Low-income Contexts Research Articles

Adolescents’ dietary patterns, their drivers and association with double burden of malnutrition in adolescents: a cross-sectional study in Kenya’s urban slums

BackgroundThe double burden of malnutrition (DBM) during adolescence is associated with growth and developmental impairment and risk of non-communicable diseases. There is limited evidence on adolescent’s dietary patterns (DPs), and how they contribute to DBM in urban low income contexts in sub Saharan Africa. This study assessed DPs of adolescents, their drivers and association with DBM in Kenya’s urban slums.MethodsAnthropometric, socio-demographic and dietary-intake data were collected through a cross-sectional survey of 621 adolescents from three major urban slums in Nairobi, Kenya. DPs were derived using principal component analysis. Multinomial-logistic-regression was used to assess the association between the DPs, individual and environmental factors and DBM.ResultsTwo DPs were identified: traditional DP (whole grains/cereals, rice, fruits, legumes/nuts, and water) and transitioning DP (refined cereals (maize/wheat), vegetables, meat, tea/coffee, sweet ultra-processed/deep fried snacks). Adolescents from Mathare (the largest slum) were more likely to adhere to the traditional DP (RRR = 3.43; 95% CI 1.85–6.37). Cultural background (Luo) had a positive association (RRR = 4.28; 95% CI 1.97–9.32), while longer residency in the slum (> 10 years) had a negative association (RRR = 0.47; 95% CI 0.25–0.90) with transitioning DP. The transitioning DP had a positive (non-linear) association with overweight/obesity in girls (RRR = 2.79; 95% CI 1.16–6.71). The DPs were not associated with thinness or stunting.ConclusionThe DPs indicate various stages of nutrition transition of adolescent diets, which are influenced by cultural background, neighbourhood and duration of stay in the slum. Transitioning DP may expose adolescents to the risks of overweight/obesity in the long-term.

Resuming work roles after injury in a low-income context: Multiple factors influencing the return to work outcomes.

Return to work (RTW) is an important outcome indicator for the effectiveness of rehabilitation services, and the functional status and overall recovery among individuals who have experienced injury. Despite the rising incidence of traumatic injury among economically productive citizens in Ethiopia, there is a paucity of evidence about the RTW status of injury survivors. This study examined factors associated with RTW success and determinants of time to RTW after injury in Ethiopia. An institution-based cross-sectional study was conducted to collect data retrospectively one year after patients arrived at the study setting due to traumatic injuries. Medical records of all patients who visited the emergency room of a large public hospital in Addis Ababa were reviewed. Data were collected from survivors of traumatic injury, interviewed by telephone one year post-injury. Multivariable logistic regression and survival analysis were carried out to explore factors. Of the 251 participants, 75% were young adults (age </ = 39 years), 78% were male, 78% were urban residents, 41% were injured by road traffic collisions, and 59% returned to work within one year. The logistic regression model revealed short inpatient admission (AOR = 4.20; 95% CI: 2.10-8.50; p ≤ 0.001), no disability (AOR = 4.44; 95% CI: 2.10-9.60; p ≤ 0.001), motivation to RTW (AOR = 3.50; 95% CI: 1.61-7.50; p = 0.002), no chronic illness (AOR = 2.31; 95% CI: 1.14-4.70; p = 0.020), being in an administrative position (AOR = 5.32; 95% CI: 1.11-25.78; p = 0.038) and receiving injury compensation (AOR = 3.10; 95% CI: 1.22-7.73; p = 0.017) as factors for successful RTW within a year after injury. Further, the Cox regression analysis identified immediate access to healthcare after injury (AHR = 1.54; 95% CI: 1.05-2.25; p ≤ 0.026) and having injury of penetrative to internal organ, strain, sprain, dislocation or soft tissue (AHR = 1.81; 95% CI: 1.20-2.80; p = 0.007) as determinants of early RTW after traumatic injury. The study uncovers factors crucial to RTW planning and interventions, and provides insights to minimize barriers, foster a smooth transition to employment, and optimize survivors' lives after injury.

