An intersectionality framework for identifying relevant covariates in health equity research.

Introduction: Health equity research uses impact evaluations to estimate the effectiveness of new interventions that aim to mitigate health inequities. Health inequities are influenced by many experiential factors and failure of research to account for such experiential factors and their potential interactions may jeopardize findings and lead to promoted methods that may unintentionally sustain or even worsen the targeted health inequity. Thus, it is imperative that health equity impact evaluations identify and include variables related to the circumstances, conditions, and experiences of the sample being studied in analyses. In this review, we promote intersectionality as a conceptual framework for brainstorming important yet often overlooked covariates in health equity related impact evaluations. Methods: We briefly review and define concepts and terminology relevant to health equity, then detail four domains of experiential factors that often intersect in ways that may obscure findings: Biological, Social, Environmental, and Economic. Results: We provide examples of the framework's application to lupus-related research and examples of covariates used in our own health equity impact evaluations with minority patients who have lupus. Discussion: Applying an intersectionality framework during covariate selection is an important component to actualizing precision prevention. While we do not provide an exhaustive list, our aim is to provide a springboard for brainstorming meaningful covariates for health equity evaluation that may further help unveil sustainable solutions to persisting health inequities.

Through the Eye of a Needle: Understanding the Identities of LGBTQ+ Teachers Within Catholic Institutions in the Philippines.

The pervasive Catholic culture permeates through the social fabric of the Philippines and exerts unique pressures on Filipinos. This study highlighted the unique experiences of Filipino LGBTQ+ educators of private Catholic schools. Using the grounded theory approach, seven participants who identified as LGBTQ+ and taught in private Catholic schools in the Philippines for a minimum of one year were interviewed. Semi-structured interviews with the participants illustrated that these LGBTQ+ educators had to contend with negotiating their identities while carefully navigating through their work environment. This yielded three key themes: (1) Recognizing the political dimension of private schools, (2) Threading the Needle, and (3) Obtaining and Optimizing Safe Spaces. As a result, the Constricting Contexts Model was proposed to better understand and contextualize such factors and emphasize the role that environments and expectations play into the identities of marginalized groups such as the LGBTQ+ community.

An Intersectional Perspective on Age Stereotypes: Bisexual and Gay Men are Stereotyped as Younger than Heterosexual Men Even When Aging.

We analyzed the age stereotypes of heterosexual, gay, and bisexual men and the implications of such stereotypes for the conceptualization of older gay and bisexual men, specifically. In Study 1a (N = 158) and 1b (N = 155), we found that compared to heterosexual men, participants stereotyped gay men more on young- than elderly-stereotypical traits. Participants represented bisexual men not as "somewhere in between" the stereotypes about heterosexual and gay men, but were characterized more by young- than elderly-stereotypical traits. In Study 2 (N = 106), we reasoned that because of their sexual orientation, both older gay and bisexual men would be viewed as atypical subtypes of older men, considered to be heterosexual by default. As atypical subtypes, both older gay and bisexual men may be stereotyped less on traits associated with elderly men and more on traits associated with their sexual orientation membership, namely young-stereotypical traits. Consistently, compared with older heterosexual men, both older gay and bisexual men were perceived as less typical of older men, and their perceived atypicality accounted for them being stereotyped less as older and more as younger men. The results have been examined for intersectional stereotyping research and practical implications are discussed.

The Prevalence of Peer Sexual Harassment During Childhood in Australia.

Sexual harassment inflicted by adolescents on their peers is a major public health issue, but its prevalence across childhood is not known. We provide the first nationally representative data on the prevalence of peer sexual harassment across childhood, using cross-sectional data from the Australian Child Maltreatment Study (ACMS). The ACMS surveyed 8,503 people aged 16 and over about their experiences of child maltreatment and associated health outcomes. The prevalence of peer sexual harassment was assessed using the Juvenile Victimization Questionnaire (JVQ)-R2 Adapted Version (ACMS), with survey data weighted to reflect characteristics of the Australian population. Overall, 1 in 10 (10.4% (95% Confidence Intervals (CI) [9.7, 11.3])) Australians experienced peer sexual harassment during childhood. Peer sexual harassment is an issue disproportionately affecting gender-diverse individuals (24.0%, 95% CI [15.5, 35.2]) and women (15.3%, 95% CI [14.0, 16.7%]), compared to men (5.0%, 95% CI [4.3, 5.9]). Rates of peer sexual harassment were also very high among sexuality diverse participants (prevalence estimates ranging between 14.2% and 29.8%). Peer sexual harassment was predominately inflicted by male peers (9.6%, 95% CI [8.9, 10.4]), compared to 1.8% (95% CI [1.5, 2.2]) reporting harassment from female peers. These findings have implications for understanding and reducing attitudes supporting peer sexual harassment in childhood, particularly against girls and gender and sexuality diverse youth, and associations with other gendered violence both in childhood and later life.

