Worker Program Research Articles

Human capital development programme for mid-career agricultural extension workers: The case of Sokoine University of Agriculture BSc. agricultural extension and education training programme

Of recent, there is changing work environment for agricultural extension workers as they operate under the multi-stakeholders’ phenomenon. This increasingly poses a challenge to frontline extension workers trained on linear model (extension-researcher-farmer linkage) in extension services delivery. This is because, facilitating the multi-stakeholder processes requires competent agricultural extension workers well-versed in human relations. In recognizing the importance of human capital development for agricultural extension service delivery in Tanzania, Sokoine University of Agriculture established a mid-career agricultural extension training programme in 1998. Informed by the human capital theory, this study employed an evaluative study design to assess the impact of the Sokoine University of Agriculture (SUA) mid-career BSc. Agricultural Extension and Education training programme on human capital development. The study was conducted in five agro-ecological zones, that is, Eastern, Western, Central, Southern Highlands and Lake zones in Tanzania. The development of the sampling frame was done in collaboration with the Ministry of Agriculture (MoA), Ministry of Livestock and Fisheries (MLF) and President’s Office-Regional Administration and Local Government (PO-RALG). A total of 200 respondents-100 alumni and 100 farmers were sampled proportionately. A snowball sampling technique was used to replace the respondents who were selected randomly but could not be reached for interview. Data were collected from respondents through a questionnaire that covered a set of competences through analysis of the mid-career agricultural extension curriculum and consultations with public and private employers. In addition, literature review and observations were also used to supplement the collected information. The findings indicate that the agricultural training programme at Sokoine University of Agriculture (SUA) equipped graduates with appropriate knowledge, competencies and skills that improved their job performance and productive capacities that enabled them to interact with various stakeholders and facilitate multi-stakeholders’ processes. This is in line with the purpose of establishing the programme. Hence, this points to the need for continuous human capital building and motivations of agricultural extension workers for the improvement of their performance. Key words: Mid-career, Agricultural extension workers, Curriculum, Human capital, Multi-stakeholder processes

Co-development of a training programme on disability for healthcare workers in Uganda

BackgroundApproximately 1.3 billion people worldwide face barriers in accessing inclusive healthcare due to disabilities, leading to worse health outcomes, particularly in low and middle-income countries (LMIC). However, there is a lack of training of healthcare workers about disability, both globally and in Uganda.ObjectivesTo use mixed research methods to develop a comprehensive training program with standardisedelements for healthcare workers in Uganda, focusing on improving their knowledge, attitudes, and skills inproviding care for people with disabilities.MethodsThe Medical Research Council (MRC) approach was employed to guide the development of the training intervention. We conducted an umbrella review to gather relevant literature on disability training for healthcare workers. Interviews were conducted with international experts to gain insights and perspectives on the topic. Additionally, interviews were undertaken with people with disabilities and healthcare workers in Uganda to understand their experiences and needs. A participatory workshop was organised involving key stakeholders, to collaboratively design the training material based on the findings from these data sources.ResultsEight review articles examined training programs for healthcare workers on disability. Training settings ranged from specialised clinical settings to non-clinical settings, and the duration and evaluation methods of the training varied widely. Lectures and didactic methods were commonly used, often combined with other approaches such as case studies and simulations. The impact of the training was assessed through healthcare worker reports on attitudes, knowledge, and self-efficacy. Interviews emphasised the importance of involving people with disabilities in the training and improving communication and understanding between healthcare providers and people with disabilities. Five themes for a training on disability for healthcare workers were generated through the workshop, including responsibilities and rights, communication, informed consent, accommodation, and referral and connection, which were used to guide the development of the curriculum, training materials and training approach.ConclusionThis study presents a novel approach to develop a training program that aims to enhance healthcare services for people with disabilities in Uganda. The findings offer practical insights for the development of similar programs in LMICs. The effectiveness of the training program will be evaluated through a pilot test, and policy support is crucial for its successful implementation at scale.

IJCM_284A: A Community based Cross-sectional study to assess the foot care practice and its associated factors among Lymphatic Filariasis patients in rural areas of Chengalpattu district, 2023.

