Dietary Behaviour and Sociocultural Determinants of Dietary Diversity among Rural Women of Reproductive Age: A Case of Amhara Region, Ethiopia.

Women of reproductive age have specific nutritional requirements due to pregnancy and lactation. Little is known about the sociocultural determinants of dietary diversity among women of reproductive age. This study assesses trends of dietary behaviour and associated determinants of dietary diversity of women of reproductive age. A community-based cross-sectional study was conducted in the Amhara region of Ethiopia in 2019. Using multistage systematic random sampling, the dietary diversity of n = 421 women of reproductive age was assessed by a qualitative 24 h dietary recall. Descriptive analysis revealed characteristics of dietary behaviour and a chi-square test enabled the identification of associated determinants of women's dietary diversity. Only about a quarter (26.8%) of the women consumed five or more food groups per day and met the minimum dietary diversity score (MDD-W). Drawing on the socioecological framework, at an intrapersonal/individual level, women's education, age, perception of nutritious diet, and frequency of consumption of animal-sourced foods, vegetables, and fruit were significantly associated with MDD-W. At an interpersonal/household level, the husbands' education, women's decision-making regarding food purchase/consumption, the family's actual eating occasion, and women's engagement in domestic and farming tasks were significantly associated with MDD-W. At a community level, access to clean water and especially cultural beliefs were significant determinants of MDD-W. Amharic proverbs and sayings prioritise men and pose severe restrictions on women regarding food allocation. The majority (76.7%) of women of reproductive age practise frequent religious fasting, relating to the institutional/national level. This undermines efforts to support healthy dietary behaviour of women of reproductive age. Indepth studies on religious and cultural practices are needed, to assess not only their negative effects on the dietary diversity of women of reproductive age but also on women's lives.

Perceptions of Health Insurance Among Self-employed Korean Immigrants From South Korea in the United States.

Korean Americans in the United States are more likely than other Asian ethnic groups to lack health insurance despite their high education and economic prosperity. According to the model of health service selection, immigrants' perceptions of the health care system and health care behaviors in their host country are affected by sociocultural referents including premigration health care experience in the country of origin. This study explored Korean immigrants' perceptions of health insurance and their intentions to purchase and maintain health insurance in the United States. We conducted in-depth interviews with 24 self-employed Korean immigrants who migrated from South Korea and were living in the Greater Los Angeles area in 2015. Participants generally had negative perceptions of U.S. health insurance in terms of cost, benefits, simplicity, and accessibility. Coupled with their positive experiences with the single-payer, universal health insurance in South Korea, respondents evaluated U.S. health insurance as not worth purchasing, and indicated they would not maintain health insurance once the individual mandate of the Affordable Care Act was abolished. On the contrary, respondents who immigrated prior to the establishment of the Korean universal health insurance in South Korea were relatively satisfied with U.S. health insurance and had maintained health insurance for substantial periods of time. Korean immigrants' premigration health care experiences appeared to influence their decisions to purchase health insurance in the United States and their intention to maintain health insurance. The study findings highlight the necessity of tailored health education that takes into account sociocultural determinants of health coverage among immigrants.

COVID-19 y Justicia Social. Un enfoque sindémico de la resistencia a la vacunación / COVID-19 i Justícia social: un enfocament sindèmic de la resistència a la vacunació / COVID-19 and Social Justice: A syndemic approach to vaccine hesitancy

The effects of COVID-19 pandemic depend on socio-cultural determinants that shield some individuals or groups from the most severe effects or make others more vulnerable to suffering harms to their health, social position, or economic stability. The case of vaccination is symptomatic of how specific groups suffer a higher degree of vulnerability due to socioeconomic inequalities and cultural determinants. Consequently, vaccine hesitancy among these groups might deepen the vulnerabilities, which is why it is necessary to design strategies that, while confronting vaccine hesitancy, do not ignore those structural inequalities which could continue feeding skepticism and resistance to vaccination, if unattended. In this work we claim that public health policies focused on promoting vaccination may benefit from a syndemic approach that considers the synergies between diseases and socioeconomic and cultural determinants. This implies introducing social justice issues into the planning of public health strategies. By critically analyzing the work of bioethicist Norman Daniels —who goes over the moral importance of public health from an interpretation of John Rawls’ theory of justice—we explore the criticism to justice as fairness made by the communitarian and the politics of difference standpoints (specifically, I. M. Young), to show that a syndemic approach to public health is essential to achieve complete vaccination: the design of strategies will have to consider the specific contexts of vaccine hesitant groups, to achieve efficiency vaccinating in the short, medium and long term.(AU)

