Evaluating the impact of using storytelling and visual multimedia music intervention to improve knowledge of the Child Rights Act and reduce the propensity to engage in child marriage.

Child marriage has continued to rear its ugly head in Nigerian society. This study aimed to evaluate the impact of storytelling and multimedia music interventions in improving knowledge of the Child Rights Act and reducing the propensity to engage in child marriage. The researchers applied a quasi-experimental design and collected data using a structured questionnaire. The children were assigned into three groups (control, storytelling and multimedia music) of 173 participants. It was found that the interventions were effective. In particular, while storytelling contributed more to reducing the propensity to engage in child marriage, multimedia music contributed more to improving knowledge of the Child Rights Act. These results suggest that storytelling and multimedia music interventions can be effective approaches for addressing the lingering problem of child marriage in Nigeria.

Psychological distress in adult women of reproductive age at different stages after breast cancer diagnosis: A qualitative study.

AIM: To explore the actual experience of psychological distress of adult women of reproductive age at different stages after breast cancer diagnosis. DESIGN: Qualitative. METHODS: Eighty-one patients with breast cancer-related distress thermometer scores >4 were selected using a purposive sampling method. Patients were divided into newly diagnosed and 1-, 3-, 6-, 9- and 12-month groups according to time since diagnosis and then interviewed. A phenomenological approach was adopted to analyse interview content, and different themes were extracted. RESULTS: Women exhibited different levels of psychological distress depending on the time since diagnosis, with newly diagnosed patients showing the highest distress. Within 1 year post-diagnosis, different events caused patients distress. Themes extracted at new diagnosis and 1-, 3-, 6-, 9- and 12 months post-diagnosis included sadness and disbelief, loss of control, optimistic but concerned, physical and mental exhaustion, difficulties returning to society and limited sexual intimacy, respectively; all groups expressed reproductive concerns. CONCLUSION: Clinical nurses should focus on different psychologically distressing events to provide targeted interventions at distinct phases. For women of childbearing age, clinical nurses should pay particular attention to patients' marriage and reproductive concerns. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: During the year after a breast cancer diagnosis, patients of childbearing age experience events that cause psychological distress that differ depending on time since diagnosis. Nurses should focus on core stressful events and perform specific nursing interventions. IMPACT: To provide holistic care, nurses should consider the psychological and emotional changes patients may undergo. For women of childbearing age, clinical nurses should pay particular attention to patients' marriage and fertility concerns, and be able to provide evidence-based professional guidance on reproductive preservation techniques. REPORTING METHOD: The study was reported using the consolidated criteria for reporting qualitative research guidelines. PATIENT OR PUBLIC CONTRIBUTION: Patients contributed to data collection through interviews.

Mindfulness, awareness, partner caring, and romantic relationship quality: Structural equation modeling.

Studies investigating the potential structures underlying the connection between mindfulness and romantic relationship quality are not sufficient and require additional empirical findings. The current study aimed to examine a hypothesized model underlying the association between mindfulness and relationship quality, while investigating the roles of individuals' level of awareness and application of care in a romantic relationship among 199 adult participants in a southeastern region of the United States. Structural equation modeling (SEM) and path analysis were executed to examine the hypothesized structural model, testing a multi-step pathway as to how mindfulness influences relationship quality. The SEM and path analyses showed a good fit for the present study's hypothesized model, indicating that individuals' mindfulness had a direct influence on their self-awareness level. Individuals' self-awareness and application of care mediated the link between mindfulness and relationship quality. Implications for family life educators, dyadic couples researchers, and marriage and family practitioners are discussed.

Childbearing Trajectories in a West African Setting: A Sequence Analysis Approach.

The lagging fertility transition in West Africa has important repercussions for global population growth but remains poorly understood. Inspired by Caldwell and colleagues' fertility transition framework, as well as by subsequent research, we examine diversity in women's holistic childbearing trajectories in Niakhar, Senegal, between the early 1960s and 2018 using a sequence analysis approach. We evaluate the prevalence of different trajectories, their contribution to overall fertility levels, and their association with women's socioeconomic and cultural characteristics. Four trajectories were observed: "high fertility," "delayed entry," "truncated," and "short." While the high fertility trajectory was most prevalent across cohorts, delayed entry grew in importance. The high fertility trajectory was more common among women born between 1960 and 1969 and was followed less often by divorced women and those from polygynous households. Women with primary education and those from higher status groups were more likely to experience delayed entry. The truncated trajectory was associated with lack of economic wealth, polygynous households, and caste membership. A short trajectory was related to lack of agropastoral wealth, divorce, and possibly secondary sterility. Our study advances knowledge on fertility transitions in Niakhar-and Sahelian West African contexts more generally-by showing the diversity of childbearing trajectories within high fertility regional contexts.

