62 research outputs found
Psychosocial and mental health impacts of migration on ‘left-behind’ children of international migrant workers
No full text
How does domestic violence stigma manifest in women's lives in Afghanistan? A study of survivors' lived experiences of help-seeking across three provinces
Get PDFAfghanistan has one of the highest rates of domestic violence in the world, with an estimated 46% women reporting lifetime violence. Survivors of domestic violence experience significant stigma from their families and communities, often in the form of blame, shame, gossip, and dismissal. While the manifestations of stigma are often the same across cultural settings, the drivers may be different. We conducted sixty semi-structured interviews with survivors of domestic violence in three provinces of Afghanistan. Data were analysed using thematic network analysis. Our analysis highlights stigma as a structural phenomenon in Afghanistan underpinned by mutually reinforcing structural elements (including community, government authorities, marital and natal families, other survivors and the self). In a country with a deeply patriarchal social structure, the main manifestation of stigma was the silencing of survivors of violence, as domestic violence was considered a private affair. Notions of honour were paramount in fuelling stigma against survivors of violence, as any action to report or leave violent relationships was considered dishonourable. Our findings have implications for the design of services to help survivors of violence seek help for the violence they experience, especially at a time when such services are increasingly constricted for women in Afghanistan
How does domestic violence stigma manifest in women’s lives in Afghanistan? A study of survivors’ lived experiences of help-seeking across three provinces.
Get PDFAfghanistan has one of the highest rates of domestic violence in the world, with an estimated 46% women reporting lifetime violence. Survivors of domestic violence experience significant stigma from their families and communities, often in the form of blame, shame, gossip, and dismissal. While the manifestations of stigma are often the same across cultural settings, the drivers may be different. We conducted sixty semi-structured interviews with survivors of domestic violence in three provinces of Afghanistan. Data were analysed using thematic network analysis. Our analysis highlights stigma as a structural phenomenon in Afghanistan underpinned by mutually reinforcing structural elements (including community, government authorities, marital and natal families, other survivors and the self). In a country with a deeply patriarchal social structure, the main manifestation of stigma was the silencing of survivors of violence, as domestic violence was considered a private affair. Notions of honour were paramount in fuelling stigma against survivors of violence, as any action to report or leave violent relationships was considered dishonourable. Our findings have implications for the design of services to help survivors of violence seek help for the violence they experience, especially at a time when such services are increasingly constricted for women in Afghanistan
Overlooked and unaddressed: A narrative review of mental health consequences of child marriages
Get PDFChild Marriage (before the age of 18) affects over 12 million young women globally, annually. Despite acknowledgement of the negative impacts of the practice on reproductive health, mental health consequences are largely overlooked. Given the ability for poor mental health to intensify other health and social challenges, understanding the mental health consequences linked to child marriage is vital. Our study is the first to examine how mental health is approached in current literature on child marriage. Our conceptual framework was informed by a rapid assessment of key issues in the field. Systematic searches of papers published between 2000–2020 were completed on four electronic databases with no language restrictions. Our protocol was registered on Prospero (CRD42019139685). Articles were assessed using PRISMA guidelines, and their quality assessed using the Joanna Briggs Institute Critical Appraisal Tools. Of the 4,457 records identified, 21 papers meeting inclusion criteria were analysed using narrative synthesis. The final sample included 5 qualitative, 1 mixed-methods and 15 quantitative studies (14 cross-sectional and 1 longitudinal study) reporting on data from 12 countries, largely in the global south. Intimate partner violence, poverty, challenges in childbirth and isolation were identified as social factors linked to emotional distress by those married as children. Depression was the most reported mental disorder. Anxiety, phobias, psychological distress, substance misuse, negative well-being and anti-social personality disorder were reported less frequently. Findings highlight that while significant emotional distress and specific mental health conditions are linked to child marriage, gaps in our understanding remain. Future studies are needed to; clarify directionality in these relationships; understand the mental health needs of young men, LGBTQI communities and those in humanitarian settings. Given the well documented cyclical relationship between social determinants and mental health conditions, we outline a series of community-oriented interventions which blend psychological, social and structural support to promote mental health and wellbeing in the contexts of child marriage
Evaluating the use of red flags by online symptom checkers.
Get PDFBACKGROUND: Online Symptom Checkers (OSCs) are digital health tools providing triage, diagnostic, and self-care advice based on user reported symptoms. Amidst global trends of increasing demand and workforce shortages, OSCs have the potential to alleviate primary care workload. However, their ability to seek red flag symptoms, a critical marker of a safe consultation in primary care, remains unexplored. Using clinical vignettes, this study evaluates OSCs' performance in seeking red flag symptoms compared to Primary Care Physicians (PCPs).