Background: Lymphatic filariasis (LF) is a neglected tropical diseases, in which India has 40% of the world’s burden. LF patients suffering from disability, social stigma and severe morbidity remains as a significant public health concern. Patients to avoid acute attacks of lymphadenitis and to alleviate lymphoedema progression should have meticulous foot care practices. Objectives: 1. To assess the foot care practices and its associated factors among lymphatic filariasis patients in rural areas of Chengalpattu. 2. To determine the association between sociodemographic characteristics and clinical foot care practice among lymphatic filariasis patients in rural areas of Chengalpattu. Methodology: A community based cross-sectional study was conducted in rural area of Chengalpattu by multi-stage random sampling method among 185 participants with lymphedema using a semi-structured questionnaire for regular foot care by interview. Data was collected by Epi-collect 5 software and analyzed using SPSS v 16. Results: Among 190 participants - 50.5% were above 60 years, 63.2% were females, 59.4% had education up to middle school, 56.8% were unemployed, 70% were from upper lower class and below. 68.4% (95% CI: 61.3-75) had good practice on foot care based on 8 recommended foot care measures. A significant association was found between good foot care practices and those above upper lower socioeconomic class [OR=3.9(1.71-8.90)], with chronic illness [OR=1.9(1.01-3.71)], with water supply at home [OR=3.64(1.23-10.7)], experiencing acute lymphadenitis attack [OR=0.345(0.14-0.82)], patient worn foot wear regularly [OR=3.51(1.26-9.74)], wearing shoes and slippers [OR=0.134(0.35- 0.51)], patient seeking OP services for filariasis regularly [OR=3.18(1.56- 6.47)] had health education[OR=3.31(1.36-8.08)] and attended training programme [OR=2.86(1.50-5.45)]. Conclusion: Study indicated that people living with lymphoedema in rural areas of Chengalpattu district had good foot care practices. But more than one fourth of people had bad foot care practice, which can be improved by strengthening the patient follow-up, health education, training programme for patients and health care workers on foot care practice and morbidity management.

Assessing the Implementation of Social Security Program for Tobacco Farmers in Jember Regency

This research delves into the implementation of social security programs, particularly focusing on tobacco farm workers in Jember regency, Indonesia. Despite the mandatory nature of the BPJS Ketenagakerjaan, many tobacco farm laborers remain uncovered, posing risks to their social and economic well-being. Utilizing a quantitative research methodology, the study employs questionnaires and statistical analysis to understand the factors influencing participation in the BPJS Employment program. Findings reveal that variables such as Program Urgency, Farmers' Knowledge, Program Benefits, Farmers' Expectations, and the Role of Local Government collectively explain 67.5% of tobacco farmers' participation. Notably, Program Urgency and Program Benefits significantly impact participation, highlighting the vital role of social security in providing financial assurance against job-related risks. Moreover, active involvement of the Local Government is essential in fostering farmers' interest and engagement in the program. These findings underscore the significance of social security programs for tobacco farm workers, emphasizing the need for government support and facilitation to enhance program participation and ensure the welfare of vulnerable laborers.

313 Data-Driven Evaluation of Community Health Worker Program

OBJECTIVES/GOALS: Thiswork is an evidential study that demonstrates the positive impactof integrating Community Health Workers (CHWs) and SocialDeterminants of Health on an important health outcome, notably in decreasing the 30-day unplanned hospital ED readmissions at Sinai Health Systems. METHODS/STUDY POPULATION: Using datafrom the Sinai Urban Health Institute (SUHI), we compare predictingthe readmissions of patients with and without data pertainingto Social Determinants of Health (SDoH). We thoroughly describe the data cleaning and data pre-processing, done in collaboration with experts in community health. We use a fundamental and ubiquitous classifier in Random Forest for its feature characterization capability in order to translate models results into insights and recommendations for the CHW program. RESULTS/ANTICIPATED RESULTS: We show that when patients are simply engaged byCHWs, regardless of the content of those conversations, we canincrease the predictive accuracy of our classifier by 5%. We usethis result to make recommendations for improving patient careand discuss limitations and future work. Importantly our workpoints directly to the human connection between patients andCHWs as an important feature in the readmission rate. DISCUSSION/SIGNIFICANCE: Our work shows that the predictive capabilities of the classifier increases with CHW logs and SDoH survey data, highlighting the benefit of collecting this information. This is the first step in early identification of such patients so that CHWs are focusing on and providing resources to patients who will most benefit from the program.

