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Native residents are indispensable participants in developing and conserving the natural environment. Specifying the factors that lead to responsible behavior among the local people can help increase sustainability. This paper aims to investigate the pro-environmental behavior among the local residents of the Kashmir region defined by the components of Theory of Planned Behavior (TPB) and Value Belief Norm (VBN) Theory. To analyze the data, Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) has been used as research methods. The results reveal that the three components of TPB (general environmental attitude, subjective norms, perceived behavior control) have a positive and significant impact on the pro-environmental behavior of residents. Moreover, the findings also demonstrate that the factors of VBN (altruistic, egoistic and biospheric values) significantly influence the general environmental attitude which in turn impacts the pro-environmental behavior of local residents. The paper seeks to contribute to the existing literature by adding local community insights based on the explanations given by socio-psychological theories within the context of natural environment. The study will help policymakers to understand better the residents' intentions and pro-environmental behavior so that they can develop strategies to manage and combat the environmental problems. [ABSTRACT FROM AUTHOR]

Entertainment-education has been touted as a potent delivery channel for health education campaigns. Yet, there is little evidence of its causal effects. This paper aims to fill the gap in the literature by using a field experiment in India to study two questions on the efficacy of health entertainment-education. First, can health entertainment-education, particularly through films that show role models and draw on emotions, lead to lasting, positive change in health knowledge and behavior? Second, can financial incentives for ex-post health literacy boost the effectiveness of health entertainment-education? The results show that health entertainment-education successfully increased health knowledge (e.g. knowledge about cleanliness and hygiene) by 16 percent. These gains persist almost one year later, although there were no observed impacts on health behaviors. Further, financial incentives do not appear to have any effects. These insights contribute to our knowledge of what works for health education in low-income settings, so that future education campaigns can be crafted with more meaningful impact. [ABSTRACT FROM AUTHOR]

Background: Sustainable development goals (SDGs) 3.9.1 and 11.6.2 call for a reduction in deaths and illnesses from air pollution, improving the air quality of cities. The above goals motivate us to organize workshops to improve the health of traffic police, who bear the brunt of air pollution. The paper examines the effect of workshops on the health-seeking behavior of the traffic police in Bhubaneswar city. Methods: The study conducted two workshops as a quasi-experimental, single-group study at an academic institution in Bhubaneswar. It included 20 traffic police officers (11 male and 9 female). The Kirkpatrick 4-level model was used to assess the effectiveness of the workshops. A paired t-test was used to compare pre- and postworkshop scores. Results: Thirteen traffic police officers rated the workshop sessions as excellent. The score before the workshop ranged from zero to three, with a mean (standard deviation [SD]) of 2.81 (1.0). The postworkshop score had a minimum to maximum score of three to five with a mean (SD) of 4.41 (0.7) (P < 0.005). The effect size dcohen (confidence interval [CI]) was 1.87 (3.27-4.71). The mean (SD) of absolute and relative gain was 1.6 (1.0) and 0.93 (1.02), respectively. All 20 traffic police officers showed improvement in health-seeking behavior. The significant lifestyle changes after the workshops ranged between 5% and 75%. Conclusion: The test scores indicated statistically significant improvement as the P value recorded was smaller than 0.05. This concludes that the improvement in understanding of the session was statistically significant because of the training imparted. [ABSTRACT FROM AUTHOR]

This paper reports child mortality and associated factors among tribal (indigenous) populations from a South Indian district. In India, 104 million people belonged to 705 tribal groups, constituting 8.6% of India's population. Of the 705 tribal groups, 75 were classified as particularly vulnerable tribal groups (PVTG). The present study aims to report the under-five child mortality among the tribal (both PVTG and non-PVTG) population in Visakhapatnam district, a district with a higher concentration of tribes in the Indian state of Andhra Pradesh. Four sub-districts were selected to conduct a cross-sectional study to understand health and health-seeking behavior, including maternal and child health. Socio-demographic details and obstetric history were collected through a pre-tested, interviewer-administered questionnaire from mothers with a child aged up to one year. These 277 mothers gave birth to 632 liveborn children, out of which 56 children died within 12 months. Multiple logistic regression revealed that living in villages with no health facility, woman-headed households, younger age at first childbirth and mother' aged 30 years or above were significantly associated with mothers experiencing child death. Implementation of home-based neonatal care is crucial in the vulnerability context of the tribes due to socioeconomic conditions and remote habitation. Health educational interventions to address early marriages leading to teenage pregnancies are needed immediately. This disaggregated analysis of under-five mortality and associated factors among the tribes highlights the need for population-specific interventions and improving infrastructural facilities like all-weather roads and improved access to quality healthcare services in addition to the overall socio-economic development. [ABSTRACT FROM AUTHOR]

