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Background: A community’s cultural beliefs, attitudes and discourse can affect their responses in surveys. Knowledge of these cultural factors and how to comply with them or adjust for them during data collection can improve data quality. Objective: This study describes implications of features of Gambian culture related to women’s reproductive health, and mortality, when collecting data in surveys. Methods: 13 in-depth interviews of female interviewers and a focus group discussion among male interviewers were conducted in two rural health and demographic surveillance systems as well as three key informant interviews in three regions in The Gambia. Results: From the fieldworker’s viewpoint, questions relating to reproduction were best asked by women as culturally pregnancies should be concealed, and menstruation is considered a sensitive topic. Gambians were reluctant to speak about decedents and the Fula did not like to be counted, potentially affecting estimation of mortality. Asking about siblings proved problematic among the Fula and Serahule communities. Proposals made to overcome these challenges were that culturally-appropriate metaphors and symbols should be used to discuss sensitive matters and to enumerating births/deaths singly instead of collecting summary totals, which had threatening connotations. This was as opposed to training interviewers to ask standardised and precise verbatim questions. Contribution: This paper presents indigenous Gambian solutions by fieldworkers to culturally sensitive topics when collecting pregnancy outcomes and mortality data in demographic and health surveys. For researchers collecting maternal mortality data, it highlights the potential shortcomings of the sibling history methodology. [ABSTRACT FROM AUTHOR]

Purpose: The overall goal of the Saleema Initiative in Sudan is to promote long-term abandonment of female genital mutilation and cutting (FGM) through a contribution to changing social norms, attitudes, and intentions related to the practice. The initiative aims to create positive cultural associations with a girl remaining uncut, a new social norm. Saleema hypothesizes that branding the alternative to FGM (abandonment) will promote social norms change. In 2014, the lead author designed a monitoring and evaluation framework for Saleema in partnership with UNICEF, the National Council for Child Welfare (NCCW), and local organizations. Methods: The Saleema evaluation aimed to evaluate the effectiveness of the campaign in reducing pro-FGM social norms. A quasi-experimental design controlled for dosage of campaign messages delivered across the 18 states in Sudan to measure a dose-response effect. We operationalized social norms through a 4-item scale validated in previous research. Results: This paper reports on quantitative evaluation findings based on data gathered in from 2015–2017 and focuses on the dose-response relationship between Saleema exposure and changes in FGM social norms. We found that self-reported exposure was associated with reduced pro-FGM social norms (coeff. = -0.329, p < .001). Additionally, higher doses of Saleema, measured through an exogenous measure of campaign event exposure from an independent monitoring system was associated with reduced pro-FGM social norms (coeff. = -0.146, p < .001). Conclusions: Saleema was effective in reducing pro-FGM social norms. It is a promising strategy and findings contribute to the growing literature on social norms approaches to behavior change. [ABSTRACT FROM AUTHOR]

