Focus Group Discussions Participants Research Articles

Experiences of progestin-only pill users in the United States and attitudes toward over-the-counter access.

Removing the prescription requirement and making oral contraceptive pills available over the counter (OTC) could increase contraceptive access in the United States. Despite current efforts to make a progestin-only pill (POP) available OTC, there are no qualitative data exploring the experiences of POP users and their perspectives on making POPs available OTC. We conducted six online, asynchronous focus group discussions with 36 POP users between July and November 2020. We stratified focus group discussion placement based on three reasons for POP use: breastfeeding, having a contraindication to estrogen (for a reason other than breastfeeding), and for any other reason. We thematically analyzed these data using inductive and deductive coding. The majority of participants described their overall POP experience as positive, mostly because they experienced minor or no side effects and thought the pill was effective. Participants overwhelmingly supported OTC availability of POPs and expressed interest in purchasing an OTC POP. Over one-third of participants had very limited knowledge or held inaccurate assumptions about POPs before they started using this method and many stressed the need to disseminate accurate information and resources about POPs to the public. Most focus group discussion participants were satisfied with POPs and supported OTC access. While misconceptions and concerns about POPs should be addressed, an OTC POP has the potential to be a safe, effective, and convenient contraceptive option in the United States.

Mental health care in the city of Lubumbashi, Democratic Republic of the Congo: Analysis of demand, supply and operational response capacity of the health district of Tshamilemba.

Integrating mental health care into the primary care system is an important policy option in the Democratic Republic of the Congo (DRC). From the perspective of the integration of mental health care in district health services, this study analyzed the existing demand and supply of mental health care in the health district of Tshamilemba, which is located in Lubumbashi, the second largest city of the DRC. We critically examined the district's operational response capacity to address mental health. A multimethod cross-sectional exploratory study was carried out. We conducted a documentary review (including an analysis of the routine health information system) from the health district of Tshamilemba. We further organized a household survey to which 591 residents responded and conducted 5 focus group discussions (FGDs) with 50 key stakeholders (doctors, nurses, managers, community health workers and leaders, health care users). The demand for mental health care was analyzed through the assessment of the burden of mental health problems and care-seeking behaviors. The burden of mental disorders was assessed by calculating a morbidity indicator (proportion of mental health cases) and through a qualitative analysis of the psychosocial consequences as perceived by the participants. Care-seeking behavior was analyzed by calculating health service utilization indicators and more specifically the relative frequency of mental health complaints in primary health care centers, and by analyzing FGDs participants' reports. The mental health care supply available was described by using the qualitative analysis of the declarations of the participants (providers and users of care) to the FGDs and by analyzing the package of care available in the primary health care centers. Finally, the district's operational response capacity was assessed by making an inventory of all available resources and by analyzing qualitative data provided by health providers and managers regarding the district' capacity to address mental health conditions. Analysis of technical documents indicated that the burden of mental health problems is a major public problem in Lubumbashi. However, the proportion of mental health cases among the general patient population seen in the outpatient curative consultations in the Tshamilemba district remains very low, at an estimated 5.3%. The interviews not only pointed to a clear demand for mental health care but also indicated that there is currently hardly any offer of care available in the district. There are no dedicated psychiatric beds, nor is there a psychiatrist or psychologist available. Participants in the FGDs stated that in this context, the main source of care for people remains traditional medicine. Our findings show a clear demand for mental health care and a lack of formal mental health care supply in the Tshamilemba district. Moreover, this district lacks adequate operational capacity to meet the mental health needs of the population. Traditional African medicine is currently the main source of mental health care in this health district. Identifying concrete priority mental health actions to address this gap, by making evidence-based mental care available, is therefore of great relevance.

