scholarly journals Perceptions and experiences of men and women towards acceptability and use of contraceptives in underserved areas of Karachi, Pakistan: A Midline Qualitative Assessment of Sukh Initiative, Karachi Pakistan

2020 ◽  
Author(s):  
Sarah Saleem ◽  
Narjis Rizvi ◽  
Anam Feroz ◽  
Sayyeda Reza ◽  
Saleem Jessani ◽  
...  

Abstract Background: Family planning (FP) is an essential component of Sustainable Development Goals (SDG) and contributes directly to SDG targets 3.7 and 5.6. In Pakistan, contraceptive use has remained stagnant over the past 5 years. This change has been very slow when compared to the FP2020 pledge. The Sukh initiative project was conceived and implemented to alleviate these challenges by providing access to quality contraceptive methods in some underserved areas of Karachi, Pakistan. A qualitative study was been conducted to understand the perceptions and experiences of men and women towards acceptability and contraceptive use.Methods: A qualitative study was conducted at ten Sukh stations located in four towns of Karachi. Focus group discussions (FGDs) were conducted with Married Women of Reproductive Age (MWRA) and married men who received FP services through the Sukh initiative. Study participants were purposively sampled for focus group discussions (FGDs). Interview data was manually transcribed and analyzed using thematic analysis.Results: A total of 20 FDGs(Men=10 FGDs; MWRA=10 FGDs) were conducted. Three overarching themes were identified: (I) Appropriateness and means to promote contraceptive use; (II) Equity and Accessibility to contraceptives; and (III) Perspective on available FP services. Generally, both men and women were informed about FP methods but women were more cognizant of FP information. The Door to Door services by community health workers in Sukh initiative areas was largely appreciated both by women and men as it has made the accessibility and availability of the information and services easy. Women suggested that the Sukh initiative should bring some strategies that can help men broaden their perspective towards FP. The study informed that the men feel left out from the FP programs. Therefore, male participants expressed keen interest in initiatives for men in their communities that would cater to their FP needs.Conclusions: This qualitative study provided a unique opportunity to understand the perceptions of men and women towards the phenomena of contraceptive use. The study identified the need for trained and qualified female and male healthcare providers and well-established health facilities alongside door-to-door services.

2020 ◽  
Author(s):  
Sarah Saleem ◽  
Narjis Rizvi ◽  
Anam Feroz ◽  
Sayyeda Reza ◽  
Saleem Jessani ◽  
...  

Abstract Background: Family planning (FP) is an essential component of Sustainable Development Goals (SDG) and contributes directly to SDG targets 3.7 and 5.6. In Pakistan, contraceptive use has remained stagnant over the past 5 years. This change has been very slow when compared to the FP2020 pledge. The Sukh initiative project was conceived and implemented to alleviate these challenges by providing access to quality contraceptive methods in some underserved areas of Karachi, Pakistan. A qualitative study was conducted to understand the perceptions and experiences of men and women towards acceptability and contraceptive use.Methods: A qualitative study was conducted at ten Sukh stations located in four towns of Karachi. Focus group discussions (FGDs) were conducted with Married Women of Reproductive Age (MWRA) and married men who received FP services through the Sukh initiative. Study participants were purposively sampled for focus group discussions (FGDs). Interview data was manually transcribed and analyzed using thematic analysis.Results: A total of 20 FDGs (Men=10 FGDs; MWRA=10 FGDs) were conducted. Three overarching themes were identified: (I) Appropriateness and means to promote contraceptive use; (II) Equity and Accessibility to contraceptives; and (III) Perspective on available FP services. Generally, both men and women were informed about FP methods but women were more cognizant of FP information. The Door to Door services by community health workers in Sukh initiative areas was largely appreciated both by women and men as it has made the accessibility and availability of the information and services easy. Women suggested that the Sukh initiative should bring some strategies that can help men broaden their perspective towards FP. The study informed that the men feel left out from the FP programs. Therefore, male participants expressed keen interest in initiatives for men in their communities that would cater to their FP needs.Conclusions: This qualitative study provided a unique opportunity to understand the perceptions of men and women towards the phenomena of contraceptive use. The study identified the need for trained and qualified female and male healthcare providers and well-established health facilities alongside door-to-door services.


2019 ◽  
Author(s):  
Jasmin Isler ◽  
N Hélène Sawadogo ◽  
Guy Harling ◽  
Till Bärnighausen ◽  
Maya Adam ◽  
...  

BACKGROUND Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso. OBJECTIVE The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings. METHODS Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors. RESULTS We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video’s protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted. CONCLUSIONS Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions.


