Socio-ecological Framework Research Articles

Barriers, attitudes and perceptions to physical activity among pregnant women in Ibadan, Nigeria and the associated factors: a mixed method study.

Physical activity has several health benefits during pregnancy. However, it remains low among pregnant women because of various barriers. This study assessed the attitude, perception, barriers to physical activity during pregnancy and the associated factors. We conducted a cross-sectional study using a sequential explanatory mixed method among 465 pregnant women attending antenatal care from four healthcare facilities in Ibadan, Nigeria. Data was collected using a pretested interviewer-administered questionnaire, and we conducted four focus group discussions. Using the Barriers to Physical Activity during Pregnancy Scale questionnaire, we assessed the barriers based on the socioecological theory. The explanatory variables included sociodemographic characteristics, obstetric factors, past obstetric history and physical activity-related issues. Data were analysed using univariate and bivariatemethods (independent T-tests and ANOVA), and multiple linear regression was at 5% significance. We applied thematic content analysis to qualitative data. The mean age of the participants was 29.22 + 5.01years. The mean ± SD of the total physical activity barrier score (PABS) was 85.35 ± 22.82. The PABS for the subscales were intrapersonal barriers (34.46 ± 8.79), non-pregnancy intrapersonal barriers (14.47 ± 5.67), and interpersonal barriers (11.67 ± 4.25), environmental, political and organisational barriers (24.766 ± 8.82). The significant relationships between the total score of physical activity barriers and religion (p < 0.030), education (p < 0.000), complaints in pregnancy (p < 0.043), antenatal admission in the hospital (p < 0.004), physical activity advice (p < 0.018), pre-pregnancy physical activity (p < 0.000). Factors associated with physical activity barrier score were maternal education: adjusted β: -15.26, 95% CI: -27.83; -2.69; p = 0.017, antenatal admission adjusted β: 12.20, 95% CI 3.74; 20.67, p = 0.005 pre-pregnancy physical activity: adjusted β: -12.27, 95% CI -1.6.5; -7.99, p = 0.001. Significant themes that emerged in the perception of pregnant women towards physical activity are understanding physical activity, personal experience of physical activity, barriers experienced by pregnant women, the role of support, perceived benefits, and information from health care workers. Our study showed that pregnant women attending antenatal clinics in Ibadan, Nigeria, face various barriers to physical activity during pregnancy. Using the socioecological framework, the most commonly reported barriers by our respondents were intrapersonal andenvironmental barriers. Sociodemographic characteristics, pre-pregnancy physical activity, and antenatal admission were significant factors associated with the total barrier scores of respondents. Healthcare professionals should be trained in promoting physical activity during pregnancy. Tailored interventions are necessary to promote physical activity among pregnant women in Nigeria, including the training of health workers.

Neighborhoods, Networks, and HIV Care Among Men Who Have Sex With Men: Proposal for a Longitudinal Study.

