Socio-ecological Framework Research Articles

Surgical informed consent practices and influencing factors in sub-Saharan Africa: a scoping review of the literature

IntroductionCurrent international standards in consent to surgery practices are usually derived from health systems in Western countries, while little attention has been given to other contexts such as sub-Saharan Africa...

Experts' perceptions on motivators and barriers of healthy and sustainable dietary behaviors among adolescents: The SWITCH project

The interplay of influences shaping dietary behaviors of adolescents needs to be well-understood to develop effective strategies stimulating healthy and sustainable behaviors. This study aimed to identify the most relevant, urgent, changeable and effective motivators and barriers of healthy and sustainable dietary behaviors among adolescents (10–19 years), as perceived by an inter- and transdisciplinary expert panel. Experts working in practice (N = 19) and academia (N = 13) – in the field of sustainability, health, nutrition and/or education – participated in this exploratory mixed-methods study. Five online semi-structured focus groups were conducted (6–7 participants). Data was thematically analyzed by two coders independently, using the socioecological framework. Subsequently, the same experts individually selected the five most relevant determinants and rated those on their urgency, changeability and effectiveness through an online questionnaire (N = 21). Participants revealed a wide system of 31 main determinants including 173 sub-determinants that motivate or hinder healthy and sustainable eating among adolescents. This system of determinants was mapped on the different layers of the socioecological model: individual factors (25 motivators; 30 barriers), social environments (15 motivators; 13 barriers), physical environments (18 motivators; 15 barriers), macro-level environments (19 motivators; 38 barriers). ‘Role of peers' (social environment) was selected most as a determinant to be targeted in interventions (N = 13; urgency (M = 6.38) changeability (M = 3.85), effectiveness (M = 5.62)), followed by ‘food environment around school' (N = 9; urgency (M = 5.78) changeability (M = 3.44), effectiveness (M = 5.44)), ‘social influences' (N = 7; urgency (M = 5.43) changeability (M = 4.00), effectiveness (M = 5.71)), ‘autonomy in development' (N = 7; urgency (M = 6.00) changeability (M = 4.29), effectiveness (M = 5.86)) and ‘food availability' (N = 7; urgency (M = 6.29) changeability (M = 3.29), effectiveness (M = 6.29)). The prioritized determinants indicate that adolescents should be provided more supportive social and physical environments that promote healthy and sustainable dietary behaviors, taking into account their growing autonomy.

TRAUMA AND RESILIENCE AMONG DIRECT CARE WORKERS IN NURSING HOMES

Abstract Direct Care Workers (DCWs) face persistent challenges with low pay, few benefits, heavy workloads, and limited access to paid leave. Experiences associated with COVID-19 have increased the precarity of the long-term care system and have increased DCW’s vulnerability. Against the backdrop of systemic racism and political turmoil, DCWs experience high rates of health risks (e.g., burnout, anxiety disorders, depression, and post-traumatic stress disorders) leading to a reduced quality of life. Building resilience within this workforce requires understanding the protective factors, at the community, organizational, and individual levels, to manage demanding work and personal lives. Yet, existing scholarship on how to build trauma-resilient organizations and identify and cultivate individual DCW strategies to support workers remains limited. Using a socio-ecological framework, the aim of this exploratory study was two-fold: (1) examine DCWs understanding of trauma and how it affects their ability to provide care, and (2) understand the strategies and supports DCWs use to cope with trauma and what it means to be resilient. Using purposive and convenience sampling techniques, participants were recruited into the study. Semi-structured interviews with nursing assistants in nursing centers (n=25) were used to gather data and analyzed using modified grounded theory. Findings demonstrate that the impact of COVID-19, work stress, and systemic inefficiencies negatively impact care work and DCWs’ experiences. The study identified strategies that long-term care employers and government agencies can adopt to support resilience-building and ultimately empowerment practices. Implications for retention and support for staff from diverse backgrounds are also discussed.

