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This study employs the therapeutic landscape theory to explore how online religious services during lockdown restrictions shape experiences of well-being and intergenerational learning. We used qualitative data from in depth interviews and focus groups with older adults and pastors in five churches in Ghana to explore how online religious places are conceptualized as therapeutic landscapes for sustaining wellbeing goals amidst a global pandemic. We identified multiple pathways of meaning through which online religious services shape the lives of people in a faith community to sustain the experience of well-being in a difficult time. In addition, this paper reflects on the broader implications of COVID-19 in shaping a paradigm shift in digital religion and intergenerational learning experiences through a changing religious landscape precipitated by lockdown restrictions that have drastically altered traditional religious places. [ABSTRACT FROM AUTHOR]

Background: In psychiatric care, doctors depend on information from interactions with patients to arrive at the right diagnosis and appropriate therapy (Brisset C, Leanza Y, Rosenberg E, Vissandjée B, Kirmayer LJ, Muckle G, et al. language barriers in mental health care: a survey of primary care practitioners. J Immigr Minor Health. 2014;16(6):1238–46). This is a qualitative descriptive study which seeks to investigate language barriers faced by psychiatrists in their interactions with patients and the effectiveness of the strategies which are employed to deal with the barriers. Methods: Research questions are informed by Convergence (Giles H. Communication Accommodation Theory. In: Baxter LA, Braithewaite DO, editors. Engaging theories in interpersonal communication: multiple perspectives. Thousand Oaks (CA): Sage Publications; 2008. p. 161–73). Using semi-structured interviews, psychiatric doctors from the three state-owned psychiatric hospitals in Ghana report their experiences with convergence strategies they use, and offer suggestions that could inform future studies and policy formulation with regard to psychiatric care in Ghana. A qualitative conventional content analysis was applied whereby coding categories were derived straight from the text data. Results: The literature suggests that the study is novel with reference to Ghana. Similar studies (Lee E. Cross-cultural communication: therapeutic use of interpreters in mental health for professionals and clinicians. In: Lee E, editor. Working with Asian Americans: a guide for clinicians. New York (NY): The Guilford Press; 1997; Swartz L, Drennan G. Beyond Words: notes on the 'irrelevance' of language to mental health services in South Africa. Transcult Psychiatry. 2000;37(2):185–201; Jarvis GE, Ahmed R, Ryder A, Kirmayer LJ. Assessing language barriers to mental health services in a multiethnic population: preliminary findings. Presentation at Health care Access for Linguistic Minorities: Breaking the Barriers. Montreal, Quebec, Canada; 2014) corroborate this paper's findings that language barriers have the potential of causing misdiagnoses if psychiatrists do not employ effective communication strategies. Conclusions: The paper recommends areas for further research and improvement measures which carry policy implications. [ABSTRACT FROM AUTHOR]

The purpose of this paper is twofold: to explore the factors influencing the emergence and growth of informal e-waste activities and to examine workers' motivation for involvement in informal e-waste activities. Semi-structured interviews and observations among actors in the recently established Dagomba-Line e-waste site in Kumasi, Ghana were employed to gather relevant data. Emergence and growth of e-waste activities are largely influenced by spatial, political, socio-cultural and economic factors. The reuse and open disposal of e-waste are the common practices due to the cost of transportation to a final disposal site. Similar to findings at the well-established Agbogbloshie e-waste site, also in Ghana, scavengers are found at the bottom of the e-waste financial ladder. The major motivating factor for engaging in e-waste handling is poverty. Additionally, some respondents mentioned the lucrative nature of the activity, landlessness, and peer influence as a motivation. The results showed that younger workers (below 35 years) were more likely to be engaged in the activity for reasons of peer influence and poverty and major source of livelihood. The paper recommends that policy and planning should reflect ways of delivering and creating stable socio-economic conditions that promote an inclusive and sustainable development. [ABSTRACT FROM AUTHOR]

People with disabilities have an inviolable right to equitable access and participation in tertiary education and support systems are known to be indispensable in making this right a reality. This article presents the voices of students with disabilities regarding aspects that influence their successful access and participation in tertiary education in Ghana. A qualitative approach was adopted for the study with data collected through interviews with 12 students with disabilities in three public universities. From the perspective of these students, successful inclusion of people with disabilities in tertiary education in Ghana is influenced by enrolment practices, the built environment, teaching and learning approaches, and assessment provisions. The context influenced provisions and support provided. Attitudes of the university community and lack of knowledge of inclusive practices such as Universal Design play a role in students' access and participation. Comprehensive awareness-raising on disability and inclusive practices is recommended to address this issue. This paper explores inclusion practices in three Ghanaian public universities focussing on the combined voices of students with disabilities. The context of the three universities influences the provisions and support available for people with disabilities. The students with disabilities involved in the study reported that access to the university environment and support for academic engagement impact their university experience. The attitude of the university community is a factor in ensuring access, participation and success of people with disabilities in higher education. Creating awareness of disability issues within the university community is pivotal in building and sustaining inclusive culture. The application of universal design principles is essential to improving access and participation of people with disabilities in higher education institutions. [ABSTRACT FROM AUTHOR]

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted. [ABSTRACT FROM AUTHOR]

Child sexual abuse (CSA) is a prevalent problem in many societies across the globe. There have been several discussions of the subject and attempts have been made to explain its incidence and find ways to prevent and/or control it. However, despite these efforts, the problem seems to persist in developing countries like Ghana with dire consequences for the children and society at large. This paper sought to glean insights about the persistence of the problem by focusing on the discourse surrounding the subject. Using Focus Group Discussions with adult members in the Ga communities in Accra namely La, Teshie, and James Town where the phenomenon is relatively pervasive, the paper sought to understand the reasoning and the implications of accusing children who were sexually abused in the Ga community of seducing the perpetrators and engaging in sex for money. The paper posits that the labeling of victims of CSA as “gbɛkɛfɔŋs” (children of bad character) disempowers children and perpetuates the abuse of children. Thus, introducing and situating this notion of “gbɛkɛfɔŋs” in the center of the discourse largely results in a victimization of the victims and a vicious cycle of CSA. The conclusions from this study point to the need for a reorientation of parental and communal roles and an empowering of children to identify and resist sexual abuse. [ABSTRACT FROM AUTHOR]

