O cuidado em saúde promovido pelas religiões afro-brasileiras / Health care promoted by afro-brazilian religions / El cuidado en salud promovido por las religiones afrobrasileñas

No decorrer da história, sempre foram infindáveis os casos em que os sujeitos recorriam a centros espíritas ou terreiros de religiões de matrizes africanas em decorrência de problemas como doenças, desempregos ou amores mal resolvidos, com o objetivo de saná-los. Por conta disso, este artigo visa apresentar os resultados da pesquisa relacionados ao objetivo de mapear os processos de cuidado em saúde ofertados em três terreiros de umbanda de uma cidade do litoral piauiense. Para isso, utilizamos o referencial da Análise Institucional "no papel". Os participantes foram três líderes de terreiros e os respectivos praticantes/consulentes dos seus estabelecimentos religiosos. Identificamos perspectivas de cuidado que se contrapunham às racionalidades biomédicas, positivistas e cartesianas, e faziam referência ao uso de plantas medicinais, ao recebimento de rezas e passes e à consulta oracular. A partir desses resultados, podemos perceber ser cada vez mais necessário, portanto, que os povos de terreiros protagonizem a construção, implementação e avaliação das políticas públicas que lhe sejam específicas.(AU)

In history, there have always been endless cases of people turning to spiritual centers or terreiros of religions of African matrices due to problems such as illnesses, unemployment, or unresolved love affairs. Therefore, this article aims to present the research results related to the objective of mapping the health care processes offered in three Umbanda terreiros of a city on the Piauí Coast. For this, we use the Institutional Analysis reference "on Paper." The participants were three leaders of terreiros and the respective practitioners/consultants of their religious establishments. We identified perspectives of care that contrasted with biomedical, positivist, and Cartesian rationalities and referred to the use of medicinal plants, the prescript of prayers and passes, and oracular consultation. From these results, we can see that it is increasingly necessary, therefore, that the peoples of the terreiros lead the construction, implementation, and evaluation of public policies that are specific to them.(AU)

A lo largo de la historia, siempre hubo casos en los cuales las personas buscan en los centros espíritas o terreros de religiones africanas la cura para sus problemas, como enfermedades, desempleo o amoríos mal resueltos. Por este motivo, este artículo pretende presentar los resultados de la investigación con el objetivo de mapear los procesos de cuidado en salud ofrecidos en tres terreros de umbanda de una ciudad del litoral de Piauí (Brasil). Para ello, se utiliza el referencial del Análisis Institucional "en el Papel". Los participantes fueron tres líderes de terreros y los respectivos practicantes / consultivos de los establecimientos religiosos que los mismos conducían. Se identificaron perspectivas de cuidado que se contraponían a las racionalidades biomédicas, positivistas y cartesianas, y hacían referencia al uso de plantas medicinales, al recibimiento de rezos y pases y a la consulta oracular. Los resultados permiten concluir que es cada vez más necesario que los pueblos de terreros sean agentes protagónicos de la construcción, implementación y evaluación de las políticas públicas destinadas específicamente para ellos.(AU)

How does a social norms-based intervention affect behaviour change? Interim findings from a cluster randomised controlled trial in Odisha, India.

BACKGROUND: Behaviour change interventions targeting social norms are burgeoning, but researchers have little guidance on what they look like, and which components affect behaviour change. The Reduction in Anaemia through Normative Innovations (RANI) project designed an intervention to increase iron folic acid (IFA) consumption in Odisha, India. OBJECTIVE: This paper examines the effect of the intervention at midline to understand which components of the RANI intervention affect uptake. METHODS: Using a cluster randomised controlled design, we collected baseline data and midline data 6 months later from women of reproductive age in the control and treatment arms (n=3800) in Angul, Odisha, India. Using nested models, we analysed data from three different intervention components, monthly community-based testing for anaemia, participatory group education sessions, and videos, to determine the extent to which exposure to each of these components accounted for the overall intervention effect on haemoglobin and self-reported IFA use. RESULTS: Overall, residing in a treatment as opposed to control village had little effect on midline haemoglobin, but increased the odds of taking supplements by 17 times. Exposure to each of the intervention components had a dose-response relationship with self-reported IFA use. These components, separately and together, accounted for most of the overall effect of treatment assignment on IFA use. CONCLUSIONS: All intervention components increased iron supplement use to differing degrees of magnitude. It appears that a social norms-based approach can result in improving IFA uptake, though improvements in haemoglobin counts were not yet discernible.

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.