Community-based empowerment program to delay marriage: Results from the More Than Brides Alliance intervention in India, Malawi, Mali and Niger.

The More Than Brides Alliance (MTBA) implemented an intervention in India, Malawi, Mali and Niger from 2017 to 2020. The holistic community-based program included girls' clubs focused on empowerment and sexual and reproductive health knowledge; work with parents and educators; community edutainment events; and local-, regional-, and national-level advocacy efforts related to child marriage. Using a cluster randomized trial design (India and Malawi), and a matched comparison design (Niger and Mali), we evaluated the effectiveness of the program on age at marriage among girls ages 12-19 in intervention communities. Repeat cross sectional surveys were collected at baseline (2016/7), midline after approximately 18 months of intervention (2018), and endline (2020). Impact was assessed using difference-in-difference (DID) analysis, adjusted for the cluster design. We find that the intervention was successful at reducing the proportion of girls ages 12-19 married in India (-0.126, p < .001). Findings in the other countries did not show impact of the intervention on delaying marriage. Our findings suggest that the MTBA program was optimized to succeed in India, in part because it was built on an evidence base that relies heavily on data from South Asia. The drivers of child marriage in India may be substantially different from those in Malawi, Mali, and Niger and require alternate intervention approaches. These findings have implications for those designing programs outside of South Asia and suggest that programs need to consider context-specific drivers and whether and how evidence-based programs operate in relation to those drivers. Trial registration: This work is part of an RCT registered August 4, 2016 in the AEA RCT registry identified as: AEAR CTR-0001463. See: https://www.socialscienceregistry.org/trials/1463.

Effect of mindfulness on sexual self-esteem and marital intimacy in postmenopausal women: a quasi-experimental study.

BACKGROUND: Menopause is a turning point in women's lives and a major medical challenge, leading to drastic changes in sexual self-esteem and the husband-wife relationship, which can have an undeniable impact on the quality of their life. AIM: To assess the effect of mindfulness-based education on sexual self-esteem and marital intimacy in postmenopausal women. METHODS: This quasi-experimental study was conducted with 130 women who were assigned to 2 groups, intervention (n = 65) and control (n = 65), out of whom 127 completed the study. The interventional group received 8 training sessions. The mindfulness-based intervention consisted of 8 educational sessions and daily mindfulness exercises. Sexual self-esteem was assessed by the Sexual Self-esteem Index for Woman-Short Form, and marital intimacy was measured with Thompson and Walker's Intimacy Scale. The collected data were analyzed via analysis of covariance. OUTCOMES: Outcomes included changes in sexual self-esteem and marital intimacy scores. RESULTS: Participants in the intervention group demonstrated higher levels of total self-esteem posttreatment than participants in the control group (125.15 vs 119.46) and higher levels of intimacy (74.22 vs 61.59). The difference was still significant after adjusting for self-esteem (η2 = 0.312, P < .001) and intimacy (η2 = 0.573, P < .001) at baseline. CLINICAL IMPLICATIONS: Mindfulness may be used as a strategy to improve sexual self-esteem and marital intimacy. STRENGTHS AND LIMITATIONS: Unlike other treatments, mindfulness seems to be low cost and less complex in improving sexual self-esteem and marital intimacy. Limitations of this study include use of available sampling methods, nonrandom allocation of participants, and self-reporting data collection. CONCLUSION: As evidenced by the results, 8 weeks of mindfulness training could improve sexual self-esteem and marital intimacy in menopausal women. The mindfulness-based intervention should be incorporated into routine care to help menopausal women.

A novel curriculum for the Same-Sex Marriage Act and Patient Right to Autonomy Act (SMPRA) module based on two new laws in Taiwan: a mixed-methods study.

BACKGROUND: The establishment of laws has had a tremendous impact on holistic medical care. The Patient Right to Autonomy (PRA) Act and the Same-Sex Marriage Act have been passed in Taiwan, and both have sparked intense societal debate. The Same-Sex Marriage Act and PRA Act (SMPRA) teaching module was created for the Gender, Medicine, and Law (GML) course of the medical curriculum. This video trigger-assisted problem-based learning (VTA-PBL) software has integrated content on the aforementioned legislative proclamations. It upends conventional beliefs and fosters reflective practices on sexual rights and the right to representation among medical students. This study examined how the SMPRA module affected the knowledge and attitudes of medical students taking up the GML course. METHODS: A simple pre-/post-test design evaluated the outcomes of the PBL module to examine the changes in knowledge and attitudes of medical students toward same-sex marriage rights. In 2019 and 2020, 126 and 49 5th-year medical students took up the GML course, respectively. The GML components included a video scenario representing advanced decision-making and a healthcare agency with a same-sex couple, a PBL discussion, and student feedback presentations. The mechanisms of feedback collection and measuring student knowledge and attitudes toward sexual rights differed between one cohort in 2019 and the other in 2020. Pre- and post-lecture tests were used in the first school year, whereas a post-lecture open-ended questionnaire survey was used in the second school year. RESULTS: In total, 90 and 39 eligible questionnaires were received in the first and second school years, respectively, which corresponded to response rates of 71% and 80%. Students showed a better understanding of and positive enhancement of proficiency in legal and ethical content and relevant clinical practice. Qualitative analysis revealed that students viewed healthcare providers as checkpoints for conflicts of interest; medical ethics as the cornerstone of clinical practice; cultural background as a significant influence on decision-making; and empathetic communication as the cornerstone of relationships between patients, family members, and doctors. CONCLUSION: The GML course of the SMPRA module fosters reflective practices on ethical and legal sexual rights issues.