Author(s):  
Christiana Naa Atsreh Nsiah-Asamoah

Aim: This study sought to explore the cultural factors that are associated with complementary feeding from the reports of Community Health Workers (CHWs) and Volunteers (CHVs) in two rural districts in Ghana. Study Design: This was a cross-sectional qualitative study that assessed cultural beliefs, norms, superstitions and practices that influence complementary feeding practices of young children under two years in two rural farming districts in Ghana Study Area: The study was conducted at Kwahu Afram Plains North and South Districts in the Eastern Region of Ghana. Methodology: The study employed qualitative methods which entailed conducting 9 focus group discussions among CHWs and CHVs working at two rural districts in Ghana. The focus group discussions were conducted with the aid of a validated, interview guide, after obtaining informed consent (written) from the health workers. Ethical clearance for the study was obtained from the Institutional Review Boards of the Dodowa Health Research Centre and the University of Cape Coast. Thematic content analytical procedures were applied to analyze the transcripts, interpret and present findings as a narrative account. Results: The reports of the health workers indicate a common practice of early introduction of solid foods to infants before they attain six(6) months of age. Cultural beliefs, superstitions, beliefs, food taboos and prohibitions influence mothers’ complementary-feeding practices and result in limiting the food scope and dietary diversity of their young children. Conclusions: Interventions designed to promote appropriate complementary feeding practices should incorporate an understanding of social context, family, and cultural factors in developing nutrition promotion messages that are tailored to meet the needs of rural populations. More community interventions that draw on the support of key influential persons in the community and fathers are needed to address cultural barriers to appropriate complementary feeding practices.


2019 ◽  
Author(s):  
Oluwaseun Akinyemi ◽  
Bronwyn Harris ◽  
Mary Kawonga

AbstractObjectivesTo explore how sociocultural factors may support or impede the adoption of community-based distribution of injectable contraceptives in Nigeria.DesignA qualitative study based on a grounded theory approach was conducted through in-depth interviews and focus group discussions.SettingMost participants lived in Gombe State, North East Nigeria. Other participants were from Ibadan (South West) and Abuja (Federal capital territory).ParticipantsThrough seven key informant interviews, 15 in-depth interviews and 10 focus group discussions, 102 participants were involved in the study.MethodsThis study, conducted in 2016 was part of a larger study on scale up of community-based distribution of injectable contraceptives. Qualitative data were collected from traditional and religious leaders, health workers and community members. The data were audio recorded, transcribed and analysed using a thematic framework method.ResultsSociocultural challenges to scale up included patriarchy and men’s fear of losing control over their spouses, traditional and religious beliefs about fertility, and myths about contraceptives and family planning. As a result of deep-rooted beliefs that children are ‘divine blessings’ and that procreation should not be regulated, participants described a subtle resistance to uptake of injectable contraceptives. Since Gombe is largely a patriarchal society, male involvement emerged as important to the success of meaningful innovation uptake. Community leaders largely described their participation in the scale up process as active, although they also identified scope for further involvement and recognition.ConclusionScale up is more than setting up health sector implementing structures, training health workers and getting innovation supplies, but also requires preparedness which includes paying attention to complex contextual issues. This requires the health system and those who work in it, to move beyond a narrow health ‘comfort zone’ by actively engaging with, and learning from, those who are leading, caring for and living in, the community.Strengths and limitations of this studyThe study participants represented a range of stakeholders - users of injectable contraceptives, community members, providers and health system managers.Our results highlighted that scale up is influenced by several socio-cultural factors; thus, showing the importance of paying attention to complex contextual issues during innovation uptake.The findings of our study emphasized how health systems and communities should interact in order to ensure successful scale up of health innovations.As with any qualitative study, the findings of this study are not statistically generalizable.FundingThis research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No--B 8606.R02), Sida (Grant No:54100113), the DELTAS Africa Initiative (Grant No: 107768/Z/15/Z) and Deutscher Akademischer Austauschdienst (DAAD). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) and the UK government. The statements made and views expressed are solely the responsibility of the authors.Declarations of interestNone.


BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e035449 ◽  
Author(s):  
Gabriella Watson ◽  
Kaajal Patel ◽  
Daly Leng ◽  
Dary Vanna ◽  
Sophanou Khut ◽  
...  

ObjectivesNeonatal mortality remains persistently high in low-income and middle-income countries. In Cambodia, there is a paucity of data on the perception of neonatal health and care-seeking behaviours at the community level. This study aimed to identify influencers of neonatal health and healthcare-seeking behaviour in a rural Cambodian province.DesignA qualitative study using focus group discussions and thematic content analysis.SettingFour health centres in a rural province of Northern Cambodia.ParticipantsTwenty-four focus group discussions were conducted with 85 community health workers in 2019.ResultsCommunity health workers recognised an improvement in neonatal health over time. Key influencers to neonatal health were identified as knowledge, sociocultural behaviours, finances and transport, provision of care and healthcare engagement. Most influencers acted as both barriers and facilitators, with the exception of finances and transport that only acted as a barrier, and healthcare engagement that acted as a facilitator.ConclusionUnderstanding health influencers and care-seeking behaviours is recognised to facilitate appropriate community health programmes. Key influencers and care-seeking behaviours have been identified from rural Cambodia adding to the current literature. Where facilitators have already been established, they should be used as building blocks for continued change.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Meghan A. Potasse ◽  
Sanni Yaya

