Positive Social Norms Research Articles

‘Walking in two worlds’: A qualitative review of income management in Cape York

AbstractThe Cape York Welfare Reform (CYWR) initiative aims to reduce ‘passive dependence’ on welfare and restore ‘positive social norms’ to revitalise cultural and social networks and support economic engagement in Indigenous communities in the Cape York Region of Australia. Critics of the initiative and, in particular, its income management (IM) policies have associated it with a broader neoliberal reform agenda that delineates social ‘problems’ from their historical and structural context. This paper discusses key qualitative findings from a strategic review of CYWR, paying particular attention to the ways in which Cape York IM (CYIM) straddles both Indigenous and settler social norms, while perpetuating neoliberal conceptualisations of welfare ‘dependency’. We situate these findings within the existing literature on Australia's other IM models and also consider them in relation to subsequent government responses to the review and associated policies. We argue that CYIM represents a unique initiative, the subtle nuances of which have been largely ignored or misunderstood by critics. Further, we conclude that any extension or revision of this initiative should be considered with respect to deep and wide‐ranging consultation of the Indigenous communities subject to CYWR. However, such consultation has not been the standard practice in Australian contexts.

Thinking and rethinking the child protection system. Mentoring, an unexplored enough resource

Site-based youth mentoring programs provide a unique context for positive youth development. Conceptually, youth derive benefit not only from the mentor alliance (i.e., youths’ feelings of compatibility with the mentor and satisfaction with the mentoring relationship), but also from their sense of belonging within the program. This paper is based on an international Erasmus + project, titled Now What?: Preparing and Empowering Youth Leaving Care Now What?: Preparing and Empowering Youth Leaving Care, implemented in four European countries (Albania, Greece, Portugal and Romania). One of the major components on the project was to develop a mentoring protocol which was applied in all four countries in the partnership. The results shown us, as anticipated, youth in the high mentor alliance-high belonging group described contributive experiences consistent with high-quality mentor characteristics (e.g., empathy, acceptance) and high-quality settings (e.g., positive social norms, support for efficacy and mattering). In contrast, youth in the low mentor alliance-low belonging group described mentors who were insensitive and noted difficulty connecting with peers.

Fear of analgesic side effects predicts preference for acupuncture: a cross-sectional study of cancer patients with pain in the USA.

Approximately one in two cancer patients globally are under-treated for pain. Opioids and other analgesics represent the mainstay of cancer pain management; however, barriers to their use are well-documented. We evaluated whether acupuncture would be a preferable treatment option among cancer patients with attitudinal barriers to pharmacological pain management. We conducted a cross-sectional survey of cancer patients at a tertiary urban cancer center and eleven suburban/rural hospitals in the Northeastern United States. We assessed attitudinal barriers to pharmacological pain management with the Barriers Questionnaire (BQ-13). The BQ-13 consists of two subscales: pain management beliefs and analgesic side effects. We also asked patients whether they prefer acupuncture, analgesics, or have no preference between these two modalities for pain management. Covariates included sociodemographics, clinical characteristics, and attitudes/beliefs about acupuncture. We used logistic regression to examine the association between attitudinal barriers and acupuncture preference. Among 628 patients, 197 (31.4%) preferred acupuncture for pain management, 146 (23.3%) preferred analgesics, and 285 (45.4%) had no preference. The highest reported attitudinal barriers were fear of addiction and fear of analgesic-associated constipation and nausea. Adjusting for covariates, we found that attitudinal barriers related to fear of analgesic side effects were significantly associated with acupuncture preference (adjusted odds ratio [AOR] 1.45, 95% confidence interval [CI] 1.17-1.81), but barriers related to pain management beliefs were not (AOR 1.17, 95% CI 0.91-1.51). Attitudes/beliefs about acupuncture (i.e., greater expected benefits, fewer perceived barriers, and more positive social norms) and female gender also predicted acupuncture preference, whereas race and educational status did not. Acupuncture may be a preferable treatment option among cancer patients at risk of inadequately controlled pain due to fear of analgesic side effects. Evidence-based integration of acupuncture and analgesics, guided by patient treatment preferences, represents an essential aspect of patient-centered care and has potential to address unmet cancer pain management needs.