We experimentally investigated whether appeals to moral principles—as operationalized by the theory of Morality-as-Cooperation—increase pandemic-related public health behavior. Participants (from the USA and India) were presented with persuasive messages, asked about their intentions to follow pandemic-related restrictions, were asked to donate to a charity fighting COVID-19, and completed the Morality-as-Cooperation Questionnaire. We found that moral messages were more effective than non-moral messages in increasing Prosocial Intentions and Donations, especially messages appealing to Heroism. In the US sample, the effect of moral messages was larger when they were concordant with participants' moral values. We also found that some moral messages were effective only in a particular population. This paper outlines the necessary next steps for using Morality-as-Cooperation for evidence-based communication. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes is a significant public health concern in India, with Kerala being labeled as the diabetes capital of the country. The study aims to evaluate the prevalence, treatment, and management of diabetes to examine the unmet need for care to propose cost-effective strategies. Design: A cross-sectional study was conducted on a geographically defined cohort population in Ernakulam. Sample: This paper presents diabetes data of adults ≥30 years enrolled from the community cohort. The interviews were conducted with 997 participants at their residence. Measurement: Random blood glucose was assessed for each participant using a finger prick test. Results: The overall prevalence of diabetes was 30.1%, of which 4.1% of participants had undiagnosed diabetes. Among those with diabetes, 86.3% were aware of their diagnosis; among those aware, 86.5% were on treatment. Among those on treatment for diabetes, 54% achieved controlled blood sugar. Conclusion: The challenge in diabetes management is controlling the blood glucose levels of people who adhere to treatment. Younger employed females from lower-income quartiles have the highest risk. The study also raises questions about quality and strategies for medication compliance. The findings inspire future research on care needs, policies, and program responses to reduce the diabetes disease burden. [ABSTRACT FROM AUTHOR]

The unmet need for contraception is documented as a significant determinant of unintended pregnancies and high number of induced abortions. The period immediately after an abortion is recognised as a unique opportunity to offer contraceptive services. This paper explores the association between place of abortion and women's post-abortion contraceptive behaviour. The reproductive calendar data from the National Family Health Survey (NFHS-4) (2015–16) was used for this study. Multinomial logistic regression models were used to understand factors associated with post-abortion method choices. Single decrement life-tables were built to examine rates of contraceptive discontinuation and proportional hazard models were employed to examine probability and correlates of method discontinuation. About 20% of women who underwent an abortion adopted a contraceptive method by the end of one month following an abortion. The decision to choose methods like sterilisation or intrauterine contraceptive devices (IUCDs) was associated with the place of abortion, past contraceptive behaviour, number and sex of surviving children at the time of abortion, mass media exposure, and time of the abortion. Compared to women who underwent an abortion at private health facilities, women who sought abortion at public health facilities were more likely to choose permanent methods or IUCDs. Furthermore, women who opted for an IUCD were less likely to discontinue the method compared to those using short-acting modern methods. The lack of post-abortion contraceptive choices for women is evident in the low uptake of post-abortion contraceptives in private facilities and the predominant promotion of permanent methods and IUCDs in public health facilities. [ABSTRACT FROM AUTHOR]

Background: This paper examines whether participating in Mahatma Gandhi National Rural Employment Guarantee Program (NREGA) is associated with the likelihood of smoking among program participants in India.Methods: We use two-stage residual inclusion (2SRI) estimation method and two waves of India Human Development Surveys completed before (2005) and after (2012) NREGA implementation.Results: The likelihood of smoking increased with NREGA participation. For every 10% increase in NREGA income, the likelihood of smoking bidis (but not cigarettes) increased by 0.88 percentage point. A bidi, a stick of unprocessed tobacco wrapped in temburini leaves, is a significantly cheaper alternative to cigarettes. Nonparticipants who had a comparable increase in income between the two India Human Development Survey waves did not show an increase in likelihood of smoking. The heterogeneity in NREGA treatment effect shows that smoking tendency is not influenced by caste/religion or literacy.Conclusions: NREGA, as the largest workfare program, most certainly has had a significantly positive influence on the rural poor in India. The findings highlight its small but meaningful influence of a negative health behavior, greater likelihood of uptake of smoking bidis/hookah among program participants.Implications: Existing studies have found mixed evidence of an exogenous increase in income among low-income adults and its impact on smoking. No studies to date have tested the influence of workfare programs in rural areas of developing countries, where unemployment rates are higher and a substantial share of population in those areas is poor. Based on participation in employment guarantee programs as a proxy for exogenous increase in guaranteed income among rural population in India, we find that participants in the program were more likely to smoke bidis/hookah but not cigarettes. [ABSTRACT FROM AUTHOR]

