Community-based Mixed-methods Study Research Articles

Impact of COVID-19 among small-scale industry fishermen - A mixed methods study from the coastal area of Karnataka.

COVID-19 pandemic resulted in widespread and devastating physical, emotional, societal, and economic repercussions among workers in India. To evaluate the impact of COVID-19 and to understand the challenges faced and coping mechanism adopted among fishermen community from the coastal area of Karnataka. This community-based mixed-methods study included participants from a coastal Karnataka fishermen's community. Questionnaire based personal interviews collected information on sociodemographics, COVID-19 diagnosis, treatment, and related costs, COVID-19-appropriate behavior and were screened using DASS-21. Focus group discussions and key informant interviews were conducted to acquire qualitative data. Quantitative data collection involved 107 participants, predominantly males [70.1%], aged between 46-60 years [37.4%] and low socioeconomic status [79.4%]. Among 107, 51 participants reported to have probable COVID-19 symptoms. Around 11% had tested for COVID-19 and two were admitted in hospital with mean hospital stay of seven days. According to DASS-21, 20.6%, 15.9% and 9.3% of participants screened positive for depression, anxiety and stress respectively. Nearly one third of the participants were found to have significant socioeconomic impact.Major challenges faced included loss of livelihood, inaccessibility to health care, repayment of loans, stigma related to COVID-19 and meeting educational expenses of children with one dropping out of college. Activities of local self-help groups in the community and grass root level marketing strategies to sell fish were highly successful in mitigating the impact as a community. COVID-19 had a significant impact on fishermen community and implies a need for better pandemic and disaster preparedness strategies in the community.

Child Birth Practices and Utilization of Antenatal Care (ANC) Services Among Migrant Tribal Women in Urban Areas of Gujarat.

Tribal women constitute a vulnerable population and migratory tribal women living in urban areas are among the most vulnerable and neglected sections. The current study was conducted among migratory tribal women living in the urban areas of Gujarat to understand their antenatal care (ANC) and child birth practices. This was a community-based mixed methods study, conducted during 2022, in four major cities of Gujarat. The sample size for the quantitative study consisted of 592 participants. Inclusion criteria for participants were tribal women migrants to urban areas; migration for employment; less than a year of residence in the urban area; married women; and working on construction-sites. The qualitative study included 20 tribal women selected from cities and a total of 24 grassroots workers and in-depth interviews were conducted. The participating women were in the age group of 16-43 years, with mean age being 26 years. Almost 67 (11%) women were pregnant at the time of the study. Around 51% of the women had FOUR antenatal care (ANC) visits during their previous pregnancy. Around 63 (18%) women had home births. Qualitative data revealed that their deep-rooted cultural practices and beliefs influenced their ANC patterns, child birth practices, and utilization of hospital services. Migrant tribal women are considered a vulnerable population in urban areas, as they do not have local documents.Further, they are bound by deep-rooted cultural beliefs. There is a need to use technology for developing tracking systems, in order to provide better maternity care to these women.

Feasibility and acceptability of self-collection of Human Papillomavirus samples for primary cervical cancer screening on the Caribbean Coast of Nicaragua: A mixed-methods study.

Cervical cancer is the primary cause of cancer death for women in Nicaragua, despite being highly preventable through vaccination against high-risk genotypes of the Human Papillomavirus (hrHPV), screening for hrHPV, and early detection of lesions. Despite technological advances designed to increase access to screening in low resource settings, barriers to increasing population-level screening coverage persist. On the Caribbean Coast of Nicaragua, only 59% of women have received one lifetime screen, compared to 78.6% of eligible women living on the Pacific and in the Interior. In concordance with the WHO's call for best practices to eliminate cervical cancer, we explored the feasibility and acceptability of self-collection of samples for hrHPV testing on the Caribbean Coast of Nicaragua through a multi-year, bi-national, community-based mixed methods study. Between 2016 and 2019, focus groups (n=25), key informant interviews (n=12) [phase I] and an environmental scan [phase II] were conducted on the Caribbean Coast of Nicaragua in partnership and collaboration with long-term research partners at the University of Virginia and community-based organizations. In spring 2020, underscreened women on the Caribbean Coast of Nicaragua were recruited and screened for hrHPV, with the choice of clinician collection or self-collection of samples. Over the course of the study, providers and potential patients expressed significant acceptability of self-collection of samples as a strategy to reduce barriers currently contributing to the low rates of screening (phases I and II). Ultimately 99.16% (n=1,767) of women chose to self-collect samples, demonstrating a high level of acceptability of self-collection in this pilot sample (phase III). Similarly, focus groups, key informant interviews, and the environmental scan (phases I and II) of resources indicated critical considerations for feasibility of implementation of both HPV primary screening and subsequently, self-collection of samples. Through phase III, we piloted hrHPV screening (n=1,782), with a 19.25% hrHPV positivity rate. Self-collection of samples for hrHPV testing demonstrated high acceptability and feasibility. Through concerted effort at the local, regional, and national levels, this project supported capacity building in reporting, monitoring, and surveilling cervical cancer screening across the continuum of cervical cancer control.