Relatos da pandemia: ser mulher e mãe em tempos de covid-19 / Pandemic reports: being a woman and mother in covid-19 times / Relatos de la pandemia: ser mujer y madre en tiempos del covid-19

Partindo da pergunta "Como tem sido ser mulher e mãe em tempos de pandemia?", o presente estudo convidou mulheres que são mães, em redes sociais virtuais, a partilhar um relato de suas experiências com a readaptação parental em função do distanciamento social causado pela pandemia de covid-19. O objetivo foi refletir sobre a experiência de ser mulher e mãe em tempos de covid-19 e distanciamento social, apontando algumas ressonâncias do cenário pandêmico na subjetividade dessas mulheres. O estudo teve como base o referencial psicanalítico, tanto na construção da pesquisa e análise dos relatos quanto na sua discussão. A análise dos cerca de 340 relatos coletados, os quais variaram de uma breve frase a longos parágrafos, apontou para uma série de questionamentos, pontos de análise e reflexões. A pandemia, e o decorrente distanciamento social, parece ter colocado uma lente de aumento sobre as angústias das mulheres que são mães, evidenciando sentimentos e sofrimentos sempre presentes. Destacaram-se, nos relatos, a sobrecarga das mulheres com as tarefas de cuidado dos filhos e da casa, a culpa, a solidão, a exaustão, e o sentimento de que não havia espaço nesse contexto para "ser mulher", sendo isso entendido especialmente a questões estéticas e de vaidade.(AU)

Starting from the question "How does it feel to be a woman and a mother in pandemic times?", this study invited women who are mothers, in virtual social networks, to share their experiences regarding parental adaptations due to social distancing caused by the COVID-19 pandemic. The objective was to reflect on the experience of being a woman and a mother in the context of COVID-19 and of social distancing, pointing out some resonances of the pandemic scenario in the subjectivity of these women. The study was based on the psychoanalytical framework, both in the construction of the research and analysis of the reports and in their discussion. The analysis of about 340 collected reports, which ranged from a brief sentence to long paragraphs, pointed to a series of questions, analysis topics, and reflections. The pandemic, and the resulting social distancing, seems to have placed a magnifying glass over the anguish of women who are mothers, showing ever-present feelings and suffering. The reports highlighted women's overload with child and house care tasks, the guilt, loneliness, exhaustion, and the feeling that there was no space in this context to "be a woman," and it extends to aesthetic and vanity related questions especially.(AU)

A partir de la pregunta "¿cómo te sientes siendo mujer y madre en tiempos de pandemia?", este estudio invitó por las redes sociales a mujeres que son madres a compartir un relato de sus experiencias sobre la readaptación parental en función del distanciamiento social causado por la pandemia del covid-19. Su objetivo fue reflexionar sobre la experiencia de ser mujer y madre en tiempos del covid-19 y el distanciamiento social, señalando algunas resonancias del escenario pandémico en la subjetividad de estas mujeres. Este estudio se basó en el marco psicoanalítico, tanto en la construcción de la investigación y análisis de los informes como en su discusión. El análisis de los casi 340 relatos, que variaron de una pequeña frase a largos párrafos, generó en las investigadoras una serie de cuestionamientos y reflexiones. La pandemia y el consecuente distanciamiento social parece haber agrandado las angustias de las mujeres que son madres, evidenciando sentimientos y sufrimientos siempre presentes. En los relatos destacan la sobrecarga de las mujeres con las tareas de cuidado de los hijos y del hogar, la culpa, la soledad, el cansancio, así como el sentimiento de que no hay espacio em este contexto para "ser mujer", relacionado principalmente a cuestiones estéticas y de vanidad.(AU)

Militância enquanto convite ao diálogo: o caso da militância monodissidente / Activism as an invitation for the dialogue: the case of monodissident activism / La militancia como invitación al diálogo: el caso de la militancia monodisidente