Management of Bilateral Congenital and Juvenile Cataracts in a Low-Income Country: Patient Identification, Treatment Outcomes, and Follow Up.

Childhood blindness remains a neglected issue in eye care within low-income countries, with congenital and juvenile cataracts being the most common treatable causes. This study aims to investigate the factors influencing the management of congenital and juvenile bilateral cataracts, provide data on general outcomes and postoperative findings, and discuss treatment in a low-income country context. In this prospective study, data from clinical care were continuously entered into a database, and one follow-up examination of a cohort of 91 patients with congenital and juvenile bilateral cataracts in Kinshasa, Democratic Republic of the Congo, was conducted. Multiple factors that affect the first clinical presentation, the clinical management, and outcome were investigated. Most patients (88.5%) who received medical treatment were identified by cataract finders. A patient's presentation time was independent of the parent's education, social status, income, and sex of the child. The median age at first presentation was 5.8 years (ranging from 0 days to 17.3 years). The best visual acuity outcomes were achieved by patients who underwent surgery during early childhood. According to WHO grades and on an eye level basis, 51.1% (93 out of 182 eyes) showed improvement, while 34.6% (63 eyes) had unchanged results post-surgery. Among the cases without improvement, 76.2% were blind prior to surgery. Postoperative findings were observed in 56% of the patients, with secondary cataracts being the most common, affecting 26.37% of the operated eyes. Optimal management of childhood cataracts involves early identification, efficient hospital infrastructure, high-quality medical care, and long-term follow up. In sub-Saharan Africa, this approach must be adapted to the context of available resources, which differs significantly from those in high- and middle-income countries.

Gendered implications for climate change adaptation among farmers in Madagascar

ABSTRACT Climate change is impacting farmers worldwide; none more so than the millions of smallholder farmers who rely entirely on rain-fed agriculture. Adapting agricultural practices is an important strategy to mitigate climate change’s harmful impacts to food security and livelihoods. Researchers have increasingly sought to understand the factors influencing farmer decision-making on adaptation practices but application of important theories in low-income country contexts is lacking. Therefore, we apply the Protection Motivation Theory (PMT) to examine farmer intention to adopt agricultural practices in response to climate change based on a survey of 328 smallholder farmers in rural Madagascar. Using structural equation modeling (SEM) to describe the relationship between social connectedness (e.g., interactions with others about farming-related issues), PMT constructs (threat and coping appraisal), and intention to adapt agricultural practices to climate change, we find that coping appraisal is a stronger predictor of intention to adapt than threat appraisal. Further, SEM results show a significant negative relationship between social connectedness and threat appraisal – farmers with greater social connectedness perceive climate change to be less of a threat. Additionally, as female farmers are significantly less socially connected than male farmers, this study provides further evidence of the gendered vulnerabilities to climate change among smallholders. This research has implications for the design of policies and interventions that consider farmer social networks, critical for reducing threat and building coping capacity, in supporting adaptation to climate change among vulnerable farmer populations.

Mutual influence of quality education and ICT skills in promoting economic growth

Aligned with the fourth UN Sustainable Development Goal, this study examines the potential correlation among education quality, ICT skills, and economic growth. Utilizing the Generalized Method of Moments (GMM) methodology, we analyze dynamic fixed-effect panel data spanning 2010 to 2021 across 26 low-income, 20 middle-income, and 15 high-income countries. Our results indicate a positive impact of ICT skills and education quality on economic growth, for all country groups, with education quality enhancing this effect compared to ICT skills alone. The interaction between these factors underscores their complementary role in fostering economic growth. Notably, the impact has become more pronounced in recent years, attributed to advancements in ICT facilitating improvements in education quality. When examining income levels, low-income nations exhibit more substantial coefficients for ICT skills and education quality than middle- and high-income countries, emphasizing the significant potential for progress in low-income contexts. Our findings withstand various robustness checks, affirming their reliability and providing compelling policy implications for the roles of education quality and ICT skills in propelling economic growth.

