scholarly journals Detection of risk for depression among adolescents in diverse global settings: protocol for the IDEA qualitative study in Brazil, Nepal, Nigeria and the UK

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e034335
Author(s):  
Syed Shabab Wahid ◽  
Gloria A. Pedersen ◽  
Katherine Ottman ◽  
Abigail Burgess ◽  
Kamal Gautam ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Lived Experience ◽  
Low Income ◽  
Adolescent Depression ◽  
Service Providers ◽  
Theory Of Change ◽  
Biological Research ◽  
Middle Income ◽  
Cultural Heterogeneity ◽  
The Uk

IntroductionGlobally, depression is a leading cause of disability among adolescents, and suicide rates are increasing among youth. Treatment alone is insufficient to address the issue. Early identification and prevention efforts are necessary to reduce morbidity and mortality. The Identifying Depression Early in Adolescence (IDEA) consortium is developing risk detection strategies that incorporate biological, psychological and social factors that can be evaluated in diverse global populations. In addition to epidemiological and neuroscience research, the IDEA consortium is conducting a qualitative study to explore three domains of inquiry: (1) cultural heterogeneity of biopsychosocial risk factors and lived experience of adolescent depression in low-income and middle-income countries (LMIC); (2) the feasibility, acceptability and ethics of a risk calculator tool for adolescent depression that can be used in LMIC and high-income countries and (3) capacity for biological research into biomarkers for depression risk among adolescents in LMIC. This is a multisite qualitative study being conducted in Brazil, Nepal, Nigeria and the UK.Methods and analysisA systematic set of qualitative methods will be used in this study. The Delphi method, Theory of Change (ToC) workshops, key-informant interviews and focus group discussions will be used to elicit perspectives on the study topics from a broad range of stakeholders (adolescents, parents, policy-makers, teachers, health service providers, social workers and experts). Delphi panellists will participate in three survey rounds to generate consensus through facilitated feedback. Stakeholders will create ToC models via facilitated workshops in the LMIC sites. The framework approach will be used to analyse data from the study.Ethics and disseminationEthical approvals were received from the Ethics Review Board of George Washington University and from site-specific institutions in Brazil, Nepal, Nigeria and the UK. The findings generated from this study will be reported in highly accessed, peer-reviewed, scientific and health policy journals.

scholarly journals Experiences and impact of international medical volunteering: a multi-country mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041599 ◽  
Author(s):  
Mary McCauley ◽  
Joanna Raven ◽  
Nynke van den Broek
Keyword(s):  
Low Income ◽  
Online Survey ◽  
Positive Impact ◽  
Healthcare Providers ◽  
International Medical ◽  
Middle Income ◽  
Use Of Resources ◽  
The Uk ◽  
Medical Volunteers ◽  
The Impact

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe.ParticipantsMedical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138).Outcome measuresExpectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC.ResultsUK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development.ConclusionHealthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers’ knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.

scholarly journals Net-zero emission vehicles shift and equitable ownership in low-income households and communities: why responsible and circularity business models are essential

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Nana O. Bonsu
Keyword(s):  
Air Pollution ◽  
Low Income ◽  
Value Chain ◽  
Business Models ◽  
Industrial Revolution ◽  
Technological Development ◽  
Middle Income ◽  
Net Zero ◽  
Zero Emission ◽  
The Uk

AbstractThe UK Plan for a Green Industrial Revolution aims to ban petrol and diesel cars by 2030 and transition to electric vehicles (EVs). Current business models for EV ownership and the transition to net-net zero emissions are not working for households in the lowest income brackets. However, low-income communities bear the brunt of environmental and health illnesses from transport air pollution caused by those living in relatively more affluent areas. Importantly, achieving equitable EV ownership amongst low-and middle-income households and driving policy goals towards environmental injustice of air pollution and net-zero emissions would require responsible and circular business models. Such consumer-focused business models address an EV subscription via low-income household tax rebates, an EV battery value-chain circularity, locally-driven new battery technological development, including EV manufacturing tax rebates and socially innovative mechanisms. This brief communication emphasises that consumer-led business models following net-zero emission vehicles shift and decisions must ensure positive-sum outcomes. And must focus not only on profits and competitiveness but also on people, planet, prosperity and partnership co-benefits.

scholarly journals Long COVID and the role of physical activity: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e047632
Author(s):  
Helen Humphreys ◽  
Laura Kilby ◽  
Nik Kudiersky ◽  
Robert Copeland
Keyword(s):  
Physical Activity ◽  
Qualitative Study ◽  
Lived Experience ◽  
Well Being ◽  
Telephone Interviews ◽  
Semistructured Interviews ◽  
The Usa ◽  
The Uk ◽  
Insight Into