Implementasi Kebijakan Pemerintah Bagi Pekerja Migran Indonesia (PMI) di Provinsi Jawa Timur Tahun 2021

This research aims to analyze the implementation of government policies for Indonesian Migrant Workers in reducing employment problems in East Java Province in 2021 using the George C. Edwards III approach. The method applied in this research is a descriptive qualitative research method. Data was obtained through interviews, observation and documentation. The data sources used are primary data and secondary data. The research results reveal that the Indonesian Migrant Workers program has been successfully implemented in East Java Province with increased action in handling complaints from Indonesian Migrant Workers

Effect of Corporate Governance on Corporate Social Responsibility: A Theoretical Review

The major points are summed up in this. Looking at the causal effects of these two forms of governance on CSR involvement, the goal of this work is to establish the empirical link between "corporate governance (CG) and corporate social responsibility (CSR)". Initially, delayed "Corporate Social Responsibility (CSR)" seems to have minimal effect on "Corporate Governance (CG)". On the other hand, delaying the CG variable favours corporate involvement in CSR projects. This is still the case when one takes into account other aspects unique to the company. We use a sizable and varied American sample. Agency theory and stakeholder theory are examined in connection to CFP and CSR. The purpose is to prioritise these three concepts. Despite endogeneity bias, CSR actions boost corporate CFP. The facts do not support stakeholder conflict-resolution theory or agency CSR overinvestment hypothesis. CFP growth is also driven by company diversification, worker, community, and environment programmes.

How you value shapes whom you value: The contribution of apprenticeships to sustainable development goals

Apprenticeships are crucial in the ILO’s decent work agenda and align with sustainable development goals. While existing scholarship underscores the relevance of specific programme features for stakeholders’ outcomes, scant attention has been paid to the HR actors’ agency in shaping the programmes. Our process study delves into a customised apprenticeship programme for temporary workers in an Austrian manufacturing firm, aiming to uncover how HR actors influence apprenticeship outcomes. Adopting a convention theory approach, we examine HR actors’ evaluations during the programmes’ realisation and their implications for consolidation or conversion of programme features. The findings reveal a range of gains and unfulfilled aspirations, particularly for employee representatives. We attribute these outcomes to HR actors’ commitment to convention-based practices, which are more salient during the recruitment and training phase than after the exam. We conclude that how HR actors value apprenticeship shapes for whom an apprenticeship programme is valuable.

Examining Youth Flexible ACT Model Implementation in the Netherlands

Model adherence is a key indicator of mental health care quality. This study investigates the degree of model adherence, as well as content and staging of care, among the first Youth Flexible Assertive Community Treatment (ACT) teams in the Netherlands. Model fidelity was assessed in sixteen teams with the Youth Flexile ACT model fidelity scale (2014 version). Mental health workers completed a ‘content of care questionnaire’ to map the interventions applied in the teams. Model fidelity scores revealed that twelve teams adhered to the Youth Flexible ACT standard with ‘optimal implementation’ (≥ 4.1 on a 5 point scale) and four teams with ‘adequate implementation’. Most disciplines were well integrated within the teams; however, several items regarding the involvement of specific disciplines and the availability of treatment interventions (peer support worker, employment and education specialist and programs, family interventions, integrated dual disorder treatment) scored below the optimum. Frequency of contact during ACT and the use of Routine Outcome Monitoring instruments scored below the optimum as well. The ‘content of care’ data showed that most clients received an individual psychological intervention, and nearly half of the client sample received scaled-up / intensified ACT care. The findings indicate a predominantly successful translation of care from the theoretical Flexible ACT framework into practice, covering both ACT and non-ACT functions. Further room for improvement lies in the incorporation of specialized disciplines in the personal and social recovery domains, including the peer support worker and employment and education specialist, as well as in specific protocolled interventions.

