| 1. |
- Absetz, Pilvikki, et al.
(författare)
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SMART2D-development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden
- 2020
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Ingår i: Translational Behavioral Medicine. - : OXFORD UNIV PRESS. - 1869-6716 .- 1613-9860. ; 10:1, s. 25-34
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Tidskriftsartikel (refereegranskat)abstract
- Type 2 diabetes (T2D) and its complications are increasing rapidly in low- and middle-income countries, as well as among socioeconomically disadvantaged populations in high-income countries. Support for healthy lifestyle and self-management is paramount but not well implemented in health systems, and there is need for knowledge on how to design and implement interventions that are contextualized and patient centered and address special needs of disadvantaged population groups. The SMART2D project implements and evaluates a lifestyle and self-management intervention for participants recently diagnosed with or being at increased risk for T2D in rural communities in Uganda, an urban township in South Africa, and socioeconomically disadvantaged urban communities in Sweden. Our aim was to develop an intervention with shared key functions and a good fit with the local context, needs, and resources. The intervention program design was conducted in three steps facilitated by a coordinating team: (a) situational analysis based on the SMART2D Self-Management Framework and definition of intervention objectives and core strategies; (b) designing generic tools for the strategies; and (c) contextual translation of the generic tools and their delivery. This article focuses on community strategies to strengthen support from the social and physical environment and to link health care and community support. Situational analyses showed that objectives and key functions addressing mediators from the SMART2D framework could be shared. Generic tools ensured retaining of functions, while content and delivery were highly contextualized. Phased, collaborative approach and theoretical framework ensured that key functions were not lost in contextualization, also allowing for cross-comparison despite flexibility with other aspects of the intervention between the sites.
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| 2. |
- De Man, Jeroen, et al.
(författare)
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Motivational determinants of physical activity in disadvantaged populations with (pre)diabetes : a cross-cultural comparison
- 2022
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Understanding motivational determinants of physical activity (PA) is essential to guide the implementation of PA at individual and population level. Knowledge about the cross-cultural generalizability of these determinants is lacking and they have mostly been studied as separate factors. This study compares a motivational process model across samples from diverse populations with, or at risk of diabetes. Methods Measurement invariance of barrier identified regulation, barrier self-efficacy and social support was assessed in a rural Ugandan sample (n = 712) and disadvantaged samples with high proportions of immigrants in urban South Africa (n = 566) and Sweden (n = 147). These motivational determinants were then compared through multigroup structural equation modeling. Results The studied motivational constructs showed scalar invariance. Latent mean levels of perceived social support and barrier self-efficacy were lower in South Africa and Sweden. Structural models (for different PA outcomes) were not consistent across settings except for the association between perceived social support and identified regulation. Identified regulation was only associated with vigorous PA in Uganda and with moderate PA in South Africa. The association between social support and PA outcomes ranged from weak to not significant and the association between self-efficacy and PA was not significant. Self-reported PA was highest in Uganda and lowest in Sweden. Self-reported vigorous PA was significantly related to lower hemoglobin A1c levels, while moderate PA was not. Conclusions Findings suggest that: 1) it is feasible to compare a motivational process model across diverse settings; 2) there is lower perceived social support and self-efficacy in the urban, migrant samples; 3) identified regulation is a more promising determinant of PA than self-efficacy or social support in these populations; 4) associations between motivational determinants and PA depend on the perceived type and/or intensity of PA; 5) perceived relatedness functions as a basic psychological need across diverse settings; and 6) people's perception of the PA they perform depends on their perceived level of intensity of PA which would have major implications for health promotion.
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| 3. |
- Kohler, Stefan, et al.
