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1.
J. Health Biol. Sci. (Online) ; 10(1): 1-12, 01/jan./2022.
Artigo em Português | LILACS | ID: biblio-1367660

RESUMO

Objetivos: contribuir para a geração de dados de avaliação econômica de estratégias de empoderamento farmacoterapêutico para pacientes com Diabetes Mellitus tipo 2 (DM tipo 2). Métodos: este estudo farmacoeconômico é aninhado a um ensaio clínico com controle não randomizado que incluiu pacientes ≥18 anos de idade, cadastrados no HIPERDIA. Os pacientes foram alocados em um modelo de Markov conforme valores de hemoglobina glicada do acompanhamento. As probabilidades do surgimento de complicações relativas ao DM, incluindo-se óbito, foram estimadas por dez anos. Cada complicação do DM tipo 2 teve seu custo estabelecido para determinação do custo anual. Resultados: entre os participantes da intervenção, não ocorrem óbitos ocasionados por DM tipo 2, e a progressão de complicações mantém-se estável durante os anos simulados, enquanto, no grupo controle, 60% dos pacientes podem evoluir para óbito nos dez anos, e a probabilidade de serem acometidos por complicações relacionadas ao DM tipo 2 é crescente. Com relação aos custos, ao final de dez anos, os pacientes que participaram da Estratégia Individual de Empoderamento Farmacoterapêutico (EIEF) tiveram um custo médio de UU$134,45 poupando a vida de 100% dos pacientes, e os pacientes do atendimento convencional um custo médio de UU$237,12 e 40% dos pacientes acompanhados chegariam ao final do ciclo com vida. Conclusão: a EIEF parece ser uma alternativa economicamente viável em longo prazo, bem como para a promoção do controle glicêmico.


Objectives: contribute to the data generation for the economic evaluation of pharmacotherapeutic empowerment strategies for type 2 diabetes mellitus patients (type 2 DM). Method: This pharmacoeconomic study is nested in a clinical trial with non-randomized control that included patients ≥18 years old, registered in HIPERDIA. The patients were allocated to a Markov model according to the follow-up glycated hemoglobin values. The probabilities of the appearance of complications related to DM, including death, have been estimated for ten years. Each complication of type 2 DM had its cost established to determine the annual cost. Results: Among the participants in the intervention, there are no deaths caused by type 2 DM, and the progression of complications remains stable during the simulated years, whereas in the control group, 60% of the patients can progress to death in ten years and the probability of being affected by complications related to type 2 DM is increasing. Regarding costs, at the end of ten years, patients who participated in Individual Pharmacotherapeutic Empowerment Strategy (IPES) had an average cost of US$ 134.45, saving 100% of patient's lives, and conventional care patients cost an average of US$ 237.12 and 40% of the patients followed would reach the end of the life cycle. Conclusion: The IPES seems like an economically viable and long-term economic alternative and promotes glycemic control.


Assuntos
Diabetes Mellitus , Análise Custo-Benefício , Custos e Análise de Custo , Empoderamento , Controle Glicêmico
2.
BMC Health Serv Res ; 22(1): 969, 2022 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-35906642

