Promoting lifestyle changes in patients with prediabetes from African-Caribbean backgrounds in the United Kingdom.

OBJECTIVES: Diabetes is a non-communicable disease where the patient's glucose level in the blood is too high. Diabetes is prevalent among ethnic minority groups in the United Kingdom (UK). Type 2 diabetes is a major cause of premature mortality in England. Unfortunately, the lifestyle of these minority groups has become a barrier to diabetes healthcare treatment. The timely intervention of programmes targeting risk factors associated with diabetes may reduce the prevalence of diabetes among these ethnic minority groups. This review critically explores and identifies barriers that hinder specific African-Caribbean groups from accessing diabetes healthcare and how nurses can promote lifestyle changes in patients with prediabetes from African-Caribbean backgrounds. DESIGN: An extended literature review (ELR). The process consisted of a search of key databases and other nursing and public health journal articles with the keywords defined in this extended review (prediabetes, diabetes, lifestyle of Afro-Caribbean). Thematic analysis is then applied from a socio-cultural theoretical lens to interpret the selected articles for the review. RESULTS: Three main barriers were identified: (a) the strong adherence to traditional diets, (b) a wrong perception about diet management and (c) 'Western medication' as a key barrier that hinders effective diabetes management in ethnic minorities, including the African-Caribbean in the UK. CONCLUSION: To address these barriers, it is important for policymakers to prioritise well-tailored interventions for African-Caribbean groups as well as support healthcare providers with the requisite capacity to provide care.

Evaluating the Effectiveness of the Housing First for Youth Intervention for Youth Experiencing Homelessness in Canada: Protocol for a Multisite, Mixed Methods Randomized Controlled Trial.

BACKGROUND: Emerging evidence at the international level suggests that the Housing First approach could improve the housing stability of young people experiencing homelessness. However, there is a dearth of literature in Canada on whether the Housing First intervention for young people experiencing homelessness can improve outcomes including housing stability, health and well-being, and access to complementary supports. Adapted from the original Housing First model, Housing First for Youth (HF4Y) was developed in Canada as a rights-based approach tailored specifically for young people aged 16 to 24 years who are experiencing or are at risk of homelessness. OBJECTIVE: The Making the Shift Youth Homelessness Social Innovation Lab is testing the effectiveness of the HF4Y intervention in Canada. The objective of this study is to determine whether the HF4Y model results in better participant-level outcomes than treatment-as-usual services for young people experiencing homelessness in 2 urban settings: Ottawa and Toronto, Ontario. Primary outcomes include housing stability, health and well-being, and complementary supports, and secondary outcomes include employment and educational attainment and social inclusion. METHODS: The HF4Y study used a multisite, mixed methods, randomized controlled trial research approach for data collection and analysis. Eligible participants included young people aged 16 to 24 years who were experiencing homelessness or housing precarity. The participants were randomly assigned to either the treatment-as-usual group or the housing first intervention group. Survey and interview data in Ottawa and Toronto, Ontario are being collected at multiple time points (3-6 months) over 4 years to capture a range of outcomes. Analytic strategies for quantitative data will include mixed-effects modeling for repeated measures and logistic models. A thematic analysis will be used to analyze qualitative data based on participants' narratives and life journeys through homelessness. Furthermore, program fidelity evaluations are conducted within each HF4Y program. These evaluations assess how well the intervention aligns with the HF4Y model and identify any areas that may require adjustments or additional support. RESULTS: The HF4Y study has received human participant research ethics approval from the Office of Research Ethics at York University. Recruitment was conducted between February 2018 and March 2020. Data collection is expected to be completed at both sites by March 2024. A preliminary analysis of the quantitative and qualitative data collected between baseline and 24 months is underway. CONCLUSIONS: This pilot randomized controlled trial is the first to test the effectiveness of the HF4Y intervention in Canada. The findings of this study will enhance our understanding of how to effectively deliver and scale up the HF4Y intervention, with the aim of continually improving the HF4Y model to promote better outcomes for youth. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) ISRCTN10505930; https://www.isrctn.com/ISRCTN10505930. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46690.

Examining the effects of individual and neighbourhood socioeconomic status/wealth on hypertension among women in the Greater Accra Region of Ghana.

Hypertension is one of the leading causes of morbidity and mortality among women in sub-Saharan Africa. Although research on the relationship between individual-level socioeconomic status (SES) and hypertension exists, to the best of our knowledge, limited empirical studies examined the effects of neighbourhood-level SES/wealth on the risks of living with hypertension in Ghana. Using data from the 2009 Women's Health Study of Accra (WHSA-II), and applying multilevel logistic regression, this study investigates the effects of both individual and neighbourhood wealth status on hypertension among women in the Greater Accra Region of Ghana. The results show that individual-level SES/wealth is a significant determinant of hypertension among Ghanaian women in Accra. Specifically, wealthy women are more likely to be hypertensive compared to poorer women. However, the effect of neighbourhood SES/wealth was attenuated after adjusting for individual-level SES/wealth. These findings suggest that it is important to develop health promotion programs targeted at a segment of SES group in the prevention, control and management of hypertension among women in the Greater Accra Region of Ghana.

