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This study employs the therapeutic landscape theory to explore how online religious services during lockdown restrictions shape experiences of well-being and intergenerational learning. We used qualitative data from in depth interviews and focus groups with older adults and pastors in five churches in Ghana to explore how online religious places are conceptualized as therapeutic landscapes for sustaining wellbeing goals amidst a global pandemic. We identified multiple pathways of meaning through which online religious services shape the lives of people in a faith community to sustain the experience of well-being in a difficult time. In addition, this paper reflects on the broader implications of COVID-19 in shaping a paradigm shift in digital religion and intergenerational learning experiences through a changing religious landscape precipitated by lockdown restrictions that have drastically altered traditional religious places. [ABSTRACT FROM AUTHOR]

Background: In psychiatric care, doctors depend on information from interactions with patients to arrive at the right diagnosis and appropriate therapy (Brisset C, Leanza Y, Rosenberg E, Vissandjée B, Kirmayer LJ, Muckle G, et al. language barriers in mental health care: a survey of primary care practitioners. J Immigr Minor Health. 2014;16(6):1238–46). This is a qualitative descriptive study which seeks to investigate language barriers faced by psychiatrists in their interactions with patients and the effectiveness of the strategies which are employed to deal with the barriers. Methods: Research questions are informed by Convergence (Giles H. Communication Accommodation Theory. In: Baxter LA, Braithewaite DO, editors. Engaging theories in interpersonal communication: multiple perspectives. Thousand Oaks (CA): Sage Publications; 2008. p. 161–73). Using semi-structured interviews, psychiatric doctors from the three state-owned psychiatric hospitals in Ghana report their experiences with convergence strategies they use, and offer suggestions that could inform future studies and policy formulation with regard to psychiatric care in Ghana. A qualitative conventional content analysis was applied whereby coding categories were derived straight from the text data. Results: The literature suggests that the study is novel with reference to Ghana. Similar studies (Lee E. Cross-cultural communication: therapeutic use of interpreters in mental health for professionals and clinicians. In: Lee E, editor. Working with Asian Americans: a guide for clinicians. New York (NY): The Guilford Press; 1997; Swartz L, Drennan G. Beyond Words: notes on the 'irrelevance' of language to mental health services in South Africa. Transcult Psychiatry. 2000;37(2):185–201; Jarvis GE, Ahmed R, Ryder A, Kirmayer LJ. Assessing language barriers to mental health services in a multiethnic population: preliminary findings. Presentation at Health care Access for Linguistic Minorities: Breaking the Barriers. Montreal, Quebec, Canada; 2014) corroborate this paper's findings that language barriers have the potential of causing misdiagnoses if psychiatrists do not employ effective communication strategies. Conclusions: The paper recommends areas for further research and improvement measures which carry policy implications. [ABSTRACT FROM AUTHOR]

People with disabilities have an inviolable right to equitable access and participation in tertiary education and support systems are known to be indispensable in making this right a reality. This article presents the voices of students with disabilities regarding aspects that influence their successful access and participation in tertiary education in Ghana. A qualitative approach was adopted for the study with data collected through interviews with 12 students with disabilities in three public universities. From the perspective of these students, successful inclusion of people with disabilities in tertiary education in Ghana is influenced by enrolment practices, the built environment, teaching and learning approaches, and assessment provisions. The context influenced provisions and support provided. Attitudes of the university community and lack of knowledge of inclusive practices such as Universal Design play a role in students' access and participation. Comprehensive awareness-raising on disability and inclusive practices is recommended to address this issue. This paper explores inclusion practices in three Ghanaian public universities focussing on the combined voices of students with disabilities. The context of the three universities influences the provisions and support available for people with disabilities. The students with disabilities involved in the study reported that access to the university environment and support for academic engagement impact their university experience. The attitude of the university community is a factor in ensuring access, participation and success of people with disabilities in higher education. Creating awareness of disability issues within the university community is pivotal in building and sustaining inclusive culture. The application of universal design principles is essential to improving access and participation of people with disabilities in higher education institutions. [ABSTRACT FROM AUTHOR]

Child sexual abuse (CSA) is a prevalent problem in many societies across the globe. There have been several discussions of the subject and attempts have been made to explain its incidence and find ways to prevent and/or control it. However, despite these efforts, the problem seems to persist in developing countries like Ghana with dire consequences for the children and society at large. This paper sought to glean insights about the persistence of the problem by focusing on the discourse surrounding the subject. Using Focus Group Discussions with adult members in the Ga communities in Accra namely La, Teshie, and James Town where the phenomenon is relatively pervasive, the paper sought to understand the reasoning and the implications of accusing children who were sexually abused in the Ga community of seducing the perpetrators and engaging in sex for money. The paper posits that the labeling of victims of CSA as “gbɛkɛfɔŋs” (children of bad character) disempowers children and perpetuates the abuse of children. Thus, introducing and situating this notion of “gbɛkɛfɔŋs” in the center of the discourse largely results in a victimization of the victims and a vicious cycle of CSA. The conclusions from this study point to the need for a reorientation of parental and communal roles and an empowering of children to identify and resist sexual abuse. [ABSTRACT FROM AUTHOR]

