'It is what was handed over to us as our heritage and must not be taken away just like that': Traditional birth attendants' attitudes towards the elimination of intergenerational female genital mutilation/cutting in Osun State, Nigeria.

Female genital mutilation/cutting is a harmful practice that violates the sexual and reproductive health rights of women and girls. The practice is often perpetrated directly or indirectly from one generation to another as a way of preserving the culture, thus making it difficult to tackle using ordinary prevention interventions. The purpose of the study was to assess the attitude of the traditional birth attendants as community leaders towards the elimination of intergenerational female genital mutilation/cutting (FGM/C) of girls and to determine their level of readiness and preparedness towards achieving it in Osun State, Nigeria. A qualitative research design, using the adapted REPLACE community readiness tool to end female genital mutilation/cutting interview guide, was used to individually interview eight traditional birth attendants who were identified through purposive sampling method as community leaders and key informants. Thematic Analysis was used to analyze the data which yielded female genital mutilation/cutting as traditional heritage, defiance against government efforts and debunking all "western" information about dangers of female genital mutilation to women as lies as findings. The current defensive attitudes of the TBAs as community leaders and custodians of the FGM/C tradition are that of denial and resistance which is characterised by misconception and incorrect knowledge about the issue as well as misconception and lack of support for addressing the issue which is an indication of low level of no readiness for any intervention to prevent or eliminate FGM/C in Osun state, Nigeria. Serious engagement and dialogue between policy makers and health professionals on FGM/C and its effects on women is highly recommended for effective FGM/C elimination strategies to be co-developed with community leaders. Such engagements should adopt a non-confrontational, respectful, and honest approach so as to not alienate the TBAs.

I did not scream. i could not; i was terrified. i just followed them. . .i blocked my mind. then they all raped me: A narrative inquiry on the onset of tonic immobility among women rape victims in Nigeria.

Tonic immobility (TI) is a common uncontrollable autonomic mammalian response to an extremely fearful situation. It is one of the most immediate devastating consequences of rape and remains poorly understood. While controversies over its definition persist among researchers, this also reflects on the care for and support to victims. The study aimed to explore and describe the onset of TI and the meaning attached to the experience among women raped victims in Nigeria. The study design was the qualitative narrative inquiry approach. Criterion and purposive sampling were conducted across four post-rape care facilities in Lagos, Nigeria, to recruit 13 participants. In-depth face-to-face interviews were conducted using a semi-structured interview guide to generate data that were thematically analysed. The findings of the study revealed five themes relating to the onset of TI as follows: the first two focused on the experience of TI: (1) the onset of TI prior to rape due to perceived imminent danger, (2) the onset of TI as a self-protection mechanism from further harm) while the last three relate to the meaning-making of the experience of TI (3) self-loathing as a meaning attached to TI, (4) suicidal ideations as a meaning attached to TI, and (5) divine intervention as a meaning attached to TI. Conclusion: The findings underscore the experiences and meanings that participants attach to TI following rape. There is a strong likelihood that tonic-immobility is not an uncommon experience amongst rape victims, but that in the absence of research, specialized care on the condition, and its associated consequences will haunt many women, affecting their psychological well-being and their entire quality of life. Describing the phenomenon as it is experienced by the participants is critical because understanding the condition is the first step toward effective appropriate management.

Policy gaps and food systems optimization: a review of agriculture, environment, and health policies in South Africa.

