Contextual Variation in Early Adolescent Childbearing: A Multilevel Study From 33,822 Communities in 44 Low- and Middle-Income Countries

PurposeExisting literature calls for a deeper examination into how local context influences adolescent sexual and reproductive health outcomes. We seek to describe individual and contextual variation in early adolescent childbearing (younger than 16 years) in 44 low- and middle-income countries by (1) examining the role of individual-level social disadvantage, (2) exploring the ecological influence of context at the country and community level, and (3) assessing whether ecological effects vary according to a woman's wealth.MethodsWe used nationally representative data from 33,822 communities in 44 low- and middle-income countries. We employed multilevel modeling to examine the variation in early adolescent childbearing apportioned to the individual, community, and country levels.ResultsGlobally, poverty and low educational attainment are associated with early adolescent childbearing. After accounting for individual-level characteristics, significant residual variance remains at both the community and country levels. Routine, individual-level covariates explain 46.4% of the total variance at the community level and 21.3% of the total variance at the country level in relation to the baseline, age-adjusted model. The variance apportioned to the community level is estimated to equal 43.5% (95% confidence interval: .40, .49) of the total variance among the poorest women compared with 32.6% (95% confidence interval: .25, .39) among the richest women. Across countries, we find substantial heterogeneity in the variance observed at the community level.ConclusionsOur results point to the need for a continued focus on multilevel interventions that include approaches to target both the individual and population levels. More research is needed to identify the mechanisms through which local context influences adolescent sexual and reproductive health outcomes.     

The association between adolescent condom use and individual and environmental resilience protective factors

Objective: Individual and environmental resilience protective factors are suggested to be associated with adolescent condom use; however, previous studies have not comprehensively examined such associations. This study aimed to determine the associations between condom use, and numerous individual and environmental resilience protective factors in sexually active Australian adolescents. Methods: Participants were Grade 10 students attending 28 Australian government high schools (n=1,688). An online survey (2011) collected data regarding: sexual intercourse (past year), condom use and 14 individual and environmental resilience protective factors. Multivariable backward stepwise logistic regression models examined associations between student condom use and protective factors (total, subscale). Results: Only total environmental protective factors remained in the final total score model; students with higher total environmental protective factors scores were 2.59 times more likely to always use a condom(95%CI:1.80–3.74). Only three of 14 protective factor subscales were associated with a higher likelihood of always using a condom in the final subscale model (individual: goals/aspirations; environmental: community participation, pro‐social peers). Conclusions: Total environmental and three protective factor subscales demonstrated prominent associations with consistent use of condoms in sexually active adolescents. Implications for public health: Consideration of particular resilience protective factors in adolescent sexual risk behaviour prevention, such as condom use, is warranted.     

Between power and powerlessness: a meta-ethnography of sources of resilience in young refugees

Objective. This article reviews available qualitative studies that report young refugees’ ways of dealing with adversity to address their sources of resilience.

Design. We searched five electronic databases. Twenty-six empirical studies were included in the review. A meta-ethnography approach was used to synthesize these qualitative studies.

Results. Six sources of resilience emerged: (1) social support, (2) acculturation strategies, (3) education, (4) religion, (5) avoidance, and (6) hope. These sources indicated social as well as personal factors that confer resilience in young refugees, but most of them also had counterproductive aspects.

Conclusion. The results, from an ecological developmental perspective, stressed the interplay between protective and risk processes in the mental health of young refugees who had resettled in Western countries, and they emphasized the variability as well as the universality of resilience-promoting processes. Further research is needed to explore the cultural shape of resilience and the long-term consequences of war and migration on young refugees.     

Perceptions of Online Support for Hospitalized Children and Adolescents

Abstract

This study identifies perceived outcomes following hospitalized children's participation in a pediatric online support network. Nineteen participants were interviewed, including child and adolescent patients who had used the network while in hospital, their parent/family caregiver, and a familiar health care provider. This triadic sampling approach provided a range of stakeholder perceptions.

Results convey a wide spectrum of benefits and challenges in accessing and utilizing an online support network for hospitalized children. Participation in the network was identified as a means of fostering pediatric patient enjoyment, education, connection with peers, and coping. Information, social connection and distraction served as catalysts fostering positive outcomes for children. Identified barriers to network participation included inaccessibility and limited availability of computers, issues with technology, and discomfort with online interaction. Findings advance understanding of online networks as supportive resources for seriously ill children and their families.     