Background: Due to changes in Polish society resulting from a significant inflow of immigrants to Poland, the need to develop the cultural competences of various professional groups who have contact with immigrants in their work has increased. These groups should include healthcare professionals, especially because of the significant increase in the number of culturally diverse patients. Therefore, medical education in Poland has had to rapidly adapt to this novel situation. For instance, the teaching process should be now more focused on the development and evaluation of the cultural competences of prospective health care workers. However, there is still a lack of standardized, valid and reliable instruments to assess cross-cultural competences among healthcare professionals. The purpose of the present paper was to describe, for the first time, the translation, adaptation, and psychometric evaluation of the Polish version of the Cross-Cultural Competence Inventory. Methods: Across two studies, we examined psychometric properties of the Cross-Cultural Competence Inventory (CCCI) such as reliability (i.e. internal consistency, test-retest reliability, factor structure) and validity (i.e. theoretical, criteria, convergent). In the first study, 408 participants (75% were healthcare professionals) completed the Polish version of the CCCI and the Positive/Negative Attitude Towards Culturally Divergent People Questionnaire. In the second study, 317 participants (97% were healthcare professionals) completed the CCCI twice, with an interval of at least 22 days. In addition, across two study sessions, participants completed questionnaires constructed to measure (a) cultural intelligence, (b) need for cognitive closure, (c) emphatic sensitiveness, (d) emotional intelligence, (e) self-esteem, (f) social desirability, and (g) personality. Finally, to additionally examine the theoretical validity, 36 professional cross-cultural competence trainers completed the CCCI during a one-session study. Results: Our findings confirm the reliability and validity of the CCCI. More precisely, in study 1 we proved the theoretical validity and reliability (i.e. internal consistency) of the CCCI. While the assumed structure did not fit the data well, all items were significantly related to the general factor, thus providing strong support for the usage of the total score of the CCCI. In study 2, we additionally estimated the test-retest reliability and theoretical, criterion and convergent validity. Across two studies we were able to successfully confirm these psychometric properties. The reliability was satisfactory and ranged from .83 to .86. We also observed a high and significant positive correlation between CCCI and the Cultural Intelligence Scale, which measures a concept similar to the one measured by CCCI. In addition, a significant relationship between intercultural competences (CCCI) and other variables such as personality, empathic sensitivity, emotional intelligence, self-esteem (positive correlations) and the need for cognitive closure (mainly negative correlation) were demonstrated. Conclusions: The obtained results support the usage of the CCCI questionnaire in scientific research, such as, for example, among healthcare professionals (nurses, doctors) and students of medical fields (nursing, medicine). [ABSTRACT FROM AUTHOR]

Attitudes and beliefs about menstruation can place restrictions on menstruating women and girls, limiting their ability to fully participate in community life, education and employment. This paper presents evidence on menstruation-related beliefs contributing to restrictive practices in Papua New Guinea (PNG), Solomon Islands (SI) and Fiji. Focus group discussions and interviews were undertaken with 307 adolescent girls, women and men in a rural and urban site in each country. Data were analysed using an inductive thematic approach. Participants described a range of attitudes and beliefs that restrict the behaviour of menstruating women and girls. Themes include the belief that menstrual blood is ‘dirty’; that when menstruating, girls and women can bring ‘bad luck’ to men; secrecy and shame associated with menstruation; and beliefs about the impact of certain behaviours on menstruation and health. Restrictive practices were more frequently reported in PNG and SI than Fiji, and more common in rural compared with urban sites. Some restrictions, such as avoidance of household chores, were perceived as desirable or driven by women themselves. However participants identified other restrictions, such as not being able to attend church or hygienically wash menstrual hygiene materials, as unwanted, in some cases impacting on participation in school, work and community life. Education initiatives guided by women and girls, implemented by local stakeholders and grounded in a sound understanding of specific contexts are needed to address discriminatory attitudes and beliefs that contribute to unwanted restrictions, and to support enabling attitudes and beliefs regarding menstruation. [ABSTRACT FROM AUTHOR]

Background: People with multimorbidity, especially older people, have complex health and social needs, and require an integrated care approach. In this respect, eHealth could be of support. This paper aims to describe the implementation of eHealth technologies in integrated care programs for people with multimorbidity in Europe, and to analyse related benefits and barriers according to outcomes from ICARE4EU study and within the more general conceptual framework of the “10 e's” in eHealth by Gunther Eysenbach. Methods: In 2014, ICARE4EU project identified 101 integrated care programs in 24 European countries. Expert organizations and managers of the programs completed an on-line questionnaire addressing several aspects including the adoption of eHealth. Findings from this questionnaire were analyzed, by linking in particular benefits and barriers of eHealth with the “10 e's” by Eysenbach (Efficiency, Enhancing, Evidence-based, Empowerment, Encouragement, Education, Enabling, Extending, Ethics, and Equity). Results: Out of 101 programs, 85 adopted eHealth tools, of which 42 focused explicitly on older people. eHealth could improve care integration/management, quality of care/life and cost-efficiency, whereas inadequate funding represents a major barrier. The “10 e's” by Eysenbach seem to show contact points with ICARE4EU findings, in particular when referring to positive aspects of eHealth such as Efficiency and Enhancing quality of care/life, although Empowerment/Education of patients, care Equity and Ethics issues seem crucial in this respect. Encouragement of a new relationship patient-health professional, and Enabling standardized exchange of electronic information, represent further aspects impacting integration/management of care. Conclusions: Aspects of eHealth, which emerged as benefits and barriers impacting integration/management of care, as well as cost-efficiency and quality of care/life, can be identified on the basis of both ICARE4EU findings and the “10 e's” in eHealth by Eysenbach. They could represent objectives of new policies for supporting the deployment of eHealth technologies within integrated care across Europe. [ABSTRACT FROM AUTHOR]

