Local Contextual Factors Research Articles

Multidimensional geographic factors behind conflicts: a case study in Sudan

ABSTRACT Sudan has been racked by complex and volatile conflicts for decades, with a new round of civil conflict erupting in April 2023, leading to significant loss of life and property. Despite the ongoing violence, the associations between conflicts and local contextual factors remain ambiguous. In this study, we developed an event-grid dataset, consisting of 50,033 observations with 20 variables derived from nighttime light (NTL) data, OpenStreetMap data, and other geographic data. Machine learning algorithms were employed to model the outbreak of conflict in 2023. Furthermore, the SHapley Additive exPlanations method was utilized to explain the relationships between diverse explanatory variables and conflicts. The results indicate that eXtreme Gradient Boosting model outperforms other models, such as Categorical Boosting and Light Gradient Boosting Machine. Multiple factors jointly contribute to conflicts. NTL-derived variables and transportation-related variables emerge as the most influential factors, followed by climate and agricultural factors. Regions characterized by economic inequality and proximity to transportation hubs are found to be more prone to conflicts. Additionally, variables impact the outbreak of conflict not only individually but also through mutual interactions. Notably, this study enhances a comprehensive and quantitative understanding of conflicts in Sudan, providing valuable insights to support humanitarian aid efforts.

Salafism and dialectics of Muslim identity in Nigeria and the Sahel

ABSTRACT Using examples from West Africa, this paper argues that Salafism has become modular. In interrelated trends, some Salafis have revised their postures towards other Muslims, while some non-Salafis selectively adopt elements of Salafism; both trends lead to forms of ‘post-Salafism’. The paper investigates three facets of these nascent ‘post-Salafi’ trends. First, Salafis have championed the hadith report as the main currency of evidence-giving in religious debate, but have lost ‘market share’ in the interpretation of hadith. Second, intellectuals trained in comparative jurisprudence can stake out an appealing middle ground between Salafism and traditionalism. Third, Salafis’ need for coalition partners in politics and society can blur the boundaries of Salafism, even to the point that some Salafis compromise on anti-Sufism, a core element of Salafism. Discussing Nigeria, Mauritania, and Mali, the paper highlights how local contextual factors have affected the construction of Muslim identity since the 1990s. These factors include democratic openings, exhaustion with Sufi-Salafi polemics, the appeal of Shi‘ism, and mass protests with religious colourations.

Making Sense of the Rural Special Education Teacher Shortage

Long-standing shortages of well-prepared special educators, especially within rural areas, have jeopardized positive outcomes for students with disabilities. In this multiple case study of administrators and special educators, the authors examined how individuals make sense of the special education teacher shortages in relation to the challenges of working in a rural school. Local contextual factors intersected with salary and state policies, highlighting how external, political factors affected districts’ ability to attract and retain special education teachers. Chief among implications for research, policy, and practice is the need to attend to multipronged approaches that have the potential to mitigate economic barriers to special educator recruitment and retention in rural school districts.

Short-Term Digital Platform Work’s Long-Term Impact on Livelihoods

As platformization and virtualization of work gain prominence in the digitally connected world, parallel efforts are being made to narrow the digital divides, driving the globalization of short-term digital labor as both a rapidly evolving theoretical construct and a practical reality. Although the disproportionate influence of platforms on Global South development is a growing area of concern, the global reach of platforms does not necessarily imply a uniform impact on development gains and constraints across different developing regions. This review paper explores this interplay between digital platform work and local development, particularly emphasizing the long-term impact of platform-mediated digital work on workers’ livelihoods in the Global South. The study delves into how the variation in local contextual factors changes the livelihood outcomes of platform work in different Global South countries. The study focuses on three key areas endogenous to local development, i.e., access to decent work, employability skills development, and workers’ resilience within the ever-changing job market. A realist synthesis method is used to distinguish between different scholarly perspectives across various disciplines and geographic areas. The findings are further utilized to refine a conception of the Sustainable Livelihood Framework, providing a tool that broadens the scope of platform work analysis to account for the diverse structural and contextual factors impacting workers’ livelihoods in different regions. The study calls for a thorough examination of the uneven distribution of platform labor outcomes, focusing particularly on the local contextual factors contributing to this disparity.

Staffing and Workload in Primary Care Facilities of Selected Geographically Isolated and Disadvantaged Communities in the Philippines.

