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Recent Knowledge on Soul Beat

Author: 
Ribhav Gupta
Safa Abdalla
Valerie Meausoone
Nikitha Vicas
Iván Mejía-Guevara
Ann M. Weber
Beniamino Cislaghi
Gary L. Darmstadt
Publication Date
Sunday, June 26, 2022
Affiliation: 

Stanford University School of Medicine (Gupta, Abdalla, Mejía-Guevara, Darmstadt); University of Minnesota School of Medicine (Gupta); University of Texas - Dallas (Vicas); University of Nevada (Weber); London School of Hygiene and Tropical Medicine (Cislaghi); Health Care Service Corporation, or HCSC (Meausoone)

"...findings emphasise that if the data is not from all of us, it may not be for any of us..."

Despite efforts globally to advance equality by addressing restrictive gender norms, gender inequalities persist and contribute to worsened health outcomes. Global health datasets that are ill-equipped for research at the gender-health nexus may be a factor impeding progress, because interventions derived from datasets built on gender bias and restrictive gender norms can perpetuate a cycle of gender inequalities and inadequate data collection. This study provides a framework to measure the effects of gender- and age-imbalanced and missing data on gender-health research. The framework is demonstrated using a previously studied pathway for effects of pre-marital sex norms among adults on adolescent HIV risk.

  <div class="field button"><a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00243-7/fulltext" target="_blank">Click here to read the article online or to download it in PDF format (14 pages).</a></div>
Contacts (user reference): 
Source: 

eClinicalMedicine 2022;50: 101513. https://doi.org/10.1016/j.eclinm.2022.101513. Image credit: UN Women/Urjasi Rudra via Flickr (CC BY-NC-ND 2.0)

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Author: 
Adetoun Olateju
Michael A. Peters
Ikponmwosa Osaghae
Olakunle Alonge
Publication Date
Thursday, June 30, 2022
Affiliation: 

Johns Hopkins University Bloomberg School of Public Health (Olateju, Peters, Alonge); University of Texas Health Science Center at Houston (Osaghae)

"Health care providers and community health workers...need to transform beyond providing health services (competence and knowledge) to become trust agents (morality and compassion for the people they serve) fostering community ownership and engagement while serving as pillars to strengthen service delivery."

  <div class="field button"><a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13681-0" target="_blank">Click here to read the article online or to download it in PDF format (13 pages).</a></div>
Contacts (user reference): 
Source: 

BMC Public Health (2022) 22:1271. https://doi.org/10.1186/s12889-022-13681-0. Image credit: ©UNICEF Ethiopia/2015/Getachew via Flickr (CC BY-NC-ND 2.0)

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"Although much progress has been made in addressing non-use of contraception through traditional behavior change programming, these programs are limited by assumptions about what prevents women from using contraception."

Launched in 2016, the 5.5-year (re)solve project worked to examine the needs, attitudes, and factors that influence women's and adolescents' family planning decisions in Bangladesh, Burkina Faso, and Ethiopia - and then developed customised solutions to support them in forming and following through on their intention to use contraception. The collaborative effort involved Pathfinder International, Camber Collective, ideas42, and the International Center for Research on Women (ICRW), with Bill & Melinda Gates Foundation funding.

Communication Strategies: 

(re)solve worked by looking at women's real needs, desires, and contraceptive choices and devising solutions - in partnership with them - to empower them to exercise their contraceptive choice, while making those choices as effective as possible. Applying segmentation analysis, behavioural design, and public health insights, (re)solve focused on the gap between women saying they intend to use a contraceptive method to prevent pregnancy - and whether they actually do. (re)solve embedded its solutions in existing platforms: the United States Agency for International Development (USAID)-funded Shukhi Jibon project, private pharmacies, and Marie Stopes Bangladesh clinics and communities in Bangladesh; Project Yam Yankré ("My Choice") in Burkina Faso; and the USAID-funded Transform: Primary Health Care project in Ethiopia.