RESUMO

BACKGROUND: Traditional antenatal care (ANC) models often do not meet women's needs for information, counseling, and support, resulting in gaps in quality and coverage. Group ANC (GANC) provides an alternative, person-centered approach where pregnant women of similar gestational age meet with the same health provider for facilitated discussion. F studies show associations between GANC and various outcomes. METHODS: We employed a pre-post quasi-experimental design using mixed methods to assess a GANC model (Lea Mimba Pregnancy Clubs) at six health facilities in Kakamega County, Kenya. Between April 2018 and January 2019, we tracked 1652 women assigned to 162 GANC cohorts. Using an intention-to-treat approach, we conducted baseline (N = 112) and endline surveys (N = 360) with women attending immunization visits to assess outcomes including experience of care, empowerment and self-efficacy, knowledge of healthy practices and danger signs, and practice of healthy behaviors, including ANC retention. At endline, we conducted 29 in-depth interviews (IDIs) and three focus group discussions with women who were currently and previously participating in GANC, and 15 IDIs with stakeholders. RESULTS: The proportion of survey respondents with knowledge of three or more danger signs during pregnancy more than tripled, from 7.1% at baseline to 26.4% at endline (OR: 4.58; 95% CI: 2.26-10.61). We also found improvements in women's reports about their experience of care between baseline and endline, particularly in their assessment of knowledge and competence of health workers (OR: 2.52 95% CI: 1.57-4.02), respect shown by ANC providers (OR: 1.82, 95% CI: 1.16-2.85), and women's satisfaction with overall quality of care (OR: 1.62, 95% CI: 1.03-2.53). We saw an increase from 58.9% at baseline to 71.7% at endline of women who strongly agreed that they shared their feelings and experiences with other women (OR: 1.73, 95% CI: 1.1-2.7). The mean number of ANC visits increased by 0.89 visits (95% CI: 0.47-1.42) between baseline (4.21) and endline (5.08). No changes were seen in knowledge of positive behaviors, empowerment, self-efficacy, and several aspects related to women's experience of care and adoption of healthy behavior constructs. Qualitatively, women and stakeholders noted improved interactions between health providers and women, improved counseling, increased feelings of empowerment to ask questions and speak freely and strengthened social networks and enhanced social cohesion among women. CONCLUSIONS: GANC offers promise for enhancing women's experience of care by providing improved counseling and social support. Additional research is needed to develop and test measures for empowerment, self-efficacy, and experience of care, and to understand the pathways whereby GANC effects changes in specific outcomes.


Assuntos
Gestantes , Cuidado Pré-Natal , Aconselhamento , Empoderamento , Feminino , Humanos , Quênia , Gravidez , Gestantes/psicologia
3.
PLoS One ; 17(7): e0271123, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35877669

RESUMO

Just a decade ago Vision and Change in Undergraduate Biology Education: A Call to Action was released, catalyzing several initiatives to transform undergraduate life sciences education. Among these was the Partnership for Undergraduate Life Sciences Education (PULSE), a national organization commissioned to increase the adoption of Vision and Change recommendations within academic life sciences departments. PULSE activities have been designed based on the recognition that life sciences departments and faculty are embedded within institutions of higher education which, similar to other large organizations, are complex systems composed of multiple, interconnected subsystems. The organizational change research suggests that effecting large-scale changes (e.g., undergraduate STEM education transformation) may be facilitated by applying systems thinking to change efforts. In this paper we introduce the approach of systems thinking as a professional development tool to empower individual STEM faculty to effect department-level transformation. We briefly describe a professional development experience designed to increase life sciences faculty members' understanding of systems thinking, present evidence that faculty applied a systems thinking approach to initiate department-level change, and discuss the degree to which transformation efforts were perceived to be successful. Though focused on faculty in the life sciences, our findings are broadly transferable to other efforts seeking to effect change in undergraduate STEM education.


Assuntos
Disciplinas das Ciências Biológicas , Docentes , Disciplinas das Ciências Biológicas/educação , Empoderamento , Docentes/psicologia , Humanos , Análise de Sistemas , Universidades
4.
Proc Natl Acad Sci U S A ; 119(25): e2117155119, 2022 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-35714290

RESUMO

This paper provides a picture of how societies in the G7 countries have responded to the COVID-19 pandemic. Our point of departure is to examine the effects of the pandemic in terms of four fundamental normative sources for well-being: Solidarity (S; willingness for social cooperation), Agency (A; empowerment to shape one's prospects through one's own efforts), GDP (G), and Environmental Performance (E)-SAGE for short. The normative foundations of SAGE are communitarianism, classical liberalism, materialistic utilitarianism, and ecoethics. We find that although G and E responded predictably and uniformly to the pandemic (such as G declining and carbon emissions improving), the societal responses were strikingly different. Societies that are cohesive and empowered (high S and A) may be expected to cope with the pandemic better than those that are fragmented and disempowered (low S and A). Furthermore, the pandemic has had diverse effects on S and A; while some societies became cohering and empowering (rising S and A), others became fragmenting and disempowering (falling S and A), and yet others became fragmenting and empowering. We also show that most G7 countries experienced greater tribalization (measured as the difference between inward S and outward S) during the pandemic. These trends are a matter of concern since they suggest that the willingness and perceived ability to address collective challenges collectively have waned. The analysis also suggests that governments' social policies may have an important role to play alongside economic and health policies in coping with the pandemic.