An appraisal on the determinants of adaptation responses to the impacts of climate variability on coffee Production: Implication to household food security in Nensebo Woreda, Ethiopia

Climate change and variability already had and will continue to harm coffee production throughout the world. Between 80% and 90% of the world’s coffee is produced by smallholder farmers who depend on nature. This study examines the determinants of climate variability adaptation response in coffee production and its implication for household food security in Nensebo Woreda, Ethiopia. Quantitative and qualitative data were collected from randomly selected 181 coffee grower farmers as well as purposively selected key informants, and focus group discussion participants. Arial gridded dikadal meteorological data were also used. Data were analyzed using thematic content analysis, descriptive statistics, and econometric analysis methods. The study reveals that in the study area monthly, seasonal, and annual minimum and maximum temperature has been increasing over the last three decades. Rainfall has been erratic both in amount and timing. Multinomial logit analysis showed that age, farm experience, farm size, family size, average days spent on non-farm and off-farm activities, DA contact, climate change information, and income from coffee were the factors that significantly influenced adaptation responses to climate variability. The study also revealed the presence of a varying degrees of household food insecurity. Therefore, to enhance the adaptive capacity of coffee grower farmers, it is necessary to provide area specific and precise weather forecast information. Likewise, the study shows that building the adaptive capacity of coffee grower farmers requires expanding access to credit and savings services as well as market information. Doing all of these requires extensive and continuous awareness creation intervention about the actual and potential effects of climate variability on coffee production.

Determinants of the choice of adaptation strategies to climate variability and extremes among pastoralist and agro-pastoralist households in Yabello and Arero Districts, Southeast Ethiopia

Climate variability and extremes adversely affect the livestock sector by reducing pasture availability, polluting and depleting water resources, aggravating livestock diseases, and distorting the production systems. The cumulative effect of climate variability undermines the adaptive capacity of pastoralists and worsens food insecurity. This study assesses the impact of climate variability and the determinants of pastoralists and agro-pastoralists adaptation strategies in Yabello and Arero Districts, southern Ethiopia. Accordingly, data were collected from randomly selected 296 sample households using a questionnaire survey. Data were also gathered from a purposively selected key informants and focus group discussion participants. Areal gridded dikadal rainfall and temperature data were collected from the National Meteorological Institute. Descriptive statistics and multinomial logistic regression data analysis methods were used. The results show that all seasons were significantly warming, while rainfall declined at various degrees and the distribution was highly variable across the study period. The ever rising minimum and maximum temperature and the erratic nature of rainfall has undermined the availability of pasture and water resources, especially during drought years resulting in the prevalence of livestock diseases. The age of the household head, poor access to information, lack of credit and saving services, limited knowledge, and erratic rainfall were found to be the determinant factors in the choice of adaptation options to climate variability and extremes. The study also found that lack of appropriate intervention and support mechanisms by government and non-government actors as well as the reluctance of pastoralists and agro-pastoralists to accept the stakeholders’ advice were the barriers to climate variability adaptation. Thus, it is clear that pastoralists’ and agro-pastoralists’ livelihood is at risk for climate variability and extremes and hence, requires context specific adaptive capacity building intervention that ranges from awareness creation to strengthening basic infrastructures and rangeland management.

Public Perception of Political Opinion Polls and Their Influence on People’s Voting Behavior: The Case of Mwanza City Residents

This study focuses on the influence of public perceptions of political opinion polls on people’s voting behavior in Mwanza city and the role of Tanzanian media in creating awareness about political opinion polls. The study uses a descriptive paradigm and a qualitative case study design. A purposive sampling technique was used to select participants for key informants and focus group discussions. The study concludes that, although polling is a new phenomenon in Tanzania, the level of awareness of polls is high among Mwanza City residents and they hold a variety of positions regarding the accuracy of the polls. The study highlights why journalists need to be trained on how to report poll-related stories to avoid false conclusions because they have become a major source of news.

Exploring the impact of COVID-19 on frontline health workers through a photovoice study in Kaduna, Kwara and Ogun States, Nigeria.