Micronutrient deficiencies, majorly iron, iodine, vitamin-A, pose a serious threat to public health in many developing countries, including India. A surfeit of nutrition and health programs was developed to address micronutrient malnutrition in India, covering many aspects of lifecycle. The importance of nutrition education and communication is emphasized in public health nutrition policies. Concomitantly, there is a surge in various interventional studies with the integration of nutrition education and communication. However, there is a lack of clarity on the overall impact of community level nutrition education/communication interventions on micronutrient (mal)nutrition in India, which may be due to the lack of critical evaluation of the nutrition education/communication components in these studies. Given this background, this article reviews the studies conducted in the last two decades in India. This systematic review identified and analyzed the studies that aimed to use nutrition education and communication as intervention methods to promote micronutrients’ intake and status among various age groups. Using four online databases and systematic library search, research articles published from 1994 to 2016 were collected based on pre-defined inclusion/exclusion criteria. Data on general information, intervention, and key outcome measures were extracted. Inferences from findings of studies were drawn; factors that contributed to the success or failure of the interventions were analyzed by developing a framework. Systematic internet and library search resulted in 1250 published papers. After applying inclusion and exclusion criteria, 19 research papers (with five studies covering nutrition education + supplementation; one study with nutrition education + supplementation + psychosocial intervention and the rest only education/communication) were selected for the review. This paper discusses the contextual factors in the area of intervention, audience targeted, methods of communication used, messages delivered, and outcomes thereof. It suggests that integrated multiple strategies may work and a critical examination is needed to address macro and micro issues of micronutrient-related communication for developing sustainable communication interventions. [ABSTRACT FROM PUBLISHER]

Within public health, investigations into the rise of metabolic syndrome disorders, such as obesity and type II diabetes, following on the heels of globalisation have tended to focus on the twin axes of diet and physical exercise. However, such a limited focus obscures wider transformations in bodily and health-related practices that emerge in response to globalisation. This paper is an exploration of public discourses about PCOS—a hormonal disorder that affects menstruation, is associated with obesity, heart disease, and type II diabetes, and has been on the rise in India since the liberalisation of its economy in 1991— and it examines the concerns regarding sociocultural, environmental, and political–economic changes brought by liberalisation that these discourses index. Attention to medical semantics, as revealed through public discourses about PCOS, can help counter the limited focus of diet and physical activity-centred models through an emphasis on the political ecology of health. Such engagement can reveal how an emerging relationship between the body and its environment, which is seen as characteristically modern, is implicated in the rise of metabolic disorders. It can also offer critical insights for biomedical and public health research into such disorders. [ABSTRACT FROM AUTHOR]

The caste system is a complex social stratification system which has been abolished, but remains deeply ingrained in India. Scheduled Caste (SC) women are one of the historically deprived groups, as reflected in poor maternal health outcomes and low utilisation of maternal healthcare services. Key government schemes introduced in 2005 mean healthcare-associated costs should now be far less of a deterrent. This paper examines the factors contributing to this low use of maternal health services by investigating the perceptions, health-seeking behaviours and access of SC women to maternal healthcare services in Bihar, India. Eighteen in-depth, semi-structured interviews were conducted with SC women in Bihar. Data were analysed using Framework Analysis and presented using the AAAQ Toolbox. Main facilitating factors included the introduction of accredited social health activists (ASHAs), free maternal health services, the Janani Shishu Suraksha Karyakram (JSSK), and changes in the cultural acceptability of institutional delivery. Main barriers included inadequate ASHA coverage, poor information access, transport costs and unauthorised charges to SC women from healthcare staff. SC women in Bihar may be inequitably served by maternal health services, and in some cases may face specific discrimination. Recommendations to improve SC service utilisation include research into the improvement of postnatal care, reducing unauthorised payments to healthcare staff and improvements to the ASHA programme. [ABSTRACT FROM AUTHOR]