This paper investigates age variations in foreign-born vs. native-born mortality ratios in an international comparative perspective, with the purpose of gaining insight into the mechanisms underlying the so-called migrant mortality advantage. We examine the four main explanations that have been proposed in the literature for the migrant mortality advantage (i.e., in-migration selection effects, out-migration selection effects, cultural effects, and data artifacts), and formulate expectations as to whether they should generate an increase, a decrease, or no change in relative mortality over the life course. Using data from France, the US and the UK for periods around 2010, we then examine typical age patterns of foreign-born vs. native-born mortality ratios in light of this theoretical framework. We find that these mortality ratios vary greatly by age, with important similarities across migrant groups and host countries. The most systematic age pattern we find is a U-shape pattern: at the aggregate level, migrants often experience excess mortality at young ages, then exhibit a large advantage at adult ages (with the largest advantage around age 45), and finally experience mortality convergence with natives at older ages. The explanation most consistent with this pattern is the “in-migration selection effects” explanation. By contrast, the “out-migration selection effects” explanation is poorly supported by the observed patterns. Our age disaggregation also shows that migrants at mid-adult ages experience mortality advantages that are often far greater than typically documented in this literature. Overall, these results reinforce the notion that migrants are a highly-selected population exhibiting mortality patterns that poorly reflect their living conditions in host countries. [ABSTRACT FROM AUTHOR]

Bangladesh is a culturally conservative nation with limited freedom for women. A number of studies have evaluated intimate partner violence (IPV) and spousal physical violence in Bangladesh; however, the views of women have been rarely discussed in a quantitative manner. Three nationwide surveys in Bangladesh (2007, 2011, and 2014) were analyzed in this study to characterize the most vulnerable households, where women themselves accepted spousal physical violence as a general norm. 31.3%, 31.9% and 28.7% women in the surveys found justification for physical violence in household in 2007, 2011 and 2014 respectively. The binary logistic model showed wealth index, education of both women and their partner, religion, geographical division, decision making freedom and marital age as significant household contributors for women’s perspective in all the three years. Women in rich households and the highly educated were found to be 40% and 50% less likely to accept domestic physical violence compared to the poorest and illiterate women. Similarly, women who got married before 18 years were 20% more likely accept physical violence in the family as a norm. Apart from these particular groups (richest, highly educated and married after 18 years), other groups had around 30% acceptance rate of household violence. For any successful attempt to reduce spousal physical violence in the traditional patriarchal society of Bangladesh, interventions must target the most vulnerable households and the geographical areas where women experience spousal violence. Although this paper focuses on women’s attitudes, it is important that any intervention scheme should be devised to target both men and women. [ABSTRACT FROM AUTHOR]

Background: Despite decades of implementation of maternity healthcare programmes, including a focus on increasing the use of antenatal care (ANC) and concomitant birth preparedness and complication readiness (BPCR), the uptake of ANC continues to be below expectations in many developing countries. This has attendant implications for maternal and infant morbidity and mortality rates. Known barriers to ANC use include cost, distance to health care services and forces of various socio-cultural beliefs and practices. As part of a larger study on BPCR in rural Ghana, this paper reflects on the use of ANC in the study areas from rights-based and maternal engagement theoretical perspectives, with a focus on the barriers to ANC use. Methods: Mixed methods approach was adopted to collect data from 8 study communities from individual in-depth interviews with 80 expectant mothers and 13 health care professionals, and 24 focus groups comprising 240 community members. The qualitative data followed a thematic analytical method, while the quantitative data was analysed using descriptive statistics. Results: The average number of ANC visits were 3.34±1.292, and the majority of expectant mothers (71.3%) enrolled for ANC at the 8th week or later, with the longest delay recorded at the 6th month of gestation. Traditional norms significantly influenced this delay. Likewise, overall use of ANC during pregnancy was shaped by cultural factors related to perceptions of pregnancy, gender-based roles and responsibilities and concerns that ANC would result in an overweighed baby and culturally inappropriate delivery at a health care facility. Conclusion: Greater understanding of the sociocultural barriers to ANC is essential if proposed changes in community-specific health education programs are to facilitate early commencement and increased use of ANC. [ABSTRACT FROM AUTHOR]

