Sharing Culture and Management of Sex Work Information on Mobile Phones by Female Sex Workers in Nepal: Implications for mHealth Practice and Research.

Female sex workers (FSWs) in Nepal continue to be disproportionately at risk for Sexually Transmitted Infections (STIs), including HIV. Due to stigma related to sex work and HIV, FSWs keep their sex work information hidden, which poses a barrier to seeking health services. Emerging research indicates a high uptake of mobile phones among FSWs in Nepal. Mobile health (mHealth) interventions can provide health information and linkage to care. However, largely missing from the literature is FSWs' experience of managing the information about their involvement in sex work in a culture where sharing personal information and belongings is a part of the social norm, and maintaining privacy could have negative social repercussions. The current study aims to understand how FSWs perceive and manage privacy when they share their mobile phones. Using the Communication Privacy Management theory, we explore FSWs' perception of the threat to their privacy posed by mobile phones. We conducted 30 in-depth interviews among FSWs in Kathmandu, Nepal. Results showed that all participants owned mobile phones, and sharing devices was common. Mobile phones pose a considerable challenge in keeping sex work information private, and FSWs use various communication strategies to circumvent privacy threats. The findings highlight the mental and emotional burden FSWs face trying to conceal their private information in a sharing culture. The study discusses the importance of theorizing privacy in the cultural context of the Global South and the practical implications for developing mHealth interventions for this population.

Examining Factors Associated With Intention to Seek Professional Mental Health Support Among First-Generation Iranian Americans.

PURPOSE: Research suggests immigrants are at a greater risk of mental health disorders compared to native-born populations. Thus, the current study investigated factors associated with professional mental help-seeking intention among American immigrants. METHOD: A cross-sectional study was conducted with 207 first-generation Iranian Americans, and data were collected using survey questionnaires. RESULTS: Younger Iranians living in western states in the United States and those with positive attitudes toward professional mental health services had greater intention to seek these services. Unexpectedly, those with better mental health literacy (MHL) held more mental health stigma (MHS). CONCLUSION: Findings elucidated valuable insights into the complex dynamics among sociodemographic factors, acculturation, MHL, MHS, attitudes, and intentions toward professional mental health help-seeking. We also highlighted the intricate relationship between MHL and MHS, suggesting that strategies to improve MHL may not necessarily mitigate MHS within this community. Therefore, integrating anti-stigma, contact-based approaches to MHL programs could effectively reduce stigma while facilitating mental health help-seeking. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Social Media Health Promotion and Audience Engagement: The Roles of Information Dissemination, Organization-Audience Interaction, and Action Confidence Building.

Social media have become an important platform for health promotion. Based on the Information-Community-Action Framework, we conducted a content analysis of 1,481 Facebook postings by Singapore's Health Promotion Board. Results showed that organizational information and health benefit information dissemination were positively associated with online audience engagement. Also, organization-audience interaction had a positive relationship with online audience engagement. In addition, messages that help build confidence for health behavior change increased online audience engagement. In addition to these main effects, organization-audience interaction also played a moderating role that strengthened the effects of information dissemination and action confidence building on online audience engagement. This study offers important theoretical contributions to the Information-Community-Action Framework and has practical implications for enhancing the effectiveness of health promotion in this digital era.

Online information and support seeking during COVID-19 lockdown in Wuhan: implications for health promotion.

The lockdown that was deployed in Wuhan, China to combat the COVID-19 pandemic curbed the infection but also created great information challenges for people in social isolation. This resulted in surge in online health information seeking (OHIS) behaviors of the patients and their families. While the Internet has been widely used by Chinese public to access and search health information, there is relatively little research in the context of pandemic outbreaks, especially at the onset of a strong lockdown while many people were panicking. From a total of 10 908 '#COVID-19 Patient Seeking Help' posts on Weibo in a period of 20 days when the lockdown policy was first initiated, we identified 1496 unique patients living in or with family in Wuhan, China. Using textual analysis, we explored OHIS behaviors at the onset of the pandemic. Many faced increased difficulties accessing offline healthcare services and such turned to social media for help and information. In particular, the findings highlight the following themes: 'OHIS for medical treatment', 'OHIS to manage self-quarantine', 'OHIS for tangible support' and 'OHIS to navigate information discrepancy'. Overall, our findings provide important insights into health information seeking behaviors and the role of social media during a pandemic. Our findings also highlight the importance of considering people's information need and challenges created due to the lockdown policies in the future pandemic communication and preparedness.