Mixed method evaluation of a learning from excellence programme for community health workers in Neno, Malawi

BackgroundCommunity Health Workers (CHWs) play an essential role in linking communities to facility-based healthcare. However, CHW programmes have often been hampered by low levels of staff motivation, and new tools aimed at improving staff motivation and work environment are needed. One such intervention is the “Learning from Excellence” (LfE) programme. We aimed to assess feasibility, outputs, and impact of a co-designed LfE programme on CHW motivation, in Neno District.MethodsWe conducted a convergent mixed-method evaluation of the LfE programme. Co-design of the programme and forms took place between October 2019 and January 2020. LfE forms submitted between September and November 2020 were analysed using descriptive statistics and memos summarising answers to the open-ended question. To investigate experiences with LfE we conducted in-depth semi-structured interviews with key stakeholders, CHWs, and site supervisors, which were analysed thematically. A pre-post intervention questionnaire was developed to assess the impact of the co-designed LfE intervention on CHW motivation and perceived supervision. Outcomes were triangulated into a logic model.ResultsIn total 555 LfE forms were submitted, with 34.4% of CHWs in Neno District submitting at least one LfE report. Four themes were identified in the interviews: LfE implementation processes, experience, consequences, and recommendations. A total of 50 CHWs participated in the questionnaire in January 2020 and 46 of them completed the questionnaire in December 2020. No statistically significant differences were identified between pre-and post-LfE measurements for both motivation (Site F: p = 0.86; Site G: p = 0.31) and perceived supervision (Site F: p = 0.95; Site G: p = 0.45). A logic model, explaining how the LfE programme could impact CHWs was developed.ConclusionsMany CHWs participated in the LfE intervention between September 2020 and November 2020. LfE was welcomed by CHWs and stakeholders as it allowed them to appreciate excellent work in absence of other opportunities to do so. However, no statistically significant differences in CHW motivation and perceived supervision were identified. While the intervention was feasible in Neno District, we identified several barriers and facilitators for implementation. We developed a logic model to explain contextual factors, and mechanisms that could lead to LfE outcomes for CHWs in Neno District. The developed logic model can be used by those designing and implementing interventions like LfE for health workers.

Efficacy of the my health too online cognitive behavioral therapy program for healthcare workers during the COVID-19 pandemic: A randomized controlled trial

BackgroundHealthcare workers' mental health has been impacted by the COVID-19 pandemic, emphasizing the need for mental health interventions in this population. Online cognitive behavioral therapy (CBT) is efficient to reduce stress and may reach numerous professionals. We developed “MyHealthToo”, an online CBT program to help reduce stress among healthcare workers during the COVID-19 pandemic. ObjectiveThe aim of our study is to investigate the efficacy of an online CBT program on stress and mental health conditions among healthcare workers during a health crisis. MethodsWe performed a multicentric randomized controlled trial among 155 participants allocated either to the experimental or active control group (bibliotherapy). The primary outcome was the decrease of perceived stress scores (PSS-10) post-treatment. Secondary outcomes included depression, insomnia and PTSD symptoms along with self-reported resilience and ruminations. Assessments were scheduled pretreatment, mid-treatment (4 weeks), post-treatment (8 weeks), and at 1-month and 4-months follow-up. ResultsFor both interventions, mean changes on the PSS-10 were significant post-therapy (W8), as at 1-month (W12) and 4-months (W24) follow-ups. The between-group comparison showed no difference at any time point (ps > 0.88). Work-related ruminations significantly decreased in the experimental group with a significant between-group difference at W8 (Δ = −1.83 [−3.57; −0.09], p = 0.04). Posttraumatic stress symptoms significantly decreased in the experimental group with a significant between-group difference at W12 (Δ = −1.41 [−2.68; −0.14], p = 0.03). The decrease in work-related ruminations at W8 mediated the decrease in posttraumatic stress symptoms at W12 (p = 0.048). ConclusionThe “MyHealthToo” online CBT intervention may help reduce ruminations about work and posttraumatic stress symptoms among healthcare workers during a major health crisis. Work-related ruminations may represent a relevant target of online interventions to improve mental health among healthcare workers.

Labor Issues that the H2A Temporary Agricultural Worker Policy Attempts to Resolve in Florida

Labor is a critical component of a successful agricultural venture. In 2020, the USDA reported that 10.3% of total US employment was in jobs in the agricultural and food sectors. We rely on food, fiber, and natural resources, and effective agricultural labor is a critical social need, but the challenges inherent in the effort to secure agricultural labor are many and difficult to solve. Particularly in Florida, maintaining a labor sufficient to meet the needs of the industry presents a complex problem. Controversies abound over issues like human rights and migrant vs. domestic labor. Today the H-2A Temporary Agricultural Workers Program is providing some compromise and progress within the agricultural labor crisis. The purpose of this publication is to review agricultural labor in Florida and analyze how the H-2A program addresses agricultural labor challenges. The publication will be of interest to consumers, labor activists, producers, corporations, and governments.