Este artigo é uma produção teórica de caráter reflexivo que focaliza a relação entre pesquisa e militância a partir do construtivismo semiótico-cultural em psicologia, tendo como base o caso da militância monodissidente. A noção de monodissidência foi cunhada no percurso da militância bissexual para se referir a uma ferramenta analítica de ordem político-comunitária que contempla todas as pessoas que se atraem sexual e/ou romanticamente por mais de um gênero. São contrapostas concepções distintas de militância político-social em psicologia: de um lado, militância é entendida a partir de um autocentramento do militante, vinculado a uma rede de exclusões, negações, vedação e defesas psicológicas em relação à experiência; de outro, há uma compreensão dialógica de militância. Metodologicamente, a proposta de pesquisa se fundamenta no campo da participação observante, entendendo que o pesquisador está, primeiro, na condição de participante de certo campo sociocultural, a partir do qual passa a observar e refletir sobre fenômenos que ocorrem nele. Tomamos como ilustração a trajetória de construção da militância monodissidente do primeiro autor, trazendo tensionamentos dialógicos para a análise, postos em discussão com outras reflexões situadas sobre o tema. O conjunto de tensionamentos dialógicos emergidos nesse percurso foi mapeado e compreendido como um processo de multiplicação dialógica no encontro de self pesquisador com o self militante.(AU)

This paper is a theoretical production of reflective character that focuses on the relationship between research and activism from the semiotic-cultural constructivism in psychology, based on the case of monodissident activism. The notion of monodissent was coined during bisexual activism to refer to an analytical tool of a political-community order that includes all people who are sexually and/or romantically attracted to more than one gender. Different conceptions of political-social activism in psychology are opposed: on the one hand, activism is understood from the militant's self-centeredness, linked to a network of exclusions, denials, gatekeeping, and psychological defenses regarding experience; on the other hand, there is a dialogical understanding of activism. Methodologically, the research proposal is based on the field of observant participation, understanding that the researcher is, first, in the condition of a participant in a certain sociocultural field, from which he starts to observe and reflect on phenomena that occur there. We take as an illustration the trajectory of the construction of the monodissident activism of the first author, bringing dialogical tensions to the analysis, discussed with other reflections on the subject. The set of dialogic tensions that emerged in this path was mapped and understood as a process of dialogic multiplication in the encounter of the researcher self with the activist self.(AU)

Este artículo realiza una producción teórica y reflexiva sobre la relación entre investigación y activismo desde el constructivismo semiótico-cultural en Psicología, a partir del caso del activismo monodisidente. La noción de monodisidencia fue acuñada en el transcurso de la militancia bisexual para referirse a una herramienta analítica de orden político-comunitario que incluye a todas las personas que se sienten atraídas sexual y / o románticamente por más de un género. Se contraponen distintas concepciones de la militancia político-social en Psicología: por un lado, la militancia se entiende desde el egocentrismo del militante, vinculado a un entramado de exclusiones, negaciones, sellamientos y defensas psicológicas con relación a la experiencia; por otro, existe una comprensión dialógica de la militancia. La investigación utiliza como metodología la participación del observador, entendiendo que el investigador se encuentra, en primer lugar, en la condición de participante de determinado campo sociocultural, desde donde comienza a observar y reflexionar sobre los fenómenos que allí ocurren. Tomamos como ilustración la trayectoria de la construcción de la militancia monodisidente del primer autor, trayendo tensiones dialógicas al análisis, discutidas con otras reflexiones sobre el tema. El conjunto de tensiones dialógicas que surgieron en este camino se caracteriza y se comprende como un proceso de multiplicación dialógica en el encuentro del self investigador con el self militante.(AU)

Unequal Transitions to Adulthood: Widening Disparities in Age at First Union, Sex, and Birth in Many Low- and Middle-Income Countries.

Research on the timing of events during the transition to adulthood, such as first union, sex, and birth in low- and middle-income countries (LMICs), focused predominantly on measures of central tendency, notably median or mean ages. In this report, we adopt a different perspective on this topic by examining disparities in the timing of these events in 46 LMICs spanning four decades. Using Demographic and Health Surveys, we estimate ages at which 25 percent, 50 percent, and 75 percent of women have first union, birth, and sex. We compute interquartile ranges to measure within-country variation and disparities in the timing of sexual initiation and family formation. Variation in the timing of first union, birth, and sex generally increases as the median ages at these events increase. Disparities in the timing of first union and birth grew in West Africa and Latin America, and women who experience these events relatively early increasingly lag behind women who experience them relatively late. Documenting trends in measures of central tendency is insufficient to capture the complexity of ongoing changes because they mask growing disparities in the timing of family formation across many LMICs. These results are important for assessing progress toward the achievement of sustainable development goals related to the reduction of early marriages and pregnancies and highlight a need for more holistic approaches to measure the timing of family formation.