The health and wellbeing of older adults have taken center-stage in global policy agendas in recent times. In 2003, Ghana introduced an insurance exemption policy to eliminate financial barriers to healthcare for older adults and other vulnerable population groups. Embedded within the National Health Insurance Scheme (NHIS), this policy ostensibly guarantees free healthcare for older adults at publicly-funded facilities across the country. In this paper, we applied the implementation problem framework to identify gaps in the implementation of the exemptions policy and their impact on the healthcare experiences of older adults. Our data collection involved qualitative interviews with a purposive sample of community-residing older adults, health workers, community leaders, and policymakers. Our thematic data analysis identified resource, substantive, bureaucratic, political, and administrative constraints in the policy implementation process which, in turn, affected quality healthcare delivery. While most of these constraints are general challenges confronting the NHIS, they serve to undermine the intent of the scheme's exemptions policy. In particular, despite the exemptions, older adults continued to pay out-of-pocket for certain categories of treatments and medications, creating as yet financial barriers to healthcare. We present policy recommendations for addressing these implementation challenges, including suggestions to decentralize, depoliticize, and financially liberate the operations of the NHIS. Ghana's health insurance scheme has not eliminated financial barriers to healthcare for older adults. Older Ghanaians reported unmet healthcare needs, despite implementation of health insurance. Resource, substantive, bureaucratic, and political constraints impede the policy implementation process. Measures are needed to decentralize and depoliticize the NHIS implementation process. [ABSTRACT FROM AUTHOR]

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted. [ABSTRACT FROM AUTHOR]

This paper presents findings of a study that explored the challenges and coping strategies of parents of children with mental disorders. In-depth interviews were conducted with 35 parents of children with mental disorders at the Psychiatric Unit of the Komfo Anokye Teaching Hospital in Kumasi. Data were analyzed using thematic content analysis. Findings indicated that financial constraints, inability to secure permanent employment, and stigma were the challenges of the parents. Having faith in God and accepting their children's condition were the coping strategies adopted by the parents. However, lack of effective support system makes coping difficult for the parents. [ABSTRACT FROM AUTHOR]

Integrating consumers' experiences into quality mental health service assessment is relevant to improve service outcomes. Despite this, limited studies have attempted to explore consumers' experiences, particularly in developing countries, such as Ghana. This paper aims to explore consumers' subjective experiences of the quality of mental health services. A qualitative method involving in-depth interviews was used to collect data from 21 consumers of mental health services. Thematic analysis was used to analyse the data, which is discussed using a realistic evaluation approach. The study identifies four themes, 33 inductive codes and 594 references. The themes used to interpret the verbatim narratives are the available mental health services, therapeutic interaction with the professionals, competency and skills of the professionals, and the changes experienced in the consumers' lives. The study indicates that the mental health services aim to provide a range of treatments and medications as well as recovery-oriented services, using mechanisms such as ensuring an effective therapeutic relationship and improving technical competency and skills. The contextual factors and the mechanisms have helped to achieve some changes in the lives of consumers (increased satisfaction, reduced symptoms, improved functionality, feeling normal, improved living skills and self-care, work and capabilities, and social inclusion). The study concludes that policymakers and clinicians should integrate evidence-based recovery services, principles and values into the existing mental health services. The mechanisms used to promote quality of mental health services should be strengthened, through periodic monitoring and evaluation, using approaches such as sensor data capturing, to ensure good coordination and continuity. [ABSTRACT FROM AUTHOR]

This paper explores consumers' understanding and perception of the etiology of mental illness in community-based residential facilities in Ghana. Qualitative data involving in-depth interviews were used to collect data from 15 consumers of mental health services from two residential facilities. Thematic analysis was used to analyze the data. The study showed that mental illness is generally constructed within the medical and religious-cultural notion. The religious-cultural construction aligned mental illness to Ghanaian belief systems (supernatural forces, spirituality and traditional belief) and cultural practices (social norms and values) whilst the medical construction ascribed the etiology to biological, emotional and substance abuse issues. Although consumers had a positive perception of mental illness, they were doubtful about the presence of illness. The study concludes that the combination of medical, social and religious-cultural constructs and understanding of mental illness should be integrated into advocacy and awareness programmes to better educate consumers and clinicians. [ABSTRACT FROM AUTHOR]

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Purpose: With the increasing number of assistance programs that target trafficking survivors around the globe, there is a need for documentation of evidence that can inform such programs. This paper examined and documented the post-intervention experiences of trafficked and vulnerable women who had received services at Lifeline, a residential care facility in Ghana, West Africa. Method: The study employed a secondary qualitative analysis of in-depth, face-to face interviews with n = 37 participants. Data analyzes were conducted using thematic analysis and themes and sub-themes were then extracted. Findings: Three major themes emerged from the study: major achievements after leaving Lifeline; challenges after leaving Lifeline; and family dynamics and relations after leaving Lifeline. Conclusion: Despite experiencing various social, psychological, and economic challenges after the intervention, participants reported that this particular agency had positively impacted their lives. [ABSTRACT FROM AUTHOR]