South Africa faces the triple burden of malnutrition, high poverty levels, unemployment, and inequality. "Wicked problems" such as these require innovative and transdisciplinary responses, multi-stakeholder coordination and collaboration, managing complex synergies and trade-offs, and achieving sustainable outcomes. Through qualitative content analysis of national and provincial sector-based policies, we explored the interlinkages between the agriculture, environment, and health sectors in South Africa in the context of sustainable food and nutrition security and the extent to which these interlinkages are integrated into policy and planning. A systemic analysis of the review outcomes was performed to identify its main learning outcome, the status quo in the policy process. The nature of feedback loops was identified, and a leverage point was suggested. The review highlighted that policymakers in the agriculture, environment and health sectors are aware of, and have understood, the relationships among the three sectors. They have also made attempts to address these interlinkages through collaboration and coordination. Unfortunately, this has been met with several challenges due to fragmented sector-specific mandates and targets and a lack of resources for integrated solutions. This creates implementation gaps and unintended duplication of activities, leading to poor service delivery. Transitioning to sustainable and healthy food systems will only be possible after these gaps have been closed and implementation optimization has been achieved. Focusing on meta-level problem-framing, functional collaboration through transdisciplinary approaches, and integrated targets are critical to successful policy implementation and progressive realization of national goals related to sustainable food and nutrition security, unemployment, poverty, and inequality.

Measuring perceived learning gains of undergraduate nursing students in ICT skills: One group pre-test and post-test design.

Purpose: This study aimed to measure learning gains during an ICT training intervention in first-year students completing a four-year undergraduate nursing degree.Methodology: This study adopted a quasi-experimental, one group pre-test and post-test design. The intervention effectiveness was measured using individual single-student normalised gains, g; class average normalised gain, 〈g〉; and average single-student normalised gain, g(ave).Results: In this study, the class average normalised gains, 〈g〉 ranged from 34.4% to 58.2%, and the average of single student normalised gains, g(ave) ranged from 32.4% to 50.7%. The overall class average normalised gain 〈g〉 was 44.8%, and the average of the single student normalised gain was 44.5%, with 68% of students having a normalised gain of 30% and above, indicating that the intervention was effective.Conclusion: Similar interventions and measurements are recommended to all health professional students during their first academic year to pave a foundation for ICT usage for academic purposes.

Health advocacy role performance of nurses in underserved populations: A grounded theory study.

AIM: Nurses' health advocacy (HA) role requires them to speak up for patients, clients, and communities in relation to healthcare. Various studies report the importance of the HA role of the nurse in healthcare. However, nurses' performance in this role is not clear yet. The present study aims to identify and explain how nurses perform their HA role in underserved populations. DESIGN: Qualitative grounded theory by Strauss and Corbin. METHODS: Data were gathered from three regional hospitals in Ghana with 24 registered nurses and midwives as participants through purposive and theoretical sampling techniques. Face-to-face in-depth semi-structured interviews were conducted from August 2019 to February 2020. The data were analysed using Strauss and Corbin's method and Nvivo software. The reporting follows Consolidated Criteria for Reporting Qualitative Research guidelines. FINDINGS: The HA role performance theory emerged from data with role enquiry, role dimension, role context, role influence, role reforms and role performance as building blocks. Data analysis showed that the main concerns of the nurses during their daily practice were mediating, speaking up, and negotiating. Among others, the intervening conditions were clientele influence and interpersonal barriers, whereas the outcome was a balance between role reforms and role performance. CONCLUSION: Although some nurses proactively initiated biopsychosocial assessment and performed the HA role, most of them relied on clients' requests to perform the role. Stakeholders should prioritise critical thinking during training and intensify mentoring programmes in the clinical areas. RELEVANCE FOR CLINICAL PRACTICE: The present study explains the process by which nurses perform their roles as health advocates in their daily activities as nurses. The findings can be used to teach and guide clinical practice for the HA role in nursing and other health care fields. There was no patient or public contribution.

An Interpretative Phenomenological Analysis of the lived experience of sensuality expression among women over 50 years of age in Nigeria.