Yoruba culture and the resilience of HIV-positive adolescent girls in Nigeria

Abstract

Although there is a growing body of research exploring the influence of culture on the resilience of African youth, few studies have examined how culture constrains or enables resilience among HIV-positive adolescent girls from the perspective of the young women themselves. This paper reports on the findings from a qualitative study of five purposively selected girls living with HIV in Ibadan, Nigeria. By analysing data drawn mainly from interviews and observations, we explored how cultural influences promote or limit resilience in participants. Social-ecological resilience theory was used to document and interpret the findings. While some cultural values and perceptions enable resilience, others constrain participants’ resilience trajectories. However, the girls were able to navigate through these constraints using their cultural identities and coping strategies, such as future dreams, emotional and physical resources linked to spirituality and networks of friends and families. Findings have implications for policymakers, researchers and programmers in strengthening the health and resilience of young people in the face of HIV.     

The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries—Argentina,Jordan, and South Africa (2017–2018)

IntroductionToward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance.MethodsIn 2017–2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC).ResultsDocument review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation.ConclusionsSystematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.     

Household emergency preparedness: a literature review

Global policies on disaster risk reduction have highlighted individual and community responsibilities and roles in reducing risk and promoting coping capacity. Strengthening local preparedness is viewed as an essential element in effective response and recovery. This paper presents a synthesis of available literature on household preparedness published over the past 15 years. It emphasizes the complexity of preparedness, involving personal and contextual factors such as health status, self-efficacy, community support, and the nature of the emergency. In addition, people require sufficient knowledge, motivation and resources to engage in preparedness activities. Social networks have been identified as one such resource which contributes to resilience. A predominant gap in the literature is the need for evidence-informed strategies to overcome the identified challenges to household preparedness. In particular, the construct of social capital and how it can be used to foster individual and community capacity in emergency situations requires further study.     

Enhancing protective factors in South African adolescents affected by HIV/AIDS

This article explores the lived experiences of early adolescents orphaned by HIV/AIDS and seeks to identify the different factors that contribute to resilience at the individual, family or home and larger community levels. Ten early adolescents aged from 12 to 14 years living in Soweto, South Africa, participated in the study. Data were collected using photovoice, structured interviews and autobiographical essays and were analysed using thematic networks analysis. The analysis revealed individual assets, family variables, peer and teacher support alongside other community resources as being protective factors that cultivate resilience. Based on the findings, recommendations are made on how to increase protective factors for adolescents affected by HIV/AIDS.     

The role of resilience and coping among Italian healthcare workers during the COVID-19 pandemic

Objective:To evaluate the psychological state of healthcare workers (HCWs) in the field of rehabilitation during the COVID-19 pandemic.Methods:Cross-sectional observational study. Sample of 334 HCWs including: nurses, medical doctors, therapists, scientists, and clerical workers working at the IRCCS San Raffaele Roma rehabilitation hospital during the second wave of the COVID-19 pandemic. Anonymous web-based questionnaire included 14-item Resilience Scale, Brief-COPE, Hospital Anxiety Depression Scale, Fear of COVID-19 Scale. Occupational and sociodemographic characteristics.Results:High levels of resilience, low levels of anxiety, depression, and fear were observed in the study population; the most frequently used coping strategies in the Brief-COPE were acceptance, planning, and active coping. Specifically, 87% of the participants reported a moderate to high level of resilience, with the highest level observed in nurses while physicians show the lowest level. HCWs showed symptoms of anxiety (29%), depressive symptoms (10%), and fear caused by the COVID-19 pandemic (44%). Statistically significant differences were observed between different occupations for fear (p <0.05) and resilience (p <0.01). Levels of anxiety and fear appeared to be higher in female and younger workers. The latter group - who also reported higher levels of depression - showed lower levels of resilience.Conclusions:In our study hospital and non-hospital workers show different emotional, cognitive, and behavioural resources when facing stressful situations, like in the case of the SARS-CoV-2 pandemics. Our results support the role of resilience and the proper use of problem-focused and emotion-focused coping strategies as protective factors from psychological distress.     