Las afectaciones por la pandemia de COVID-19 dependen de determinantes socio-culturales que blindan a algunos individuos o grupos de los efectos más severos o vuelven a otros más susceptibles de sufrir daños a su salud, posición social o estabilidad económica. El caso de la vacunación es sintomático de cómo grupos específicos sufren mayor vulnerabilidad por inequidades socioeconómicas y determinantes culturales. Consecuentemente, la resistencia a la vacunación entre estos grupos puede profundizar la vulnerabilidad, por lo que es necesario diseñar estrategias que, al confrontar la resistencia a la vacunación, no dejen de lado aquellas inequidades estructurales que, de no atenderse, seguirán alimentando la suspicacia y renuencia a vacunarse. En este trabajo sostenemos que las políticas de salud pública enfocadas a promover la vacunación pueden beneficiarse de un enfoque sindémico que considere las sinergias entre enfermedades y determinantes socioeconómicas y culturales. Esto implica introducir problemas de justicia social en la planificación de estrategias de salud pública. Haciendo un análisis crítico del trabajo del bioeticista Norman Daniels —quien aborda la importancia moral de la salud pública desde una interpretación de la teoría de la justicia de John Rawls—retomamos las críticas a la justicia como imparcialidad de las posturas comunitarista y delas políticas de la diferencia (específicamente I. M. Young), para mostrar que un enfoque sindémico de la salud pública es indispensable para lograr una vacunación completa: el diseño de estrategias tendrá que considerar los contextos específicos de grupos renuentes a vacunarse para lograr eficiencia a corto, mediano y largo plazo.(AU)

Les afectacions per la pandèmia de COVID-19 depenen de determinants socioculturals que blinden a alguns individus o grups dels efectes més severs o tornen a uns altres més susceptibles de sofrir danys a la seva salut, posició social o estabilitat econòmica. El cas de la vacunació és simptomàtic de com grups específics sofreixen major vulnerabilitat per inequitats socioeconòmiques i determinants culturals. Conseqüentment, la resistència a la vacunació entre aquests grups pot aprofundir la vulnerabilitat, per la qual cosa és necessari dissenyar estratègies que, en confrontar la resistència a la vacunació, no deixin de costat aquelles inequitats estructurals que, de no atendre's, continuaran alimentant la suspicàcia i renuència a vacunar-se. En aquest treball sostenim que les polítiques de salut pública enfocades a promoure la vacunació poden beneficiar-se d'un enfocament sindèmic que consideri les sinergies entre malalties i determinants socioeconòmiques i culturals. Això implica introduir problemes de justícia social en la planificació d'estratègies de salut pública. Fent una anàlisi crítica del treball del bioeticista Norman Daniels —qui aborda la importància moral de la salut pública des d'una interpretació de la teoria de la justícia de John Rawls—reprenem les crítiques a la justícia com a imparcialitat de les postures comunitarista i de les polítiques de la diferència (específicament I. M. Young), per a mostrar que un enfocament sindèmic de la salut pública és indispensable per a aconseguir una vacunació completa: el disseny d'estratègies haurà de considerar els contextos específics de grups renuents a vacunar-se per a aconseguir eficiència a curt, mitjà i llarg termini.(AU)

Sociocultural overview and predisposing factors of body art in a health promotion perspective: survey on a sample of Italian young adults.

Background: The body art (tattoos, body piercing and other aesthetic practices) is increasing at global level and involves different aspects of public health, from epidemiological feature to cultural and psychosocial determinants and regulatory issues. The study is aimed at estimating the prevalence of tattooed and pierced in youth, focusing on emerging profiles. Study design: A cross-sectional study has been conducted on 575 students at the first year of degree courses of an Italian University. Methods: Students were asked to fill an online questionnaire. Logistic regression models were evaluated in order to identify predictive factors and determinants of practice (tattoos, piercing, body art). Results: The 41.9% of participants underwent at least one body art intervention, with a higher prevalence in females. Multivariate logistic regression suggested an association of body art practice with type of school and university course, as well as lifestyle characteristics (smoking, alcohol abuse). In addition, the intention to undergo to body art intervention in the future appeared significantly higher in women and more frequent in apparently 'protected' categories such as medical students and non-problematic alcohol users. Conclusions: The study confirmed the importance of the surveillance and social and behavioural research on body art practice and suggested different health promotion perspectives, such as early intervention towards adolescents and late intervention towards young adults belonging to lesser risky population groups.