Examining intentions to take iron supplements to inform a behavioral intervention: The Reduction in Anemia through Normative Innovations (RANI) project.

BACKGROUND: More than half of women of reproductive age in India have anemia. Over the last decade, India has made some progress towards reducing anemia in pregnant women, but non-pregnant women, who make up the largest sub group of people with anemia, are largely disregarded. OBJECTIVES: The objective of this paper is to examine intentions to take iron supplements and factors associated with intentions to inform a social norms-based behavioral intervention to increase uptake of iron supplements and reduce anemia in Odisha, India. METHODS: We collected data from 3,914 randomly sampled non-pregnant women of reproductive age in 81 villages. We conducted a survey and took hemocue (anemia level) readings from each participant. We analyzed data using linear regression models beginning with demographics and social norms and adding other factors such as self-efficacy to take iron supplements, anemia risk perception, and knowledge about anemia in a subsequent model. RESULTS: 63% of women in our sample were anemic but less than 5% knew they were anemic. Despite national guidelines that all women of reproductive age should take weekly iron supplements to prevent anemia, less than 3% of women in our sample were currently taking them. While actual use was low, intentions were rather high. On a five point Likert scale where higher numbers meant more intentions to take supplements, average intentions were above the midpoint (M = 3.48, SD = 1.27) and intentions and iron supplement use were significantly correlated (r = .10, p < .001). Both injunctive norms and collective norms were associated with intentions to take iron supplements but descriptive norms were not. Other significant factors included age, breastfeeding, knowledge, self-efficacy, and outcome expectations. The final model accounted for 74% of the variance in iron supplement intentions. CONCLUSIONS: In this context, where the actual behavior is low but intentions to enact the behavior are high, starting an intervention with injunctive norms messaging (expectations around the behavior) and self-efficacy to enact the behavior is the step we recommend based on our results. As an intervention unfolds and iron supplement use increases, descriptive norms messaging (that people are indeed taking iron supplements) may add value.

Effect of a Social Norm Email Feedback Program on the Unnecessary Prescription of Nimodipine in Ambulatory Care of Older Adults: A Randomized Clinical Trial.

Importance: Nimodipine is a highly prescribed drug for the treatment of cognitive impairment and dementia in Argentina. There is little evidence to support the use of nimodipine for cognitive impairment and dementia. Objective: To test the effectiveness of a behavioral intervention based on social norm feedback to reduce prescription of nimodipine for cognitive impairment in Argentina. Design, Setting, and Participants: This pragmatic parallel-group randomized clinical trial included 2 arms with a 1:1 allocation ratio. General practitioner physicians in the national health care system for older adults in Argentina (INSSJP-PAMI) with history of high nimodipine prescription rate were enrolled. The study was conducted from May 2019 to October 2019, and data were analyzed from November 2019 to February 2020. Interventions: The treatment group received 2 emails with evidence-based information about nimodipine plus the individual's level of nimodipine prescription compared with their peers. The control group received 2 emails with general information about the risks of overprescription in older adults. Main Outcomes and Measures: The primary outcome was the cumulative number of nimodipine prescriptions per 1000 prescriptions of all drugs made by the targeted physicians during the 6 months of the study. Secondary outcomes included annual monetary savings attributable to the intervention and physicians' qualitative perceptions of the acceptability of the procedure. Results: Of 1811 physicians enrolled, 906 physicians (354 [39.1%] women; mean [SD] age, 57.10 [10.73] years) were randomized to treatment and 905 participants (331 [36.6%] women; mean [SD] age, 56.49 [10.47] years) to the control group. Physicians in the treatment group wrote a mean of 93.25 (95% CI, 89.27 to 97.24) prescriptions of nimodipine, compared with 98.99 (95% CI, 95.00 to 102.98) prescriptions among practitioners in the control group during the half-year of the intervention (mean difference, -5.73 [95% CI, -11.38 to -0.10] prescriptions; P = .046), which meant a 5.79% reduction. Regression analysis revealed a significant association of the group condition with number of prescriptions per 1000 total prescriptions when controlling for baseline prescriptions (B = -0.312 [95% CI, -0.465 to -0.160]; P < .001). The observed difference corresponds to a 4.48% reduction in nimodipine prescriptions per 1000 prescriptions of all drugs made by physicians in the treated group compared with the control group. Physicians who effectively opened the email in the treatment group (427 physicians [47.1%]) prescribed the drug 11.3% less compared with the control group (426 physicians) (mean difference, -10.78 [95% CI, -18.53 to -3.03] prescriptions; P = .006). Expenditures were 7.18% lower in the treatment group, resulting in an estimated annual net cost benefit of US $234 893.35 (95% CI, $225 565.35 to $237 112.30). Conclusions and Relevance: In this randomized clinical trial, the social norm email feedback program showed an effect on curbing the nonrecommended prescription of nimodipine. It was highly cost-effective and well accepted by participants. Trial Registration: ISRCTN.org identifier: ISRCTN17823729.