Staffing shortages and health inequities are persistent barriers in the Philippines toward achieving universal health care. To ensure an adequate and responsive health workforce, there is a need to evaluate the Human Resources for Health (HRH) status across health facilities, particularly those in underserved communities. Hence, this study aims to determine the staffing requirements and workload pressure among primary care facilities in selected geographically isolated and disadvantaged areas (GIDAs) in the Philippines. The study utilized the workload indicators of staffing need (WISN) methodology from the World Health Organization to determine the staffing and workload situation among three health worker cadres (physicians, nurses, and midwives) in the study sites. Particularly, six primary care facilities (four rural health units and two community hospitals) located in Surigao del Norte were involved in the study. WISN-related data (health service statistics, available working time, and health professionals' workload components) were collected through records review, focus group discussions, and key informant interviews. The WISN software was used to analyze the staffing levels and workload pressure in the selected facilities. A total of 40 health workers, including physicians (n = 5, 13%), nurses (n = 21, 52%), and midwives (n = 14, 35%) participated in the study. The findings noted varying levels of staffing and workload pressures among the three cadres in selected primary care facilities, which were influenced by several factors. Particularly, health facilities with additional human resources obtained from deployment programs indicated adequate staffing and low to normal workload pressures. However, further analysis revealed potential HRH maldistribution and reliance on the temporary nature of the staff augmentation program in delivering primary care services, which need to be addressed to optimize health workforce planning. Service workload may also have been impacted by the temporary closure of health facilities due to disasters. Among the few cadres that reported staffing shortage and high workload pressure, these were due to higher service demands, increased task delegation, and inadequate service coordination. Hence, context-specific challenges and situational factors in GIDAs need to be considered when determining the staffing and workload requirements. There is a need to improve the capacities of health facilities and local government units (LGUs) to engage in evidence-based HRH planning through the WISN methodology. Doing so could improve staffing and workload distribution among health care facilities in the country. Moreover, interorganizational collaboration (DOH, LGUs, and health facilities) should be strengthened to improve delineation and prevent duplication/omission of health services, rationalize HRH distribution and augmentation, and streamline the priority health services based on the local contextual factors.

Assessing the relationship between malaria incidence levels and meteorological factors using cluster-integrated regression

This paper introduces a novel approach to modeling malaria incidence in Nigeria by integrating clustering strategies with regression modeling and leveraging meteorological data. By decomposing the datasets into multiple subsets using clustering techniques, we increase the number of explanatory variables and elucidate the role of weather in predicting different ranges of incidence data. Our clustering-integrated regression models, accompanied by optimal barriers, provide insights into the complex relationship between malaria incidence and well-established influencing weather factors such as rainfall and temperature.We explore two models. The first model incorporates lagged incidence and individual-specific effects. The second model focuses solely on weather components. Selection of a model depends on decision-makers priorities. The model one is recommended for higher predictive accuracy. Moreover, our findings reveal significant variability in malaria incidence, specific to certain geographic clusters and beyond what can be explained by observed weather variables alone.Notably, rainfall and temperature exhibit varying marginal effects across incidence clusters, indicating their differential impact on malaria transmission. High rainfall correlates with lower incidence, possibly due to its role in flushing mosquito breeding sites. On the other hand, temperature could not predict high-incidence cases, suggesting that other factors other than temperature contribute to high cases.Our study addresses the demand for comprehensive modeling of malaria incidence, particularly in regions like Nigeria where the disease remains prevalent. By integrating clustering techniques with regression analysis, we offer a nuanced understanding of how predetermined weather factors influence malaria transmission. This approach aids public health authorities in implementing targeted interventions. Our research underscores the importance of considering local contextual factors in malaria control efforts and highlights the potential of weather-based forecasting for proactive disease management.

Chinese State Capital as a Partner for Resource-Based Structural Transformation? The Belt and Road Initiative and Downstream Linkages in Bolivia and Kazakhstan

Lee argues that outbound Chinese state capital (CSC) is distinct from global private capital in terms of a greater willingness to accommodate recipient country priorities. This article uses the cases of Kazakhstan and Bolivia to explore this claim in relation to state-led efforts to foster structural transformation via upgrading in extractive industries (lithium and iron/steel in Bolivia, and petrochemicals in Kazakhstan). We focus particularly on attempts to move into domestic downstream processing. The article explores variation in the degree of accommodation with local demands on the part of CSC and proposes an explanatory framework for these differences, grounded in three axes. These are (i) mix of BRI drivers motivating a particular project from the Chinese side (export of industrial surplus, political relations with partner states and/or concern for resource security); (ii) nature of state-capital investment partnership (the mix of Chinese institutions and firms involved in negotiating and implementing the deal, as well as the time horizon implied by contract type); and (iii) a range of local contextual factors such as availability of alternative sources of capital, host state industrial capacities and local political conditions. Further research will be needed to refine and test this framework across other sectors and developmental goals beyond upgrading in extractives.