INTRODUCTION: Sensuality, an essential component of sexuality, is the enjoyment, expression, or pursuit of physical and sexual pleasure or satisfaction. Sensuality expression of women over 50 is under-researched and often ignored, making it difficult to have a scientific basis to develop age-appropriate healthy-ageing programmes for this group in Nigeria. An exploratory study was conducted to explore the lived experiences of the expression of sensuality of Nigerian women over 50 and the meaning they attach thereto. METHODOLOGY: An Interpretative Phenomenological Analysis approach was used to collect and analyze data from 17 female teachers from three public secondary schools in Osun state, Nigeria, to represent a homogenous group of professional women over the age of 50. A semi-structured questionnaire was used to obtain qualitative data that was thematically analyzed. FINDINGS: Four superordinate themes emerged: 'Self-reinvention to camouflage ageing realities for sensuality expression'; 'Embracing own sensuality'; 'Yearning for old self'; and 'Loss of interest in romantic relationships', with various subordinate themes. CONCLUSION: These finding provide the basis to develop age-appropriate healthy-ageing programmes for this group, and a baseline for further sexual health research among this group of women in Nigeria, who are often overlooked or considered asexual due to their being beyond the reproductive age.

A call for total nursing role reformation: Perceptions of Ghanaian nurses.

Nurses in Ghana believe that training, practise, practitioner and policy reforms are required for total nursing profession reform to be effective. Their views for role reformation in the nursing profession, which is currently needed, are not only academic but also clinically relevant in the pursuit of health equity and quality nursing care. We explored and described nurses' views on their roles in the profession using data collected from 24 professional nurses in three regional hospitals in Ghana. Using an inductive descriptive qualitative design, data were gathered and analysed using a qualitative content analysis to describe the views of the nurses. Four major themes, namely practise reforms, practitioner reforms, training reforms and policy reforms have emerged in relation to role reformation in the nursing profession. Three strategic areas, practitioner attitudes, new training modalities and policy realignment, must be reviewed and remodelled for better positioning of the nursing profession before its entire role reformation.

Men's experience of perpetrating intimate partner violence following disclosure of HIV status by their seropositive female intimate partners: a qualitative study.

BACKGROUND: Gender-Based (GB) intimate partner violence is a social and public health issue globally. Several risks of violence related to male sexual partners' perpetration of intimate partner violence (IPV) following the disclosure of their female intimate partners' HIV + status have been reported. No research has been conducted on male sexual partner's perspectives of perpetrating IPV following their female intimate partners' disclosure of human immunodeficiency virus (HIV) seropositive status as a risk factor for the perpetration of IPV in Ghana. OBJECTIVE: The objective of this study is to explore and describe male sexual partners' views or perspectives of perpetrating IPV following their female intimate partners' disclosure of being HIV positive in Ghana. METHODS: Interpretive phenomenological approach was used to collect and analyse data from a purposive sample of 18 Male participants whose female intimate relations informed them of being HIV + in Ghana. The sample population was taken from Ghana because such research has been reported elsewhere but none has been done in Ghana. A semi-structured interview guide was used to collect the data. The interview guide covered topics such as background information, participants' reaction to HIV positive disclosure, lived experiences of participants, and Participants' understanding of different forms of IPV. RESULTS: The findings of this study reveal five main themes that emerged from the interviews which include views on the perpetration of emotional, psychological, and verbal abuse; views on the perpetration of sexual deprivation; views on the perpetration of social isolation; views on the perpetration of financial abuse and views on escalated perpetration of physical abuse. CONCLUSION: From the data, HIV positive status disclosure served as a risk factor for different forms of GB IPV against HIV positive women in Ghana, thus making this group more vulnerable and exposed to more GB IPV. Strategies to prevent the perpetration of IPV against women newly diagnosed as HIV positive are needed. We recommend screening all newly diagnosed HIV-positive women for abuse as an additional prevention strategy for IPV associated with disclosure of positive HIV status. KEY MESSAGESHIV positive status disclosure serves as a risk for the perpetration of IPV.Men are predisposed to violence upon hearing that their female heterosexual intimate partners are HIV positive.HIV infection information is distressful to receive from an intimate partner.

Female students' perceptions of interpersonal risk and protective factors for dating violence in a Nigerian university.