Social norms as possible causes of stillbirths.

OBJECTIVE: High stillborn rates are a concern in developing countries. Hence, this article aims to describe the sociocultural norms contributing to the high number of stillbirths as perceived by mothers, significant others, midwives and records of the Pregnancy Problem Identification Programme (PPIP). DESIGN & SETTING: A multimethod qualitative descriptive study was conducted in a district in the Free State, South Africa. Each of the five sub-districts has a district hospital where most pregnant women give birth. Eighty per cent of the community is black of which about a quarter live in poor conditions below the poverty line. PARTICIPANTS: The first author conducted unstructured in-depth interviews with 36 mothers and their significant other who gave birth to a stillborn. She also extracted relevant data from the PPIP record of each mother. A skilled moderator conducted three focus group interviews with a convenience sample of midwives. The data were inductively analysed to identify subthemes under the central theme of social norms. KEY CONCLUSIONS: The authors concluded that traditional practices, traditional role players (traditional healer, mother-in-law, partner), abuse, and prescriptive social norms might contribute to stillbirths. Pregnant women are oppressed as they adhere to traditional social norms and are unable to make independent, informed healthcare decisions. The midwives, who are mostly female, may find it difficult to empower pregnant women because they are under the same social oppression as their clients. IMPLICATIONS FOR PRACTICE: It is imperative that healthcare providers consider social determinants of health, including social norms, when providing healthcare, especially to pregnant women as some social practices may have detrimental outcomes for the mother and/or baby.

A global analysis of cultural tightness in non-industrial societies.

Human groups have long faced ecological threats such as resource stress and warfare, and must also overcome strains on coordination and cooperation that are imposed by growing social complexity. Tightness-looseness (TL) theory suggests that societies react to these challenges by becoming culturally tighter, with stronger norms and harsher punishment of deviant behaviour. TL theory further predicts that tightening is associated with downstream effects on social, political and religious institutions. Here, we comprehensively test TL theory in a sample of non-industrial societies. Since previous studies of TL theory have sampled contemporary countries and American states, our analysis allows us to examine whether the theory generalizes to societies in the ethnographic record and also to explore new correlates of tightness that vary more in non-industrial societies. We find that tightness covaries across domains of social norms, such as socialization, law and gender. We also show that tightness correlates with several theorized antecedents (ecological threat, complexity, residential homogeneity) and several theorized consequences (intergroup contact, political authoritarianism, moralizing religious beliefs). We integrate these findings into a holistic model of tightness in non-industrial societies and provide metrics that can be used by future studies on cultural tightness in the ethnographic record.

The reduction in anemia through normative innovations (RANI) project: study protocol for a cluster randomized controlled trial in Odisha, India.

BACKGROUND: More than half of women in India are anemic. Anemia can result in fatigue, poor work productivity, higher risk of pre-term delivery, and maternal mortality. The Indian government has promoted the use of iron-folic acid supplements (IFA) for the prevention and treatment of anemia for the past five decades, but uptake remains low and anemia prevalence high. Current programs target individual-level barriers among pregnant women and adolescents, but a more comprehensive approach that targets multiple levels among all women of reproductive age is needed to increase uptake of IFA and iron-rich foods. METHODS: The Reduction in Anemia through Normative Innovations (RANI) project is a norms-based intervention to reduce anemia among women of reproductive age. We will evaluate the intervention through a clustered randomized controlled trial in Odisha, India. We will collect data at three time points (baseline, midline, and end line). For the study, we selected 89 clusters of villages, which we randomized into treatment and control on a 1:1 basis. The treatment arm will receive the RANI project components while the control arm will receive usual care. Fifteen clusters (40-41 villages) were selected and 4000 women (2000 in each arm) living in the selected clusters will be randomly selected to take part in data collection. Women in both study arms will have their hemoglobin concentrations measured. They will also complete in-person surveys about their knowledge, attitudes, perceptions of iron folic acid supplements, and nutritional intake. We will also select a smaller cohort of 300 non-pregnant women (150 in each arm) from this cohort for additional physical activity and cognitive testing. We will conduct both within- and between-group comparisons (treatment and control) at baseline, midline and end line using t-tests. We will also conduct structural equation modeling to examine how much each factor accounts for IFA use and hemoglobin levels. DISCUSSION: This RCT will enable us to examine whether a social norms-based intervention can increase uptake of iron folic acid supplements and iron rich foods to reduce anemia. TRIAL REGISTRATION: This trial was registered with Clinical Trial Registry- India (CTRI) (CTRI/2018/10/016186) on 29 October 2018.