Assuntos
COVID-19 , Pandemias , Política Pública , Comportamento Social , Adaptação Psicológica , COVID-19/economia , COVID-19/psicologia , Comportamento Cooperativo , Empoderamento , Produto Interno Bruto , Humanos , Responsabilidade Social
5.
Perspect Public Health ; 142(4): 231-236, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35766316

RESUMO

AIMS: Co-production is an emerging field in public health practice. We aim to present evidence of what works well to support co-production and what can be improved based upon learning from our evaluation of a co-production project implemented by Rape Crisis England and Wales (RCEW). RCEW designed and delivered a national co-production project called Weaving the Web, to inform the development of an online support service for women who have experienced sexual violence. METHODS: We qualitatively evaluated the RCEW co-production approach. The specific objectives of our evaluation were to assess the increased role and voice for women and girls in co-producing services and provide better quality of evidence for what works in empowering women and girls. The evaluation was conducted in two phases: Phase 1 was the observation of co-production events (n = 8), with findings from this used to develop an interview schedule for Phase 2, where semi-structured interviews (n = 26) were conducted with a range of stakeholders (staff, partners and service users). RESULTS: Staff supporting the co-production project were highly committed to the work, investing time, money, and preparation, and having a good understanding of co-production. Service users were less familiar with the approach and felt alienated by some of the language used. Most service users described participation as empowering and, in some instances, important in their own recovery. They were keen to stay involved beyond the creation of the online resource. CONCLUSION: The data from our evaluation illustrate that co-production on a national level is challenging. While RCEW used values-based practice, and provided a supportive culture to underpin the co-production of their online service, transformative engagement and true participation were not achieved. Learning from this project is drawn out here to outline transferrable lessons for practitioners intending to use models of co-production in other public health settings.


Assuntos
Empoderamento , Delitos Sexuais , Serviços de Saúde da Mulher , Inglaterra , Feminino , Humanos , País de Gales
6.
Health Expect ; 25(4): 1882-1891, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35644908

RESUMO

INTRODUCTION: Empowerment of families raising children with developmental disabilities (DDs) is essential to achieving rights-based service development. METHODS: In this qualitative study, we investigated stakeholder perceptions on the role of advocacy and empowerment in developing caregiver interventions for families of children with DDs in a global context. Participants had experience with at least one intervention, namely the Caregiver Skills Training developed by the World Health Organization (WHO). Participants were clinicians, caregivers and researchers representing five continents, and representatives of WHO and Autism Speaks. Two focus group discussions and 25 individual interviews were conducted. Data were analysed thematically. RESULTS: Three themes were developed: empowerment as independence and as a right; the role and practices of advocacy; and using evidence to drive advocacy. Many professional participants defined empowerment within the realms of their expertise, focusing on caregivers' individual skills and self-confidence. Caregivers expressed that this expert-oriented view fails to acknowledge their intuitive knowledge and the need for community-level empowerment. Participants discussed the challenges of advocacy in light of competing health priorities. The gap between the rights of caregivers and the availability of services, for example, evidence-based interventions, was highlighted as problematic. Scientific evidence was identified as a key for advocacy. CONCLUSION: Rights-orientated empowerment of caregivers and advocacy may make vital contributions to service development for children with DDs in contexts worldwide. PATIENT AND PUBLIC CONTRIBUTION: Research questions were revised based on views presented during focus group discussions. Participant feedback on preliminary themes informed the development of the interview guides.


Assuntos
Defesa da Criança e do Adolescente , Atenção à Saúde , Deficiências do Desenvolvimento , Empoderamento , Cuidadores/educação , Criança , Atenção à Saúde/normas , Deficiências do Desenvolvimento/terapia , Família , Grupos Focais , Humanos , Internacionalidade , Defesa do Paciente , Pesquisa Qualitativa
8.
J Prev Med Public Health ; 55(2): 193-204, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35391531