Dating violence is a public health problem with severe implications for social, physical, mental/psychological and spiritual health of victims/survivors, families and the society at large. For female students, it can gravely affect their academic performance and thus affect gender equality in universities. This article identifies and described the interpersonal risk and protective factors associated with dating violence in a Nigerian University. Data were collected from a sample of 90 undergraduate female students in the university of Benin using nine (9) focus group discussions. Thematic content analysis, using the socio-ecological framework revealed interpersonal risk factors a theme with subthemes which are: negative childhood experiences, negative influence from other persons, and the clash in belief systems between partners. While the theme: protective factors have subthemes which are: having elders as good role models, trusting relationships, mutual respect between partners, open relationship and transparency between partners. This study identified that students should be given orientation in schools to avoid bad peer, friends, influence; Mentoring between older students and younger ones to be encouraged as they serve as elder and adviser to the young ones. In addition, Nigerian universities' management and stakeholders should develop evidence-based policies and programs. Including heathy relationship topics built into the school curriculum gear at having healthy relationship, prevent dating violence and respond to other forms of gender-based violence.

"I just became like a log of wood I was paralyzed all over my body": women's lived experiences of tonic immobility following rape.

Tonic immobility is considered the last involuntary self-protecting act/mechanism experienced by victims of rape when they are under attack. It is associated with trauma related mental health risks post-rape. Despite this, tonic immobility has not received priority as an area of research on Nigerian female victims of rape. As a result, little has been known about this phenomenon by nurses and other professionals who are involved in the care and management of rape survivors in Nigeria. The limited knowledge about tonic immobility as a phenomenon might have resulted in mismanagement and secondary victimization of rape victims experiencing manifestations suggestive of tonic immobility during or after rape. This study was a qualitative narrative inquiry that explored, analysed, and interpreted the lived experiences suggestive of tonic immobility, and the meaning attached to such experiences by victims. A sample of fourteen Nigerian women who self-identified as rape victims was utilized. Individual semi-structured, in-depth interviews were conducted to generate data. Thematic data analysis revealed four overarching themes: namely (i) Tonic immobility as an Altered Physical State, (ii) Tonic Immobility as Mental Paralysis, (iii) Painful Loss of Self-defence, and (iv) Constant Self-blame. The findings provided an insight into the traumatic experience of raped women and the psychological implication of tonic immobility as extreme defence mechanism. This study will prove invaluable to nurses and other professionals/stakeholders involved in the care and management of rape victims; to help them develop and use appropriate strategies for management and prevention of secondary victimisation.

Facilitators of the health advocacy role practice of the nurse in Ghana: A qualitative study.

BACKGROUND: Identifying facilitators of health advocacy role practice of nurses is important in reducing health disparities and inequities in Ghana. The struggle to reducing these disparities and inequities needs a combination of bravery, courage, and professionalism. In many instances, many barriers hinder nurses from practicing their health advocacy role in Ghana. Facilitators that motivate nurses who would perform this health advocacy role have not been identified and adequately described in Ghana. AIM: To explore and describe the facilitators of the health advocacy role of nurses in Ghana. METHODS: This qualitative study used Strauss and Corbin's grounded theory approach to collect and analyze data from 2018 to 2019 in three regions in Ghana. Semistructured interviews (n = 24) and field notes were used to collect data. RESULTS: Professional influence emerged as a core category among other three facilitators that motivate nurses to perform the health advocacy role. The other three are clientele influence, intrinsic influence, and cultural influence. CONCLUSIONS: Facilitators to the health advocacy role practice of nurses are multidimensional and hidden. In this respect, educating hospital managers on these facilitators should be done through workshops and seminars to enhance the managers' strategies of motivating nurses to advocate for the less privileged and the disadvantaged of the society.

"They all laughed and asked me if I enjoyed having sex with those guys": Exploring men's lived experiences when reporting rape to police in South Africa.

