Engage Community Leaders Research Articles

COVID-19 Vaccine Hesitancy Among Black Women in the US

COVID-19 vaccine hesitancy among Black women is a critical public health concern, potentially exacerbating existing health disparities and impacting community-wide vaccination efforts. To explore the factors associated with COVID-19 vaccine hesitancy among Black women in the US and identify the specific concerns and experiences shaping hesitant attitudes toward vaccination. Qualitative study using in-depth, semistructured interviews conducted virtually between June and November 2021. Thematic analysis was used to identify key themes from the interview data. Participants were recruited through social media platforms and word-of-mouth referrals from various regions of the US. Interviews were conducted remotely via Zoom. Data were analyzed from June to October 2023. Identification of key themes associated with COVID-19 vaccine hesitancy, identified through thematic analysis of interview data. Fifty-four Black women aged 21 to 66 years participated in the study. Most participants (41 [75.9%]) resided in the South. The sample was predominantly well-educated, with 41 (75.9%) holding a bachelor's degree or higher. Income levels varied, with 16 (29.6%) earning between $40 000 and $59 999 annually. Regarding family structure, 32 participants (59.3%) reported having no children, while 22 (40.7%) had 1 or more children. Three primary themes emerged as being associated with vaccine hesitancy: (1) mistrust in health care and government, rooted in past medical exploitation; (2) concerns over vaccine safety and long-term effects, particularly regarding reproductive health; and (3) ineffective and coercive vaccine communication and promotion. Participants expressed deep-rooted skepticism about being treated as "expendable" in medical research, fears about the rapid vaccine development process, and frustration with coercive vaccine advertisements. Many women desired more comprehensive education about vaccine mechanisms and criticized the use of coercive financial incentives and celebrity endorsements in vaccine promotion. Addressing COVID-19 vaccine hesitancy among Black women requires a multifaceted approach that acknowledges historical traumas, provides clear and transparent safety information, and avoids coercive vaccine promotion strategies. These findings emphasize the need for health care practitioners and public health officials to prioritize trust-building, engage community leaders, and tailor interventions to address the unique concerns of Black women to improve vaccine confidence and uptake.

Advancing gender equality through strategic project management: A framework for integrating gender-responsive policies in development projects

This review presents a strategic framework for integrating gender-responsive policies into project management to advance gender equality within development projects. Gender equality is increasingly recognized as a crucial component of sustainable development, yet significant gaps remain in effectively embedding gender considerations in project planning and execution. Through a review of successful case studies and current project management practices, this review explores how structured, gender-responsive strategies can enhance the impact of development projects across diverse sectors. The proposed framework emphasizes a systematic approach to incorporating gender perspectives from the project design phase through implementation and evaluation. Key components include conducting initial gender impact assessments, establishing gender-specific goals and indicators, and ensuring adequate budget allocations for gender-focused activities. Additionally, the framework underscores the importance of continuous monitoring, stakeholder engagement, and the collection of gender-disaggregated data to inform adaptive management. Challenges such as institutional constraints, cultural resistance, and limited gender-specific expertise among project teams are addressed with recommendations for building capacity and securing policy support. Best practices highlighted include fostering partnerships with local women’s organizations, engaging community leaders, and providing gender sensitivity training for project staff. This review concludes that integrating gender-responsive policies in project management not only advances gender equality but also contributes to more inclusive and effective development outcomes. The framework offers a replicable model for project managers and policymakers, advocating for a shift towards projects that prioritize equitable participation and benefits for all genders. By implementing these practices, development initiatives can create sustainable socio-economic improvements and foster gender-inclusive environments.

Leveraging investments, promoting transparency and mobilising communities: a qualitative analysis of news articles about how the Ebola outbreak informed COVID-19 response in five African countries

BackgroundThe WHO declared the novel COVID-19 outbreak a pandemic in March 2020. While the COVID-19 pandemic was unprecedented, prior experiences with diseases such as Middle East respiratory syndrome, severe acute...

