"Taking care of your pregnancy": a mixed-methods study of group antenatal care in Kakamega County, Kenya.

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.

It's Your Place: Development and Evaluation of an Evidence-Based Bystander Intervention Campaign.

Preventing sexual assault on college campuses is a national priority. Bystander intervention offers a promising approach to change social norms and prevent sexual misconduct. This study presents the implementation and evaluation of a theory-based campaign to promote active bystander intervention. The theory of planned behavior (TPB) served as a conceptual framework throughout campaign development and evaluation. Formative research published elsewhere was used to develop campaign strategies, communication channels, and messages, including "It is your place to prevent sexual assault: You're not ruining a good time." The It's Your Place multi-media campaign fosters a culture of bystander intervention through peer-to-peer facilitation and training, as well as traditional and new media platforms. A cross-sectional post-test only web-based survey was designed to evaluate the campaign and test the TPB's ability to accurately predict intention to intervene. Survey data were collected from 1,505 currently enrolled students. The TPB model predicted intention to intervene. There was a significant effect of campaign exposure on attitude, subjective norms, and perceived behavioral intention. This theory-based communication campaign offers implications for promoting active bystander intervention and reducing sexual assault.

A Policy for Addressing Menstrual Equity in Schools: A Case Study From New York City, U.S.A.

There has been a growth in menstrual equity policy advancements in the U.S.A. in recent years; with much of the new legislation prioritizing the needs of adolescent girls in schools. New York City, a predecessor of this movement, was the first U.S.A. locality to pass such legislation in 2016. The aim of this case study was to better understand the various factors which led to the development, passage and initial implementation of New York City's Menstrual Equity in Schools Policy. Data collection methods included a desk review and qualitative assessment with several actors involved across the policy and introduction phases. Key findings included (1) the utility of community narratives and a pilot project as a means for overcoming initial skepticisms, proving feasibility, and generating support; (2) the importance of policy champions for overcoming fiscal objections and navigating political discourse; and (3) lessons learned from early implementation efforts, including variance in awareness and distribution models. This case study yields valuable insights into the practical considerations when designing or implementing policies aimed at tackling issues of menstrual equity within school settings.

It's Not My Place: Formative Evaluation Research to Design a Bystander Intervention Campaign.

Sexual misconduct remains a problem on college campuses despite years of documentation and research, and program development and implementation. The purpose of this study was to conduct systematic theory-based formative audience research to understand how college women and men make meaning of sexual assault and bystander intervention. A total of 69 men and women aged 18 to 24 years participated in eight gender-specific focus group discussions. A grounded theory approach was used to identify patterns and themes across the data. Themes emerging from the data included the following: (a) female participants' experiences of sexism and misogyny, (b) the myth that rape is falsely reported, (c) complex understandings of consent and entitlement, (d) the reluctance to stop someone from having a "good time," (e) the role of alcohol as a moderating factor in sexual misconduct and bystander intervention, and (f) preference for direct and impactful messaging. This study informs researchers and practitioners about college students' perceptions of, and experiences with, bystander intervention and sexual assault. Practitioners can use this information to develop effective mixed media, campus-wide social marketing campaigns.

Voices of the "99 Percent": The Role of Online Narrative to Improve Health Care.

CONTEXT: Communal blogs facilitate online narratives by providing opportunities for individuals to co-construct meaning and to engage in discussion about lived health experiences. OBJECTIVE: To examine the role of health as a connective narrative among individuals organizing collectively in an online community. The "We are the 99 percent" Tumblr blog emerged as a spontaneous community platform of the Occupy Wall Street movement in the US. DESIGN: Researchers conducted a qualitative content analysis of a total of 2003 blog posts. MAIN OUTCOME MEASURES: Data analysis included a process of data reduction, display, and conclusion drawing and verification. RESULTS: Bloggers discussed medical crises and the role of injury and illness in maintaining financial solvency. The difficulty of obtaining health care and the lack of accessible quality care emerged as themes. In particular, unemployment and underemployment limited access to health insurance coverage. The bloggers expressed dissatisfaction with the health care system and the impact of financial status on health. These challenges were exacerbated for marginalized populations, such as women and veterans. CONCLUSION: Findings offer implications for the value of online narrative to improve health care initiatives and to provide insight to integrated health care systems, including health care practitioners, nonprofit organizations, hospitals, and policy makers. Results suggest opportunities to address the health care gaps of marginalized populations and to develop public health policy.

Analyzing fault in pedestrian-motor vehicle crashes in North Carolina.

Crashes between pedestrians and motor vehicles are an important traffic safety concern. This paper explores the assignment of fault in such crashes, where observed factors are associated with pedestrian at fault, driver at fault, or both at fault. The analysis is based on police reported crash data for 1997 through 2000 in North Carolina, U.S.A. The results show that pedestrians are found at fault in 59% of the crashes, drivers in 32%, and both are found at fault in 9%. The results indicate drivers need to take greater notice of pedestrians when drivers are turning, merging, and backing up as these are some of the prime factors associated with the driver being found at fault in a crash. Pedestrians must apply greater caution when crossing streets, waiting to cross, and when walking along roads, as these are correlated with pedestrians being found at fault. The results suggest a need for campaigns focused on positively affecting pedestrian street-crossing behavior in combination with added jaywalking enforcement. The results also indicate that campaigns to increase the use of pedestrian visibility improvements at night can have a significant positive impact on traffic safety. Intoxication is a concern and the results show that it is not only driver intoxication that is affecting safety, but also pedestrian intoxication. The findings show in combination with other research in the field, that results from traffic safety studies are not necessarily transferable between distant geographic locations, and that location-specific safety research needs to take place. It is also important to further study the specific effects of the design of the pedestrian environment on safety, e.g. crosswalk spacing, signal timings, etc., which together may affect pedestrian safety and pedestrian behavior.