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Owing to increased inclusion of young people with disabilities into the private sector in Bangladesh and Kenya, there is an urgent need to find alternative ways to support young graduates with a disability in the workplace with assistive technology solutions. The aim of the paper is to identify barriers for private workplace sectors to use assistive technology to support young graduates seeking, maintaining and retaining employment. This qualitative study adopted the research onion design of Saunders et al. Data were collected using interviews and focus group discussions and analysed using thematic analysis. The findings reveal that barriers are linked to seven key person‐centred capability themes: the dream, external factors, internal factors, assistive technology vision, strategic design priorities and gaps and assistive actions. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: There is a general lack of awareness and understanding of dementia within ethnic minority groups in the United Kingdom. There is also a dearth of research involving ethnic minority caregivers about reducing barriers to accessing services and optimizing engagements with religiously tailored interventions. This paper reports findings from a qualitative study that examined the barriers to health care service use in the Bangladeshi community living in the United Kingdom. Methods: The research draws on findings from a doctoral level research study on understanding dementia among the Bangladeshi community in England. The data for the doctoral research were gathered in two ways: (a) focus group discussions and (b) semi‐structured interviews. All data were audio‐recorded and analysed using thematic analysis. NVivo software was used to aid transcribing, coding, and interpretation of emergent themes. Results: The data showed that there were some barriers experienced by participants due to their religious and cultural beliefs and practices with other barriers related to the complexity of the UK health care system. Gender‐based caregiving also appeared to interfere with religious ideologies while religiously appropriate health care services were deemed of great importance for successfully accessing those services. Conclusions: The findings provide an understanding of the experiences of the Bangladeshi community when seeking to access mainstream UK health care services and may help to provide useful directions for future research. [ABSTRACT FROM AUTHOR]

Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight and is recommended by World Health Organization (WHO) in countries with high maternal undernutrition. Few countries have implemented BEP programmes due in part to high cost, lack of data on acceptability and feasibility, and complexity of delivery. We sought to address implementation gaps in BEP interventions through a formative study designed to understand implementation outcomes. We conducted 52 in‐depth interviews and 8 focus‐group discussions with married women of reproductive age, family members, health care providers and pharmacists in three unions of the Gaibandha district in rural Bangladesh. Interviews were translated and transcribed in English and analysed using an analytic framework for implementation science in nutrition. BEP was viewed as an acceptable and appropriate intervention to combat undernutrition in this setting. There was a lack of clarity on who should or could be responsible for providing/distributing BEP in a way convenient to mothers. Many participants preferred door‐to‐door delivery and thought this approach could address social and gender inequities, but providers mentioned already being overworked and worried about adding new tasks. Participants were concerned about the affordability of BEP and opportunity costs associated with travel to proposed distribution sites such as ANC or pharmacies. Women in these communities do not always have the agency to travel without supervision or make purchasing decisions. BEP supplementation is a complex intervention; future trials seek to assess ways to overcome these implementation challenges and inform a long‐term systems‐owned BEP intervention. Key messages: Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight but its implementation through ANC, as recommended by WHO, is complex.Decisions about who bears the cost of the product should consider the feasibility of scaling solutions to different groups. Targeting the most in need and with government supported programmes should be considered.Door‐to‐door distribution emerged as the preferred delivery modality, though the feasibility of this mechanism at scale is a concern, particularly given the documented lack of human resources in health.Given the positive community perceptions around BEP supplements, delivery through ANC could increase ANC participation. [ABSTRACT FROM AUTHOR]

Existing literature on women's empowerment (aligned with SDG 5) overlooks the diverse experiences and obstacles faced by women from various racial, ethnic, and socioeconomic backgrounds. This lack of intersectionality within women's empowerment studies hinders our understanding of the unique challenges encountered by marginalized women and limits the effectiveness of policies and interventions aimed at fostering their empowerment. To address this gap, this study delves into the challenges and processes of empowering women in Bangladesh. Qualitative data were gathered through semi‐structured interviews with 12 working women. Thematic analysis of the qualitative data revealed that women face numerous challenges, including lack of education, family support, and economic freedom, as well as complicated processes to access government support and adapt to technological changes. Furthermore, the study identified several potential processes for empowering women, including free education, and training, government support, awareness development, technological support, and mentorship. The study concludes with discussions, policy implications, limitations, and future research directions. [ABSTRACT FROM AUTHOR]