(författare)
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Postpartum quality of life in Indian women after vaginal birth and cesarean section : a pilot study using the EQ-5D-5L descriptive system
- 2018
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: There has been little evaluation of the postpartum quality of life (QOL) of women in India and its association with the mode of birth. This study piloted the use of the generic EQ-5D-5L questionnaire to assess postpartum QOL experienced by rural Indian women.Methods: A convenience sample of rural women who gave birth in a health facility in Gujarat or Madhya Pradesh was recruited into this pilot study. QOL was measured during three interviews within 30days of birth using the EQ-5D-5L questionnaire. Patient-level quality-adjusted life days (QALDs) were estimated. Multivariate regression was used to adjust for selected baseline characteristics.Results: Forty-six women with cesarean section and 178 with vaginal birth from 17 public and private health facilities were studied. Postpartum QOL in both groups improved between interviews 1 and 3. Comparing between vaginal and cesarean births indicated that the vaginal birth group had a higher QOL (0-3 days postpartum: 0.28 vs. 0.57, 3-7 days postpartum: 0.59 vs. 0.81; P<0.001) and was more likely to report no or slight problems in 4 of 5 health dimensions (mobility, self-care, usual activities, painordiscomfort; P0.04) during interviews 1 and 2. Postpartum QOL converged, but still differed between groups by the time of interview 3 (21-30 days postpartum: 0.85 vs. 0.93; P<0.001). While most women reported no problems by the end of the first postpartum month, the difference in the ability to perform usual activities persisted (P=0.001). In result, fewer QALDs were attained by women in the cesarean section group between day 1 and day 21 postpartum (13.1 vs. 16.6 QALDs; P<0.001). Subgroup analysis showed that having had an episiotomy during vaginal birth was also associated with reduced QOL postpartum, but to a lesser extent than cesarean section. Similar results were obtained when adjusting for socioeconomic, pregnancy and birth characteristics, but postpartum QOL already ceased to be statistically different between groups before interview 3.Conclusions: Vaginal births, even with episiotomy, were associated with a higher postpartum QOL than cesarean births among the Indian women in our pilot study. Finding these expected results suggests that the EQ-5D-5L questionnaire is asuitable instrumentto assess postpartum QOL in Indian women.
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| 4. |
- Oumrait, Nuria Güil, et al.
(författare)
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Can Self-Determination Explain Dietary Patterns Among Adults at Risk of or with Type 2 Diabetes? : A Cross-Sectional Study in Socio-Economically Disadvantaged Areas in Stockholm
- 2020
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Ingår i: Nutrients. - : MDPI. - 2072-6643. ; 12:3
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Tidskriftsartikel (refereegranskat)abstract
- Type 2 Diabetes (T2D) is a major health concern in Sweden, where prevalence rates have been increasing in socioeconomically disadvantaged areas. Self-Determination Theory (SDT) is posited as an optimal framework to build interventions targeted to improve and maintain long-term healthy habits preventing and delaying the onset of T2D. However, research on SDT, T2D and diet has been widely overlooked in socio-economically disadvantaged populations. This study aims to identify the main dietary patterns of adults at risk of and with T2D from two socio-economically disadvantaged Stockholm areas and to determine the association between those patterns and selected SDT constructs (relatedness, autonomy motivation and competence). Cross-sectional data of 147 participants was collected via questionnaires. Exploratory Factor Analysis was used to identify participants' main dietary patterns. Multiple linear regressions were conducted to assess associations between the SDT and diet behaviours, and path analysis was used to explore mediations. Two dietary patterns (healthy and unhealthy) were identified. Competence construct was most strongly associated with healthy diet. Autonomous motivation and competence mediated the effect of relatedness on diet behaviour. In conclusion, social surroundings can promote adults at high risk of or with T2D to sustain healthy diets by supporting their autonomous motivation and competence.
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| 5. |
- Sabde, Yogesh, et al.