Low adoption of mobility device in later life: Insights from the lens of intersectionality.

OBJECTIVES: To investigate the utilization of mobility device, whether age and gender-related use disparities exist, and whether falls can further explain use disparities over time among Chinese older adults in need of devices. METHODS: Community-dwelling older adults who needed mobility devices and completed four waves of the China Health and Retirement Survey 2011-2018 were included (N = 1,302). A categorical variable was created to represent respondents' intersectionality of age (50-64, 65-74, and ≥75 years) and gender (men vs. women). RESULTS: The baseline prevalence of device use was 18.2 % (n = 237). Overall, the device use increased over time. Intersectionality-wise, oldest-old women were 1.53 times more likely than youngest-old men to use devices over time. Respondents with falls were more likely to use devices over time. CONCLUSIONS: Older adults with mobility impairment, especially the oldest-old women and those with falls, lag in mobility devices utilization, suggesting future tailored interventions to support these populations.

Youth adversity and trajectories of depression/anxiety symptoms in adolescence in the context of intersectionality in the United Kingdom.

BACKGROUND: Youth adversity is associated with persistence of depression and anxiety symptoms. This association may be greater for disadvantaged societal groups (such as females) compared with advantaged groups (e.g. males). Given that persistent symptoms are observed across a range of disadvantaged, minoritized, and neurodivergent groups (e.g. low compared with high socio-economic status [SES]), the intersection of individual characteristics may be an important moderator of inequality. METHODS: Data from HeadStart Cornwall (N = 4441) was used to assess the effect of youth adversity on combined symptoms of depression and anxiety (Strengths and Difficulties Questionnaire emotional problems subscale) measured at three time-points in 11-14-year-olds. Latent trajectories and regressions were estimated for eight intersectionality profiles (based on gender, SES, and hyperactivity/inattention), and moderating effects of the individual characteristics and their intersections were estimated. RESULTS: Youth adversity was associated with higher average depression/anxiety symptoms at baseline (11-12-years) across all intersectionality profiles. The magnitude of effects differed across profiles, with suggestive evidence for a moderating effect of youth adversity on change over time in depression/anxiety symptoms attributable to the intersection between (i) gender and SES; and (ii) gender, SES, and hyperactivity/inattention. CONCLUSIONS: The detrimental effects of youth adversity pervade across intersectionality profiles. The extent to which these effects are moderated by intersectionality is discussed in terms of operational factors. The current results provide a platform for further research, which is needed to determine the importance of intersectionality as a moderator of youth adversity on the development of depression and anxiety symptoms in adolescence.

Using an intersectional life course perspective to understand familial environment and its impact on sexuality development among Asian American sexual minority college students.

There is a dearth of research understanding the sexual health of Asian American adolescents, and even more so for those who identify as sexual minorities (lesbian, gay, bisexual, queer, asexual, and other sexual orientations). This study is a secondary qualitative analysis focused on young adults' recollections of their formal and informal sex education experiences in childhood and adolescence using a sub-sample of in-depth interviews from students who self-identified as both Asian and sexual minorities living in the USA (n = 9). Results were organised into three sections: (1) latent cultural factors (e.g. stigma surrounding sex, self-sufficiency, filial piety); (2) the downstream effects of latent cultural factors (e.g. sex-related discussions, rules disallowing dating, role of lateral family members); and (3) the impact of deficient familial sex-related discussions (e.g. Internet, resentment). Study findings underscore the links between identity concealment and relationship concealment that are unique to Asian sexual minority individuals. We suggest that interventions involving Asian American US youth and their families should be culturally informed and promote cross-generational sex-related discussion. Future research should further explore the role of chosen family and non-parental family members as a point of intervention as they can be helpful sources of informal sex education.