The health and wellbeing of older adults have taken center-stage in global policy agendas in recent times. In 2003, Ghana introduced an insurance exemption policy to eliminate financial barriers to healthcare for older adults and other vulnerable population groups. Embedded within the National Health Insurance Scheme (NHIS), this policy ostensibly guarantees free healthcare for older adults at publicly-funded facilities across the country. In this paper, we applied the implementation problem framework to identify gaps in the implementation of the exemptions policy and their impact on the healthcare experiences of older adults. Our data collection involved qualitative interviews with a purposive sample of community-residing older adults, health workers, community leaders, and policymakers. Our thematic data analysis identified resource, substantive, bureaucratic, political, and administrative constraints in the policy implementation process which, in turn, affected quality healthcare delivery. While most of these constraints are general challenges confronting the NHIS, they serve to undermine the intent of the scheme's exemptions policy. In particular, despite the exemptions, older adults continued to pay out-of-pocket for certain categories of treatments and medications, creating as yet financial barriers to healthcare. We present policy recommendations for addressing these implementation challenges, including suggestions to decentralize, depoliticize, and financially liberate the operations of the NHIS. Ghana's health insurance scheme has not eliminated financial barriers to healthcare for older adults. Older Ghanaians reported unmet healthcare needs, despite implementation of health insurance. Resource, substantive, bureaucratic, and political constraints impede the policy implementation process. Measures are needed to decentralize and depoliticize the NHIS implementation process. [ABSTRACT FROM AUTHOR]

While mobile phones promise to be an important tool for bridging the healthcare gaps in resource-poor areas in developing countries, scalability and sustainability of mobile phones for health (mhealth) interventions still remain a major challenge. Meanwhile, health workers are already using their own mobile phones (referred to as 'informal mhealth') to facilitate healthcare delivery in diverse ways. Therefore, this paper explores some strategies for integrating 'informal mHealth' in the healthcare delivery of Ghana, by highlighting some opportunities and challenges. The study mainly employed a combination of literature review, focus group discussions and key informant interviews with community health nurses (CHNs) and other stakeholders, who were purposively selected from the three ecological zones in Ghana. The study found that, while scale-up of 'formal mhealth' remains challenging in Ghana, almost all CHNs in our study are using their personal mobile phones 'informally' to bridge healthcare gaps, thereby promoting universal health coverage. This provides opportunities for promoting (or formalising) 'informal' mhealth in Ghana, in spite of some practical challenges in the use of personal mobile phones that need to be addressed to ensure sustainable healthcare delivery in the country. [ABSTRACT FROM AUTHOR]

This paper presents findings of a study that explored the challenges and coping strategies of parents of children with mental disorders. In-depth interviews were conducted with 35 parents of children with mental disorders at the Psychiatric Unit of the Komfo Anokye Teaching Hospital in Kumasi. Data were analyzed using thematic content analysis. Findings indicated that financial constraints, inability to secure permanent employment, and stigma were the challenges of the parents. Having faith in God and accepting their children's condition were the coping strategies adopted by the parents. However, lack of effective support system makes coping difficult for the parents. [ABSTRACT FROM AUTHOR]

Integrating consumers' experiences into quality mental health service assessment is relevant to improve service outcomes. Despite this, limited studies have attempted to explore consumers' experiences, particularly in developing countries, such as Ghana. This paper aims to explore consumers' subjective experiences of the quality of mental health services. A qualitative method involving in-depth interviews was used to collect data from 21 consumers of mental health services. Thematic analysis was used to analyse the data, which is discussed using a realistic evaluation approach. The study identifies four themes, 33 inductive codes and 594 references. The themes used to interpret the verbatim narratives are the available mental health services, therapeutic interaction with the professionals, competency and skills of the professionals, and the changes experienced in the consumers' lives. The study indicates that the mental health services aim to provide a range of treatments and medications as well as recovery-oriented services, using mechanisms such as ensuring an effective therapeutic relationship and improving technical competency and skills. The contextual factors and the mechanisms have helped to achieve some changes in the lives of consumers (increased satisfaction, reduced symptoms, improved functionality, feeling normal, improved living skills and self-care, work and capabilities, and social inclusion). The study concludes that policymakers and clinicians should integrate evidence-based recovery services, principles and values into the existing mental health services. The mechanisms used to promote quality of mental health services should be strengthened, through periodic monitoring and evaluation, using approaches such as sensor data capturing, to ensure good coordination and continuity. [ABSTRACT FROM AUTHOR]

This paper explores consumers' understanding and perception of the etiology of mental illness in community-based residential facilities in Ghana. Qualitative data involving in-depth interviews were used to collect data from 15 consumers of mental health services from two residential facilities. Thematic analysis was used to analyze the data. The study showed that mental illness is generally constructed within the medical and religious-cultural notion. The religious-cultural construction aligned mental illness to Ghanaian belief systems (supernatural forces, spirituality and traditional belief) and cultural practices (social norms and values) whilst the medical construction ascribed the etiology to biological, emotional and substance abuse issues. Although consumers had a positive perception of mental illness, they were doubtful about the presence of illness. The study concludes that the combination of medical, social and religious-cultural constructs and understanding of mental illness should be integrated into advocacy and awareness programmes to better educate consumers and clinicians. [ABSTRACT FROM AUTHOR]

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This paper explores assets for health and well-being for women in extremely poor rural areas in Ghana, Haiti, India, the Philippines, and Tanzania. Data were collected through individual interviews and focus group interviews with local women. The paper asks (i) which assets women draw on for well-being in resource-poor settings, and (ii) whether an assets approach, as understood in the Salutogenic Model, is appropriate and meaningful in the most deprived areas. Low levels of natural, material and infrastructural resources were reported by the respondents to cause stress, and assets of a human, social and cultural character were identified as being important in coping with this stress. By mobilizing the capacity and assets of people and places, local development initiatives will make sense logically (comprehensibility), they will be perceived to be practically realistic (manageability), and they will be motivating because they are meaningful, based on involvement in decision-making (meaningfulness). The assets focus must co-exist with initiatives to improve distributional justice. We conclude that an asset approach to well-being is not only appropriate, but also necessary, in even the poorest contexts. [ABSTRACT FROM PUBLISHER]