Why Villagers Use Toilets Only During Specific Time and Season? A Mixed-Methods Study in Rural Tamil Nadu

Background: Due to the efforts of sanitation promotion interventions in India, majority of the villagers started using toilets. But there is an inconsistency in toilet usage with regard to time and season. Objectives: The objectives were to determine the time and seasonal variations in toilet usage among villagers who use toilets and to identify the reasons for time and seasonal variations in toilet usage. Methodology: A community-based mixed-methods study was executed in the four field practice villages of UHTC, Villupuram. After IEC clearance, 405 individuals who were using an owned toilet were selected by Simple Random Sampling. Qualitative component (free listing) was used for questionnaire development and quantitative component (survey + observation) was used for data collection. Results: Majority, 52% villagers used toilets only in the night and 64% villagers used toilets during rainy season. Fear of darkness and snakes, emergency and large family size were the common reasons for night time toilet usage. While, non-availability of open space, illness on exposure to rain and quick filling of toilet pit contributed to toilet usage in the rainy season. Conclusion: The study findings would help in the development of culturally-sensitive and socially-acceptable key messages for future sanitation promotion interventions.

Cohort Profile: The Assessing Economic Transitions (ASSET) Study-A Community-Based Mixed-Methods Study of Economic Engagement among Inner-City Residents.

The Assessing Economic Transitions (ASSET) study was established to identify relationships between economic engagement, health and well-being in inner-city populations given that research in this area is currently underdeveloped. This paper describes the objectives, design, and characteristics of the ASSET study cohort, an open prospective cohort which aims to provide data on opportunities for addressing economic engagement in an inner-city drug-using population in Vancouver, Canada. Participants complete interviewer-administered surveys quarterly. A subset of participants complete nested semi-structured qualitative interviews semi-annually. Between April 2019 and May 2022, the study enrolled 257 participants ages 19 years or older (median age: 51; 40% Indigenous, 11.6% non-Indigenous people of colour; 39% cis-gender women, 3.9% transgender, genderqueer, or two-spirit) and 41 qualitative participants. At baseline, all participants reported past daily drug use, with 27% currently using opioids daily, and 20% currently using stimulants daily. In the three months prior to baseline, more participants undertook informal income generation (75%) than formal employment (50%). Employed participants largely had casual jobs (42%) or jobs with part-time/varied hours (35%). Nested qualitative studies will focus on how inner-city populations experience economic engagement. The resulting evidence will inform policy and programmatic initiatives to address socioeconomic drivers of health and well-being.

Evaluation of a novel therapeutic education programme for people with alcohol use disorder in France: a mixed-methods intervention study protocol (ETHER)