Prostitution in the shadow of life-long sexual abuse: Arab women's retrospective experiences.

The present study uses the life-course and intersectionality perspectives to explore the meaning that aging Arab women attribute to their lived experiences of life-long sexual abuse in the shadow of engaging in prostitution. Interpretive phenomenological analysis was used to analyze the narratives of 10 older Arab women in Israel who were engaged in prostitution. Four themes emerged: experiencing childhood in the shadow of sexual abuse, becoming a prostitute, being entrapped in prostitution, and settling accounts with the native culture. Women aging in prostitution experience a harsh reality of abuse and loss. The present study points to multiple channels of abuse throughout the life course, from childhood until old age.

Intersectional Male-Centric and White-Centric Biases in Collective Concepts.

In principle, the fundamental concepts person, woman, and man should apply equally to people of different genders and races/ethnicities. In reality, these concepts might prioritize certain groups over others. Based on interdisciplinary theories of androcentrism, we hypothesized that (a) person is more associated with men than women (person = man) and (b) woman is more associated with women than man is with men (i.e., women are more gendered: gender = woman). We applied natural language processing tools (specifically, word embeddings) to the linguistic output of millions of individuals (specifically, the Common Crawl corpus). We found the hypothesized person = man / gender = woman bias. This bias was stronger about Hispanic and White (vs. Asian) women and men. We also uncovered parallel biases favoring White individuals in the concepts person, woman, and man. Western society prioritizes men and White individuals as people and "others" women as people with gender, with implications for equity across policy- and decision-making contexts.

"It made me feel like a shit parent": an intersectional analysis of pandemic mothering.

The COVID-19 pandemic brought to the fore the everyday and exceptional challenges for mothers. Rarely, however, did research or social commentary acknowledge the multiplicities of motherhood during this prolonged period of risk, disruption, and uncertainty. This paper draws upon interviews with 24 mothers living in Aotearoa New Zealand during the pandemic, including women who were pregnant and gave birth during lockdowns, teenage mothers, single and low-income mothers, and working mothers. The sample was intentionally diverse, including Maori, Pacific, Asian and migrant mothers. Engaging an intersectional lens on motherhood and women's health, this paper builds upon and extends feminist research on mothers' experiences during the pandemic, highlighting the many different challenges facing mothers of diverse social, cultural, and economic positionalities and during various stages of motherhood. Across the sample, we reveal the significant emotional toll on mothers, particularly with the absence of critical social, medical and health support systems during lockdown periods and sustained social restrictions. Many of the women described how the pandemic affected their feelings about motherhood, prompting new reflections on their relationships with the home, family, work, and broader society. Despite some similarities, the pandemic experiences of Maori, Pacific, migrant and single mothers were further intensified by various forms of isolation, judgement, and discrimination. In this way, the pandemic shed light on the gendering of everyday maternal life, but also the need for more intersectional culturally and gender-responsive policies that acknowledge the multi-layered complexities of mothers' lives.

Living with dementia: Exploring the intersections of culture, race, and dementia, stigma.

Research documents the presence of stigma and discrimination as key components in the lived experience of dementia. However, to date, there is limited understanding regarding how social location, particularly as it relates to culture and race, may shape this experience of stigma and discrimination. In this qualitative exploratory study, personal interviews were held with ten Chinese Canadians living with dementia focused on better understanding how culture, race, and dementia stigma influence their experiences. From the onset, themes related to stigma and discrimination were woven into the participants' stories about living with dementia. Consistent with other research, all participants described an increased sense of vulnerability and invisibility related to how both they and others responded to their diagnosis of dementia. Participants also provided examples of how this experience of stigma was compounded by culture, race, and immigration status. Importantly, these acts of stigma and discrimination were both externally and internally imposed, resulting in feelings of lack of safety and insecurity. This research draws attention to the increased vulnerability that accompanies a diagnosis of dementia and illustrates how this may be heightened by one's culture and racism.

Intersectional race-gender stereotypes in natural language.