Comparison of COVID-19 Information Seeking, Trust of Information Sources, and Protective Behaviors in China and the US.

Due to the increasing amount of new information that is emerging about COVID-19, traditional and web-based information sources are commonly used to spread and seek information. This study compared differences in information seeking, trust of information sources, and use of protective behaviors (e.g., mask wearing) among individuals in the US and China during the COVID-19 pandemic. A total of 722 valid responses in the US and 493 valid responses in China were collected via online surveys in May 2020. Pearson's Chi-square tests, independent samples t-tests, and multiple linear regressions were used to conduct the analyses. Results showed that US respondents accessed significantly fewer COVID-19 information sources, rated significantly lower levels of trust in these sources, and reported significantly lower levels of protective behaviors than the Chinese respondents. In both countries, trust in newspapers, radio/community broadcasting, and news portals were significantly positively correlated with protective behaviors. While trust of TV was significant in both populations, in China it was positively correlated, whereas in the US was negatively correlated, with protective behaviors. Findings from this study showed that coordinated and consistent messages from governmental officials, health authorities, and media platforms are important to promote and encourage protective behaviors.

Gendered social practices in reproductive health: A qualitative study exploring lived experiences of unwed single mothers in China.

China's family planning policy has historically silenced the voices of women, especially unwed single mothers at the expense of their reproductive health and overall wellbeing. Further, reproductive decisions in China are closely intertwined with marriage decisions and intergenerational dynamics, highlighting the relevance of gender in women's reproductive health experiences. Chinese unwed single mothers are in particular penalized for violating the gendered social norms supported by the national reproductive policies. Drawing on previous work that calls on the need to explore gender system and its influence on health, this manuscript explores the ways in which gender norms are played out for the unwed single mothers within romantic and intergenerational relations, with impacts on their reproductive health and decision-making. The findings show that reproductive decisions are interwoven with the fulfilment of other gendered identities, such as daughter, daughter-in-law and wife. Although the decision to go through unwed motherhood is reflective of their agency, the tie between childbirth and marriage does not allow the women to entirely break free from the social system. The findings also highlight the importance of considering the role of gender system that is played out within social relations, which in turn impacts the health of the women.

Lived Experiences of Unwed Single Mothers: Exploring the Relationship between Structural Violence and Agency in the Context of Chinese Reproductive Health Discourse.

China's family planning policy prioritizes the state and has historically silenced the voices of women in their own reproductive discourse. Unwed single Chinese mothers are in particular penalized and remain invisible in the national reproductive health discourse that promotes childbirth only within the institution of marriage. Drawing on Giddens' theoretical framework of structure-agency, thirty in-depth interviews were conducted to understand the lived experiences of Chinese unwed single mothers. Specifically, this study explored the ways in which structural violence is communicatively enacted in the interactions within institutions such as police station, family planning office and health care system; and interpersonal relationships such as family and neighbors that silence the voices of the unwed single mothers. Further the study also explored the ways in which the women enact their agency to navigate these macro and micro level constrains and limitations. The findings revealed that the women's experience of structural violence is often a manifestation of the state-controlled sexuality discourse in the social institutions and interpersonal relationships, and highlighted the women's agency enactment through employing various communicative behaviors to manage these day-to-day struggles.

Online Health Information Seeking Using "#COVID-19 Patient Seeking Help" on Weibo in Wuhan, China: Descriptive Study.