Challenges and coping mechanisms among women living with unrepaired obstetric fistula in Ethiopia: A phenomenological study.

INTRODUCTION: Obstetric fistula remains a debilitating complication of childbirth and maternal morbidity in developing countries. Few studies document the challenges and coping mechanisms among women living with obstetric fistula in Ethiopia. Therefore, this study aimed to explore the challenges and coping mechanisms among women with obstetric fistula in Ethiopia. METHODS: A phenomenological study was employed among purposively selected eleven women with obstetric fistula and three key informants at five fistula treatment centers in Ethiopia. An in-depth interview was conducted, audio-recorded, and transcribed into a Microsoft Word document. The transcripts were imported into Atlas. ti version 8.4 for thematic analyses. RESULTS: Painful social life, consequences of fistula, and coping mechanisms with fistula problems were the main themes in this study. Difficult social life, stigma, discrimination, impaired marital status; psychological, physical, sexual, and reproductive health problems were the major challenges for women with obstetric fistulas. Women with fistulas used coping mechanisms such as-going to spiritual sites and drinking alcohol to cope with their fistula disease; separating themselves from community participation and living alone in the forest to cope with a painful social life; restricting the amount of drinking water and wearing many clothes at a time to cope with wetness and odors, and allowing their husband to marry a new wife to cope with the impaired marital responsibilities. CONCLUSION: Women with obstetric fistulas encountered challenges such as a painful social life, impaired marital status, psychological, physical, sexual, and reproductive health problems; and used coping mechanisms with their fistula condition, difficult social life, and impaired marital responsibility that may have an added negative effect on their overall health. Therefore, policymakers need to prioritize the availability and early utilization of obstetric fistula surgery in all settings for all women living with obstetric fistulas to restore their holistic health.

Building sustainable and scalable peer-based programming: promising approaches from TESFA in Ethiopia.

BACKGROUND: Girls in Ethiopia's Amhara region experience high rates of child marriage and are less able to negotiate sex or use family planning. Seeking to improve their lives, CARE's TESFA programme delivered reproductive health and financial savings curricula to married girls via reflective dialogues in peer-based solidarity groups. From 2010 to 2013, 5,000 adolescent girls participated via three intervention arms: sexual and reproductive health, economic empowerment, and a combination of both. At end-line, participants reported improvements across health and empowerment outcomes. Four years post-TESFA, 88% of groups reported meeting without continued assistance from CARE. Some original participants had created new groups based on the TESFA model, and some girls not recruited for TESFA spontaneously replicated it to create their own groups. However, questions remained about what had contributed to this organic sustainment and scale-up of groups. METHODS: This 2018 study investigated factors affecting sustainability and scale-up of peer solidarity groups through a systematic mapping of TESFA groups across five woredas (districts) and interviews with key stakeholders. Data were collected from 39 focus groups with active and dissolved Girl Groups, Social Analysis and Action groups, and girls' husbands and from 29 in-depth interviews with group facilitators and community health workers across three districts. Data were coded and analyzed per grounded theory principles. RESULTS: Changes in reproductive health knowledge and specific behaviours, such as contraceptive use and institutional delivery, were maintained 5 years after the intervention ended. Group connectedness, spousal support, integration of holistic community platforms, and opportunities for financial independence were found to be important for group sustainability. Observed changes in TESFA girls' confidence to negotiate and assert their rights, hopes of improved mobility, and the promise of economic opportunity commonly inspired spontaneous replication of groups. Recommendations for future peer-based programmes include creating environments of solidarity and holistically engaging intervention communities. CONCLUSION: By increasing knowledge of and access to reproductive health services, TESFA mitigates some of the harmful effects of child marriage. The maintenance and organic replication of groups suggest that TESFA provides a successful, scalable and sustainable tested model for reproductive health program delivery through peer-based solidarity groups.

In Ethiopia, married girls are a particularly vulnerable adolescent population because of the many health risks associated with early marriage. Peer-based approaches are a common strategy to improve sexual and reproductive health knowledge and behaviours for marginalized groups. Critiques of these approaches are that they lack sustainability without ongoing investment and have no lasting impact on health behaviours. CARE's TESFA programme, a peer-based approach with married adolescent girls in South Gondar, was found to be effective in creating long-term behavior change related to uptake of family planning and rates of institutional delivery. Some 88% of groups who received the TESFA curriculum were still meeting 4 years after the programme had concluded. Some participants even created groups of their own, scaling TESFA beyond the original audience, suggesting a potential approach to wider scale-up. To explore lessons learned around scale and sustainability, this study interviewed TESFA participants and stakeholders.Improvements in behaviours related to contraceptive use, institutional delivery, and girls' agency in reproductive decision-making were sustained over time regardless of group status. Factors that affected the sustainability and scale-up of groups included solidarity among group members, support from husbands and community members, ongoing savings and loan structures, flexibility of group processes, and availability of relevant curriculum topics. Through an analysis of these findings, this paper discusses recommendations for sustainable and scalable peer-based programme design via existing Ethiopian community structures. Using TESFA principles as a model, practitioners could design and implement scalable and sustainable peer-based programming for adolescents sexual and reproductive health.