How are Asian and Black men and women stereotyped? Research from the gendered race and stereotype content perspectives has produced mixed empirical findings. Using BERT models pre-trained on English language books, news articles, Wikipedia, Reddit and Twitter, with a new method for measuring propositions in natural language (the Fill-Mask Association Test, FMAT), we explored the gender (masculinity-femininity), physical strength, warmth and competence contents of stereotypes about Asian and Black men and women. We find that Asian men (but not women) are stereotyped as less masculine and less moral/trustworthy than Black men. Compared to Black men and Black women, respectively, both Asian men and Asian women are stereotyped as less muscular/athletic and less assertive/dominant, but more sociable/friendly and more capable/intelligent. These findings suggest that Asian and Black stereotypes in natural language have multifaceted contents and gender nuances, requiring a balanced view integrating the gender schema theory and the stereotype content model. Exploring their semantic representations as propositions in large language models, this research reveals how intersectional race-gender stereotypes are naturally expressed in real life.

'Surviving and thriving': intersectional stigma and resilience of dual minority identities among Chinese gay and bisexual men living with HIV.

Intersectionality has facilitated an understanding of the complexities of the adversities and challenges faced by individuals with multiple disadvantaged identities, including gay and bisexual men living with HIV. This study used deficiency- and empowerment-based perspectives together with an intersectionality lens to examine the intersections between sexuality minority and HIV-related stigma and resilience, as well as their compound effects on Chinese gay and bisexual men living with HIV. We conducted in-depth interviews with 21 gay and bisexual men living with HIV in Shenzhen, identifying two overarching themes and six subthemes in the provided accounts via thematic analysis. The theme of 'Interplay between Minority Identities' comprised aggravating effects and alleviating effects at the intrapersonal, interpersonal, community and structural levels. The theme of 'Compound Impact of Intersecting Identities' was contributed to by the subthemes 'the pressure to continue family lineage', 'persistent health concerns', 'financial concerns', and 'heightened psychological distress and resilience'. Integrating deficiency and empowerment perspectives, our findings highlight the importance of addressing intersectional stigma and identifying resilience resources to empower Chinese gay and bisexual men living with HIV to thrive amidst compounded adversities. Findings have implications for future intersectional research and intervention practice, especially in fostering resilience within the context of intersectional stigma.

Categorization of continuous covariates and complex regression models - friends or foes in intersectionality research.

OBJECTIVE: To reduce health inequities it is important to identify intersections in characteristics of individuals subject to privilege or disadvantage. Different proposals for that have recently been published. One approach (1) considers models specified with 1st and all 2nd-order effects and another (2) the stratification based on multiple covariates; both categorize continuous covariates. A simulation study was conducted in order to review both methods with regard to identification of intersections showing true differences, rate of false positive results, and generalizability to independent data compared to an established approach (3) of backward variable elimination according to Bayesian information criterium (BE-BIC) combined with splines. STUDY DESIGN AND SETTING: R software has been used to simulate the covariates age, sex, body mass index, education, and diabetes to examine their association with a continuous frailty score for osteoporosis using multiple linear regression. In setting 1, none of the covariates was associated with the frailty score, i.e. only noise is present in the data. In setting 2, the covariates age, sex, and their interaction were associated with the frailty score, such that only females above 55 years formed an intersection associated with an increased frailty score. All approaches were compared under varying sample sizes (N=200-3000) and signal-to-noise ratios (SNR, 0.5-4) in 1000 replications. For model evaluation, bootstrap resampling was used. The models were fitted in internal learning data and then used to predict outcomes in the internal validation data. The mean squared error (MSE) was used for comparison and the frequency of false positive findings calculated. RESULTS: In setting 1, approaches 1 and 2 generated spurious effects in more than 90% of simulations across all sample sizes. In smaller sample size, approach 3 (BE-BIC) selected 36.5% the correct model, in larger sample size in 89.8% and always had a lower number of spurious effects. MSE in independent data was generally higher for approaches 1 and 2 when compared to 3. In setting 2, approach 1 selected most frequently the correct interaction but frequently showed spurious effects (>75%). Across all sample sizes and SNR, approach 3 generated least often spurious results and had lowest MSE in independent data. CONCLUSION: Categorization of continuous covariates is detrimental to studies on intersectionality. Due to high and unrestricted model complexity such approaches are prone to spurious effects and often lack interpretability. Approach 3 (BE-BIC) is considerably more robust against spurious findings, showed better generalizability to independent data, and can be used with most statistical software. For intersectionality research we consider it most important to describe relevant differences between intersections and to avoid non-reproducible and spurious findings.

Building physician wellness into the culture: evaluating a family physician well-being programme using the physician wellness inventory.

