'Government don't know me and if I stop, they won't know': A qualitative study on the lived experiences of volunteer health workers in the Nigerian health system and their implications for the sustainable development goals.

BACKGROUND: Volunteer health workers play an important, but poorly understood role in the Nigerian health system. We report a study of their lived experiences, enabling us to understand their motivations, the nature of their work, and their relationships with formally employed health workers in Primary Healthcare Centres (PHCs) in Nigeria, the role of institutional incentives, and the implications for attaining the health-related sustainable development goals (SDGs) targets. METHODS: The study used ethnographic observation of PHCs in Enugu State, supplemented with in-depth interviews with volunteers, formally employed health workers and health managers. The analysis employed a combination of narrative and reflexive thematic approaches. FINDINGS: The lived experiences of most volunteers unfold in four stages as they move into and out of their volunteering status. The first stage signifies hope, arising from the ease with which they are accepted and integrated into the PHC space. The anger stage emerges when volunteers confront the marked disparity in their treatment compared to formal staff, despite their substantial contributions to healthcare. Then, the bargaining stage sets in, where they strive for recognition and respect by pursuing formal employment and advocating for fair treatment and improved stipends. A positive response, such as improved stipends, can reignite hope among volunteers. If not, most volunteers transition to the acceptance stage - the acknowledgement that their status may never be formalised, prompting many to lose hope and disengage. CONCLUSION: There should be a clear policy on recruitment, compensation, and protection of volunteers in the health systems, to enhance the contribution they can make to the achievement of the health-related SDG targets.

A systematic review of actors, actions, and outcomes of community-based efforts to prevent or reduce methamphetamine use.

Background: There has been an increase in methamphetamine use across the globe, despite widespread control of the drug, prevention, and treatment. Community-based approaches have proven effective in tackling diverse health-related challenges including substance use; however, little is known regarding community programs targeting methamphetamine use. We conducted a systematic literature review on community programs aimed at tackling the use of methamphetamine across the globe. Method: Relevant literature from peer-reviewed and gray literature sources were systematically identified. A grid template was used to extract and synthesize findings from retrieved literature regarding themes of actors, actions, and outcomes related to identified programs. Results: A total of 19 documents met our inclusion criteria. Some of the dominant actors in efforts to reduce methamphetamine use in communities were local councils, drug enforcement units, influential persons in the community, people who use or had used methamphetamine, business corporations, and already-existing health promoting platforms. Actions taken were typically education/awareness/information campaigns. Drug enforcement agencies appeared to make little gains when acting alone, and appeared to drive dealers and users underground. Many of the efforts made at the community level were alluded to be beneficial; however, it was difficult to quantify the impact of programs. Community-level efforts also tended to cascade to other drugs. Conclusion: Community-based actors and actions are diverse and critical to the prevention of methamphetamine use. There is a need to better coordinate and integrate different actors and interventions so that outcomes can be better monitored and evaluated for greater effectiveness in reducing methamphetamine use.

"I can't kill myself": Local narratives and meanings that foster absenteeism in Nigerian primary health centres.

Background: Absenteeism in the health sector is increasingly seen as a form of harmful rule-breaking, with health workers receiving a salary although they are not present to provide care. It is a barrier to achieving universal health coverage yet remains widespread in primary health centres (PHCs) in Nigeria and many other low-resource settings. Traditional approaches to combatting absenteeism have relied on anti-corruption measures such as promoting accountability and transparency. However, more needs to be understood about the social and cultural realities, including perceptions and norms enabling or constraining the application of such measures in Nigeria and in similar contexts. Methods: We conducted 34 in-depth interviews (IDIs) with frontline health workers and their managers/supervisors and two focus group discussions (FDGs) with service users (n = 22) in Enugu State, South Eastern Nigeria. We discussed their experiences and views about absenteeism, allowing the respondents' framings to emerge. We adopted a mixed approach of narrative analysis and phenomenology to examine respondents' narratives - identifying the concepts and social constructs within the narratives that manifested through the language used. Results: Stakeholders acknowledged the problem of absenteeism but had differing perspectives on its dynamics. Health workers distinguished two forms of absenteeism: one as a mundane, everyday response to the poorly funded health system; and the other, brazen and often politically enabled absenteeism, where health workers whom powerful politicians protect are absent without facing consequences. There is a general feeling of powerlessness among both health service providers and service users confronted by politically backed absentees as the power dynamics in the health sector resonate with experiences in other spheres of life in Nigeria. Health workers rationalised mundane, technical absenteeism, adjusted to it and felt it should be accommodated in the health system. Service users are often unsure about who is absent and why, but when they notice absenteeism, they often ascribe it to wider system malpractices that characterise public services. Conclusion: Interventions to tackle absenteeism and other forms of health sector corruption should be sensitive to socio-cultural and political contexts that shape everyday lives in specific contexts. Challenging narratives/beliefs that normalise absenteeism should be part of reform plans.

Measurement invariance of the Personality Inventory for the DSM-5 (PID-5) for Nigerian and White American university students.