This paper examines Ghanaian young people's perceptions of the determinants of HIV- and AIDS-related stigma and discrimination, and how these perceptions may influence the de-stigmatisation process. Drawing on findings from an in-depth, multi-method qualitative study involving 104 school and street young people aged between 14 and 19 years, the paper presents young people's accounts of HIV and AIDS. The paper provokes discussion on how language and images associated with existing educational programmes on HIV and AIDS place young people in a dilemma. It also argues that fear and secrecy associated with the disease not only consolidate stigmatisation and discrimination, but also create the desire for retribution. It concludes by challenging health educators to pay particular attention to the language and images used in future educational programmes. [ABSTRACT FROM AUTHOR]

The need for the poor, the marginalised and socially excluded to live healthier and longer lives has in recent times become paramount in the development literature and policy discussions seeking to achieve the Millennium Development Goals (MDGs). In response to this, attempts are being made to redirect the research focus to examine socio-economic factors underpinning disease occurrence and ill health for health planning policies and practices to benefit the poor and vulnerable in society. Tliis paper explores the relationship between socio-economic conditions and health outcomes. It identifies and examines through participatory rural assessment techniques, basic socio- economic factors acting as significant pathways through which poverty increases the susceptibility of rural households to diseases. It seeks to address the reasons why the poor are poorer in health in rural communities of the Amansie West district of Ghana. This paper thus emphasises how social stratification and inequalities could affect quality of life of people in any given society, hence supporting the theory of social suffering and its implications on societal health. [ABSTRACT FROM AUTHOR]

Purpose: With the increasing number of assistance programs that target trafficking survivors around the globe, there is a need for documentation of evidence that can inform such programs. This paper examined and documented the post-intervention experiences of trafficked and vulnerable women who had received services at Lifeline, a residential care facility in Ghana, West Africa. Method: The study employed a secondary qualitative analysis of in-depth, face-to face interviews with n = 37 participants. Data analyzes were conducted using thematic analysis and themes and sub-themes were then extracted. Findings: Three major themes emerged from the study: major achievements after leaving Lifeline; challenges after leaving Lifeline; and family dynamics and relations after leaving Lifeline. Conclusion: Despite experiencing various social, psychological, and economic challenges after the intervention, participants reported that this particular agency had positively impacted their lives. [ABSTRACT FROM AUTHOR]

Comprehensive sexuality education (CSE) is a key component of efforts to improve sexual and reproductive outcomes for young people. While many governments have established policies and curricula for CSE, there are no quantitative measures of the quality of their implementation in schools. We describe the construction of a school-level index to measure CSE implementation quality using data from Peru, Guatemala, Kenya and Ghana for validation. The composite index represents seven key components of a successful programme: range of topics, values imparted, teaching methods, teacher training, resources available, monitoring and evaluation, and the school environment. These components are combined into two sub-indices (curriculum content and implementation context), which together provide a summary index of implementation quality. We present scores for the seven components, the two sub-indices and the summary index for each country. Ghana scored highest on the summary index, while Guatemala scored lowest, but country rankings varied within the different components. The paper discusses the implications of the findings for improving school-based CSE in these countries. An assessment of the validity and reliability of the index indicates it can be used in other settings and could be a useful tool for educationalists, researchers and programme implementers to measure CSE implementation quality. [ABSTRACT FROM AUTHOR]

Background: Persons with disabilities have often been overlooked in the context of HIV and AIDS risk prevention and service provision. This paper explores access to and use of HIV information and services among persons with disabilities. Methods: We conducted a multi-country qualitative research study at urban and rural sites in Uganda, Zambia, and Ghana: three countries selected to exemplify different stages of the HIV response to persons with disabilities. We conducted key informant interviews with government officials and service providers, and focus group discussions with persons with disabilities and caregivers. Research methods were designed to promote active, meaningful participation from persons with disabilities, under the guidance of local stakeholder advisors. Results: Persons with disabilities emphatically challenged the common assumption that persons with disabilities are not sexually active, pointing out that this assumption denies their rights and – by denying their circumstances – leaves them vulnerable to abuse. Among persons with disabilities, knowledge about HIV was limited and attitudes towards HIV services were frequently based upon misinformation and stigmatising cultural beliefs; associated with illiteracy especially in rural areas, and rendering people with intellectual and developmental disability especially vulnerable. Multiple overlapping layers of stigma towards persons with disabilities (including internalised self-stigma and stigma associated with gender and abuse) have compounded each other to contribute to social isolation and impediments to accessing HIV information and services. Participants suggested approaches to HIV education outreach that emphasise the importance of sharing responsibility, promoting peer leadership, and increasing the active, visible participation of persons with disabilities in intervention activities, in order to make sure that accurate information reflecting the vulnerabilities of persons with disabilities is accessible to people of all levels of education. Fundamental change to improve the skills and attitudes of healthcare providers and raise their sensitivity towards persons with disabilities (including recognising multiple layers of stigma) will be critical to the ability of HIV service organisations to implement programs that are accessible to and inclusive of persons with disabilities. Discussion: We suggest practical steps towards improving HIV service accessibility and utilisation for persons with disabilities, particularly emphasising the power of community responsibility and support; including acknowledging compounded stigma, addressing attitudinal barriers, promoting participatory responses, building political will and generating high-quality evidence to drive the continuing response. Conclusions: HIV service providers and rehabilitation professionals alike must recognise the two-way relationship between HIV and disability, and their multiple overlapping vulnerabilities and stigmas. Persons with disabilities demand recognition through practical steps to improve HIV service accessibility and utilisation in a manner that recognises their vulnerability and facilitates retention in care and adherence to treatment. In order to promote lasting change, interventions must look beyond the service delivery context and take into account the living circumstances of individuals and communities affected by HIV and disability. Persons with disabilities are vulnerable to HIV infection but have historically been excluded from HIV and AIDS services, including prevention education, testing, treatment, care and support. Fundamental change is needed to address practical and attitudinal barriers to access, including provider training. Rehabilitation professionals and HIV service providers alike must acknowledge the two-way relationship between HIV and disability: people with disability are vulnerable to HIV infection; people with HIV are increasingly becoming disabled. Peer participation by persons with disabilities in the design and implementation of HIV services is crucial to increasing accessibility. Addressing political will (through the National Strategic Plan for HIV) is crucial to ensuring long-term sustainable change in recognizing and responding to the heightened vulnerability of people with disability to HIV. [ABSTRACT FROM AUTHOR]

