Search

Purpose: Rural women and their babies experience poorer perinatal outcomes than their urban counterparts and this inequity has existed for decades. This study explored the barriers and enablers that exist for rural women in Australia in accessing perinatal care., Methods: A qualitative descriptive design, using reflexive thematic analysis, was employed. Semi-structured interviews were conducted in 2023 with women who had recently given birth in rural Victoria, Australia (n=19). A purposive sampling strategy was used, recruiting women via social media platforms from rural communities across the state. The Socioecological Model (SEM) was used as a framework to organise the findings., Results: Study participants reported multilevel barriers and enablers to accessing perinatal care in their own communities. Intrapersonal factors included financial resources, transportation, self-advocacy, health literacy, rural stoicism, personal agency, and cost of care. Interpersonal factors included factors such as ineffective relationships, poor communication, and care provider accessibility. Organisational factors included inequitable distribution of services, under-resourcing of perinatal services in rural areas, technology-enabled care models and access to continuity of care. Community factors included effective or ineffective interprofessional or interorganisational collaboration. Policy factors included centralisation of perinatal care, lack of funded homebirth and midwifery care pathways and access to free perinatal care., Conclusion: Participants in this study articulated several key barriers influencing access to perinatal care in rural areas. These factors impede help-seeking behaviour and engagement with care providers, compounding the impact of rurality and isolation on perinatal outcomes and experience of care. Key enablers to accessing perinatal care in rural communities were also identified and included personal agency, health literacy, social capital, effective collaboration and communication between clinicians and services, technology enabled care and free perinatal care., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: There is a limited understanding of the dynamic influences that shape infant and young child feeding (IYCF) decisions over time. We conducted an innovative qualitative study to reconstruct IYCF trajectories across early life course phases, in the context of the socioecological model (SEM) and the commercial determinants of IYCF., Methods: Women of different socioeconomic status were interviewed in two large metropolitan areas in Mexico. Our specific goal was to allow us to better understand if and how the commercial milk formula (CMF) marketing influenced breastfeeding decisions in a complex dynamic way involving the individual, relational, community and societal levels., Results: Hospitals, health professionals, and interactions with social media were key category entry points throughout the prenatal, perinatal, early infancy period and beyond. The CMF industry interfered by engaging a wide array of actors across the different layers of the SEM, most prominently the health care system and the workplace. Through its marketing strategies the CMF operates subconsciously and its messages are most effective when health institutions, health care providers, workplace spaces and social norms are weak in their support for breastfeeding., Conclusions: The cases in our study highlight how, together with a weak breastfeeding counseling system, and health professionals who lack training in breastfeeding and normal infant behavior, lead to the opportunity for CMF marketing to shape infant feeding, and ultimately to the decision to feed formulas that some mothers were not planning to use and cannot afford., (© 2024. The Author(s).)

Background: The advent of antiretroviral therapy has led perinatally HIV-infected (PHI) adolescents to live long, fulfilling lives through lifelong treatment. However, there is limited knowledge about the lived experiences and psychosocial and mental health challenges faced by PHI adolescents in sub-Saharan Africa, where 80% of PHI adolescents reside. To address this gap, we adapted the socioecological model to investigate the challenges and lived experiences of PHI adolescents in rural coastal Kenya., Methods: Between October and November 2018, a sample of 40 participants (20 PHI adolescents and their 20 primary caregivers) participated in a qualitative study using an H-assessment data collection approach for adolescents and focus group discussions with caregivers. Data analysis was conducted using a framework approach on NVIVO 11 software., Results: PHI adolescents from this setting experience many challenges across various levels of the ecosystem. At the individual level, challenges include living in denial, HIV status disclosure, antiretroviral adherence, internalized stigma, and mental health issues. Within the family, challenges such as parental loss, insufficient care from parents, and unacceptance lead to threats of harm. In the broader community, key challenges such as gossip, unsupportive community members, long waiting times at the health facility, isolation, rejection, and an unresponsive school system fail to address the needs of PHI adolescents. Finally, HIV-related stigma and discrimination manifested across different levels of the socioecological framework. To cope with these challenges, PHI adolescents often rely on privacy and social support from their families., Conclusion: The findings underscore the need to develop and implement multi-level adolescent-friendly interventions to address PHI adolescent challenges and guide future investment in adolescent's health. Furthermore, there is a need to address internalized and interpersonal stigmas through individual-level interventions that promote resilience and the active involvement of adolescents, their caregivers, peers, and teachers who are their social support system., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wanjala, Nyongesa, Luchters and Abubakar.)