The spatial‐temporal evolution of urban development patterns in Chinese cities: Dynamics and interpretations

AbstractThis paper examines the spatial‐temporal evolution of urban spatial structure across 269 Chinese prefectural cities from 2002 to 2019. Our analysis identifies a consistent trend toward a more polycentric configuration in the 25 Chinese mega‐cities during this period, primarily due to population growth and a supportive policy environment. However, the evolutionary pathways of small‐ and medium‐sized cities unfolded in a rather complex and diverse manner, with some becoming more polycentric while the majority adhering to a monocentric trajectory. In these cases, population growth is usually associated with a more monocentric pattern, characterized by rapid expansion of the urban core, while polycentric development is primarily attributed to specific spatial policies that support the emergence of subcenters. We conclude that polycentric development, while potentially suitable for mega‐cities to alleviate diseconomies of scale, may be less appropriate for small‐ and medium‐sized cities as it may constrain growth associated with agglomeration economies. We suggest that the development and implementation of regional spatial policy should be considerate of local historical paths and contextual factors. Finally, we propose a stylized framework to more accurately reflect the diverse and complex nature of urban spatial structure evolution in Chinese prefectural cities.

Between equilibrium and chaos, with little restitution: a narrative analysis of qualitative interviews with clinicians and parent carers of children with medical complexity

BackgroundChildren with medical complexity (CMC) comprise 1% of the paediatric population, but account for over 30% of health service costs. Lack of healthcare integration and coordination for CMC is well-documented. To address this, a deep understanding of local contextual factors, experiences, and family-identified needs is crucial. The aim of this research was to investigate the lived experiences of CMC, their families, and healthcare staff, focusing on understanding the dynamics of care coordination and the challenges faced in providing integrated care, in order to inform the development of effective, family-centred models of care.MethodsIn April to July 2022, 31 semi-structured interviews were conducted with parents/guardians of CMC and healthcare professionals who care for CMC. Interviews explored complex paediatric care and care coordination barriers. An inductive thematic analysis was undertaken. Themes were then further explored using Frank’s narrative approach.ResultsThrough analysis, we identified that the restitution typology was absent from both staff and parent/guardian narratives. However, we uncovered narratives reflective of the chaos and quest typologies, depicting overwhelming challenges in managing complex medical needs, and proactive efforts to overcome barriers. Importantly, a novel typology termed ‘equilibrium’ was uncovered. Narratives aligning with this typology described medical complexity as a balance of power and a negotiation of roles. Within the equilibrium typology, illness trajectory was described as a series of negotiations or balancing acts between healthcare stakeholders, before finally reaching equilibrium. Participants described seeking a balance, where their expertise is respected, whilst maintaining the ability to rely on professional guidance and support. These insights provide a nuanced understanding of the multifaceted narratives shaping care experiences for CMC and their families.ConclusionsOur research delineates multifaceted challenges within the care landscape for CMC, their families, and healthcare staff. Embracing the equilibrium narrative typology highlights the criticality of tailored, integrated care models. This necessitates prioritising clear role delineation and communication among caregivers, implementing support systems addressing the challenges of continuous caregiving, and integrating parents/guardians as essential members of the care team. These insights advocate for pragmatic and sustainable strategies to address the unique needs of CMC and their families within healthcare systems.