Same-sex competition and sexual conflict expressed through witchcraft accusations.

There is significant cross-cultural variation in the sex of individuals most likely to be accused of practising witchcraft. Allegations of witchcraft might be a mechanism for nullifying competitors so resources they would have used become available to others. In this case, who is targeted may result from patterns of competition and conflict (same-sex or male-female) within specific relationships, which are determined by broader socio-ecological factors. Here we examine patterns of sex-specific accusations in historic cases from sub-Saharan Africa (N = 423 accusations). Male 'witches' formed the greater part of our sample, and were mostly accused by male blood-relatives and nonrelatives, often in connection to disputes over wealth and status. Accusations of women were mainly from kin by marriage, and particularly from husbands and co-wives. The most common outcomes were that the accused was forced to move, or suffered reputational damage. Our results suggest that competition underlies accusations and relationship patterns may determine who is liable to be accused.

Concurrent randomized control trials of the 1-year efficacy of two couple relationship education programs: ELEVATE and Couples Connecting Mindfully.

A long-standing university-community partnership used a longitudinal randomized control trial to implement and evaluate two couple relationship education (CRE) curricula, ELEVATE and Couples Connecting Mindfully (CCM), among an economically and racially diverse population of adult couples. Married and non-married couples (n = 929 couples) completed baseline surveys and were randomly assigned to either one of the two program groups or to the control group by implementation site. Follow-up surveys were collected at 2 months, 6 months, and 1 year after baseline. Using an intent-to-treat approach, growth curve modeling comparisons of trajectories indicated program effects at 1 year post-baseline in key outcome areas. Both the ELEVATE and the CCM group reported significant gains in couple relationship skills, couple quality, and family harmony over time compared to the control group that experienced either no change or declines. Further, the ELEVATE group also demonstrated positive program effects on measures of mental health and sleep quality. An assessment of the central premise of CRE indicated that the immediate post-program improvements in couple relationship skills predicted later couple quality for both program groups. This study indicates that both ELEVATE and CCM can be considered evidence-based CRE programs for use with a broad population of couples.

Una asociación duradera entre la universidad y la comunidad utilizó un ensayo controlado aleatorizado y longitudinal para implementar y evaluar dos currículos de educación sobre las relaciones de pareja, ELEVATE y Couples Connecting Mindfully (CCM), entre una población de parejas adultas económicamente y racialmente diversa. Parejas casadas y no casadas (n = 929 parejas) contestaron encuestas en el momento basal, y luego, en el lugar de implementación, se las distribuyó aleatoriamente a alguno de los dos grupos del programa o al grupo de referencia. Se recogieron encuestas de seguimiento dos meses, seis meses y un año después del momento basal. Utilizando un método por intención de tratar, las comparaciones de trayectorias del modelo de curva del crecimiento indicaron efectos del programa un año después del momento basal en áreas de resultado claves. Tanto el grupo de ELEVATE como el de CCM informaron beneficios significativos en las habilidades para las relaciones de pareja, la calidad de la pareja y la armonía familiar con el tiempo en comparación con el grupo de referencia, que no tuvo ningún cambio ni empeoramientos. Además, el grupo de ELEVATE también demostró efectos del programa en las medidas de salud mental y calidad del sueño. Una evaluación de la premisa fundamental de la educación sobre las relaciones de pareja indicó que las mejoras inmediatas después del programa en las habilidades para las relaciones de pareja predijeron una posterior calidad de la pareja para ambos grupos del programa. Este estudio indica que tanto ELEVATE como CCM pueden considerarse programas factuales de educación sobre las relaciones de pareja aptos para su uso con una amplia población de parejas.

The effectiveness of cognitive developmental hypnotherapy on differentiation of self, meaning in life and marital conflicts in married women.

The aim of the present study is to investigate the effectiveness of Cognitive Developmental Hypnotherapy (CDH) on Differentiation of Self, Meaning in Life and Marital Conflicts in married women. The method is quasi-experimental pretest and posttest with a control group. The statistical population of this study includes married women who came to FUM Counseling and Psychological Services Center to receive psychological services. The sample of this study included 40 married women who were selected by targeted sampling method and randomly assigned to two experimental and control groups. Participants in the pretest and posttest study answered the Differentiation of Self Inventory, the Marital Conflicts questionnaire by Sanaei, and the Meaning in Life questionnaire. The research data were analyzed using ANCOVA and MANCOVA with SPSS-21. The findings showed CDH led to an increase in Differentiation of Self and Meaning in life, and a reduction in Marital Conflicts in women. Accordingly, CDH through using techniques such as induction and empowerment of the Ego is effective in marital conflicts of married women. Therefore, using it as a means to improve the quality of married women's lives is recommended.