PURPOSE: Family physicians have a higher incidence of burnout, dissatisfaction, and disengagement compared to other medical specialties. Addressing burnout on the individual and systemic level is important to promoting wellness and preventing deleterious effects on physicians and patients. We used the Physician Wellness Inventory (PWI) to assess the effects of a wellness programme designed to equip family physicians with skills to address burnout. METHODS: The PWI is a fourteen-item 5-point Likert scale broken down into 3 scores; (i) career purpose, (ii) cognitive flexibility, and (iii) distress. The PWI was distributed to a cohort of n = 111 family physician scholars at 3 time points: January 2021, May-June 2021, and October 2021. The response rate was 96.4% at baseline, and 72.1% overall. Demographic information was collected to assess differences. The survey was distributed online through Qualtrics (Provo, UT). RESULTS: Cognitive Flexibility scores at the endpoint were higher for POC scholars than white scholars (P = 0.024). Distress scores for all groups decreased over time. Female scholars were more nervous, and anxious at the start than male scholars (P = 0.012), which decreased over time (P = 0.022). New career scholars were more likely than later career scholars to be distressed (P = 0.007), but both groups' distress decreased over time (P = 0.003). Later career scholars' feelings of being bothered by little interest or pleasure in doing things decreased more than new career scholars (endpoint: P = 0.022; overall: P = 0.023). CONCLUSIONS: The wellness programme shows improvement in PWI scores, indicating the programme content should be evaluated further for system level improvements.

Studying intersectionality using ideological dilemmas: The case of paid domestic labour.

Intersectionality has gained a great deal of academic purchase within the social sciences but there is still a need for further conceptual and methodological innovation and clarity. As such, this study uses paid domestic labour as a case study to apply Billig et al.'s (Ideological dilemmas: A social psychology of everyday thinking, 1988) notion of ideological dilemmas to explore the common sense that paid domestic workers draw on to position themselves as women and workers. The analysis highlights how participants use (often contradictory) themes of common sense when speaking about their place in the household through dilemmas of servitude, belonging, and intimacy. Speakers draw on gendered ideology, not as a fixed set of ideas, but rather as a mobile discursive resource that can be deployed in situ, allowing them to justify, subvert, and evaluate social positions of domestic womanhood. The study provides both a conceptual window and a robust method for studying nonessentialist intersectionality through ideological dilemmas.

Exploring experiences with alcohol and how drinking has changed over time among minority ethnic groups with a diagnosed mental health problem.

INTRODUCTION: Minority ethnic groups are more likely to experience poor mental health but less likely to seek formal support. Mental health problems and alcohol use (including non-drinking) co-occur, the reasons for this among minority ethnic groups are not well understood. This study explored i) alcohol use among minority ethnic individuals with a mental health problem,ii) how alcohol was used before individuals received support for their mental health,iii) how alcohol changed whilst and after individuals received treatment for their mental health. METHODS: Participants were purposively sampled through community/online mental health organisations. Participants took part if they i)were not White British, ii) had a mental health diagnosis, iii) drank at hazardous and above levels or former drinkers. Telephone/online semi-structured interviews were conducted. Data were analysed using framework analysis with an intersectional lens. RESULTS: 25 participants took part. Four themes were developed; "drinking motivations", "mental health literacy and implications on drinking behaviour", "cultural expectations and its influence on mental health problems and drinking practices", and "reasons for changes in drinking". Themes reflect reasons for drinking and the role of understanding the range of mental health problems and implicit cultural expectations. An intersectional lens indicated gendered, ethnic and religious nuances in experiences with alcohol and seeking support. Engaging with formal support prompted changes in drinking which were facilitated through wider support. CONCLUSION: There were specific reasons to cope among minority ethnic individuals who have a mental health problem. Applying an intersectional lens provided an insight into the role of cultural and gendered expectations on mental health and drinking practices. Mental health literacy and implicit cultural expectations within specific minority ethnic groups can affect both mental health and drinking practices. Healthcare professionals and wider community play an important role in prompting changes in drinking among minority ethnic groups who have a mental health problem.

Gender, race, and space: A qualitative exploration of young Black women's perceptions of urban neighborhoods.