Knowledge, Perception, and Acceptability of Vasectomy among Adult Males at University of Nigeria, Enugu Campus

Background: Vasectomy is a minimally invasive surgical procedure involving the severing of the vas deferens, effectively cutting off the supply of sperm to the semen so that the ejaculated semen is devoid of sperm cells. Howbeit, despite its high efficacy and minimal invasiveness, it remains underutilised in sub-Saharan Africa. Aim: This study assessed knowledge, perception, and acceptability of vasectomy among adult males at the University of Nigeria, Enugu Campus. Methods and Materials: A cross-sectional survey design was employed among 106 men attending St Mulumba Chaplaincy and Chapel of Redemption UNEC. A researcher-developed questionnaire was used to collect data, which was analysed using descriptive and inferential statistics with the aid of (SPSS) version 25 and Microsoft Excel. Results: The mean age and standard deviation of the respondents was 43.08±9.12. A greater percentage (n=70, 66%) had poor knowledge about vasectomy. The majority (n=74, 69.85%) had a negative perception of vasectomy. Only 1.9% (n=2) of the men have undergone vasectomy. Of those who have not had a vasectomy, only 6.7% (n=7) reported that they would consider it. The overall acceptability of vasectomy was 8.5% (n=9) and was not significantly associated with knowledge (p = .268). Conclusion: Overall, there was poor knowledge, negative perception, and low acceptability of vasectomy among the respondents. Although acceptability was not dependent on knowledge, there is still a need for healthcare workers to carry out educational programs, especially geared towards religious and cultural beliefs, engage community leaders, and train peer educators to improve the knowledge and acceptability of vasectomy among men. Keywords: Vasectomy, Acceptability, Adult men, Knowledge, Perception.

Island Health Crisis: Bridging Gaps in Indonesia's Healthcare Deserts

This narrative literature review examines critical healthcare challenges in Indonesia's island communities, focusing on workforce shortages, inadequate health infrastructure, and the profound impact of geographical and socioeconomic factors. Drawing from eight studies published between January 2000 and December 2023, the discussion highlights both the strengths and weaknesses of existing research. The studies were selected based on their relevance to healthcare issues in island communities, rigorous methodological approaches, and significant insights into healthcare challenges and solutions. This time frame was chosen to encompass a comprehensive evolution of healthcare challenges and responses, particularly considering the effects of the COVID-19 pandemic. Grounded in the Diffusion of Innovations and Health Belief Model frameworks, the study proposes evidence-based strategies to enhance healthcare accessibility and quality in these underserved regions. The Health Belief Model is employed to understand health behaviors within island communities, addressing perceived susceptibility, severity, benefits, and barriers. Strategies include increasing awareness of health risks, highlighting the benefits of telemedicine and improved infrastructure, and reducing access barriers through incentives and infrastructural enhancements. In contrast to, The Diffusion of Innovations Theory guides the dissemination of new healthcare practices and technologies. Emphasizing innovation attributes such as relative advantage, simplicity, trialability, and observability, and utilizing effective communication channels and local social systems. The study aims to promote the adoption of telemedicine and other innovations. By engaging community leaders and health workers, and considering the time needed for adoption, the proposed recommendations aim to accelerate the diffusion process, ultimately improving healthcare accessibility and outcomes in Indonesia's island communities.

Knowledge, attitudes and demographic drivers for COVID-19 vaccine hesitancy in Malawi

This study assessed the association among knowledge, attitudes and uptake of COVID-19 vaccine in Malawi, examining demographic factors influencing these variables. The study employed a quantitative research design. It thus sampled 394 participants from Malawi’s three districts of Zomba, Dowa and Nkhatabay. Results showed that 163 (41.4%) participants had low levels of knowledge of COVID-19 vaccine, 231 (58.6%) had high levels of knowledge, 237 (60.2%) had a positive attitude, and 156 (39.8%) had a negative attitude towards the COVID-19 vaccine. On vaccine uptake, the study found that only 29 (17%) male and 52 (23%) female participants had received the vaccine. Further, participants with low levels of knowledge and a positive attitude towards the vaccine were 5.9 times more likely (p-value = 0.001) to be vaccinated than those with low levels of knowledge and negative attitudes towards the vaccine. On the other hand, those with high knowledge and a positive attitude towards the vaccine were 8.2 times more likely (p-value < 0.001) to be vaccinated compared to those with low knowledge and negative attitudes towards the vaccine. The findings highlight the importance of vaccine-related knowledge and attitudes in shaping uptake and reveal disparities across demographic groups. To improve vaccination coverage in Malawi, targeted interventions focusing on enhancing COVID-19 vaccine knowledge, addressing attitudinal barriers, and countering misinformation are needed. Strategies should be tailored to reach populations with lower uptake, such as males, younger adults, and those with lower education levels. Strengthening public health messaging, engaging community leaders, and building trust in healthcare systems are crucial for promoting widespread acceptance and uptake of COVID-19 vaccines in Malawi.