Social research in primary education management: understanding community needs and priorities

Social research plays a pivotal role in informing primary education management by delving into community needs and priorities. This review elucidates the significance of social research in comprehending the multifaceted dynamics inherent in primary education management. Understanding community needs and priorities is fundamental in shaping effective educational strategies that cater to the diverse requirements of the primary education landscape. Social research methodologies provide invaluable insights into the intricate interplay of factors influencing educational outcomes, including socio-economic backgrounds, cultural nuances, and local contextual factors. By employing qualitative and quantitative research methods, scholars and educators gain a comprehensive understanding of the needs and aspirations of the communities they serve. Moreover, social research facilitates the identification of gaps and disparities within primary education systems, enabling policymakers and school administrators to develop targeted interventions aimed at fostering inclusive and equitable educational environments. By engaging with stakeholders through participatory research approaches, such as community consultations and focus groups, researchers can co-create solutions that resonate with the unique realities of each community. Furthermore, social research serves as a catalyst for fostering collaboration between educational institutions, government agencies, and community-based organizations. By fostering partnerships grounded in empirical evidence and shared goals, primary education management can be strengthened through collective efforts aimed at addressing systemic challenges and advancing educational equity. Social research in primary education management is indispensable for understanding community needs and priorities. By leveraging research-driven insights, stakeholders can work collaboratively to cultivate inclusive, responsive, and effective primary education systems that empower learners and communities alike.

Adapting an Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Co-Design of the MIMIC Intervention.

Uptake of evidence-based care for acute myocardial infarction (AMI) is suboptimal in Tanzania, but there are currently no published interventions to improve AMI care in sub-Saharan Africa. Co-design a quality improvement intervention for AMI care tailored to local contextual factors. An interdisciplinary design team consisting of 20 physicians, nurses, implementation scientists, and administrators met from June 2022 through August 2023. Half of the design team consisted of representatives from the target audience, emergency department physicians and nurses at a referral hospital in northern Tanzania. The design team reviewed multiple published quality improvement interventions focusing on ED-based AMI care. After selecting a multicomponent intervention to improve AMI care in Brazil (BRIDGE-ACS), the design team used the ADAPT-ITT framework to adapt the intervention to the local context. The design team audited current AMI care processes at the study hospital and reviewed qualitative data regarding barriers to care. Multiple adaptations were made to the original BRIDGE-ACS intervention to suit the local context, including re-designing the physician reminder system and adding patient educational materials. Additional feedback was sought from topical experts, including patients with AMI. Draft intervention materials were iteratively refined in response to feedback from experts and the design team. The finalized intervention, Multicomponent Intervention to Improve Myocardial Infarction Care in Tanzania (MIMIC), consisted of five core components: physician reminders, pocket cards, champions, provider training, and patient education. MIMIC is the first locally tailored intervention to improve AMI care in sub-Saharan Africa. Future studies will evaluate implementation outcomes and efficacy.

Primary Care Physician Engagement in Integrated Health System Transformation: A Case Study 

Background: Primary care physician (PCP) engagement is essential in enhancing health system performance, efficacy and collaboration, however; limited research exists in terms of how PCPs are engaged in health system reform. 
 Aims & Methods: Ontario is undergoing a healthcare transformation with the introduction of Ontario Health Teams (OHTs). OHTs provide a new way of organizing and delivering care that is more connected to patients in their local communities. In response to the need for a coordinated sector approach, a group of PCPs in Southwestern Ontario formed a primary care organization: London-Middlesex Primary Care Alliance (LMPCA). This grassroots organization aims to support unified PCP engagement within the health system reform. The aim of our study is to explore the development of the grassroots LMPCA organization and understand how physicians are engaged within the regional health system. The first phase of our study consisted of a literature review which identified that PCP engagement is critical to the success of OHTs. 
 Using an integrated knowledge translation approach (i.e.: in collaboration with members of the LMPCA and Middlesex-London OHT), the second phase of our study involves a case study to explore the development of a regional primary care organization and physician engagement. We will use key informant interviews with physicians, nurse practitioners (NPs) and health care administrators to explore the LMPCA development and understand PCP engagement. The objectives of the overall study are to 1) plot key junctures in the development of the regional organization, 2) explore PCP engagement at local and regional levels and 3) discuss the barriers and facilitators to PCP engagement.
 Results: Despite PCP engagement being recognized as an important aspect of health systems integration, several barriers exist: ineffective communication within organizations, administrative and legal hurdles, remuneration and reimbursement and other local contextual factors. Results from our literature review indicate that greater levels of PCP engagement can lead to improved primary care performance and efficacy. Engagement in primary care settings has been facilitated both top-down and bottom-up; however, empirical evidence on bottom-up approaches is limited. Three over-arching themes were evident: lack of physician voice, insufficient renumeration, and unsuitable strategies. 
 We anticipate that results of our interviews can provide recommendations to increase physician voice, compensate appropriately, suggest alternative strategies for PCP engagement and gain physician buy-in. Moreover, we expect our results to help shape the LMPCA and the Middlesex-London OHT with their physician engagement efforts within the region. 
 Implications: Findings of our study will benefit researchers, PCPs, NPs, and health care administrators by highlighting barriers and recommendations to support and improve physician engagement efforts. The findings may encourage the international audience to use similar PCP engagement strategies within their organization. 
 Next Steps: We will provide a rich narrative of the development of a grassroots primary care organization as well as an empirical example of PCP engagement in health system reform. We anticipate our results will describe effective strategies for engaging physicians and by extension, provide recommendations to improve organizational efficacy and patient care.