Background: Empirical evidence shows that the relationship between health-seeking behaviour and diverse gender elements, such as gendered social status, social control, ideology, gender process, marital status and procreative status, changes across settings. Given the high relevance of social settings, this paper intends to explore how gender elements interact with health-seeking practices among men and women residing in an Indian urban slum, in consideration of the unique socio-cultural context that characterises India's slums. Methods: The study was conducted in Sahid Smriti Colony, a peri-urban slum of Kolkata, India. The referral technique was used for selecting participants, as people in the study area were not very comfortable in discussing their health issues and health-seeking behaviours. The final sample included 66 participants, 34 men and 32 women. Data was collected through individual face-to-face in-depth interviews with a semi-structured questionnaire. Results: The data analysis shows six categories of reasons underlying women's preferences for informal healers, which are presented in the form of the following themes: cultural competency of care, easy communication, gender-induced affordability, avoidance of social stigma and labelling, living with the burden of cultural expectations and geographical and cognitive distance of formal health care. In case of men ease of access, quality of treatment and expected outcome of therapies are the three themes that emerged as the reasons behind their preferences for formal care. Conclusion: Our results suggest that both men and women utilise formal and informal care, but with different motives and expectations, leading to contrasting health-seeking outcomes. These gender-induced contrasts relate to a preference for socio-cultural (women) versus technological (men) therapies and long (women) versus fast (men) treatment, and are linked to their different societal and familial roles. The role of women in following and maintaining socio-cultural norms leads them to focus on care that involves long discussions mixed with socio-cultural traits that help avoid economic and social sanctions, while the role of men as bread earners requires them to look for care that ensures a fast and complete recovery so as to avoid financial pressures. [ABSTRACT FROM AUTHOR]

Raikas are the largest group of nomadic pastoralists of India. Each year after the rains, hundreds and thousands of shepherds embark in collective camps on migratory journeys that can span distance up to 1200 kms, and last up to nine months. The present paper is an attempt to study the reproductive health (family welfare & population control) among Raikas, who though, understand the significance of a small family, but because of various reasons, discussed in the paper, fail to adhere to the modern days Family Planning Practices. [ABSTRACT FROM AUTHOR]

This paper provides evidence for informational spillovers within urban slums in Chandigarh, India. I identify three groups, a treatment group, a neighbouring spillover group, and a non-adjacent pure control group. Mothers of children (aged three to six years) enrolled in government day-care centres are given recipe books in the treatment group to reduce malnutrition in their children. Spillovers to neighbouring (untreated) mothers can be through social learning or imitation. Results from a difference-in-differences analysis show that nutritional knowledge measured through a quiz increases among neighbouring untreated mothers relative to a control group. Neighbouring mothers exhibit learning spillovers, changes in dietary behaviour and a reduction in food expenditure regardless of their level of literacy. Spillovers not only raise the cost effectiveness of health information programmes but are important to consider when designing an experiment as causal effects of treatments can be attenuated if the spillover group is used as a control group. [ABSTRACT FROM PUBLISHER]

This paper concerns the use of photo-elicitation interviews in constructing migrant narratives of health and well-being. It argues that photo-elicitation can be particularly effective in producing nuanced understandings about relationships among culture, place and health. It explores how, through this method, subject-centred understandings of health and well-being are able to challenge dominant discursive constructions that tend to ‘other’ and potentially stereotype minority groups in explanations of health behaviour. The paper includes discussion of issues of power and representation in research with marginalized populations, which further elaborates the value of photo-elicitation in developing a non-essentializing view of minority groups. The paper concludes with comment on the potential value of this method in the formulation of health and social policies aiming to incorporate the views and needs of marginalized or minority groups. [ABSTRACT FROM PUBLISHER]