Perceptions on violence against women and its impacts on mental health and response mechanisms among community-based stakeholders: a qualitative study from Nepal

BackgroundViolence against women (VAW) is a significant public health problem. With the emergence of the COVID-19 pandemic, the frequency and severity of VAW has escalated globally. Approximately one in four women in Nepal have been exposed to either physical, psychological, and/or sexual violence in their lifetime, with husbands or male partners being the perpetrators in most cases. VAW prevention has been under-researched in low- and middle-income countries, including Nepal. This study aims to explore the perspectives of local stakeholders, including healthcare providers and survivors of violence in Madhesh Province. The overarching goal is to provide insights for designing prevention and support programs that are acceptable to communities and cater to the needs of survivors.MethodsAn explorative qualitative study was conducted in Madhesh Province, southern Nepal. A total of 21 interviews, including 15 in-depth interviews (IDIs) with health care providers, three IDIs with women seeking general or maternal and child health services at health care centres, three key informant interviews with the local stakeholders working in the field of VAW, and one focus group discussion with violence survivors, were conducted in Nepali by trained field interviewers. Interviews were recorded, transcribed, translated into English, and analysed using content analysis.ResultsVAW, particularly physical violence, was a common experience in the study area. Sociocultural traditions such as dowry, child marriages and son preference were identifiable triggers for VAW, causing significant physical injuries and mental health problems, including suicide. Health care providers reported that violence survivors often hide their experiences of violence and do not seek any kind of help. Women feared that violence would increase in frequency and intensity if their perpetrators found out that they had disclosed their experiences of violence to health care providers. Local stakeholders emphasized the importance of engaging community leaders and garnering support from both women and men in interventions designed to reduce VAW and its impacts on mental health.ConclusionsParticipants reported that verbal and physical violence is often perceived as a normal part of women’s lives. Women should be made aware of available support services and empowered and supported to increase access and uptake of these services. Additionally, more individual-based counselling sessions that encourage women to escape violence and its mental health consequences while maintaining privacy and confidentiality are recommended.

Mental Health Stigma in Minority Communities: Understanding Cultural Perceptions and Access to Care

Purpose: The general purpose of this study was to understand how cultural perceptions and beliefs about mental health in minority communities influence their access to mental health care services. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to mental health stigma in minority communities. Preliminary empirical review revealed that cultural perceptions heavily influenced access to care. It emphasized the necessity of cultural competence in mental health advocacy and intervention, stressing the importance of engaging community leaders. The research identified significant barriers to care, including language barriers and distrust of mainstream healthcare systems. Recommendations included increasing diversity among mental health professionals and implementing policies to address disparities. Overall, the study highlighted the need for comprehensive, culturally sensitive approaches to destigmatize mental health and improve access to care in minority communities. Unique Contribution to Theory, Practice and Policy: The Social Cognitive theory, Intersectionality theory and Cultural Adaptation theory may be used to anchor future studies on mental health stigma in minority communities. The study on "Mental Health Stigma in Minority Communities" offered recommendations that contributed significantly to theory, practice, and policy. It emphasized the importance of culturally sensitive interventions, community engagement, education, policy changes, research, and intersectionality in addressing mental health stigma. By advocating for tailored approaches, collaborative efforts, awareness-raising campaigns, systemic reforms, and inclusive strategies, the study aimed to reduce barriers to mental health care access and promote a more supportive environment for individuals within minority communities.

A Quantitative and Qualitative Program Evaluation of a Case-Area Targeted Intervention to Reduce Cholera in Eastern Democratic Republic of the Congo.