(författare)
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Bypassing health facilities for childbirth in the context of the JSY cash transfer program to promote institutional birth : A cross-sectional study from Madhya Pradesh, India
- 2018
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Bypassing health facilities for childbirth can be costly both for women and health systems. There have been some reports on this from Sub-Saharan African and from Nepal but none from India. India has implemented the Janani Suraksha Yojana (JSY), a large national conditional cash transfer program which has successfully increased the number of institutional births in India. This paper aims to study the extent of bypassing the nearest health facility offering intrapartum care in three districts of Madhya Pradesh, India, and to identify individual and facility determinants of bypassing in the context of the JSY program. Our results provide information to support the optimal utilization of facilities at different levels of the healthcare system for childbirth. Data was collected from 96 facilities (74 public) and 720 rural mothers who delivered at these facilities were interviewed. Multilevel logistic regression was used to analyze the data. Facility obstetric care functionality was assessed by the number of emergency obstetric care (EmOC) signal functions performed in the last three months. Thirty eighth percent of the mothers bypassed the nearest public facility for their current delivery. Primiparity, higher education, arriving by hired transport and a longer distance from home to the nearest facility increased the odds of bypassing a public facility for childbirth. The variance partition coefficient showed that 37% of the variation in bypassing the nearest public facility can be attributed to difference between facilities. The number of basic emergency obstetric care signal functions (AOR = 0.59, 95% CI 0.37 +/- 0.93), and the availability of free transportation at the nearest facility (AOR = 0.11, 95% CI 0.03 +/- 0.31) were protective factors against bypassing. The variation between facilities (MOR = 3.85) was more important than an individual's characteristics to explain bypassing in MP. This multilevel study indicates that in this setting, a focus on increasing the level of emergency obstetric care functionality in public obstetric care facilities will allow more optimal utilization of facilities for childbirth under the JSY program thereby leading to better outcomes for mothers.
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| 6. |
- Sabde, Yogesh, et al.
(författare)
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The availability of emergency obstetric care in the context of the JSY cash transfer programme in Madhya Pradesh, India
- 2016
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Since 2005, India has implemented a national cash transfer programme, the Janani Suraksha Yojana (JSY), which provides women a cash transfer upon giving birth in an existing public facility. This has resulted in a steep rise in facility births across the country. The early years of the programme saw efforts being made to strengthen the ability of facilities to provide obstetric care. Given that the JSY has been able to draw millions of women into facilities to give birth (there have been more than 50 million beneficiaries thus far), it is important to study the ability of these facilities to provide emergency obstetric care (EmOC), as the functionality of these facilities is critical to improved maternal and neonatal outcomes. We studied the availability and level of provision of EmOC signal functions in public facilities implementing the JSY programme in three districts of Madhya Pradesh (MP) state, central India. These are measured against the World Health Report (WHR) 2005benchmarks. As a comparison, we also study the functionality and contribution of private sector facilities to the provision of EmOC in these districts. Methods: A cross-sectional survey of all healthcare facilities offering intrapartum care was conducted between February 2012 and April 2013. The EmOC signal functions performed in each facility were recorded, as were human resource data and birth numbers for each facility. Results: A total of 152 facilities were surveyed of which 118 were JSY programme facilities. Eighty-six percent of childbirths occurred at programme facilities, two thirds of which occurred at facilities that did not meet standards for the provision basic emergency obstetric care. Of the 29 facilities that could perform caesareans, none could perform all the basic EmOC functions. Programme facilities provided few EmOC signal functions apart from parenteral antibiotic or oxytocic administration. Complicated EmOC provision was found predominantly in non-programme (private) facilities; only one of six facilities able to provide such care was in the public sector and therefore in the JSY programme. Only 13 % of all qualified obstetricians practiced at programme facilities. Conclusions: Given the high proportion of births in public facilities in the state, the JSY programme has an opportunity to contribute to the reduction in maternal and perinatal mortality However, for the programme to have a greater impact on outcomes; EmOC provision must be significantly improved.. While private, non-programme facilities have better human resources and perform caesareans, most women in the state give birth under the JSY programme in the public sector. A demand-side programme such as the JSY will only be effective alongside an adequate supply side (i.e., a facility able to provide EmOC).
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| 7. |
- Sahoo, Krushna Chandra, et al.
(författare)
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Dynamics of Household Waste Segregation Behaviour in Urban Community in Ujjain, India : A Framework Analysis
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:12
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Tidskriftsartikel (refereegranskat)abstract
- Waste segregation practices must be socially acceptable, affordable, context-specific, and participatory, which is essential for promoting waste segregation. Therefore, this study explored the urban community members’ motivation, opportunity, and household waste segregation ability. We performed a qualitative study in Ujjain city, India. Ten focus group discussions and eight in-depth interviews were conducted with female and male household members in residential and slum areas. All interviews were digitally recorded, transcribed, and translated. We used the thematic framework technique using the Motivation-Opportunity-Ability-Behaviour theory for analysis. Three themes were constructed: motivation, where household members are motivated to sort waste yet fear the consequences of improper sorting; ability, where household waste segregation is rapidly gaining acceptance as a social norm; and opportunities, involving convenient facilities and a social support system for household members towards waste segregation. This study contributes to developing a knowledge base on waste segregation behaviour and a repertoire to facilitate evidence-based management and policymaking. There is a need for educational intervention and women’s self-help groups’ involvement to develop community orientation and waste segregation literacy. Finally, this study emphasizes the importance of all three behavioural change components, i.e., motivation, opportunity, and ability, in managing sustainable waste segregation practices.