ObjectivesTo explore the lived experience of long COVID with particular focus on the role of physical activity.DesignQualitative study using semistructured interviews.Participants18 people living with long COVID (9 men, 9 women; aged between 18–74 years; 10 white British, 3 white Other, 3 Asian, 1 black, 1 mixed ethnicity) recruited via a UK-based research interest database for people with long COVID.SettingTelephone interviews with 17 participants living in the UK and 1 participant living in the USA.ResultsFour themes were generated. Theme 1 describes how participants struggled with drastically reduced physical function, compounded by the cognitive and psychological effects of long COVID. Theme 2 highlights challenges associated with finding and interpreting advice about physical activity that was appropriately tailored. Theme 3 describes individual approaches to managing symptoms including fatigue and ‘brain fog’ while trying to resume and maintain activities of daily living and other forms of exercise. Theme 4 illustrates the battle with self-concept to accept reduced function (even temporarily) and the fear of permanent reduction in physical and cognitive ability.ConclusionsThis study provides insight into the challenges of managing physical activity alongside the extended symptoms associated with long COVID. Findings highlight the need for greater clarity and tailoring of physical activity-related advice for people with long COVID and improved support to resume activities important to individual well-being.

scholarly journals Unraveling PBF effects beyond impact evaluation: results from a qualitative study in Cameroon

2018 ◽  
Vol 3 (2) ◽  
pp. e000693 ◽  
Author(s):  
Manuela De Allegri ◽  
Maria Paola Bertone ◽  
Shannon McMahon ◽  
Idrissou Mounpe Chare ◽  
Paul Jacob Robyn
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Low Income ◽  
Impact Evaluation ◽  
Healthcare Providers ◽  
Analytical Techniques ◽  
Demand Side ◽  
Middle Income ◽  
Implementation Processes ◽  
Heterogeneous Effects

IntroductionPerformance-based financing (PBF) has acquired increased prominence as a means of reforming health system purchasing structures in low-income and middle-income countries. A number of impact evaluations have noted that PBF often produces mixed and heterogeneous effects. Still, little systematic effort has been channelled towards understanding what causes such heterogeneity, including looking more closely at implementation processes.MethodsOur qualitative study aimed at closing this gap in knowledge by attempting to unpack the mixed and heterogeneous effects detected by the PBF impact evaluation in Cameroon to inform further implementation as the country scales up the PBF approach. We collected data at all levels of the health system (national, district, facility) and at the community level, using a mixture of in-depth interviews and focus group discussions. We combined deductive and inductive analytical techniques and applied analyst triangulation.ResultsOur findings indicate that heterogeneity in effects across facilities could be explained by pre-existing infrastructural weaknesses coupled with rigid administrative processes and implementation challenges, while heterogeneity across indicators could be explained by providers’ practices, privileging services where demand-side barriers were less substantive.ConclusionIn light of the country’s commitment to scaling up PBF, it follows that substantial efforts (particularly entrusting facilities with more financial autonomy) should be made to overcome infrastructural and demand-side barriers and to smooth implementation processes, thus, enabling healthcare providers to use PBF resources and management models to a fuller potential.

scholarly journals Theory of change for the delivery of talking therapies by lay workers to survivors of humanitarian crises in low-income and middle-income countries: protocol of a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018193 ◽  
Author(s):  
Grace Kathryn Ryan ◽  
Andreas Bauer ◽  
Judith K Bass ◽  
Julian Eaton
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Low Income ◽  
Tertiary Education ◽  
Grey Literature ◽  
Theory Of Change ◽  
Cochrane Library ◽  
Middle Income ◽  
Middle Income Countries ◽  
Humanitarian Crises

IntroductionThere is a severe shortage of specialist mental healthcare providers in low-income and middle-income countries (LMICs) affected by humanitarian crises. In these settings, talking therapies may be delivered by non-specialists, including lay workers with no tertiary education or formal certification in mental health. This systematic review will synthesise the literature on the implementation and effectiveness of talking therapies delivered by lay workers in LMICs affected by humanitarian crises, in order to develop a Theory of Change (ToC).Methods and analysisQualitative, quantitative and mixed-methods studies assessing the implementation or effectiveness of lay-delivered talking therapies for common mental disorders provided to adult survivors of humanitarian crises in LMICs will be eligible for inclusion. Studies set in high-income countries will be excluded. No restrictions will be applied to language or year of publication. Unpublished studies will be excluded. Seven electronic databases will be searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library and ClinicalTrials.gov. Contents pages of three peer-reviewed journals will be hand-searched. Sources of grey literature will include resource directories of two online mental health networks (MHPSS.net and MHInnovation.net) and expert consultation. Forward and backward citation searches of included studies will be performed. Two reviewers will independently screen studies for inclusion, extract data and assess study quality. A narrative synthesis will be conducted, following established guidelines. A ToC map will be amended iteratively to take into account the review results and guide the synthesis.Ethics and disseminationFindings will be presented in a manuscript for publication in a peer-reviewed journal and disseminated through a coordinated communications strategy targeting knowledge generators, enablers and users.PROSPERO registration numberCRD42017058287.