Adolescents’ experiences of mentor alliance and sense of belonging in a site-based mentoring intervention

Site-based youth mentoring programs provide a unique context for positive youth development. Conceptually, youth derive benefit not only from the mentor alliance (i.e., youths’ feelings of compatibility with the mentor and satisfaction with the mentoring relationship), but also from their sense of belonging within the program. Using an exploratory sequential design, the purpose of this study was to illustrate the lived experiences of youth engaged in a site-based mentoring program. To draw distinctions in youths’ experiences, we purposively sampled and interviewed 76 youth (ages 11–18; 60.5% male) in one of four subgroups based on self-reported survey data: high mentor alliance-high belonging, high mentor alliance-low belonging, low mentor alliance-high belonging, and low mentor alliance-low belonging. As anticipated, youth in the high mentor alliance-high belonging group described contributive experiences consistent with high-quality mentor characteristics (e.g., empathy, acceptance) and high-quality settings (e.g., positive social norms, support for efficacy and mattering). In contrast, youth in the low mentor alliance-low belonging group described mentors who were insensitive and noted difficulty connecting with peers. Difficulty connecting with peers was also a salient barrier for youth in the high mentor alliance-low belonging group. Finally, absent from the experiences of youth in the low mentor alliance-high belonging group was mentor empathy, acceptance, and authenticity. Our findings describe experiences that contribute to mentor alliance and sense of belonging in a site-based youth mentoring program, noting the challenge facing similar programs, which is to attend simultaneously to mentor and setting quality.

Stigma, Opioids, and Public Health Messaging: The Need to Disentangle Behavior From Identity.

Stigma plays an important role in understanding successful interventions to control the opioid epidemic in the United States. Stigma has been described both as an agent to incentivize positive health behavior and as an agent of marginalization contributing to poorer health. Past scholarship has argued that stigma has positively motivated public health changes, for example, among tobacco users; it has also been associated with discrimination against vulnerable individuals, resulting in increasingly poorer health behaviors, for example in relation to HIV-prevention messaging.The discourse on stigma may conflate the denormalization of unhealthy behaviors with wholesale rejection of individual identities. More effective interventions would counter stigma against people who use opioids in general and specifically denormalize opioid misuse. These interventions might alter the effect of public health messaging and ultimately improve outcomes.We argue that public health educators and communication campaigns can contribute to positive social norm change and motivate healthy behaviors by incorporating strategies that attempt to disentangle unhealthy behaviors from identity.

Investigating Mechanisms for Maternal Education Disparities in Enacting Health-Promoting Infant Care Practices.

Although higher education and healthier practices are positively associated, the explanatory mechanisms for this association remain unclear. The purpose of this study was to better understand mechanisms underlying this association by examining maternal adherence to 2 health-promoting infant care practices: supine placement and breastfeeding. We analyzed nationally representative data from the Study of Attitudes and Factors Effecting Infant Care, which surveyed US mothers after infant birth and 2 months thereafter. Using the Theory of Planned Behavior as a framework, we used structural equation models to elucidate mediational pathways from maternal education to supine infant placement or any breastfeeding. Data from 3297 mothers demonstrated 77.0% of infants usually were placed supine, and 57.8% received any breastfeeding. The overall direct effect of maternal educational level on supine placement and any breastfeeding was odds ratio (OR) 1.31 (95% confidence interval [CI] 1.11-1.54) and OR 2.82 (95% CI 2.35-3.37), respectively. In pathway analyses, the strongest associations with both supine position and breastfeeding were seen with positive attitudes (supine: aOR 18.96, 95% CI 9.00-39.92; breastfeeding: aOR 3.86, 95% CI 2.19-6.82) and positive social norms (supine: aOR 6.69, 95% CI 4.52-9.89; breastfeeding: aOR 5.17, 95% CI 4.28-6.23). Mothers with more education had higher odds of both positive attitudes and positive norms for the 2 practices. The associations linking educational attainment with health practices are intricate, with multiple mediating pathways. Attitudes and social norms are powerful forces that mediate the association between maternal educational attainment and both infant supine positioning and breastfeeding, and may be important mediators for other health behaviors.