Background: Persons with disabilities have often been overlooked in the context of HIV and AIDS risk prevention and service provision. This paper explores access to and use of HIV information and services among persons with disabilities. Methods: We conducted a multi-country qualitative research study at urban and rural sites in Uganda, Zambia, and Ghana: three countries selected to exemplify different stages of the HIV response to persons with disabilities. We conducted key informant interviews with government officials and service providers, and focus group discussions with persons with disabilities and caregivers. Research methods were designed to promote active, meaningful participation from persons with disabilities, under the guidance of local stakeholder advisors. Results: Persons with disabilities emphatically challenged the common assumption that persons with disabilities are not sexually active, pointing out that this assumption denies their rights and – by denying their circumstances – leaves them vulnerable to abuse. Among persons with disabilities, knowledge about HIV was limited and attitudes towards HIV services were frequently based upon misinformation and stigmatising cultural beliefs; associated with illiteracy especially in rural areas, and rendering people with intellectual and developmental disability especially vulnerable. Multiple overlapping layers of stigma towards persons with disabilities (including internalised self-stigma and stigma associated with gender and abuse) have compounded each other to contribute to social isolation and impediments to accessing HIV information and services. Participants suggested approaches to HIV education outreach that emphasise the importance of sharing responsibility, promoting peer leadership, and increasing the active, visible participation of persons with disabilities in intervention activities, in order to make sure that accurate information reflecting the vulnerabilities of persons with disabilities is accessible to people of all levels of education. Fundamental change to improve the skills and attitudes of healthcare providers and raise their sensitivity towards persons with disabilities (including recognising multiple layers of stigma) will be critical to the ability of HIV service organisations to implement programs that are accessible to and inclusive of persons with disabilities. Discussion: We suggest practical steps towards improving HIV service accessibility and utilisation for persons with disabilities, particularly emphasising the power of community responsibility and support; including acknowledging compounded stigma, addressing attitudinal barriers, promoting participatory responses, building political will and generating high-quality evidence to drive the continuing response. Conclusions: HIV service providers and rehabilitation professionals alike must recognise the two-way relationship between HIV and disability, and their multiple overlapping vulnerabilities and stigmas. Persons with disabilities demand recognition through practical steps to improve HIV service accessibility and utilisation in a manner that recognises their vulnerability and facilitates retention in care and adherence to treatment. In order to promote lasting change, interventions must look beyond the service delivery context and take into account the living circumstances of individuals and communities affected by HIV and disability. Persons with disabilities are vulnerable to HIV infection but have historically been excluded from HIV and AIDS services, including prevention education, testing, treatment, care and support. Fundamental change is needed to address practical and attitudinal barriers to access, including provider training. Rehabilitation professionals and HIV service providers alike must acknowledge the two-way relationship between HIV and disability: people with disability are vulnerable to HIV infection; people with HIV are increasingly becoming disabled. Peer participation by persons with disabilities in the design and implementation of HIV services is crucial to increasing accessibility. Addressing political will (through the National Strategic Plan for HIV) is crucial to ensuring long-term sustainable change in recognizing and responding to the heightened vulnerability of people with disability to HIV. [ABSTRACT FROM AUTHOR]

Expanding access to sexual and reproductive health (SRH) services is one of the key targets of the Sustainable Development Goals. The extent to which sexual and reproductive health and rights (SRHR) targets will be achieved largely depends on how well they are integrated within Universal Health Coverage (UHC) initiatives. This paper examines challenges and facilitators to the effective provision of three SRHR services (maternal health, gender-based violence (GBV) and safe abortion/post-abortion care) in Ghana. The analysis triangulates evidence from document review with in-depth qualitative stakeholder interviews and adopts the Donabedian framework in evaluating provision of these services. Critical among the challenges identified are inadequate funding, non-inclusion of some SRHR services including family planning and abortion/post-abortion services within the health benefits package and hidden charges for maternal services. Other issues are poor supervision, maldistribution of logistics and health personnel, fragmentation of support services for GBV victims across agencies, and socio-cultural and religious beliefs and practices affecting service delivery and utilisation. Facilitators that hold promise for effective SRH service delivery include stakeholder collaboration and support, health system structure that supports continuum of care, availability of data for monitoring progress and setting priorities, and an effective process for sharing lessons and accountability through frequent review meetings. We propose the development of a national master plan for SRHR integration within UHC initiatives in the country. Addressing the financial, logistical and health worker shortages and maldistribution will go a long way to propel Ghana's efforts to expand population coverage, service coverage and financial risk protection in accessing essential SRH services. [ABSTRACT FROM AUTHOR]

Purpose: As cancers increase in Ghana and in many low-and middle-income countries, healthcare utilization has become critical for disease management and patients' wellbeing. There is evidence that medical pluralism is common among cancer patients in Ghana and many other African countries, which results in lack of adherence to and absconding from hospital treatments. The objective of this study was to examine ways in which beliefs in disease causation influence medical pluralism among Akan cancer patients in Ghana. Methods: A qualitative research approach was employed in this study. In-depth interviews were conducted for thirty (30) cancer patients who were purposively recruited from Komfo Anokye Teaching Hospital in Ghana. Thematic content analysis was used in analysing data. Results: Our findings revealed that cancer patients ascribed both physical and spiritual causality to their illness. As such, they combined orthodox treatment with spiritual healing and herbal medicine. Regarding the order of therapeutic search, patients reported to herbal and spiritual centres before going to the hospital, a phenomenon which contributes to the late reporting and diagnosis as well as bad prognosis of cancers in Ghana. Conclusion: The findings of this research elucidate the relationship between culture and health care choices of cancer patients in Ghana. Increased awareness creation is crucial in eradicating myths surrounding cancers in Ghana. [ABSTRACT FROM AUTHOR]