Introduction: Negev Bedouin settlements suffer from poor infrastructure, and the population's health status is low across all indicators. While it is difficult for Bedouin citizens of Israel to integrate into the Israeli employment market, integrating this population into the health system is far-reaching. The aim of this study is to analyze the barriers and motivational factors experienced by Bedouin doctors to promote public health in the Bedouin community in southern Israel and to examine the perceptions these doctors have around the concept of leadership in a public health setting. Methods: We conducted semi-structured interviews with Bedouin doctors from the Negev Bedouin community and analyzed them using thematic analysis. Results: Most interviewees saw themselves as leaders whose role was to improve public health in their community. They stressed the need for health leadership in Negev Bedouin society, and their desire to lead change in the community from within. All interviewees had grown used to a different way of life and a higher standard of living, and as a result, had difficulty returning home. Interviewees presented that trust in the health system is a critical factor for the success of health promotion programs. However, they noted the evolving trends of general mistrust in the government and its institutions that form the infrastructure for mistrust in the health system. Lack of time and workload were barriers to exercising leadership. Interviewees reported their perception of how socioeconomic status, the standard of living, and lack of infrastructure, education, and training affect health outcomes and collaboration potential. Discussion: This study presents a unique perspective on the views of doctors from the Negev Bedouin population on their involvement with grassroots leadership as a strategy to reduce health disparities in this community. [ABSTRACT FROM AUTHOR]

Despite the success of health programs conducted within African American (AA) churches, research has been limited in understanding facilitators and barriers that exist when conducting adult health programs within AA churches. Thus, the objective of this study was to systematically review the literature to identify these facilitators and barriers. A comprehensive literature search was conducted and studies that met the eligibility criteria were divided based on their focus: disease topic or behavior, health promotion activities, or church readiness. Facilitators and barriers were also stratified using the socioecological model. Out of 288 articles initially identified, only 29 were included. Facilitators and barriers were predominantly found at the intrapersonal and organizational level for disease topic or behavior studies, and at the organizational level for studies focused on health promotion activities and church readiness. None of the articles identified facilitators and barriers at the policy level. [ABSTRACT FROM AUTHOR]

Findings on children's mental health promotion at the policy level are scarce, and the perceptions of the municipal administration on factors affecting children's mental health have not been reported. This study describes the perspectives of policymakers and leading officeholders on promotive and risk factors for children's mental health in a socioecological context. The perspectives of Finnish policymakers (n = 15) and officeholders (n = 10) in municipalities were examined using semi-structured interviews. The data were analyzed using inductive content analysis and were categorized according to the five levels of a socioecological model of health promotion: public policy, community, organizational, interpersonal and individual levels. The public policy level emerged strongly in the findings, specifically strategic planning and implementation challenges related to the promotion of children's mental health in the municipality and state administration. At the community level, environmental factors promoting children's mental health as well as risk factors were described. The organizational level consisted of support, requirements and development needs in children's services. The importance of family and close networks at the interpersonal level, as well as the individual basis of mental health, were also evident. The integration and better collaboration of child and family services, the use of child rights impact assessment in political decision-making, and financial support from the state could contribute to improving strategic planning to support children's mental health at the municipal level. [ABSTRACT FROM AUTHOR]