Traditional Birth Attendants (TBAs) have been a critical human resource in maternal health care delivery in Ghana. However, following the World Health Organization's directive for countries to discontinue using TBAs, the government of Ghana has since emphasized the use of skilled birth attendants. This policy shift created tensions between TBAs and Community Health Nurses. We examine this conundrum in this paper. We find that despite the ban, TBAs still attend a significant number of births – a situation which has produced intense contestations and continuous jostling for "functioning space" and clients between TBAs and nurses. We recommend a consensus-based partnership approach that promotes cultural competence and is sensitive to contextual cultural practices that underpin pregnancy and childbirth. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to gain a deeper understanding of Ghana's tourism positioning and whether a literature-derived positioning framework can further elaborate the latter. Using the face-to-face long interviews among key policy makers, marketing managers and experts, and observation techniques, data were collected and analyzed via the inductive reasoning approach. The results show that Ghana's tourism positioning aim is built around perceptions of a “competitive middle class tourist destination,” i.e., “profit and status” through the pursuit of “functional” positioning objective. Positioning strategies including “service”, “value for money”, “culture”, “selectivity”, “attractiveness”, “reliability”, “manpower development”, “quality controls” and “ecology” are pursued in order to achieve the aim and objectives. The latter are managed/positioned in the “primal” positioning life cycle stage. Conclusions, managerial implications, future research directions and limitations are noted. [ABSTRACT FROM PUBLISHER]

Multi-level marketing (MLM0), a business model in which product distributors are compensated for enrolling further distributors as well as for selling products, has experienced dramatic growth in recent decades, especially in the so-called global South. This paper argues that the global success of MLM is due to its involvement in local health markets. While MLM has been subject to a number of critiques, few have analyzed the explicit health claims of MLM distributors. The majority of the products distributed through MLM are health products, which are presented as offering transformative health benefits. Based on interviews with MLM distributors in Ghana, but focusing on the experiences of one woman, this paper shows that MLM companies become intimately entwined with Ghanaian quests for health by providing their distributors with the materials to become informal health experts, allowing their distributors to present their products as medicines, and presenting MLM as an avenue to middle class cosmopolitanism. Ghanaian distributors promote MLM products as medically powerful, and the distribution of these products as an avenue to status and profit. As a result, individuals seeking health become a part of ethically questionable forms of medical provision based on the exploitation of personal relationships. The success of MLM therefore suggests that the health industry is at the forefront of transnational corporations’ extraction of value from informal economies, drawing on features of health markets to monetize personal relationships. [ABSTRACT FROM AUTHOR]

This study examines the effects of various factors, including socioeconomic status, built environment, access to healthcare, educational level, social participation, and economic stability, on older adults' psychological health. The current study analyzed a nationally representative sub-sample of 2,577 respondents aged 50 and above from the World Health Organization's Study on Global AGEing and Adult Health (WHO SAGE) Wave 2. WHO SAGE Wave 2 is cross-sectional data collected via in-person structured interviews. Ordinal least square (OLS) was used to measure the average effect of social determinants of health (SDoH), and quantile regression analysis was used to determine the effects of SDoH on older adults' psychological health at different quantiles, specifically 10th, 50th, and 90th percentiles. Significant determinants of psychological health across all quantiles included age, healthcare access, marital status, economic stability, and neighborhood and built environment. However, the degrees of significance for residence, gender, educational level, chronic diseases, and social participation varied between quantiles, showing differing effects on older adults with high or low psychological health. Religion was insignificant across all quantiles. This study highlights the need for governments and public health agencies to develop targeted interventions and strategies that support the psychological well-being of older adults in the country. [ABSTRACT FROM AUTHOR]

The successful implementation of comprehensive sexuality education (CSE) programmes in schools depends on the development and implementation of strong policy in support of CSE. This paper offers a comparative analysis of the policy environment governing school-based CSE in four low- and middle-income countries at different stages of programme implementation: Ghana, Peru, Kenya and Guatemala. Based on an analysis of current policy and legal frameworks, key informant interviews and recent regional reviews, the analysis focuses on seven policy-related levers that contribute to successful school-based sexuality education programmes. The levers cover policy development trends; current policy and legal frameworks for sexuality education; international commitments affecting CSE policies; the various actors involved in shaping CSE; and the partnerships and coalitions of actors that influence CSE policy. Our analysis shows that all four countries benefit from a policy environment that, if properly leveraged, could lead to a stronger implementation of CSE in schools. However, each faces several key challenges that must be addressed to ensure the health and wellbeing of their young people. Latin American and African countries show notable differences in the development and evolution of their CSE policy environments, providing valuable insights for programme development and implementation. [ABSTRACT FROM AUTHOR]

Objectives: Currently in Ghana, there is an on-going task-shifting strategy in which nurses are trained in hypertension management. While this study will provide useful information on the viability of this approach, it is not clear how patients in the intervention perceive hypertension, the task-shifting strategy, and its effects on blood pressure management. The objective of this paper is to examine patients' perceptions of hypertension and hypertension management in the context of an on-going task-shifting intervention to manage blood pressure control in Ghana. Design: Forty-two patients participating in the Task Shifting Strategy for Hypertension program (23 males, 19 females, and mean age 61. 7 years) completed in-depth, qualitative interviews. Interviews were transcribed, and key words and phrases were extracted and coded using the PEN-3 Cultural Model as a guide through open and axial coding techniques, thus allowing rich exploration of the data. Results: Emergent themes included patients' perceptions of hypertension, which encompassed misperceptions of hypertension and blood pressure control. Additional themes included enablers and barriers to hypertension management, and how the intervention nurtured lifestyle change associated with blood pressure control. Primary enabling factors included the supportive nature of TASSH nurses, while notable barriers were financial constraints and difficulty accessing medication. Nurturing factors included the motivational interviewing and patient counseling which instilled confidence in the patients that they could make lasting behavior changes. Conclusions: This study offers a unique perspective of blood pressure control by examining how patients view an on-going task-shifting initiative for hypertension management. The results of this study shed light on factors that can help and hinder individuals in low-resource settings with long-term blood pressure management. [ABSTRACT FROM AUTHOR]