METHODS: Four OSCs (Ada, Babylon, Symptomate, Healthily) were evaluated using 51 clinical vignettes. Two standard setters used guidelines to determine which vignettes required emergency triage and identified the relevant red flags symptoms for the remaining vignettes. Two laypersons entered data from vignettes into OSCs and outputs were collected following a standardised form. The same vignettes were independently assessed by PCPs to compare triage accuracy and red flag identification. Summary statistics and 95% confidence intervals were calculated using Wilson Score intervals, and Fisher's exact test was used to compare performance between OSCs and PCPs.
RESULTS: Of the 51 clinical vignettes, standard setters determined 14 to require emergency triage and the remaining 37 vignettes suitable for primary care triage. Of the primary care triaged vignettes, standard setters identified a total of 77 relevant red flag symptoms to be sought. Of the 14 emergency vignettes, PCPs correctly triaged 85.7% (95% CI: 74.3-92.6%) of cases compared to OSCs 76.9% (95% CI: 59.3-87.9%), with no statistically significant difference (p = 0.299). Specificity, the proportion of correctly triaged primary care vignettes, PCPs performed significantly better compared to OSCs, 91.9% (95%CI 78.9-97.0%) vs. 83.3% (95%CI 68.1-91.9%), p = 0.024.
CONCLUSIONS: OSCs demonstrated comparable ability to appropriately triage clinical vignettes requiring emergency triage as PCPs, however, were less specific, triaging more primary care vignettes as emergency. OSCs do not seek the majority of red flags. This raises concerns about their safety and effectiveness in primary care. OSCs developers should focus on improving OSCs' red flag coverage to ensure safe integration into primary care settings
Evaluating the use of red flags by online symptom checkers
No full textBACKGROUND: Online Symptom Checkers (OSCs) are digital health tools providing triage, diagnostic, and self-care advice based on user reported symptoms. Amidst global trends of increasing demand and workforce shortages, OSCs have the potential to alleviate primary care workload. However, their ability to seek red flag symptoms, a critical marker of a safe consultation in primary care, remains unexplored. Using clinical vignettes, this study evaluates OSCs’ performance in seeking red flag symptoms compared to Primary Care Physicians (PCPs). METHODS: Online Symptom Checkers (OSCs) are digital health tools providing triage, diagnostic, and self-care advice based on user reported symptoms. Amidst global trends of increasing demand and workforce shortages, OSCs have the potential to alleviate primary care workload. However, their ability to seek red flag symptoms, a critical marker of a safe consultation in primary care, remains unexplored. Using clinical vignettes, this study evaluates OSCs’ performance in seeking red flag symptoms compared to Primary Care Physicians (PCPs). RESULTS: Of the 51 clinical vignettes, standard setters determined 14 to require emergency triage and the remaining 37 vignettes suitable for primary care triage. Of the primary care triaged vignettes, standard setters identified a total of 77 relevant red flag symptoms to be sought. Of the 14 emergency vignettes, PCPs correctly triaged 85.7% (95% CI: 74.3–92.6%) of cases compared to OSCs 76.9% (95% CI: 59.3–87.9%), with no statistically significant difference (p = 0.299). Specificity, the proportion of correctly triaged primary care vignettes, PCPs performed significantly better compared to OSCs, 91.9% (95%CI 78.9–97.0%) vs. 83.3% (95%CI 68.1–91.9%), p = 0.024. CONCLUSIONS: OSCs demonstrated comparable ability to appropriately triage clinical vignettes requiring emergency triage as PCPs, however, were less specific, triaging more primary care vignettes as emergency. OSCs do not seek the majority of red flags. This raises concerns about their safety and effectiveness in primary care. OSCs developers should focus on improving OSCs' red flag coverage to ensure safe integration into primary care settings
Overlooked and Unaddressed: A narrative review of mental health consequences of child marriages.
No full textChild Marriage (before the age of 18) affects over 12 million young women globally, annually. Despite acknowledgement of the negative impacts of the practice on reproductive health, mental health consequences are largely overlooked. Given the ability for poor mental health to intensify other health and social challenges, understanding the mental health consequences linked to child marriage is vital. Our study is the first to examine how mental health is approached in current literature on child marriage.
Our conceptual framework was informed by a rapid assessment of key issues in the field. Systematic searches of papers published between 2000-2020 were completed on four electronic databases with no language restrictions. Our protocol was registered on Prospero (CRD42019139685). Articles were assessed using PRISMA guidelines, and their quality assessed using the Joanna Briggs Institute Critical Appraisal Tools. Of the 4,457 records identified, 21 papers meeting inclusion criteria were analysed using narrative synthesis. The final sample included 5 qualitative, 1 mixed-methods and 15 quantitative studies (14 cross-sectional and 1 longitudinal study) reporting on data from 12 countries, largely in the global south.