Individuals living near cholera patients have an increased risk of cholera infections. Case-area targeted interventions (CATIs) promoting improved water, sanitation, and hygiene (WASH) present a promising approach to reducing cholera for those residing near cholera cases. However, there is limited evidence on the effectiveness and implementation of this approach in increasing WASH behaviors. We conducted a mixed-methods program evaluation in rural and urban eastern Democratic Republic of the Congo. The quantitative component included household structured observations and spot checks in CATI and control areas to assess WASH conditions and behaviors. The qualitative component included semi-structured interviews with CATI recipients, non-recipients, and implementers to assess CATI implementation. A total of 399 participants were enrolled in the quantitative evaluation conducted within 1 month of CATI delivery. For the qualitative evaluation, 41 semi-structured interviews were conducted, 30 with individuals in CATI areas (recipients and non-recipients) and 11 with CATI implementers. Handwashing with soap was low among both CATI and control area participants (1% vs. 2%, p = 0.89). Significantly more CATI area households (75%) had chlorine tablets present compared to control area households (0%) (p < 0.0001); however, the percentage of households with stored water free chlorine concentrations > 0.2 mg/L was low for both CATI and control area households (11% vs. 6%, p = 0.45). Implementers reported an insufficient supply of soap for distribution to recipients and mistrust in the community of their activities. CATI recipients demonstrated low knowledge of the correct preparation and use of chlorine for water treatment. Recipients also indicated a need for CATI implementers to engage community leaders. As CATIs are part of cholera control plans in many cholera-endemic countries, it is important to evaluate existing programs and develop evidence-based approaches to deliver CATIs that are both tailored to the local context and engage affected communities to increase WASH behaviors to reduce the spread of cholera.

Modern Contraceptive Use and Associated Factors In USSA Local Government Area Of Taraba State, Nigeria

With the high rate of unintended pregnancy in the world, encouraging the use of contraceptives has become necessary. However, some factors may influence whether a woman agrees to utilize contraceptives or not. This paper examines the impact of individual factors, sociocultural factors, and health system factors on the utilization of contraceptives in Ussa Local Government Area of Taraba State, Nigeria. Through a literature-based analysis and the application of rational choice theory, the findings highlight the complex interplay of these factors in shaping contraceptive utilization patterns in Ussa Local Government Area. Individual hurdles to uptake were identified as a lack of information about contraception, socioeconomic status, misconceptions, and unfavorable attitudes. Individuals' decision-making processes are influenced by sociocultural variables such as religion and cultural traditions that oppose contraception. Furthermore, a lack of contraceptive availability, a shortage of skilled healthcare practitioners, and a weaker healthcare infrastructure all restrict access to and utilization of contraceptive therapies. The paper recommended that focused interventions should address these various challenges to boost contraceptive usage in Ussa LGA. Individuals, communities, and religious leaders should be targeted for education and awareness efforts to debunk misunderstandings, enhance knowledge, and encourage favorable attitudes regarding contraception. Engaging community leaders and religious organizations in family planning advocacy can assist transform sociocultural norms in favour of family planning. Improving the availability, price, and quality of contraception, as well as training healthcare practitioners, will be crucial for boosting the utilization of contraceptives.

The Impact of Meso-Level Factors on SARS-CoV-2 Vaccine Early Hesitancy in the United States.

The extant literature on the U.S. SARS-CoV-2 virus indicates that the vaccination campaign was lagging, insufficient, and uncoordinated. This study uses the spatial model to identify the drivers of vaccine hesitancy (in the middle of the pandemic), one of the critical steps in creating impactful and effective interventions to influence behavioral changes now and in the future. The applied technique accounted for observed and unobserved homogeneity and heterogeneity among counties. The results indicated that political and religious beliefs, quantified by Cook's political bipartisan index and the percentage of the population affiliated with the main Christian groups, were the main drivers of the SARS-CoV-2 vaccine hesitancy. The past vaccination experience and other variables determining the demand and supply of vaccines were also crucial in influencing hesitancy. The results imply that vaccination campaigns require engaging community leaders at all levels rather than depending on politicians alone and eliminating barriers to the supply and demand of vaccines at all levels. Coordination among religious and community leaders would build a practical institutional arrangement to facilitate (rather than frustrate) the vaccination drives.