MULTILEVEL LIFESTYLE INTERVENTIONS ARE NEEDED TO IMPROVE DIABETES SELF-MANAGEMENT IN OLDER ADULTS

Abstract Type 2 diabetes (T2D) is a major public health concern in older adults. Physical activity (PA) and healthy eating (HE) are two major lifestyle intervention strategies in diabetes self-management for controlling glucose levels, preventing complications, and improving functionality and quality of life. This qualitative study aimed to explore perceived factors influencing PA and HE among predominately Latino older adults with T2D ((age=70.5±4.8; Latinos=73.3%). We conducted semi-structured interviews with 15 community dwelling older adults with T2D at the end of a 12-week pre- and post- study assessing self-monitoring on lifestyles and health outcomes. All interviews were recorded and transcribed. Two researchers analyzed the data independently using a combination of deductive and inductive thematical analysis. Codes were categorized into five themes based on the socio-ecological framework, and sub-themes were identified. The themes included five levels of factors: 1) individual (e.g., knowledge, self-efficacy, self-monitoring, perceived benefits and threats, health status,); 2) interpersonal (e.g., family, friend, health provider); 3) organizational (e.g., availability of physical activity equipment in senior apartments); 4) environment (e.g., culture norms); and 5) policy factors (e.g., health provider, retirement). The factors in one level could influence the factors in another level. Most current lifestyle interventions focus on individual level, and multilevel lifestyle interventions to promote healthy lifestyles, and improve health, independence, and quality of life in older adults with T2D are warranted. The input of additional stakeholders such as family members and community staff need to be accounted when designing multilevel intervention in older adults with T2D.

HEALTH STATUS AND ENVIRONMENTAL FACTORS ASSOCIATED WITH OLDER ADULTS’ MOBILITY IN 2021 COMPARED TO 2020

Abstract The COVID-19 pandemic has had significant negative impact on life-space mobility of people of all ages around the world. Using the 2019-2021 National Health and Aging Trend Study (N=3,063, age 70+) and the socioecological mobility framework, we examined the changes in the frequency of going outside among U.S. older adults between 2020 (during the pandemic) and 2021 (post-COVID vaccine). Respondents self-reported changes in their frequency of going outside: no change (=about the same), increased frequency (=more often), and decreased frequency (=less often). We then fit multinomial logistic regression to examine the associations of the changes in the frequency of going outside with physical, psychosocial, and cognitive health, environmental (COVID concerns and transportation) factors, and social media use, controlling for the 2020 frequency of going outside. We found that in 2021 compared to 2020, 13% and 16% of those age 70+ reported increased and decreased frequencies, respectively. Increased frequency was associated with social media use. Decreased frequency was associated with poor physical health, depression/anxiety, and perceived memory decline. COVID concerns and transportation problems, as well as female gender, age 90+, and being non-Hispanic Black, were also significant correlates of decreased frequency. In conclusion, most U.S. adults age 70+ appear to have resumed their 2019 level of frequency of going outside in 2021 after the COVID vaccines became available; however, 16% reported decreased frequency of going outside in 2021 compared to 2020. Older adults with physical, mental, and cognitive health challenges need help to increase their frequency of going outside.