Risk factors for Caesarean sections in Ghana: evidence from the Ghana Maternal Health Survey.

A Caesarean section can be a life-saving intervention in case of pregnancy complications or difficult labour. The prevalence of Caesarean section continues to increase, especially in sub-Saharan Africa, yet the reasons for this remain largely unexplored. This study investigated risk factors contributing to the decision to perform Caesarean sections in Ghana using data from 8645 women aged 15-49 years from the 2017 Ghana Maternal Health Survey. The data were analysed by applying complementary log-log and logit models. The majority of Ghanaian women (about 87%) reported preferring vaginal delivery to Caesarean section. Of those who had undergone a Caesarean section for their most recent birth, about 55% had an elective rather than an emergency section. Women with labour complications (prolonged/obstructed labour) were significantly more likely to have a Caesarean section (OR=4.09, 95% CI=3.10-5.41). Furthermore, women with maternal complications, particularly prolonged/obstructed labour, were less likely to have an elective Caesarean section than those who had no such complications (OR=0.25, 95% CI=0.14-0.46). Compared with poorer women, wealthy women were significantly more likely to have an elective Caesarean section (OR=1.84, 95% CI=1.08-3.14). The findings suggest that beyond maternal complications, women's socioeconomic and demographic characteristics are important risk factors for undergoing a Caesarean section in Ghana.

Determinants of Low Birth Weight in Ghana: Does Quality of Antenatal Care Matter?

OBJECTIVES: Low birth weight is a public health issue that contributes to perinatal and infant mortality, especially in limited-resource settings, but there is limited understanding of the determinants of low birth weight and the contributions of quality antenatal care to maintaining healthy birth weights for newborns in such settings. This study aims at establishing links between birthweight and quality antenatal care in Ghana. METHODS: We used data collected from the recent 2017 Ghana Maternal Health Survey and applied complementary log-log models to investigate relationships between the quality of antenatal care (screening/diagnostic procedures, clinical interventions, type of health provider) and low birth weight in Ghana. RESULTS: The results reveal that compared to women who received low quality clinical interventions, those who received high quality interventions were significantly less likely to have a low birth weight baby. Similarly, women who made the recommended number of antenatal visits (at least eight) were significantly less likely to have a baby with low birth weight than women making fewer visits. CONCLUSION: Our findings suggest that while the number of antenatal visits is important, the quality of care received during such visits is equally relevant to reducing low birth weight in Ghana.

Social Support Systems and the Self-Management of Non-Communicable Diseases (NCDs) in Ghana.

There is a large body of literature on the role of social support systems in the management of chronic conditions in the West, with limited research on the sub-Saharan African and Ghanaian context. In the past, the organization and delivery of formal health services in Ghana were geared towards the treatment of infectious diseases rather than non-communicable diseases (NCDs). We conducted qualitative interviews with a sample of 33 NCD patients purposefully selected from two teaching hospitals in Ghana. The information they provided indicated that the most common types of support received were instrumental and emotional. While a majority of stroke patients experienced activity limitations related to bathing and cooking, they received the emotional support necessary to maintain their psychological well-being. Overall, we found social connections and relationships were an important strategy in the promotion of the physical and mental well-being of these NCD patients.

The effects of individual and community-level factors on maternal health outcomes in Ghana.

BACKGROUND: Utilization of maternal health care services is key to reducing the number of perinatal deaths and post-natal complications in sub-Saharan Africa. With a few exceptions, many studies that examine the use of maternal health services in sub-Saharan Africa have focused largely on individual-level explanations and have ignored the importance of contextual and community-level explanations. In Ghana, progress has been made in reducing maternal mortality ratio from 740/100,000 in the late 1990s to 319/100,000 in 2015 but these rates are still high. Our study focuses on impact of individual and community level-factors on maternal outcomes with the hope that it will inform public policy in Ghana. This approach highlights latent or unacknowledged aspects of fragility within health systems designed to improve maternal health and opportunities for improving uptake of services. METHODS AND FINDINGS: Using the 2014 Ghana Demographic and Health Survey, we examined the effects of individual and community-level factors on antenatal care, facility-based delivery, and post-natal care. Multilevel logistic regression models were used to examine the effects of individual and community-level factors on the outcome variables. Our analysis revealed that overall utilization of antenatal, facility-based delivery and post-natal care was substantial across the board; however, both individual and community-level factors were significant predictors of these maternal health outcomes. Wealthier and better educated women were more likely to use antenatal services and facility-based delivery; in contrast poor and uneducated women were more likely to use antenatal and postnatal care but not facility-based delivery. Additionally, use of National Health Insurance Scheme was statistically associated with the utilization of maternal health services. CONCLUSIONS: The findings point to areas where services can be better tailored to meet community-specific needs. Policy makers must consider factors such as educational levels and economic security at both individual and community-levels that shape women's preferences and uptake of maternal health care in Ghana.