The majority of people living with HIV in the United States are men who have sex with men (MSM), with race- and ethnicity-based disparities in HIV rates and care continuum. In order to uncover the neighborhood- and network-involved pathways that produce HIV care outcome disparities, systematic, theory-based investigation of the specific and intersecting neighborhood and social network characteristics that relate to the HIV care continuum must be engaged. Using socioecological and intersectional conceptual frameworks, we aim to identify individual-, neighborhood-, and network-level characteristics associated with HIV care continuum outcomes (viral suppression, retention in care, and antiretroviral adherence) among MSM living with HIV in New York City. In the longitudinal cohort study, we assess 3 neighborhoods of potential influence (residential, social, and health care access activity spaces) using Google Earth. We investigate the influence of neighborhood composition (eg, concentrated poverty and racial segregation) and four neighborhood-level characteristics domains: (1) community violence, physical disorder, and social disorganization (eg, crime rates and housing vacancy); (2) alcohol and other drug use; (3) social norms (eg, homophobia and HIV stigma); and (4) community resources (eg, social services and public transit access). We test theoretical pathways of influence, including stress or coping, stigma or resilience, and access to resources, across the different neighborhoods in which MSM live, socialize, and receive HIV care. At each visit, we locate each participant's reported activity spaces (ie, neighborhoods of potential influence) and collect individual-level data on relevant covariates (including perceptions of or exposure to neighborhoods) and social network inventory data on the composition, social support, and perceived social norms. The outcomes are HIV viral suppression, retention in care, and antiretroviral adherence. These data are combined with an existing, extensive geospatial database of relevant area characteristics. Spatial analysis and multilevel modeling are used to test the main theory-driven hypotheses and capture independent neighborhood-level and network-level effects and changes over time. The study began enrollment in March 2019 and concluded visits in December 2023, with a total of 327 participants enrolled. The median age was 44.1 (SD 11.5) years. Almost all participants self-identified as cisgender men (n=313, 98.1%) and as gay, homosexual, or bisexual (n=301, 94.4%). Overall, 192 (60.1%) participants identified as non-Hispanic Black, and 81 (25.3%) identified as Hispanic. Most (n=201, 63%) reported at least occasional difficulty in meeting basic needs (eg, rent and food) in the past 6 months. The mean number of years living with HIV was 15.4 (SD 10.1). This study will have direct implications for the design of multilevel interventions, addressing factors at the neighborhood, network, and individual levels. Results may inform urban planning and program design to improve HIV care outcomes for MSM, particularly for Black and Latino MSM living in urban areas. PRR1-10.2196/64358.

Machine learning-based infection diagnostic and prognostic models in post-acute care settings: a systematic review.

This study aims to (1) review machine learning (ML)-based models for early infection diagnostic and prognosis prediction in post-acute care (PAC) settings, (2) identify key risk predictors influencing infection-related outcomes, and (3) examine the quality and limitations of these models. PubMed, Web of Science, Scopus, IEEE Xplore, CINAHL, and ACM digital library were searched in February 2024. Eligible studies leveraged PAC data to develop and evaluate ML models for infection-related risks. Data extraction followed the CHARMS checklist. Quality appraisal followed the PROBAST tool. Data synthesis was guided by the socio-ecological conceptual framework. Thirteen studies were included, mainly focusing on respiratory infections and nursing homes. Most used regression models with structured electronic health record data. Since 2020, there has been a shift toward advanced ML algorithms and multimodal data, biosensors, and clinical notes being significant sources of unstructured data. Despite these advances, there is insufficient evidence to support performance improvements over traditional models. Individual-level risk predictors, like impaired cognition, declined function, and tachycardia, were commonly used, while contextual-level predictors were barely utilized, consequently limiting model fairness. Major sources of bias included lack of external validation, inadequate model calibration, and insufficient consideration of data complexity. Despite the growth of advanced modeling approaches in infection-related models in PAC settings, evidence supporting their superiority remains limited. Future research should leverage a socio-ecological lens for predictor selection and model construction, exploring optimal data modalities and ML model usage in PAC, while ensuring rigorous methodologies and fairness considerations.

Culture, community, and cancer: understandings of breast cancer from a non-lived experience among women living in Soweto

BackgroundIndividual perceptions, socio-cultural beliefs and health system factors are key determinants of people’s health seeking behavior and are widely cited as the causes of delayed breast cancer diagnosis among women from structurally vulnerable settings. Asking: “how do women with a non-lived experience of cancer understand the disease and, what informs their health seeking behaviors?”, we qualitatively explored, individual, sociocultural and health system elements from a conceptual model derived from the Socioecological, Health Belief and Cancer Stigma Frameworks, to understand perspectives of breast cancer in a South African urban community setting.MethodsUsing a deductive approach and allowing new themes to emerge inductively, we investigated phenomenologically, breast cancer perceptions among 34 women from Soweto, Johannesburg (aged 35–74 years) in 6 Focus Group Discussions. We then conducted 20 follow-up semi-structured in-depth interviews to explore novel themes and suggestions for increasing breast cancer screening.ResultsFindings revealed some awareness of breast and other cancers, but confusion and gaps in understanding of the disease, resulting in socio-culturally influenced misperceptions of risks, causes, and outcomes following treatment of breast cancer. This fueled perceptions of profound fear and stigma against people with breast and other cancers. These findings together with participant perceptions of primary healthcare providers being unwelcoming, under-resourced, and insufficiently trained to deal with breast cancer, resulted in women reporting being reluctant to participating in screening/early detection care seeking behavior. Women only accessed primary care when experiencing extreme pain or ill-health. Participants suggested as solutions for future interventions, the need for sustained community engagement, harnessing existing clinic and community stakeholders and resources to provide clear and understandable breast cancer information and encouragement for screening uptake.ConclusionsHealth literacy gaps surrounding breast cancer fuels socio-culturally influenced misperceptions, fear, stigma, and fatalism among women from Soweto. Women perceive primary care providers of having insufficient knowledge, skills, and resources to provide effective breast cancer screening services. Participants suggested the need for greater community engagement involving primary clinics and existing community stakeholders working collaboratively. Clear, understandable, and consistent information about breast cancer must be regularly disseminated and communities must be regularly encouraged to utilize breast cancer screening services.