BackgroundETHER (“Education THEérapeutique pour la Réduction des dommages en alcoologie” or Therapeutic education for alcohol-related harm reduction) is a multicentre community-based mixed-methods study, which aims to evaluate the effectiveness of the innovative therapeutic patient education (TPE) programme ‘Choizitaconso’ in a sample of French people with alcohol use disorder (people with AUD). Choizitaconso teaches people with AUD psychosocial skills to help them (re)establish controlled drinking and reduce alcohol-related harms. Recruitment started in October 2019. We present here the protocol of the ETHER study.MethodsETHER’s quantitative component involves a 6-month controlled intervention study which evaluates Choizitaconso’s effectiveness by comparing 30 people with AUD following the programme with a control group of 60 people with AUD not enrolled in it, using a questionnaire co-constructed by the research team and members of the people with AUD community. Thirty-four alcohol-related harms are assessed and summed to provide an individual measure of the ‘harm burden’ from consuming alcohol (primary outcome). Secondary outcomes are anticipated and internalized stigma, alcohol consumption measures, craving for alcohol, coping strategies, health-related quality of life, self-confidence to control or abstain from drinking, treatment self-regulation, anxiety and depressive symptoms, alcohol-related neuropsychological impairments, and capabilities (a measure of wellbeing in adults). Data will be collected in face-to-face and phone-based interviews at enrolment and 6 months later. Linear regression models will be used to assess the impact of the TPE programme on changes in the primary and secondary outcomes, while adjusting for other correlates and confounders. The study’s qualitative component comprises semi-structured interviews with 16 people with AUD who have already completed the TPE programme at least 6 months before the interview. Qualitative interviews will be analysed using thematic analysis.Results and conclusionsETHER is the first evaluation study of an innovative TPE programme specifically designed to reduce alcohol-related harms and reach controlled drinking in France. The involvement of the people with AUD community in selecting which experienced and perceived alcohol-related harms to measure ensures that ETHER will provide healthcare staff and researchers with a relevant set of harm reduction criteria for use in future research. Finally, ETHER will provide scientific justification for implementing novel alcohol-related harm reduction approaches and champion controlled drinking as a therapeutic goal.Trial registration ClinicalTrials.gov, NCT03954054. Registered 17 May 2019—Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03954054?cond=alcohol&cntry=FR&city=Marseille&draw=1&rank=1.

Awareness, practices, and myths related to coronavirus disease-19 among rural people in Kolar District, South India: A community-based mixed-methods study.

BACKGROUND:Capturing the baseline information on awareness, practices, and prevailing myths related to the ongoing coronavirus disease-19 (COVID-19) pandemic in rural India will help in planning interventions to improve the health literacy on COVID-19. The aim of the study was to assess the level of awareness, practices, and myths regarding COVID-19 among rural population of Kolar district in South India.MATERIALS AND METHODS:A concurrent mixed-methods study with a quantitative community-based cross-sectional analytical design and a qualitative phenomenological design was conducted in five randomly selected villages during June 2020. A prevalidated and pretested semi-structured questionnaire was administered to one adult in the households selected using systematic random sampling to capture the sociodemographic details and their awareness, practices, and myths related to COVID-19. The supervisors additionally and concurrently used a nonparticipant observation technique to record the real-time behaviors and preventive practices adopted by the villagers. Quantitative analysis was done using STATA and included multivariable regression analysis, and the association was reported using prevalence rates along with their 95% confidence intervals (CIs). Qualitative analysis was done manually as per discussion and concordance among supervisors and reported as categories along with supporting statements.RESULTS:Among the 298 respondents, “poor awareness” was seen in 128 (43.0%, 95% CI: 37.5%–48.6%). Among the responders, 89 (29.9%) believed in the myth that “Corona disease is due to God's wrath or curse.” The field observations were categorized under three categories – “avoidance of masks,” “nonexistent social distancing,” and “rampant spitting.”CONCLUSION:About two in five villagers were found to have “poor awareness” to COVID, and practices related to COVID were found to be largely unsatisfactory. Lower level of education and belonging to nuclear family were associated with “poor awareness.” Various myths were identified that has to be debunked on priority basis by the government, especially targeting the people having low level of education in rural India.

Access to sexual and reproductive health care among young adult sex workers in Toronto, Ontario: a mixed-methods study.

Background:Young adult sex workers may benefit from sexual and reproductive health care services; however, little research has examined their access experiences. This study aimed to assess barriers to and facilitators of access to sexual and reproductive health care among young adult sex workers, and identify practices suggested by participants to improve services.Methods:This was a community-based mixed-methods study of adults aged 18–29 years who were currently or had previously been engaged in sex work, conducted in Toronto in 2017–2018. The study was guided by a Youth Advisory Committee of 4 youth with lived experience of sex work. Participants completed an online survey, or participated in a focus group or a one-on-one interview; all 3 modalities included parallel questions about barriers to and facilitators of access to sexual and reproductive health care. We summarized quantitative data using descriptive statistics and identified qualitative themes using thematic analysis, followed by triangulation of the 2 strands.Results:There were 54 survey respondents (response rate 48%) and 17 participants in the qualitative phase (14 in focus groups and 3 in interviews), for a total sample size of 71. Survey respondents reported suboptimal access to sexual and reproductive health care, with 8 (15%) reporting no regular source of care, and only 6 (11%) reporting that they disclose their sex work experience to providers. Actual or expected stigma regarding sex work on the part of providers was the dominant barrier to care, whereas nonjudgmental providers, particularly those who themselves have sex work experience, was a key facilitator. Participants suggested 7 practices to improve access to sexual and reproductive health care.Interpretation:Young adult sex workers face many barriers to accessing sexual and reproductive health care. Including people with sex work experience in the development of solutions will maximize the capacity to address the needs of this underserved population.