The source of punishment matters: Third-party punishment restrains observers from selfish behaviors better than does second-party punishment by shaping norm perceptions

Punishment aims to deter individuals’ selfish behaviors, but it can occasionally backfire. Some scholars have proposed promoting prosocial behaviors using punishment that communicates positive social norms because it provides additional motivation. However, it is unclear which factors affect the norm expressive function of punishment. This study proposes that third-party punishment communicates more positive normative information, and thus, promotes more prosocial behavior in observers than does second-party punishment. Using dictator games, we investigated the effects of second-party punishment compared to third-party punishment of another’s unfair sharing on observers’ norm perceptions and subsequent sharing decision-making. Two experiments consistently found that third-party punishment was more effective than second-party punishment at inducing observers’ beliefs that unfair distribution was unusual (descriptive norm) and unacceptable (injunctive norm). The altered descriptive but not injunctive norm perception further guided individuals’ own sharing behaviors. Taken together, these results suggest that third-party punishment might be better than second-party punishment at decreasing selfish behaviors by shaping individuals’ norm perceptions, especially descriptive norm perception, regarding the relevant behaviors.

Autobiographical memory functions: an emancipatory approach to construct environmental education outcomes

In this study, we assessed how 34 young adult participants in an environmental education (EE) program from 2011 to 2014 constructed their learning outcomes through interviews and the exploration of autobiographical memory functions (AMFs) regarding program experiences. We articulated a variety of directive, social, and self AMFs, including the achievement of the top five typical objectives of EE, increase in positive social norms through reminiscing and sharing memories, and attainment of diverse personal growth. We also constructed the relationship of these outcomes with the ultimate objective of EE. This method can presumably be used to emergently construct outcomes for evaluating emancipatory EE programs, which are on the request of tackling wicked environmental problems.

Poly-Strengths and Peer Violence Perpetration: What Strengths Can Add to Risk Factor Analyses

Adolescence is a high-risk time for perpetration of different forms of peer-based violence including harassment, bullying, and sexual assault. Research documents a number of important risk factors but less understood are protective factors like sense of mattering or how combinations of strengths may reduce perpetration risk. The current study examined how protective factors (i.e., positive social norms), including a diversity of strengths (termed poly-strengths), influenced the perpetration of harassment, bullying, and sexual assault for young people, while accounting for the use of alcohol both cross-sectionally and over time. Youth (N = 2232, 52.6% female) in grades 7-10 enrolled in a study using active parental consent (53% response rate) and completed online surveys in school that asked about bullying and harassment, alcohol use, positive social norms related to violence prevention, and a composite of intra-personal strengths. Follow-up surveys took place 6 months later (N = 2150). Logistic regression analyses examined how social norms and poly-strengths influenced odds of perpetration after accounting for demographic variables and the risk factor of alcohol use. Use of alcohol increased the odds of perpetrating all forms of violence. Strengths were significantly related to lower perpetration at Time 1 but not Time 2. Positive social norms reduced perpetration at both time points. The findings suggest adolescent perpetration of bullying, harassment, and sexual violence is lower in the presence of positive social norms over time and more proximally, in the presence of a diverse strengths portfolio. Prevention efforts that incorporate positive social norms and alcohol reduction strategies may reduce peer violence.