RESUMO

OBJECTIVES: The primary objective of this study was to examine the effect of women's empowerment on the immunization of Indonesian children. The secondary objective was to examine the effect of wealth as a factor modifying this association. METHODS: We utilized data from the 2017 Indonesian Demographic and Health Survey (IDHS). The subjects were married women with children aged 12-23 months (n=3532). Complete immunization was defined using the 2017 IDHS definition. Multiple components of women's empowerment were measured: enabling resources, decision-making involvement, and attitude toward intimate partner violence. The primary analysis was conducted using binomial logistic regression. Model 1 represented only the indicators of women's empowerment and model 2 controlled for socio-demographic variables. Subgroup analyses were conducted for each wealth group. RESULTS: The primary analysis using model 1 identified several empowerment indicators that facilitated complete immunization. The analysis using model 2 found that maternal education and involvement in decision-making processes facilitated complete immunization in children. Subgroup analyses identified that wealth had a modifying effect. The indicators of women's empowerment were strong determinants of complete immunization in lower wealth quintiles but insignificant in middle-income and higher-income quintiles. CONCLUSIONS: To our knowledge, this study is the first to explore women's empowerment as a determinant of child immunization in Indonesia. The results indicate that women's empowerment must be considered in Indonesia's child immunization program. Women's empowerment was not found to be a determinant in higher wealth quintiles, which led us to rethink the conceptual framework of the effect of women's empowerment on health outcomes.


Assuntos
Tomada de Decisões , Empoderamento , Criança , Estudos Transversais , Feminino , Humanos , Imunização , Indonésia
9.
BMC Pregnancy Childbirth ; 22(1): 351, 2022 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-35459098

RESUMO

BACKGROUND: Maternal health literacy is defined as the acquisition of required cognitive and social skills to enable women to access, understand, appraise, and use the information needed to maintain and enhance their health conditions. The World Health Organization (WHO) proposes health literacy and women empowerment as two pivotal components of maternal health improvement programs. In this regard, providing women with education and training in various fields is a key factor for their empowerment, prosperity, and well-being. Therefore, the present study aimed to determine the relationship between health literacy and empowerment during pregnancy. METHODS: This descriptive-analytical cross-sectional study examined 355 pregnant women, presented to different health centers in Sanandaj, Iran, in 2021. The cluster technique was used for sampling. For data collection, the socio-demographic and obstetrics characteristics, health literacy, and pregnant women's empowerment questionnaires were completed by interviewing research subjects. Data analysis was done using t-test, one-way ANOVA, Pearson correlation coefficient, and multivariate linear regression in STATA13. RESULTS: The mean and standard deviation of health literacy and empowerment were 80.03 ± 12.79 (0-100) and 80.30 ± 8.14 (27-108), respectively. In terms of empowerment, the highest (19.50) and the lowest (12.92) scores were, respectively, observed in subdomains of "self-efficacy" and "the joy of an addition to the family." With respect to health literacy, the highest (88.52) and lowest (73.78) mean scores were, respectively, observed in the subdomains of "understanding" and "access." Pearson correlation test suggested that there was a significant direct correlation between the overall health literacy (r = 0.26; p < 0.001) and access (r = 0.18; p = 0.001), understanding (r = 0.11; p = 0.038), evaluation (r = 0.18; p = 0.001), and decision-making (r = 0.33; p < 0.001) with empowerment during pregnancy. Based on the multivariate linear regression model, empowerment during pregnancy improved with increasing health literacy (B = 0.16, 95% CI = 0.09 to 0.23; p < 0.001). CONCLUSION: The results show a direct relationship between health literacy and its dimensions with empowerment during pregnancy. Therefore, it is recommended to improve the health literacy of all women of reproductive age.


Assuntos
Letramento em Saúde , Gestantes , Estudos Transversais , Empoderamento , Feminino , Humanos , Saúde Materna , Gravidez , Gestantes/psicologia
10.
BMC Womens Health ; 22(1): 115, 2022 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-35413906

RESUMO

BACKGROUND: Sub-Saharan Africa (SSA) bears the highest burden of Human Immunodeficiency Virus (HIV) in the world. Even though the prevention of mother to child transmission (PMTCT) programmme is one of the strategies to control the HIV pandemic, the uptake in SSA countries is low. Women's decision-making power has a positive influence on health seeking behavior and uptake of several maternal health services. However, its relationship with knowledge of PMTCT services is understudied in SSA. Therefore, this study aimed to examine the association between women's decision-making power and knowledge of PMTCT in 24 countries in SSA. METHODS: Analysis of this study included data on 158,812 married women from the Demographic and Health Surveys of 24 sub-Saharan African countries conducted between 2010 and 2020. Using Stata version-14 software, bivariate and multivariable logistic regression analyses were conducted. The results were presented using adjusted odd ratios (aOR) with the corresponding 95% confidence intervals (CI). RESULTS: In the pooled results, 69.5% (95% CI; 66.7-72.1%) of married women in the studied countries had knowledge of PMTCT, ranging from 13.9% (95% CI; 11.9-16.2%) in Comoros to 75.4% (95% CI; 73.7-76.9%) in Zimbabwe. Higher odds of PMTCT knowledge were seen among married women who had decision-making power compared to married women who had no decision-making power. Moreover, we found higher odds of PMTCT knowledge among married women with manual occupation, those in the richest households and those with 1-2 children compared to married women who were not working, from the poorest households, and those with no children, respectively. CONCLUSION: Women's decision-making power had positive influence on PMTCT knowledge. To increase the coverage of PMTCT knowledge, policy makers and other stakeholders need to target ways to empower women through increasing women's decision-making power. Moreover, creating employment opportunities and economic empowerment for women need to be considered, especially in countries with very low coverage of PMTCT knowledge.