Poly-Strengths and Peer Violence Perpetration: What Strengths Can Add to Risk Factor Analyses.

Adolescence is a high-risk time for perpetration of different forms of peer-based violence including harassment, bullying, and sexual assault. Research documents a number of important risk factors but less understood are protective factors like sense of mattering or how combinations of strengths may reduce perpetration risk. The current study examined how protective factors (i.e., positive social norms), including a diversity of strengths (termed poly-strengths), influenced the perpetration of harassment, bullying, and sexual assault for young people, while accounting for the use of alcohol both cross-sectionally and over time. Youth (N = 2232, 52.6% female) in grades 7-10 enrolled in a study using active parental consent (53% response rate) and completed online surveys in school that asked about bullying and harassment, alcohol use, positive social norms related to violence prevention, and a composite of intra-personal strengths. Follow-up surveys took place 6 months later (N = 2150). Logistic regression analyses examined how social norms and poly-strengths influenced odds of perpetration after accounting for demographic variables and the risk factor of alcohol use. Use of alcohol increased the odds of perpetrating all forms of violence. Strengths were significantly related to lower perpetration at Time 1 but not Time 2. Positive social norms reduced perpetration at both time points. The findings suggest adolescent perpetration of bullying, harassment, and sexual violence is lower in the presence of positive social norms over time and more proximally, in the presence of a diverse strengths portfolio. Prevention efforts that incorporate positive social norms and alcohol reduction strategies may reduce peer violence.

Examining the effects of role play practice in enhancing clinical skills to assess and manage suicide risk.

Background: Mental health professionals (MHPs) often lack skills necessary to effectively manage suicide risk. Training designed to combat this deficiency tend to rely on passive techniques, despite research suggesting active methods may better facilitate skill development.Aim: This study examines the effect of a role-play training on MHPs' attitudes, subjective norms and perceived behavioral control surrounding suicide risk assessment behaviors.Methods: Two hundred and three MHPs participated in a 4.5 hour role-play training after participation in an online suicide risk assessment training. The training utilized active learning and behavioral modification strategies. MHPs completed questionnaires assessing attitudes, subjective norms, perceived behavioral control and training variables.Results: MHPs endorsed positive attitudes, social norms and perceived behavioral control in suicide risk assessment and management skills, especially in assessing/determining the severity of risk, establishing rapport, documenting risk assessment information and developing a treatment plan. Results also revealed support for the feasibility of disseminating role-play training utilizing active learning methods.Conclusion: Factors found to be associated with participation in the role-play training are discussed. Findings may inform future development and improvement of suicide risk assessment training and practices that target risk and protective factors to effectively reduce suicide-related behavior.

Who benefits from mindfulness? The moderating role of personality and social norms for the effectiveness on psychological and physiological outcomes among police officers.

There is a growing interest to use mindfulness-based interventions (MBIs) for occupational health promotion. As most evidence for the beneficial effects comes from convenience samples in the social/education/health sector, it is still an open question if MBIs are effective in other contexts, or for whom MBIs are more effective. In addition, self-selection and sample characteristics may have biased previous findings. Theoretically and practically, it is important to know whether MBIs are also effective for nonselective samples outside the social and health sector, especially in agentic and male-oriented cultures. Therefore, this study investigates the effects of a MBI on physiological and psychological criteria in a nonselective sample of police officers. Moreover, this study examines whether effectiveness depends on participants' personality (neuroticism, openness, and conscientiousness) and on perceived social norms toward MBIs. Using a pre-post intervention design, N = 267 police officers were randomly assigned to an intervention group receiving a 6-week intervention and to a control group. Repeated-measures analysis of variance showed a positive effect on heart rate variability and a stronger reduction of psychological strain, health complaints, and negative affect, as well as more improvement of mindfulness and self-care in the intervention group in comparison with the control group. Additionally, participants higher in neuroticism and openness benefitted more, and the effectiveness was stronger for those who perceived a favorable social norm toward MBIs. Our findings provide evidence that participants with male-oriented occupations may also benefit from a MBI. The importance of individual differences and the social context is discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Program Impact Pathways and Contexts: A Commentary on Theoretical Issues and Research Applications to Support the EsIAN Component of Mexico's Conditional Cash Transfer Program.