Family building desires among transgender and gender expansive adolescents: A longitudinal family-level analysis

Introduction Professional societies state that Transgender and gender expansive (TGE) adolescents and their families should be counseled about future family building options prior to initiating gender affirming therapy. While emerging data show that TGE adolescents have diverse desires regarding future family building, little is known regarding how these preferences are developed in a larger ecological context. Aim The current study used Ecological Systems Theory as a framework to describe the family building attitudes of TGE adolescents, their caregivers, and their siblings. Methods Participants were recruited from community-based venues in the New England region of the U.S. to participate in the TTFN Project, a longitudinal community-based mixed methods study. The sample for the current study included 84 family members from 30 families (30 TGE adolescents, 11 siblings, 44 caregivers). All participants completed a semi-structured qualitative interview about family building attitudes and desires for TGE and cisgender adolescents at two waves across 6-8 months. Interview transcripts were analyzed using a combination of immersion/crystallization, thematic analysis, and template organizing style approaches. The Transgender Youth Fertility Attitudes Questionnaire (TYFAQ) was employed to quantitatively describe the family building attitudes of TGE adolescents and their families. Results Eight themes corresponding to the levels of the ecological systems model – individual-level (perceived reproductive potential, reproductive identity), family-level (communication about family building, familial experiences and expectations), community-level (community support and role models; community expectations and norms), and societal/institutional-level (medicalization of family building, external sociopolitical factors) – were developed from the interviews. Results from the TYFAQ indicated that compared to cisgender adolescents, TGE adolescents were less likely to value having biological children and more likely to consider adoption in comparison to their cisgender siblings. Discussion Findings emphasize the importance of using Ecological Systems Theory to understand the family building attitudes and desires of TGE adolescents and their families.

Psychosocial barriers and enablers of exclusive breastfeeding: lived experiences of mothers in low-income townships, North West Province, South Africa

BackgroundDespite national efforts to promote exclusive breastfeeding (EBF), South Africa’s EBF rate is only 32 %. The aim of this study was to examine the rate of EBF discontinuation and the lived experiences of breastfeeding mothers at postnatal time points 3–14 days, 4–8 weeks, 10–14 weeks and 20–24 weeks.MethodsThis community-based mixed-methods study collected data within a prospective cohort study on sociodemographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at 6–8 weeks with infant feeding data collected at 4–8, 10–14 and 20–24 weeks from 159 mothers living in low income areas. Six focus groups with 32 mothers with infants aged 6–24 weeks were conducted. Descriptive statistics was used for the quantitative data and thematic analysis for qualitative data.ResultsThe majority of mothers were unmarried (84.9%), living with family (69.2%) and unemployed (74.2%). Exclusive breastfeeding decreased from 34% at 4–8 weeks to 9.7% at 20–24 weeks. Mixed feeding with infant formula increased from 17.0 to 30.6% and food feeding from 3.1 to 54.2%. While there were no statistically significant associations between EBF and any of the quantitative sociodemographic variables, in the qualitative data, codes associated with barriers were more than enablers. The themes were Mothers’ attributes (wellbeing, experiences and relationships) with the code mother’s stress the strongest barrier, Mother’s knowledge, attitudes and practices of breastfeeding with the code conventional medicines the strongest barrier, Family environment with the code home setting the strongest barrier, Social environment with public spaces and places a barrier and in Baby cues the code baby stomach ailments the barrier. Within these same themes mother’s positive emotions, benefits of breastfeeding, support in the home, access to information and services from health professionals and baby’s health were strong enabling factors.ConclusionsLow EBF, high mixed feeding and a high EPDS score were explained by the barriers identified in the qualitative data. The data suggests that mothers from low-income households would be better supported through interventions that address food insecurity; family relationships and those that build confidence in mothers and resilience in confronting difficult and hostile breastfeeding environments.