BACKGROUND: First detected in Wuhan, China in December 2019, the COVID-19 pandemic stretched the medical system in Wuhan and posed a challenge to the state's risk communication efforts. Timely access to quality health care information during outbreaks of infectious diseases can be effective to curtail the spread of disease and feelings of anxiety. Although existing studies have extended our knowledge about online health information-seeking behavior, processes, and motivations, rarely have the findings been applied to an outbreak. Moreover, there is relatively little recent research on how people in China are using the internet for seeking health information during a pandemic. OBJECTIVE: The aim of this study is to explore how people in China are using the internet for seeking health information during a pandemic. Drawing on previous research of online health information seeking, this study asks the following research questions: how was the "#COVID-19 Patient Seeking Help" hashtag being used by patients in Wuhan seeking health information on Weibo at the peak of the outbreak? and what kinds of health information were patients in Wuhan seeking on Weibo at the peak of the outbreak? METHODS: Using entity identification and textual analysis on 10,908 posts on Weibo, we identified 1496 patients with COVID-19 using "#COVID-19 Patient Seeking Help" and explored their online health information-seeking behavior. RESULTS: The curve of the hashtag posting provided a dynamic picture of public attention to the COVID-19 pandemic. Many patients faced difficulties accessing offline health care services. In general, our findings confirmed that the internet is used by the Chinese public as an important source of health information. The lockdown policy was found to cut off the patients' social support network, preventing them from seeking help from family members. The ability to seek information and help online, especially for those with young children or older adult members during the pandemic. A high proportion of female users were seeking health information and help for their parents or for older adults at home. The most searched information included accessing medical treatment, managing self-quarantine, and offline to online support. CONCLUSIONS: Overall, the findings contribute to our understanding of health information-seeking behaviors during an outbreak and highlight the importance of paying attention to the information needs of vulnerable groups and the role social media may play.

Exploring the Interlinkages Between Gender, Power, and Health in the Entertainment Establishment Settings in Kathmandu Nepal.

This article explores the ways in which gender inequalities are reproduced and reinforced within entertainment establishments, and in turn the ways in which it affects health of the women working in these establishments. Specifically, this article is based on 35 in-depth interviews with women working in entertainment establishments in Kathmandu, Nepal. The findings highlight daily encounters of harassment by customers demanding engagement and acceptance of various sexual advances; strategies of exploitation by employers such as threatening the loss of work and/or salary to coerce the women into engaging in sexual talks and innuendoes to increase sales for the business; and an adverse impact on the physical, emotional, and psychological health of women working in the entertainment establishment. The findings urge us to locate the discussion of health, particularly health of marginalized women, within the context of gender inequalities, labor divisions, and power relations.

Applying the Modified Comprehensive Model of Information Seeking to Online Health Information Seeking in the Context of India.

This study extends the Comprehensive Model of Information Seeking (CMIS) to online health information seeking in the context of India. This study considers the Internet (i.e., media) use an antecedent factor and the personal relevance factor salience is separated into two dimensions - susceptibility and severity. Structural equation modeling analysis (N = 990) tested the associations between health-related antecedents, information-carrier factors, and their direct effects on online information seeking. The results among online health information seekers in India showed significant relationships between length and frequency of media use and self-efficacy to engage in preventive behavior to the information carrier utility. As predicted, demographics have no significant relationship with utility of the Internet, and direct experience with illness resulted in negative relationship with the Internet utility. Contrary to expectations, susceptibility and severity produced negative relationships with the Internet utility. Result shows that both information-carrier factors - characteristics related to trust and utility related to perceived usefulness and relevance of information - directly affect online health-information-seeking behavior. Unlike the original CMIS that primarily focused on specific illnesses, the current modified CMIS can be adapted and tailored to general online health-information-seeking behavior.

Perspectives of young Chinese Singaporean women on seeking and processing information to decide about vaccinating against human papillomavirus.

Human papillomavirus (HPV) vaccination uptake in Singapore is low among young women. Low uptake has been found to be linked to low awareness. Thus, this study aimed to understand active and passive vaccine information-seeking behavior. Furthermore, guided by the Elaboration Likelihood Model (ELM), this study examined young women's (aged 21-26 years) processing of information they acquired in their decision to get vaccinated. ELM postulates that information processing could be through the central (i.e., logic-based) or peripheral (i.e., heuristic-based) route. Twenty-six in-depth interviews were conducted from January to March 2016. Data were analyzed using thematic analysis. Two meta-themes-information acquisition and vaccination decision-revealed the heuristic-based information processing was employed. These young women acquired information passively within their social network and actively in healthcare settings. However, they used heuristic cues, such as closeness and trust, to process the information. Similarly, vaccination decisions revealed that women relied on heuristic cues, such as sense of belonging and validation among peers and source credibility and likability in medical settings, in their decision to get vaccinated. The findings of this study highlight that intervention efforts should focus on strengthening social support among personal networks to increase the uptake of the vaccine.