Biological and social cascades of prenatal contextual risk and maternal psychological distress to early-childhood adjustment.

In the peripartum, putative mechanisms in the transmission of prenatal contextual risk and maternal psychological distress include biological and social processes. In this study, path analyses were used to test unique, cascading pathways of prenatal contextual risk and pre- and postnatal maternal psychological distress through social mediators (parenting) and biological mediators (infant stress physiology) on infant temperament and toddler adjustment. The sample is comprised of racially and ethnically diverse first-time mothers (N = 200) living in low-income contexts (< 200% poverty) who were followed from pregnancy to 18-36 months postpartum. In pregnancy, mothers reported contextual risk and psychological distress (anxiety, depression). In the postpartum, mothers reported their psychological distress. At 2-4 months postpartum, observed mother-infant interactions were coded for sensitive responsiveness. Infant cortisol baseline and reactivity to a lab stressor were collected when infants were 4-6 months old. Mothers reported on infant's temperament (negative affect, effortful control) at 10-12 months and on child adjustment (internalizing, externalizing symptoms) at 18-36 months. Prenatal contextual risk predicted infant cortisol reactivity. Prenatal psychological distress predicted postnatal distress but, when accounting for postnatal distress, did not predict putative mediators or indicators of child adjustment. In contrast, maternal postnatal depression predicted subsequent maternal sensitive responsiveness, which in turn predicted later infant baseline cortisol and cortisol reactivity. Baseline cortisol predicted infant negative affectivity, which predicted toddler internalizing and externalizing symptoms. There was no evidence of mediated effects of prenatal variables on child adjustment outcomes, whereas contextual risk, postnatal psychological distress, and parenting were more salient predictors of child adjustment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mutual capacity building model for adaptation (MCB-MA): a seven-step procedure for bidirectional learning and support during intervention adaptation

Global health reciprocal innovation emphasizes the movement of technologies or interventions between high- and low-income countries to address a shared public health problem, in contrast to unidirectional models of “development aid” or “reverse innovation”. Evidence-based interventions are frequently adapted from the setting in which they were developed and applied in a new setting, presenting an opportunity for learning and partnership across high- and low-income contexts. However, few clear procedures exist to guide researchers and implementers on how to incorporate equitable and learning-oriented approaches into intervention adaptation across settings. We integrated theories from pedagogy, implementation science, and public health with examples from experience adapting behavioral health interventions across diverse settings to develop a procedure for a bidirectional, equitable process of intervention adaptation across high- and low-income contexts. The Mutual capacity building model for adaptation (MCB-MA) is made up of seven steps: 1) Exploring: A dialogue about the scope of the proposed adaptation and situational appraisal in the new setting; 2) Developing a shared vision: Agreeing on common goals for the adaptation; 3) Formalizing: Developing agreements around resource and data sharing; 4) Sharing complementary expertise: Group originating the intervention supporting the adapting group to learn about the intervention and develop adaptations, while gleaning new strategies for intervention implementation from the adapting group; 5) Reciprocal training: Originating and adapting groups collaborate to train the individuals who will be implementing the adapted intervention; 6) Mutual feedback: Originating and adapting groups share data and feedback on the outcomes of the adapted intervention and lessons learned; and 7) Consideration of next steps: Discuss future collaborations. This evidence-informed procedure may provide researchers with specific actions to approach the often ambiguous and challenging task of equitable partnership building. These steps can be used alongside existing intervention adaptation models, which guide the adaptation of the intervention itself.