Women and girls need proper sanitation and hygiene facilities to maintain health and dignity. In this study we show how schoolgirls from a peri-urban community of Ghana, experience severe multidimensional 'hygiene poverty' when attending schools. Hygiene poverty was characterized by poor water and sanitation infrastructures and serious social and emotional challenges, including shaming and disciplining of their sanitation and menstrual practices, which forces girls to apply secretive coping strategies. We discuss the importance of changing the negative MHM discourses at schools and fostering supportive teaching methods in adolescent female health. [ABSTRACT FROM AUTHOR]

The need to improve the sexual and reproductive health (SRH) and rights of women with disabilities is increasingly acknowledged. Unfortunately, women with disabilities in low- and middle-income settings, including Ghana, face several barriers (including structural, financial, physical, social and attitudinal) to accessing SRH services and care. This paper explores the enablers and barriers to accessing SRH services and care among visually impaired women in the Ashanti and Brong Ahafo Regions of Ghana. Qualitative data from in-depth interviews and focus group discussions were collected from 21 visually impaired women, selected through purposive and snowballing sampling techniques. Thematic analysis was used to develop codes, and data were further grouped into emerging themes. The barriers to accessing SRH services and care were financial difficulties and lack of preferential treatment. The enablers which facilitated access to SRH services and care were the support provided by caregivers and friendly relationships with health providers. To address these challenges and promote access, SRH related policies, services and programmes should be inclusive of the needs of visually impaired women, and measures to remove financial challenges to service utilisation and foster positive relationships with health workers, church and community members should be adopted. [ABSTRACT FROM AUTHOR]

Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women’s perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to “correct” disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman’s experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth. [ABSTRACT FROM AUTHOR]

Pregnancy among adolescent girls is a public health problem globally and especially in developing countries. Its occurrence can be prevented with the correct and consistent use of effective contraceptive methods. This study explored the personal determinants of hormonal contraceptive uptake and consistent use among adolescent girls as evidence for informing effective hormonal contraceptive use interventions among them. In-depth interviews were carried out among 16 girls aged 15 to 19 years with hormonal contraceptive experience between April and June 2022 in Kintampo, Ghana. Results showed that knowledge on hormonal contraceptive types and sources of obtaining them, organizing hormonal contraceptive uptake and self-efficacy in getting access, hormonal contraceptive use decision-making, and disclosure of hormonal contraceptive use were important factors explaining uptake and consistent hormonal contraceptive use among adolescent girls in this study. Also, coping mechanisms and skills for accessing and using hormonal contraceptives, attitude toward hormonal contraceptives, and risk perception toward pregnancy influence the uptake and consistent use of hormonal contraceptives. Participants in this study were resilient and highly in favor of hormonal contraceptive use. They have demonstrated that it is possible for adolescent girls to use hormonal contraceptives and use them consistently if interventions are targeted at their attitude to hormonal contraceptives, their self-efficacy, decision-making skills, coping skills, and pregnancy risk perception, among others. [ABSTRACT FROM AUTHOR]

One of the common undesirable outcomes of pregnancy is perinatal loss. Healthcare systems strive to reduce the incidence of perinatal loss but typically little attention is on the experiences of bereaved mothers following perinatal loss, particularly in low and middle-income countries where such deaths are common. This research explored the lived experiences of mothers with perinatal loss in the Kumasi metropolis, Ghana. A qualitative design was used to explore the experiences of nine (9) bereaved mothers from the Komfo Anokye Teaching Hospital's postnatal ward and the Mother and Baby Unit. Data were collected through face-to-face interviews using a semi-structured interview guide, audio-recorded, and thematically analyzed. One major finding was that mothers restricted mourning their dead babies based on fear of recurrent perinatal loss and traditional beliefs on delayed return to fertility. Mothers blamed healthcare providers for their loss due to their concerns about care received. Gaps in communication flow from healthcare professionals to bereaved mothers were commonly identified as mothers struggled to make meaning of their loss and coped with cultural restrictions and beliefs. Healthcare professionals must explore mothers' concerns and "gut-feelings," and pay attention to their communication needs following perinatal loss. [ABSTRACT FROM AUTHOR]

We assessed the challenges facing 29 women in their quest for maternal health services in the Shai Osudoku District of Ghana. In-depth, semi-structured interviews with health professionals and focus-group discussions with women on uptake of maternal health services were conducted. Findings showed inadequate human resources and logistics for maternal health care and transportation problems. Women whose pregnancies required specialized care at district or regional hospitals deliberately reported late to the community clinics in an advanced stage of labor to avoid referrals. Findings have implications for health policymakers, implementers, and researchers. [ABSTRACT FROM AUTHOR]

Adinkra symbols are ubiquitous cultural artifacts in Ghana, West Africa. This qualitative multiple case study examined how proverbial meanings of Adinkra symbols impacted the cultural identity development of five Ghanaian emerging young adults. Using semi-structured interviews and an Adinkra printmaking activity, this study revealed six major themes describing how Adinkra symbols and their meanings inform participants' cultural identity. These themes included: exposure to Adinkra symbolism; religion, spiritual, and moral guidance; cultural significance and grounding; meaning making through visual expression; Ghanaian identity expression; and respect for parents, elders, and community. This study has implications for understanding how explicit cultural messages contribute to positive cultural identity development of Ghanaian emerging young adults, and how printmaking can be used as a creative method to promote positive mental health. [ABSTRACT FROM AUTHOR]