Aim To explore the experiences of women from three population groups of immediate skin-to-skin contact ( SSC) with their newborn babies. Method A mixed methods approach was adopted in a phenomenological study to elicit the experiences of English, Pakistani and Bangladeshi women. Audiotaped diaries, semi-structured interviews, photographs and video recordings were employed. Concept mapping was central to data analysis. Results This paper reports novel findings that women contextualized and accepted secretions and bodily fluids from birth. This contradicts the beliefs of midwives that Asian women find bodily secretions abhorrent and culturally unacceptable. All participants reported positive experiences of SSC despite varying degrees of soiling from birth fluids. Limitations The study was conducted in a single setting, and participants may not have been representative of others in their cultural groups. Third-party translation may have added an unsought layer of interpretation. The imposition of cultural expectations by peers in the recruitment process excluded some potential participants. Conclusion Stereotypical assumptions about cultural background often characterize professional responses. When this stereotyping was put aside, women of all three cultures, whether breastfeeding or bottle-feeding, were able to enjoy SSC with their babies. Implications for Nursing and Health Policy The findings suggest that changes will be needed in professional practice to be more open to women's expressed preferences, in local policy to ensure that choices are made clear and are available, and in national strategic direction to ensure widespread adoption of positive practices for opportunities to increase breastfeeding, promote parent-child bonding and support patient choice to be realized. [ABSTRACT FROM AUTHOR]

Background: Self‐management strategies improve asthma outcomes, although interventions for South Asian populations have been less effective than in White populations. Both self‐management and culture are dynamic, and factors such as acculturation and generation have not always been adequately reflected in existing cultural interventions. We aimed to explore the perspectives of Bangladeshi and Pakistani people in the United Kingdom, across multiple generations (first, second and third/fourth), on how they self‐manage their asthma, with a view to suggesting recommendations for cultural interventions. Methods: We purposively recruited Bangladeshi and Pakistani participants, with an active diagnosis of asthma from healthcare settings. Semi‐structured interviews in the participants' choice of language (English, Sylheti, Standard Bengali or Urdu) were conducted, and data were analysed thematically. Results: Twenty‐seven participants (13 Bangladeshi and 14 Pakistani) were interviewed. There were generational differences in self‐management, influenced by complex cultural processes experienced by South Asians as part of being an ethnic minority group. Individuals from the first generation used self‐management strategies congruent to traditional beliefs such as 'sweating' and often chose to travel to South Asian countries. Generations born and raised in the United Kingdom learnt and experimented with self‐management based on their fused identities and modified their approach depending on whether they were in familial or peer settings. Acculturative stress, which was typically higher in first generations who had migration‐related stressors, influenced the priority given to asthma self‐management throughout generations. The amount and type of available asthma information as well as social discussions within the community and with healthcare professionals also shaped asthma self‐management. Conclusions: Recognizing cultural diversity and its influence of asthma self‐management can help develop effective interventions tailored to the lives of South Asian people. Patient or Public Contribution: Patient and Public Involvement colleagues were consulted throughout to ensure that the study and its materials were fit for purpose. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) increasingly provide interpersonal counselling to childbearing women and their families to improve adoption of recommended maternal and child nutrition behaviours. Little is known about CHWs' first‐hand experiences garnering family support for improving maternal nutrition and breastfeeding practices in low‐resource settings. Using focused ethnography, we drew insights from the strategies that CHWs used to persuade influential family members to support recommendations on maternal diet, rest and breastfeeding in a behaviour change communication trial in rural Bangladesh. We interviewed 35 CHWs providing at‐home interpersonal counselling to pregnant women and their families in seven 'Alive & Thrive' intervention sites. In‐depth probing focused on how CHWs addressed lack of family support. Thematic coding based on Fisher's narrative paradigm revealed strategic use of three rhetorical principles by CHWs: ethos (credibility), pathos (emotion) and logos (logic). CHWs reported selectively targeting pregnant women, husbands and mothers‐in‐law based on their influence on behavioural adoption. Key motivators to support recommended behaviours were improved foetal growth and child intelligence. Improved maternal health was the least motivating outcome, even among mothers. Logically coherent messaging resonated well with husbands, while empathetic counselling was additionally required for mothers. Mothers‐in‐law were most intransigent, but were persuaded via emotional appeals. Persuasion on maternal rest was most effort‐intensive, resulting in contextually appealing but scientifically inaccurate messaging. Our study demonstrates that CHWs can offer important insights on context‐relevant, feasible strategies to improve family support and uptake of nutrition recommendations. It also identifies the need for focused CHW training and monitoring to address scientifically flawed counselling narratives. Key messages: Analysis of narratives of nutrition‐promoting, rural Bangladeshi community health workers (CHWs) suggest that behavior change communication (BCC) strategies to persuade husbands require logical and credible information (logos and ethos) to establish their support, while childbearing women may additionally require emotional appeals (pathos) to adopt promoted behaviors. Mothers‐in‐law, who traditionally influence multiple nutrition behaviors, can be persuaded via strategic use of ethos and pathos.CHW communication strategies are useful in developing persuasive narratives that capture influential family members' value beliefs and outcome expectancies and promote behavior change. However, additional programmatic efforts are needed to discourage use of unscientific narratives by CHWs. [ABSTRACT FROM AUTHOR]