Assuntos
Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Criança , Empoderamento , Características da Família , Feminino , Infecções por HIV/prevenção & controle , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Casamento
11.
Int J Qual Health Care ; 34(2)2022 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-35445256

RESUMO

BACKGROUND: The context related to maternal mortality has improved over the past decade in Cameroon. However, the demand for reproductive health care use remains insufficient with regard to public health policy targets, and women's empowerment is identified as a catalyst with a great potential. OBJECTIVE: This study aims to analyse the association between the dimensions of women's empowerment and the utilization of adequate reproductive health care. METHOD: The data comes from the fifth demographic and health survey of Cameroon carried out in 2018. Women's empowerment is measured through two indices: the economic status index and the decision-making index. Given the dichotomous nature of reproductive health outcomes, namely the use of at least four antenatal visits during pregnancy, the timing from the first antenatal visit and the place of delivery, a logistic regression model is adopted. RESULTS: The results suggest that an increase in the decision-making index was significantly associated with higher chances of having at least four antenatal visits during pregnancy (odds ratio [OR]: 1.25; 95% confidence interval [CI]: 1.20, 1.29), of making the first prenatal visit during the first 3 months of pregnancy (OR: 1.03; 95% CI: 1.01, 1.07) and delivery in a hospital (OR: 1.34; 95% CI: 1.29, 1.39). However, a better economic status of the woman in the household was associated with lower chances of making the first prenatal visit during the first 3 months of pregnancy (OR: 0.65; 95% CI: 0.60, 0.71) and giving birth in a hospital (OR: 0.92; 95% CI: 0.83, 1.01); but no significant association was found with the number of antenatal visits. These different associations do not remain the same when mother and household characteristics are controlled. In addition, the results illustrate the key role that education, household wealth and media exposure played in the use of reproductive health care. CONCLUSION: One of the strategic objectives of the Health Sector Strategy 2016-2027, the framework document for the public health policy in force, is to reduce maternal mortality rates by improving access to reproductive health care. To achieve this objective, this study suggests that policymakers should emphasize social policies favourable to women's empowerment in Cameroon by pointing out access to income-generating activities and decision-making within the household.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pré-Natal , Camarões , Empoderamento , Feminino , Humanos , Gravidez , Fatores Socioeconômicos
12.
PLoS One ; 17(2): e0263958, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35171939

RESUMO

BACKGROUND: Sexually transmitted infections (STIs) among women have led to substantial public health and economic burdens in several low-middle-income countries. However, there is a paucity of scientific knowledge about the relationship between empowerment and symptoms of STIs among married Bangladeshi women. This article aimed to examine the association between women empowerment and symptoms of STIs among currently married Bangladeshi women of reproductive age. MATERIALS AND METHODS: We extracted data from the Bangladesh Demographic and Health Survey (BDHS), conducted from June 28, 2014, to November 9, 2014. We utilised cross-tabulation, the conceptual framework and multivariable multilevel mixed-effect logistics regression to explore the association between women's empowerment indicators and women's self-reported symptoms of genital sore and abnormal genital discharge. All of the analysis was adjusted using cluster weight. RESULTS: We found that among 16,858 currently married women, 5.59% and 10.84% experienced genital sores and abnormal genital discharge during the past 12 months, respectively. Women who depended on husbands to make decisions regarding their health care (AOR = 0.75, 95% CI = 0.67-0.84), significant household purchases (AOR = 0.79, 95% CI = 0.71-0.88), and visiting family or relatives (AOR = 0.72, 95% CI = 0.64-0.80) were less likely to report signs of abnormal genital discharge. Women who could make joint healthcare decisions with their husbands were also less likely to report genital sores (AOR = 0.78, 95% CI = 0.67-0.90). CONCLUSION: Genital sores and abnormal genital discharge were prevalent across all parameters of women empowerment among currently married women in Bangladesh. Our estimates show that the husband plays a significant role in decision-making about sexual and reproductive health. Efforts need to be invested in establishing culturally relevant gender policies which facilitate the involvement of women in joint decision-making.