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| 8. |
- Sidney Annerstedt, Kristi
(författare)
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'Nobody delivers at home now' : who and why women participate in a conditional cash transfer program to promote institutional delivery in Madhya Pradesh, India
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: One-fifth of global maternal deaths occur in India making this a serious public health challenge. It is well known that skilled birth attendance and access to quality emergency obstetric care reduces maternal mortality. However, up until 2005, efforts by the government at providing access to emergency obstetric care were thwarted by low uptake of facility-based delivery (39% in the same year). A cash incentive program, Janani Suraksha Yojana (JSY) was implemented in 2005 by the central government to increase facility-based births and reduce maternal mortality. It gave money directly to the women upon discharge from a public health facility after childbirth. Subsequently in 2009 an emergency transport model (Janani Express Yojana, JEY) was implemented to support the JSY program and eliminate physical access barriers to giving birth in a facility. Methods: Data for this thesis was collected between January 2011 and April 2015 from three districts (Ujjain, Shahdol and Panna) in the central Indian state of Madhya Pradesh. The thesis is organized into four studies (I-IV). In study I, a structured questionnaire was used to identify predictors of JSY program participation and reasons for non-participation in a population-based sample of 478 women. In study II, qualitative interviews with 24 JSY beneficiaries and non-beneficiaries explored reasons for their participation in the program. In study III, a facility-based study among 1,005 women was used to study predictors of emergency transport use. In study IV, another population-based survey assessed out-of-pocket expenditures (OOPE) among 2,615 women giving birth. Results: Program uptake was high (76%). Women who were uneducated, multiparous or lacked prior knowledge of the JSY program were more likely to deliver at home. Lack of transportation was the main reason for home births at this point in time (study I). The decision of most women to participate in the program reflected a change in social norms towards delivering in a health facility along with individual perceptions of a safe and easy delivery and pressure from an accredited social health activist (ASHA). Many women reported their behavior was influenced by receiving the incentive, but just as many said it did not play a role in their decision to deliver in a facility. Non-participation was often unintentional due to personal circumstances or driven by a perception of poor quality of care in public sector facilities (study II). JEY uptake was greater in women from lower socio-economic backgrounds: rural women were 4.46 times more likely to use JEY (95% CI: 2.38-8.37) compared to urban; and women belonging to scheduled tribes were 1.60 times more likely (95% CI: 1.18-2.16) than women from a general caste. A third of the JEY users experienced a delay in reaching the health facility (study III). The large majority (91%) of women reported OOPE. It was driven largely by indirect costs like informal payments (37%) and food and cloth items for the baby (47%), not direct medical payments (8%). Being a JSY beneficiary increased odds (AOR: 1.58; 95% CI: 1.11- 2.25) of incurring OOPE. However among women who had any OOPE, JSY beneficiaries had a 16% decrease (95% CI: 0.73 - 0.96) in OOPE compared to women who gave birth at home (study IV). Discussion/Conclusion: There was significant program uptake in our study area with a large majority of poor women participating in the program. There are multiple drivers influencing participation: (i) a number of supporting elements (ASHA, cash incentive, transportation support) and (ii) the program does not occur in a vacuum but in a context with dynamic social norms around childbirth. There were limits to the influence of the cash and behaviors may be as much influenced by social norms and social pressures for many. Even though the uptake to the emergency transport service was low, the JEY complemented the JSY program by providing some of the most vulnerable women transport to a health facility and decreasing the geographical barrier. Nevertheless, there are opportunities to expand the service to more women and improve the time it takes to reach the health facility. OOPE is still prevalent among women who deliver under the JSY program. However the cash incentive was large enough to defray the OOPE enabling the poorest women to have a net gain. The program seems to be effective in providing financial protection for the most vulnerable groups (i.e. women from poorer households and disadvantaged castes).