Integrating human factors engineering into your pediatric radiology practice.

Human factors engineering involves the study and development of methods aimed at enhancing performance, improving safety, and optimizing user satisfaction. The focus of human factors engineering encompasses the design of work environments and an understanding of human mental processes to prevent errors. In this review, we summarize the history, applications, and impacts of human factors engineering on the healthcare field. To illustrate these applications and impacts, we provide several examples of how successful integration of a human factors engineer in our pediatric radiology department has positively impacted various projects. The successful integration of human factors engineering expertise has contributed to projects including improving response times for portable radiography requests, deploying COVID-19 response resources, informing the redesign of scheduling workflows, and implementation of a virtual ergonomics program for remote workers. In sum, the integration of human factors engineering insight into our department has resulted in tangible benefits and has also positioned us as proactive contributors to broader hospital-wide improvements.

The Reality of Common Sexual Problems for Students with Down’s Syndrome in Saudi Arabia

Introduction: The current study aimed to identify the sexual problems of students with Down’s syndrome in Saudi Arabia from the point of view of their parents and teachers in the light of a range of variables (student’s age, educational program, and family’s economic situation). Method: This descriptive comparative study was based on a sample of 120 participants consisting of 68 parents and 52 teachers caring for students with Down’s syndrome. The questionnaire of sexual problems for students with disabilities was applied and the data was statically analyzed using Analysis of Variance (ANOVA) and One- way ANOVA. The findings indicated that the most prevalent sexual problems experienced by students with Down’s syndrome according to their parents and teachers are a lack of knowledge of sexual development, difficulties in the child presenting themselves in front of others, and the inability to distinguish between normal and abnormal physical contact. Findings: The arithmetic one-way analysis of variance (ANOVA), mean, standard deviation, and t-test were used to calculate the findings that revealed no statistically significant differences between the perspectives of the parents and teachers of students with intellectual disability regarding the most prevalent sexual problems. Moreover, there was no statistically significant correlation between the student’s age and the sexual problems they encountered. Finally, the findings found statistically significant differences in the sexual problems encountered according to the of the program variables to which the students with Down’s syndrome belong and the family’s economic situation Discussion: It is recommended that a group counseling program be devised for the parents of students with Down’s syndrome to advance their knowledge of sexual development and to obtain an understanding of how to deal with the variables resulting from such development. Develop training programs for families, teachers, psychologists, and social workers working in special needs care on how to identify the sexual problems experienced by intellectually disabled students. Raise parents’ awareness of the importance of communication and dialogue with teachers to identify the most important sexual problems their children face and collaborate to resolve them through training courses.

Hospital Pharmacy Professionals and Cardiovascular Care: A Cross-Sectional Study Assessing Knowledge, Attitudes, and Practices in Saudi Arabia.

In Saudi Arabia, cardiovascular diseases (CVDs) establish a significant health challenge, with a high prevalence and substantial impact on mortality and disability burden. Evaluating the knowledge, attitude, and practices (KAPs) of hospital pharmacy professionals towards CVDs prevention and management is crucial for effective healthcare strategies. A cross-sectional, multicenter study was conducted using a self-administered survey targeting hospital pharmacists and pharmacy technicians in the Madinah region of Saudi Arabia. The survey assessed their KAPs towards CVDs prevention and management, incorporating demographic variables and perceived barriers. Out of 177 contacted pharmacy professionals, 159 (89.8%) completed the survey. The study results revealed inadequate knowledge levels with an average score of 3.87 out of 7, indicating significant gaps in comprehending drug interactions, managing lipid levels, and addressing resistant hypertension. Attitudes were generally positive towards CVDs prevention. Practices in CVDs prevention were satisfactory but varied, with notable gaps in providing educational materials and collaboration with other healthcare professionals. Major barriers included time constraints, lack of private counseling areas, and low patient expectations regarding pharmacy professionals' roles. The study has uncovered notable deficiencies in cardiovascular care, especially within the realm of hospital pharmacy professionals in Saudi Arabia's Madinah region. This finding underscores the importance of implementing specialized educational initiatives and ongoing professional development programs for these healthcare workers. By focusing on these areas and overcoming the challenges identified, we can significantly improve the contribution of hospital pharmacy professionals in Saudi Arabia toward the prevention and management of cardiovascular diseases.

