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Why do costs act as a barrier in maternity care for some, but not all women? A qualitative study in rural Nepal
Dr Bibha Simkhada, Maureen Porter, Edwin van Teijlingen, Professor Padam Simkhada
International Journal of Social Economics 41 (8), 705-713, 2014.
Purpose – The purpose of this paper is to analyse cost as a barrier to the uptake of antenatal care (ANC) in rural Nepal amidst a variety of barriers and facilitators. Design/methodology/approach – A qualitative study with face-to-face interviews were conducted with 50 ANC users and non-users participants. The setting is rural Nepal, some 20 kilometres outside the capital Kathmandu. Interviews were audiotaped, transcribed and translated into English and results were presented thematically. Findings – Cost was sometimes a barrier to seeking ANC for poor rural women. It included transport costs, opportunity costs of not being able to work in the household and service-related costs (such as blood or urine tests). The effect of cost as a barrier varied between women of different socio-economic status. Cost was a barrier to accessing ANC partly due to the women's lack of control over household resources. Social implications – It is important to consider cost in the wider socio-economic context of rural people's lives as financial costs alone do not explain the level of uptake of ANC. Originality/value – This study provides an original insight of women's experiences on financial issues relating to the use of ANC services in Nepal. Another important aspect of this study was approached with the multiple respondents (i.e. women, their husbands and their mothers-in-law) regarding the use of ANC and financial impact in the use of services. The findings of this study have important implications in health policy formation by providing clear picture of women's financial situation in access to ANC.
Knowledge and Risk Perceptions about HIV/AIDS among Nepalese Migrants in Gulf Countries: a Cross-sectional Study
Suresh Joshi, Gordon Prescott, Professor Padam Simkhada, Narayan Sharma, Yagya Bhurtyal
Health Science Journal 8 (3), 350-360, 2014.
Abstract: Background: Migration is considered as one of the major risk factor for HIV/AIDS transmission. Inadequate knowledge and misconceptions about HIV/AIDS transmission are still the major challenges in developing countries. Aim: This study aimed to explore the knowledge and risk perceptions about HIV/AIDS among a sample of Nepalese migrants working in three Gulf countries. Method and Material: A cross-sectional study was performed among a sample of 408 adult Nepalese migrants who had a work experience of at least six months in one of the three Gulf countries, (Qatar, Saudi Arabia and United Arab Emirates). An interview-based questionnaire was used to obtain the information from these migrant workers. Results: The respondents in this study were from different parts of Nepal and the majority were adult males, most frequently of age 26-35. More than half of the respondents were involved in construction related works. The majority of the respondents were aware that HIV virus is transmitted through sexual intercourse without using condoms and having sex with many people. The most prevalent misconceptions about HIV/AIDS transmission was that a person can get HIV/AIDS from a mosquito bite. More than a quarter of the respondents perceived that they were not at risk of being infected with HIV/AIDS due to their sexual activities. Conclusions: There is still a lack of adequate awareness and risk perceptions about HIV/AIDS among some of the Nepalese migrants. We can suggest to government of Nepal and employers to provide proper preventive health information regarding HIV/AIDS to migrant workers in both home and destination countries.
Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study
Harm Reduction Journal 11:19, 2014.
Abstract (provisional): Background The UK continues to experience a rise in the number of anabolic steroid-using clients attending harm reduction services such as needle and syringe programmes. Methods The present study uses interviews conducted with harm reduction service providers as well as illicit users of anabolic steroids from different areas of England and Wales to explore harm reduction for this group of drug users, focussing on needle distribution policies and harm reduction interventions developed specifically for this population of drug users. Results The article addresses the complexity of harm reduction service delivery, highlighting different models of needle distribution, such as peer-led distribution networks, as well as interventions available in steroid clinics, including liver function testing of anabolic steroid users. Aside from providing insights into the function of interventions available to steroid users, along with principles adopted by service providers, the study found significant tensions and dilemmas in policy implementation due to differing perspectives between service providers and service users relating to practices, risks and effective interventions. Conclusion The overarching finding of the study was the tremendous variability across harm reduction delivery sites in terms of available measures and mode of operation. Further research into the effectiveness of different policies directed towards people who use anabolic steroids is critical to the development of harm reduction.
Adverse childhood experiences and associations with health-harming behaviours in young adults: surveys in the European Region
Professor Mark Bellis, Professor Karen Hughes, Nicola Leckenby, Lisa Jones, Adriana Baban, Margarita Kachaeva, Robertas Povilaitis, Iveta Pudule, Gentiana Qirjako, Betul Ulukol, Marija Raleva, Natasa Terzic
Bulletin of the World Health Organization, Online first format, 2014.