Promoting data harmonization to evaluate vaccine hesitancy in LMICs: approach and applications

BackgroundFactors influencing the health of populations are subjects of interdisciplinary study. However, datasets relevant to public health often lack interdisciplinary breath. It is difficult to combine data on health outcomes with datasets on potentially important contextual factors, like political violence or development, due to incompatible levels of geographic support; differing data formats and structures; differences in sampling procedures and wording; and the stability of temporal trends. We present a computational package to combine spatially misaligned datasets, and provide an illustrative analysis of multi-dimensional factors in health outcomes.MethodsWe rely on a new software toolkit, Sub-National Geospatial Data Archive (SUNGEO), to combine data across disciplinary domains and demonstrate a use case on vaccine hesitancy in Low and Middle-Income Countries (LMICs). We use data from the World Bank’s High Frequency Phone Surveys (HFPS) from Kenya, Indonesia, and Malawi. We curate and combine these surveys with data on political violence, elections, economic development, and other contextual factors, using SUNGEO. We then develop a stochastic model to analyze the integrated data and evaluate 1) the stability of vaccination preferences in all three countries over time, and 2) the association between local contextual factors and vaccination preferences.ResultsIn all three countries, vaccine-acceptance is more persistent than vaccine-hesitancy from round to round: the long-run probability of staying vaccine-acceptant (hesitant) was 0.96 (0.65) in Indonesia, 0.89 (0.21) in Kenya, and 0.76 (0.40) in Malawi. However, vaccine acceptance was significantly less durable in areas exposed to political violence, with percentage point differences (ppd) in vaccine acceptance of -10 (Indonesia), -5 (Kenya), and -64 (Malawi). In Indonesia and Kenya, although not Malawi, vaccine acceptance was also significantly less durable in locations without competitive elections (-19 and -6 ppd, respectively) and in locations with more limited transportation infrastructure (-11 and -8 ppd).ConclusionWith SUNGEO, researchers can combine spatially misaligned and incompatible datasets. As an illustrative example, we find that vaccination hesitancy is correlated with political violence, electoral uncompetitiveness and limited access to public goods, consistent with past results that vaccination hesitancy is associated with government distrust.

Exemplifying the situated nature of teacher noticing: Elementary teachers' use of insider knowledge

AbstractTeacher noticing is a crucial aspect of responsive and ambitious mathematics teaching, allowing educators to understand students' mathematical thinking and make informed decisions. However, this noticing is influenced by teachers' insider knowledge (i.e., past and present knowledge and experience with students), which is shaped by societal norms, biases, and expectations, including potentially harmful deficit discourses. This study investigates teachers' noticing of written work from a situated perspective using qualitative secondary analysis. The goal of this work is to exemplify upper elementary teachers' use of historical knowledge gained from classroom interactions or informal school settings, along with local and broader contextual factors. Data analysis included elementary teachers' noticing mathematical thinking in written work from their class, their use of insider knowledge of their students, and distinctions in orientations toward students and their thinking. Results indicate how insider knowledge enhances, impedes, or does not impact individual teachers' focus on the details and reasoning evidenced in their students' strategies. The findings contribute to a more nuanced understanding of the complexities of teacher noticing and emphasize the importance of acknowledging the socio–cultural and historical context which is needed for equitable mathematics teaching. Implications are discussed.