In each country in which (re)solve worked, collaborators undertook 4 main steps: landscape analysis, behavioural diagnosis, design and user testing, and implementation. Specifically:

  1. (re)solve started with a behavioural landscape analysis, delving into different segments of the population and defining the "drivers of intention" to use contraception for each of them. These "drivers" include the following:
    • Health Optimism: The degree of openness in a woman's outlook on health and contraception (health proactivity, perceived provider bias, and perception of western influence on contraceptive use)
    • Unmet Demand: The gap between want and use of modern contraception (for whom pregnancy would pose a problem)
    • Agency: A woman's ability and desire to make her own decisions about using contraception (perceived control/voice in health decisions, autonomy in contraceptive and reproductive decision-making, ability to decide when to have sex with partner, use of contraception without partner permission, willingness to try something new)
  2. Then, through a behavioural diagnosis, (re)solve "mapped" a behavioural problem, generating hypotheses about the behavioural bottlenecks or barriers that may be inhibiting women and girls from using contraception and the underlying drivers that trigger those bottlenecks. Collaborators refuted or confirmed these hypotheses through research and then prioritised the behavioural barriers they wanted to address. They mapped these barriers back to the population segments they were working with.
  3. Next, (re)solve undertook a design process that led to customised solution sets for that behavioural problem. Through an iterative approach, collaborators tested and tweaked the solutions with the women and girls they are meant for - helping ensure they would accept and use the solutions, which:
    • in Bangladesh included visual reminders and stickers for pill packs, as well as a telephone hotline allowing women to receive a reminder to take the pill, geared toward women working in the ready-made garment industry, whose lack of leisure time makes it easy for them to miss taking the contraceptive pill every day;
    • in Burkina Faso consisted in a portable, locally sourced board game related to contraceptive decision-making (La Chance), along with health passports, posters, and IDs - all designed to reach sexually active unmarried young women; and
    • in Ethiopia involved a counseling sheet, referral card, and home visit tracking tool for use by health extension workers (HEWs) among postpartum women, who experience low contraceptive prevalence rates in this country.
  4. (re)solve's solutions have been implemented and/or evaluated in all three countries. In brief:
    • Bangladesh: (re)solve worked with the government on scaling up the solutions through Shukhi Jibon, the national USAID-funded family planning programme. As of March 2021, the government had supported family planning initiatives in 400 factories, and a scale-up plan was in place to reach an additional 50 factories with (re)solve solutions. The government has incorporated the (re)solve solutions into training curricula used at factory health clinics and will apply evidence from the testing phase to develop a national scale-up plan that includes factories in rural areas.
    • Burkina Faso: (re)solve solutions were implemented in 16 randomly selected secondary schools - 8 each in Bobo-Dioulasso (Bobo) and Ouagadougou (Ouaga). Regional Health Directorates and secondary-education departments supported the introduction of the solutions in health facilities and schools, respectively. A total of 3,120 girls in grades 3ème and 4ème played La Chance between December 2019 and March 2020, and facilitators distributed 11,908 passports to girls in this timeframe. See Related Summaries, below, for a report on the mixed-methods evaluation.
    • Ethiopia: (re)solve implemented the solution set in 7 primary health care units (PHCUs) in Tigray from April to December 2021. A total of 183 male and female providers were oriented to the (re)solve project, objectives, and process and trained on proper implementation of each tool. See Related Summaries, below, for a report on the mixed-methods evaluation.

Click here to access additional reports and information about (re)solve.

Development Issues: 

Family Planning, Women, Youth

Key Points: 

In each of the three countries where (re)solve worked, between one-quarter and one-third of all children born were either mistimed or unintended. In Bangladesh, (re)solve identified solutions to reach garment workers, who tend to incorrectly or inconsistently use oral contraceptives, or discontinue use because of long periods of abstinence when workers live away from their partners. In Burkina Faso, (re)solve worked with sexually active unmarried young women, whose unintended pregnancy rate is 57%. And in Ethiopia, (re)solve geared its activities toward postpartum women, 2.6% of whom use modern contraception one month of giving birth and 15.6% who do so six months following their deliveries.

Partner Text: 
  • Pathfinder International: uses large-scale evidence-based family planning programing approaches through existing country projects. These projects provide the platform from which (re)solve implements its solutions.
  • Camber Collective: uses a market segmentation approach to identify population segments marked by behavioural and/or attitudinal differences, which inform solutions catered to each segment's needs. Camber identifies segments through large-scale, quantitative surveys.
  • Ideas42: uses behavioural design to develop and test solutions meant to reshape people's environment to positively influence their behaviour. ideas42 designs for behavioural bottlenecks that are identified through qualitative interviews and observations.
  • International Center for Research on Women (ICRW): uses a gender-focused research and evaluation approach. ICRW is conducting process and impact evaluations of (re)solve solutions.

Funder: Bill & Melinda Gates Foundation.

Contacts (user reference): 
Source: 

Pathfinder website, June 8 2022. Image credit: Pathfinder

Insight, Hindsight, and Foresight: End of Project Learnings from the Passages Project - June 28 2022 - Webinar

Click here to register

Online: June 28, 2022 09:00 AM in Eastern Time (US and Canada)

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Publication Date
Thursday, April 7, 2022

"...when contextualized to local and national contexts and epidemiological situations, the framework provides a foundation for country-led movements to achieve the globally agreed HIV goals in the Global AIDS Strategy 2021-2026 and work towards achieving gender equality."

