workplace environmental factors rather than the full breadth of factors that influence provider behavior, including the broader systems and contexts where providers operate. This commentary contributes to a common understanding of PBC, including the determinants of provider behavior, and describes actions to advance PBC efforts in family planning and reproductive health. To inform these considerations, we conducted a narrative review of more than 70 articles and project materials describing interventions that aimed to change provider behaviors pertaining to family planning and reproductive health and used the review to identify the most and least common provider cadres addressed, behavioral determinants targeted, and strategies implemented. We strongly encourage global health practitioners to design future PBC interventions for a more diverse set of cadres and contexts, consider the full set of factors that influence provider behavior, pair provider- and client-side interventions, shift the narrative around PBC from "blaming" to supporting providers, move beyond training-only interventions, and improve the rigor of measurement and evidence-building efforts for PBC. These considerations can be used to advance the field of PBC in family planning and reproductive health to improve outcomes across the service delivery continuum.

Developing a Community-Based Tailored Exercise Program for People With Severe and Persistent Mental Illness.

BACKGROUND: People with severe and persistent mental illness (SPMI) are at a greater risk of medical issues compared with the general population. Exercise has a positive effect on physical and mental health outcomes among this population in community settings. OBJECTIVES: To describe community-based participatory research (CBPR) methods used to tailor an exercise program among people with SPMI, demonstrate its impact, and present lessons learned for future research. METHODS: The partnership developed a project to explore the feasibility of implementing a physical activity program at a community agency among clients with SPMI. LESSONS LEARNED: Data showed improved trends in mood, social support, and physical and mental health outcomes. Facilitators and barriers must be carefully considered for recruitment and retention. CONCLUSIONS: A gender-specific, group-based, tailored exercise intervention developed through collaboration with a community agency serving people with SPMI using CBPR methods is feasible.

Translating community-based participatory research principles into practice.

BACKGROUND: Although academics are trained in research methods, few receive formal training in strategies for implementing equitable community engaged research. Academics and their community partners can benefit from such direction and assistance as they establish and maintain community-based participatory research (CBPR) partnerships. Research partners from the University of Pittsburgh, the Johns Hopkins Center for Injury Research and Policy, and the House of Ruth Maryland, one of the nation's leading domestic violence centers serving Baltimore and the surrounding areas, joined together to design, implement, and evaluate a series of activities to increase local CPBR capacity. OBJECTIVES: This article provides an overview of process and findings from two CBPR workshops jointly held for academic and community members and explores specific suggestions from the workshop participants about how to put the CBPR principles into practice to promote community engaged research to address intimate partner violence (IPV). METHODS: Twenty-four academic and community partners with experience addressing IPV participated in the two workshops. Facilitators led discussions based on the core CPBR principles. Participants were asked to interpret those principles, identify actions that could help to put the principles into practice, and discuss challenges related to CBPR approaches for IPV research. Observational notes and transcripts of the discussions and workshop evaluations are summarized. RESULTS: The CBPR principles were interpreted and revised through consensus into common language that reflected the group discussion of the core CBPR principles. Workshop participants provided a range of actions for putting the principles into practice and identified the need for sensitivity in relation to IPV research. A majority of participants felt that the workshop generated novel ideas about how they could use CPBR in their own work. CONCLUSIONS: Translating CBPR principles into common, action-oriented language is a useful first step when building a new academic-community research partnership.