Country-Level Meritocratic Beliefs Moderate the Social Gradient in Adolescent Mental Health: A Multilevel Study in 30 European Countries

PurposeAdolescents with higher socioeconomic status (SES) report better mental health. The strength of the association—the “social gradient in adolescent mental health”—varies across countries, with stronger associations in countries with greater income inequality. Country-level meritocratic beliefs (beliefs that people get what they deserve) may also strengthen the social gradient in adolescent mental health; higher SES may be more strongly linked to adolescent's perceptions of capability and respectful treatment.MethodsUsing data from 11–15 year olds across 30 European countries participating in the 2013/2014 Health Behaviour in School-aged Children study (n = 131,101), multilevel regression models with cross-level interactions examined whether country-level meritocratic beliefs moderated the association between two individual-level indicators of SES, family affluence and perceived family wealth, and three indicators of adolescent mental health (life satisfaction, psychosomatic complaints, and aggressive behavior).ResultsFor family affluence, in some countries, there was a social gradient in adolescent mental health, but in others the social gradient was absent or reversed. For perceived family wealth, there was a social gradient in adolescent life satisfaction and psychosomatic complaints in all countries. Country-level meritocratic beliefs moderated associations between SES and both life satisfaction and psychosomatic complaints: in countries with stronger meritocratic beliefs associations with family affluence strengthened, while associations with perceived family wealth weakened.ConclusionsCountry-level meritocratic beliefs moderate the associations between SES and adolescent mental health, with contrasting results for two different SES measures. Further understanding of the mechanisms connecting meritocratic beliefs, SES, and adolescent mental health is warranted.     

Intent to obtain pediatric influenza vaccine among mothers in four middle income countries

BackgroundDespite a large burden of influenza in middle income countries, pediatric vaccination coverage remains low. The aims of this study were to (1) describe mothers’ knowledge and attitudes about influenza illnesses and vaccination, and (2) identify characteristics associated with mothers’ intent to vaccinate their child.MethodsFrom 2015 to 2017, infants 0–11 months old in Nicaragua, Philippines, Jordan, and Albania were enrolled from community settings and hospitals. Interviewers administered a questionnaire to their mothers. Mothers of infants aged 6–11 months rated their intention (small-to-moderate vs. large chance) to accept pediatric vaccination if it was offered at no-cost. The importance of knowledge, attitudes, and sociodemographic characteristics in predicting influenza vaccination intention was measured as the mean decrease in Gini index when that factor was excluded from 1000 decision trees in a random forest analysis.ResultsIn total, 1,308 mothers were enrolled from the community setting and 3,286 from the hospital setting. Prevalence of at least some knowledge of influenza illness ranged from 34% in Philippines to 88% in Albania (in the community sample), and between 23% in Philippines to 88% in Jordan (in the hospital sample). In the community sample, most mothers in Albania (69%) and Philippines (58%) would accept the influenza vaccine, and these proportions were higher in the hospital sample for all countries except Albania (48%) (P < 0.0001). Perceived vaccine safety (mean decrease in Gini index = 61) and effectiveness (55), and perceived knowledge of influenza vaccine (45) were the most important predictors of influenza vaccination intention in models that also included country and community versus hospital sample.ConclusionIntent to vaccinate infants aged 6–11 months in four middle income countries was tied primarily to knowledge of the vaccine and perceptions of vaccine safety and effectiveness. These findings were noted among mothers interviewed in the community and mothers of recently hospitalized infants.     

Health care professionals’ perspectives on physical activity within the Ugandan mental health care system

BackgroundMental health care systems in Africa are faced with a high burden of mental disorders. There is need to explore evidence-based, scalable interventions to compliment the “traditional” health care system. Physical activity (PA) can augment the effectiveness of existing programs. However, little is known about the perspectives of health care professionals on PA. Understanding this is key to implementation.MethodsThis was a qualitative exploratory study based on 13 key informant interviews among experienced health care professionals working at Butabika National Referral and Teaching Hospital, Uganda. Data was analyzed through content thematic analysis.ResultsParticipants reported PA benefits were: improved individual competences and engagement, social reintegration and reduced family and community burden. Self-stigma, lack of community support, lack of infrastructure and equipment, lack of monitoring capacity, human resource challenges and a focus solely on pharmacotherapy were among the most reported barriers to application of PA in management of mental health problems.ConclusionDespite the high level of understanding of PA among health care professionals, PA promotion largely depends on implementation of strategies to deal with community and health systems barriers. Although patients need to be empowered to deal with their individual barriers, greater support and action is needed by policy makers. Public health programs should support PA through community engagement and social re-integration programs. The government should promote a holistic mental health care perspective and provide adequate infrastructural and human resources to support PA in the existing primary and mental health care systems.     

Improving Dementia Care Through Community Linkages: A Multi-Site Demonstration Project

ABSTRACT

The purpose of the multi-site project was to develop and implement a model for dementia care which improved linkages of care-givers to community services. Key components of the model included a single point of informational contact, provider education, case-finding, caregiver education and support, internal linkages, and linkages with community services. The model was implemented at six medical centers. Outcome measures included caregiver, provider, and community agency satisfaction. Caregivers reported high satisfaction with information provided to them about community resources. Primary care providers reported that dementia services had improved from one year earlier. Community agencies reported high satisfaction with the dementia program initiatives. Key learnings for successful implementation are discussed.     