Expanding the Role of Women in Vector Control: Case Studies From Madagascar, Rwanda, and Zambia.

Historically, vector control, including entomological monitoring, has been a field dominated by men. Each year, the U.S. President's Malaria Initiative (PMI) VectorLink project hires 50,000 to 70,000 seasonal workers across the countries in which it works to implement vector control activities, creating an economic opportunity for both men and women. Remaining barriers to women's employment in vector control include social and cultural norms regarding acceptability of formal employment for women, perceptions that women are not fit to serve as spray operators, and a historical context of male-dominated fields such as entomology. We use PMI VectorLink project data from Madagascar, Rwanda, and Zambia for 2019-2021 and key informant interviews with project staff in these countries to examine levels of female employment, effectiveness and efficiency of female versus male malaria spray operators, and strategies to expand the role of women in vector control. The percentage of female seasonal employees ranges from 25% in Madagascar to 32% in Rwanda and 45% in Zambia. The percentage of women in leadership positions ranges from 32% in Madagascar and Rwanda to 38% in Zambia. Men and women are equally effective and efficient as spray operators. Best practices for recruiting and retaining women in vector control include engaging community leaders in recruitment, implementing affirmative action hiring policies, mentoring women to progress to leadership positions, and ensuring equitable, safe, and attractive workplaces. As vector control programs transition away from donor funding and are increasingly government led, sustaining gains in female empowerment is critical. Country programs should work closely with national, regional, district, and local leaders to demonstrate the importance of hiring women in vector control-including leadership positions-and the impact on female economic empowerment, community well-being, and success of vector control programs.

The Role of Communication Leaders in Planning and Acceleration of Development In Tanjung Alam Sei Dadap Asahan Village

This study aims to determine the role of communication from community leaders in development planning including the construction of village roads, the development of drinking water sources, the National Community Empowerment Program (PNPM) Mandiri, the preservation of community traditions and the construction of mosques. in Tanjung Alam Village, Sei Dadap District, Asahan District. Participation of community leaders is involvement carried out by non-formal circles. When talking about the community, it means talking about the community itself, community leaders are representatives of the village community. In this study, researchers used descriptive qualitative research with data collection techniques through interviews, observation and documentation. There were 7 informants in this study taken using a purposive sampling technique, including the Head of Tanjung Alam Village, 2 community leaders of Tanjung Alam and 4 members of the Tanjung Alam Village community. The researcher used an interactive data analysis model to describe the results of the research into a data analysis technique and to check the validity of the researcher's data using a triangulation technique. The focus of this research is the communication role of Community Leaders in development planning in Tanjung Alam Village. The data analysis technique used in this study is descriptive qualitative, namely collecting data by conducting interviews with related parties. The results of the research show that the role of communication of community leaders is to increase knowledge in development so that development planning is carried out by referring to applicable regulations, and upholding community ethics and values .

Bridging the gap: Development of an experiential learning-based health disparities curriculum.

The increasing number of vulnerable populations served by the emergency department (ED) calls for developing and implementing curricula aimed at training residents to deliver quality care for the most marginalized groups. We aimed to address this by developing and piloting a curriculum to introduce the unique challenges and disparities encountered by our diverse ED patient population using an experiential learning approach. We engaged community partners in designing and implementing a curriculum for incoming interns. This curriculum addresses specific populations encountered within the ED including patients with psychiatric illness, patients with cognitive disabilities, intoxicated patients, violent patients, patients of various cultural backgrounds, non-English-speaking patients, and LGBTQ patients. Experiential and active learning sessions with content experts and site visits to area organizations were arranged. Pre-, post-, and time-delayed surveys were deployed to evaluate the pilot of this curriculum. Thirteen incoming interns participated in the orientation curriculum. Residents' comfort with each of these various patient populations as well as familiarity with community and ED resources was assessed before, after, and 1 year delayed from each session (response 13/13, 100%). Their scores increased significantly from baseline in the postsurvey and were maintained 1 year later (p < 0.05). Residents additionally provided narrative responses regarding what they learned and what was most helpful after completing their intern year. This pilot curriculum demonstrates that implementing an experiential learning curriculum and engaging community leaders and resources is key to training residents to address health disparities within their unique ED patient population. As such, it is imperative that we seek to immersively introduce trainees to the unique needs of the patient population they will serve early in training.