Abstract: Objective To evaluate the association between adverse childhood experiences – e.g. abuse, neglect, domestic violence and parental separation, substance use, mental illness or incarceration – and the health of young adults in the eastern European Region. Methods: Between 2010 and 2013, adverse childhood experience surveys were undertaken in Albania, Latvia, Lithuania, Montenegro, Romania, the Russian Federation, The former Yugoslav Republic of Macedonia and Turkey. There were 10’696 respondents – 59.7% female – aged 18–25 years. Multivariate modelling was used to investigate the relationships between adverse childhood experiences and health-harming behaviours in early adulthood including substance use, physical inactivity and attempted suicide. Findings: Over half of the respondents reported at least one adverse childhood experience. Having one adverse childhood experience increased the probability of having other adverse childhood experiences. The number of adverse childhood experiences was positively correlated with subsequent reports of harming behaviours. Compared with those who reported no adverse experiences, respondents who reported at least four adverse childhood experiences were at significantly increased risk of many health-harming behaviours, with odds ratios varying from 1.68 (95% confidence interval (CI): 1.32–2.15) – for physical inactivity – to 48.53 (95% CI: 31.98–76.65) – for attempted suicide. Modelling indicated that prevention of adverse childhood experiences would substantially reduce the occurrence of many health-harming behaviours within the study population. Conclusion: Our results indicate that individuals who do not develop health-harming behaviours are more likely to have experienced safe, nurturing childhoods. Evidence-based programmes to improve parenting and support child development need large-scale deployment in the eastern European Region.
Aligning everyday life priorities with people’s self-management support networks: An exploration of the work and implementation of a needs-led telephone support system
Dr Christian Blickem, Anne Kennedy, Praksha Jariwala, Rebecca Morris, Robert Bowen, Ivaylo Vassilev, Helen Brooks, Tom Blakeman, Anne Rogers
BMC Health Serv Res. Jun 17;14:262, 2014.
Abstract: Background: Recent initiatives to target the personal, social and clinical needs of people with long-term health conditions have had limited impact within primary care. Evidence of the importance of social networks to support people with long-term conditions points to the need for self-management approaches which align personal circumstances with valued activities. The Patient-Led Assessment for Network Support (PLANS) intervention is a needs-led assessment for patients to prioritise their health and social needs and provide access to local community services and activities. Exploring the work and practices of patients and telephone workers are important for understanding and evaluating the workability and implementation of new interventions. Methods: Qualitative methods (interviews, focus group, observations) were used to explore the experience of PLANS from the perspectives of participants and the telephone support workers who delivered it (as part of an RCT) and the reasons why the intervention worked or not. Normalisation Process Theory (NPT) was used as a sensitising tool to evaluate: the relevance of PLANS to patients (coherence); the processes of engagement (cognitive participation); the work done for PLANS to happen (collective action); the perceived benefits and costs of PLANS (reflexive monitoring). 20 patients in the intervention arm of a clinical trial were interviewed and their telephone support calls were recorded and a focus group with 3 telephone support workers was conducted. Results: Analysis of the interviews, support calls and focus group identified three themes in relation to the delivery and experience of PLANS. These are: formulation of 'health' in the context of everyday life; trajectories and tipping points: disrupting everyday routines; precarious trust in networks. The relevance of these themes are considered using NPT constructs in terms of the work that is entailed in engaging with PLANS, taking action, and who is implicated this process. Conclusions: PLANS gives scope to align long-term condition management to everyday life priorities and valued aspects of life. This approach can improve engagement with health-relevant practices by situating them within everyday contexts. This has potential to increase utilisation of local resources with potential cost-saving benefits for the NHS.
Preventing smoking among nine to ten-year-old children using a novel school-based physical activity intervention: Overview of SmokeFree Sports
Joanne Trigwell, Dr Ciara McGee, Helen Casstles, Rebecca Murphy, Dr Lorna Porcellato, Michael Ussher, Lawrence Foweather
Education and Health, 2014.
P hysical activity (PA) is associated with many health benefits, including reduced risk of of hypertension, coronary heart disease, stroke and heart disease (Chief Medical Officers, 2011). From an educational perspective, PA has been found to improve cognitive functioning, aiding children’s learning through improved concentration (Norlander et al., 2005), attention (Maher, 2011) and memory (Kamijo et al., 2011). Children participate in PA in multiple ways; for example, active play, physical education (PE), and extra-curricular and community sport programmes. Moreover, children enjoy participating in PA and often want to increase their participation (Ridgers et al., 2006). Given that there is evidence that taking part in PA may be protective against smoking uptake (Audrain-McGovern et al., 2003; Rodriguez and Audrain-McGovern, 2005; Kaczynski et al., 2008), it is suggested that PA contexts such as PE and sport could be utilised as a vehicle for smoking prevention. The use of sport to deliver smoking education has previously been trialled in the US and Canada with initiatives such as Tobacco Free Sports (The US Centers for Disease Control and Prevention, 2007), Tobacco Free Athletes (www.tobaccofreemaine.org) and Play, Live, Be Tobacco Free.
Training sports coaches to tackle tobacco: formative evaluation of the SmokeFree Sports campaign
Toni Hilland, Dr Caryl Beynon, Dr Ciara McGee, Rebecca Murphy, Daniel Parnell, Maria Romeo-Velilla, Gareth Stratton, Lawrence Foweather
International Journal of Health Promotion and Education, 2014.