Assuntos
Tomada de Decisões , Empoderamento , Autonomia Pessoal , Comportamento Sexual/psicologia , Infecções Sexualmente Transmissíveis/epidemiologia , Cônjuges/psicologia , Adolescente , Adulto , Bangladesh/epidemiologia , Estudos Transversais , Feminino , Instalações de Saúde , Humanos , Incidência , Masculino , Casamento , Pessoa de Meia-Idade , Infecções Sexualmente Transmissíveis/psicologia , Fatores Socioeconômicos , Adulto Jovem
14.
PLoS One ; 17(2): e0263811, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35226676

RESUMO

INTRODUCTION: Intimate Partner Violence (IPV) is the most serious and pervasive yet under-recognized human rights violation in the world, particularly in Ethiopia. Hence, the objective of this study was to find the spatial distribution of IPV and its determinant factors in Ethiopia. METHODS: Secondary data analysis was conducted among 2,687 reproductive age group women (15-49 years). The distribution of IPV across the country was observed by ArcGIS software. In SaTScan software, the Bernoulli model was fitted by Kulldorff methods to identify the purely spatial clusters of IPV. Besides, Generalized Structural Equation Model (GSEM) was used to determine factors associated with each domain of IPV (physical, emotional & sexual violence). RESULT: The spatial distribution of IPV was found to be clustered in Ethiopia with Global Moran's I 0.09 (p < 0.001), and the highest IPV cluster was observed in Oromia (p < 0.001), Somali (p < 0.001) and SNNP (p<0.001) regions. Watching television and not having attitudes toward wife beating were negatively associated with physical violence. Being rich and nonsmoker were inversely associated with emotional violence. The odds of experiencing sexual violence were high among pregnant women and wives of uneducated husbands/partners. In addition, women's decision-making autonomy and husband/partner drinking alcohol have positive and negative associations with all domains of IPV respectively. CONCLUSION: There was a significant clustering of IPV in Ethiopia and the highest IPV cluster was observed in Oromia, Somali and SNNP regions. Being rich, watching television, not having attitudes toward wife beating, women's decision-making autonomy, and husband's/partner's high education and non-alcohol drinker status were negatively associated with IPV. The likelihood of experiencing IPV was also high among smokers and pregnant women. Thus, we recommend that improving the economic status of the household through social protection and empowerment of women in decision-making autonomy by education and employment and increasing community awareness about the consequences of IPV with particular emphasis on Oromia, Somali and SNNP regions is essential.


Assuntos
Empoderamento , Violência por Parceiro Íntimo , Adolescente , Adulto , Escolaridade , Etiópia , Feminino , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Masculino , Pessoa de Meia-Idade , Gravidez , Fatores de Risco
15.
BMC Pregnancy Childbirth ; 22(1): 155, 2022 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-35216564

RESUMO

BACKGROUND: The introduction of Janani Suraksha Yojana (JSY) in India, a conditional cash transfer program which incentivized women to deliver at institutions, resulted in a significant increase in institutional births. Another major health policy reform, which could have affected maternal and child health care (MCH) utilization, was the public health insurance scheme (RSBY) launched in 2008. However, there is a noticeable lack of studies that examine how RSBY had impacted on MCH utilization in India. We used data from a cohort of mothers whose delivery had been captured in both the 2005 and 2011/12 rounds of the Indian Human Development Survey (IHDS) to study the impact of health insurance (in particular, the public insurance scheme versus private insurance) on MCH access. We also investigated whether maternal empowerment was a significant correlate that affects MCH utilization. METHODS: We used the multilevel mixed-effects ordered logistic regression model to account for the clustered nature of our data. We derived indexes for women's empowerment using Principal component analysis (PCA) technique applied to various indicators of women's autonomy and socio-economic status. RESULTS: Our results indicated that the odds of mothers' MCH utilization levels vary by district, community and mother over time. The effect of the public insurance scheme (RSBY) on MCH utilization was not as strong as privately available insurance. However, health insurance was only significant in models that did not control for household and mother level predictors. Our findings indicated that maternal empowerment indicators - in particular, maternal ability to go out of the house and complete chores and economic empowerment-were associated with higher utilization of MCH services. Among control variables, maternal age and education were significant correlates that increase MCH service utilization over time. Household wealth quintile was another significant factor with mothers belonging to upper quintiles more likely to access and utilize MCH services. CONCLUSIONS: Change in women's and societal attitude towards maternal care may have played a significant role in increasing MCH utilization over the study period. There might be a need to increase the coverage of the public insurance scheme given the finding that it was less effective in increasing MCH utilization. Importantly, policies that aim to improve health services for women need to take maternal autonomy and empowerment into consideration.