Described as the 'backbone of health systems', particularly in low- and middle-income countries, community health workers (CHWs) are a critical cadre on the frontline of any outbreak response. However, it is widely recognised that CHWs are frequently lacking in appropriate support from the health system due to inadequate physical, social and financial resources. Furthermore, despite their critical role in service delivery, the health and well-being of CHWs is seldom considered and the additional emotional and physical burdens that health systems shocks can present are frequently ignored. Thus a critical step in strengthening health systems to manage disease outbreaks or other system shocks is to ensure that CHWs are adequately supported. Within this study we document the experiences of CHWs within Nigeria during the coronavirus disease 2019 (COVID-19) outbreak to understand the impact of the pandemic on CHW well-being with a view to identifying strategies that could support CHWs during COVID-19 and subsequent health system shocks. This study was based in Ogun, Kaduna and Kwara States, Nigeria. We used the creative participatory methodology of photovoice with 30 CHWs (10 in each state). Participants were asked to take photos documenting their experiences of working and living through the pandemic. Participants sent photos with captions to the research team via WhatsApp following one-on-one discussions. Photos were co-analysed among participants in focus group discussions using thematic analysis. Our findings reveal similar experiences of CHWs across Ogun, Kwara and Kaduna States in Nigeria, providing a unique insight into how the Nigerian health system was impacted and how this closely aligns to the performance and well-being of CHWs. CHW experiences related to three overarching themes: major stressors and challenges experienced due to COVID-19 (fear of contracting COVID-19, food insecurity, personal and gendered impacts), the impact of COVID-19 on providing routine care (stigma from community members, heavy workloads and inadequate equipment provision) and motivation and support from the community (pride in their roles and valued support from community leaders). The challenges highlighted through photovoice led to developing recommendations to address some of the challenges. This included training, adequate resource provision, routine supervision and peer support. COVID-19 highlighted the burden health workers often face. Photovoice allowed a space for frontline health workers to come together to share common experiences, particularly the psychosocial impact of working during health system shocks and its impact on performance. This underlines the need to acknowledge mental health and prioritise the well-being of healthcare staff. Sharing stories from the perspectives of health workers provides a platform to share learning and strategies on how to best support health workers holistically, particularly during health system shocks.

A qualitative study exploring perceptions of people living with HIV using antiretroviral therapy on self-management of healthy nutrition and the related healthcare service in Ethiopia

ABSTRACT In Ethiopia, undernutrition is a quite common health problem among people living with HIV. Unlike in developed countries, nutritional counseling for people living with HIV has not received much attention. This study aimed to explore the perception of people living with HIV on their dietary practice and the existing health care service in Ethiopia. A phenomenological qualitative study was conducted in two hospitals in southern Ethiopia from March to June 2018. A pre-tested interview guide was prepared in English and translated into the Amharic language. The data were collected using key informant interviews, focus group discussions and observations in the ART clinics by six trained nurses. The data were analyzed thematically. Almost all focus group discussion participants mentioned that a healthy diet for ART patients is very important. The majority of the participants mentioned that they were not satisfied with the counseling service given at the ART clinics. Lack of training for health care professionals on nutritional counseling was also reported as a challenge by the nurses themselves. Nutritional counseling given by health care professionals at the ART clinic was poor. Emphasis should be given to the training of healthcare professionals working in ART clinics on nutritional counseling.

Development of Discharge Planning Instruments Based on Patient Family-Centered Care in the COVID-19 Inpatient Room, Universitas Airlangga Hospital, Surabaya

Introduction: The current era of the COVID-19 pandemic requires innovation in the provision of discharge planning by involving family members through the media safely and effectively. This study aimed to develop a discharge planning instrument based on patient family-centered care. Method: Research design Research and Development. The sampling technique used purposive sampling with a total sample of 110 medical record documents, 23 focus group discussion participants, and 2 experts (expert consultation). Data were collected through observation sheets, focus group discussions, and expert consultations. Data analysis using descriptive analysis, and validity test using I-CVI. Results: Development of a patient family centered care-based discharge planning instrument at the beginning of the patient’s admission (admission), namely sorting and adding assessment items to the level of knowledge of the disease, information and education needs, values, and beliefs, cultural background as well as physical and psychological. During treatment, namely arranging and sorting discharge planning items, providing information and education according to the assessment results using a media approach and the method according to the COVID-19 pandemic protocol. Towards home that is adding items; readiness or environmental conditions (environment), referral plans (Outpatient referral), and continued treatment while at home (Medication). Conclusion: The developed instrument tested is valid. As a result of this development, the new instrument can be tested and applied, and researched in the next stage on the outcomes of patient family-centered care.