Cultural narratives on disability have received much attention over the past few decades. In contexts of poverty, limited information and everyday challenges associated with having, or caring for someone with a disability, different understandings have emerged. A project was set up to promote disability awareness in neighborhood communities in a rural part of Kenya, using a process of reflection and education. This paper reports on the first aspect–reflection. The aim was to investigate local understanding of disability as a co-constructed concept. The research questions were: 1. What cultural beliefs shape local understanding of disability? 2. What challenges are perceived to be associated with disability? A phenomenological approach was adopted. Focus group discussions were conducted with twenty-one community groups involving 263 participants and audio-recorded. The data were transcribed and thematic analysis was carried out. Visual maps were created to illustrate any interconnections, before establishing the final conclusions. Local beliefs attributed disability to: human transgression of social conventions, particularly concerning inappropriate family relations, which invoked a curse; supernatural forces affecting the child; the will of God; unexplained events; and biomedical factors. Challenges associated with disability related to the burden of caregiving and perceived barriers to inclusion, with stress as a shared bi-product. Local understanding of disability in this rural part of Kenya demonstrated overlapping explanations and plurality of beliefs. Two possible interpretations are offered. Firstly, oscillation between explanatory lines demonstrated instability, affecting broader acceptance of disability. Secondly, and more positively, in the face of challenges, the desire to make sense of the existing situation, reflected a healthy pluralism. [ABSTRACT FROM AUTHOR]

The Health Literacy Questionnaire (HLQ), developed in Australia in 2012 using a ‘validity-driven’ approach, has been rapidly adopted and is being applied in many countries and languages. It is a multidimensional measure comprising nine distinct domains that may be used for surveys, needs assessment, evaluation and outcomes assessment as well as for informing service improvement and the development of interventions. The aim of this paper is to describe the German translation of the HLQ and to present the results of the validation of the culturally adapted version. The HLQ comprises 44 items, which were translated and culturally adapted to the German context. This study uses data collected from a sample of 1,058 persons with chronic conditions. Statistical analyses include descriptive and confirmatory factor analyses. In one-factor congeneric models, all scales demonstrated good fit after few model adjustments. In a single, highly restrictive nine-factor model (no cross-loadings, no correlated errors) replication of the original English-language version was achieved with fit indices and psychometric properties similar to the original HLQ. Reliability for all scales was excellent, with a Cronbach’s Alpha of at least 0.77. High to very high correlations between some HLQ factors were observed, suggesting that higher order factors may be present. Our rigorous development and validation protocol, as well as strict adaptation processes, have generated a remarkable reproduction of the HLQ in German. The results of this validation provide evidence that the HLQ is robust and can be recommended for use in German-speaking populations. Trial Registration: German Clinical Trial Registration (DRKS): . Registered 23 March 2011. [ABSTRACT FROM AUTHOR]

This paper examines the factor structure and measurement invariance of the Task and Ego Orientation in Sport Questionnaire (TEOSQ) across American and Chinese samples. Results based on the mean and covariance structure analyses supported configural invariance, metric invariance and scalar invariance across groups. Latent means analyses revealed that American sample had significantly higher mean scores on task and ego orientations than the Chinese sample. The findings suggest that the TEOSQ is a valid and reliable instrument in assessing achievement motivation across these two diverse populations. [ABSTRACT FROM AUTHOR]