Qualitative Evidence to Inform Municipal Government Actions to Increase Recreation Space Usage and Promote Equitable Participation in Leisure-Time Physical Activity

Municipal recreation infrastructure is critical for enhancing people’s opportuni-ties to be physically active during leisure time and reducing usage inequities. Yet, the literature on municipal equity-sensitive strategies is limited. To address this gap, we combined a socio-ecological framework with equity, diversity, and inclu-sion (EDI) and health equity lenses to examine intersecting social and structural determinants of municipal recreation (indoor and outdoor) infrastructure usage. We used data from 22 focus groups involving youth, adult regular users, and adult non-regular users. The intersecting factors influencing people’s utilization experi-ences were organized at intrapersonal, socio-cultural environment, organization, and built and natural environment levels. Policy and practice implications for mu-nicipal governments vis-à-vis EDI and health equity considerations are discussed. Recommendations include public transportation improvement, design of strategic communication plans, and linking activities with opportunities for socialization, among others.

Factors Associated with Suicidal Behavior in Adolescents: An Umbrella Review Using the Socio-Ecological Model.

Adolescent suicide is a critical social issue with profound and lasting individual and collective consequences. This umbrella review examines factors associated with adolescent suicidal behavior through the socioecological framework of prevention and seeks to identify gaps in the existing literature. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included a comprehensive search of the of the Web of Science, Scopus, and Cochrane databases in both English and Spanish, covering the period from 2018 to 2024, using terms related to adolescence and suicidal behavior. Out of 6,138 articles identified, 37 met the quality criteria and were selected for analysis. The studies highlighted individual risk factors such as age, gender, belonging to ethnic or gender minorities, emotional disorders, self-destructive behavior, emotional regulation, and experience of physical or emotional pain. Interpersonal factors such as parental relationships, sexual abuse, social isolation, peer pressure, and loneliness were also found. However, the review revealed a worrying lack of studies on societal and community factors and a paucity of research focusing on protective factors. The study highlights the need to include factors related to the physical and social environments that influence health and behavior in future research, as well as to enhance the resources and strengths of adolescents.

Reimagining maternal resilience: Incorporating the socioecological framework, lifecourse theory, and weathering hypothesis.

Women of color are at least twice as likely as non-Hispanic White women to die during the perinatal period or deliver infants who are low birthweight, preterm, or die within the first year of life. Maternal stress before and during pregnancy is associated with adverse obstetric outcomes. A growing body of literature has explored maternal resilience as protective factors contributing to healthy maternal and child health (MCH) outcomes. However, several gaps exist in how this construct has been conceptualized and operationalized. First, extant research has primarily conceptualized maternal resilience as individual attributes that enable women to "bounce back" after facing adversity during pregnancy, thereby failing to incorporate the broader systemic and environmental factors that contribute to chronic stress, particularly among vulnerable groups. Second, the literature has largely neglected to examine resilience in relation to maternal stress, therefore not acknowledging that women who experience greater stress will likely require more resources. Third, though resilience has been investigated at discrete life stages, longitudinal research has not been conducted to explore how it develops over the lifecourse. This article critically evaluates the resilience literature, expands upon the gaps described, and proposes a conceptual framework that reimagines material resilience using three population health theories, including Bronfenbrenner's socioecological framework, Elder's lifecourse theory, and Geronimus' weathering hypothesis. The proposed framework will inform future research that examines the development of multilevel resilience resources over the lifecourse as well as interventions to increase resilience and ultimately yield healthier MCH outcomes among vulnerable communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Barriers to Sexual and Reproductive Health and Rights of Migrant and Refugee Youth: An Exploratory Socioecological Qualitative Analysis