Examining risk factors for hypertension in Ghana: evidence from the Study on Global Ageing and Adult Health.

Like most countries in sub-Saharan Africa, hypertension contributes substantially to morbidity and mortality in Ghana, yet nationally representative studies that examine the odds of becoming hypertensive among Ghanaians are conspicuously missing. We aimed to fill this void in the literature. The data used for analysis came from the first wave of the Study on Global Ageing and Adult Health (SAGE), collected in Ghana from January 2007 to December 2008 by the World Health Organization (WHO). A total of 5573 respondents were sampled for the study. Random-effects C-log-log models were employed in examining socio-economic, lifestyle and psychosocial factors on the odds of becoming hypertensive in Ghana. Separate models were run for male and females. Results indicated there were strong significant associations between socio-economic, lifestyle and psychosocial factors on the likelihood of becoming hypertensive, among Ghanaian men and women. Compared with the poorest, Ghanaians from wealthy households were significantly more likely to be hypertensive. Educated women, as compared with the uneducated, were also more likely to be hypertensive. Ghanaians who engaged in vigorous or intensive activities continuously, for at least 10 minutes, were significantly less likely to be hypertensive, compared to those who did not. Happier men had lower odds of becoming hypertensive, and depressed women had increased odds of reporting they were hypertensive.

Validity of Self-Report Data in Hypertension Research: Findings From The Study on Global Ageing and Adult Health.

Several studies indicate little congruence between self-report and biometric data, yet very few have examined the reasons for such differences. This paper contributes to the limited but growing body of literature that tracks inconsistent reports of hypertension using data from the Study on Global Ageing and Adult Health (SAGE). Focusing on five countries with different levels of development (Ghana, China, India, South Africa, and Russia), this study offers a comparative perspective that is missing in the literature. Data were obtained from wave 1 of SAGE collected in 2007/2008. A multinomial logit model was used to examine the effects of demographic and socioeconomic variables on the likelihood of respondents self-reporting that they are not hypertensive when their biometric data show otherwise. The authors also model the likelihood of respondents self-reporting that they are hypertensive when in fact their biometric data show they are not. Socioeconomic and demographic variables were shown to be significantly associated with inconsistent reporting of hypertension. For instance, it was observed that wealth was associated with a lower likelihood of self-reporting that one is not hypertensive when their biometric data indicate otherwise. Tracking such inconsistent reports is crucial to minimizing measurement errors and generating unbiased and more precise parameter estimates in hypertension research.

Occupational types and antenatal care attendance among women in Ghana.

Improving antenatal care is considered a priority and has been relevant toward achieving the Millennium Development Goals (MDGs), yet antenatal care attendance remains relatively low in Ghana. Guided by the Andersen and Newman framework and employing logit models, we examine associations between occupational types and antenatal care among Ghanaian women aged 15-49. Type of occupation, conceptualized as a predisposing factor, has a significant impact on the frequency and timing of antenatal care attendance at the bivariate level. The effect of occupational type was considerably mediated, however, when other socioeconomic variables such as wealth status were controlled in the multivariate models.

Implementation challenges of maternal health care in Ghana: the case of health care providers in the Tamale Metropolis.

BACKGROUND: Achieving the Millennium Development Goal (MDG) of improving maternal health has become a focus in recent times for the majority of countries in sub-Saharan Africa. Ghana's maternal mortality is still high indicating that there are challenges in the provision of quality maternal health care at the facility level. This study examined the implementation challenges of maternal health care services in the Tamale Metropolis of Ghana. METHODS: Purposive sampling was used to select study participants and qualitative strategies, including in-depth interviews, focus group discussions and review of documents employed for data collection. The study participants included midwives (24) and health managers (4) at the facility level. RESULTS: The study revealed inadequate in-service training, limited knowledge of health policies by midwives, increased workload, risks of infection, low motivation, inadequate labour wards, problems with transportation, and difficulties in following the procurement act, among others as some of the challenges confronting the successful implementation of the MDGs targeting maternal and child health in the Tamale Metropolis. CONCLUSIONS: Implementation of maternal health interventions should take into consideration the environment or the context under which the interventions are implemented by health care providers to ensure they are successful. The study recommends involving midwives in the health policy development process to secure their support and commitment towards successful implementation of maternal health interventions.