This study aimed to identify the challenges in implementing green supply chain management (GSCM) practices in Bangladeshi manufacturing industries and pathways to address those challenges. Data were collected through semi‐structured interviews and analysed employing thematic analysis (N = 20, mean age = 42 years). The results demonstrated that among other challenges that impede implementing GSCM practices in the Bangladeshi manufacturing sector, lack of organizational policy, lack of infrastructure and technology, lack of knowledge, lack of management support and interest, and financial constraints are the significant ones. The findings also reported that setting and implementing effective organizational policies, monitoring, allocating sufficient resources, building informed and open collaboration with suppliers, developing knowledge and awareness, introducing environmental educational subjects and programs, and providing training and orientation programs may be effective pathways in implementing GSCM practices manufacturing firms can use to overcome challenges for GSCM practices. The findings may help managers, policymakers, supply chain professionals, and the management of the manufacturing industries to identify and address challenges of applying GSCM practices in Bangladesh. [ABSTRACT FROM AUTHOR]

The impact of the COVID‐19 pandemic on the overall well‐being of consumers is disastrous. However, there is limited understanding of how the COVID‐19 situation affects consumer well‐being and how subsistence consumers mitigate well‐being concerns and unique stresses. Following an exploratory, qualitative approach, 39 in‐depth semi‐structured interviews with subsistence consumers were conducted in India and Bangladesh. Findings from the thematic analysis reveal that subsistence consumers experienced unique stresses and hardships during COVID‐19, which are unforeseen transitory financial stress, psychosocial stress, and marketplace and consumption‐related stresses. Drawing on the appraisal theory of stress, our analysis of the data identifies the co‐existence of two emotion‐focused coping strategies—religiosity and social support—that interplay to overcome their well‐being concerns in the emerging countries of India and Bangladesh. Therefore, it may be of particular interest to managers and policymakers who seek to address the severe consequences of the COVID‐19 pandemic on socio‐economically subsistence consumers. [ABSTRACT FROM AUTHOR]

Mobile financial services (MFS) have the potential to impact developing countries by making financial services more accessible. To realize this potential, it is imperative to illuminate why and how people use these new platforms to accomplish their goals. Using affordance theory as a guiding tool, this study aims to uncover the underlying goal directed affordances and actualization techniques used by MFS users in Bangladesh. The data are collected through in‐depth interviews with MFS users and analyzed using thematic analysis to uncover affordances along with actualization techniques that are embedded in everyday social contexts of the users. The study finds that users in their attempts to accomplish specific goals uncover various latent affordances of MFS platforms such as financial services accessibility, self‐controlling ability, spatial and temporal mobility, disintermediation ability, self‐sustainability, secrecy maintainability, and networkability, and employ several techniques to actualize those affordances. These results have implications for utilizing MFS platforms to promote ICT4D goals. [ABSTRACT FROM AUTHOR]

BRAC, an international development organization, implemented a home‐fortification programme from 2014 to 2018 in Bangladesh. This study aimed to understand the unintended consequences of programmatic changes that occurred during the implementation of the programme on the prevalence of good infant and young child feeding (IYCF) practices and other associated factors. We used pooled data from eight cross‐sectional surveys and data from a series of qualitative investigations carried out as part of a mixed‐methods evaluation approach. A total of 6,479 caregivers of children aged 6 to 23 months participated in the surveys. The prevalence of good IYCF practices increased from baseline (42.1%) to midline (45.3%), but it decreased at the endline survey (31.9%). Qualitative investigations identified several reasons for low IYCF practices at the programme level, such as the withdrawal of community health worker (CHW) incentives for promoting IYCF, providing incentives for the home‐fortification of micronutrient powder (MNP) and changing the focus from IYCF promotion to MNP promotion. A multivariable generalized estimating equation model for pooled data revealed that caregivers were 28% (adjusted risk ratio [ARR]: 0.72, 95% CI [0.67, 0.78]) less likely to maintain good IYCF practices during the period when CHWs were not incentivized to promote IYCF compared to the period when CHWs were incentivized to promote it. The prevalence of good IYCF practices decreased from both baseline and midline to the endline survey due to the unintended consequences of the programmatic changes. An integrated intervention strategy to promote the home‐fortification of MNP and IYCF could be helpful to avoid unintended negative consequences of programmatic changes. [ABSTRACT FROM AUTHOR]