Health Equity Is No Spectator Sport: The Radical Rooting of a Post-Pandemic Bioethics.

The relationship between equality and equity has been theorized and described in many ways. Recently, this relationship has been popularly illustrated via a meme depicting three people watching a baseball game while standing on boxes. The meme's analogy, that achieving health equity is the ability to view a spectator sport, is a neoliberal account of health. The analogy defines equality at the expense of equity, characterizes health as individualistic, describes health equity as a static outcome, and implies that the bioethical questions for achieving health equity are about the distribution and redistribution of resources. As the SARS CoV-2 pandemic vividly reminded us, health equity is no spectator sport. Health equity is the intentional removal of obstacles to health and the enabling of human flourishing to assure that everyone has fair and just opportunities for health. That relational and radical account of health equity requires different analogies. This article reimagines and re-illustrates the relationship between equality and equity using an organic analogy of three plants. The analogy calls for bioethics to nurture communal relationships and engage community leaders in pursuit of communal flourishing.

The Role of Tungku Tigo Sajarangan in Educating Adolescent Morality Through the Indigenous Values of Sumbang Duo Baleh

The flow of globalization and cultural acculturation on the one hand has an impact on the character of the generation of a nation, therefore local wisdom, participation of community leaders in creating a generation that is able to maintain a good local culture is highly expected. In line with that, this study aims to discuss the shape of the impact of Sumbang on Adolescent Girls, Tungku Tigo Sajarangan's Efforts in Educating Teens Through the Sumbang Duo Baleh Donation Custom, and how effective Tungku Tigo Sajarangan's efforts in Educating Teenagers Morals are through the Duo Baleh Donation Custom. The method used is a qualitative research method, which is also known as Naturalistic research. The primary data sources are ninik mamak, out-of-pocket clever, pious ulama and youth in Nagari Sungai Buluah. While the data collection technique uses observation, interviews and FGD with analytical techniques using interactive qualitative model analysis techniques (Interactive Model of Analysis). The results of the study indicate that the form of the impact of discord on adolescent girls is the fall of their identity as Minangkabau women, Mudarnyo Raso Jo Pareso, the erosion of Minang customary values. The efforts of Tungku Tigo Sajarangan in educating youth morals are carried out in various forms, such as giving warnings and traditional sanctions, conducting socialization in various places and activities, establishing cooperation between institutions, forming youth Wirid activities, holding traditional activities.

Enhancing the Trajectories of Cancer Health Disparities Research: Improving Clinical Applications of Diversity, Equity, Inclusion, and Accessibility.

In order to accurately detect and prevent racial disparities, self-reported race (SRR) and ethnicity remain valuable tools; however, inaccurate capture of patient identity and broad aggregation of minoritized race groups present challenges for data interpretation. Also, although SRR is a proxy for shared social/cultural experience, it is not an accurate representation of shared endogenous factors. Biological investigations into cancer disparities, particularly those involving genetic features, should be framed in the context of genetic background or ancestry, as these are heritable aspects of population health. In reality, both genetics and environment work in concert to influence cancer risk and clinical outcomes. The best opportunity to define actionable means for reducing health disparities is in rigorous and comprehensive generation of rich data sets that characterize environmental, biological, and genetic components of disparate disease burden. To translate this pivotal disparities research into clinical tools and improved policies, we describe a diversity, equity, inclusion, and accessibility (DEIA) framework, which will increase participation from diverse backgrounds, reexamine previous research with a rigorous evaluation of appropriate SRR groupings, and engage community leaders to ensure that future research addresses the needs of communities at increased risk. On this path forward, we may finally end cancer disparities.