Open educational resources as the panacea for the decolonisation of e-learning content in South Africa

Higher education institutions have been following the global trend of advocating open educational resources (OER) for tuition and learning. In the South African context of higher education, there is also an increasingly strong call for decolonisation in educational content. However, there is a lack of knowledge and theories for the decolonisation of learning content. This study sought to establish the possibilities of decolonisation of OER in digital learning. To employ the appropriate lens for the decolonisation of content, the study opted for contextualised theory, contextual knowledge world views, and the African indigenous knowledge frameworks, while following the Transformative Learning Theory. This theory made it possible to follow the decolonisation elements relevant to low-income contexts. Consequently, the decolonisation lesson guided the appropriate systems for the decolonisation of the tuition content. After decolonisation, the concepts of Africanisation and transformative learning were considered by using the Technology Appropriation Model as a guide for adopting and developing OER appropriate for the African context. The study employed the qualitative approach and case study strategy by focussing on one of the largest comprehensive open distance e-learning (CODEL) institutions in South Africa and on the African continent. The study established that CODEL encourages the use of OER for the decolonisation of tuition content. However, there is still a lack of strategies, models, policies, and practical guidelines for the decolonisation of OER. Therefore, the study proposed the decolonisation of an e-learning content model that academia can use to advance the decolonisation of e-learning content.

Formative qualitative research on the potential for digital solutions to address diabetes care gaps in Tanzania and Sri Lanka

ObjectivesDiabetes care remains unavailable and unaffordable for many people. Adapting models of care to low-income and middle-income country contexts is a priority. Digital technology offers substantial potential yet must surmount...

Access to assisted reproductive technologies in sub-Saharan Africa: fertility professionals’ views

Across sub-Saharan Africa, there remains disagreement among local expert providers over the best ways to improve access to assisted reproduction in low-income contexts. Semi-structured qualitative interviews were conducted between 2021 and 2023 with 19 fertility specialists and 11 embryologists and one clinic manager from South Africa, Zimbabwe, Namibia, Kenya, Ethiopia and Uganda to explore issues surrounding access and potential low-cost IVF options. Lack of access to ART was variously conceptualised as a problem of high cost of treatment; lack of public funding for medical services and medication; poor policy awareness and prioritisation of fertility problems; a shortage of ART clinics and well-trained expert staff; the need for patients to travel long distances; and over-servicing within the largely privatised sector. All fertility specialists agreed that government funding for public sector assisted reproduction services was necessary to address access in the region. Other suggestions included: reduced medication costs by using mild stimulation protocols and oocyte retrievals under sedation instead of general anaesthetics. Insufficient data on low-cost interventions was cited as a barrier to their implementation. The lack of skilled embryologists on the continent was considered a major limitation to expanding ART services and the success of low-cost IVF systems. Very few specialists suggested that profits of pharmaceutical companies or ART clinics might be reduced to lessen the costs of treatments.

When perception is reality: examining perceived accessibility of recreational public spaces through social space production

ABSTRACT Social space production theorizes space as a socially constructed phenomenon, comprising of the expectations of society, technical design decisions, and the physical features that result. This theorization of space is especially relevant to recreational public spaces (e.g. parks, playgrounds, community centres) in low-income settings. This is because, the power linkages between technical decisions and neo-capitalist influence, have in some instances, translated to physical features for recreation that do not meet societal expectations or ideals on use. However, recognized opportunities of use (i.e. perceived accessibility) are yet to be examined through the physical, technical, and social facets that collectively guide considerations, as theorized in social space production. Our study hence adopts social space production as a lens to examine perceived accessibility to public recreational spaces in low-income residential contexts. Participatory mapping interviews with resident leads in a low-income residential context in the United States, revealed three thematic considerations. The themes were namely: physical ease of use, planning and design experiences, and social interactions with and within space. Our findings demonstrate that multifaceted considerations, which are pertinent to physical, technical, and social aspects of social space production, are informative to perceived accessibility.