Objectives: To briefly describe the postpartum practices among the three major ethnic groups in Malaysia and to identify commonalities in their traditional postpartum beliefs and practices. Methods: This narrative review collated information on traditional postpartum practices among Malaysian mothers through a literature search for published research papers on traditional postpartum practices in Malaysia. Results: This review shows that Malaysian mothers have certain postpartum practices that they considered to be important for preventing future ill health. Despite the perceived differences in intra-ethnic postpartum practices, most Malaysian mothers, although from different ethnicities, share similarities in their postpartum regimens and practices in terms of beliefs and adherence to food taboos, use of traditional postpartum massage and traditional herbs, and acknowledgment of the role of older female family members in postpartum care. Conclusions: Health care providers should be aware of multiethnic traditional postpartum practices and use the commonalities in these practices as part of their postpartum care regimen. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is an endocrine disorder linked to type II diabetes and the leading cause of female infertility worldwide. Despite being considered a “lifestyle” disease, PCOS has received scant attention in the social science literature. In India, media accounts citing prominent doctors have expressed concern that the syndrome affects a growing number of urban middle-class Indian women. The general public, doctors, and afflicted women all attribute the condition to stress, lifestyle changes, “Westernization,” modernization, and disrupted circadian rhythms. These factors are associated with changes in diets, gender roles, and aspirations since 1991, when the introduction of neoliberal reforms opened up the country to processes of globalization. Women with PCOS have come to be seen as living embodiments of the biosocial stresses associated with modern urban middle-class living, and discourse about PCOS serves as commentary indexing anxieties about social and political–economic shifts in the country. In this paper, based on ethnographic fieldwork in Mumbai, India, with 141 participants from 2012 to 2014, we point to local understanding of PCOS as corresponding to an ecosocial perspective that highlights the structural vulnerabilities of urban middle-class women. Whereas most research on structural vulnerabilities and health has centered on economically and otherwise disadvantaged groups, we use PCOS as a case study to draw attention to the rise of lifestyle disorders linked to the impact of globalization and the pressures of “modern” identities and aspirations among middle-class populations. [ABSTRACT FROM AUTHOR]

Textile sector in India plays an important role in the country's economy, providing employment to a significant population in rural and urban areas. Objectives: This paper focuses on health and safety aspects of textile workers in Solapur City (one of the key textile cluster) in the state of Maharashtra, India. Methodology: A sample of 180 workers from the identified textile industries of Solapur city were assessed for their general physique, muscle tone, lung condition, and eyesight using different techniques. The study aimed at developing a framework for understanding risks to textile workers resulting from lack of health and safety standards in companies. Results: Findings showed that most of the workers have been affected by respiratory problems, increase in muscle tone, eye problems and musculoskeletal problem. It has been also observed that job security or regular work impacts positively to the worker's long term body health. However, there is an immediate need to adopt and implement measures in accordance with Indian Factories Act (OHSAS 18001/ILO-OSH 2001) which includes directions and procedures in respect of industrial installations, work environment and occupational health and safety guidelines. [ABSTRACT FROM AUTHOR]

The body mass index (BMI), which measures body mass divided by height squared (kg/m²), has become a popular technology for quickly measuring and assessing individuals' health and disease risk. However, the BMI has also been widely criticized by health professionals who argue that it's a poor measure of health. Feminist scholars are also critical, arguing BMI is a technology of neoliberal health promotion that pathologizes body size, and produces responsibilized subjects invested in maintaining "proper" weights, while often ignoring the social and environmental conditions that result in differently sized bodies. In this paper, I look at a series of BMI "camps" held across rural North India in 2017 and put forth two central arguments. First, BMI is not an a priori technology of neoliberal governmentality, but can be also be a means to highlight social marginalization and create relations of care. I find the spaces of BMI deployment are tightly linked to the types of responsibility and care it produces. Second, while the intended goal of these BMI camps is to propel people, mostly women, to change their behavior to be more healthful, this behavior change was often stymied by the everyday business of surviving in India's current political economic climate. Despite that women were unable to implement much of the nutrition advice (and sometimes reported additional stress due to attendance at such camps), women continued to attend health-related camps. This paper draws on the notion of cruel optimism, which argues that the objects of our attachments, such as ideas of "the good life" can be self-detrimental, as a way to unpack the paradox of women who continue to show up for health camps despite not taking anyway many useful skill and sometimes causing them anxiety. • Body-mass index (BMI) camps are held in rural India where undernutrition is significant. • Social spaces of BMI's use are linked to the types of health responsibility produced. • Intimate BMI exercises situate responsibility with local culture and a neglectful state. • Large, impersonal BMI camps led to responsibility being individualized to bodies. • Nutrition behavior change is goal of BMI camps, yet is stymied by structural poverty. [ABSTRACT FROM AUTHOR]

The article presents a research paper which examines reliability and validity of Indian Migration Study Physical Activity Questionnaire (IMS-PAQ) in urban and rural groups in India. Study is based on examination of a sub-sample of IMS participants. Findings reveal that IMS-PAQ reliability and validity are similar to comparable self-reported instruments and is appropriate tool for ranking PA of individuals in India but requires refinements for sedentary population and women in India.