This commentary on the Integrated Strategy for Attention to Nutrition (EsIAN) journal supplement begins with a discussion about the challenges that implementation researchers confront with respect to analyzing complex impact pathways. We note that the research on the implementation of the EsIAN component of Mexico's conditional cash transfer program was based implicitly or explicitly on a program impact pathway approach, which used both quantitative and qualitative methods to examine bottlenecks in program implementation. We then identify 5 categories of contexts that affect the impact, implementation, and survival of intervention programs: 1) biological, 2) social-cultural, 3) delivery modalities and platforms, 4) bureaucratic, and 5) political. Each of these contexts presents theoretical and methodological challenges for investigators. In this commentary, we focus primarily on biological and social-cultural contexts, discussing the theoretical and methodological challenges the investigators faced and the research strategies they used to address them, which have produced a unique compilation of "learning by doing" studies. We also touch briefly on the political context in which the Prospera program research was conducted. We conclude with statements that highlight the exceptional value of the journal supplement, not only with respect to the analysis of the interventions the studies cover and the sustained examination of a long-term program but also as a major contribution to the literature in implementation science in nutrition.

Sociocultural Influences on Poor Nutrition and Program Utilization of Mexico's Conditional Cash Transfer Program.

BACKGROUND: The impact of the Conditional Cash Transfer Program in Mexico was significant but smaller than expected. Several bottlenecks related to program design and implementation have been identified that may have limited its impact; population and other contextual factors may be equally important to analyze. OBJECTIVES: We aimed to explore how sociocultural context contributes to poor nutrition in Mexico and how it shaped the acceptability, fidelity, and penetration of the fortified food and of education sessions provided by the program. METHODS: We carried out qualitative research studies in the central and southern states in urban, rural, and indigenous settings between 2001 and 2014 with different informants and by using interviews, focus group discussions, and nonparticipatory observation. We explored 4 dimensions of the sociocultural context: objective dimension (e.g., food availability and family organization), social norms and symbolic meaning related to child feeding, literacy and communication with the biomedical culture, and knowledge related to child care generally and child feeding. We generated information about the experience of the beneficiaries with fortified food and education sessions. RESULTS: Several sociocultural factors, including patriarchal family organization, high availability of nonnutritious food, social norms promoting the consumption of food in liquid form for young children, sharing of food among family members, traditional knowledge, and communication barriers with the biomedical culture, participated in shaping the poor nutrition situation, the inadequate utilization of fortified foods, and the inappropriateness of the education sessions. CONCLUSIONS: Our studies revealed the importance of local context and culture to understand the acceptance, utilization, and impact of a nutrition program and shed light on infant and child feeding practices. This knowledge is critical to strengthen program designs and ensure adequacy with the diversity of cultural and social contexts in which programs are implemented.

The effectiveness of repeating a social norm feedback intervention to high prescribers of antibiotics in general practice: a national regression discontinuity design.

OBJECTIVES: Unnecessary antibiotic prescribing contributes to antimicrobial resistance. A randomized controlled trial in 2014-15 showed that a letter from England's Chief Medical Officer (CMO) to high-prescribing GPs, giving feedback about their prescribing relative to the norm, decreased antibiotic prescribing. The CMO sent further feedback letters in succeeding years. We evaluated the effectiveness of the repeated feedback intervention. METHODS: Publicly available databases were used to identify GP practices whose antibiotic prescribing was in the top 20% nationally (the intervention group). In April 2017, GPs in every practice in the intervention group (n=1439) were sent a letter from the CMO. The letter stated that, 'the great majority of practices in England prescribe fewer antibiotics per head than yours'. Practices in the control group received no communication (n=5986). We used a regression discontinuity design to evaluate the intervention because assignment to the intervention condition was exogenous, depending on a 'rating variable'. The outcome measure was the average rate of antibiotic items dispensed from April 2017 to September 2017. RESULTS: The GP practices who received the letter changed their prescribing rates by -3.69% (95% CI=-2.29 to -5.10; P<0.001), representing an estimated 124 952 fewer antibiotic items dispensed. The effect is robust to different specifications of the model. CONCLUSIONS: Social norm feedback from a high-profile messenger continues to be effective when repeated. It can substantially reduce antibiotic prescribing at low cost and on a national scale. Therefore, it is a worthwhile addition to antimicrobial stewardship programmes.