School Social Capital and Tobacco Experimentation Among Adolescents: Evidence From a Cross-Classified Multilevel, Longitudinal Analysis

PurposeSchool social capital incorporates the intangible prosocial resources from social networks, including expectations and social norms, found in a school environment. School social capital may influence health behaviors such as smoking. This study examined the association of school social capital with smoking behaviors from childhood into adolescence. MethodsWe used a cohort sampled from three U.S. cities for the Healthy Passages Longitudinal Study of Adolescent Health. The primary outcome was cigarette smoking at grade 10 (Wave 3). The primary predictor of interest was school social capital at grade 5 (Wave 1). We included potential covariates at the individual, school, and neighborhood levels at Wave 1. To account for simultaneous clustering in schools and neighborhoods, cross-classified multilevel models were used. ResultsAfter exclusions and imputations for missing variables, our final sample contained 3,968 students as constituents of 118 schools and 479 neighborhoods. With adjustment for the covariates, school social capital for grade 5 was negatively associated with cigarette smoking in grade 10. We estimated that a 1 standard deviation increase in the school average social capital for grade 5 is associated with an odds ratio of .86 (95% credible interval: .75–.98) for school-level smoking in grade 10. ConclusionsThis study suggests that school social capital in late elementary years is associated with reduced smoking behaviors among adolescents in the U.S. Influencing school social capital through enrichment of positive social norms and parent/teacher expectations may be a useful strategy to reduce adolescent smoking, with long-term implications for adult health.

A longitudinal study on the relationship between screen time and adolescent alcohol use: The mediating role of social norms

Background and aimsIt has been proposed that increased screen time contributes to increasing rates of adolescents abstaining from alcohol use. We argue that this proposition depends on the extent to which a type of screen time promotes social norms. We examined whether social norms mediated the association between alcohol use and i) social media, ii) television, and iii) video gaming. DesignMultilevel models distinguishing between two time-varying factors: between-person effects and within-person effects. We used data from a randomized-controlled trial examining the efficiency of a personality-targeted substance use programme. Participants3612 adolescents (47% female, mean age = 12.7, SD = 0.5 years) were recruited from 31 schools in the Greater Montreal area. MeasurementsWe estimated the association between three types of screen time (social media, television, and video gaming), alcohol-related social norms, and alcohol use. FindingsSocial norms mediated the association between social media use and alcohol use at both the between-person (β = 0.09, 95% CI = 0.08, 0.11, p = .000) and within-person level (β = 0.02, 95% CI = 0.01, 0.03, p = .000) and association between television use and alcohol use at the within-person level (β = 0.01, 95% CI = −0.004, 0.01, p = .000). Social norms did not mediate the association between video gaming and alcohol use. ConclusionsAlcohol-related social norms were shown to mediate the association between social media use, both at a correlational and longitudinal level, and the association between alcohol use and television use and alcohol use, at a longitudinal level, which may imply that these promote positive social norms towards alcohol use, subsequently increasing adolescents' drinking behaviour.

Association of social network factors with weight status and weight loss intentions among hispanic adults.

Hispanic adults have the highest obesity prevalence in the United States, but little is known about weight-related social network influences. A community-based sample of 610 Hispanic participants completed height/weight and a survey. The proportion of overweight or obese (OW/OB) network members was higher for OW/OB respondents compared to normal weight respondents. Participants with high weight loss intentions reported more positive social norms for weight control, social support, and social cohesion. If most or all of OW/OB participant's social contacts were trying to lose weight, the odds that they were likely to try to lose weight was four times higher than other participants. The relationship between weight loss intentions and number of social contacts trying to lose weight was strongly mediated by social norms for weight control and social support. These results suggest that social contacts and functional network characteristics may impact weight status and weight control intentions among Hispanic adults.

Information Diffusion and Social Norms Are Associated with Infant and Young Child Feeding Practices in Bangladesh