The study purpose is to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviors related to bladder health across the life course using a socioecological perspective. Lower urinary tract symptoms affect between 20-40% of young adult to middle-aged women, with symptoms increasing in incidence and severity with aging. There is limited evidence to address bladder health promotion and prevention of dysfunction. This first study of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is designed to address gaps in existing qualitative research in this area. This focus group study will be implemented across seven geographically diverse United States research centers using a semi-structured focus group guide informed by a conceptual framework based on the socioecological model. The study was approved in July 2017. A total of 44 focus groups composed of 6-8 participants representing six different age categories (ranging from 11 to over 65 years) will be completed. We aim to recruit participants with diverse demographic and personal characteristics including race, ethnicity, education, socioeconomic status, urban/rural residence, physical/health conditions and urinary symptom experience. Up to 10 of these focus groups will be conducted in Spanish. Focus group transcripts will undergo content analysis and data interpretation to identify and classify themes and articulate emerging themes. This foundational qualitative study seeks to develop an evidence base to inform future research on bladder health promotion in adolescent and adult women. This study has the potential to provide new insights and understanding into adolescent and adult women's lived experience of bladder health, the experience of lower urinary symptoms and knowledge and beliefs across the life course. This article is protected by copyright. All rights reserved.

To explore gym staff perspectives on the inclusion of people with disability in the gym setting. Semi-structured interviews were conducted with 16 staff at four urban gym facilities, exploring perspectives on disability inclusion. An interpretive descriptive approach was adopted with reflexive thematic analysis of interview data and subsequent mapping of themes to the socioecological model. Consistent with the socioecological model, the themes identified were "people with disability benefit from participation in gym settings" (personal); "positive interactions with people with disability" (interpersonal); "managing expectations of other gym users" (interpersonal); "inclusion is supported by a positive ethos, staff training and accessible facilities" (organisational); "people with disability lack awareness of inclusive exercise opportunities" (community); "desire to increase collaboration with healthcare professionals" (community); "access to transport can facilitate gym attendance" (community) and "local gym policy" (policy). Although an overall ethos of inclusion was apparent, areas identified for enhancement were: awareness of gym services in the community; inter-sectoral collaboration with healthcare and disability organisations; comprehensive disability inclusion training; transport systems and accessibility; engaging people with disability in gym service planning. Gym staff value collaboration with healthcare and rehab professionals to support inclusion of people with disability in exercise. Standardised disability inclusion training for gym staff is recommended. Individuals with disability should be empowered to contribute to the development of inclusive gym facilities and services. Rehab professionals have a role to play in raising awareness and advocating for inclusive exercise opportunities. [ABSTRACT FROM AUTHOR]

Despite the health benefits of sport, the proportion of people participating in sport decreases with age. This qualitative study explored the benefits and barriers regarding older adult community sport participation, from the perspective of national sporting organizations, in addition to older adult sport club and nonsport club members, across eight focus group interviews (n = 49). Seven benefits were discussed, primarily social and physical health and intergenerational opportunities. Ten barriers were also discussed, including physical health, time constraints, and lack of appropriate playing opportunities. Ensuring access to activities that can benefit social health is of great importance to older adults. As sport can provide participation opportunities across generations, it can be an ideal physical activity option for this age group. However, a major barrier is that sport policy often prioritizes the participation for younger age groups. Policymakers should include a focus on older adults, to derive social health benefits. [ABSTRACT FROM AUTHOR]