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| 9. |
- Sidney, Kristi, et al.
(författare)
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Out-of-pocket expenditures for childbirth in the context of the Janani Suraksha Yojana (JSY) cash transfer program to promote facility births : who pays and how much? Studies from Madhya Pradesh, India
- 2016
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Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: High out-of-pocket expenditures (OOPE) make delivery care difficult to access for a large proportion of India’s population. Given that home deliveries increase the risk of maternal mortality, in 2005 the Indian Government implemented the Janani Suraksha Yojana (JSY) program to incentivize poor women to deliver in public health facilities by providing a cash transfer upon discharge. We study the OOPE among JSY beneficiaries and women who deliver at home, and predictors of OOPE in two districts of Madhya Pradesh.Methods: September 2013 to April 2015 a cross-sectional community-based survey was performed. All recently delivered women were interviewed to elicit delivery costs, socio-demographic characteristics and delivery related information.Results: Most women (n = 1995, 84 %) delivered in JSY public health facility, the remaining 16 % (n = 386) delivered at home. Women who delivered under JSY program had a higher median, IQR OOPE ($8, 3–18) compared to home ($6, 2–13). Among JSY beneficiaries, poorest women had twice net gain ($20) versus wealthiest ($10) post cash transfer. Informal payments (64 %) and food/baby items (77 %) were the two most common sources of OOPE. OOPE made among JSY beneficiaries was pro-poor: poorer women made proportionally less expenditures compared to wealthier women. In an adjusted model, delivering in a JSY public facility increased odds of incurring expenditures (OR: 1.58, 95 % CI: 1.11–2.25) but at the same time to a 16 % (95 % CI: 0.73–0.96) decrease in the amount paid compared to home deliveries.Conclusions: OOPE is prevalent among JSY beneficiaries as well in home deliveries. In JSY, OOPE varies by income quintile: wealthier quintiles pay more OOPE. However the cash incentive is adequate enough to provide a net gain for all quintiles. OOPE was largely due to indirect costs and not direct medical payments. The program seems to be effective in providing financial protection for the most vulnerable groups.
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| 10. |
- Timm, Linda, et al.
(författare)
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Application of the Theoretical Framework of Acceptability to assess a telephone-facilitated health coaching intervention for the prevention and management of type 2 diabetes
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Lifestyle interventions focusing on diet and physical activity for the prevention and management of type 2 diabetes have been found effective. Acceptance of the intervention is crucial. The Theoretical Framework of Acceptability (TFA) developed by Sekhon et al. (2017) describes the multiple facets of acceptance: Affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs and self-efficacy. The aims of this study were to develop and assess the psychometric properties of a measurement scale for acceptance of a telephone-facilitated health coaching intervention, based on the TFA; and to determine the acceptability of the intervention among participants living with diabetes or having a high risk of diabetes in socioeconomically disadvantaged areas in Stockholm.Methods: This study was nested in the implementation trial SMART2D (Self-management approach and reciprocal learning for type 2 diabetes). The intervention consisted of nine telephone-facilitated health coaching sessions delivered individually over a 6-month period. The acceptability of the intervention was assessed using a questionnaire consisting of 19 Likert scale questions developed using Sekhon's TFA. Exploratory factor analysis (EFA) was performed.Results: Ratings from 49 participants (19 with type 2 diabetes and 30 at high risk of developing diabetes) in ages 38-65 were analyzed. The EFA on the acceptability scale revealed three factors with acceptable reliabilities: affective attitude (alpha 0.90), coherence and understanding (alpha 0.77), perceived burden (alpha 0.85), explaining 82% of the variance. Positive affect and coherence had high median scores and small variance. Median score for perceived burden was low, but with significant variance due to younger individuals and those at high risk reporting higher burden.Conclusions: The telephone-facilitated health coaching intervention was perceived as acceptable by the study population using a questionnaire based on Sekhon's TFA, with a wider variation in perceived burden seen among high risk and younger participants.
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