(1) Background: Migrant and refugee youth’s (MRY’s) sexual and reproductive health and rights (SRHRs) are a global health issue. MRY encounter adverse SRH experiences due to limited access to and knowledge of SRHRs services. Using a socioecological framework, this study examined the barriers affecting MRY’s SRHRs. (2) Methods: A cross-sectional study utilising a participatory action research design was used. A total of 87 MRY (ages 16–26, from 20 cultural groups within Greater Western Sydney, Australia) completed seventeen focus group discussions on their SRHRs experiences. The focus groups were co-facilitated by youth project liaisons to ensure their authenticity and validity. The data were analysed thematically and interpreted using socioecological theory. (3) Results: The findings identified socioecological barriers, a lack of awareness about and access to services, and sociocultural dissonance as leading to the under-implementation of SRHRs services. These barriers included cultural disconnects, language barriers, remote service locations, intergenerational cultural conflicts, and ineffective SRHRs services. The key themes identified included traditional and institutional stigma, lack of SRH education, reliance on social media for SRH information, and privacy concerns. (4) Conclusions: There is a limited consideration of MRY’s SRHRs and the impact of intergenerational discordance and stigma on MRY’s rights. The findings suggest the necessity for a collaborative SRHRs strategy and policy design that empowers MRY’s agency across multicultural contexts.

Social and environmental determinants of sleep health disparities

Abstract Sleep is not equitable. Historically minoritized individuals have a high prevalence of sleep disorders and adverse sleep health. Research supports that social determinants of health are contributing to sleep health inequities. Further, sleep is socially patterned. Neighborhoods with high rates of crime, violence, disadvantage, pollution, inopportune light exposure, and noise, where historically minoritized individuals are most likely to live are associated with adverse sleep health and sleep disorders. Social determinants including discrimination, racism, socioeconomic status, lack of access to care are associated with adverse sleep health, particularly among minoritized individuals. While there is an abundance of evidence identifying risk factors for adverse sleep health, evidence also supports factors that promote healthy sleep. A small but growing literature supports that neighborhood social environment is associated with healthy sleep and may be avenue for addressing sleep disparities. Dr. Johnson will present epidemiologic data on the social and environmental determinants of adverse sleep health using a socioecological framework and discuss the mechanisms by which these factors are contributing to sleep disparities. The goal is to identify these factors, and how they can be utilized to address sleep health disparities.

Resilience Components in Mexican Whale-Watching Regulation

Whale watching (WW) is a growing tourist activity that is at risk of becoming unsustainable. Legislation regarding WW must mitigate adverse effects on species and address the dynamics of complex systems. This study proposes analyzing this interaction using a socio-ecological resilience framework, considering both social and ecological components. Resilient governance is characterized by four features: flexibility to respond to change, adaptability, multi-level governance, and participation. The aim of this study was to assess how Mexican WW regulations contribute to the resilience of the socio-ecosystem through a literature review on compliance with the regulations and the presence of resilience elements in the regulations. Non-compliance with 12 guidelines was identified, with vessel crowding, distance, and unauthorized vessels being the most frequently reported issues. The analysis of the regulations revealed the presence of all four elements of resilient governance; however, participation is limited to certain key stakeholders, which undermines whale conservation due to non-compliance. In conclusion, the Mexican regulations contribute to resilient governance; however, to ensure whale conservation and socio-ecological resilience, it is essential that all involved parties understand their roles and actively participate in decision-making processes.