Validation of the 5-item workplace outcome suite on employee assistance programs for office workers

To evaluate the effectiveness of Employee Assistance Program (EAP) interventions, the Workplace Outcome Suite (WOS) was developed. This study aims to determine if the new WOS 5-item version can be used to approximate the WOS 25-item version without excessive loss of reliability, validity, or sensitivity. A quantitative psychometric evaluation study design was employed. Secondary data analysis of the WOS 25-item questionnaire was conducted before and after EAP services were delivered to participants. This analysis used 2046 data responses from 1023 participants. Quantitative data analysis included descriptive statistics, Cohen’s d, paired t-test, the Wilcoxon signed-rank (non-parametric test), and bivariate factor analysis. Findings demonstrate that the WOS 5-item version can successfully detect changes in workplace functioning. Within all five constructs, users’ scores improved after EAP interventions, indicating improvement in mental health. Significant changes were detected for absenteeism, presenteeism, work engagement, and workplace distress. Bivariate correlation results indicate the WOS 5-item is a good representation of the 25-item version. There are strong correlations between each item on the WOS-5 and the corresponding items in each construct on the WOS-25. This evidence suggests the WOS 5-item version can be used to approximate the WOS 25-item version without excessive loss of reliability, validity, or sensitivity.

Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model

Community health worker (CHW) programs may improve health outcomes, increase quality of life, and reduce hospitalizations and cost of care. However, knowledge is limited on the barriers and facilitators associated with scaling evidence-based CHW programs to maximize their public health outcomes. To identify barriers and facilitators to implementing an evidence-based CHW model. This qualitative study examined perspectives of Individualized Management of Person-Centered Targets (IMPaCT) program staff (health system leaders, program managers, and community health workers) and patients receiving the intervention between March 9, 2020, and July 22, 2021, at 5 institutionally and geographically diverse health systems across the US. The collected data were analyzed between December 1, 2021, and April 27, 2022. Program staff were recruited via purposive sampling, and patients were recruited via convenience sampling. The disease-agnostic IMPaCT CHW model includes a standardized implementation approach and a structured set of theory-informed intervention components to create and achieve individualized action plans. Interview guides were informed by the Consolidated Framework for Implementation Research. A rapid qualitative analytic technique was used to identify key themes, which were categorized into barriers and facilitators associated with framework ecological domains. Of a total 41 individuals invited, 39 agreed to participate (95% response rate; mean [SD] age, 45.0 [12.6] years; 30 women). General barriers included economic and policy constraints, including insufficient funding for CHW programs, clinical integration challenges, and CHW difficulty with maintaining boundaries. Program-specific barriers included insufficiently tailored materials for certain populations and upfront and ongoing program costs. General facilitators included CHWs' interpersonal skills and life experiences. Program-specific facilitators included the model's strong evidence base, supportive implementation team, and program design that enabled relationship building and engagement. Additional themes were cited as both barriers and facilitators, including the COVID-19 pandemic, organizational leadership, IMPaCT training, and program fidelity. These findings suggest growing recognition of the importance of CHWs to improving health equity and population health. Barriers identified point to important policy and practice implications for CHW programs more broadly, including the need for continued attention to improving clinical integration and the need for sustainable program financing to preserve the longevity of this workforce.

Are populations of postpartum women differentially served by community health worker programs: an observational cohort study from Zanzibar, Tanzania