scholarly journals Are Poor Parents Poor Parents? The Relationship between Poverty and Parenting among Mothers in the UK

Sociology ◽  
2020 ◽  
pp. 003803852093939
Author(s):  
Kerris Cooper
Keyword(s):  
Low Income ◽  
Parenting Skills ◽  
Middle Income ◽  
Mainstream Media ◽  
Political Discourses ◽  
Low Income Mothers ◽  
The Uk ◽  
Income Gradient ◽  
The Relationship ◽  
Parenting Behaviours

Low-income parents have long been demonised in both political discourses and mainstream media, portrayed as lacking in parenting skills not just financial resources. Using the Millennium Cohort Study (MCS) this article examines to what extent there are differences in the parenting of low-income mothers by examining parenting behaviours of low-, middle- and high-income mothers. The findings show that where there are negative differences in the parenting of low-income mothers these are often part of a broader income gradient that extends all the way up the distribution, rather than unique to low-income mothers. Furthermore, there are some positive differences in parenting among low-income mothers compared to middle-income mothers. These findings have important implications: low-income parents are not an unusual or deviant group parenting differently to everyone else. The findings suggest more attention ought to be given to parenting differences higher up the income distribution. In focusing on low-income parents only, existing evidence exaggerates differences and wrongly identifies low-income parents as problematic.

scholarly journals Impact of Universal Credit in North East England: a qualitative study of claimants and support staff

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029611 ◽  
Author(s):  
Mandy Cheetham ◽  
Suzanne Moffatt ◽  
Michelle Addison ◽  
Alice Wiseman
Keyword(s):  
Mental Health ◽  
Local Government ◽  
Qualitative Study ◽  
Low Income ◽  
Welfare Benefits ◽  
North East ◽  
The Uk ◽  
The Impact ◽  
Community Sector ◽  
Roll Out

ObjectivesTo understand the impact of the roll-out of Universal Credit (UC) from the perspectives of claimants and staff supporting them in North East England.DesignQualitative study comprising interviews and focus groups.SettingGateshead and Newcastle, two localities in North East England characterised by high levels of socioeconomic deprivation, where the roll-out of UC started in 2017 as a new way to deliver welfare benefits for the UK working age population.Participants33 UC claimants with complex needs, disabilities and health conditions and 37 staff from local government, housing, voluntary and community sector organisations.ResultsParticipants’ accounts of the UC claims process and the consequences of managing on UC are reported; UC negatively impacts on material wellbeing, physical and mental health, social and family lives. UC claimants described the digital claims process as complicated, disorientating, impersonal, hostile and demeaning. Claimants reported being pushed into debt, rent arrears, housing insecurity, fuel and food poverty through UC. System failures, indifference and delays in receipt of UC entitlements exacerbated the difficulties of managing on a low income. The threat of punitive sanctions for failing to meet the enhanced conditionality requirements under UC added to claimant’s vulnerabilities and distress. Staff reported concerns for claimants and additional pressures on health services, local government and voluntary and community sector organisations as a result of UC.ConclusionsThe findings add considerable detail to emerging evidence of the deleterious effects of UC on vulnerable claimants’ health and wellbeing. Our evidence suggests that UC is undermining vulnerable claimants’ mental health, increasing the risk of poverty, hardship, destitution and suicidality. Major, evidence-informed revisions are required to improve the design and implementation of UC to prevent further adverse effects before large numbers of people move on to UC, as planned by the UK government.

scholarly journals Verbal Autopsy with Participatory Action Research (VAPAR) programme in Mpumalanga, South Africa: protocol for evaluation

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e036597
Author(s):  
Sophie Witter ◽  
Maria Van Der Merwe ◽  
Rhian Twine ◽  
Denny Mabetha ◽  
Jennifer Hove ◽  
...  
Keyword(s):  
Action Research ◽  
Participatory Action Research ◽  
Low Income ◽  
Verbal Autopsy ◽  
Secondary Data ◽  
Health Indicators ◽  
Theory Of Change ◽  
Local Health ◽  
Participatory Action ◽  
Middle Income