Exploring Factors Affecting Breastfeeding: Insights From Hispanic and Black Mothers and Healthcare Providers in El Paso, Texas

Objective:Breastfeeding has been shown to have many health benefits to both the infant and the mother. However, there are racial and ethnic disparities in breastfeeding rates across all U.S. states and territories. This study sought to understand the support needed to improve breastfeeding rates and address disparities in El Paso County, Texas using the socioecological model framework for analysis.Methods:We conducted focus groups involving 16 Hispanic and Black mothers. During these sessions, we asked them about the environmental and social factors that influenced their decisions to either start or stop breastfeeding. Additionally, we interviewed six health professionals to gain insights into the support activities they provide to breastfeeding women and identify potential gaps in care.Results:The study found several themes that align with prior research on breastfeeding support: (a) Breastfeeding is recognized as being healthy, but misconceptions exist about formula. (b) Some mothers find public breastfeeding or pumping inappropriate, but opinions vary. (c) Family members significantly influence the decision to breastfeed; their support varies. (d) Although aid from healthcare professionals (HCPs) in breastfeeding is appreciated and valued, it is not always available. (e) HCPs are not uniformly perceived as knowledgeable or helpful, occasionally providing conflicting information. (f) Prenatal classes featuring breastfeeding are appreciated, but the depth of information provided varies. (g) Women seek increased postdischarge support from hospitals. (h) The transition back to work introduces various challenges. (i) Community norms and attitudes toward breastfeeding can be unsupportive. (j) Demand exists for updated, accessible local breastfeeding resources. (k) The Special Supplemental Nutrition Program for Women, Infants, and Children is valued, but there is confusion about services and eligibility requirements. (l) Undocumented immigrants might hesitate to access public services due to concerns about their status.Conclusions:Breastfeeding support programs should take into account the cultural context, the influence of healthcare providers, and the availability of community support. Addressing these aspects can be key to promoting breastfeeding and reducing disparities in breastfeeding rates.

Sharing the motherload: A review and development of the CO-Parent conceptual model for early childhood obesity prevention.

Fathers remain under-represented in early childhood obesity prevention research and interventions, despite growing evidence that paternal biopsychosocial factors and behaviors from pre- and post-conception can influence lifelong offspring health. Informed by a literature review of high-quality evidence, "CO-Parent" (childhood obesity-Parent) is a new conceptual model underpinned by couple interdependence theory and a socioecological framework. Literature was searched for the concepts parental AND weight-related behaviors AND child weight or weight-related behaviors, in databases including MEDLINE, PsycINFO, Global Health, Scopus, and SocINDEX. Prior evidence syntheses were prioritized as source data to inform model development. "CO-Parent" illustrates the interdependent and independent effects of maternal and paternal weight, weight-related behaviors, and well-being, across preconception, pregnancy, postpartum, and the early years on child weight-related behaviors and weight up to age five. The influences of public policy, social, environmental, economic, community, and other complex modifiable mediating factors are included in the model. The "CO-Parent" conceptual model paves the way for a paradigm shift by recognizing fathers as key figures in early childhood obesity prevention initiatives, encouraging them to "share the motherload." It highlights both the independent and interdependent roles fathers play in the epidemiology of obesity starting from preconception. CO-Parent also provides the foundations necessary to guide future theory and research to be more inclusive of fathers to further understanding of the independent and interdependent influences of parents in early childhood obesity prevention.

Barriers and facilitators to providing rehabilitation for long-term care residents with dementia: a qualitative study

BackgroundRehabilitation can help long-term care (LTC) residents with dementia maintain their independence. However, many residents do not receive rehabilitation. This study aimed to identify the barriers and facilitators to providing rehabilitation for LTC residents with dementia and propose practical interventions for overcoming them.MethodsUsing a phenomenological research design, we conducted a qualitative study involving 17 privately owned LTC homes in Nova Scotia, Canada. Data were collected through individual interviews and a focus group with residents with dementia (n = 3), family members (n = 4), rehabilitation providers (n = 6), and other staff (n = 3). We analyzed the data using inductive thematic content analysis and mapped the results onto the socioecological framework and the Behaviour Change Wheel (BCW) to classify and analyze barriers and facilitators to rehabilitation. The APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) in the BCW were used to identify feasible interventions and policies linked to the identified barriers and facilitators.ResultsBarriers at the intrapersonal level included communication difficulties, comorbidities, and lack of motivation among residents. Interpersonal factors encompassed the availability of family support and lack of interdisciplinary practice. Policy/environmental factors involved limited resources, complex admission processes, low staff ratios, and restrictive restraint policies. Enhancing communication, reducing the use of restraints, promoting interdisciplinary practice, and increasing accessibility to activity spaces and equipment will improve the provision of rehabilitation for the residents.ConclusionEnhancing the capabilities, opportunities, and motivations of all actors in LTC homes can potentially minimize these barriers. Interventions such as staff training on effective communication and dementia care, promoting person-centred and meaningful activities, and improving interdisciplinary collaboration are crucial. Policy measures to improve hospital-to-LTC transitions, increase volunteer involvement, educate families and communities, and recruit more staff are recommended. Addressing these barriers through targeted interventions and policy changes can significantly improve rehabilitation provision for residents with dementia in LTC settings.