Intimate partner violence, poverty, challenges in childbirth and isolation were identified as social factors linked to emotional distress by those married as children. Depression was the most reported mental disorder. Anxiety, phobias, psychological distress, substance misuse, negative well-being and anti-social personality disorder were reported less frequently. Findings highlight that while significant emotional distress and specific mental health conditions are linked to child marriage, gaps in our understanding remain. Future studies are needed to; clarify directionality in these relationships; understand the mental health needs of young men, LGBTQI communities and those in humanitarian settings. Given the well documented cyclical relationship between social determinants and mental health conditions, we outline a series of community-oriented interventions which blend psychological, social and structural support to promote mental health and wellbeing in the contexts of child marriage
Ethnic discrimination, asking for fair treatment, and poor self-rated health: a gender stratified analysis of 13,443 Korean Chinese waged workers in South Korea
No full textAbstract Background In South Korea, Korean Chinese workers experience ethnic discrimination although they share physical similarities and ethnic heritage with native-born Koreans. This study aimed to examine whether perceived ethnic discrimination is associated with poor self-rated health and whether the association differs by gender among Korean Chinese waged workers in South Korea. Methods We conducted a pooled cross-sectional analysis using data of 13,443 Korean Chinese waged workers from the Survey on Immigrants’ Living Conditions and Labor Force conducted in 2018, 2020, and 2022. Based on perceived ethnic discrimination, asking for fair treatment, and subsequent situational improvement, respondents were classified into the following four groups: “Not experienced,” “Experienced, not asked for fair treatment,” “Experienced, asked for fair treatment, not improved,” and “Experienced, asked for fair treatment, improved.” Poor self-rated health was assessed using a single question “How is your current overall health?” We applied logistic regression to examine the association between perceived ethnic discrimination and poor self-rated health, with gender-stratified analyses. Results We found an association between ethnic discrimination and poor self-rated health among Korean Chinese waged workers. In the gender-stratified analysis, the “Experienced, not asked for fair treatment” group was more likely to report poor self-rated health compared to the “Not experienced” group, regardless of gender. However, gender differences were observed in the group stratified by situational improvements. For male workers, no statistically significant association was found in the “Experienced, asked for fair treatment, improved” group with poor self-rated health (odd ratios: 0.87, 95% confidence intervals: 0.30–2.53). Conversely, among female workers, a statistically significant association was observed (odd ratios: 2.63, 95% confidence intervals: 1.29–5.38). Conclusions This study is the first to find an association between perceived ethnic discrimination and poor self-rated health, along with gender differences in the association between situational improvements after asking for fair treatment and poor self-rated health among Korean Chinese waged workers in South Korea
Mechanisms for the prevention of adolescent intimate partner violence: A realist review of interventions in low- and middle-income countries
Get PDFAdolescent girls are among those at the greatest risk of experiencing intimate partner violence (IPV). Despite adolescence being widely regarded as a window of opportunity to influence attitudes and behaviours related to gender equality, evidence on what works to prevent IPV at this critical stage is limited outside of high-income, school-based settings. Even less is understood about the mechanisms of change in these interventions. We conducted a realist review of primary prevention interventions for adolescent IPV in low- and middle-income countries (LMICs) to synthesise evidence on how they work, for whom, and under which circumstances. The review took place in four iterative stages: 1) exploratory scoping, 2) developing initial programme theory, 3) systematic database search, screening and extraction, and 4) purposive searching and refinement of programme theory. We identified eleven adolescent IPV prevention interventions in LMICs, most of which demonstrated a positive impact on IPV experience and/or perpetration (n = 10). Most interventions (n = 9) implemented school- or community-based interactive peer-group education to transform attitudes and norms around gender and relationships for behaviour change. The central mechanism of change related to gender transformative content prompting adolescents to critically reflect on their attitudes and relationships, leading to a reconceptualisation of their values and beliefs. This central mechanism was supported by two secondary implementation mechanisms: 1) the design and delivery of interventions: interactive, age-appropriate education delivered in peer-groups provided adolescents a safe space to engage with content and build communication skills, and 2) the target group: social norms interventions targeting the wider community created enabling environments supportive of individual change. This review highlights the immense potential of gender transformative interventions during the critical period of adolescence for IPV prevention. Future interventions should consider the broader drivers of adolescent IPV and ensure intersectionality informed approaches to maximise their potential to capitalise on this window of opportunity
- …