Scaling up of integrated tuberculosis (TB)-human immunodeficiency virus (HIV) services remains sub-optimal in many resource-limited countries, including Ghana, where the two conditions take a heavy toll on the financial resources of health systems as well as infected persons. Previous studies have documented several implementation challenges towards TB-HIV service integration, but views of patients on integrated service delivery have not received commensurate research attention. This paper explored the experiences of 40 TB-HIV co-infected patients at different stages of treatment in Ghana. Using Normalisation Process Theory as a framework, data were coded using inter-rater coding technique and analysed inductively and deductively with the help of QSR NVivo 10. For several participants, either of the diseases was diagnosed ‘accidentally’, leading to inconsistencies in co-therapy administration, constraints regarding separate clinic appointment dates for TB and HIV and prolonged TB treatment due to treatment failure. Put differently, there were widespread negative experiences among TB-HIV co-infected patients with regard to treatment and care, especially among patients who were accessing care in separate facilities or separate units in the same facility. Co-infected patients unanimously support full-service integration. However, they felt powerless to request for reforms on a mode of service delivery. [ABSTRACT FROM AUTHOR]

Background: The importance of tackling economic, social and health-related inequities is increasingly accepted as a core concern for the post-Millennium Development Goal framework. However, there is a global dearth of high-quality, policy-relevant and actionable data on inequities within populations, which means that development solutions seldom focus on the people who need them most. INTREC (INDEPTH Training and Research Centres of Excellence) was established with this concern in mind. It aims to provide training for researchers from the INDEPTH network on associations between health inequities, the social determinants of health (SDH), and health outcomes, and on presenting their findings in a usable form to policy makers. Objective: As part of a baseline situation analysis for INTREC, this paper assesses the current status of SDH training in three of the African INTREC countries - Ghana, Tanzania, and South Africa - as well as the gaps, barriers, and opportunities for training. Methods: SDH-related courses from the three countries were identified through personal knowledge of the researchers, supplemented by snowballing and online searches. Interviews were also conducted with, among others, academics engaged in SDH and public health training in order to provide context and complementary material. Information regarding access to the Internet, as a possible INTREC teaching medium, was gathered in each country through online searches. Results: SDH-relevant training is available, but 1) the number of places available for students is limited; 2) the training tends to be public-health-oriented rather than inclusive of the broader, multi-sectoral issues associated with SDH; and 3) insufficient funding places limitations on both students and on the training institutions themselves, thereby affecting participation and quality. We also identified rapidly expanding Internet connectivity in all three countries, which opens up opportunities for e-learning on SDH, though the current quality of the Internet services remains mixed. Conclusions: SDH training is currently in short supply, and there is a clear role for INTREC to contribute to the training of a critical mass of African researchers on the topic. This work will be accomplished most effectively by building on pre-existing networks, institutions, and methods. [ABSTRACT FROM AUTHOR]

Mental health remains a low priority in Ghana. No comprehensive studies have assessed the current status of mental health policy, legislation and services in Ghana. This paper presents the qualitative results of a situation analysis conducted as part of the first phase of the Mental Health and Poverty Project. The aim of this paper was to explore what a range of stakeholders perceive as the main challenges facing Ghana's mental health system and the primary ways of addressing them. A total of 81 interviews and seven focus groups were held with key stakeholders drawn from five of the 10 regions in Ghana. The major challenges identified included: inadequate implementation of mental health policy; legislative limbo; inadequate human and financial resource; widespread stigma; dominance of psychiatric hospitals; and insufficient human rights protections for the mentally ill. A range of policy, legislative and service-related recommendations were made for addressing the situation. The results revealed that mental health services in Ghana need to scaled-up to respond to unmet needs in ways that are cost-effective within the budget of a low-income country. Enacting the current mental health bill and identifying strategies for overcoming the barriers to policy implementation will mark significant steps forward. [ABSTRACT FROM AUTHOR]

The objective of this paper is to investigate the relationship between ethnocentrism of Ghanaian consumers and their attitudes toward a “buy local” campaign. Two hundred and thirty three consumers were interviewed in Cape Coast, the capital city and administrative centre of the Central region of Ghana. Data for the study were collected through interviewing using the mall intercept approach and factor analysed. Our findings show a relationship between ethnocentrism and attitudes of Ghanaian consumers toward the “buy local” campaign. Furthermore, the factor analysis results indicate that the attitudes of the Ghanaian consumers to the buy locally-made products can be characterized as protectionist, nationalistic, and self-interest. Implicitly, the consumers will buy Ghanaian-made products where they are of comparable quality and price as foreign-made products. This requires companies to ensure that their products are of high quality and prices are commensurate with quality. This study contributes to the ethnocentrism and country of origin literature pertaining to the African region, which is sorely under-researched. [ABSTRACT FROM PUBLISHER]

In Ghana, many individuals employ traditional and faith healing for treating illnesses. Although attitudes and knowledge of laypeople on mental illness have been explored, little is known about Christians’ knowledge and how the church influences such knowledge. The present study explored knowledge on definition, types and symptoms of mental illness, church teachings on mental illness and the influence of such teachings on the mental well-being of 86 congregants of six Charismatic churches in Ghana. Through in-depth interviews, focus group discussions and observations, we found that knowledge surrounded psychotic disorders with a few citing other DSM/ICD categories. Regarding church teachings, some churches provided education and spiritual healing, and others emphasised non-existence of, and immunity from, mental illness. Findings showed the “double-edged” role of religion in enhancing and hindering congregants’ mental well-being. The paper concludes with an argument for psycho-education on mental illness and collaboration between churches and mental health practitioners. [ABSTRACT FROM PUBLISHER]