In Uganda, almost half of children under 5 years old suffer from undernutrition. Undernutrition, a common form of malnutrition in children, encompasses stunting, wasting and underweight. The causes of child undernutrition are complex, suggesting that interventions to tackle malnutrition must be multifaceted. Furthermore, limited access to healthcare for vulnerable populations restricts the potential of hospital‐based strategies. Community‐based management of acute malnutrition (CMAM), which includes nutritional counselling, ready‐to‐use therapeutic foods and the outpatient management of malnutrition by caregivers, is recognised as an effective approach for children's recovery. However, evaluations of CMAM programs are largely based on biomedical and behavioural health models, failing to incorporate structural factors that influence malnutrition management. The objective of this evaluation was to understand the factors influencing malnutrition management in a CMAM program in rural Uganda, using the socioecological model to assess the multilevel determinants of outpatient malnutrition management. This evaluation used qualitative methods to identify factors related to caregivers, healthcare providers and societal structures that influence children's outpatient care. Data were collected at a community health clinic in 2019 through observations and interviews with caregivers of malnourished children. We observed 14 caregiver‐provider encounters and interviewed 15 caregivers to examine factors hindering outpatient malnutrition management. Data were thematically analysed informed by the socioecological model. Findings showed that caregivers had a limited understanding of malnutrition. Counselling offered to caregivers was inconsistent and insufficient. Poverty and gender inequality limited caregivers' access to healthcare and their ability to care for their children. Factors at the caregiver and healthcare levels interacted with societal factors to shape malnutrition management. Results suggest that CMAM programs would benefit from providing holistic interventions to tackle the structural barriers to children's care. Using a socioecological approach to program evaluation could help move beyond individual determinants to address the social dynamics shaping malnutrition management in low‐ and middle‐income countries. [ABSTRACT FROM AUTHOR]

Despite the many benefits of club-organized sports participation for children, studies have shown that sports participation is lower among children from low-income families than among children from middle- or high-income families. Adopting a socioecological perspective, the main aim of our study was to identify and describe experiences of person–environment (PE) misfits in relation to parental facilitation of children's sports participation. We conducted 24 interviews with parents from low-income families. PE misfits were found in multiple behaviors related to the facilitation of children's sports participation: financing sports participation; planning and investing time; transporting children; acquiring, processing, and providing information; and arranging support. Across these PE misfits, influential attributes were found on the individual level (e.g., skills) as well as within the social, policy, physical, and information environment. In response to PE misfits experienced, parents deployed multiple strategies to reduce these PE misfits, aimed at enhancing either themselves (e.g., increasing financial capacities) or their environments (e.g., arranging social support). These results provide an insight into experienced PE misfits that took the form of multiple specific behaviors which parents found difficult while facilitating their children's sports participation. Furthermore, the results provide insight into the environmental and individual attributes that were involved in these PE misfits, and into how parents modified themselves or their environments in order to make their environments more supportive. The study contributes to future research on individual and environmental influences on parental facilitation of their children's sports participation, as well as on the development of multilevel interventions aimed at increasing sports participation among children from low-income families. [ABSTRACT FROM AUTHOR]

Aim: To describe promotive and risk factors for children's mental health at the individual, interpersonal, organizational, community and public policy levels of the socioecological environment. Design: A descriptive qualitative interview study. Methods: Data were collected in Finland during autumn 2019 via semi‐structured interviews. Participants (n = 23) comprised public health nurses who worked in child health clinics and school healthcare. Data were analyzed using inductive content analysis. Results: Several promotive and risk factors were identified to have affected children's mental health. Intra‐family factors were the most important in the opinion of public health nurses, and they were most concerned about family related risk factors. In addition, the descriptions of nurses revealed that children are in a socially unequal position in terms of their place of residence. It was also uncovered that there were fewer social and healthcare and leisure services in small municipalities, the distances to services were longer, which was perceived to complicate the use of services, and the fear of stigma was greater. Conclusion: According to public health nurses, factors at the individual, interpersonal, organizational, community and public policy levels of the socioecological environment affect children's mental health and overall well‐being. Consequently, the promotion of children's mental health should be emphasized at every level of the society, considering the whole family. Impact: This study indicated the importance of considering factors that affect children's mental health at all levels of the socioecological environment. The results can be reflected in the relation of the socioecological model of health promotion and used in planning the work of nurses in primary healthcare and other relevant nursing settings to emphasize promotive and preventive work. [ABSTRACT FROM AUTHOR]