Assuntos
Empoderamento , Seguro Saúde , Serviços de Saúde Materno-Infantil , Mães/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Autonomia Pessoal , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Índia , Modelos Logísticos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
16.
BMJ Glob Health ; 7(2)2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35140139

RESUMO

INTRODUCTION: Intimate partner violence (IPV) is the most common form of violence women experience globally. Economic empowerment interventions have been implemented across countries to prevent and address IPV, with mixed results. A sociological 'male-backlash' model suggests that addressing unequal gender norms is crucial to reduce IPV. This study evaluates the impact of a multipronged intervention among heterosexual couples in urban and periurban Ibadan that aimed at reducing IPV by increasing financial and reproductive literacy, fostering gender equality and improving relationship quality. METHODS: A four-arm mixed-methods cluster randomised control trial was employed. Baseline data and end line data six months postintervention were collected to estimate changes in key outcomes. In-depth interviews were conducted with 15 couples 2 years postintervention to explore the drivers of changes in outcomes. Difference-in-differences regression models were estimated to compare changes in IPV levels across the three intervention arms and control arm, and thematic analysis was conducted to understand drivers of change in IPV outcomes. RESULTS: Physical IPV decreased significantly in the gender socialisation (GS) (ß: -4.63 (SE: 2.12)) and GS and financial literacy (ß: -4.61 (SE: 2.02)) groups as compared with the control group. Changes in emotional and sexual IPV were marginally significant or insignificant, respectively, suggesting that the intervention did not have an impact on non-physical forms of IPV. In the in-depth interviews, couples reported improved communication and trust, enhanced conflict management skills, and increased mutual respect as a result of participation across intervention arms, which may have facilitated the reduction of violence in their relationships. CONCLUSION: This study highlights the potential utility of gender transformative interventions for improving physical IPV outcomes. Future research should seek to understand the mechanisms that influence sexual and emotional IPV as their aetiology may be different from physical violence. TRAIL REGISTRATION NUMBER: The study protocol was registered at ClinicalTrials.gov (ID: NCT03888495).


Assuntos
Violência por Parceiro Íntimo , Comunicação , Empoderamento , Feminino , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Masculino , Nigéria
17.
PLoS One ; 17(1): e0262323, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34990479

RESUMO

INTRODUCTION: Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women's empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan. METHODS: We used Pakistan Demographic and Health Survey 2017-18 (PDHS) data which comprises of 6,602 currently married women aged between 15-49 years who had a live birth in the past five years preceding the survey. Our exposure variables were three-dimensional measures of women empowerment (social independence, decision making, and attitude towards domestic violence), and our outcome variables were quality of antenatal coverage [i.e. a composite binary measure based on skilled ANC (trained professional), timeliness (1st ANC visit during first trimester), sufficiency of ANC visits (4 or more)] and quality of ANC consultation (i.e. receiving at least 7 or more essential antenatal components out of 8). Data were analysed in Stata 16.0 software. Descriptive statistics were used to describe sample characteristics and binary logistic regression was employed to assess the association between empowerment and quality of antenatal care. RESULTS: We found that 41.4% of the women received quality ANC coverage and 30.6% received quality ANC consultations during pregnancy. After controlling for a number of socio-economic and demographic factors, all three measures of women's empowerment independently showed a positive relationship with both outcomes. Women with high autonomy (i.e. strongly opposed the notion of violence) in the domain of attitude to violence are 1.66 (95% CI 1.30-2.10) and 1.45 (95% CI 1.19-1.75) and times more likely to receive antenatal coverage and quality ANC consultations respectively, compared with women who ranked low on attitude to violence. Women who enjoy high social independence had 1.87 (95% CI 1.44-2.43) and 2.78 (95% CI 2.04-3.79) higher odds of quality antenatal coverage and consultations respectively, as compared with their counterparts. Similarly, women who had high autonomy in household decision making 1.98 (95% CI 1.60-2.44) and 1.56 (95% CI 2.17-1.91) were more likely to receive quality antenatal coverage and consultation respectively, as compared to women who possess low autonomy in household decision making. CONCLUSION: The quality of ANC coverage and consultation with service provider is considerably low in Pakistan. Women's empowerment related to social independence, gendered beliefs about violence, and decision-making have an independent positive association with the utilisation of quality antenatal care. Thus, efforts directed towards empowering women could be an effective strategy to improve utilisation of quality antenatal care in Pakistan.