Phu Chom Ngea Reserved Forest Conservation Model, Xiangngern District, LuangPrabang Province, Lao Peoples’s Democratic Republic

This study aimed to investigate problem conditions, recommendations for problem-solving, and the identification of an appropriate conservation model for the Phu Chom Ngae reserved forest. The locale of the study was at Xiang Ngern district, Luang Prabang province, Lao People’s Democratic Republic. Focus group discussion was used for data collection conducted with a sample group of three government officials in the area, five members of village forestry committee, five community leaders, and 13 focus group discussion participants. This study consisted of 3 parts: 1) data collection on problem conditions and opinions of officials and villagers to solve problems in the conservation of Phu Chom Ngae reserved forest (Descriptive data analysis); 2) creating a reserved forest conservation model; and 3) Assessment of Phu Chom Ngea reserved forest conservation Model. Results of the study revealed that the conservation problems in the Phu Chom Ngae reserved forest are at a high level (3.59). The following were found at a high level: People in the area, the community administrative organization, and the public sector agency, however, found the problem of conservation to be moderate: Context area and Forest conditions. The opinions of officials and villagers identified: 1) The community should realize the importance and necessity of being involved in forest conservation; 2) concerned agencies should promote occupational training; 3) prevention of forest encroachment by clear determination of the forest area; 4) strengthen community leaders; 5) training on knowledge about conservation; 6) continually instill awareness of forest conservation; 7) should have continual plans on projects implemented in the area; 8) government officials must take the regulations comprehensively and seriously. The Phu Chom Ngae reserved forest conservation model comprised the following: 1) driving force of stakeholders–the government, community administrative organizations and people in the area. 2) operation–3 important sector: The public sector-The former included budgets material equipment support, clear determination of the forest area, issuing regulations and training/education trip; community administrative organization-public relations, campaigning, being a coordinator with people and other agencies. The latter included people in the area-participate in forest conservation. 3) output-increased participate in the forest conservation. The model had been evaluated and approved by experts.

Sosialisasi dan Edukasi Alokasi Dana Desa kepada Aparatur Desa di Kabupaten Timor Tengah Selatan

Purpose: The purpose of implementing community service activities is to provide education to village officials so that they have an understanding of the complexity of village fund allocations and the ability to evaluate and analyze problems in village fund allocation management. Methodology: The implementation of this community service uses the focus group discussion (FGD) method. The partners involved were all village heads in the District of Timor Tengah Selatan, and the Dinas Pemberdayaan Masyarakat of Timor Tengah Selatan District. Participants were determined by non-probability by purposive sampling. Based on this technique, the number of FGD participants was 267 people. The mechanism for implementing FGDs consists of discourse and evaluations. Discourse are conducted through information sharing, knowledge sharing, and relations. Meanwhile, the evaluation of the results was carried out through a non-test method using a direct-open questionnaire. Results: The implementation of village fund allocation management in the village is still a problem and obstacle caused by the limited human resources of the village head, limited supporting infrastructure, limited guidance and assistance, capacity building activities for village officials who are not yet oriented to village needs, programming and policies that are not adaptive between interests. government to the village, and sectoral ego. Conclusion: The activities carried out can educate so that participants have knowledge of the management of village fund allocations. In addition, participants were able to evaluate problems and obstacles in implementing village funds, especially those related to the allocation of village funds. In addition, participants were able to reconstruct recommendations for improving the management of village fund allocations to village fund stakeholders, especially the government, from the village head itself to the central government level.

Knowledge, attitudes, and practices of Crimean Congo hemorrhagic fever among livestock value chain actors in Kagadi district, Uganda.