Black women experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) is a once-daily pill that can prevent HIV transmission. To enhance PrEP uptake among Black women, it is essential to examine their perceptions of PrEP. In 2018, 33 Black women in New York City completed interviews about their attitudes, knowledge, and perceived barriers and facilitators to PrEP use. Emergent themes were organized using a socioecological model. Participants identified barriers at the sociocultural level, including stigma, medical mistrust, and health care avoidance. At the community level, health care access issues and limited community knowledge were reported. Partner-level barriers included trust in partners and meaning attributed to PrEP use within the context of monogamy. Individual-level barriers included lowperceived risk and concerns aboutPrEP's safety and efficacy. Our findings can inform future PrEP research with Black women, as well as PrEP implementation efforts aimed at increasing uptake among this population. [ABSTRACT FROM AUTHOR]

Aim: The study purpose is to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviours related to bladder health across the life course using a socioecological perspective. Lower urinary tract symptoms affect between 20–40% of young adult to middle‐aged women, with symptoms increasing in incidence and severity with aging. There is limited evidence to address bladder health promotion and prevention of dysfunction. This first study of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is designed to address gaps in existing qualitative research in this area. Design: This focus group study will be implemented across seven geographically diverse United States research centres using a semi‐structured focus group guide informed by a conceptual framework based on the socioecological model. Methods: The study was approved in July 2017. A total of 44 focus groups composed of 6–8 participants representing six different age categories (ranging from 11 to over 65 years) will be completed. We aim to recruit participants with diverse demographic and personal characteristics including race, ethnicity, education, socioeconomic status, urban/rural residence, physical/health conditions, and urinary symptom experience. Six of the focus groups will be conducted in Spanish and translated into English. Focus group transcripts will undergo content analysis and data interpretation to identify and classify themes and articulate emerging themes. Discussion: This foundational qualitative study seeks to develop an evidence base to inform future research on bladder health promotion in adolescent and adult women. Impact: This study has the potential to provide new insights and understanding into adolescent and adult women's lived experience of bladder health, the experience of lower urinary symptoms and knowledge and beliefs across the life course. [ABSTRACT FROM AUTHOR]

Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency’s protocols to develop the personalized visit plan. They revised the plan based on changes in the patient’s clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: The purpose of this study was to explore multilevel factors affecting older Korean immigrants' health-seeking behaviours. Background: Although studies have documented significant issues related to healthcare access and utilisation issues among older immigrants, a noted limitation of current research is its failure to explore multiple factors related to their health-seeking behaviours. Design: A qualitative study using interview data from two previous studies. Methods: We performed a qualitative analysis of focus groups and individual interviews using inductive coding methods. The socioecological model provided a useful framework to guide this study. The sample included 17 community-dwelling older Korean immigrants aged 65 years living in the metropolitan area of Seattle, WA, USA. Results: Findings revealed various factors at the individual (e.g., perception of health and illness, mistrust, cultural values and norms, length of residency in the United States, language barriers and ageing experiences), interpersonal (e.g., peers, family and primary care physicians), community (e.g., ethnic community centres and organisations, home care helpers and interpretation services) and policy (e.g., lack of affordability and health benefits coverage) levels. Each of these factors played a role as either a barrier to or facilitator of older Korean immigrants' health-seeking behaviours. Several factors, such as language barriers and lack of available information, were intertwined. Conclusions: Findings indicate the importance of considering four major areas when designing culturally appropriate, community-based interventions for older immigrants. Also, utilising peers or trusted human resources in the community is critical to the design and implementation of health promotion interventions for older immigrants. Implications for Practice: Examining intrapersonal, interpersonal, community, and policy level factors that affect older immigrants' health-seeking behaviours informs the design of community-based health promotion interventions for older immigrants. [ABSTRACT FROM AUTHOR]