Stakeholder engagement in developing a father-inclusive early life obesity prevention intervention: First Heroes

BackgroundAlthough paternal involvement in the perinatal period is associated with benefits for maternal-child health and reduced obesity risk, fathers are seldom included in perinatal or obesity prevention efforts. Engaging community leaders and fathers as stakeholders in intervention development is a critical step in designing a father-inclusive intervention that is efficacious and responsive to their needs.MethodsWe conducted a structured engagement study, including community stakeholder engagement and qualitative interviews with new fathers, to inform the development of a prospective randomized controlled trial that includes mothers and fathers as equal partners in infant obesity prevention. We interpreted stakeholder feedback through the Consolidated Framework for Implementation Research (CFIR) framework.ResultsBetween September 2019 and April 2020, we held a Community Engagement meeting, formed a Community Advisory Board, and conducted 16 qualitative interviews with new fathers. Stakeholder engagement revealed insights across CFIR domains including intervention characteristics (relative advantage, complexity, design quality & packaging), outer setting factors (cosmopolitanism and culture), individual characteristics (including self-efficacy, state of change, identification with the organization) and process (engagement and adaptation). Stakeholders discussed the diverse challenges and rewards of fatherhood, as well as the intrinsic paternal motivation to be a loving, supportive father and partner. Both community leaders and fathers emphasized the importance of tailoring program delivery and content to meet specific parental needs, including a focus on the social-emotional needs of new parents.ConclusionsA structured process of multidimensional stakeholder engagement was successful in improving the design of a father-inclusive perinatal obesity prevention interventions. Father engagement was instrumental in both reinforcing community ties and increasing our understanding of fathers’ needs, resulting in improvements to program values, delivery strategies, personnel, and content. This study provides a practical approach for investigators looking to involve key stakeholders in the pre-implementation phase of intervention development.Trial registrationClinicalTrials.gov, NCT04477577. Registered 20 July 2020.

Pregnant adolescents' lived experiences and coping strategies in peri-urban district in Southern Ghana.

BackgroundAdolescence, a transition period from childhood to adulthood forms the foundation of health in later life. The adolescence period which should have been characterised by good health is often marred with life-threatening and irreparable consequences of public health concern. Teen pregnancy is problematic because it could jeopardise adolescents’ safe transition to adulthood which does not only affect adolescents, but also their families, babies and society. There is ample evidence about the determinants and effects of teen pregnancy, but it is fragmented and incomplete, especially in Sub-Sahara Africa. This study presents pregnant adolescents’ voices to explain significant gaps in understanding their lived experiences and coping strategies.MethodsThis narrative inquiry, involved in-depth interviews with 16 pregnant adolescents, who were recruited from a peri-urban district in Southern Ghana using purposive and snowball techniques in health facilities and communities respectively. The audio recorded interviews were transcribed verbatim and analysed manually using content analysis.ResultsMany pregnant adolescents are silent victims of a hash socio-economic environment, in which they experience significant financial deprivation, parental neglect and sexual abuse. Also, negative experiences of some adolescent girls such as scolding, flogging by parents, stigmatisation and rejection by peers and neighbors result in grieve, stress and contemplation of abortion and or suicide. However, adolescents did not consider abortion as the best option with regard to their pregnancy. Rather, family members provided adolescents with critical support as they devise strategies such as avoiding people, depending on God and praying to cope with their pregnancy.ConclusionAdolescent pregnancy occurred through consensual sex, transactional sex and sexual abuse. While parents provide support, pregnant adolescents self-isolate, depend on God and pray to cope with pregnancy and drop out of school. We recommend that the Ministries of Education and Health, and law enforcement agencies should engage community leaders and members, religious groups, non-governmental organisations and other key stakeholders to develop interventions aimed at supporting girls to complete at least Senior High School. While doing this, it is also important to provide support to victims of sexual abuse and punish perpetrators accordingly.

Older black rural South African adults’ perceptions on organ donation: An exploratory study

In this study, we explored older rural South African adults’ perceptions of organ donation. Twelve older Pedi adults (male = 50%; age range 51 to 78 years) completed in-depth interviews on their knowledge of organ donation, cultural views, and influences on their orientation to the medical practice. Four themes emerged from the data synthesis: (i) organ donation regarded as body part harvesting; (ii) organ donation as a taboo practice; (iii) organ donation interfering with closure and spirituality; and (iv) the centrality of family in the decision making on health and life matters. The cultural lens rooted in family and spiritual futures is central to older black Pedi adults’ understanding of organ donation. Organ donation education and awareness campaigns should engage community leaders in bridging the cultural divide that may discourage people from participating in this beneficial practice.