Psicologia ambiental e recursos em sustentabilidade: revisão integrativa / Environmental psychology and sustainability resources: integrative review / Psicología ambiental y recursos de sostenibilidad: revisión integradora

O objetivo deste estudo foi examinar, por meio de revisão integrativa de artigos empíricos, a produção científica relacionando a Psicologia Ambiental (variáveis de comportamento/cognição) e sustentabilidade, considerando diferentes recursos. Para efeitos deste estudo, foram analisados os artigos que abordam um recurso único. A busca foi realizada nos periódicos Environment and Behavior, Journal of Environmental Psychology e Psyecology, reconhecidos pela relevância internacional em produção científica no campo da Psicologia Ambiental. Foram selecionados 24 artigos, publicados entre os anos de 2012 e 2016, a partir dos critérios de inclusão pré-estabelecidos. Os anos com maior número de publicação foram 2014 (n = 8) e 2015 (n = 8). A maioria dos artigos se refere a estudos realizados na Europa, apenas um trata de pesquisa no Brasil. Os recursos abordados nos estudos abrangeram transporte, produtos, água, energia elétrica, sacola plástica e pastagem natural. Os resultados revisados demonstram que há uma diversidade de conceitos na mediação entre comportamentos/cognições e diferentes recursos, indicando a relevância destas abordagens para a promoção de sustentabilidade. Sugere-se caminhos para pesquisa e intervenção nas relações sustentáveis entre pessoas e recursos disponíveis em seus meios.(AU)

The objective of this study was to examine, through an integrative review of empirical articles, the scientific production on the relation between Environmental Psychology (behavior/cognition variables) and sustainability considering different resources. For that purpose, this analysis considered articles approaching a unique resource. Search was conducted in three journals with international relevance in the scientific production of Environmental Psychology: Environment and Behavior, Journal of Environmental Psychology and Psyecology. Following pre-established inclusion criteria, results included 24 articles published from 2012 and 2016. Years with higher number of publications were 2014 (n = 8) and 2015 (n = 8). The articles found refer mostly to studies conducted in Europe; only one article is a research from Brazil. Resources included transportation, products, water, energy, plastic bag, and natural grassland. Results indicate that there is a diversity of concepts mediating behaviors/cognitions and different resources, which reveals the relevance of these approaches to the promotion of sustainability. Research and intervention paths are suggested to sustainable relations between people and resources available in their surroundings.(AU)

El objetivo de este estudio fue examinar, por medio de una revisión integradora de artículos empíricos, la producción científica que relaciona la Psicología Ambiental (variables de comportamiento/cognición) y la sostenibilidad, considerando diferentes recursos. Para los propósitos de este estudio, se analizaron artículos que abordan un solo recurso. La búsqueda fue realizada en los periódicos Environment and Behavior, Journal of Environmental Psychology y Psyecology, reconocidos por la relevancia internacional en producción científica en el campo de la Psicología Ambiental. Se seleccionaron 24 artículos, publicados entre los años 2012 y 2016, basados en criterios de inclusión preestablecidos. Los años con el mayor número de publicaciones fueron 2014 (n = 8) y 2015 (n = 8). La mayoría de los artículos se refiere a estudios realizados en Europa, sólo uno trata de investigación en Brasil. Los recursos abordados en los estudios incluyeron transporte, productos, agua, energía eléctrica, bolsas de plástico y pastoreo natural. Los resultados revisados demuestran que hay una diversidad de conceptos en la mediación entre comportamientos/cogniciones y diferentes recursos, indicando la relevancia de estos enfoques para la promoción de la sostenibilidad. Se sugieren caminos para la investigación e intervención en las relaciones sostenibles entre personas y recursos disponibles en sus medios.(AU)

Does level of specificity affect measures of motivation to comply? A randomized evaluation.

The theory of planned behavior (TPB) is a popular value-expectancy model in social and behavioral health. Motivation to comply, one of the theory's constructs, has not been well operationalized and measured in the past, and to date, there has been no assessment of whether level of specificity affects the measurement of the construct. The purpose of this study was to measure the motivation to comply construct across four domains (from general to TACT-behavior specific) and evaluate the potential impact the differences have when identifying determinants of generalized injunctive norms. Students (n = 234) attending a large southwestern university completed a TPB survey related to sleep and physical activity, and were randomized to one of four domains that measured motivation to comply (General domain, n = 58; Health domain, n = 60; Behavioral domain, n = 56; and TACT domain, n = 60). Across both behaviors, motivation to comply measurements did not appear to be affected by changing the level of specificity. Referents for sleep and physical activity were mostly significant, but the effects were small to medium. Future researchers should consider removing motivation to comply measures from TPB surveys to reduce respondent burden or find alternative ways of measuring the construct.