A HISTORICAL-CONTEXTUAL PERSPECTIVE ON GRANDPARENTS’ ACTIVITIES WITH GRANDCHILDREN

Abstract Grandparenting is one of the most positive roles for many older adults, yet there is limited understanding of what activities grandparents and grandchildren actually engage in together or how these may vary based on both context (e.g., residential grandparenthood, grandparents’ marriage) and historical events (e.g., COVID-19). Drawing from multiple theoretical frameworks and methodological approaches, this symposium begins with Flood providing a broad view of time grandparents and grandchildren spend together using large-scale population-level data from IPUMS. Illustrating how such activities may vary based on context, Stephan and Chan provide insights into how activity engagement varies by caregiver status and whether activity engagement with grandchildren is related to grandparents’ perceived roles. Extending this examination of context to consider specific processes, Juris and Zvonkovic will then describe the process of family leisure among grandparent couples by examining how both individuals in a couple experience family leisure with their grandchildren. Providing a historical perspective on these experiences, Fruhauf and colleagues reveal the challenges of raising grandchildren in the context of COVID-19 and the importance of engaging in different and new activities with their grandchildren during this time. Finally, as discussant, Rauer will draw upon Bronfenbrenner’s socioecological framework to illustrate how grandparenting is situated within a complex network of interdependent systems and dynamic contexts. Together, this symposium will highlight the implications of grandparenting for catalyzing development and enhancing well-being across multiple generations.

POLICIES TO OUTCOMES: MULTILEVEL CONSIDERATIONS FOR THE ASSISTED LIVING WORKFORCE

Abstract Assisted living (AL) staff mix, levels, training requirements, regulatory enforcement, and career opportunities vary widely across license types, companies, and states. ALs represent the largest care providers for people living with dementia across the U.S. In most states, ALs must have enough qualified, trained staff to sufficiently meet the needs of their resident populations. While the use of interventions to address appropriate staffing levels and workforce retention is increasing, little is known about how the variation in the AL workforce relates to resident and staff experiences or manifests from policies governing these settings. This symposium uses a socioecological framework to examine AL-specific workforce variation. Presentations focus on national variation in staff training requirements, workforce recruitment and retention, trends in staffing levels, how staffing levels can relate to resident outcomes, and direct care staff experiences with stress and coping in long-term care communities. Findings emphasize similarities and differences in workforce composition and experience between states and across different types of facilities. From national comparison of state regulations to facility contexts to individual resident and staff experiences, this panel embraces multilevel contextual understanding of how policies, practices, and outcomes can intersect across AL and residential care environments. This is an Assisted Living Interest Group Sponsored Symposium.

Perspectives of Black Adults Living with Chronic Obstructive Pulmonary Disease on Barriers to Cardiovascular Disease Prevention.

Rationale: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with chronic obstructive pulmonary disease (COPD). Black women with COPD are at elevated risk of CVD-related mortality compared with White women. CVD risk factors are undertreated in Black men and women. However, barriers to CVD prevention from the perspective of Black individuals living with COPD have not been previously identified. Objectives: To identify barriers and facilitators for CVD prevention among Black individuals living with COPD. Methods: We conducted semistructured interviews with Black participants living with COPD and attending clinics at two urban hospitals. Participants were included if they had physician-confirmed COPD diagnoses and presence of CVD or CVD risk factors. Interviews were conducted until thematic saturation was reached, with additional interviews conducted to confirm saturation. Data were analyzed using thematic analysis, iteratively revising and updating the codebook by consensus of the study team. Codes were grouped into categories, subthemes, and themes. Themes were organized using the social ecological framework into individual, interpersonal, health system, and societal levels. Results: We interviewed 30 participants of mean age 67.8 ± 8.3 years; 17 (57%) were Black women and 13 (43%) were Black men. Individual-level themes were that living with COPD and resultant multimorbidity affects CVD prevention (theme 1) and that self-efficacy and advocacy affect care received (theme 2). At the interpersonal level, supportive relationships facilitate improved access to CVD prevention (theme 3). System-level themes were that health systems are not designed to support patients with COPD and CVD (theme 4) and that health systems do not deliver effective patient education (theme 5). At the societal level, structural barriers and racism prevent access to care and adoption of a healthy lifestyle (theme 6). Conclusions: We identified barriers to CVD prevention at all levels of the socioecological framework for Black individuals living with COPD. To maximize their impact, future interventions to prevent CVD among individuals with COPD can use these findings to target barriers at multiple levels.

High temperatures on mental health: Recognizing the association and the need for proactive strategies-A perspective.