Crimean Congo hemorrhagic fever (CCHF) is a zoonotic tick-borne disease with an increasing number of outbreaks among communities in Uganda. Following the disease outbreak in the western district of Kagadi on 20th February 2020, a KAP survey was conducted to identify knowledge gaps and at-risk behaviors related to the disease among livestock value chain actors. A household survey using a semi-structured questionnaire was conducted in 399 households in the two sub counties of Bwikara and Ruteete, Kagadi district. A focus group discussion with members of the community was conducted as well as key informant interviews with at-risk individuals. Descriptive and inferential analysis was performed using STATA version 13 (Statacorp Texas; USA). Comparative analysis of the data from the two sub counties was also performed using cross tabulations in STATA, between each independent variable and the subcounty variable. The descriptive and comparative statistics used were minimum, mean and maximum values, standard deviations, frequencies, percentages, chi square values and t-statistics. A chi-square test was then employed on each tabulation, to determine whether there was an association between the two categorical variables or not. The test was set at an alpha level of 0.05, and where the p-value was less than or equal to the alpha value, we concluded that the 2 variables were associated. Although majority of the respondents believed in the existence of the disease, only 12.8% had knowledge of prevention measures against CCHF. 67.2% of the respondents reported regular interaction with ticks during routine farm operations and they employed tick control measures on their farms. Although the respondents believe the disease is fatal, almost all of them (99%) would welcome a CCHF survivor back into the community. 95.2% of the respondents actively attended to animals but only 25.8% participated in slaughtering animals. Qualitatively, the technical informants had knowledge about CCHF but non technical informants hardly knew about the disease. Limited funding appropriated for local governments, as well as limited engagement in One health activities were some of the barriers highlighted towards the infection prevention and control activities. Most of the focus group discussion participants knew about the disease, but lacked knowledge on its transmission and prevention. Limited access to personal protective equipment and high exposure to tick-prevalent areas when slaughtering and grazing animals respectively, were the major challenges highlighted. Knowledge on CCHF among majority of the respondents was poor. There is a need for educational programs to increase awareness of CCHF in communities. This awareness should be done by both the community leaders and technical people to ensure the community receives enough knowledge on how to prevent and control the disease. To ensure effectiveness of these programs a One health approach should be adopted to implement prevention and control strategies.

Misconceptions About Female Cancers Contributing to Late Presentation to Health Facilities in Ethiopia: A Qualitative Study.

Morbidity and mortality from female cancers is a major public health problem in low- and middle-income countries, including Ethiopia. More than three quarters of women visiting health facilities are diagnosed with late-stage cervical and breast cancer. Evidence reveals that misconception affects timely health seeking behavior which could have averted expensive treatment and poor survival. This study aimed to explore misconceptions about female cancers that may have contributed to late presentation of the problem to health facilities in Sidama region, Ethiopia. A descriptive qualitative study was carried out in June 2021. Nine focus group discussions (six with women and three with men) and 14 key informants were conducted. Data were collected using interview guide until all information get saturated. Data were inductively coded and qualitative content analysis was applied. A total of 63 (24 men and 39 women) people participated in this study. Nearly all (12) key informant interviewees have awareness about cervical and breast cancer, yet reported that their community members clearly lack awareness and they are working to improve misconceptions regarding cervical and breast cancer. The focus group discussion participants (15 men and 36 women) reported lack of detailed information related to cervical and breast cancer. Women believe that cervical and breast cancer mainly resulted from poor hygiene, trauma, having multiple sexual partners, early marriage, breast exposure to heat, not breast feeding, birth complication, urinating in the sun, hereditary, devil's intrusion and God's punishment. There were misconceptions among the community on what cervical and breast cancer mean, how they could happen, what the symptoms are, why and when to screen, when to seek health care and how to use modern treatment options. Therefore, we recommended the design of social and behavioral change strategies to address the misconceptions among different population groups.

The exploitation of Nigeria’s Chibok girls and the creation of a social problem industry

ABSTRACT Scholarship on the #BringBackOurGirls (#BBOG) movement mainly focuses on its success in generating global attention to the 2014 kidnapping of Nigeria’s Chibok girls. This paper focuses on an unintended consequence of the movement—the establishment of a social problem industry around the Chibok girls and their community. The paper draws on a dataset with over 160 interviewees and focus group discussion (FGD) participants, including 42 #BBOG activists. The findings demonstrate the interplay of contextually situated actors with particular values and interests engaged in claims-making regarding the Chibok girls. The #BBOG turned the Chibok kidnapping into a social problem in a sociological sense. In the process, the BBOG engaged in an ideational battlefield with three other entities. The paper contributes to the sociology of social problems by articulating weaknesses in social problem theory. This helps to suggest how to make social problems theory more applicable to developing world contexts. The paper’s approach avoids the unilinearism and determinism of existing theory. It argues that not all social problems are resolved in ways that are favourable to those affected. The exploitation of the Chibok girls and their community provides an example of the persistence of social problems: social problems are useful in appropriate hands.