How Do Adolescent Smoking Prevention Interventions Work in Different Contextual Settings? A Qualitative Comparative Study Between the UK and Colombia

BackgroundAdolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex interventions work, and how they work when implemented in different contextual settings.MethodA comparative qualitative analysis was conducted to explore various influences on behavior change among participants taking part in two smoking prevention interventions in Northern Ireland and Bogotá. Twenty-seven focus groups were conducted in 12 schools (6 in Northern Ireland and 6 in Bogota, n = 195 pupils participated; aged 11–15 years). The Theoretical Domains Framework guided a content analysis of the data.ResultsWe found similarities across settings in terms of knowledge, skills, and beliefs related to smoking or vaping behavior change, as well as differences in contextual resources and social influence. Different environmental resources included availability to purchase tobacco products in the neighborhoods and previous information about tobacco risk. Participants in both interventions perceived behavioral change outcomes related to personal skills and intention to not smoke or vape.ConclusionThese findings have highlighted how both individual factors and contextual resources influence behavior change for smoking prevention in practice. Local contextual factors and social influences affecting pupils should be taken into account in the implementation and evaluation of health behavior change interventions. In particular, this study supports using social and contextual influence strategies in interventions to reduce the onset of adolescent smoking and vaping.

Participatory systems science for enhancing health and wellbeing in the Indian Ocean territories.

Co-creation of diabetes and obesity prevention with remote communities allows local contextual factors to be included in the design, delivery, and evaluation of disease prevention efforts. The Indian Ocean Territories (IOT) comprise the Christmas (CI) and Cocos Keeling Islands (CKI) and are remote Australian external territories located northwest of the mainland. We present results of a co-design process conducted with residents of IOT using realist inquiry and system mapping. Interviews with 33 community members (17 CI, 14 CKI, 2 off Islands) on causes and outcomes of diabetes (2020/21) comprising community representatives, health services staff, dietitians, school principals and government administrators. Interviews were used to create causal loop diagrams representing the causes of diabetes in the IOT. These diagrams were used in a participatory process to identify existing actions to address diabetes, identify areas where more effort would be valuable in preventing diabetes, and to described and prioritize actions based on feasibility and likely impact. Interviews identified 31 separate variables categorized into four themes (structural, food, knowledge, physical activity). Using causa loop diagrams, community members developed 32 intervention ideas that included strengthening healthy behaviors like physical activity, improving access to healthy and culturally appropriate foods, and overcoming the significant cost and availability limitations imposed by remoteness and freight costs. Interventions included relatively unique Island issues (e.g., freight costs, limited delivery timing), barriers to healthy food (e.g., limited fresh food availability), physical activity (e.g., transient workforce) and knowledge (e.g., multiple cultural backgrounds and language barriers, intergenerational knowledge).

Local contextual factors of child stunting found via shared values of stakeholder groups: an exploratory case study in Kaffrine, Senegal.

This work aims to demonstrate an original approach to identify links between locally situated shared values and contextual factors of stunting. Stunting results from multi-factorial and multi-sectoral determinants, but interventions typically neglect locally situated lived experiences, which contributes to problematic designs that are not meaningful for those concerned and/or relatively ineffective. This case study investigates relevant contextual factors in two steps: by first facilitating local stakeholder groups (n 11) to crystallise their shared-values-in-action using a specialised method from sustainability studies (WeValue_InSitu (WVIS)). Secondly, participants (n 44) have focus group discussions (FGD) about everyday practices around child feeding/food systems, education and/or family life. Because the first step strongly grounds participants in local shared values, the FGD can reveal deep links between contextual factors and potential influences on stunting. Kaffrine, Senegal, an 'Action Against Stunting Hub' site. December 2020. Eleven stakeholder groups of mothers, fathers, grandmothers, pre-school teachers, community health workers, farmers, market traders and public administrators. Local contextual factors of stunting were identified, including traditional beliefs concerning eating and growing practices; fathers as decision-makers; health worker trust; financial non-autonomy for women; insufficient water for preferred crops; merchants' non-access to quality produce; religious teachings and social structures affecting children's food environment. Local contextual factors were identified. Pre-knowledge of these could significantly improve effectiveness of intervention designs locally, with possible applicability at other sites. The WVIS approach proved efficient and useful for making tangible contextual factors and their potential links to stunting, via a lens of local shared values, showing general promise for intervention research.

Settling in New Zealand’s Small Towns: Experiences of Minority Ethnic Immigrants

Small town New Zealand has, in recent years, experienced an increasing number1 and diversity of immigrants, with visible yet under-researched impacts for less populated regions that historically have been dominated by Pākehā (New Zealanders of European descent) and Māori populations. Using qualitative interviews with three ethnic sub-groups in the Clutha District and Southland Region—the Filipino, Samoan, and Malay communities—we investigate their experiences of settling in small towns. While there is considerable variation in the experiences and aspirations of these ethnic minorities, for each community we demonstrate how local and regional contextual factors shape life aspirations, support infrastructures and settlement trajectories. Particularly drawing upon informal networks and social capital immigrants mediate the considerable challenges they face. Our study also demonstrates the limitations of current policy support and initiatives. Indeed, while local authorities clearly have a significant role in creating the conditions for enabling immigrant settlement in small centres in Southland-Clutha, now the role of government services and community-based support also needs to be considered.