Purpose: As cancers increase in Ghana and in many low-and middle-income countries, healthcare utilization has become critical for disease management and patients' wellbeing. There is evidence that medical pluralism is common among cancer patients in Ghana and many other African countries, which results in lack of adherence to and absconding from hospital treatments. The objective of this study was to examine ways in which beliefs in disease causation influence medical pluralism among Akan cancer patients in Ghana. Methods: A qualitative research approach was employed in this study. In-depth interviews were conducted for thirty (30) cancer patients who were purposively recruited from Komfo Anokye Teaching Hospital in Ghana. Thematic content analysis was used in analysing data. Results: Our findings revealed that cancer patients ascribed both physical and spiritual causality to their illness. As such, they combined orthodox treatment with spiritual healing and herbal medicine. Regarding the order of therapeutic search, patients reported to herbal and spiritual centres before going to the hospital, a phenomenon which contributes to the late reporting and diagnosis as well as bad prognosis of cancers in Ghana. Conclusion: The findings of this research elucidate the relationship between culture and health care choices of cancer patients in Ghana. Increased awareness creation is crucial in eradicating myths surrounding cancers in Ghana. [ABSTRACT FROM AUTHOR]

There have been few assessments of sexual and reproductive health (SRH) education programmes in sub-Saharan Africa from the students' and educators' perspective. This study examined students' opinions on an SRH programme in northern Ghana and explored the facilitators and barriers for educators regarding the implementation of the programme. The sample comprised 147 students and 3 educators. Questionnaires were used to collect data from students, and semi-structured interviews were conducted with educators. According to the students, the SRH programme was both important and interesting. Their expectations were moderately well met. They agreed that the main objectives of the programme and most of the objectives regarding the ‘family planning’ sessions had been achieved. Significant differences were found for school type, age and religion, but not for gender. For the educators, important facilitators were a clear manual, the presence of foreign volunteers working as educators, the increased influence of new media, students' eagerness to learn, and the feeling that the SRH programme really benefited students' lives. Important barriers were traditional and cultural influences, lack of funding and poor scheduling of the programme within the schools. The paper concludes by offering recommendations regarding the implementation of future SRH programmes in Ghana. [ABSTRACT FROM PUBLISHER]

Expanding access to sexual and reproductive health (SRH) services is one of the key targets of the Sustainable Development Goals. The extent to which sexual and reproductive health and rights (SRHR) targets will be achieved largely depends on how well they are integrated within Universal Health Coverage (UHC) initiatives. This paper examines challenges and facilitators to the effective provision of three SRHR services (maternal health, gender-based violence (GBV) and safe abortion/post-abortion care) in Ghana. The analysis triangulates evidence from document review with in-depth qualitative stakeholder interviews and adopts the Donabedian framework in evaluating provision of these services. Critical among the challenges identified are inadequate funding, non-inclusion of some SRHR services including family planning and abortion/post-abortion services within the health benefits package and hidden charges for maternal services. Other issues are poor supervision, maldistribution of logistics and health personnel, fragmentation of support services for GBV victims across agencies, and socio-cultural and religious beliefs and practices affecting service delivery and utilisation. Facilitators that hold promise for effective SRH service delivery include stakeholder collaboration and support, health system structure that supports continuum of care, availability of data for monitoring progress and setting priorities, and an effective process for sharing lessons and accountability through frequent review meetings. We propose the development of a national master plan for SRHR integration within UHC initiatives in the country. Addressing the financial, logistical and health worker shortages and maldistribution will go a long way to propel Ghana's efforts to expand population coverage, service coverage and financial risk protection in accessing essential SRH services. [ABSTRACT FROM AUTHOR]

This paper explores the state of Kente cloth weaving in Ghana, West Africa through four short case studies. It reviews the effects of the current socio-political climate on the weavers and the markets in which they sell their cloth and examines whether the balance of tradition and innovation can ensure the survival of the cloth. Furthermore, it looks at whether the patterns and colours being used still hold traditional value or whether this has been dropped in favour of purely aesthetic decisions. The case studies follow the two research trips carried out by Jessica in 2010/11 and are based on the interviews conducted there. As a weaver herself, she has learned the art of Kente first-hand and is able to report back following journeys to Daboya, one of the last indigo villages; Agbozume, the weaving epicentre of the Ewe region; and Adanwomase, in the heart of the Ashanti region. [ABSTRACT FROM AUTHOR]

Women and girls need proper sanitation and hygiene facilities to maintain health and dignity. In this study we show how schoolgirls from a peri-urban community of Ghana, experience severe multidimensional 'hygiene poverty' when attending schools. Hygiene poverty was characterized by poor water and sanitation infrastructures and serious social and emotional challenges, including shaming and disciplining of their sanitation and menstrual practices, which forces girls to apply secretive coping strategies. We discuss the importance of changing the negative MHM discourses at schools and fostering supportive teaching methods in adolescent female health. [ABSTRACT FROM AUTHOR]

The need to improve the sexual and reproductive health (SRH) and rights of women with disabilities is increasingly acknowledged. Unfortunately, women with disabilities in low- and middle-income settings, including Ghana, face several barriers (including structural, financial, physical, social and attitudinal) to accessing SRH services and care. This paper explores the enablers and barriers to accessing SRH services and care among visually impaired women in the Ashanti and Brong Ahafo Regions of Ghana. Qualitative data from in-depth interviews and focus group discussions were collected from 21 visually impaired women, selected through purposive and snowballing sampling techniques. Thematic analysis was used to develop codes, and data were further grouped into emerging themes. The barriers to accessing SRH services and care were financial difficulties and lack of preferential treatment. The enablers which facilitated access to SRH services and care were the support provided by caregivers and friendly relationships with health providers. To address these challenges and promote access, SRH related policies, services and programmes should be inclusive of the needs of visually impaired women, and measures to remove financial challenges to service utilisation and foster positive relationships with health workers, church and community members should be adopted. [ABSTRACT FROM AUTHOR]