The influence of temperature on various aspects of daily life is often underestimated, and its effects on mental health are not widely recognized. Understanding and addressing the relationship between temperature and mental well-being is crucial in the context of climate change and rising global temperatures. This perspective aimed to investigate the effects of high temperatures on mental health and identify proactive strategies to mitigate these effects. This perspective adopted a twofold approach, including a comprehensive literature review and socioecological framework. The literature review involved extensive searches across Google Scholar, PubMed, and Scopus to identify relevant, peer-reviewed articles, and reports from diverse disciplines. The perspective emphasized the significance of recognizing heat stress and its consequences on mental well-being. Chronic heat stress can lead to increased stress, anxiety, and cognitive impairment. Vulnerable populations include, the very young, older adults, and individuals with pre-existing mental health conditions. Socioeconomic factors can further exacerbate vulnerability, highlighting the need for tailored strategies to manage mental health challenges during high temperatures. Additionally, the article identified and discussed proactive coping strategies to minimize both the psychological and physical impacts of heat stress. Mindfulness, stress management techniques, and therapy are suggested as effective means for individuals to manage psychological distress. Implementing preventive measures are essential steps in promoting mental wellness in high temperatures. Proactive strategies by addressing the physiological and psychological effects of heat and considering the specific needs of vulnerable populations can help individuals and communities navigate the challenges posed by rising temperatures and promote resilience and preserve their mental well-being.

Applying the socioecological framework as a methodological approach to combat chronic diseases challenges: a case-in-point illustration using a narrative review of factors for tuberculosis medication non-adherence in India

The “slow-moving disaster” of chronic diseases has wide-ranging social implications. While prevention of chronic diseases has shifted from individual behavioral interventions to broad socio-ecological interventions, an organizing framework for complex chronic disease situations could prove to be valuable. In this article, we proposed the socio-ecological framework as one solution to identify gaps at multiple levels and guide further research, intervention efforts, and policy direction for individual chronic diseases. We illustrate this through a case-in-point example in the form of a narrative review of factors of nonadherence to therapy for tuberculosis in India. A literature search was conducted within PubMed, Scopus, Cinahl, Medline, and the Penn State Harrell Library Resources to identify peer-reviewed articles emanating from India describing factors associated with nonadherence to tuberculosis medications. The factors for non-adherence to tuberculosis medication were reported and described as individual (age, gender, religion, socioeconomic status, etc.), interpersonal (patients, family, & friends, stigma & discrimination, patient-provider relationship, etc.), organizational, community and policy levels of the socioecological model. Furthermore, gaps in the literature pertaining to these factors of nonadherence were also identified and categorized at each level of the socioecological model. The socio-ecological framework has the potential for broader and more comprehensive application to other chronic diseases and the problems associated. Integrating and conceptualizing these contributors organizes the complexities around chronic diseases that may, in turn, inform various policymakers, researchers, program implementation experts, and field personnel in formulating the desired strategy to combat the challenges.

The Role of Health Systems in Black Maternal Mental Health Care Delivery: a Socio-Ecological Framework

The Role of Health Systems in Black Maternal Mental Health Care Delivery: a Socio-Ecological Framework

Understanding multilevel barriers to childhood vaccination uptake among Internally Displaced Populations (IDPs) in Mogadishu, Somalia: a qualitative study