Terapias de conversão: histórico da (des)patologização das homossexualidades e embates jurídicos contemporâneos / Conversion therapies: a history of the (de)pathologization of homosexuality and contemporary legal conflicts / Terapias de conversión: histórico de la (des)patologización de las homosexualidades y los enfrentamientos legales contemporáneos

O presente artigo analisa alguns elementos concernentes ao embate atual no campo legal brasileiro em relação às "terapias de conversão". É apresentado inicialmente um breve panorama da patologização das sexualidades dissidentes para, em seguida, descrever tal processo em relação às homossexualidades em específico. Na sequência, é feita uma descrição e análise histórica das terapias de reversão da orientação sexual, em especial nos EUA e no Brasil, seguida da discussão sobre as "terapias de conversão", de base religiosa, e do enfrentamento de seus proponentes com os conselhos profissionais nestes mesmos países. Ao final, são analisados aspectos concernentes aos discursos presentes em Ação Popular recente contra a Resolução no 001/1999, do CFP, apontando-se alguns elementos para se pensar estratégias de enfrentamento da disseminação destas terapias. Dentre eles, destacam-se: a necessidade de desconstrução do argumento da liberdade individual, utilizado pelos defensores destas terapias; a problematização do uso da "ciência" como argumento central pelos conselhos de classe nesse embate jurídico, uma vez que tais práticas foram sustentadas historicamente por argumentos "científicos" de sua época; e a necessidade do debate se centralizar nas questões éticas que envolvem tais práticas a partir do conceito de laicidade, tendo em vista que os discursos jurídicos e científicos se mostraram em muitos momentos históricos inseparáveis das concepções de base religiosa.(AU)

The present article analyzes some elements concerning the current clash in the Brazilian legal field in relation to "conversion therapies". A brief overview of the pathologization of dissident sexualities is presented initially and then this process is described especially in relation to homosexuality. After this, the paper presents a description and historical analysis of sexual orientation reversion therapies, especially in the USA and Brazil, followed by the discussion of religiously based "conversion therapies" and the confrontation of their proponents with professional counseling in these countries. Finally, aspects related to the discourses present in the recent Popular Action against Resolution 001/1999 of the CFP are analyzed, pointing out some elements for the analysis of the coping strategies of the dissemination of these therapies. Among them, the following stand out: the need to deconstruct the arguments of individual freedom used by proponents of these therapies; the problematization of the use of "science" as central argument by the class councils in this juridical attack, since such practices were supported historically by "scientific" arguments of its time; and the need to focus on the ethical issues surrounding such practices, based on the concept of secularity, given that legal and scientific discourses have been shown in many historical moments inseparable from conceptions of religious basis.(AU)

El presente artículo analiza algunos elementos relacionados con el choque actual en el campo legal brasileño con respecto a las "terapias de conversión". Se presenta una breve descripción de la patologización de las sexualidades disidentes, y luego se describe en relación con homosexualidades específicas. A continuación, se presenta una descripción histórica y un análisis de las terapias de inversión de la orientación sexual, particularmente en EE. UU. y en Brasil, seguida de una discusión sobre las "terapias de conversión" basadas en la religión y la confrontación de sus defensores con los consejos profesionales en estos mismos países. Al final, se analizan aspectos relacionados con los discursos presentes en la reciente Acción Popular contra la Resolución 001/1999, del CFP señalando algunos elementos para pensar en estrategias para hacer frente a la difusión de estas terapias. Entre ellos, destacan los siguientes: la necesidad de desconstrucción del argumento de la libertad individual, utilizado por los defensores de estas terapias; la problematización del uso de la "ciencia" como argumento central por parte de los consejos de clase en este choque legal, ya que tales prácticas fueron históricamente apoyadas por argumentos "científicos" de su tiempo; y la necesidad del debate para centrarse en los problemas éticos que rodean a tales prácticas desde el concepto de secularismo, dado que los discursos legales y científicos se han mostrado en muchos momentos históricos inseparables de concepciones basadas en la religión.(AU)

Lay community perceptions and treatment options for hypertension in rural northern Ghana: a qualitative analysis.