Diagnosis of the fragmentation of urban ecological network structure and its social-ecological responses.

The fragmentation of ecological network structures has become a common problem faced by cities. By establishing the urban ecological network under a specific socio-ecological system framework, we aimed to propose a quantitative index to diagnose the fragmentation of the network structure, and to construct detection model to explore the driving factors and mechanism of the network fragmentation. Using Shenzhen City as an example, we used the Floyd-Prim algorithm to generate the skeleton structure of the ecological network and construct a density discontinuity index to diagnose network fragmentation. Combined with the ecological network scenario, social-ecological system framework and a two-layer indicator system were constructed. The detection models were then established to explore the drivers of network disruption and their mode of impact. The models show that the average degree of network fragmentation in Shenzhen was 0.13, and the density of about 85% of corridor discontinuities was greater than 0.01, reflecting the serious state of structural fragmentation. Corridors with more severe structural fragmentation have poorer social-ecological coordination. The fragmentation in Shenzhen was mainly affected by the activities of actors (A) at the microlevel and the resource system (RS) at the macrolevel. The methods and the framework of socio-ecosystem analysis proposed in this paper can reveal the driving factors and influence modes of network fragmentation, providing decision-making reference for ecological restoration practice in urbanized areas.

A dynamic analysis of a tourism-based socioecological system

The study proposes a dynamic analysis regarding interactions between the resources provided by the forest, the wildlife present inside or in the proximity of that environment and visitors revolving around the before mentioned socioecological framework. The mathematical model is described by a nonlinear system with three differential equations. The discrete time delay is introduced to illustrate the entire past impact of tourists on forest resources and wildlife. The basic assumption is that the wildlife species which inhabit the area are relying entirely on forest resources to meet their needs for food, shelter, and to attract tourists. Also, there is a positive correlation between ecotourism activities and the presence of forest resources and wildlife. The equilibrium states are determined, and they are subjected to a stability and bifurcation analysis. The study employs a Hopf bifurcation analysis in the neighborhood of the equilibrium states by choosing the time delay as the bifurcation parameter. The critical values of the time-delay that lead to oscillatory behavior are determined. Numerical simulations are carried out to show the system’s qualitative behavior in the vicinity of the equilibria.

Protective Factors Associated With Lower Likelihood of Injection Drug Use and Experiencing Overdose Among Incarcerated Women

PurposePrior studies evaluated protective factors individually as they relate to fewer drug use risk behaviors and related consequences. This is the first study to examine protective factors as part of a multilevel framework along a risk continuum among women involved in the criminal legal system who use drugs. This study describes factors within the socio-ecological framework that are protective against engaging in injection drug use and experiencing nonfatal overdose. MethodData were collected from 900 women with a history of opioid use disorder who were incarcerated and enrolled in the National Institutes of Health/National Institute on Drug Abuse–funded Justice Community Opioid Innovation Network cooperative. Analysis focused on the relationship among individual, interpersonal, and community- or institutional-level protective factors associated with not injecting drugs and not experiencing an overdose in the 90 days before incarceration using multinomial logistic regression. FindingsFindings from this study suggest that, even among a sample of women who use drugs, there are a number of factors associated with being less likely to report higher-risk injection behavior and/or overdose experiences at the individual level (age, religiosity, and less polysubstance use), interpersonal level (not having a partner who injects drugs), and community or institutional level (fewer months incarcerated, less treatment utilization, and less enacted stigma by health care workers). ConclusionsFindings from this study underscore the importance of being able to target prevention interventions to women at different stages of substance use severity and to capitalize on protective factors for those at lower-risk levels to reduce the trajectory of risk of injection practices and overdose experiences.