SummaryIntroduction1Definitions of ethnic groups and demographics of minority ethnic groups in the UK○ 1.1 Definitions of 'ethnic groups' and 'ethnicity'○ 1.2 Demographics and characteristics of minority ethnic groups in the UK– Countries of origin– Age/sex distribution and life expectancy– Geographical distribution and size of household– Religious beliefs– Education and employment patternsKey points2Overview of the health profile and dietary habits of minority ethnic groups in the UK○ 2.1 Available surveys○ 2.2 Overview of the health profiles among adults from minority ethnic groups– Overall health– Cardiovascular disease (CVD)– Coronary heart disease (CHD)– Stroke– Type 2 diabetes– Obesity○ 2.3 Possible causes of increased disease risk among minority ethnic groups○ 2.4 Smoking, drinking and physical activity habits○ 2.5 Dietary habits and nutritional status○ 2.6 Overview of the health profiles and dietary and health behaviour patterns of children from minority ethnic groups– Overall health– Diet and health behaviour patterns○ 2.7 Gaps in data availabilityKey points3Factors affecting food choice– Income and socio‐economic status– Food availability and access– Awareness of healthy eating– Religious beliefs– Food beliefs– Time and cooking skills– Generation and genderKey points4Traditional diets of minority ethnic groups○ 4.1 Overview of traditional diets of minority ethic groups– South Asians– African‐Caribbeans– Chinese○ 4.2 Dietary acculturation○ 4.3 Nutritional composition of ethnic‐style cuisineKey points5Nutritional interventions and health promotion among minority ethnic groups○ 5.1 Effective nutritional interventions○ 5.2 Health promotion interventions to prevent problems associated with fasting○ 5.3 Priorities for nutritional interventions and health promotion○ 5.4 Using behaviour change models○ 5.5 Current community initiatives○ 5.6 Catering for institutionalised individuals○ 5.7 Recommendations for future research, policy and practiceKey points6Conclusion• Acknowledgements• References Summary: According to the latest census, non‐white minority ethnic groups made up 7.9% of the UK's population in 2001. The largest of these groups were South Asians, Black African‐Caribbeans and Chinese. Studies have shown that some minority ethnic groups are more likely to experience poorer health outcomes compared with the mainstream population. These include higher rates of cardiovascular disease (CVD), type 2 diabetes and obesity. The differences in health outcomes may reflect interactions between diet and other health behaviours, genetic predisposition and developmental programming, all of which vary across different groups. As is the case for the rest of the population, the dietary habits of minority ethnic groups are affected by a wide variety of factors, but acquiring a better understanding of these can help health professionals and educationalists to recognise the needs of these groups and help them to make healthier food choices. Unfortunately, to date, there have been few tailored, well‐designed and evaluated nutritional interventions in the UK targeting minority ethnic population groups. Further needs assessment and better evaluation of nutritional interventions have been recommended to enhance the understanding of the effectiveness of different approaches amongst minority ethnic groups. This briefing paper will provide an overview of the health profile, dietary habits and other health behaviours of the three largest non‐white minority ethnic groups in the UK, explore the factors affecting their food choices, provide a summary of their traditional diets and review the evidence base to identify the factors that support successful nutrition interventions in these groups. [ABSTRACT FROM AUTHOR]