BackgroundDisparities in vaccination coverage exist in Somalia with Internally Displaced Persons (IDPs) being among the groups with the lowest coverage. We implemented an adapted Participatory Learning and Action (PLA) intervention, which focused on routine vaccinations among displaced populations living in Mogadishu IDP camps. The intervention was successful in improving maternal knowledge and vaccination coverage but unsuccessful in improving timely vaccination. We conducted a qualitative study to understand this result and analyze the multi-level barriers to routine childhood immunization uptake.MethodIn this qualitative study we used observation data from 40 PLA group discussions with female caregivers and purposively sampled nine vaccination service providers and six policy makers for interview. We also reviewed national-level vaccine policy documents and assessed the quality of health facilities in the study area. We used the socioecological framework to structure our analysis and analyzed the data in NVivo.ResultsThe barriers to childhood vaccination among IDPs at the individual level were fear due to lack of knowledge, mistrust of vaccines, concerns about side effects and misinformation; opportunity costs; and costs of transportation. At the interpersonal level, family members played an important role as did the extent of decision-making autonomy. Community factors such as cultural practices, gender roles, and household evictions influenced vaccination. Organizational issues at health facilities such as waiting times, vaccine stock-outs, distance to the facility, language differences, and hesitancy of health workers to open multi-dose vials affected vaccination. At the policy level, confusion about the eligible age for routine vaccination and age restrictions for catch-up vaccination and certain antigens such as BCG were important barriers.ConclusionComplex and interrelated factors affect childhood vaccination uptake among IDPs in Somalia. Interventions that address multiple barriers simultaneously will have the greatest impact given the complex nature of vulnerabilities in this population. There is a need to strengthen the health system and connect it with existing community structures to increase demand for services. Our research highlights the importance of formative research before implementing interventions. Further research on the integration of health service strengthening with PLA to improve childhood vaccination among IDPs is recommended.Trial registration numberISRCTN-83,172,390. Date of registration: 03/08/2021.

Publications reveal how socio-ecological research is implemented: Lessons from the Rhône long term socio-ecological research platform

Socio-ecological research enlists inter- and transdisciplinarity to address complex environmental issues. Yet the “socio-ecological system” concept can be interpreted in many different ways. A characterization of the diverse practices in socio-ecological research could facilitate dialogue between researchers about the possible conceptual and ethical approaches. In this study, we investigated if a detailed analysis of scientific articles would reveal the nature and course of a socio-ecological research network, and the research angle of its members. The example we used was the Rhône River Long-Term Socio-Ecological Research (LTSER) platform in France. We combined a multivariate analysis of a reading grid of publications by Rhône River LTSER researchers and a textual analysis of the scientific narratives. The publications were from a 10-year period and corresponded to those used in a recent international comparative analysis of LTSER platforms. The analysis revealed that the research was dominated by a biophysical approach, with a progressive increase in social aspects. The emergence of a transdisciplinary approach, co-constructed with operational partners, was also shown. The research conducted by the Rhône River LTSER was grounded in the context of managing a river with strong anthropic influences and interests, and the scientific approach aimed to provide knowledge for guiding decisions. Little referencfte was made in the publications to socio-ecological conceptual frameworks. Beyond the example of this LTSER platform, we identified indicators for describing the degree of inter- and transdisciplinarity and the different perceptions of socio-ecological systems. The narrative analysis revealed the angle of the research approach; this method could be used in future studies for a comparison of the diverse approaches of multiple research groups.

What should inpatient psychological therapies be for? Qualitative views of service users on outcomes.

There is limited research on what, when and how outcomes should be measured in psychological therapy trials in acute mental health inpatient wards. This study aimed to consider what outcomes service users think are important to measure. This qualitative study explored the views of 14 participants, who had an inpatient admission within the last year, on outcomes of psychological therapies using semistructured interviews. Data were analysed using thematic analysis from a critical realist perspective with both inductive and deductive coding. The 126 outcomes that were important to participants were mapped onto an established taxonomy of outcomes across different health areas and the socioecological framework to consider the wider context and help summarise the outcomes. Most of the outcomes were mapped to the intrapersonal and interpersonal level. In addition to the outcome mapping, three themes were constructed from the qualitative data: (1) I am not a problem I am a person, (2) Feeling cared for and loved, (3) What does getting better look like. Our results highlight the need for patient-reported outcomes which are cocreated with service users, disseminating research and training on preventing dehumanising experiences, enhancing psychological safety and therapeutic relationships and improving access to psychological therapy. The wider People with Personal Experience Involvement Committee at the University of Bath were consulted which included a focus group during the early planning stages. We also collaborated with a person with personal experience, at every stage of the research. This included developing our research question and aims, protocol, participant documents (e.g., information and debrief forms), advertisement and recruitment strategy, interview topic guide, the codes, the final themes and quotes and reviewing the manuscript. People with lived experience of being admitted to an acute mental health inpatient ward participated in our study.