A range of complex factors contribute to men's and boys' low uptake of HIV-related services, often underpinned by prevailing harmful gender norms. From the Joint United Nations Programme on HIV/AIDS (UNAIDS), this framework for action outlines building blocks for planning, implementing, and monitoring improvement in the HIV response among men and boys in Eastern and Southern Africa (ESA) within a broader gender equality framework. It summarises what is currently working across the ESA region and provides an overview of what is required at the country level to meet the goal of ending the AIDS epidemic as a public health threat by 2030.

  <div class="field button"><a href="https://www.unaids.org/sites/default/files/media_asset/east-south-africa-engaging-men_en.pdf" target="_blank">Click here for the 88-page report in PDF format.</a></div>
Contacts (user reference): 
Source: 

UNAIDS website, June 24 2022. Image caption/credit: Peer educators in an artisanal mining community, Kadoma District, Zimbabwe. November 2019. © UNAIDS/C. Matonhodze

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Publication Date
Publication Date: 

2021 (MFP Transforming Masculinities manual); 2020 (MFP Community Dialogues manual)

"This is a community-led and community-owned initiative, rooted in the potential of individuals, cultures, traditions and faiths to promote a life of dignity and happiness so all members are free from harm, discrimination and violence."

Implemented by the Institute for Reproductive Health (IRH) at Georgetown University and Tearfund in partnership with two local partner organisations, Masculinities, Faith, and Peace (MFP) addresses harmful social norms in mixed Muslim and Christian communities in Plateau State, Nigeria. Detailed at Related Summaries, below, MFP is an adaptation of Transforming Masculinities, Tearfund's faith-based intervention to end sexual and gender-based violence (SGBV). The resources below emerge from and support implementation of MFP and may guide those undertaking other social-norms-centred initiatives.

Publisher: 
Number of Pages: 

MFP Transforming Masculinities manual: 96 (Christian), 92 (Muslim); MFP Community Dialogues manual: 60 (Christian), 56 (Muslim)

Contacts (user reference): 
Source: 

Tearfund website, June 22 2022. Image credit: Petra Röhr-Rouendaal

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Author: 
Laura Hinson
Elizabeth Anderson
Kesete Berhane
Hailemariam Berhe
Mohamad (Bram) Brooks
Reshma Trasi
Gebremedhin Gebrehiwot
Atsbaha Abraha
Cecelia Angelone
Erin Leasure
Awala Equar
Publication Date
Tuesday, March 1, 2022
Affiliation: 

International Center for Research on Women - ICRW (Hinson, Anderson, Leasure); Pathfinder International (Berhane, Brooks, Trasi, Gebrehiwot, Angelone, Equar); Ahadu Consulting Natural and Social Science PLC (Berhe, Abraha); Mekelle University (Berhe)

"[I]t appears that the (re)solve intervention is able to move postpartum women along the intention-action continuum to actualize changes in key contraceptive behavior."

  <div class="field button"><a href="https://www.pathfinder.org/wp-content/uploads/2022/04/resolve-ETH-Evaluation-Report_r5_May-2022.pdf" target="_blank">Click here for the 41-page report in PDF format.</a></div>
Contacts (user reference): 
Source: 

Pathfinder website, June 9 2022. Image credit: Pathfinder

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Author: 
Paul Bukuluki
Moses Okwii
Kamden Hoffmann
Melinda Pavin
Publication Date
Friday, January 21, 2022
Affiliation: 

Independent Consultant (Bukuluki); Devcom Consult (Okwii); MOMENTUM Integrated Health Resilience (Hoffmann, Pavin)

"Gaining insights into social norms and their key drivers is important for designing SBC [social and behaviour change] programs and activities that are locally appropriate and culturally sensitive to the diverse South Sudanese population, as well as understanding what behaviors can be most effectively targeted."

  <div class="field button"><a href="https://usaidmomentum.org/wp-content/uploads/2022/03/MOMENTUM-IHR-South-Sudan-Social-Norms-Assmt-01-21-22.pdf" target="_blank">Click here for the 73-page report in PDF format.</a></div>
Contacts (user reference): 
Source: 

USAID MOMENTUM website, June 13 2022.