Hierarchies of power among healthcare professionals are well documented, nonetheless, power remains neglected, understudied and under-theorised in health systems analysis and policy discussions, especially in the domain of Traditional, Complementary and Alternative Medicine (TCAM). Sociological and public health scholarship has documented the persistence of medical dominance in the health system, theorised as the limitation, subordination, exclusion and incorporation of other professions. This paper explores how interprofessional power dynamics shape the integration of TCAM into Indian primary healthcare centres, as part of a nationwide policy of TCAM integration and medical pluralism implemented since 2005. We conducted interviews (n = 37) with health system administrators, nurses, pharmacists, TCAM and biomedicine doctors, and observed day-to-day activities of primary healthcare centres for six months in Odisha state, India. Thematic analysis enabled the identification of themes and exploration of sub-themes. The analysis revealed multilayered forms of medical dominance within the primary healthcare system and identified multiple sites where everyday power is mobilised. Biomedicine practitioners exercised authoritative power and restricted TCAM doctors' access to facility-level resources, i.e. financial and workforce support, which inhibited the integration policy implementation. Significantly, TCAM doctors were 'ordered' to practice biomedicine at primary healthcare centres, which was beyond the scope of the integration policy. However, TCAM doctors were also able to exercise countervailing power in their day-to-day activities in the primary healthcare centres and sought to assist patients' health behaviour change through their authoritative knowledge about 'how to live a healthy life'. The health system actors involved in policy implementation hold a range of forms of power specific to the circumstances, influencing the integration processes. We explain these dynamics in relation to existing theories of medical dominance and countervailing power, while introducing a previously unreported dimension of dominance: 'co-optation', which enrols TCAM practitioners in the practice of biomedicine. • Medical dominance in Indian primary health care centres (PHCs) is multi-layered. • AYUSH doctors working in PHCs experience subordination, exclusion and limitation. • A new form of medical dominance – co-optation – was also uncovered in this setting. • Co-optation here involved AYUSH doctors being ordered to undertake biomedical tasks. • Via countervailing power, AYUSH doctors retained autonomy in community-based work. [ABSTRACT FROM AUTHOR]

Abstract  Improving the health of urban residents, particularly those living in slum areas, requires an integrated approach. Appropriate interventions must be based on a well-grounded understanding of health determinants. Social factors are as important as physical factors in determining health status and suggest alternative interventions. Employment, stress, social exclusion, social support, substance use, nutrition, transport, and conditions during childhood are among the most important social determinants of health status identified by the International Center for Health and Society. This paper uses social determinants of health approach to understand morbidity outcomes for people residing in the slums of Surat City, India. To quantify suboptimal health behavior and identify the determinants of health status for this population survey data on household characteristics, health-seeking behavior, socioeconomic status, food and personal habits, social life, and physical activity has been used. After controlling for socioeconomic and demographic factors, logistic regression analysis reveals that social exclusion, stress, and lack of social support are significantly associated with morbidity. Thus, understanding of social determinants of health by policy makers is important as the health sector has a crucial role in addressing disparities in social determinants. [ABSTRACT FROM AUTHOR]

This paper uses ethnographic data from a sex workers' HIV project in India to consider the appropriateness of individual, social/group and structural theories of health behaviour when applied to HIV-prevention initiatives. Existing theories are critiqued for their modernist representation of behaviour as determined by individual rational decision-making processes or by external structural forces, with inadequate recognition being given to the roles that human agency, subjective meaning and local context play in everyday actions. Analysis of sex workers' accounts of their sexual practices suggests that existing theories of health behaviour can only partially account for sexual behaviour change retrospectively and that they have limited predictive value with respect to the outcomes of individual sexual encounters. Our data show that these outcomes were, in fact, highly context dependent, while possibilities for action were ultimately strongly constrained by structural forces. Findings suggest that interventions need to adopt an integrated, structurally-oriented approach for promoting safer sexual practices in sex work settings. Recognising that no one model of health behaviour is likely to be adequate in explaining or predicting behaviour change encourages responsiveness to local people's agency, recognises the different (health- and non-health-related) registers of risk with which people operate and encourages flexibility according to local contingencies and contexts. [ABSTRACT FROM AUTHOR]

The Tibetan refugee in India grudgingly preserve their culture and traditional way of life, even though the new situation they are required to face here call for new adjustments to be made by them. It cannot be said that they have been particularly successful in doing this because there are certain areas where the new environmental and socio-economic features differ markedly from those prevailing in Tibet and on which they have absolutely no control. In addition, the extreme love for their own tradition and an inclination to continue their old habits create some difficulties for the migrant Tibetans in India. This is particularly noticeable in their health and health related behaviours. The paper aims at examining the advantages and disadvantages intrinsic to be a Tibetan refugee in India, the observations being limited to the sphere of health. [ABSTRACT FROM AUTHOR]