Same difference, different sameness: gender-navigating the denominational maze in a Christian African context

ABSTRACT The large and growing denominational diversity of sub-Saharan Christianity has attracted considerable scholarly attention, but its implications for individual experiences and well-being remain poorly understood. I examine women’s perceptions, assessments, and practices in everyday construction of church idiosyncrasies, clustering, and hierarchies and women’s abilities and propensities to navigate along and across the corresponding organisational boundaries in a predominantly Christian setting in rural Mozambique. The analysis uses a combination of data from a census of religious congregations, a household survey, in-depth interviews, and participant observation conducted over a decade. It demonstrates that women’s church involvement is socially indispensable yet also subjectively non-binding. Accordingly, church boundaries, while clearly delineated and recognised, are also seen as highly permeable. This permeability facilitates the crossing of those boundaries but may also disincentivise such crossing. Although rural women are increasingly capable of navigating through the religious space, they are generally precluded from exiting that space altogether, as secular options for non-family social anchoring remain very limited in this and other similar low-income patriarchal contexts.

A multi-criteria model for measuring the sustainability orientation of Italian water utilities

This article investigates the influence of socioeconomic context and stakeholder pressure on water utilities' sustainability performance and disclosure. The Urban Water Cycle Services (UWCS) framework has been adapted to the Italian context and integrated with a social equity variable, which enhances the framework's ability to account for the distinctive characteristics and mission of water utilities in measuring sustainability performance. The sample comprises 17 Italian utilities providing water services that released a sustainability report in 2021. The results show that the socioeconomic context and stakeholder pressure influence how water utilities align with economic, environmental, and social sustainability goals. Listed multi-utility companies are strongly influenced by private shareholders, pushing them towards financial sustainability, while small public water utilities are more sensitive to the needs of their disadvantaged users, especially in low-income contexts. The findings of the study have interesting theoretical, managerial and policy implications.

Sustainability criteria for introducing new technologies in low-income contexts

AbstractIntroducing new technologies in low-income contexts have potential for positive social impact, and such efforts are made by humanitarian engineering non-govermental organisations (NGOs). The impact can increase if a systemic sustainability perspective is considered in the design process. Sustainability criteria are identified using a literature study combined with an empirical study together with a Swedish NGO. These criteria are synthesized into a simplified Sustainability Fingerprint tool which is evaluated and deemed to be useful when introducing new technologies in low-income contexts.

Evaluation of the implementation of the objective structured clinical examination in health sciences education from a low-income context in Tunisia: A cross-sectional study.

Objective structured clinical examination (OSCE) is well-established and designed to evaluate students' clinical competence and practical skills in a standardized and objective manner. While OSCEs are widespread in higher-income countries, their implementation in low-resource settings presents unique challenges that warrant further investigation. This study aims to evaluate the perception of the health sciences students and their educators regarding deploying OSCEs within the School of Health Sciences and Techniques of Sousse (SHSTS) in Tunisia and their efficacity in healthcare education compared to traditional practical examination methods. This cross-sectional study was conducted in June 2022, focusing on final-year Health Sciences students at the SHSTS in Tunisia. The study participants were students and their educators involved in the OSCEs from June 6th to June 11th, 2022. Anonymous paper-based 5-point Likert scale satisfaction surveys were distributed to the students and their educators, with a separate set of questions for each. Spearman, Mann-Whitney U and Krusakll-Wallis tests were utilized to test the differences in satisfaction with the OSCEs among the students and educators. The Wilcoxon Rank test was utilized to examine the differences in students' assessment scores in the OSCEs and the traditional practical examination methods. The satisfaction scores were high among health sciences educators and above average for students, with means of 3.82 ± 1.29 and 3.15 ± 0.56, respectively. The bivariate and multivariate analyzes indicated a significant difference in the satisfaction between the students' specialities. Further, a significant difference in their assessment scores distribution in the practical examinations and OSCEs was also demonstrated, with better performance in the OSCEs. Our study provides evidence of the relatively high level of satisfaction with the OSCEs and better performance compared to the traditional practical examinations. These findings advocate for the efficacy of OSCEs in low-income countries and the need to sustain them.