Exploring Family Support for Older Chinese Singaporean Women in a Confucian Society.

This study investigated the functions of family support in older Chinese Singaporean women's daily health management in a Confucian cultural context, wherein family solidarity and women's caregiving responsibilities are emphasized. Thirty-eight interviews were conducted with ethnic Chinese women above the age of 60 in Singapore. Our thematic analysis showed that older women played dual roles as support providers and recipients in the family. Their caregiver identity and intent to preserve tradition resulted in a downward transmission of informational and physical support and their hesitance to accept resources provided by younger family members. The asymmetrical flow of family support generated mixed impacts on the women's daily health management. In their transition between tradition and modernity, older women fulfilled their family responsibilities but did not require their children to do so. Our findings suggested an integration of familial and institutional resources to meet older women's support needs and help them enhance their health behavior.

Examining Live-In Foreign Domestic Helpers as a Coping Resource for Family Caregivers of People With Dementia in Singapore.

In Singapore, the responsibility of caring for persons with dementia falls on family members who cope with a long-term caregiver burden, depending on available support resources. Hiring foreign domestic workers to alleviate caregiver burden becomes a prevalent coping strategy that caregivers adopt. This strategy allows caregivers to provide home care as part of fulfilling family obligations while managing the caregiver burden. This study aimed to investigate primary caregivers' relationship with hired support and its impact on coping with caregiver burden. Twenty in-depth interviews were conducted with primary caregivers who hired live-in domestic helpers to take care of their family members with dementia. The findings revealed that caregivers perceived the normative obligations to provide home care to family members with dementia. They sought support from domestic helpers to cope with physical and mental burnout, disruption of normal routines, and avoidance of financial strain. A mutual-support relationship was built between caregivers and domestic helpers through trust and interdependence. The presence of domestic helpers as a coping resource reveals the positive outcomes of problem-, emotional-, and diversion-focused coping. This study illustrates that coping strategies are employed in different ways depending on the needs of caregivers, access to infrastructure, cultural expectations, and available resources.

Structural Violence in Health Care: Lived Experience of Street-Based Female Commercial Sex Workers in Kathmandu.

Thirty-five in-depth, semi-structured interviews were conducted with female, street-based, commercial sex workers in Kathmandu, Nepal. The framework of structural violence guided this study in identifying the structural context that impacts the female sex workers' lives and may cause harm to their health. Structural violence in health care was revealed through thematic analysis as (a) discrimination, (b) forced choice, and (c) limitations to health information sources. Lived experiences highlight how the sex workers engaged with structural limitations in health care access, services, and utilization. Structural violence conveys a message about who is entitled to health care and what a society emphasizes and expects regarding acceptable health behavior. Examining the structural violence highlighted how the sex workers negotiated, understood, and engaged with structural limitations in health care access, services, and utilization.

Framing of Influenza A (H1N1) pandemic in a Singaporean newspaper.

This study seeks to understand how public health messages provided by the government in Singapore during an Influenza A (H1N1) pandemic were framed by the news media for the public. News articles were analyzed to explore how the global pandemic was framed as a local event, providing a unique exploration of the dynamic involving public health communication, news media and the state. Thematic analysis (n = 309) included the government-issued press releases disseminating public health information about H1N1 that were directly linked to news stories (n = 56) and news stories about H1N1 generated by the newspaper (n = 253). Four themes were found: (i) imported disease, (ii) war/battle metaphors, (iii) social responsibility and (iv) lockdown policies. Frame analysis revealed that the news coverage during the H1N1 pandemic reflected how the newspaper framed and mediated the information flow, amplified a positive tone for the government response, emphasized individual responsibility and utilized gain frames to construct local messages about the global H1N1 pandemic that reified Singapore as a nation-state.

Negotiating biomedical and traditional Chinese medicine treatments among elderly Chinese Singaporean women.