Despite advances in human rights and treatments, stigma toward individuals diagnosed with mental illness is common across the African continent. This article explores experiences of stigma and social exclusion among individuals diagnosed with mental illness and receiving treatment in a psychiatric facility in Ghana. The study, based on in-depth, semi-structured interviews generated the following themes: beliefs in spiritual causes of mental illness; spirituality as a coping mechanism; mistreatment and abuse. The findings highlight the significance of social exclusion and spirituality as the main roots of stigma; also the importance of awareness-raising as tools for anti-stigma work in the global South. [ABSTRACT FROM AUTHOR]

Drawing on the insights of Bronfenbrenner's ecological systems and Lazarus' coping theories, this article highlights the challenges and coping strategies of women living with obstetric fistula in the Northern Region of Ghana. Employing the convenience sampling technique, 55 women were purposively recruited to participate in the study. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted to collect data. With the permission of participants, the FGDs and IDIs were audio-recorded and transcribed. The data were analyzed to identify emerging themes that addressed the objectives of the study. The findings indicated that participants encountered varied challenges (physiological issues; abandonment and divorce; psychological problems; financial constraints; and difficulty accessing healthcare). Furthermore, it was found that the women included in this study adopted both problem-focused and emotion-focused coping strategies. Evidence showed that the problem-focused strategies were begging for assistance and seeking support from the Fistula Kpandai support group. Maintaining personal hygiene and optimistic motivation were the emotion-focused strategies employed by the participants. Based on the findings of the study, implications are discussed. [ABSTRACT FROM AUTHOR]

Introduction: There is growing evidence that group-based mental health intervention programmes can encourage the development of peer support, psychosocial skills, and collaborative therapeutic relationships with longer lasting effects. This study explored participants' experiences of, perceived benefits of, and recommendations to improve a 10-session group-based multicomponent positive psychology intervention (mPPI)—the Inspired Life Programme (ILP)—designed to promote positive mental health and reduce symptoms of depression and negative affect in a sample of rural Ghanaian adults. Method: Face-to-face semi-structured individual interviews were conducted with 18 randomly selected programme participants three months after their participation in the ILP. Data were analysed thematically with an inductive approach. Results: Participants described their experience of the ILP as a forum for growth that granted them the opportunity to introspect, practicalise and situate everyday life challenges, connect with others, and to develop a sense of mutual accountability. Results indicate that the ILP led participants to develop a stronger sense of positivity and well-being, fructify their ideas, and to cultivate stronger social networks and relationships that led to increased vocational productiveness. Participants recommended that researchers include facets of physical health promotion in the programme and invite close relations of participants to participate in the programme. Conclusion: This study provides the first insight into participants' experiences of a group-based mPPI in Ghana. These findings may provide useful information to inform the design of context-appropriate community-based mental health interventions to fit participants' specific needs, capacities, and circumstances. [ABSTRACT FROM AUTHOR]

Pleasure is a key motivator for sex globally, while unsafe sex is the largest risk factor for young women's mortality and the second for young men. However, framing of sex education and sexual health programmes continues to be around avoiding danger, death and disease, rather than striving for pleasurable, satisfying, and safe sexual experiences. Omission of pleasure and sex-positivity goes against growing evidence that shows that people with more positive views of sexuality are more likely to practice safer sex, use contraception consistently, have higher sexual self-esteem and be more assertive. The Pleasure Project and Rutgers, with GH SRHR Alliance (Ghana) and SRHR Alliance (Kenya), conducted a qualitative pilot study of sexuality education under the Get Up Speak Out programme, analysing the extent to which they included sex-positive content, with recommendations to enhance sex-positivity. Data were collected through interviews with facilitators, focus group discussions with learners, observation of sessions, and curricula content analysis. Findings reveal possibilities of sex-positivity in restrictive contexts, illustrating ways for sexuality education to become more sex-positive and pleasure inclusive. This study enables the development of a new tool for a 'pleasure audit', with markers of high-quality, sex-positive and pleasure-inclusive sexuality education or sexual health programmes. [ABSTRACT FROM AUTHOR]

District Health Management Teams (DHMTs) are often entry points for the implementation of health interventions. Insight into decision-making and power relationships at district level could assist DHMTs to make better use of their decision space. This study explored how district-level health system decision-making is shaped by power dynamics in different decentralised contexts in Ghana, Malawi and Uganda. In-depth interviews took place with national- and district-level stakeholders. To unravel how power dynamics influence decision-making, the Arts and Van Tatenhove (2004) framework was applied. In Ghana and Malawi, the national-level Ministry of Health substantially influenced district-level decision-making, because of dispositional power based on financial resources and hierarchy. In Uganda and Malawi, devolution led to decision-making being strongly influenced by relational power, in the form of politics, particularly by district-level political bodies. Structural power based on societal structures was less visible, however, the origin, ethnicity or gender of decision-makers could make them more or less credible, thereby influencing distribution of power. As a result of these different power dynamics, DHMTs experienced a narrow decision space and expressed feelings of disempowerment. DHMTs' decision-making power can be expanded through using their unique insights into the health realities of their districts and through joint collaborations with political bodies. [ABSTRACT FROM AUTHOR]