The present study explored perceived causes of, and preferred treatment approach for, mental illness among congregants of six Neo-prophetic churches in Accra and Kumasi through in-depth interviews. Using thematic analysis, five themes emerged from participants' causal attributions of mental illness. These included lifestyles and environmental stressors, spiritual causes, interaction of multiple factors, trauma and biological causes. Additionally, participants discussed four main mechanisms through which stress leads to mental illness. These included persistent worrying over stressors, use of inappropriate coping strategies to cope with stress, refusal to talk about one's problems and individuals' appraisal of stress and available coping resources. These beliefs directly determined congregants' preferred treatment approach. Implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Many people living with HIV in Ghana make use of spiritual therapy, however complex. This paper describes the complexities of these therapies in the context of increasing access to antiretroviral (ARV) drugs and high levels of HIV stigma. The study took place in Kumasi and Offinso, both in the Ashanti Region of Ghana (the most populated region, with around 4.5 million people), and is the result of 15 months of anthropological and ethnographic research utilising observations and in-depth interviews with 48 HIV-positive persons, their families, and other significant people in the lives. The article describes the participants' experience of their HIV infection as a 'spiritual challenge,' which thereby formulated a personal need to 'heal body and soul.' The findings illustrate how crossing religious and denominational boundaries is an important element in people's search for healing and wellbeing. The article argues that, especially in the context of high levels of HIV stigma in Ghana, spiritual therapy is one pragmatic option available to people living with HIV as it helps them to find meaning to their predicament or extends their coping mechanisms. [ABSTRACT FROM AUTHOR]

Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women’s perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to “correct” disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman’s experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth. [ABSTRACT FROM AUTHOR]

Pregnancy among adolescent girls is a public health problem globally and especially in developing countries. Its occurrence can be prevented with the correct and consistent use of effective contraceptive methods. This study explored the personal determinants of hormonal contraceptive uptake and consistent use among adolescent girls as evidence for informing effective hormonal contraceptive use interventions among them. In-depth interviews were carried out among 16 girls aged 15 to 19 years with hormonal contraceptive experience between April and June 2022 in Kintampo, Ghana. Results showed that knowledge on hormonal contraceptive types and sources of obtaining them, organizing hormonal contraceptive uptake and self-efficacy in getting access, hormonal contraceptive use decision-making, and disclosure of hormonal contraceptive use were important factors explaining uptake and consistent hormonal contraceptive use among adolescent girls in this study. Also, coping mechanisms and skills for accessing and using hormonal contraceptives, attitude toward hormonal contraceptives, and risk perception toward pregnancy influence the uptake and consistent use of hormonal contraceptives. Participants in this study were resilient and highly in favor of hormonal contraceptive use. They have demonstrated that it is possible for adolescent girls to use hormonal contraceptives and use them consistently if interventions are targeted at their attitude to hormonal contraceptives, their self-efficacy, decision-making skills, coping skills, and pregnancy risk perception, among others. [ABSTRACT FROM AUTHOR]

One of the common undesirable outcomes of pregnancy is perinatal loss. Healthcare systems strive to reduce the incidence of perinatal loss but typically little attention is on the experiences of bereaved mothers following perinatal loss, particularly in low and middle-income countries where such deaths are common. This research explored the lived experiences of mothers with perinatal loss in the Kumasi metropolis, Ghana. A qualitative design was used to explore the experiences of nine (9) bereaved mothers from the Komfo Anokye Teaching Hospital's postnatal ward and the Mother and Baby Unit. Data were collected through face-to-face interviews using a semi-structured interview guide, audio-recorded, and thematically analyzed. One major finding was that mothers restricted mourning their dead babies based on fear of recurrent perinatal loss and traditional beliefs on delayed return to fertility. Mothers blamed healthcare providers for their loss due to their concerns about care received. Gaps in communication flow from healthcare professionals to bereaved mothers were commonly identified as mothers struggled to make meaning of their loss and coped with cultural restrictions and beliefs. Healthcare professionals must explore mothers' concerns and "gut-feelings," and pay attention to their communication needs following perinatal loss. [ABSTRACT FROM AUTHOR]

Sexuality education in African contexts is riddled with socio-cultural complexity, tension and taboo. Such tensions are compounded when the focus of intervention is primary school children who are presumed ‘innocent’. However, sub-Saharan Africa remains the region of the world most severely impacted upon by the human immunodeficiency virus and the acquired immunodeficiency syndrome, thus heightening the need to talk to children about sex and sexuality. This paper explores the role of consulting pupils, participation and dialogue as methodological innovations that have the potential to enable new ways of thinking about sex and sexuality and the transcendence of ‘dead end debates’ about what should and should not be taught. The paper is based on data from an action research project in Kenya, Ghana and Swaziland. The data show that the desire to create a space characterised by consultation, listening and dialogue in which adults and children could participate ‘as if’ they were social equals was inevitably not straightforward or ever fully realised. Nevertheless, pupils were able to make their voices heard at many points in these spaces and powerful moments of dialogue did exist with some of the adults undergoing significant changes of opinion throughout the process. [ABSTRACT FROM PUBLISHER]

Having a good knowledge of family planning methods is vital for reducing maternal morbidity and mortality resulting from unintended pregnancies and unsafe abortions. In this paper, we highlight deaf people’s ability to discern various misconceptions about pregnancy, with the aim of assessing their level of knowledge on pregnancy prevention methods. The article is derived from a sexual and reproductive health (SRH) needs assessment involving participants residing in two cities and a senior high school in Ghana. The needs assessment involved three focus groups with 26 participants, a survey with 152 respondents, and an interview with one health professional. Apart from the health professional, all the remaining participants were deaf people. Findings from the study indicated that more than half the participants lacked familiarity with pregnancy prevention methods. The findings of this study confirm other studies that there is a general lack of knowledge on SRH issues among deaf people in Ghana. Thus, although this study focused on prevention of unwanted pregnancy, which is just one component of SRH issues, the study provides insights into the broader SRH needs of the deaf community and calls for making these issues visible for policy-making. [ABSTRACT FROM PUBLISHER]

Undergraduate nursing students in developed countries are reported to have poor perceptions and low preference for gerontological nursing. However, perceptions and preferences of undergraduate nursing students toward gerontological nursing in low-income countries have not been well explored. This study explored the perceptions and preferences of undergraduate nurses in Ghana toward gerontological nursing. A mixed method study design was used to explore Ghanaian undergraduate nursing students' perceptions and preferences for caring for older people. One hundred and seventy-four nursing students were surveyed and 30 of them were interviewed. Quantitative data were analyzed descriptively using SPSS version 27. Content analysis was used to analyze qualitative data to generate themes. Response rate in the study was 73%. The majority of participants (95.4%) were below the age of 29. Gerontological nursing was ranked as the least preferred nursing specialty among graduating undergraduate nurses. Poor perceptions and inadequate knowledge about the care of older people were largely responsible for the lack of preference for gerontological nursing. Improving undergraduate nursing students' knowledge about gerontological nursing is critical in correcting poor perceptions about gerontological nursing. [ABSTRACT FROM AUTHOR]