In this article we examine how elderly Chinese Singaporean women navigated between biomedicine and traditional Chinese medicine in their practices of maintaining well-being. We interviewed 36 elderly women to understand their negotiation of medical choices in the interplay of structure, culture, and personal agency. Our findings show that participants made situational decisions under structural and cultural influences, such as family members' changing expectations and interpretations of medical practices, institutional preferences for biomedicine, and the patients' negotiating position between biomedicine and traditional Chinese medicine. Participants demonstrated their capacity to enact agency through their examination of the effects and side effects of each medical system and through their integrative use of different medical treatments, depending on the purpose. Through our findings, we unveil contextual meanings of health among elderly women and the unique coexistence of traditional and modern medical practices within the context of Singapore.

Lived experiences of street-based female sex workers in Kathmandu: implications for health intervention strategies.

The lived experiences of women sex workers illustrate that sex work is frequently a manifestation of limited access to education, resources and jobs due to violence, oppression and patriarchy. However, some Nepalese sex workers reconstitute sex work as a viable form of work that provides food and shelter for their families and allows fulfillment of their duties as mothers. Through a culture-centred approach to research, which emphasis the voices of the marginalised and their own articulations of how marginalised spaces are negotiated, this paper offers an entry point to locating sex workers as active participants in their day-to-day lives. Thirty-five in-depth, semi-structured interviews were conducted with street-based female sex workers. Thematic analysis revealed the following three themes: (1) surviving through sex work, (2) financial security in sex work and (3) surviving sex work stigma. These findings have implications for health promotion involving members of this population. Lived experiences illustrate the need to move away from traditional, top-down, linear behaviour-change health campaigns to reconstitute health interventions within a participatory bottom-up approach that includes the voices of participants and is situated within their own context and needs.

Seeking and processing information for health decisions among elderly Chinese Singaporean women.

Information behavior includes activities of active information seeking, passive acquisition of information, and information use. Guided by the Elaboration Likelihood Model, this study explored elderly Singaporean women's health information behavior to understand how they sought, evaluated, and used health information in everyday lives. Twenty-two in-depth interviews were conducted with elderly Chinese women aged 61 to 79. Qualitative analysis of the interview data yielded three meta-themes: information-seeking patterns, trustworthiness of health information, and peripheral route of decision making. Results revealed that elderly women took both systematic and heuristic approaches to processing information but relied on interpersonal networks to negotiate health choices.

From press release to news: mapping the framing of the 2009 H1N1 A influenza pandemic.

Pandemics challenge conventional assumptions about health promotion, message development, community engagement, and the role of news media. To understand the use of press releases in news coverage of pandemics, this study traces the development of framing devices from a government public health agency's press releases to news stories about the 2009 H1N1 A influenza pandemic. The communication management of the H1N1 pandemic, an international news event with local implications, by the Singapore government is a rich locus for understanding the dynamics of public relations, health communication, and journalism. A content analysis shows that the evolution of information from press release to news is marked by significant changes in media frames, including the expansion and diversification in dominant frames and emotion appeals, stronger thematic framing, more sources of information, conversion of loss frames into gain frames, and amplification of positive tone favoring the public health agency's position. Contrary to previous research that suggests that government information subsidies passed almost unchanged through media gatekeepers, the news coverage of the pandemic reflects journalists' selectivity in disseminating the government press releases and in mediating the information flow and frames from the press releases.

Factors Associated with Professional Mental Help-Seeking Among U.S. Immigrants: A Systematic Review.

Structural and cultural barriers have led to limited access to and use of mental health services among immigrants in the United States (U.S.). This study provided a systematic review of factors associated with help-seeking attitudes, intentions, and behaviors among immigrants who are living in the U.S. This systematic review was performed using Medline, CINAHL, APA PsycInfo, Global Health, and Web of Science. Qualitative and quantitative studies examining mental help-seeking among immigrants in the U.S. were included. 954 records were identified through a search of databases. After removing duplicates and screening by title and abstract, a total of 104 articles were eligible for full-text review and a total of 19 studies were included. Immigrants are more reluctant to seek help from professional mental health services due to barriers such as stigma, cultural beliefs, lack of English language proficiency, and lack of trust in health care providers.