Examining socio-ecological factors contributing to the promotion and protection of education for unaccompanied and separated children in Jordan

ObjectivesLimited research exists on the underlying processes through which socio-ecological factors contribute to the educational resilience of UASCs. This can be attributed to a lack of quantitative reporting on the educational outcomes of UASCs. The study examined the relationship between UASC status and educational achievement among Palestinian refugees in Jordan using the PISA 2009 dataset. It identified socio-ecological factors at the student-level, teacher-level, and school-level that are associated with the promotion and protection of education for this vulnerable group. Methods and AnalysisThe sample comprised 410 Palestinian refugee students in Jordan, of which 91 were identified as UASCs. Correlational analysis examined the relationship between UASC status and educational achievement. Hierarchical regression analysis then identified socio-ecological factors impacting educational achievement after controlling for student, teacher, and school variables. Main effects and interaction effects in the regression models revealed key promotive and protective processes. FindingsFindings showed that UASC status negatively correlated with achievement across all subjects. However, female gender, higher educational, social, and cultural status, positive class disciplinary climate, positive teacher-student relations, and higher school use of ability grouping provided promotive effects on achievement for UASCs. Higher teacher use of structuring and scaffolding strategies provided a protective-enhancing effect on reading achievement for UASCs. Higher school use of ability grouping provided a protective-stabilizing effect on both reading achievement and scientific achievement for UASCs. In contrast, high school academic selectivity provided a vulnerable-reactive effect on scientific achievement for UASCs. Novelty and ImprovementThe study highlights the importance of adopting a socio-ecological and socio-interactional framework with robust quantitative approaches to gain in-depth understanding of UASCs' educational resilience. The identification of microsystemic and mesosystemic factors (those at teacher-level and school-level) as critical promotive and protective assets provides vital insights to inform research, policy, and practice aimed at supporting UASCs' ability to thrive academically despite risks associated with being UASC.

Evaluating a social and emotional well-being model of service piloted in Aboriginal Community Controlled Health Services in Western Australia: an Aboriginal Participatory Action Research approach

IntroductionThe delivery of services to improve Aboriginal health and well-being must centre culture and integrate a social and emotional well-being understanding and approaches. These approaches are essential in increasing access...

Postpartum medication for opioid use disorder outcomes associated with prenatal treatment and neighborhood-level social determinants

Opioid use disorder is a leading cause of death through the year postpartum. This study aimed to identify the association of neighborhood-level social determinants of health and prenatal opioid use disorder treatment receipt with the outcomes of medication treatment for opioid use disorder through the year postpartum among a cohort of birthing people. This was a population-based retrospective cohort study that used state Medicaid claims and enrollment data for the 1690 individuals who delivered a live infant between July 1, 2016 and December 31, 2020 and received medication for opioid use disorder at delivery. The primary exposure was the state Health Opportunity Index, a composite measure of social determinants of health linked at the census-tract level. Secondary exposures included comprehensiveness of opioid use disorder treatment and duration of medication treatment for opioid use disorder received prenatally. Outcomes included the duration and continuity of postpartum medication treatment for opioid use disorder, operationalized as the time from delivery to the discontinuation of medication treatment for opioid use disorder, and percentage of days covered by medication treatment for opioid use disorder within the 12 months after delivery, respectively. Within the study sample, 711 deliveries were to birthing people in the lowest state Health Opportunity Index tercile (indicating high burden of negative social determinants of health), 647 in the middle state Health Opportunity Index tercile, and 332 in the highest state Health Opportunity Index tercile. Using stepwise multivariable regression (Cox proportional hazards and negative binomial models) guided by a socioecological framework, prenatal receipt of more comprehensive opioid use disorder treatment and/or longer duration of prenatal medication treatment for opioid use disorder was associated with improved 1-year postpartum opioid use disorder treatment outcomes (duration and continuity of medication treatment for opioid use disorder). When the state Health Opportunity Index was added to the models, these significant associations remained stable, with the state Health Opportunity Index not demonstrating an association with the outcomes (duration hazard ratio, 1.39; 95% confidence interval, 0.551-3.512; continuity relative risk, 1.024; 95% confidence interval, 0.323-3.247). Targeted efforts at expanding access to and quality of evidence-based opioid use disorder treatments for reproductive-age people across the life course should be prioritized within the spectrum of work aimed at eradicating disparities in pregnancy-related mortality.