The extant literature has explored sexuality education from the perspectives of the adolescents, but the views of parents are largely neglected. The few studies that have examined the views of both parents and adolescents are selective in scope, coverage, and assessment. There is thus, a dearth of data on the type of topics discussed and the frequency of parent-adolescent sexual communication. The present study sought to explore adolescents' lived experiences of sexuality education and its impact on their sexual and reproductive health. To achieve this, a qualitative research design with a semi-structured interview was employed to gather data from thirty parents and adolescents in Ablekuma South Metropolis. An Interpretative Phenomenological Analysis (IPA) was used in analyzing the data with each theme showing divergence categories of experiences of sexuality education although the views of both parents and adolescents on each category were similar. Parent-adolescent sex communication showed frequently discussed topics and the less discussed ones. Perceptions of sexuality education revealed both positive and negative perceptions. Perceived impact of sexuality education also brought to light both positive and negative impacts. It is recommended that stakeholders ought to institutionalize diverse behavior change interventions such as interpersonal communication and skills training aimed at empowering both parents and adolescents to communicate explicitly about sexuality rather than using euphemisms and timing techniques. [ABSTRACT FROM AUTHOR]

We assessed the challenges facing 29 women in their quest for maternal health services in the Shai Osudoku District of Ghana. In-depth, semi-structured interviews with health professionals and focus-group discussions with women on uptake of maternal health services were conducted. Findings showed inadequate human resources and logistics for maternal health care and transportation problems. Women whose pregnancies required specialized care at district or regional hospitals deliberately reported late to the community clinics in an advanced stage of labor to avoid referrals. Findings have implications for health policymakers, implementers, and researchers. [ABSTRACT FROM AUTHOR]

Purpose: Although social capital influences health-related decisions and behavioural patterns in many developing countries, minimal attention has been paid to the nuances of its effect on healthcare. This paper examines how bonding social capital affects healthcare delivery for inpatients in Ghana. Methods: Semi-structured in-depth interviews were used and thematic analysis method employed to analyse the data. Interviews were conducted with health professionals and relatives and close friends of inpatients in three public health facilities in Ashanti region. Results: Relatives and close friends of inpatients were a critical source of instrumental support such as provision of meals, laundry services, running errands and financial assistance as well as emotional support. These functions—that were both 'expected' and 'encouraged'— reduced the burden on the health facilities, which apparently had limited resources to offer adequate care. However, the relatives of inpatients sometimes inadvertently obstructed efficient healthcare delivery through actions such as extending 'unapproved' alternative care to patients. Moreover, the process of contributing towards health and well-being of the sick exposed the relatives to health risks due to poor living conditions. Conclusion: A well-defined and befitting role must be devised for at least an immediate social relation of inpatients to improve the positive effects of bonding social capital on healthcare delivery. [ABSTRACT FROM AUTHOR]

Adinkra symbols are ubiquitous cultural artifacts in Ghana, West Africa. This qualitative multiple case study examined how proverbial meanings of Adinkra symbols impacted the cultural identity development of five Ghanaian emerging young adults. Using semi-structured interviews and an Adinkra printmaking activity, this study revealed six major themes describing how Adinkra symbols and their meanings inform participants' cultural identity. These themes included: exposure to Adinkra symbolism; religion, spiritual, and moral guidance; cultural significance and grounding; meaning making through visual expression; Ghanaian identity expression; and respect for parents, elders, and community. This study has implications for understanding how explicit cultural messages contribute to positive cultural identity development of Ghanaian emerging young adults, and how printmaking can be used as a creative method to promote positive mental health. [ABSTRACT FROM AUTHOR]

Ethics reflects the moral principles upon which most professional practices rest. It forms the basis to do good, to do no harm, to respect others, and ensure justice. The purpose of this study was to investigate ethical dilemmas experienced by 20 clinical psychologists in Ghana. Semi-structured interviews were used to investigate ethical dilemmas faced in professional practice. Using thematic analysis, the reported dilemmas included third-party involvement, (sub-themes: Therapy with Minors, Marital Disclosures, Source of referral, Duty to Warn), Dual relationships (subthemes: Collegial Relationships, Power Differential in Relationships), Cultural competence, and Policies and practices. The findings showed that although some of these dilemmas are universal, others arise (e.g., cultural competence) from the general cultural context of Ghana and the professional culture within which clinical psychologists are socialized. Recommendations to assist clinical psychologists address ethical dilemmas in Ghana and implications for the development of ethical regulations in the country are addressed. [ABSTRACT FROM AUTHOR]

Despite advances in human rights and treatments, stigma toward individuals diagnosed with mental illness is common across the African continent. This article explores experiences of stigma and social exclusion among individuals diagnosed with mental illness and receiving treatment in a psychiatric facility in Ghana. The study, based on in-depth, semi-structured interviews generated the following themes: beliefs in spiritual causes of mental illness; spirituality as a coping mechanism; mistreatment and abuse. The findings highlight the significance of social exclusion and spirituality as the main roots of stigma; also the importance of awareness-raising as tools for anti-stigma work in the global South. [ABSTRACT FROM AUTHOR]

Drawing on the insights of Bronfenbrenner's ecological systems and Lazarus' coping theories, this article highlights the challenges and coping strategies of women living with obstetric fistula in the Northern Region of Ghana. Employing the convenience sampling technique, 55 women were purposively recruited to participate in the study. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted to collect data. With the permission of participants, the FGDs and IDIs were audio-recorded and transcribed. The data were analyzed to identify emerging themes that addressed the objectives of the study. The findings indicated that participants encountered varied challenges (physiological issues; abandonment and divorce; psychological problems; financial constraints; and difficulty accessing healthcare). Furthermore, it was found that the women included in this study adopted both problem-focused and emotion-focused coping strategies. Evidence showed that the problem-focused strategies were begging for assistance and seeking support from the Fistula Kpandai support group. Maintaining personal hygiene and optimistic motivation were the emotion-focused strategies employed by the participants. Based on the findings of the study, implications are discussed. [ABSTRACT FROM AUTHOR]