Informed by a socioecological framework, this qualitative study contributes to the fields of allied health and aging by identifying the factors that influence older women's participation in competitive softball. Focus groups were conducted with 6 teams of women (N = 64) ranging in age from 55 to 79 years. Data were audio-recorded, transcribed verbatim, and analyzed thematically. Results revealed issues of recruitment, access to resources, and breaking age-related cultural stereotypes. Knowledge from this study can offer insight into how allied health professionals might mitigate these issues to promote competitive sports alternatives for future cohorts of aging women. [ABSTRACT FROM AUTHOR]

Objective: To develop and apply a framework exploring the extent of involvement in promoting environmental changes to prevent obesity by a group of nutrition educators (NE). Design: Cross-sectional, mixed methods: qualitative interviews informed framework development; survey applied framework to describe NE’s involvement in environmental changes. Setting: Cooperative Extension in New York State. Participants: Interviewees (n = 7) selected to vary in environmental change activities and rural/urban location. Survey response rate was 100% (n = 58). Phenomenon o f Interest/Variables Measured: Dimensions and degree of NE’s involvement in promoting environmental change. Analysis: Thematic analysis of qualitative data, triangulated with descriptive analyses of NE’s performance of tasks in various settings. Results: NE’s promotion of environmental changes was characterized using framework based on settings and tasks, dimensions that emerged from qualitative analysis. NE’s actions varied across these dimensions and ranged from low to high intensity of collaboration and leadership for environmental change. Most NE surveyed reported actions limited to providing information and recommendations on healthy eating and physical activity. Few reported intensive engagement in developing, implementing, and evaluating plans to change environments for obesity prevention. Conclusions and Implications: Framework identifies the levels of engagement in promoting environmental changes and supports future research and practice of community nutrition professionals by providing a roadmap for assessing their involvement on multiple levels to prevent obesity. [ABSTRACT FROM AUTHOR]

Although cervical cancer is one of the most commonly diagnosed cancers among Vietnamese American women (VAW) and Korean American women (KAW), both groups consistently report much lower rates of cervical cancer screening compared with other Asian ethnic subgroups and non-Hispanic Whites. This study aimed to explore multilevel factors that may underlie low screening rates among VAW and KAW living in a city where their ethnic communities are relatively small. The socioecological model was used as a conceptual framework. Thirty participants were conveniently recruited from ethnic beauty salons run by VA and KA cosmetologists in Albuquerque, New Mexico. The participants' average age was 44.6 years (SD = .50; range = 21-60). Most participants were married (80 %) and employed (73.3 %), and had health insurance (83.3 %). A qualitative interview was conducted in Vietnamese or Korean and transcribed verbatim. A thematic content analysis was used to identify major codes, categories, and patterns across the transcripts. The study identified several factors at the individual (e.g., pregnancy, poverty, personality), interpersonal (e.g., family responsibility, mother as influential referent), and community (e.g., lack of availability, community size) levels. The study sheds light on four major areas that must be taken into consideration in the development of culturally appropriate, community-based interventions aimed to reduce disparities in cervical cancer screening among ethnic minority women in the United States: (1) ethnic community size and geographic location; (2) cross-cultural similarities and dissimilarities; (3) targeting of not only unmarried young women, but also close referents; and (4) utilization of trusted resources within social networks. [ABSTRACT FROM AUTHOR]

This study was conducted to understand the factors influencing the food habits of restaurant chefs in northern New Jersey. Data was collected from participants (N = 12) using dietary recalls, and semi-structured interviews based on the socio-ecological model. Dietary recall analysis revealed multiple nutritional intake hazards including skipping meals, and substitution of foods rich in fats and sugar for fruits and vegetables, and increased consumption of alcohol. Qualitative data analysis revealed that their food habits were influenced by a repertoire of individual, organizational, and interpersonal factors. The relevance of these findings to nutrition intervention programs for this population is discussed. [ABSTRACT FROM AUTHOR]