Determination of Dyadic Adjustment, Marriage and Sexual Satisfaction as Risk Factors for Women with Lifelong Vaginismus: A Case Control Study.

This study was conducted to assess dyadic adjustment, marriage, and sexual satisfaction as risk factors for women with lifelong vaginismus. This is a case-control study. A total of 142 women were included in the study: 71 women with a diagnosis of lifetime vaginismus constituted the study group and 71 women without a history of vaginismus/painful sexual activity constituted the control group. Data were collected using a questionnaire and the Revised Dyadic Adjustment Scale (RDAS), the Marriage Satisfaction Scale (MSS), and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Duration of marriage (OR = 1.344), frequency of sexual intercourse (OR = 0.059), marital satisfaction (OR = 1.450), sexual satisfaction (OR = 0.901), and consensus (OR = 1.749), which is a sub-dimension of RDAS, were found to be risk factors increasing likelihood of vaginismus by 83% (χ2 = 140.191, p < .001). In addition, those with low level of education, diagnosed with a psychological disorder (anxiety, depression, etc.), who found their spouse's body disgusting, who scored lower in MAS sub-dimensions, and who received lower total score in the RDAS and its satisfaction subdimension were more likely to have vaginismus (p < .05). Duration of marriage, sexual intercourse frequency, sexual satisfaction, marital satisfaction, and consensus are important risk factors for vaginismus. It may be incomplete to consider vaginismus only as a vaginal penetration problem. Women's demographic characteristics, dyadic adjustment, and marital and sexual satisfaction should be handled in a holistic manner.

Transforming social norms to improve girl-child health and well-being: a realist evaluation of the Girls' Holistic Development program in rural Senegal.

BACKGROUND: Early adolescence is a critical period where social norms, attitudes, and behaviors around gender equality form. Social norms influence adolescent choices and behaviors and are reinforced by caregivers and community members, affecting girls' reproductive health and educational opportunities. Understanding how to shift these often-interconnected norms to delay child marriage, pregnancy and keep girls in school requires understanding of the structure and dynamics of family and community systems. The Senegalese and American non-governmental organization, the Grandmothers Project-Change through Culture, seeks to address these intertwined factors through innovative community change strategies that build on the specific structure and values of West African collectivist cultures. METHODS: The Girls' Holistic Development approach in rural Vélingara, Senegal posits that by increasing recognition, knowledge and empowerment of elder community women and reinforcing intergenerational communication and decision-making, community members including girls will support and advocate on behalf of girls' interests and desires. We assessed the Girls Holistic Development approach using Realist Evaluation with a mixed-method, quasi-experimental design with a comparison population. We examined differences in intergenerational communication, decision-making and descriptive and injunctive norms related to early marriage, pregnancy and schooling. RESULTS: After 18 months, intergenerational communication was more likely, grandmothers felt more valued in their communities, adolescent girls felt more supported with improved agency, and norms were shifting to support delayed marriage and pregnancy and keeping girls in school. Grandmothers in intervention villages were statistically significantly more likely to be perceived as influential decision-makers by both VYA girls and caregivers for marriage and schooling decisions compared to girls and caregivers in comparison villages. CONCLUSIONS: This realist evaluation demonstrated shift in social norms, particularly for VYA girls, in intervention villages favoring delaying girls' marriage, preventing early pregnancy and keeping girls in school along with increased support for and action by grandmothers to support girls and their well-being related to these same outcomes. These shifts represent greater community social cohesion on girl-child issues. This research helps explain the linkage between social norms and girls' reproductive health and education outcomes and demonstrates that normative shifts can lead to behavior change via collective community action mechanisms.

During adolescence in Senegal, as elsewhere, decisions on whether to keep girls in school and at what age to marry girls are made by their caregivers and influenced by family and community members. Early pregnancy occurs at these ages, either before or during marriage. These social influences, called social norms, set expectations for parents and girls.The Grandmothers Project­Change through Culture developed an intervention to shift social norms and change these three outcomes­early pregnancy, early marriage and keeping girls in school. The project, called Girls Holistic Development (GHD), builds on local relationships between girls, grandmothers, parents and community leaders and local values to facilitate discussion, reflection, collaboration and advocacy.This study used realist evaluation methods, including qualitative and quantitative interview and focus group discussions, to understand whether these shifts in norms and behaviors took place. Research took place with girls, grandmothers and male and female caregivers 18 months after GHD started. Quantitative survey included 7 intervention and 7 comparison villages.Results supported GHDs' expectations and strategy. In intervention villages, grandmothers and girls reported closer relationships; parents considered grandmothers important sources of advice. Girls, grandmothers and caregivers described social expectations as favoring girl's education, marriage at older ages and development of strategies to prevent girl's pregnancy in intervention villages.This evaluation provided strong support for GHDs' ability to shift social norms to improve girls' outcomes. By working with local relationships and values, GHD created more communication between community and family members and facilitated increased social bonds within the community.