Abstract Background There are many barriers that impact a woman’s access to contraception in rural sub-Saharan Africa, such as financial constraints, supply shortages, stigma, and misconceptions. Through and African Feminist lens, this study examines how these perceived barriers intersect with each other, and how they negatively impact women’s access to family planning and their perceived value of contraceptives in Luweero, Uganda. Methods This qualitative study analyzed data collected from healthcare workers at one private clinic and one public clinic that offer family planning services in four focus group discussions in Luweero, Central Region, Uganda. Two focus group discussions were held in each clinic. Eligible participants spoke English, were at least 18 years of age, and had at least 3 years of experience as a healthcare worker in Luweero. Among the participants were nurses, midwives, family planning counsellors, and village health workers, both male and female. Coded transcripts were analyzed using a reflexive methodology through an African Feminist lens. Results Most of the responses indicated that financial constraints experienced either by the clinic or the women significantly impact access to family planning. Certain social barriers were discussed, and the participants explained that barriers such as stigma, misconceptions, lack of knowledge, religiosity and cultural values impact women’s motivation or ability to access contraceptive methods. Side effects also have a significant role to play in women’s ability or motivation to navigate through these perceived social barriers. Conclusions Participants determined that increased funding for transportation for village health teams, consistent funding for free contraception, and expanded sensitization efforts that particularly target men would be some of the most impactful methods they can adapt to address some of these barriers.


10.2196/13604 ◽  
2019 ◽  
Vol 7 (11) ◽  
pp. e13604
Author(s):  
Jasmin Isler ◽  
N Hélène Sawadogo ◽  
Guy Harling ◽  
Till Bärnighausen ◽  
Maya Adam ◽  
...  

Background Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso. Objective The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings. Methods Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors. Results We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video’s protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted. Conclusions Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions.


2020 ◽  
Author(s):  
Reizkiana Feva Kosmah Dewi ◽  
Meita Dhamayanti ◽  
Sri Endah Rahayuningsih ◽  
Kuswandewi Mutyara ◽  
Nita Arisanti ◽  
...  

Abstract Background Child abuse (CA) is a serious problem and difficult to detect. According to World Health Organization (WHO), CA is responsible on 950,000 deaths in children aged below 18 every year. As many cultures as various of CA among parents inside. This research aims to determine the cultural perceptions of child abuse in terms of parents in Indonesia. Method A qualitative study using focus group discussions was conducted to thirty one parents that selected purposively. The discussion centered about CA definition, classification, and frequency, level of CA (mild, moderate, and severe), the difference between violence and discipline. The focus group discussions divided in to 3 groups level education, Elementary/Junior high school, senior high school, and bachelor’s degree. The process offocus group discussion were recorded, transcribed, and analyzed using manifest qualitative content analysis. Results Every cultures in Indonesia perceived that CA is a form of parents’ emotion which lead to injure children physically and mentally. Indonesian cultures were not familiar with neglect and exploitation. Participants’ opinion regarding level of violence can be categorized as severe if leaving wounds, need to be hospitalized, and visumed. The parents assumed as CA if occurred more than twice and/or leaving marks. The discipline’s ussualy purpose is not to mistreat, but for goods, character building, and educating the children. Conclusions Cultural perceptions of parents about CA is a form of parents’ emotion which lead to injure children physically and mentally. The community and health workers should be aware to decrease morbidity and mortality of CA


2021 ◽  
Author(s):  
VINCENT MUBANGIZI ◽  
Jane Plastow ◽  
Florence Nakaggwa ◽  
Haeven Nahabwe ◽  
Sylvia Natukunda ◽  
...  

Abstract Background: There is a paucity of literature on the effectiveness of drama or documentary films in changing knowledge, beliefs, attitudes, and behavior of people towards family planning. This study aimed to compare and assess the acceptability of health promotion films based on documentary or drama, and their effect on knowledge, attitudes, and intention to use family planning.Methods: We developed short documentary and drama films about contraceptive implants, using the person-based approach. Their acceptability was assessed in focus group discussions with younger women below 23 years, women over 23 years, men of reproductive age, and health workers in four different areas of Uganda (Bwindi/Kanungu, Walukuba/Jinja, Kampala, and Mbarara). Transcripts of the focus group discussions were analyzed using thematic analysis, to generate themes and examine the key issues. We assessed changes in knowledge, attitudes, and intentions to use family planning after watching the films. Results: Sixteen focus groups with 150 participants were carried out. Participants said that the documentary improved their knowledge and addressed their fears about side effects, myths, and implant insertion. The drama improved their attitudes towards the implant and encouraged them to discuss family planning with their partner. The final versions of the documentary and the drama films were equally liked. Conclusions: Viewing a short documentary on the contraceptive implant led to positive changes in knowledge, while a short drama improved attitudes and intentions to discuss the implant with their partner. The drama and documentary have complementary features, and most participants wanted to see both.


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