Assuntos
Demografia/estatística & dados numéricos , Violência Doméstica/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Empoderamento , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Serviços de Saúde Materna/estatística & dados numéricos , Pessoa de Meia-Idade , Paquistão , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Primeiro Trimestre da Gravidez/fisiologia , Fatores Socioeconômicos , Adulto Jovem
18.
Am J Nurs ; 122(2): 44, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35085148
19.
J Nerv Ment Dis ; 210(1): 71-76, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34982753

RESUMO

ABSTRACT: Little is known regarding the mechanisms involved in the clinical improvement of patients with bipolar disorder (BD) after group psychoeducation. We aimed at investigating these mechanisms by focusing on their subjective experience. Thirteen patients with BD aged 35.54 (SD, 12.06) were recruited. Interviews were analyzed using thematic analysis. Four high-order themes were identified: a) relationship among patients, b) effect of the facilitation style, c) program-related factors, and d) subjective impacts. "Relationships among patients" included a lower-ordered theme evoked by all participants, that is, "shared experiences." Shared experiences included acknowledging that BD has a neurobiological substrate and that its manifestations are similar in BD; the social support and empowering message of those who have managed to exert control over the illness were also highlighted. Our results shed some light on the mechanisms underlying the effectiveness of group psychoeducation. The shared experience of patients seems to play an important role, probably through destigmatization.


Assuntos
Transtorno Bipolar/terapia , Educação de Pacientes como Assunto/métodos , Psicoterapia de Grupo/métodos , Adulto , Transtorno Bipolar/psicologia , Empoderamento , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Apoio Social , Adulto Jovem
20.
Glob Health Res Policy ; 7(1): 4, 2022 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-35090567

RESUMO

BACKGROUND: The Livelihood Empowerment against Poverty (LEAP) programme in Ghana as part of its beneficiary programme, identifies the poor/indigents for exemptions from premium payments in the National Health Insurance Scheme (NHIS). This paper sought to understand community perceptions of enrolling the poor in the NHIS through LEAP in order to inform policy. METHODS: The study adopted a descriptive cross-sectional study design by using a qualitative approach. The study was conducted in three geographical regions of Ghana: Greater Accra, Brong-Ahafo and Northern region representing the three ecological zones of Ghana between October 2017 and February 2018. The study population included community members, health workers, NHIS staff and social welfare officers/social development officers. Eighty-one in-depth interviews and 23 Focus Group Discussions were conducted across the three regions. Data were analysed thematically and verbatim quotes from participants were used to support the views of participants. RESULTS: The study shows that participants were aware of the existence of LEAP and its benefits. There was, however, a general belief that the process of LEAP had been politicized and therefore favours only people who were sympathizers of the ruling government as they got enrolled into the NHIS. Participants held the view that the process of selecting beneficiaries lacked transparency, thus, they were not satisfied with the selection process. However, the study shows the ability of the community to identify the poor. The study reports varying concepts of poverty and its identification across the three ecological zones of Ghana. CONCLUSION: There is a general perception of politicization and lack of transparency of the selection of the poor into the NHIS through the LEAP programme in Ghana. Community-based approaches in the selection of the indigent are recommended to safeguard the NHIS-LEAP beneficiary process.


Assuntos
Programas Nacionais de Saúde , Pobreza , Estudos Transversais , Empoderamento , Gana/epidemiologia , Humanos
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