Rape is the most demoralizing type of crime violating human rights worldwide. Research has primarily focused on children and women's experiences of rape, even though victims include men and little documentation available concerning their experiences of reporting these incidents. The study aimed to investigate men's experiences when reporting rape to the police. An Interpretative Phenomenological Analysis was used to collect and analyze qualitative data from a purposive sample of eleven men who were rape victims. The findings of the study revealed three superordinate and twenty-two subordinate themes. First, motivation for reporting rape to the police included self-protection from re-victimization, being killed, and prevalent prison cultural practice, seeking justice and answers for rape, moral duty, family support, and encouraging reports of the crime. Second, perceived barriers for reporting rape included fear of stigmatization and ridicule, unknown perpetrators, internalized homophobia, men's preconceived prejudices, perceived justice system delays, fear of being killed, and protecting their reputation. Third, negative experiences when reporting rape included a long waiting period at the reception before opening a case file and the delayed responses of police investigating the rape scene. Also, there was discouragement from the police, disparaging behavior of police, victim-blaming, lack of communication with the victim about case progress and experiences of police homosexual intolerance. The findings show that most men were motivated to report rape to the police despite the perceived barriers and negative experiences they had with the police. Thus, this provides baseline evidence for strategies to be developed to encourage the reporting of rape. Each police station must provide dedicated personnel for professional and sensitive handling of all rape victims, including men. Furthermore, future studies should be conducted to evaluate rape victims' satisfaction with the services provided by the police.

"They destroyed my life because I do not feel like a man anymore": An Interpretative Phenomenological Analysis of Men's lived experiences of rape victimization.

Over the past three decades, rape victimization has been regarded as a women-only issue, with men regarded as the only offenders. This has resulted in a narrow-focused approach in addressing this scourge where men who could be primary victims are marginalized. This marginalization has also occurred in research, resulting in the paucity of literature on men's experiences of rape victimization in South Africa and globally. The main aim of the study was to explore, analyze and interpret men's lived experiences of rape victimization and the meaning they attached to such experiences. An Interpretative Phenomenological Analysis research design was used to collect and analyze data from a purposive sample of 11 participants, using semi-structured face-to-face interviews. The findings of the study revealed eight superordinate themes and related subordinate themes as follows: unexpected overpowering experience, forceful sexual violations, rape as torture, intense emotions attached to being raped, rape as a permanent emotional scar, negative perceptions of self, rape as something being taken away, and rape as divine punishment. The findings highlight the experiences and meanings which men attach to being raped, thus demonstrating the need to develop men-specific post-rape care management guidelines to support and care for men who are rape victims.

"As I Was Walking Down the Street, Four Strange Guys Came and Took Me Under the Bridge, Where They All Raped Me": An Interpretative Phenomenological Analysis of the Types of Rape Experienced by Men in South Africa.

Globally, rape is regarded as the most demoralizing type of trauma, and it has negative implications for victims and their families. Although rape affects the community in general, there is a paucity of literature on rape victimization of men. As a result, the types of rape experienced by them are not understood, and thus it is often difficult to develop contextually relevant interventions to prevent male rape and to support male rape victims. The objective of this study was to first determine and then describe, the types of rape experienced by men. An interpretative phenomenological analysis (IPA) qualitative approach was used to collect and analyze data from a purposive sample of 11 participants, using semistructured individual interviews. The findings of the study reveal six themes and related subthemes as six types and related subtypes of rape experienced by men as follows: acquaintance rape, including familial rape; stranger rape; gang rape, including corrective-gang rape, drug-facilitated gang rape, pack-hunting rape, women retributive rape (or women vengeance) for violence experienced from men; homophobic rape; prison rape, including transactional rape and gang initiation rape; and armed rape. The findings reveal the different contexts or settings where men are vulnerable to rape. This highlights the possibilities for the development of context-specific sexual violence prevention interventions for men, which include self-defense training and awareness campaigns specific to rape victimization of men. Furthermore, future studies are recommended to expose this pandemic. Activism is advocated to stop the silence around this public and social health issue.