Despite strong policy and program commitment, essential maternal nutrition services are not reaching enough women in many countries. This paper examined multifactorial determinants (personal, family, community, and health services) associated with maternal nutrition practices in Uttar Pradesh, India. Data were from a household survey of pregnant (n = 667) and recently delivered women (n = 1,835). Multivariable regression analyses were conducted to examine the determinants of four outcomes: consumption of diverse diets, consumption of iron folic acid (IFA) and calcium tablets, and weight monitoring during pregnancy. Population attributable risk analysis was used to estimate how much the outcomes can be improved under optimal program implementation. During pregnancy, women consumed 28 IFA and 8 calcium tablets, 18% consumed diverse diet, and 17% were weighed ≥3 times. Nutrition knowledge was associated with consumption of diverse diet (odds ratio [OR] = 2.2 times), IFA (2.3 times), calcium (11.7 times), and weight monitoring (1.3 times). Beliefs and self‐efficacy were associated with IFA (OR = 2.0) and calcium consumption (OR = 4.6). Family support and adequate health services were also associated with better nutrition practices. Under optimal program implementation, we estimate that 51% of women would have adequate diet diversity, an average consumption of 98 IFA, and 106 calcium tablets, and women would be weighed 4.9 times during pregnancy. Strengthening existing program operations and increasing demand for services has the potential to result in large improvements in maternal nutrition practices from current baseline levels but may not be sufficient to meet World Health Organization‐recommended levels without creating an enabling environment including improvements in education and income levels to support behaviour change. [ABSTRACT FROM AUTHOR]

Background: Youth focused Life Skills Education and Counseling Services (YLSECS) program, trained teachers/National Service Scheme (NSS) officers to deliver Life Skills Education (LSE) and counseling services to college going youth in the state of Karnataka in India. Available evaluation of life-skills training program have neglected the recording and or reporting of outcome among those trained to implement life-skills training program. Present paper highlights the quality of YLSECS training program and change in perception among teachers/NSS-officers trained in-terms of improvement in their cognitive/affective domains.Methods: YLSECS program focused on World Health Organization identified ten essential domains of life-skills. Participants of the YLSECS program were trained by adopting facilitatory approach based on the principles of Kolb's learning theory. Quasi experimental study design was used to evaluate the outcome of training among participants. Quality of the training was assessed using scoring system and change in perception was assessed using Likert scale. Statistical significance of change in perception before and after training was assessed by paired't' test for proportion.Results: Overall, 792 participants rated the quality of training as either "good" or "excellent". Post-training, significant (p < 0.001) proportion of the participants reported improved awareness about life-skills (before training 49.9 to 74.4% vs post-training range from 91.6 to 95.1% for various domains). There was statistically significant (p < 0.001) increase in participants reporting "very confident" in teaching various life skill domains (before training from 22.7 to 34.2% for various domains and post-training it ranged from 65.2 to 74.7% for various domains). There was modest increase in participants reporting perceived ability to conduct life-skills workshop "without assistance" post-training (before training from 16.8 to 22.9% for various domains vs post-training ranged from 29.8 to 36.8% for various domains). Interestingly, considerable proportion of participants who prior to training reported being confident in providing life skills training (without any assistance), later (i.e post training) reported they need some/more assistance for the same.Conclusion: YLSECS training program significantly improved participants knowledge and confidence in imparting life-skills and highlight the need for continued handholding of participants for effective implementation of LSE and counseling service program. [ABSTRACT FROM AUTHOR]

Dietary intake during pregnancy plays a vital role in determining the health of both mother and baby. Maternal undernutrition affects a large proportion of women in low and lower middle income countries (LLMIC) likely influencing high maternal, infant, and child mortality in these countries. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This paper reviews the literature to evaluate the effectiveness of mHealth interventions on improving dietary/nutrients intake of pregnant women in LLMIC. Eight electronic databases were searched from inception up to April 2018, including the MEDLINE, EMBASE, CINAHL, Cochrane, Web of Science, Scopus, Global Index Medicus, and Maternity and Infant Care. Using Covidence, two reviewers assessed articles for inclusion, assessed study quality and extracted data. Only studies published in English language were included. Data were summarised narratively. In total, 6,778 were identified of which four were included, with three randomised controlled trials and one prepost experimental study. Studies were conducted in India (n = 2), Indonesia (n = 1), and Kenya (n = 1). All articles evaluated the use of nutrient supplements; iron supplements (n = 1), vitamin supplements (composition not mentioned; n = 1), or calcium supplements (n = 1). This review suggests that mHealth interventions can be used to improve intake of micronutrient supplementation and nutritional status of pregnant women in LLMIC. Further studies are needed to address the limited evidence base related to mHealth nutrition interventions targeting dietary intakes of pregnant women in LLMIC. [ABSTRACT FROM AUTHOR]