BackgroundInteraction within mothers’ social networks can theoretically diffuse messages from interventions and campaigns into norms and practices for infant and young child feeding (IYCF).ObjectivesWe hypothesized that mothers’ social networks, diffusion of information, and social norms differed in intensive [intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM)] compared with nonintensive (standard IPC and less-intensive CM and MM) intervention areas, were associated with IYCF practices, and partly explained practice improvement.MethodsWe conducted household surveys at endline in 2014 and follow-up in 2016 (n = ∼2000 each round). We used multiple regression to test differences and changes in networks, diffusion, and norms within intervention areas. We analyzed paths from intervention exposure to IYCF practices through networks, diffusion, and norms.ResultsMothers’ networks were larger in intensive than in nonintensive areas in 2014 and increased in both areas over time [25–38 percentage points (pp)]. The prevalence of receipt of IYCF information was high, with no changes over time in intensive areas but an increase in nonintensive areas (8–16 pp). In both areas, more family members and health workers provided IYCF information over time. Sharing of information increased 17–23 pp in intensive and 11–41 pp in nonintensive areas over time. Perceived descriptive norms improved 8–16 pp in intensive and 17–28 pp in nonintensive areas. Perceived injunctive norms were high in both areas. Breastfeeding practices were associated with networks, diffusion, and norms (OR: 1.6–4.4 times larger comparing highest with lowest quartile). Minimum dietary diversity was associated with larger networks and diffusion (OR: 1.5–2.2) but not with social norms. Indirect paths from intervention exposure to practices explained 34–78% of total effects.ConclusionsDiffusion of IYCF information through social networks, reinforced by positive social norms for messages promoted over time, will contribute to positive changes in IYCF practices that may be achieved and sustained through large-scale social and behavior change interventions. This trial was registered at clinicaltrials.gov as NCT0274084.

TRANSITION FACTORS TO LOW CARBON COMMUNITY - ENGAGEMENT INITIATIVE FOR SLUM COMMUNITIES

Thailand has been classified as one of the ten countries that are at high risk for long-term climate change due to greenhouse gas emission, directly connected with the population size and urbanization. In 2019, Bangkok has 2,070 communities, one-third are slum communities with increasing greenhouse gas emissions. This research proposes a set of potential factors influencing community engagement initiatives to achieve a low carbon community in slum areas. The case studies on four slum communities in Bangkok by qualitative research found that the factors influencing the strength of engagement and the factors influencing the community motivation to achieve low carbon communities are still low. Consequently, this research provides new guidelines with four practical activities; (1) promoting the creation of an internal community network that can contribute to trust and positive social norms (2) promoting greenhouse gas emission reducing behaviors and adjusting attitudes toward climate change issues and (3) promoting proper relationships between the Bangkok Metropolitan Administration (BMA) and the communities.

Using the theory of planned behavior to understand intentions to perform bystander CPR among college students

Objective The purpose of this study was to determine the extent to which the Theory of Planned Behavior (TPB) accounts for variability in intention to perform cardiopulmonary resuscitation (CPR) and to explore which constructs in the TPB most strongly predict intention to perform CPR among college students. Participants: Undergraduate college students (N = 588, 51% women) recruited between September and November 2016. Methods: A cross-sectional survey design. Results: Attitude was the strongest predictor of intention to perform CPR (β = 0.381, p < .001), followed by subjective norm (β = 0.303, p < .001), and perceived behavioral control (β = 0.167, p < .001). The TPB accounted for 51% of the variance in intention to perform CPR (F[3, 536] = 186, p < .001). Conclusion: Attitude and subjective norm are the strongest predictors of intention to perform CPR among college students. Resuscitation trainings that highlight positive outcomes and social norms associated with performing CPR may help bystanders form intentions to perform CPR in an emergency.

Perceived social norms, psychological capital and entrepreneurial intention among undergraduate students in Bukavu