Background There is still limited knowledge regarding the translation of early child development (ECD) knowledge into effective policies and large-scale programmes. A variety of frameworks that outline the key steps in scaling up exist, but we argue that taking a complex adaptive systems (CAS) approach assists in understanding the complex, dynamic processes that result in programmes being taken to scale. Objectives The objective of this study is to examine the process of scaling up four major country-level ECD programmes through the application of a CAS framework. Methods Nine key informants with a deep knowledge of how each ECD programme was established and brought to scale were interviewed via Skype or phone by using open-ended interviews. The interviews were tape recorded and then transcribed verbatim for subsequent coding by using CAS domains. The coding and integration of the results to identify unique and common CAS scaling up features across the case studies involved an iterative process of reaching consensus. Results The scaling up of all four programmes behaved as a CAS including as follows: (i) positive feedback loops (five themes) and negative feedback loops (two themes); (ii) scale-free networks (two themes); (iii) phase transitions (four themes); (iv) path dependence (two themes); and (v) emergent behaviour (six themes). Five additional themes were identified for sustainability, which was repeatedly mentioned as an important consideration when deciding how to scale up programmes. Conclusions CAS analysis is likely to improve our understanding of how effective ECD programmes become scaled up. Prospective CAS implementation research is needed to continue advancing the knowledge in the field. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) have strong potential to extend health and nutrition services to underserved populations. However, CHWs face complex challenges when working within weak health systems and among communities with limited abilities to access and utilise CHW services. It is crucial to understand these challenges to improve programme support mechanisms. This study describes the results of qualitative investigations into CHW perceptions of barriers to quality of care among two groups of workers implementing community case management of acute respiratory infection, diarrhoea and severe acute malnutrition in southern Bangladesh. We explored systemic barriers to service delivery, pertaining to communities and health systems, which limited the usefulness and effectiveness of CHW services. Focus group discussions (n = 10) were conducted in March 2010. Discussions were analysed for themes related to CHWs' work challenges. Findings highlight several perceived barriers to effective service provision, including community poverty constraining uptake of recommended practices, irregular supplies of medicine from the health facility and poor quality of care for CHW referrals sent there. This study further documents interactions between demand‐side and supply‐side constraints including the influence of health system resource constraints on community trust in CHW services, and the influence of community resource constraints on the utilisation and effectiveness of CHW services. By documenting service delivery challenges from the perspective of the frontline workers themselves, this article contributes evidence to help identify appropriate support mechanisms for these workers, in order to develop scalable and sustainable CHW programmes in countries with under‐resourced public health care infrastructure. [ABSTRACT FROM AUTHOR]

The objectives of this study were to examine the accounts of Bangladeshi Muslim men with premature ejaculation ( PE) and to qualitatively explore self-reported causation. Twenty-three men with either lifelong or acquired PE were interviewed using a semi-structured schedule. Participant's responses were transcribed and analysed using thematic analysis. Three common themes were identified, biomedical, psychological and cultural, that were used to explain PE, with a 'preference' for biomedical causation. Each theme had sub-themes that were used to explain 'acceptable' forms of sexual practice and subsequent help-seeking behaviours. Using thematic analysis, we identified core themes that appear to characterize the way individuals with PE perceive themselves and their interpersonal relationships. Thematic analysis offers a promising tool to explore how men with PE 'explain' their sexual responses to themselves and their partners. [ABSTRACT FROM AUTHOR]

People of Bangladeshi origin have the highest mortality ratio from coronary heart disease of any minority ethnic group in UK and their rate of kidney disease is three- to five-fold higher than that of the European UK population. However, there is little information regarding their dietary customs or knowledge, beliefs and attitudes towards health and nutrition. This multi-method qualitative study aimed to identify: (i) barriers and facilitators to dietary sodium restriction; (ii) traditional and current diet in the UK; and (iii) beliefs and attitudes towards development of hypertension, and the role of sodium. Methods included focus group discussions, vignettes and food diaries. Twenty female chronic kidney disease patients attended four focus group discussions and maintained food diaries; ten responded to vignettes during telephone interviews. Triangulation of the results obtained from the three methods identified categories and themes from qualitative thematic analysis. Identified barriers to sodium restriction were deeply-rooted dietary beliefs, attitudes and a culturally-established taste for salt. Facilitators of change included acceptable strategies for cooking with less salt without affecting palatability. Dietary practices were culturally determined but modified by participants' prosperity in the UK relative to their previous impoverished agrarian lifestyles in Bangladesh. Cultural background and orientation were strong determinants of the group's dietary practices and influenced their reception and response to health communication messages. Efforts to understand their cultural mores, interpret and convey health-promotion messages in culturally-appropriate ways met with a positive response. [ABSTRACT FROM AUTHOR]