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Author: 
Martha Silva
Sethson Kassegne
Robert-Hugues Yaovi Nagbe
Rebecca Ezouatchi
Lorimpo Babogou
Farida Moussa
Publication Date
Tuesday, February 1, 2022
Affiliation: 

Tulane University (Silva); CERA Group (Kassegne, Nagbe, Ezouatchi, Babogou, Moussa)

"[The Merci Mon Héros campaign] allowed us to find techniques to talk about sexuality with our children, to talk to them earlier about early pregnancies, because before it was not easy..." - adult man, Abidjan

  <div class="field button"><a href="https://breakthroughactionandresearch.org/wp-content/uploads/2022/03/BR_WABA_MostSigChange_Report.pdf" target="_blank">Click here for the 40-page report in PDF format.</a></div>
Contacts (user reference): 
Source: 

Population Council website, June 28 2022. Image credit: MMH via Facebook

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"We realised that it's good that the girl is involved...because young girls are future parents and the agents of change." - Communications Officer, Expanded Programme on Immunization (EPI)

From 2016-2020, Gavi and Girl Effect worked together in Ethiopia, Malawi, Rwanda, and Tanzania to understand and address some of the barriers preventing adolescent girls from accessing the human papillomavirus (HPV) vaccine. This partnership leveraged Girl Effect's girl-centred brands and media, developing educational and entertaining content that aimed to encourage positive, health-seeking behaviour in adolescent girls - with a focus on fostering positive attitudes toward, and uptake of, both HPV and routine immunisations.

Communication Strategies: 

Through a combination of entertainment-education-based media, the partnership aimed to build greater knowledge about cervical cancer and trust in the HPV vaccine and to encourage girls to actively protect their health. The project began with the conviction that, without an accurate understanding of adolescent girls' realities - from their own perspectives - solutions designed to support them would be irrelevant or ineffective. Thus, organisers turned to TEGAs (Technology Enabled Brand Ambassadors), girls aged 18-24 who are trained as researchers by Girl Effect. The TEGAs use Girl Effect's mobile research application to collect insights into the lives of their peers through conversation - providing girls with what is meant to be a safe space to share their authentic views, fears, and hopes. Data collected through the TEGA network in each country played an essential part in the creation of girl-led content that was meant to be authentic and relatable. These data, for example, illuminated the barriers girls and their parents face in understanding cervical cancer and accessing the HPV vaccine, and how best to reach these audiences with media.

Girl Effect's media is designed to communicate factual information in a fun and digestible way, building the knowledge and confidence girls need to make active choices in their lives. Gavi and Girl Effect used an integrated approach by developing content for girls that reflects their world holistically. This meant including storylines in the content not only about the HPV vaccine, but about health and the other issues girls face, such as menstrual health management, contraception, HIV, early marriage, gender-based violence, and education. By embedding HPV content within this larger offering, the aim was to encourage girls to not only obtain the HPV vaccine but also to talk to their peers about their decisions and, more broadly, to act with agency in their pursuit of health. Some examples of media content produced through the project include:

  • The radio drama for Tujibebe, Girl Effect's brand in Tanzania, used girl-to-girl conversations as a way to help build awareness, knowledge and attitudes towards the HPV vaccine.
  • One storyline in the TV drama for Girl Effect's brand Yegna in Ethiopia showed a loved character dying from cervical cancer and used it as an opportunity to explain how to prevent the disease. Building in the drama of the consequence of the disease was a strategy to help girls see the relevance of the vaccine to them. Another storyline showed that the HPV vaccine is going to be rolled out in school, sparking debate amongst girls and boys about what it is, its benefits, and its potential side effects. A central girl character persuaded her resistant mother she should get the vaccine, using facts.
  • Trusted "Aunty" figures in Girl Effect's magazines and radio talkshows (e.g., in Rwanda) provided girls with HPV vaccine information in a way that is meant to be credible and authoritative.
  • For Girl Effect's brand Zathu in Malawi, framing health messaging in the context of broader life priorities in its radio drama and magazine was designed to catch girls' attention and prompt action. Music also helped build appeal and reinforce key messages.

In all four countries, Gavi and Girl Effect proactively engaged with the Ministry of Health to build government capacity to use girl-centred approaches for addressing vaccine myths and generating informed demand for HPV vaccination. For example, organisers worked closely with the Ministry of Health in Tanzania and its HPV taskforce, conducting research for them to identify reasons for low uptake of the HPV vaccine and potential solutions. They then recommended how the Ministry of Health's five-year communications strategy might be adjusted to reflect research findings. Media products included, among others, an HPV section in an existing magazine, which was distributed to girls and teachers, and a 3-minute film with music to help build awareness of the HPV vaccine and bust myths about it. The Ministry of Health plans to continue to use a radio and social media campaign created by Girl Effect Tanzania beyond the partnership.