In a previous study, it was reported that the typically replicable factor structure of the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PID-5) was noninvariant across samples of Black American and White American university students. The investigators of that study attributed this noninvariance across these two racial groups to Black American racialization, defined as Black individuals living in a predominantly non-Black society. In the current investigation, we examined further the effects of Black racialization by examining PID-5 factor structure invariance using a sample of nonracialized Black (Nigerian) university students (i.e., Black people living in a primarily Black society) and a sample of White American students. The factor structure of the PID-5 across the samples indicated overall configural invariance, suggesting that the same PID-5 facet traits, for the most part, load on the same factors for the nonracialized Black people and White Americans. This result is consistent with the view that Black racialization likely contributes to PID-5 factor structure noninvariance across White and Black Americans. There were some differences, however, between the Nigerian and White American students with respect to metric invariance and scalar invariance, suggesting the facet-to-factor loadings have different magnitudes of association across groups and that domain scale score elevations in Nigerian and White American students are not comparable; this was particularly prominent for the disinhibition domain. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of corruption and unaccountability on responses of frontline health workers to COVID-19 in Nigeria: Lessons and considerations for the social work profession.

COVID-19 stretched health systems, exacerbated by concerns about those that are corrupt and lack equity. Twelve (12) health workers and 12 hospital social workers across Nigeria were purposively sampled and virtually interviewed to explore unaccountability and corruption effects on COVID-19 responses. Findings show that corruption and unaccountability negatively affected responses of frontline health workers to the pandemic. Lack of social care and justice services for patients and health workers across health facilities in Nigeria worsened the negative effects. Effectively mainstreaming social care and justice services into Nigeria's healthcare led by well-trained social workers will improve the health sector via anticorruption.

An exploratory, cross-cultural study on perception of putative cyclical changes in facial fertility cues.

Although many researchers have argued that facial traits evolved as honest cues to women's current fertility (possibly via changes in facial femininity), evidence that women's facial attractiveness is significantly, positively related to probability of conception throughout menstrual cycle is mixed. These mixed results could reflect differences among studies in the methods used to assess facial attractiveness (i.e., forced choice versus rating-scale methods), differences in how fertility was assessed, differences in perceiver characteristics (e.g., their own attractiveness), and facial preferences possibly being moderated by the characteristics of the living environment. Consequently, the current study investigated the putative effect of cyclical changes in fertility on women's facial attractiveness and femininity (1) using forced choice and rating-scale method, (2) conducting both ovulation tests and repeated daily measures of estradiol assessing the conception probability, (3) based on a culturally diverse sample of perceivers, while (4) controlling for inter-individual variation. Although we found some limited evidence that women's faces became more attractive when conception probability increased, these effects differed depending on the methods used to assess both attractiveness and fertility. Moreover, where statistically significant effects were observed, the effect sizes were extremely small. Similarly, there was little robust evidence that perceivers' characteristics reliably predicted preferences for fertility cues. Collectively, these results suggest that mixed results in previous studies examining cyclical fluctuation in women's facial attractiveness are unlikely to reflect inter-cultural differences and are more likely to reflect differences in the methods used to assess facial attractiveness and fertility.

Where Do We Start? Building Consensus on Drivers of Health Sector Corruption in Nigeria and Ways to Address It.

BACKGROUND: Corruption is widespread in Nigeria's health sector but the reasons why it exists and persists are poorly understood and it is often seen as intractable. We describe a consensus building exercise in which we asked health workers and policy-makers to identify and prioritise feasible responses to corruption in the Nigerian health sector. METHODS: We employed three sequential activities. First, a narrative literature review identified which types of corruption are reported in the Nigerian health system. Second, we asked 21 frontline health workers to add to what was found in the review (based on their own experiences) and prioritise them, based on their significance and the feasibility of assessing them, by means of a consensus building exercise using a Nominal Group Technique (NGT). Third, we presented their assessments in a meeting of 25 policy-makers to offer their views on the practicality of implementing appropriate measures. RESULTS: Participants identified 49 corrupt practices from the literature review and their own experience as most important in the Nigerian health system. The NGT prioritised: absenteeism, procurement-related corruption, under-the-counter payments, health financing-related corruption, and employment-related corruption. This largely reflected findings from the literature review, except for the greater emphasis on employment-related corruption from the NGT. Absenteeism, Informal payments and employment-related corruption were seen as most feasible to tackle. Frontline workers and policy-makers agreed that tackling corrupt practices requires a range of approaches. CONCLUSION: Corruption is recognized in Nigeria as widespread but often seems insurmountable. We show how a structured approach can achieve consensus among multiple stakeholders, a crucial first step in mobilizing action to address corruption.

Narratives of childless widows: exploring the lived experiences and well-being of childless widows in rural Nigeria.