PurposeEntrepreneurship is important for economic growth, through its role in the provision of employment. In the recent past, a number of African universities have developed entrepreneurship education courses to facilitate the growing demand for entrepreneurs in the market. An immediate outcome anticipated from entrepreneurship education is to increase entrepreneurial intention (EI) among the participants. Unfortunately, most of the entrepreneurship education in developing economies has not been linked to an increase in the EI of students. This paper thus proposes that it is when students possess high levels of psychological capital and perceive positive social norms that entrepreneurship education will lead to positive EI. The purpose of this paper is to establish the relationship between perceived social norms (PSN), psychological capital and EI of university students.Design/methodology/approachQuantitative data were collected through a self-administered questionnaire on a random sample of 196 final year entrepreneurship and business management students, from three universities in Bukavu (East of DRC). Structural equation modeling was used to test the research hypotheses.FindingsThe paper provides four main findings. First, PSN and psychological capital have a positive significant effect on EI. Second, PSN contribute more to this effect than psychological capital. Third, PSN make a positive and significant effect on psychological capital. Lastly, psychological capital positively mediates the relationship between PSN and EI.Research limitations/implicationsThis study could have benefited from a qualitative approach to have a more in-depth explanation of these relationships. The study is conducted amongst students who operate in a controlled environment. This may not reflect the actual behavior of entrepreneurs.Practical implicationsThis work provides cues of what entrepreneurship educators should consider as they recruit and train students. Specifically, the study highlights the importance of students’ psychological capital and positive social norms in transforming entrepreneurial education into intention.Originality/valueThis study adds value to knowledge by highlighting the mediating role of psychological capital on the relationship between PSN and EI.

How the older population perceives self-driving vehicles

Self-driving vehicles (SAE Level 5) are driven by automated vehicle technology and without any human driver input. These vehicles will especially be helpful to people who cannot drive, whether for medical- or age-related reasons. Since the current population of older Americans is the largest it has ever been, it is important to study transportation needs for older population and the potential of self-driving vehicles to solve their mobility problems. This study investigated older adults’ (aged 60 and over) perception of self-driving vehicles from the perspective of users and pedestrians. Five factors were measured to assess older adults’ perception including attitude, perceived usefulness, social norm, trust, and compatibility. Older adults’ willingness to use a self-driving vehicle, defined as acceptance, was also assessed. Data collection (N = 173) was done using an online survey approach. The results show that older adults perceive self-driving vehicles with positive attitude, perceived usefulness, trust, social norm, and acceptance as users. However, as pedestrians, the perception was either neutral or negative, except for the positive perceived usefulness. The results also revealed that if the older adults are familiar with self-driving vehicles, they are more likely to have a favorable perception of them. These results indicate great potential for the adoption of self-driving vehicles by older adults. However, they also raise concern about the interaction between older pedestrians and self-driving vehicles. The findings of this study will be helpful to developers in designing vehicles that meet the transportation needs of older adults and allow effective interaction between them and the vehicles.

Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence

BackgroundMass media campaigns can be used to communicate public health messages at the population level. Although previous research has shown that they can influence health behaviours in some contexts, there have been few attempts to synthesise evidence across multiple health behaviours.ObjectivesTo (1) review evidence on the effective use of mass media in six health topic areas (alcohol, diet, illicit drugs, physical activity, sexual and reproductive health and tobacco), (2) examine whether or not effectiveness varies with different target populations, (3) identify characteristics of mass media campaigns associated with effectiveness and (4) identify key research gaps.DesignThe study comprised (1) a systematic review of reviews, (2) a review of primary studies examining alcohol mass media campaigns, (3) a review of cost-effectiveness evidence and (4) a review of recent primary studies of mass media campaigns conducted in the UK. A logic model was developed to inform the reviews. Public engagement activities were conducted with policy, practitioner and academic stakeholders and with young people.ResultsThe amount and strength of evidence varies across the six topics, and there was little evidence regarding diet campaigns. There was moderate evidence that mass media campaigns can reduce sedentary behaviour and influence sexual health-related behaviours and treatment-seeking behaviours (e.g. use of smoking quitlines and sexual health services). The impact on tobacco use and physical activity was mixed, there was limited evidence of impact on alcohol use and there was no impact on illicit drug behaviours. Mass media campaigns were found to increase knowledge and awareness across several topics, and to influence intentions regarding physical activity and smoking. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. The evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.LimitationsStatistical synthesis was not possible owing to considerable heterogeneity across reviews and studies. The focus on review-level evidence limited our ability to examine intervention characteristics in detail.ConclusionsOverall, the evidence is mixed but suggests that (1) campaigns can reduce sedentary behaviour, improve sexual health and contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective.Future workFuture work could fill evidence gaps regarding diet mass media campaigns and new-media campaigns, examine cost-effectiveness in areas other than tobacco and explore the specific contribution of mass media campaigns to multicomponent interventions and how local, regional and national campaigns can work together.Study registrationThis study is registered as PROSPERO CRD42015029205 and PROSPERO CRD42017054999.FundingThe National Institute for Health Research Public Health Research programme.