Understanding the sexual and reproductive health rights and experiences of very young adolescents in rural Uganda from the perspectives of emerging adults.

We investigated the sexual and reproductive health rights and experiences of very young adolescents (VYAs), 10-14 years old, from the perspective of emerging adults (18-25 years old). Data collection and analysis were guided by the socio-ecological and positive youth development frameworks. Data were collected through naturalistic observation of the community, photovoice, key informant interviews (n=5), and focus group discussions with emerging adults (n=20). Key emerging themes included: limited economic resources, sex education, and gender expectations. While limited economic resources and certain gender expectations play a role in increasing VYAs' exposure to risky settings and behaviours, sex education in schools and parental support play an important role in protecting VYAs from poor sexual and reproductive health outcomes. Identifying ways to minimize exposure to risky settings and behaviours while strengthening existing protective factors found in the community need to be considered when designing future strength-based, community tailored, and culturally sensitive interventions.

The Role of Distance from Home to Hospital on Parental Experience in the NICU: A Qualitative Study.

Prolonged admission to the neonatal intensive care unit presents challenges for families, especially those displaced far from home. Understanding specific barriers to parental engagement in the NICU is key to addressing these challenges with hospital-based interventions. The objective of this qualitative study was to explore the impact of distance from home to hospital on the engagement of parents of very preterm infants (VPT) in the neonatal intensive care unit (NICU). We used a grounded theory approach and conducted 13 qualitative interviews with parents of VPT who were admitted ≥14 days and resided ≥50 miles away using a semi-structured interview guide informed by the socio-ecological framework. We used constant comparative method with double coders for theme emergence. Our results highlight a multitude of facilitators and barriers to engagement. Facilitators included: (1) individual-delivery preparedness and social support; (2) environmental-medical team relationships; and (3) societal-access to perinatal care. Barriers included: (1) individual-transfer stressors, medical needs, mental health, and dependents; (2) environmental-NICU space, communication, and lack of technology; and (3) societal-lack of paid leave. NICU parents with geographic separation from home experienced a multitude of barriers to engagement, many of which could be addressed by hospital-based interventions.

Building the case for a social and behaviour change approach to prevent and respond to the recruitment and use of children by armed forces and armed groups

AbstractOver the last decade, social and behaviour change strategies have increasingly been used to address human rights and child protection concerns, including harmful practices such as child marriage, female genital mutilation and violent discipline. Social and gender norms have also been recognized as key drivers of child recruitment. Nonetheless, the use of social and behaviour change strategies to prevent and respond to the recruitment and use of children in armed conflict has not yet been systematically explored or applied. Building on academic and practical sources, including findings from studies by the International Committee of the Red Cross and United Nations University, social and behavioural science theory, experiences from the Monitoring and Reporting Mechanism on grave violations against children, and academic literature, this article explores how social and behaviour change approaches can inform prevention of and response to the recruitment and use of children in armed conflict. The article concludes that social and behaviour change approaches can effectively inform prevention and reintegration efforts and can facilitate responses that bridge the humanitarian, development and peace nexus. Using social and behaviour change approaches can help to reveal why children are recruited from the perspective of key actors and entities across the socio-ecological framework in order to prevent the practice from becoming more accepted.