Abstract Smoking is one of the leading causes of preventable morbidity and death in England, and is an addiction largely taken up in youth. Given the need for early prevention strategies, this formative study evaluated sports coaches' perceptions of a preliminary SmokeFree Sports (SFS) campaign. The research was conducted in five youth clubs with eight coaches who attended a Level 1 Brief Intervention Training workshop. Semi-structured interviews were conducted, and a questionnaire assessed the impact of the Brief Intervention Training on coaches' self-efficacy to deliver smoke-free messages at pre, post and follow-up. Interviews were transcribed verbatim, and pen profiles were constructed to provide an overview of coaches' perspectives of SFS with regard to: (a) Brief Intervention Training, (b) SFS implementation and (c) suggestions for improvements. One-way repeated measures ANOVA revealed a significant increase in coaches' self-efficacy towards knowledge and delivery of smoke-free messages from pre- to post-Brief Intervention Training that was maintained at follow-up. This formative work suggests that there is potential in educating coaches and using sports to deliver health education around smoking. Recommendations to improve the Brief Intervention Training included making it more interactive and specific with respect to sport and particular age groups. SFS could also be trialled in structured setting and with other sports. These findings will be used to inform and tailor the design and development of a larger, definitive SFS intervention.
Environments, risk and health harms: a qualitative investigation into the illicit use of anabolic steroids among people using harm reduction services in the UK
BMJ Open, 2014, 4, 2014.
Abstract: Objectives: The illicit use of anabolic steroids among the gym population continues to rise, along with the number of steroid using clients attending harm reduction services in the UK. This presents serious challenges to public health. Study objectives were to account for the experiences of anabolic steroid users and investigate how ‘risk environments’ produce harm. Methods: Qualitative face-to-face interviews with 24 users of anabolic steroids engaged with harm reduction services in the UK. Results: Body satisfaction was an important factor when deciding to start the use of anabolic steroids. Many users were unaware of the potential dangers of using drugs from the illicit market, whereas some had adopted a range of strategies to negotiate the hazards relating to the use of adulterated products, including self-experimentation to gauge the perceived efficacy and unwanted effects of these drugs. Viewpoints, first-hand anecdotes, norms and practices among groups of steroid users created boundaries of ‘sensible’ drug use, but also promoted practices that may increase the chance of harms occurring. Established users encouraged young users to go to harm reduction services but, at the same time, promoted risky injecting practices in the belief that this would enhance the efficacy of anabolic steroids. Conclusions: Current steroid-related viewpoints and practices contribute to the risk environment surrounding the use of these drugs and may undermine the goal of current public health strategies including harm reduction interventions. The level of harms among anabolic steroid users are determined by multiple and intertwining factors, in addition to the harms caused by the pharmacological action or injury and illness associated with incorrect injecting techniques.
The contribution of social networks to the health and self-management of patients with long-term conditions: A longitudinal study
David Reeves, Dr Christian Blickem, Ivaylo Vassilev, Helen Brooks, Anne Kennedy, Gerry Richardson, Anne Rogers
PLoS ONE, 9(6), 2014.
Abstract: Evidence for the effectiveness of patient education programmes in changing individual self-management behaviour is equivocal. More distal elements of personal social relationships and the availability of social capital at the community level may be key to the mobilisation of resources needed for long-term condition self-management to be effective. Aim: To determine how the social networks of people with long-term conditions (diabetes and heart disease) are associated with health-related outcomes and changes in outcomes over time. Methods: Patients with chronic heart disease (CHD) or diabetes (n = 300) randomly selected from the disease registers of 19 GP practices in the North West of England. Data on personal social networks collected using a postal questionnaire, alongside face-to-face interviewing. Follow-up at 12 months via postal questionnaire using a self-report grid for network members identified at baseline. Analysis: Multiple regression analysis of relationships between health status, self-management and health-economics outcomes, and characteristics of patients' social networks. Results: Findings indicated that: (1) social involvement with a wider variety of people and groups supports personal self-management and physical and mental well-being; (2) support work undertaken by personal networks expands in accordance with health needs helping people to cope with their condition; (3) network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs. Health service costs were significantly (p<0.01) reduced for patients receiving greater levels of illness work through their networks. Conclusions: Support for self-management which achieves desirable policy outcomes should be construed less as an individualised set of actions and behaviour and more as a social network phenomenon. This study shows the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community groups and resources for producing a more desirable and cost-effective way of supporting long term illness management.
A qualitative study of anabolic steroid use amongst gym users in the United Kingdom: motives, beliefs and experiences
Journal of Substance Use, Online, 29 April, 2014.
The illicit use of anabolic steroids amongst the gym population continues to rise in the United Kingdom presenting serious challenges to public health. This study used qualitative interviews to explore the experiences of 24 users of anabolic steroids and investigate their motives and experiences. Body satisfaction was a motivating factor in the use of anabolic steroids. Anabolic steroid users’ drug use and associated behaviour were influenced by numerous sources of information, in particular, first-hand accounts of their peers, along with personal opinion and anecdotes on the Internet. As a result of this knowledge, users expressed their belief that these drugs can be used relatively safely. The prevailing viewpoint, that the harms associated with anabolic steroids can be managed and that this behaviour is part of a healthy lifestyle, contributes to the potential health risks.