IntroductionThere is a growing recognition of the importance of developing learning health systems which can engage all stakeholders in cycles of evidence generation, reflection, action and learning from action to deal with adaptive problems. There is however limited evaluative evidence of approaches to developing or strengthening such systems, particularly in low-income and middle-income settings. In this protocol, we aim to contribute to developing and sharing knowledge on models of building collaborative learning platforms through our evaluation of the Verbal Autopsy with Participatory Action Research (VAPAR) programme.Methods and analysisThe evaluation takes a participatory approach, focussed on joint learning on whether and how VAPAR contributes to its aims, and what can be learnt for this and similar settings. A realist-informed theory of change was developed by the research team as part of a broader collaboration with other stakeholders. The evaluation will draw on a wide variety of perspectives and data, including programme data and secondary data. This will be supplemented by in-depth interviews and workshops at the end of each cycle to probe the different domains, understand changes to the positions of different actors within the local health system and feedback into improved learning and action in the next cycle. Quantitative data such as verbal autopsy will be analysed for significant trends in health indicators for different population groups. However, the bulk of the data will be qualitative and will be analysed thematically.Ethics and disseminationEthics in participatory approaches include a careful focus on the power relationships within the group, such that all groups are given voice and influence, in addition to the usual considerations of informed participation. Within the programme, we will focus on reflexivity, relationship building, two-way learning and learning from failure to reduce power imbalances and mitigate against a blame culture. Local engagement and change will be prioritised in dissemination.

scholarly journals Is overseas volunteering beneficial to the NHS? The analysis of volunteers’ responses to a feedback questionnaire following experiences in low-income and middle-income countries

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017517 ◽  
Author(s):  
Daniel Yeomans ◽  
Grace Le ◽  
Hemant Pandit ◽  
Chris Lavy
Keyword(s):  
Professional Development ◽  
Low Income ◽  
Personal Development ◽  
Positive Impact ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Middle Income Countries ◽  
Feedback Questionnaire ◽  
Sub Saharan ◽  
The Uk

IntroductionLocally requested and planned overseas volunteering in low-income and middle-income countries by National Health Service (NHS) staff can have benefits for the host or receiving nation, but its impact on the professional development of NHS staff is not proven. The Knowledge and Skills Framework (KSF) and Leadership Framework (LF) are two tools used by employers as a measure of individuals' development. We have used dimensions from both tools as a method of evaluating the benefit to NHS doctors who volunteer overseas.Methods88 NHS volunteers participating with local colleagues in Primary Trauma Care and orthopaedic surgical training courses in sub-Saharan Africa were asked to complete an online self-assessment questionnaire 6 months following their return to the UK. The survey consisted of questions based on qualities outlined in both the KSF and LF.Results85 completed responses to the questionnaire were received. In every KSF domain assessed, the majority of volunteers agreed that their overseas volunteering experience improved their practice within the NHS. Self-assessed pre-course and post-course scores evaluating the LF also saw a universal increase, notably in the ‘working with others’ domain.DiscussionThere is a growing body of literature outlining the positive impact of overseas volunteering on NHS staff. Despite increasing evidence that such experiences can develop volunteers’ essential skills, individuals often find it difficult to gain support of their employers. Our study, in line with the current literature, shows that overseas volunteering by NHS staff can provide an opportunity to enhance professional and personal development. Skills gained from volunteering within international links match many of the qualities outlined in both KSF and LF, directly contributing to volunteers’ continued professional development.

scholarly journals Syrian Crisis in Jordan: Case Study of Hosting Community Psycho-social in Low Income areas in Amman

2020 ◽  
Vol 9 (1) ◽  
pp. 171
Author(s):  
Manal Fathi Anabtawi
Keyword(s):  
Qualitative Study ◽  
Focus Groups ◽  
Low Income ◽  
Service Providers ◽  
Self Esteem ◽  
Policy Makers ◽  
Syrian Crisis ◽  
Syrian Refugee

This paper explores the influence that the Syrian crisis has on hosting community psycho-social in low income areas in Amman, Capital of Jordan. Case study was chosen as a design that would support a wider and in-depth exploration because it would be able to address the sensitivity of the issue; based on data from a qualitative study involving ten focus groups conducted from July to October 2017. Available reports and researches have investigated Syrian refugee needs and experiences, while few studies have explored the experiences of Jordanians in a hosting community, especially their psycho-social. In this paper, researcher argues that policy makers and service providers have to pay attention to hosting community experiences; especially their psycho-social. Paper concludes that Jordanians living in low income areas in Amman have been influenced by the Syrian crisis; suffering from  frustration and despair, fears, anger, low self-esteem and hopelessness.

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