Repeat pregnancy may be more challenging to teenage mothers and their children because of increased socio-economic impact, as well as the influence of generally short pregnancy interval. Guided by Bronfenbrenner's ecological systems theory, this study explored challenges faced by teenage mothers with repeat pregnancy and support services available to them. Utilizing a qualitative research design, convenience and snowball sampling methods were used to recruit 41 participants, which consisted of 33 teenage mothers and eight health workers from Mamprobi Polyclinic, Accra, Ghana. Individual in-depth interviews and focus group discussions were utilized to gather data that were analyzed thematically. Findings showed that teenage mothers faced educational, financial, and health challenges. They also experienced psychological issues, particularly stigma. Additionally, teenage mothers did not obtain much support from their spouses and had to fend for themselves or relied on their families, neighbors, and health workers. Furthermore, teenage mothers encountered some barriers (family members rationalizing their problems, being accused of infidelity, and negative attitudes of some health professionals) when they accessed support services. Moreover, many of the teenage mothers were ignorant of available formal support services. The findings suggest the need to promote education on repeat pregnancy, family planning, and available support services. [ABSTRACT FROM AUTHOR]

Purpose: In Majority World countries, where speech-language pathology services are extremely limited, people with communication disabilities (PWCD) may seek help from a range of service providers. This qualitative research aimed to explore the nature of community services offered to people with communication disabilities who seek help in Accra, Ghana. Method: Semi-structured interviews were conducted with nine individuals from three professions: pastors (3), doctors (3), and herbalists (3) exploring services that they may offer to PWCD seeking help. Interviews were analysed using Thematic Network Analysis. Result: Six global themes described beliefs about communication disability, types of intervention, explanations provided to people with communication disabilities, promoting communication, processes for selecting treatments, and links between service providers. Interventions encompassed physical, spiritual, psychosocial and environmental approaches, with the notion of plural beliefs interwoven through a number of themes. Conclusion: In Ghana, and other Majority World contexts, service providers in sectors not commonly associated with communication disability rehabilitation may have important roles to play in supporting people with communication disabilities. Understanding the contributions of other service providers may assist the growing profession of speech-language pathology to collaborate across sectors, to develop specific, culturally responsive approaches to service development. [ABSTRACT FROM AUTHOR]

In spite of the consistent evidence of cash transfers' (CTs) impact on the social determinants of health (SDoH) in low-and middle-income countries, and their potential for achieving health sector objectives, there is a growing concern that the health sector has not been actively involved in these programs. This study used a critical realist approach to examine the factors affecting health sector involvement in CTs in Ghana. In-depth semi-structured interviews were conducted with 20 health promoters comprising national policymakers, District Directors of Health Service, Regional/District Health Promotion Managers and health promotion academics between October 2017 and February 2018. Interviews were audio-recorded and transcripts were analysed using thematic framework analysis. In addition, policy documents concerning the Ghana CT program were reviewed. All the participants were aware of the CT program, but had limited or no involvement in it to date. The findings indicate that CTs' cross-cutting goals and health sector mandates and responsibilities constitute the key structures and powers with the potential to trigger a more substantive involvement of the health sector in the program. Factors found to shape health sector involvement in CTs included CT policymakers' understanding of the SDoH, national health sector leadership, evidence linking CTs to SDoH, intersectoral collaboration and politicisation of CTs. As CTs continue to adapt and expand across low-and middle-income countries, the findings from this study can help the health sector to take a more substantive role in the programs to optimise their impacts on the SDoH and health inequities. [ABSTRACT FROM AUTHOR]

Cervical cancer is the second most common cancer among Ghanaian women and screening coverage is low. ACCESSING is a cross-sectional study investigating human papillomavirus (HPV) prevalence via self-sampling in rural communities of the North Tongu district in Ghana. Female health-care providers (HCPs) were invited to self-collect a cervicovaginal sample with a commercial sampler in order to acquaint themselves with the sampling method. This study set out to explore female HCPs' perceptions, advocacy for, and implications of self-sampling with the aim of enhancing self-sampling acceptability in the targeted screening population. A mixed-methods approach was used, consisting of (a) a survey among 52 female HCPs working in a district hospital and (b) 10 one-to-one semi-structured interviews with purposefully sampled HCPs. The quantitative analysis of the survey (n = 52) showed that, among HCPs who took the sample themselves (50/52), all found it 'Easy' or 'Very Easy' and felt 'Very Comfortable' or 'Comfortable'. 82.7% indicated that they would undertake screening more often, and 98.1% indicated they would prefer self-sampling, if cervical cancer risk is as reliably determined as by clinician-directed cytobrush sampling. All interview participants (n = 10) indicated that they appreciated the program and would recommend the screening to their patients and/or family members and neighbours. Common reasons for preferring self-sampling were less (anticipated) pain compared to speculum examination and more privacy. Self-sampling for cervical cancer screening is highly acceptable to female HCPs. Setting up a workplace screening program that entails the option of self-sampling could create greater awareness and positive attitudes among HCPs to educating their patients, families, and neighbours on cervical cancer risks and motivate HCPs to advocate for women's participation in screening. [ABSTRACT FROM AUTHOR]