The Association Between Psychological Resilience and Physical Function Among Older Adults With Hip Fracture Surgery

ObjectivesTo examine the associations of prefracture psychological resilience and prefracture general mental health with physical function among older adults with hip fracture surgery.DesignSingle-center observational study.InterventionNone.Setting and participantsPatients aged ≥50 years who underwent first hip fracture surgery between January 2017 and December 2017 (N = 152).MethodsWe used data collected prospectively from the hospital's hip fracture registry. We performed generalized estimating equations to examine the associations of prefracture psychological resilience (10-item Connor-Davidson Resilience Scale) and prefracture general mental health (Short Form–36 mental health subscale) with physical function (Short Form–36 physical functioning subscale) at 4 time points—prefracture (based on recall), and 1.5, 3, and 6 months after surgery.ResultsPrefracture psychological resilience had an association with physical function; a 1-unit increase in psychological resilience score was associated with 1.15 units [95% confidence interval (CI) 0.71, 1.59] higher physical function score across 4 time points. In contrast, the association between general mental health and physical function varied over time; a 1-unit increase in general mental health score was associated with 0.42 units (95% CI 0.18, 0.66) higher physical function score at prefracture, 0.02 units (95% CI –0.18, 0.22) lower at 1.5 months, 0.23 units (95% CI –0.03, 0.49) higher at 3 months, and 0.39 units (95% CI 0.09, 0.68) higher at 6 months after surgery.Conclusions and implicationsPsychological resilience is associated with physical function among older adults with hip fracture surgery, independent from general mental health. Our findings suggest the potential for interventions targeting psychological resilience for these patients and call for more studies on psychological factors affecting physical function recovery after hip fracture surgery.     

Reasons for Institutionalization of People With Dementia: Informal Caregiver Reports From 8 European Countries

ObjectivesTo explore reasons for institutionalization of people with dementia according to informal caregivers as well as variation in reasons between countries.DesignAn explorative cross-sectional study was conducted in 8 European countries.SettingPer country, a minimum of 3 long term care facilities, offering care and accommodation as a package, participated in this study. Participating countries were selected to represent different geographic areas in Europe.ParticipantsOf the 791 informal caregivers involved in the RightTimePlaceCare project of people with dementia who were recently admitted to a long term care facility, 786 were included for this study.MeasurementsAs part of a semistructured interview, informal caregivers were asked the main reason for institutionalization in an open-ended question. Answers were categorized according to a conventional coding approach. All reasons were then quantified and tested.ResultsMainly patient-related reasons were stated, such as neuropsychiatric symptoms (25%), care dependency (24%), and cognition (19%). Neuropsychiatric symptoms were among the most often mentioned reasons in most countries. Besides patient-related reasons, caregiver burden and the inability of the informal caregiver to care for the patient were stated as reasons (both 15%). Further analyses showed countries differ significantly in reasons according to informal caregivers. Additionally, reasons were analyzed for spouses and child-caregivers, showing that spouses more often stated reasons related to themselves compared with child-caregivers.ConclusionMultiple reasons contribute to the institutionalization for people with dementia, with several factors that may influence why there were country differences. Variation in the organization of dementia care and cultural aspects, or the relationship between the informal caregiver and person with dementia may be factors influencing the reasons. Because of a wide variation in reasons between countries, no one-size-fits-all approach can be offered to guide informal caregivers when facing the possibility of institutionalization of the person with dementia.     

Resilience and Resources Among South Asian Immigrant Women as Survivors of Partner Violence

This study explored resilience among South Asian (SA) immigrant women who were survivors of intimate partner violence (IPV). Eleven women participated in in-depth interviews. Thematic analysis was conducted using constant comparison. We identified five cross-cutting themes: resources before and after the turning-point (i.e. decision to confront violence), transformations in self, modification of social networks, and being an immigrant. Women drew upon their individual cognitive abilities, social support, and professional assistance to move beyond victimization. All women modified their social networks purposefully. The changes in individual-self included an increased sense of autonomy, positive outlook, and keeping busy. The changes in collective-self occurred as women developed a stronger feeling of belonging to their adopted country. This hybrid identity created a loop of reciprocity and a desire to contribute to their community. Women were cognizant of their surmountable challenges as immigrants. SA immigrant women IPV survivors sought multiple resources at micro, meso and macro levels, signifying the need for socio-ecological approaches in programs and policies along with inter-sectoral coordination to foster resilience.     