Demographic Determinants and Geographical Variability of COVID-19 Vaccine Hesitancy in Underserved Communities.

COVID-19 hospitalizations and deaths disproportionately affect underserved and minority populations, emphasizing that vaccine hesitancy can be an especially important public health risk factor in these populations. To characterize COVID-19 vaccine hesitancy in underserved diverse populations. The Minority and Rural Coronavirus Insights Study recruited a convenience sample of adults (ages ≥18, n=3,735) from Federally Qualified Health Centers in California, Midwest (Illinois/Ohio), Florida and Louisiana and collected baseline data in November 2020-April 2021. Vaccine hesitancy status was defined as responses "no" or "undecided" to the question "Would you get a coronavirus vaccine, if it was available?" ("yes" categorized as not hesitant). The cross-sectional descriptive analyses and logistic regression models examined vaccine hesitancy prevalence by age, gender, race/ethnicity, and geography. The expected vaccine hesitancy estimates for the general population were calculated for the study counties using published county-level data. Crude associations with demographic characteristics within each region were assessed by the chi-squared test. The main effect model included age, gender, race/ethnicity, and geographical region to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Interactions between geography and each demographic characteristic were evaluated in separate models. The strongest vaccine hesitancy variability was by geographic region: in California 28.3% (26.5-31.1), the Midwest 36.1 % (32.1-40.2), Louisiana 59.1% (56.0-62.1), Florida 67.9% (65.0-70.8). The expected estimates for the general population were lower: 9.7% (California), 15.2 % (Midwest), 18.2% (Florida), and 27.0% (Louisiana). The demographic patterns also varied by geography. An inverted U-shape age pattern was found, with the highest prevalence among ages 25-34 in the Midwest (39.3%), Florida (79.5%,) and Louisiana (79.4%) (p <0.05). Females were more hesitant than males in the Midwest (36.5% vs 23.9%), Florida (71.6% vs 59.4%), and Louisiana (66.5% vs. 46.4%) (p<0.05). Racial/ethnic differences were found in California with the highest prevalence among non-Hispanic Black (45.8%) and in Florida with the highest among Hispanic (69.3%) participants (p<0.05) but not in the Midwest and Louisiana. The main effect model confirmed the U-shape association with age: strongest association with age 25-34, OR=2.28 (1.74, 2.99). Statistical interactions of gender and race/ethnicity with the region were significant, following the pattern found by the crude analysis. The associations with the female gender were strongest in Florida and Louisiana: ORs were 7.83 (5.94, 10.33) and 6.04 (4.52, 8.06) compared to males in California, respectively. Compared to non-Hispanic White participants in California, the strongest associations were found with being Hispanic in Florida and Black in Louisiana: ORs were 11.18 (7.01, 17.85) and 8.94 (5.53, 14.47), respectively. However, the strongest race/ethnicity variability was observed within California and Florida: ORs varied 4.7- and 2-fold between racial/ethnic groups in these regions, respectively. These findings highlight the role of local contextual factors in driving vaccine hesitancy and its demographic patterns.

Turnout, government performance and localism in contemporary by-elections

ABSTRACT Pored over by the media and used as crucial testing grounds for new candidates and campaign techniques by political parties, by-elections – or special elections – are comparatively under-studied in contemporary academic analyses. These elections, held outside the normal election cycle enable local voters to replace a departing representative, but the way in which they vote has often been dismissed as being driven by national factors. In the British case, despite the attention such contests bring, understandings of the way in which people vote in contemporary by-elections are based largely on data from over forty years ago. This article represents a substantial updating of the literature on by-elections, using data on 148 contests from the British context to examine whether pre-existing assumptions from the literature hold: namely the importance of national and local factors. It finds that by-elections no longer represent useful routes by which defeated MPs can re-enter Parliament. For both turnout and party vote share at these contests, a combination of local contextual and national factors impact by-election results, whereas contest specific factors such as having a local candidate only make a difference in a few cases.