Background: Widows are socioeconomically disadvantaged, especially in low resource regions. Childless widows are a group whose plight may be worse given sociocultural circumstances. In the current study, we examined the lived experiences of childless widows living in remote Nigeria, highlighting this group as being in critical need for social interventions.Method: Childless widows (n = 11) in rural settings in South East Nigeria were interviewed. Narrative analysis was used in navigating the lived experiences of the widows.Results: Extreme distress, ostracism, stigma, and traumatic experiences were common in the narratives of the widows. However, childlessness was at the core of their distress. Treated as outcasts, the widows resigned to God, though some were scarcely allowed to play supportive roles among relatives. As social welfare packages are almost non-existent in this region, religious groups often played supportive roles.Conclusion: Legislation protecting widows are good but may not be sufficient if it does not translate to improved wellbeing/welfare for widows. Childless widows, especially those in rural areas, are especially vulnerable as they face peculiar deprivation and psychological distress arising from cultural/social realities. Recognising the limited resources in low income countries, mobilisation of local structures and resources to educate and monitor local communities are important.

Associations between schizotypal traits and antisocial behaviours in a sub-Saharan sample.

Schizophrenic symptoms have often been associated with antisocial behaviours (ASBs). Most studies have focused on violence. The association between schizophrenia and violence is often confounded by socio demographic characteristics of patients. Overemphasis on diagnosis, rather than traits, and the traditional focus on violence may have obscured associations between psychotic features and antisocial behaviour. In this study, an analogue sample (n = 604, females = 54.4%, mean age = 21.46, SD = 5.89) completed self-report measures of schizotypy and antisocial behaviours. The aim was to identify the strength of associations between different schizotypal traits/symptoms (unusual experiences, cognitive disorganisation, impulsivity & introvertive anhedonia) and different forms of antisocial behaviour (rule breaking, physical aggression & social aggression). Differential patterns of association between genders were also considered. Traits akin to positive symptoms were more strongly associated with antisocial behaviours. Impulsive non-conformity was associated with rule breaking, physical aggression and social aggression for both males and females whilst unusual experiences traits were associated with physical and social aggression in both males and females but had only a weak (gender-nonspecific) association with rule breaking. Finally, cognitive disorganisation was not associated with any class of ASB for males but was associated with physical and social aggression in females. These specific associations could inform the development of more targeted treatment approaches for specific types of ASBs in males and females.

Prolonged incarceration and prisoners' wellbeing: livid experiences of awaiting trial/pre-trial/remand prisoners in Nigeria.

PURPOSE: Awaiting trial prisoners (ATPs) are represented in prisons globally, and may stay for long periods in detention. This group is however underrepresented in literature on incarcerated persons. We aim to explore the lived experiences of ATPs detained for prolonged years in a sub-Saharan country; examining what they make of their status and how their conditions have affected their wellbeing. METHOD: Eight inmates awaiting trial for armed robbery and murder offences, held for between 8 years and 15 years participated in a focus group discussion. Hermeneutic phenomenology guided the interpretation of transcripts. RESULT: ATPs recount disbelief and negative emotional experiences upon incarceration. Alienated and uncertain about their status, ATPs experience intensified distressful ruminations which impact wellbeing. ATPs re-rationalized incarceration and made social comparisons which breed poor perception of self. ATPs nonetheless recounted hopefulness, made favorable comparisons; and find consolation in religious beliefs. CONCLUSION: Prolonged years spent awaiting trial fuels a deterioration of wellbeing. Alternatives to incarceration are urgently needed for ATPs. Distressful experiences recalled by the inmates beg for the inclusiveness of ATPs in programs that promote wellbeing. The Good Lives Model holds potentials for building an inclusive framework to accommodate ATPs in prison interventions.

Business-life balance and wellbeing: Exploring the lived experiences of women in a low-to-middle income country.

AIM: With most studies on work-life balance focused on employees, this study sets out to explore the everyday living of business women who trade on petty goods and earn very little in a low-to-middle income country (LMIC). We explore their conceptions of balance, how they manage intersecting roles, and how they cope with daily hassles and stress to maintain wellbeing. BACKGROUND: With the proportion of self-employed to employed people in Sub-Saharan LMICs being an inverse of the situation in Euro-American countries, there is a need to explore what balance could mean for the people in LMICs. Most studies in the work-life literature have explored how employees pursue balance and the various strategies that work for a specific group of people. Perhaps because work-life balance literature has largely sprung from advanced economies, little focus has been placed on how other societies, especially people in LMICs, navigate balance, given their unique milieu. DESIGN: Adopting the reflective life-world approach, we inquire into the daily lives of women in very small businesses. METHOD: Twenty women who trade on a range of items and earn very little (gross daily sales of $0.41 to $62.98) were interviewed using a semi-structured guideline. Analysis was conducted using interpretative phenomenology. RESULT: Conceptions of balance for the women incorporated the notions of satisfactory progress across roles, proper time apportionment to roles, conditional balance as well as harmony and/or synchrony across roles-a slight difference from the popular understandings. Their conception of business life roles was deemed much more integral. Negative physical and psychological experiences impacting health and wellbeing, identified as culminating as a result of both roles, were commonplace but were typically considered a normal part of living. Engagements in extra-social roles appeared to have a double-edged effect. Placing the family first, time management, and prioritizing were some of the important measures of ensuring balance and wellbeing. Financial gains and personal satisfaction were top motivational reasons that kept the women committed to pursuing simultaneous roles. CONCLUSION: There is a strong overlap between what balance means for petty trading women and employees. However, the unique social platform offers a more communal perspective of issues in pursuing balance.