Practitioners’ Perceptions and Experiences of the Baby Mat Mental Healthcare Intervention

ABSTRACT

This study explored the perceptions of practitioners who deliver the Baby Mat community-based, parent–infant mental healthcare intervention offered at primary healthcare clinics in Alexandra Township, South Africa. This intervention aims to foster secure attachments between mothers/caregivers and infants, shaping a healthy foundation for future holistic well-being. Data for this study was collected using qualitative techniques including two focus group discussions and three individual interviews. The 12 Baby Mat practitioners who currently deliver the intervention formed the sample of purposively selected participants. Data were analysed using thematic analysis. The practitioners’ perceptions highlighted that their demonstrated skills of reflective functioning promote caregiver–infant attachment. The supportive disposition of the Baby Mat practitioners was suggested as an essential characteristic that mirrors caregivers’ experiences of umdlezane. This Nguni term refers to the post-partum period when the caregiver–infant relationship is prioritised by the support of other women in the family or community. The culturally diverse co-facilitating practitioners were understood to support the therapeutic alliance and thus enrich the applicability of the Baby Mat intervention within the targeted community context. Given the critical need for relevant and accessible mental healthcare services in communities such as Alexandra Township, the findings from the study illustrate how this community-based intervention may be useful in other comparable contexts.     

Social Networks Effects on Spouse and Adult-Child Dementia Caregivers’ Experiences: A Cross-Sectional Study

ObjectivesA large body of literature addresses experiences of spouse and adult-children caregiver of individuals with dementia (IWDs) but has not examined the role and strength of social networks in associations between spouses and adult-children caregivers’ experience. Based on the stress process model, we aimed to explore the strength levels of social networks and their association with spouses/adult-children caregivers for IWDs.DesignA cross-sectional study.Setting and ParticipantsA questionnaire-based survey was conducted with a total of 146 family caregivers of IWDs (78 adult-child, and 68 spouses) in China.MethodsData collection comprised 4 sections: (1) care-related stressors (dementia stage, neuropsychiatric symptoms); (2) caregiver context; (3) social network, using the Lubben Social Network Scale; and (4) caregiving experience, using the short-form Zarit Burden Interview and 9-item Positive Aspects of Caregiving Scale. Linear regression, mediation model analysis, and interactive analysis were performed to explore the mechanisms of associations between variables.ResultsSpouses had weaker social network strength (β = −0.294, P = .001) and reported greater positive aspects of caregiving (β = 0.234, P = .003) than adult-children caregivers; no significant difference was found between them for caregiver burden. Mediation analysis suggests that associations between caregiver type and caregiver burden are indirect-only mediation effects of social networks (β = 0.140, 95% CI = 0.066-0.228). The social network strength suppressed the association between caregiver type and positive aspects of caregiving. The caregiver type/social network interaction statistically significantly (P = .025) affected the “positive aspects”: a stronger social network was associated with more positive aspects of caregiving among the spouse subgroup (β = 0.341, P = .003).Conclusions and ImplicationsSocial networks mediate responses to caregiving experiences among different care provider types and are vital intervention targets, especially for spousal caregivers. Our results can serve as references for identifying caregivers for clinical intervention.     

Presentation of caregiver-specific vaccine-related information on National Cancer Institute designated cancer center websites

BackgroundHousehold-based caregivers serve an important role in protecting the health of cancer patients, who may be vulnerable to infectious diseases due to their cancer treatments. Caregiver preventive care should be prioritized to maintain continuity of care and to reduce potential for transmission of infectious diseases to cancer patients. Uptake of vaccines, such as influenza vaccine, is suboptimal in the United States in general, as well as among caregivers for cancer patients. Little is known about the types of information about vaccination and prevention of infectious diseases (e.g. influenza) presented to caregivers of cancer patients.MethodsA qualitative content review of NCI cancer center websites (N = 70), searching for vaccine-related information and the need for and availability of vaccines for caregivers, and comparison of the availability of this information to that for caregiver support groups and general preventative health information (e.g. diet, exercise) for caregivers or patients was conducted.ResultsWhile 53 of 70 (76%) cancer centers routinely presented general preventative health information for caregivers or patients, only eight (11%) cancer centers had any information about vaccinations for caregivers or patients. Of these eight cancer center websites, only one had information about vaccinations for caregivers or family contacts.ConclusionsAs vaccinations confer both individual and community-level protection against infectious diseases, promotion of routine vaccination for caregivers should be considered as part of caregiver support resources provided by cancer centers. This can include changes such as including this information on cancer center websites or adding to caregiver support resource documents.