Role of social media for sexual communication and sexual behaviors: A focus group study among young people in Nepal

Over the past decade, young people’s use of the social media has increased steadily in many countries including Nepal. Studies in other countries suggest that social media platforms can play an important role in facilitating sexual communication and relationships. This qualitative study comprising focus group discussions (FGDs), intends to explore: (a) perceptions of and motives toward social media re. sexual communication in educated unmarried young people in Nepal; and (b) their views of the link between social media and risky sexual behavior. We carried out eight FGD, four with young men and four with young women. FDGs were audio recorded, transcribed and thematically analyzed. All FGD participants were students (age range 15-22) from Kathmandu. Five themes emerged from the thematic analysis: a) use of and motives for using social media; b) sex education in general; c) sexual information through social media; d) social media’s role in forming romantic and sexual relationships; and e) negative experience of social media. Social media are popular among young people in Nepal and is considered as an important platform to access sexual health information. Young people also use these to establish romantic and sexual relationships, however, it doesn’t necessarily mean that social media are directly leading to unsafe sexual behaviors in young people. It is the lack of awareness and inadequate education about sex that is resulting in unsafe sexual practices. Overall, suggesting the need for more appropriate health promotion activities in the field sex and relationship education.

Students’ perception of problem-based learning at a Japanese medical school: an exploratory sequential mixed method

This study aimed to assess the perception of PBL among Japanese medical students. Learning effects and challenges of PBL from the students' viewpoint were assessed with an exploratory sequential mixed method. Focus group discussions followed by thematic analysis were conducted with 27 students and residents. Then a questionnaire survey was carried out. A total of 119 out of 258 students (46.1%) responded. The results from 24 questions were analyzed with a residual analysis. Thematic analysis extracted 14 themes from four discussion topics. The participants in focus group discussion regarded the PBL program as a better learning method than lectures. But some key phrases on the challenge of social interaction, including reluctance to actively discuss and collaborate with unfamiliar peers, were found. The questionnaire survey revealed a significantly lower adjusted standardized residual (ASR) for the positive response in five of six questions in the category of social interaction; improvement of communication skills (ASR = -3.303, n = 118, p < .001), enhancement of responsibility at group discussions (ASR = -2.078, n = 119, p = .038), building social networking (ASR = -3.006, n = 119, p = .003), becoming to sympathize with patients (ASR = -2.449, n = 119, p = .014) and understanding social aspects of clinical practice (ASR = -5.790, n = 119, p < .001). Conclusion: The Japanese medical students perceived PBL as an effective learning strategy. However, they had a problem with social interactions.

Qualitative and quantitative investigation into the indoor built environment of modular student housing: A multiple-room case study

Studies on the indoor built environment (IBE) of modular student housing (or dormitory/hostel) are scant. This study aims to investigate the IBE of a Dutch modular student housing using a research approach that integrates both IBE performance data and occupants’ perception for synthetic analysis. In the first stage, based on grounded theory, a focus group discussion (FGD) was conducted to capture occupants’ perceptions of the IBE of the student housing. With thermal quality and indoor air quality (IAQ) revealed from the FGD as the most critical IBE factors, a field study was carried out to measure the temperature, relative humidity, and CO2 concentration in the apartments of the FGD participants; meanwhile, the participants’ ventilation control behaviours were logged. Statistical analysis was carried out and the results suggested significant differences between the five sampled apartments in temperature and CO2 concentration. Furthermore, the logged behaviour data revealed that both room orientation and occupant behaviour have significant impacts on the thermal quality and IAQ. This study unveiled the correlation between the IBE and the occupant behaviour, and the methodology developed can be applied to investigate more modular student housing in future, for enhancing their design and management.

Racial/ethnic disparities in influenza risk perception and vaccination intention among Pima County residents in Arizona

ABSTRACT While influenza cases in Arizona have nearly tripled since 2018, vaccination rates continue to lag. Statewide, Hispanics and African Americans had the lowest vaccination rates despite having higher influenza infection rates than Whites. Given Arizona’s racial influenza vaccination disparity and the general increase in vaccination hesitancy due to COVID-19, the purpose of this study was to better understand the influences of seasonal influenza vaccination in Arizona during the COVID-19 pandemic using qualitative methods. Findings from this study revealed that many participants were motivated to get the influenza vaccine to protect their family and close friends. The heightened concern for COVID-19 prompted some Hispanic/Latino focus group discussion participants to consider getting vaccinated. However, many Hispanic/Latino participants also expressed that they stopped getting influenza vaccine due to negative vaccination experiences or concern about sickness following immunization. African American participants primarily discussed receiving the vaccine as part of their routine health visit. Compared to other races, more White participants believed that vaccination was unimportant because they were healthy, and the people they interacted with never got sick. Distinct factors influence risk perception and vaccination intention across different racial/ethnic groups. Effective interventions can account for these factors and be tailored to the target population to maximize vaccination uptake.