Insect as a promising food source: implications for sustainable consumption across species. a review

Insects provide a crucial source of nutrients for human beings and many other animal species. Several insects, such as black soldier flies, house crickets, fruit flies, houseflies, and mealworms, play crucial roles in providing essential micronutrients. Processing can transform insects into different formats, including pastes, powders, and meals. Edible insects (black soldier fly, crickets) have their potential to be farmed by using organic food waste, including manure, compost, and vegetable scraps unsuitable for individual consumption. Eating insects appears to have a lower environmental impact in relation to climate change compared to raising cattle, pigs, or chickens. Consuming insects appears to offer a sustainable solution for fulfilling the nutritional needs of our expanding global community. To better comprehend the potential socio-economic advantages of insect gathering and farming, further investigation is necessary to determine how these practices can improve food security in low-income contexts. Insects appear to raise minimal concerns regarding animal welfare, though the extent to which they may experience discomfort and pain remains unclear.

Quality of life in people with epilepsy: Associations with resilience, internalized stigma, and clinical factors in a low-income population

IntroductionEpilepsy is a common neurological disorder associated with comorbidities and a reduced quality of life (QoL). Internalized stigma is negatively correlatedwiththe QoL, whereas high levels of resilience are associated with increased QoL. Although the stigma towards people with epilepsy (PWE) is expected to be higher in low-income settings than in high-income settings, further research is needed. This study aimed to examine the extent to which resilience and internalized stigma correlatewith the QoL in PWE from a low-income population. Material and MethodsA cross-sectional, observational, descriptive study was conducted on 60 PWE who visited the Neurology Department of the Hospital de Clinicas (Buenos Aires, Argentina) between May and September 2022. Demographic and clinical data were collected. Participants completed the Quality of Life, Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), the Chronic Illness Anticipated Stigma Scale (CIASS), and the Resilience Scale (RS). Variables that showed a significant association with the QoL in the univariate analysis were included in a multiple regression model. ResultsParticipants had a low overall QoL score, with a median of 59 (95 %CI: 57.2–61.8). They had an average level of education and a high rate of unemployment. Perceived stigma was higher in the workplace than in the medical or family settings. Univariate analysis revealed that the QoL was associated with internalized stigma score, resilience score, seizure frequency, seizure etiology, work status, and educational level. The multiple regressionrevealed a significant decrease in the QoL when perceived stigma increased (p = 0.0016) or when the cause of epilepsy was structural (p = 0,006) and a significant increase in the QoL when the resilience score was higher (p = 0.0004). ConclusionThe QoL of PWE in a low-income context is strongly associated with their levels of resilience and internalized stigma. When addressing the social burden of epilepsy, resilience support should be increased in the care of PWE to reduce internalized stigma and improve the QoL.

Absorbent hygiene products disposal behaviour in informal settlements: identifying determinants and underlying mechanisms in Durban, South Africa

BackgroundWithin South Africa, many low-income communities lack reliable waste management services. Within these contexts, absorbent hygiene product (AHP) waste, including nappies (diapers), are not recycled, and are often dumped, ending up in watercourses and polluting the local environment. The structural barriers to collection which have been well explored, however the behavioural determinants of safe disposal for AHPs remains poorly understood. The purpose of this study is to determine the psycho-social factors driving AHP disposal behaviour for caregivers, while identifying potential underlying mechanisms (such as mental health), which may be influencing disposal behaviour, with the intention of informing a future, contextually appropriate and sustainable, collection system.MethodsThe cross-sectional study was conducted within three low-income communities located within eThekwini Municipality (Durban), South Africa. The study included a pre-study and a quantitative survey of 452 caregivers, utilising the RANAS approach of behaviour change. The quantitative questionnaire was based on the RANAS model to measure psycho-social factors underlying sanitary disposal of AHPs. Mental health was assessed using the Self-Reporting Questionnaire (SRQ-20). Statistical analysis involved regressing psycho-social factors onto disposal behaviour and exploring their interaction with mental health through a moderation model.ResultsOur findings suggest that one third of caregivers do not dispose of nappies sanitarily, despite intent (86.9%). Regression analysis revealed ten psycho-social factors which significantly predict the desired behavioural outcome, the sanitary disposal of AHPs. Caregivers with poor mental health were less likely to dispose of AHP sanitarily, which reflects previous research linking poor mental health and the impairment of health-related daily activities, particularly within vulnerable groups. Specifically, several psycho-social factors underlying were moderated by poor mental health, the prevalence of sanitary disposal of AHPs depended on mental condition of caregiver.ConclusionsOur findings confirmed the link between poor mental health and unsanitary AHPs disposal. This is especially relevant because poor mental health is common within South Africa. Addressing mental health problems within these communities is an essential step to providing sustainable waste management services. The findings informed an intervention strategy to implement a future collection system for these communities, and similar low-income or informal contexts within South Africa.