The pattern and socio-cultural determinants of intimate partner violence in a Nigerian rural community.

BACKGROUND: Intimate partner violence (IPV) refers to a violation of women's reproductive rights as it impacts on their sexual and reproductive health autonomy. AIM: In this study, we aimed at assessing the pattern of IPV and the socio-cultural determinants and predictors of partner violence in a rural community setting where the bulk of the abuse prevails. SETTING: This study was conducted in a rural community in Southern Nigeria. METHODS: This study employed a mixed method comprising seven focus group discussions (FGDs) and quantitative components. The cross-sectional survey was conducted amongst 209 ever married or cohabited females in 2018 using the World Health Organization (WHO) multi-country survey questionnaire adapted to the study objectives. Data analysis was conducted by using IBM SPSS v21.0. The level of significance was set at p 0.05. RESULTS: The overall IPV prevalence was 79.4%. The prevalence of partner's controlling behaviour, emotional IPV, physical IPV and sexual IPV was 62.6%, 55.98%, 49.3% and 2.6%, respectively. Membership of an interest group was protective against IPV (OR = 0.430, 95% CI = 0.193-0.957) whilst the belief that a good wife obeys her partner even if she disagrees (OR = 9.201, 95% CI = 1.299-65.194) and the belief that it is the wife's obligation to have sex with the husband even if she doesn't feel like (OR = 2.356, 95% CI = 1.049-5.288) were risk factors. CONCLUSION: The burden of IPV in the studied rural community is enormous. There should be public enlightenment to desensitise people regarding the erroneous views that encourage partner violence. We encourage women to become a part of social groups that can enhance their education and empowerment.

Challenges encountered in community-based physiotherapy interventions for urinary incontinence among women in rural areas of Anand District of Gujarat, India.

BACKGROUND: It is necessary to understand the way women think about their health. There is a "culture of silence" among women regarding urinary incontinence (UI). Physiotherapy is proven effective mode of therapy in case of UI. OBJECTIVES: This study aimed to explore the attitude of the women toward UI, to understand the related sociocultural factors and health-seeking behavior, and to ascertain the challenges encountered in community-based physiotherapy interventions. METHODS: A qualitative study was conducted among women who refused to participate in a physiotherapy intervention for UI in the rural community of Gujarat, India. Fourteen in-depth key informant interviews were conducted using an interview guide. The responses were noted and compiled into a composite interview script. Interviews were not recorded due to nonavailability of consent. Interviews were reviewed by investigators and content analysis was carried out. Key themes were identified after multiple iterations. RESULTS: Most of the women were unaware of the UI and believed that it may be due to their gender or due to aging. Physiotherapy interventions were disregarded due to various reasons such as shy nature, lack of priority and privacy, dependency, self-neglect, and influence of social and cultural norms. CONCLUSION: Cultural and social systems were more important determinants of health seeking than health systems themselves particularly when sensitive issue such as UI in women of rural Western India was concerned.

Qualitative exploration of sociocultural determinants of health inequities of Dalit population in Dhaka City, Bangladesh.