Based on learnings from the partnership, organisers launched the "Girl Focus Toolkit" in 2020 (available at Related Summaries, below). The toolkit aims to support Ministries of Health and other partners in delivering HPV immunisation programmes, providing a resource that will live on beyond this partnership. It includes a set of creative and strategic resources that aim to encourage and enable others to develop their own girl-focused approach to HPV vaccine communications.

Based on this experience, the Ministry of Health in Rwanda requested a new extended partnership with Gavi and Girl Effect ("Rwanda Bridge") to understand gender-based barriers to routine immunisation and to develop girl-centred communications to address these.

Development Issues: 

Adolescent Girls, Immunisation and Vaccines, Health

Key Points: 

Partnership rationale:
Unlike other vaccines, the HPV vaccine is administered to girls during adolescence, and is often their first health intervention since childhood. As such, the HPV vaccine is an opportunity to teach girls about the benefits not only of vaccines, but also of other health interventions, at a crucial time in their lives. This can help set them on a path to adopting positive, health-seeking behaviours. However, negative attitudes and social norms often prevent girls from accessing the HPV vaccine, even when it is available. The barriers girls face to accessing the vaccine include:

  • considering health services as not "for them";
  • worrying that the HPV vaccine will make them infertile;
  • feeling uncomfortable talking about their health; and
  • thinking that cervical cancer only happens to middle-aged women.

Impact:
A combination of large- and small-scale studies across each country looked at the impact and reach of different components of the branded media ecosystem. Example findings include (see the document available at the Source section below for more details):

  • The media products raised awareness of cervical cancer and the HPV vaccine. For example, 9-year-old girls who read the Zathu magazine were 2.3 times more likely to be aware of the HPV vaccine than those who hadn't. In Ethiopia, girls who viewed the Yegna TV drama were 1.6 times more likely to be aware of the HPV vaccine.
  • Girls were less likely to believe myths about cervical cancer and have correct knowledge about the vaccine. In Ethiopia, girls aged 13-15 who watched the Yegna TV drama were more likely to know "a lot" or "some things" about cervical cancer (53% vs. 30%) and were more likely to believe that the vaccine will not stop girls from giving birth (69% vs. 64%). In Malawi, girls aged 9 who read the Zathu magazine thought that the HPV vaccine will not stop girls from giving birth (vs. 32% of those who did not read the magazine, who thought it would).
  • Girls were more likely to discuss the HPV vaccine. For example, in Ethiopia, girls aged 13-15 who had seen the Yegna TV drama were more likely to have spoken to someone about the HPV vaccine (61% vs. 37%). In Malawi, girls aged 9 who read the Zathu magazine were more likely to have spoken to someone else about the HPV vaccine (46% vs. 32%), and girls were more likely to have spoken to someone else about their general health (37% vs. 28%).
  • There was an increased intention and/or decision to receive the HPV vaccine. For example, 13-15 year old girls who had seen the Yegna TV drama were 60% more likely to intend to have the vaccine than those girls who hadn't. In Ethiopia, girls who had watched the Yegna TV drama had greater intention to vaccinate than those who had not (70% vs. 43%). In Malawi, girls who read the Zathu magazine were more likely to have had their first dose than those who had not read it (20% difference); 9-year-old girls in that country who had consumed Zathu content were 32% more likely to have the vaccine. And in Ethiopia, girls who were exposed to the Yegna talk show campaign (on TV, radio, and social media) were more likely to have received the second dose of the HPV vaccine in 2021 (83% vs. 78%).

Alongside quantitative studies, the partnership engaged girls in the design, testing, and evaluation of the content and products in an effort to ensure the messages were engaging, relevant, and meaningful.

Lessons learned for future partnerships include:

  • Ensure the Ministry of Health and HPV technical working group are involved in programme design from the beginning as well as during the partnership.
  • Build on the partnership model to be an integrated part of overall partnership strategy: Once vaccines are launched, there is scope to reach under-immunised girls more effectively by understanding the barriers they face and building further partnerships to reach them.
  • Go beyond gender sensitivity by working closely with partners to transform key gender inequalities, to be measured by the impact on all relevant groups (e.g., including boys).
  • Agree on indicators that enable regular tracking, and formalise value for money, from the beginning.
  • Share lessons learned more broadly - e.g., through regular workshops and webinars.
Partner Text: 

Gavi and Girl Effect, with Ministries of Health in Ethiopia, Malawi, Rwanda, and Tanzania

Contacts (user reference): 
Source: 

"Creating Demand for the HPV Vaccine through Girl-Centred Communications" [PDF], accessed on June 14 2022. Image credit: Girl Effect