Should We Activate Risk Perceptions in the Context of Suicide Prevention? Examining Fear Appeals, Help-Seeking Determinants, and Help-Seeking Sources Among University Employees Who Suffer from Depression.

Health promotion strategies have largely focused on activating risk perceptions for health conditions in resistant at-risk populations in order to induce behavior change. Yet, doing so remains a questionable approach when promoting help-seeking behaviors among individuals who suffer from depression because clinical symptoms can negatively affect interpretations and responses to such efforts. This study sought to test the effects and effectiveness of risk-based health messaging utilizing fear appeals on help-seeking determinants, intentions, and sources. One hundred seventeen university employees affected by symptoms of depression were recruited to participate in a lab-based experimental setting. Participants were randomly assigned to one of three message conditions that differed in strength of fear appeal (low, moderate, high) when inducing suicide risk perceptions and promoting help-seeking. Consistent with previous research, participants indicated high stigma perceptions and low intentions to seek help. Risk-based messaging strategies such as fear appeals did not have an effect on help-seeking intentions in this sample. Intentions were largely determined by positive outcome expectations and social norms, whereas efficacy perceptions were positive and not a predictor of help-seeking intentions. Participants were most likely to seek help from intimate partners and friends and least likely to utilize a help-line. Health promotion messages should contain cues that activate, rather than change, the already positive outcome expectations of seeking help when targeting at-risk populations. Future research should explore possibilities for health promotion and education among support networks of those who suffer from depression and anxiety.

A rite of passage: a mixed methodology study about knowledge, perceptions and practices of menstrual hygiene management in rural Gambia

BackgroundAppropriate menstrual hygiene management (MHM) is impeded by taboos and secrecy surrounding menstruation. Unhygienic menstrual practices and unpreparedness for managing menstruation has been associated with adverse health and social outcomes among adolescent girls. In The Gambia, there is limited data on menstrual practices among girls and women in rural communities and the sources of information about menstruation for the adolescents. This study aimed to explore knowledge, preparedness and practices of menstruation and its management among adolescents, mothers and teachers in rural Gambia.MethodsA mixed methods study was conducted in the rural Kiang West district of The Gambia. Twenty focus group discussions and thirteen in-depth interviews were conducted among mothers, adolescents and teachers to explore their views on menstruation, cultural beliefs, sources and level of knowledge on menstruation and MHM practices. In addition, a survey was done among 331 school girls to assess their knowledge, practices and attitudes of menstruation and its management. Inductive content analysis was used to analyse the qualitative data, and descriptive analysis and chi-squared tests were used to analyse quantitative data.ResultsAll participants had different levels of knowledge about menstruation. Knowledge score was higher among post-menarche girls compare with pre-menarche girls (p = 0.0001). All groups expressed difficulties, embarrassment and shame in relation to discussing menstruation. Two thirds of the surveyed girls reported having learnt about menstruation before menarche, however at menarche most felt unprepared. Teachers were the main source of information, but when asking for advice most girls preferred to ask their mothers. Mothers reported facing difficulties in discussing menstruation with their children and felt that boys did not need to be taught about it, however boys were very curious to know about. Most girls used reusable cloth unless they are given free pads from school.ConclusionTaboos, secrecy and embarrassment associated with discussing menstruation hinder adolescents from seeking advice from parents and teachers on appropriate MHM practices. Strategies to encourage positive social norms towards menstruation would help to promote more open discussions about it at the family, community and national level, which will support improvements in MHM in this and similar communities in low and middle income settings.