OBJECTIVES: In recent years, Bangladesh has made remarkable advances in health outcomes; however, the benefits of these gains are unequally shared among citizens and population groups. Dalits (jaat sweepers), a marginalised traditional working community, have relatively poor access to healthcare services. This study sought to explore the sociopolitical and cultural factors associated with health inequalities among Dalits in an urban setting. DESIGN: An exploratory qualitative study design was adopted. Fourteen in-depth interviews, five focus group discussions and seven key informant interviews were conducted. The acquired data were analysed using an iterative approach which incorporated deductive and inductive methods in identifying codes and themes. SETTINGS: This study was conducted in two sweeper communities in Dhaka city. PARTICIPANTS: Participants were Dalit men and women (in-depth interviews, mean age±SD 30±10; and focus group discussions), and the community leaders and non-governmental organisation workers (key informant interviews). RESULTS: The health status of members of these Dalit groups is determined by an array of social, economic and political factors. Dalits (untouchables) are typically considered to fall outside the caste-based social structure and existing vulnerabilities are embedded and reinforced by this identity. Dalits' experience of precarious access to healthcare or poor healthcare is an important manifestation of these inequalities and has implications for the economic and social life of Dalit populations living together in geographically constrained spaces. CONCLUSIONS: The provision of clinical healthcare services alone is insufficient to mitigate the negative effects of discriminations and to improve the health status of Dalits. A better understanding of the precise influences of sociocultural determinants of health inequalities is needed, together with the identification of the strategies and programmes needed to address these determinants with the aim of developing more inclusive health service delivery systems.

Sociocultural Determinants of Risky Sexual Behaviors among Adult Latinas: A Longitudinal Study of a Community-Based Sample.

Few studies have examined the sociocultural determinants of risky sexual behavior trajectories among adult Latinas. To longitudinally examine the link between sociocultural determinants of risky sexual behaviors, we followed a sample of adult Latina mother-daughter dyads (n = 267) across a 10-year span through four waves of data collection. The present study investigates how risky sexual behavior (operationalized as sex under the influence of alcohol or other drugs, sex without a condom, or multiple sex partners) is affected by: (a) socioeconomic conditions; (b) mental health; (c) medical health; (d) acculturation to U.S. culture; (e) interpersonal support; (f) relationship stress; (g) mother-daughter attachment; (h) intimate partner violence; (i) religious involvement; and (j) criminal justice involvement. Results indicate the following factors are negatively associated with risky sexual behavior: drug and alcohol use, treating a physical problem with prescription drugs, religious involvement, and mother-daughter attachment. The following factors are positively associated with risky sexual behavior: higher number of mental health symptoms, being U.S.-born, and criminal justice involvement. We discuss implications for the future development of culturally relevant interventions based on the study findings.

Experiencia y percepciones de la diabetes gestacional y su automanejo en un grupo de mujeres multíparas con sobrepeso / Experiences, perceptions and self-management of gestational diabetes in a group of overweight multiparous women

La diabetes mellitus gestacional (DMG) es un problema de salud pública en México, cuya primer línea de tratamiento es la dietoterapia. Se requieren habilidades de automanejo para el control de la enfermedad. En este trabajo se estudiaron cinco mujeres con DMG, quienes manifestaron su percepción de riesgo de la presencia de la DMG y vivencias en algunas prácticas del autocuidado. Se obtuvieron datos sociodemográficos; se realizaron entrevistas en profundidad, las cuales se analizaron con el paquete Atlas ti V.5. Los resultados demuestran que las mujeres están conscientes del papel que juega la alimentación y la actividad física en mejorar el control de su enfermedad, además de los riesgos perinatales a los que se asocia la DMG. El cumplimiento de las recomendaciones dietéticas en su mayoría fue parcial, pero se demuestran cambios positivos y graduales en el estilo de vida. Las percepciones desde las emociones que les produce la DMG, fue factor clave para que llevaran a cabo la dieta. En conclusión, el tratamiento médico y dietético influye en el comportamiento cultural alimentario de las mujeres con DMG. Los profesionales de la salud deben tomar en cuenta los determinantes socioculturales al diseñar e implementar estrategias de tratamiento.

Gestational diabetes mellitus (GDM) is a public health problem in Mexico and diet therapy is the main form of treatment. Self-management abilities are required to control the disease. Five women with GDM were studied to assess GDM risk perception and experiences related with self-management practices. Sociodemographic data were obtained and in-depth interviews were conducted and subsequently analyzed using Atlas ti V.5 software. The results revealed that women were conscious regarding the role of diet and physical activity in improving GDM control, and about the perinatal risks associated with the disease. Adherence to diet recommendations was partial, but gradual and positive lifestyle changes were observed. Emotionally, perception about having GDM was a key factor with respect to adhering to the diet. In conclusion, the medical and dietary treatment influences the cultural food behavior of women with GDM. Health professionals should consider sociocultural determinants when designing and implementing treatment strategies.