BackgroundAlthough community health worker (CHW) programs focus on improving access to healthcare, some individuals may not receive the intended quality or quantity of an intervention. The objective of this research was to examine if certain populations of pregnant women differentially experience the implementation of a community health worker-led maternal health intervention in Zanzibar.MethodsWe included pregnant women enrolled in the Safer Deliveries (Uzazi Salama) program, which operated in 10 of 11 districts in Zanzibar, Tanzania between January 1, 2017, and June 19, 2019 (N = 33,914). The outcomes of interest were receipt of the entire postpartum intervention (three CHW visits) and time to first postpartum CHW visit (days). Visits by CHWs were done at the women’s home, however, a telehealth option existed for women who were unable to be reached in-person. We conducted statistical tests to investigate the bivariate associations between our outcomes and each demographic and health characteristic. We used multivariate logistic regression to estimate the relationships between covariates and the outcomes and multivariate linear regression to estimate the association between covariates and the average time until first postpartum visit.ResultsHigher parity (OR = 0.85; P = 0.014; 95%CI: 0.75–0.97), unknown or unreported HIV status (OR = 0.64; p < 0.001; 95%CI: 0.53–0.78), and receipt of phone consultations (OR = 0.77; p < 0.001; 95%CI: 0.69–0.87) were associated with a lower odds of receiving all postpartum visits. Similarly, women with an unknown or unreported HIV status (estimated mean difference of 1.81 days; p < 0.001; 95%CI: 1.03–2.59) and those who received a phone consultation (estimated mean difference of 0.83 days; p < 0.001; 95%CI: 0.43–1.23), on average, experienced delays to first visit. In addition, current delivery at a referral hospital was associated with lower odds of receiving a postpartum visit and longer time to first visit compared to delivery at home, cottage hospital, PHCU + , or district hospital. Women from all other districts received their first visit earlier than women from Kaskazini B. There were no differences in the odds of receiving the entire postpartum intervention by sociodemographic variables, including age, education, and poverty assessment indicators.ConclusionThe results indicate no differences in intervention contact across wealth and education levels, suggesting that the program is effectively reaching women regardless of SES. However, women with other characteristics (e.g., higher parity, unknown or unreported HIV status) had lower odds of receiving the complete intervention. Overall, this work generates knowledge on existing disparities in intervention coverage and enables future programs to develop approaches to achieve equity in health care utilization and outcomes.

Documents, education, and aesthetics: Exploring processes of subjectification among community health workers in Peru

ABSTRACT This article examines the processes of subjectification involving community health workers in the Peruvian Andes. Community health worker programmes keep education at the core, striving to provide marginalized people with information about mother-and-child health, family planning, nutrition, and illness prevention, among other things. Education is one of the arenas where Foucauldian themes of subjectification are most explicit (Kipnis 2011). However, the subjectivities such development programmes seek to produce by training and monitoring those involved are not necessarily those that emerge. In studies of health policies and their implementation in targeted areas, the focus tends to be on how governmentality discourses and techniques produce responsible and governable subjects. However, little attention has been paid to understanding the processes of subjectification and how they are interpreted and enacted by the targeted subjects (Winkler-Reid 2017). This article aims to illuminate how community health workers use their embodied understanding of school literacy and aesthetics to engage with specific community health-related tasks. It argues that aesthetics is a central part of the formation of subjectivity and that expectations of aesthetic qualities similar to those of classroom situations contribute to accentuating the community health workers becoming ‘good students’. In this specific setting, being evaluated as a ‘good student’ receives more emphasis than other goals of the community health worker programme, such as providing easier access to health care services for their fellow community members.

Migrant Agricultural Workers’ Experiences of Support in Three Migrant‐Intensive Communities in Canada

Canada has intensified its reliance on temporary foreign workers, including migrant agricultural workers (MAWs) who have contributed to its agriculture sector, rural economies, and food security for decades. These workers live and work in rural communities across Canada for up to two years. Thousands of MAWs engage in recurring cyclical migration, often returning to the same rural communities in Canada for decades, while others are undocumented. Yet MAWs do not have access to the supports and services provided for immigrant newcomers and pathways for permanent residence. The exclusion of these workers from such entitlements, including labour mobility, reinforces their precarity, inhibits their sense of belonging, and reflects the stratification built into Canada’s migration regime. This article draws on interviews with 98 MAWs in three migrant‐intensive regions in southwestern Ontario to examine how workers construct and describe support in relation to co‐workers, employers, residents, and community organizations. Drawing on conceptualizations of support as an important vehicle for social connection and inclusion that comprises social and citizenship belonging, we document how the strategies MAWs employ to forge connections are enabled or undermined by Canada’s Temporary Foreign Worker Program, community dynamics, and the broader forces of racialization, gender, and exclusion. This article contributes to the limited scholarship on the support landscape for MAWs, whose experiences foreground the contested nature of belonging and inclusion among migrant populations across smaller cities and rural areas.