Health symptoms among adults living near a coal-burning power plant

Coal ash is a waste product generated when coal is burned for energy. The purpose of this study was to assess health symptoms in adults living near a coal-burning power plant and compare the symptoms to a non-exposed population. A community-based mixed methods study was conducted with four neighborhoods adjacent to a coal-burning power plant. The comparison population was not exposed to coal ash and did not live near a coal-burning power plant. Adults who lived near the coal-burning power plant were significantly more likely to suffer from respiratory (AOR = 5.27, 95% CI = 2.16–12.0), gingiva (AOR = 2.46, 95% CI = 1.46–4.15), and skin symptoms (AOR = 3.37, 95% CI = 2.09–5.43). Results suggest that health symptoms may develop in people living near coal-burning power plants.

Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study

IntroductionSub-Saharan Africa is particularly vulnerable to the growing global burden of hypertension, but epidemiological studies are limited and barriers to optimal management are poorly understood. Therefore, we undertook a community-based...

“Our Kids Aren’t Dropping Out; They’re Being Pushed Out”: Native American Students and Racial Microaggressions in Schools

ABSTRACTPoor graduation rates, truancy rates, and standardized tests results have been presented as indicators of a school crisis among Native American youths. This crisis, however, relies on ahistoric and deficit models of intervention, which imagine academic success as an individual- or family-level phenomenon. Responding to Reyhner’s (1991) suggestion to assess the role of schools and teachers in working to push students out of school, we explored the experiences of Native American youths in schools. This article documents findings from a community-based mixed-methods study. It establishes not only the significant prevalence of microaggressions for Native American youths in schools but it also presents the unique discriminatory experiences and aspects of those microaggressions. We suggest that these microaggressions play a role in school climate and push-out and provide suggestions for research, professional development, and social action.

Are healthcare providers asking about environmental exposures? A community-based mixed methods study.

People living near environmental hazards may develop symptoms and health conditions that require specialized monitoring and treatment by healthcare providers. One emerging environmental hazard is coal ash. Coal ash is comprised of small particles containing heavy metals, polycyclic aromatic hydrocarbons, and radioactive elements. The overall purpose of this study was to explore whether healthcare providers ask patients if they live near an environmental hazard like coal ash storage sites and to assess what health conditions prompt a provider inquiry. Focus groups were conducted in 2012 and a cross-sectional survey was administered in 2013. Overall, 61% of survey respondents reported that their healthcare providers never asked if they lived near an environmental hazard. One focus group member stated “No, they don't ask that. They just always blame stuff on you….” Respondents with asthma and other lung conditions were significantly more likely to be asked by a healthcare provider if they lived near an environmental hazard. Due to the unique exposures from environmental hazards and the low prevalence of patients being asked about environmental hazards, we recommend that healthcare providers take environmental health histories in order to understand patients' exposures, to monitor symptoms of exposure, and to assist with education about reducing exposure.

Social determinants of quality of elderly life in a rural setting of India

Objective:The aim of this study is to understand the social determinants of quality of elderly life in rural central India and describe their perspectives on various issues related to their quality of life.Materials and Methods:It was a community-based mixed-methods study in which quantitative (survey) method was followed by qualitative (Focus Group Discussion, FGD). The study was done in field practice area of a Rural Health Training Centre. We decided to interview all the elderly (>60 years) in two feasibly selected wards of village Anji by using the “WHO-Quality of Life (WHOQOL)-brief questionnaire.” We used WHOQOL syntax for the calculation of mean values of four domains. Following survey, four FGDs were carried out.Results:The determinants of perceived physical health, amenable for intervention were their currently working status, not being neglected by the family, and involvement in social activities. The determinants for psychological support were health insurance, and their current working status. The determinants for social relations were membership in social group and their present working status. The determinants for perceived environment were membership in social groups and relationship with the family members. In qualitative research, factors such as active life, social activity, spirituality, health care, involvement in decision making, and welfare schemes by the Government were found to contribute to better quality of elderly life. Problems or conflicts in family environment, lack of shelter and financial security, overtapped resources, and gender bias add to negative feelings in old age life.Conclusions:There is a need for intervention at social and family level for elderly friendly environment at home and community level.