OBJECTIVE: Adherence to hypertension treatment is a major public health challenge for low and middle-income countries particularly in sub-Saharan Africa. One potential reason could be the discordance between lay and medical explanatory models of hypertension and its treatment. Understanding community perceptions and practices may contribute to improving hypertension control as they present insights into psychosocial and cultural factors that shape individual behaviour. We explore community perceptions regarding hypertension and its treatment in rural northern Ghana and how they differ from medical understanding. DESIGN: This was a qualitative study using semi-structured interviews and focus group discussions to collect data, which were analysed using a thematic approach. SETTING: A multisite study conducted in four rural communities in two regions of northern Ghana. PARTICIPANTS: We conducted 16 semi-structured interviews and eight focus group discussions with community leaders and members, respectively. RESULTS: Three major themes were identified: community perceptions, treatment options and community support for people with hypertension. Community perceptions about hypertension include hypertension perceived as excess blood in the body and associated with spiritual or witchcraft attacks. Traditional medicine is perceived to cure hypertension completely with concurrent use of biomedical and traditional medicines encouraged in rural communities. Community members did not consider themselves at risk of developing hypertension and reported having inadequate information on how to provide social support for hypertensive community members, which they attributed to low literacy and poverty. CONCLUSION: There is a substantial mismatch between communities' perceptions and medical understanding of hypertension and its treatment. These perceptions partly result from structural factors and social norms shaped by collective processes and traditions that shape lay beliefs and influence individual health behaviour. Socioeconomic factors also thwart access to information and contribute to inadequate social support for persons with hypertension. These findings highlight the need for a public health approach to hypertension control targeting families and communities.

"A kind of agonie in my thoughts": writing puritan and non-conformist women's pain in 17th-century England.

The relationship between pain as a physical and emotional experience and the concept of suffering as an essential aspect of sanctification for faithful believers was a paradoxical and pressing theological and phenomenological issue for puritan and non-conformist communities in 17th-century England. Pain allows the paradox of non-conformists' valorisation and suppression of corporeality to be explored due to its simultaneous impact on the mind and body and its tendency to leak across boundaries separating an individual believer from other members of their family or faith community. The material world and the human body were celebrated as theatres for the display of God's glory through the doctrines of creation and providence despite the fall. Pain as a concept and experience captures this tension as it was represented and communicated in a range of literary genres written by and about puritan and non-conformist women including manuscript letters, spiritual journals, biographies and commonplace books. For such women, targeted by state authorities for transgressing gender norms and the religion established by law, making sense of the pain they experienced was both a personal devotional duty and a political act. Three case studies comprise a microhistory of 17th-century English puritan and non-conformist women's lived experience, interpretation and representation of pain, inscribed in a series of manuscripts designed to nurture the spiritual and political activism of their communities. This microhistory contributes to a better understanding of pain in early modern England through its excavation of the connections that such writers drew between the imperative to be visibly godly, their marginalised subject position as a proscribed religious minority and their interpretation of the pain they experienced as a result.

Perceived support for medical cannabis use among approved medical cannabis users in Canada.

INTRODUCTION AND AIMS: Very little is known about the social experience of medical cannabis use, including the experience of stigma among approved users. The current study examined perceptions of support from physicians, family and friends as well as the prevalence of 'hiding' medicinal cannabis use. DESIGN AND METHODS: An online cross-sectional survey (N = 276) was conducted from 29 April to 8 June 2015. No public sampling frame was available from which to sample approved medical cannabis users (MCU). Eligible respondents were approved MCUs, aged 18 years or older, and reported cannabis use in the past 30 days for health reasons. Logistic regression analyses were used to assess aspects of stigma, including perceived support from their immediate social environment as well as behaviours reflecting a perceived social disapproval. RESULTS: Approximately one-third of respondents (32.6%) reported that their physician had refused to provide a medical document, and the vast majority of respondents (79.3%) reported hiding their medical cannabis use, most commonly to avoid judgement. Fewer than half of approved users perceived that their doctor was 'supportive' (38%), whereas two-thirds perceived support from family (66.3%) and friends (66.3%). Perceptions of support were similar across most socio-demographic sub-groups. DISCUSSION AND CONCLUSIONS: Substantial proportions of approved MCUs in Canada report a lack of support and most have made some effort to conceal their medical cannabis use. Overall, the findings suggest that social norms around medical cannabis use remain unfavourable for many users, despite that fact that medical cannabis has been legal in Canada for more than a decade.