Factors Associated with Attitude towards Wife-Beating among Married Women of the Reproductive Ages in Arba Minch Town, Southern Ethiopia: A Community-Based Cross-Sectional Study.

Evidence from demographic and health surveys in various countries and Ethiopia too showed that more women are generally believed to justify intimate partner violence (IPV) than men do. An attitude that justifies IPV is one of the factors affecting victimization and perpetration from IPV. However, women's justification about the violence and factors affecting the justification are not well documented, particularly by addressing household factors such as household food conditions. Therefore, the present study aims to fill this gap among married women of childbearing age so that evidence can be drawn for holistic interventions. A community-based cross-sectional study was conducted among 696 currently married women of childbearing age (15-49) by using a multistage cluster sampling technique to obtain the women from 11 kebeles (the smallest administrative unit in the government structure of Ethiopia) of Arba Minch town, Southern Ethiopia. Data were collected using a pretested and structured questionnaire. Logistic regression was performed using IBM SPSS version 20. The odds ratio with its 95% confidence interval was used to show the degree of association between the outcome variable and explanatory variables. Nearly two-thirds (59.5%) of the study women justified wife-beating in at least one of the five conditions. A higher odds of justification of wife-beating was observed among women whose marriage was arranged by any other person than the couples themselves, from food-insecure households, with a family size of 5 and above, in the age group of 30-39 years, and whose partner was in the age range of 31-39 years. In contrast, lower odds of justification of wife-beating was observed among women having an age difference of 10 or more years with their partner and those in a household wealth index of middle and higher category. Despite great efforts in realizing gender equality in the country, a higher proportion of women were having the attitude that justifies wife-beating in the five conditions specified to them. Interventions targeting the improvement of women's attitude towards wife-beating should target against the traditional norms of arranged marriage, improve household food conditions, and decrease family size.

Linking Sexual Mindfulness to Mixed-Sex Couples' Relational Flourishing, Sexual Harmony, and Orgasm.

Marriage is an important adult relationship, and recent research indicates that sexual mindfulness, awareness and non-judgment, may be an important tool in helping maintain relational and sexual well-being. Using a nationally representative U.S. sample of newly married, mixed-sex couples (women's age M = 29.70 years; men's age M = 31.76 years; N = 1473 couples), we evaluated whether the two factors of sexual mindfulness, awareness and non-judgment, were linked with relational flourishing, sexual harmony, and orgasm consistency. We utilized an actor-partner interdependence model within a structural equation modeling framework to evaluate how husbands' and wives' awareness and non-judgment were associated with relational flourishing, sexual harmony, and orgasm consistency. Results indicated that both wives' and husbands' awareness was positively associated with relational flourishing, sexual harmony, and orgasm consistency. Partner effects were found for all outcomes. However, no partner effects were found between non-judgment and orgasm consistency. Therapists, educators, and couples may consider the use of sexual mindfulness skills when addressing marriage and sexual relationships.

Intersectionality of gender in recruitment and retention of the health workforce in Africa: a rapid review

Background: Despite the importance of gender and intersectionality in policy-making for human resources for health, these issues have not been given adequate consideration in health workforce recruitment and retention in Africa. Aims: The objective of this review was to show how gender intersects with other sociocultural determinants of health to create different experiences of marginalization and/or privilege in the recruitment and retention of human resources for health in Africa. Methods: This was rapid review of studies that investigated the intersectionality of gender in relation to recruitment and retention of health workers in Africa. A PubMed search was undertaken in April 2020 to identify eligible studies. Search terms used included: gender, employment, health workers, health workforce, recruitment and retention. Criteria for inclusion of studies were: primary research; related to the role of gender and intersectionality in recruitment and retention of the health workforce; conducted in Africa; quantitative or qualitative study design; and published in English. Results: Of 193 publications found, nine fulfilled the study inclusion criteria and were selected. Feminization of the nursing and midwifery profession results in difficulties in recruiting and deploying female health workers. Male domination of management positions was reported. Gender power relationship in the recruitment and retention of the health workforce is shaped by marriage and cultural norms. Occupational segregation, sexual harassment and discrimination against female health workers were reported. Conclusion: This review highlights the importance of considering gender analysis in the development of policies and programmes for human resources for health in Africa.