Child sexual abuse is increasingly becoming an issue of concern in most societies across the globe, including Ghana. This is a phenomenological study that sought to describe the lived experiences of victims of child sexual abuse in Ghana, using the Ga community as a case study. Purposive and snowball sampling techniques were used to identify 17 sexually abused children in the Ga Community. Using the interpretative phenomenological analysis (IPA), four main themes described the experiences of the victims: (a) forced sex (b) incest (c) joleying and (d) transactional sex. The findings illustrate the different circumstances in which children were sexually abused in the community studied. It also presents socio-cultural factors that normalizes the sexual abuse of children in the Ga Community. These findings underline the need for effective preventive programs and community interventions to protect children and support victims of child sexual abuse. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the needs of Family Caregivers of people living with mental illness in Kumasi, Ghana. An exploratory research design using a Qualitative approach was employed for the study and one on one interview was used to collect data. A total of 13 participants who were identified as Family Caregivers of mentally ill persons having their rehabilitation in Kumasi were used for the study. Thematic content analysis was used to analyse and interpret the qualitative data. The results indicated that Family Caregivers were in need of medical attention as well as helping hand to assist them in their many physical engagement and adequate sleep and time off to replenish their lost energies to prevent stress. They were also in need of shelter to accommodate their mentally ill relatives as well as social affection. Others were in need of information to gain insight into patient's treatment and condition as well as financial support. Family Caregivers needed support from friends and society in order to psyche them for their task. It is, therefore, necessary that the needs of Family Caregivers are addressed so that they can function accordingly. [ABSTRACT FROM AUTHOR]

This study investigated psychosocial experiences and coping strategies of caregivers of persons with mental illness in a psychiatric hospital in Ghana. The study adopted a qualitative design in which 20 participants (10 psychiatric nurses and 10 family caregivers) were sampled from the hospital and interviewed. Using thematic analysis, the results showed that stress was common with both psychiatric nurses and family caregivers, which impact on their physical health. Both groups of caregivers reported experiences of stigma, with psychiatric nurses being stigmatized mainly by other health workers whereas family caregivers reported stigma from the public, particularly neighbors. Coping strategies differed between family caregivers and psychiatric nurses, in that nurses mostly used avoidance strategies and humor in dealing with stress and stigma associated with their work whereas family caregivers used emotion-focused coping. The implications of these findings include the need for counseling services to help caregivers manage negative experiences and psychoeducation of caregivers on adaptive coping strategies as well as training strategies targeting the public and healthcare workers on measures to reduce the stigma associated with caring for persons with mental illnesses. [ABSTRACT FROM AUTHOR]

Although disclosure of positive HIV status has recognized benefits, enacted and perceived stigma is a continuing problem in Ghana, especially affecting women living with HIV (WLHIV). This qualitative study investigates how WLHIV make these decisions. We interviewed 40 WLHIV, analysing their transcripts using thematic content analysis. Four themes emerged from the data: selectivity in disclosure; disclosure for education, prevention and to provide support; concern for the potential confident, and safety in secrets. Women’s awareness of and concerns about HIV-related stigma led them to seriously weigh the costs and benefits of disclosure decisions. Overall, our participants disclosed only when they believed that disclosure would benefit them or the confidant. They did not condone open disclosure, and preferred non-disclosure to minimize harm to themselves and loved ones. Though disclosure occurred for HIV education and prevention purposes, personal safety was the priority. We recommend revision of current post-HIV testing and pre-treatment counselling procedures to incorporate WLHIVs’ judgements about disclosure and discussion of the perceived benefits of disclosure. Disclosure is an intricate process that involves support seeking and educating others while averting harm. Continued research of the factors related to disclosure is important to enhance understanding of the disclosure process. [ABSTRACT FROM PUBLISHER]

While the role of evidence-based public health in improving health outcomes is frequently touted, there remains a dearth of research examining the use of evidence in public health service particularly in low- and middle-income countries. Therefore, the aim of this research was to examine the use of evidence in local public health service in Ghana, a lower middle-income country. Semi-structured in-depth interviews were conducted with local health managers from 11 District Directorates of Health in Ashanti Region. Three organising themes emerged from the interview transcripts: understanding of evidence-based public health; the process of using evidence; and the value of evidence in public health practice. The study suggests that though evidence-based practice was not new to the local health managers, its application was very low. The process of using evidence commenced with making a decision about the direction of a programme which had been already prioritised and planned by other high-level actors and then various sources of information, including available research evidence, were used to justify the decision. The study has revealed that there is an urgent need for pre-service and in-service training programmes that build and maintain common skill sets and language among local public health practitioners in Ghana to accomplish evidence-based public health goals. Similarly, giving local health managers flexibility to prioritise and make decisions would result in increased uptake of evidence in local public health service. [ABSTRACT FROM PUBLISHER]