Closing the gap: proposing a socio-ecological framework to make cancer clinical trials more accessible, equitable, and acceptable to adolescents and young adults.

This commentary focuses on what would make cancer clinical trials more accessible, equitable, and acceptable to adolescents and young adults.

Dietary Behaviour of Pregnant Women in Ethiopia: The Missing Aspect of Care.

Background: Nutrition and adequate dietary intake during pregnancy strongly influence the health and well-being of the mother, as well as the physical and cognitive development of the unborn child. While previous studies have documented factors associated with the dietary behaviour of pregnant women in Ethiopia, a comprehensive overview is missing. Objective: The aim of this study was to close this research gap. Methodology: We conducted a mapping review, including 37 studies published between 2000 and 2022 in our analysis. Dietary behaviour refers to all phenomena related to food choice, eating behaviour and dietary intake. We used an innovative approach by integrating a socio-ecological framework with UNICEF's conceptual framework on maternal and child nutrition, which specifies multidimensional individual, underlying and enabling determinants associated with the nutritional status of women. Importantly, we integrated a focus on care for women and healthy environments. Results: A total of 68 factors were identified as influencing the dietary behaviour of pregnant women, with a focus on the intra- (31/68) and interpersonal (21/68) levels, while factors at the community (11/68) and the institutional levels (5/68) were scarce. Few studies investigated socio-cultural aspects, such as gender roles, decision-making power and workload of women, psychological factors and eating practices related to food taboos. None of the studies explored the influence of resources at the institutional level. Conclusions: This attests that the focus in maternal nutrition is still placed on the individual responsibility of women, instead of addressing the structural conditions that would enable women to access resources such as land, education and nutrition information.

The locality challenges facing the ‘levelling up’ of sport participation and health inequality in England

ABSTRACT In the context of the UK Government’s levelling up agenda, current sport policy seeks to reduce inequalities in sport participation, supported by investment in facilities. Drawing on a socio-ecological theoretical framework, this paper analyses a large-scale dataset measuring individual sport and fitness participation, local authority facility availability and level of multiple deprivation to examine the individual/compositional and locality/contextual influences on participation in sport and fitness activities for men and women in England. Multi-level regressions highlight the challenges faced for policy, arguing that scaled-up local action is needed to account for the interaction between individual factors, facility availability and area deprivation.

How can community music shape individual and collective well-being? A case study of a place-based initiative.

There is an urgent need to investigate innovative and creative approaches in health promotion that support work towards health equity. In response, this study explores the potential for arts, and community music specifically, to strengthen individual and collective well-being. This study used a qualitative case study methodology that involved interviews, focus groups and ethnographic observation with participants (N = 13), facilitator (N = 1) and support staff (N = 2) of an established community music initiative conducted in an urban community. Data collection was conducted across 2023 and data analysis drew on a socioecological framework to explore potential individual and collective outcomes from the perspective of those involved in the initiative. Findings point to outcomes across socioecological levels with researchers identifying positive health and well-being implications for participants including joy, healing and a sense of purpose, creative self-expression, confidence, social connection and contribution. Positive outcomes for the wider community were also identified including developing community ties, promoting safety and shaping and sharing of collective identity. Findings suggest community-led opportunities for engagement can support healing and empowerment for people who are marginalised, and this can enable active community participation related to challenging the status quo and developing a shared set of values. Potential implications of these outcomes in relation to broader societal transformations are discussed. This study highlights how community music, and the arts more broadly are working in communities in ways that support potential personal, community and societal transformations towards health equity. SO WHAT?: By developing coalitions and collaborating with diverse sectors, including the arts and social sectors, health promotion practitioners and researchers can harness the creative strengths and resources that exist within a community to support positive individual and collective well-being.