How people think and feel about their neighborhood impacts the way they think of themselves and their futures. These linkages are especially important to understand in the case of urban-residing young Black women. Researchers know very little about what contributes to young Black adults' urban neighborhood perceptions and often rely on "expert" definitions of markers of neighborhood quality. These definitions and subsequent explorations of residents' neighborhood assessment have not adequately considered intersecting oppressive systems that structure urban spaces both physically and socially. Further, within-group diversity of young Black adults based on other social identities, such as gender and class, has gone underexplored in research on residents' neighborhood assessment. We used theory from Black feminist geography and sociology to guide our thematic analysis of interviews with young Black women (N = 9) regarding their urban neighborhood quality. We sought to explore the aspects or features of the neighborhood that young Black women discussed and how social identities may play a role in young Black women's descriptions of their urban neighborhoods. We argue three themes tell an overarching story of young Black women's urban spatial critical analysis: (1) outsiders' perceptions versus our realities, (2) gendered safety, and (3) visibility of young Black women. Young Black women's narratives highlighted communal aspects of neighborhood evaluation and attention to dominant narratives regarding marginalized groups and urban spaces.

Enfoques extras disciplinarios para aproximar la brecha teoría y práctica: Pierre Bourdieu y la interseccionalidad / Abordagens extra-disciplinares para colmatar o fosso entre a teoria e a prática: Pierre Bourdieu e a interseccionalidade / Extra-disciplinary approaches to bridging the theory-practice gap: Pierre Bourdieu and intersectionality

En esta editorial el autor reflexiona acerca de la dicotomía teoría/práctica y como la integración de teorías transdisciplinarias pueden contribuir a acercar posturas. Para ello comenta la teoría de la práctica desarrollada por Bourdieu y la interseccionalidad aportando un ejemplo de como su interconexión puede mejorar tanto la teoría como la práctica de la enfermería y por tanto contribuyendo a su vertebración y epistemología.(AU)

In this editorial the author reflects on the theory/practicedichotomy and how the integration of transdisciplinarytheories can help to bring positions closer together. To doso, he discusses the theory of practice developed by Bourdieuand intersectionality, providing an example of how theirinterconnection can improve both the theory and practice ofnursing and thus contribute to its structuring and epistemology.(AU)

Neste editorial o autor reflecte sobre a dicotomia teoria/práticae como a integração de teorias transdisciplinares pode ajudar aaproximar posições. Para isso, discute a teoria da prática desenvolvidapor Bourdieu e a interseccionalidade, exemplificando como a suainterligação pode melhorar a teoria e a prática da enfermageme, assim, contribuir para a sua estruturação e epistemologia.(AU)

Exploring the healthcare access challenges faced by visually impaired young women in Nepal: Navigating sexual harassment and stigma within healthcare settings.

Introduction: Despite global progress in gender equality, still not every woman has access to safe and the highest quality health care. Visually impaired young adult women represent one of the most vulnerable groups with a poorer ability to access necessary healthcare services. This study aims to explore and comprehend the experiences of visually impaired young adult women in accessing healthcare services in Nepal. Methods: A descriptive phenomenological study was conducted among 16 visually impaired women aged 20 to 35 years who had utilized healthcare services within the past 12 months. Face-to-face, in-depth interviews were conducted for data collection, and thematic analysis was conducted for data analysis. Results: Our study revealed a range of challenges faced by visually impaired young women that impeded their healthcare-seeking. These challenges included sexual harassment by male healthcare providers, disability-related stigma, financial difficulties, limited autonomy in decision-making, and a lack of disability-friendly healthcare facilities and services. Particularly, experiencing sexual harassment from male healthcare providers, coupled with underlying disability-related stigma, profoundly influenced the avoidance of healthcare. To navigate these challenges, some women sought support by having family members or friends accompany them or by requesting to be seen by a female healthcare provider. Nevertheless, financial dependence on families and women lacking employment and income led to a feeling of burden on the family, contributing to a reluctance among women to seek expensive healthcare. Social organization-based, collaborative efforts and peer support networks played a significant role in breaking down barriers and improving overall healthcare experiences. Conclusions: While integrating disability-friendly healthcare services and infrastructure is essential, fostering attitudinal and behavioral change-particularly among male healthcare providers-is more important to ensure safety for young women in healthcare settings. The implementation of anti-sexual harassment policies is imperative to ensure a safe and respectful environment. Community mobilizing and peer group-based programs can be tested for increasing visually impaired women's utilization of relevant healthcare services.