Integrated Participatory Approach Reveals Perceived Local Availability of Wild Edible Plants in Northwestern Kenya

Availability is a crucial aspect of wild edible plants (WEPs) consumption by indigenous communities. Understanding the local perception of this availability helps to determine, which contribution WEPs can make to rural communities. We used an integrated participatory approach to investigate important parameters and themes that influenced the perception of availability of woody WEPs. We demonstrate the approach in three communities in Turkana County, Kenya. By availability, we referred to the ease of accessing, harvesting, transporting, and processing WEPs for consumption. We conducted three focus group discussions (FGDs). We asked FGD participants to list, score, and discuss availability. We used logistic regression and mixed-content analysis to identify important parameters and themes, respectively. The most important WEPs were the toothbrush tree (Salvadora persica L.), Indian jujube (Ziziphus mauritiana Lam.), and mbamba ngoma (Balanites rotundifolia (Tiegh.) Blatt.). Distance, seasonality, price, and adequacy of harvested WEPs for household consumption were important parameters. Culture and tradition, distribution of WEPs, seasonality, and climate change emerged as important themes. We showed the importance of using an integrated participatory approach when assessing the perception of WEPs’ availability by local communities and could be used in comparable arid and semi-arid areas with semi-nomadic pastoralists across Africa.

Community Knowledge, Perceptions and Experiences on Healthcare Services for Malaria Prevention and Treatment in the Okavango Delta, Botswana.

This paper analyses community knowledge, perceptions, and experiences of effectiveness of healthcare service provision on malaria prevention/treatment in two disease-endemic villages of the Okavango Delta panhandle in northern Botswana. A stratified random sampling of 355 households was conducted in October-November 2015. Follow-up retrospective cohort interviews were undertaken in August 2016 from 79 households that reported malaria incidences during the household survey. Data were also collected from 16 key informant interviews and 2 focus group discussions participants. Descriptive statistics and content analyses were used to summarise quantitative and qualitative data, respectively. Results indicate that communities in the study sites had positive perceptions about efficiency of health services based on availability, accessibility and utilization, adequacy of prevention and treatment interventions. Local health clinics were crucial information channels used by respondents. Additionally, factors related to acceptability, availability and accessibility are likely to contribute to perceived effectiveness of the interventions provided by healthcare service providers. Affirmation of efficiency health service provision against malaria has public health implications for adherence to treatment/prevention and participation in community health education campaigns and program implementation in the Okavango Delta region.

"It Will Lead You to Make Better Decisions about Your Health"-A Focus Group and Survey Study on Women's Attitudes towards Risk-Based Breast Cancer Screening and Personalised Risk Assessments.

Singapore launched a population-based organised mammography screening (MAM) programme in 2002. However, uptake is low. A better understanding of breast cancer (BC) risk factors has generated interest in shifting from a one-size-fits-all to a risk-based screening approach. However, public acceptability of the change is lacking. Focus group discussions (FGD) were conducted with 54 women (median age 37.5 years) with no BC history. Eight online sessions were transcribed, coded, and thematically analysed. Additionally, we surveyed 993 participants in a risk-based MAM study on how they felt in anticipation of receiving their risk profiles. Attitudes towards MAM (e.g., fear, low perceived risk) have remained unchanged for ~25 years. However, FGD participants reported that they would be more likely to attend routine mammography after having their BC risks assessed, despite uncertainty and concerns about risk-based screening. This insight was reinforced by the survey participants reporting more positive than negative feelings before receiving their risk reports. There is enthusiasm in knowing personal disease risk but concerns about the level of support for individuals learning they are at higher risk for breast cancer. Our results support the empowering of Singaporean women with personal health information to improve MAM uptake.