Background: Public-private mix (PPM) can supplement public sector initiatives, including public health. As National Tuberculosis Control Programmes around the world embrace PPM, conforming to the four key principles of partnership values of beneficence, non-maleficence, autonomy, and equity as espoused by the World Health Organization can provide a useful framework to guide successful implementation. Design: This is a qualitative case study of PPM in tuberculosis (TB) control, which utilised a purposive sample of 30 key stakeholders involved in TB control in Ghana. Respondents comprised an equal number of respondents from both the public and private sectors. Semi-structured in-depth interviews (IDI) were conducted with respondents. Data emanating from the IDIs were analysed deductively. Results: Although the respondents' perceptions about beneficence were unanimous, their views about non-maleficence, autonomy, and equity appeared incongruous with the underlying meanings of the PPM values. Underlying the unfavourable perceptions were disruptions in funding, project implementers' failure to follow- up on promised incentives, and private providers lost interest. This was perceived to have negatively affected the smooth implementation of PPM in the country. Conclusions: Going forward, it is imperative that future partnerships are built around utilitarian principles and also adhere to the dictates of agreements, whether they are 'soft' or standard contracts. [ABSTRACT FROM AUTHOR]

Drawing on Earnshaw and Chaudoir’s HIV stigma framework, this study explored the experiences of persons living with HIV and AIDS regarding stigmatization and discrimination in accessing health services. Using a qualitative research methodology, 42 participants were purposively recruited during support group meetings of persons living with HIV and AIDS (PLWHA) at Amasaman in Accra, Ghana. Four focus group discussions (n= 22) and 10 in-depth interviews were conducted. Discussions and interviews were audio-taped, transcribed, and categorized based on the objectives of the study. The findings indicated that PLWHAs had knowledge of stigma that was experienced through enacted, anticipated, and internalized stigma mechanisms. Evidence showed that PLWHA did not experience stigma and discrimination when they accessed services at the Korle-Bu Teaching Hospital, the largest hospital in Ghana. However, the situation was different when they accessed services at other public health facilities. Based on the findings, implications are discussed for policy, social work, and public health practices. [ABSTRACT FROM AUTHOR]

Quality improvement (QI) is used to promote and strengthen maternal and child health services in middle- and low-income countries. Very little research has examined community-level factors beyond the confines of health facilities that create demand for health services and influence health outcomes. We examined the role of community outreach in the context of Project Fives Alive!, a QI project aimed at improving maternal and under-5 outcomes in Ghana. Qualitative case studies of QI teams across six regions of Ghana were conducted. We analysed the data using narrative and thematic techniques. QI team members used two distinct outreach approaches: community-level outreach, including health promotion and education efforts through group activities and mass media communication; and direct outreach, including one-on-one interpersonal activities between health workers, pregnant women and mothers of children under-5. Specific barriers to community outreach included structural, cultural, and QI team-level factors. QI efforts in both rural and urban settings should consider including context-specific community outreach activities to develop ties with communities and address barriers to health services. Sustaining community outreach as part of QI efforts will require improving infrastructure, strengthening QI teams, and ongoing collaboration with community members. [ABSTRACT FROM PUBLISHER]

Ghanaian women's food beliefs and practices during pregnancy and the scope for developing more effective maternal health interventions were explored in this study. Thirty-five multiethnic Ghanaian women between the ages of 29 and 75 were interviewed about pregnancy food beliefs and practices. I show that, based on the data analysis, their knowledge about food was drawn from lifeworlds (family and friends), educational settings, health professionals, mass media, and body-self knowledge (unique pregnancy experiences). Core lay ideas converged with expert knowledge on maternal health nutrition. Multiple external factors (e.g., economics, cultural representations of motherhood) and internal factors (e.g., the unpredictable demands of the pregnant body) influenced pregnancy food practices. I suggest and discuss a need for culturally situated multilevel interventions. [ABSTRACT FROM AUTHOR]

Globally, abortion has emerged as a critical determinant of maternal morbidity and mortality. The Ghana government amended the country's abortion law in 1985 to promote safe abortion. This article discusses the findings of a qualitative study that explored the decision-making experiences of 28 female abortion seekers aged between 15 and 30 years in Ghana. Key findings from the study are that individuals claimed autonomy in their abortion decisions; underlying the abortion decisions were pragmatic concerns such as economic difficulties, child spacing, and fear of parental reaction. In conclusion, we examine the health implications of Ghanaian women's abortion decisions. [ABSTRACT FROM PUBLISHER]

Background: Many current debates about global mental health have increasingly called for collaboration between biomedical and traditional medical health systems. Despite these calls, not much has been written about the variables that would influence such collaboration. To a large extent, collaboration dialogues have considered biomedicine on the one hand, and a wide range of traditional and faith-based treatments on the other hand. However, this dualistic bifurcation does not reflect the plurality of healing systems in operation in many contexts, and the diverse investments that different non-biomedical healing approaches may have in their own power to heal. Objective: We set out to explore the diversity of different healers' perceptions of power, and the relationship between that power and the perceived power of biomedical approaches. Methods: Through a qualitative design, and using the case of medical pluralism in urban Ghana as an example, we conducted interviews among different categories of traditional and alternative medicine (TAM) practitioners living and/or working in the Greater Accra Region of Ghana. Results: Through thematic analyses, differences in the notions about collaboration between the different categories of healers were identified. Their perceptions of whether collaboration would be beneficial seemed, from this study, to co-occur with their perceptions of their own power. Conclusions: We suggest that an important way to move debates forward about collaboration amongst different sectors is to examine the notions of power and positioning of different categories of TAM healers in relation to biomedicine, and the attendant implications of those notions for integrative mental healthcare. [ABSTRACT FROM AUTHOR]