Optometry student clinical practice at public health facilities: A systematic review.

Clinical training, supervision and practice are the most important aspects of health profession education, including optometry. Institutions implore various methods for students to gain access, exposure and experience in different clinical environments, away from their normal academic settings. This review aimed to investigate studies and related documentary evidence to determine existing standards and methods for educational institutions in conducting optometry clinical training at the external sites. The electronic databases - ProQuest One, Scopus, EBSCOhost, Sabinet, Science Direct and Google Scholar - were searched systematically for studies on the implementation of workplace clinical training of undergraduate optometry students. The study followed the Joanna Briggs Institute (JBI) systematic review methodology and a systematic search of various electronic databases was conducted for studies on implementation of workplace clinical training. Of the 450 full-text studies searched, 13 studies were found to be reputable sources of evidence and were included in this systematic review. Four themes relating to student clinical training emerged, namely, clinical training approaches implemented, expected minimum standards at the training sites, clinical training environment wherein students and supervisors find themselves and clinical competence of the supervisors and students. They encompass important factors to consider in the planning and provision of quality, efficient and effective student clinical supervision at the external training facilities. There is a dearth of scholarly studies to guide clinical training of optometry training within the public health sector. However, more studies are undertaken in other health disciplines, and they provide generic guidelines, which can be adapted for optometry. The article highlights the need for further studies in optometry student clinical training, focussing on programme designs and standardisation of clinical training in multi-institutional, low-income contexts.

Photo-able Urban Green-Blue Spaces

Urban green–blue spaces (UGBSs) are increasingly integrated into the urban fabric transformation, playing a pivotal role in shaping everyday interactions and experiences with nature in the Anthropocene era. Crowdsourcing, facilitated by digital technologies, has emerged as a novel methodological advance for accessing subjective place-based information, allowing the public to produce and share photographs at an unprecedented scale. As people can now readily capture and disseminate images on social media from virtually any location, these photographs contribute to the digital representation of places. Many studies have leveraged social media imagery to explore mental maps of cities, place perceptions, and ecosystem services. This raises fundamental questions: What are the UGBSs that promote photography across cities? What are the similarities and differences among cities’ photogenic UGBSs? And how do cities’ photogenic UGBSs relate to the happiness of their inhabitants? This study investigates these questions through an analysis of 203,020 photographs, taken from social media, of sites across 186 cities over a five-year period (2014 to 2018). Employing Google Cloud Vision and topic modelling with a state-of-the-art neural network model, photographs are clustered and used to identify cross-city features. The correlation between prevalence of photogenic UGBSs and levels of happiness is investigated using linear regression analysis. The results show that UGBSs eliciting photography practice are predominantly characterised by water-related subjects, confirming a widespread aesthetic appreciation for urban blue spaces. Perceptions of UGBSs exhibit significant variability among cities, offering a metric to assess environmental policy efficacy. Lastly, a positive association is found in high-income contexts between number of social media photographs of UGBSs and subjective well-being, while this correlation is not significant in middle- and low-income contexts. This sheds light on human–nature relationships by providing global evidence of how aesthetic appreciation of urban nature influences human well-being.