Perceived causes of change in Nigerian adolescent sexual risk behaviour ­ Results from semi-structured mobile instant messaging interviews

The study explores the perceived causes of change in sexual risk behaviour among Nigerian adolescents over the past years. By embedding the results into a theoretical context, the study aims to further develop interventions targeting adolescent sexual health. To do so, 23 semi-structured interviews are conducted through the mobile-instant-messaging tool WhatsApp. The interview sample consists of both female and male adolescents and adults from different regions in Nigeria. The interviews are conducted as simultaneous chats and analysed based on the qualitative content analysis approach. Respondents perceive a multitude of different factors as causes of change in sexual risk behaviour among Nigerian adolescents. They can be categorised into (1) individual actors, (2) structural factors, and (3) socio-cultural factors. Interrelations between the different factors can partly be observed. The other factors are mostly modifiable and can therefore contribute to reducing adolescent SRB.

Assessing infant and young child feeding priorities to inform the development of a nutrition social and behaviour change communication (SBCC) strategy during a pandemic threat

Objectives: This study was undertaken to identify stakeholder needs and wants in relation to an Infant and Young Child Feeding, Social and Behaviour Change Communication (SBCC) strategy for the 16 Southern African Development Community (SADC) member states during Covid-19 lockdowns and travel restrictions.Design: A rapid-assessment mixed-methods approach using qualitative and quantitative studies was adopted. Secondary data sources supported in-field findings. Setting/Subjects: Qualitative approaches included 17 key informant interviews from 7 SADC member states. Quantitative methods of an online survey elicited feedback from 61 participants from 11 SADC member states.Outcome measures: More strategic, best practice, infant and young child feeding SBCC programmes are recommended in SADC.Results: Programme challenges included increased demands on health systems from Covid-19, poor attitudes and beliefs toward IYCF behaviours, the dual burden of undernutrition and overnutrition, and financial and human resource capacity challenges to implement and evaluate SBCC campaigns at scale. Opportunities were also identified for improved detection,better meeting IYCF nutritional needs from locally sourced foods, training and capacity building for greater engagement of front-line field staff, effective policy development to support parent-friendly hospitals and workplaces, and improved regional integration. Conclusions: The needs assessment demonstrated that priority programme planning can continue while the health sector deals with a pandemic threat. The adaptation to virtual support provided a variety of learnings for research designs, data collection and analysis, albeit over an extended timeframe of six months. A number of innovative approaches were identified in the resultant SBCC strategy for SADC along with opportunities for regional efficiencies in adapting existing, best practice SBCC creative and programming approaches.

A study on Perceived Threat, Behavior Change, Lockdown Compliance and Coping Strategies among Indian Adults amid COVID-19 outbreak

Introduction: During the current pandemic, threat perception of people during lockdown, any subsequent change in their behaviour , coping mechanisms along with lockdown compliance used to deal with the crisis in the Indian subcontinent have been important. The study aims to explore prevalence of perceived threat, behaviour change, lockdown compliance, and coping strategies amid COVID-19 outbreak in India. Methodology: This cross-sectional study used a semi-structured online questionnaire. Study applied non- probability snowball sampling technique for data collection. The survey questionnaire included four sections on (a) socio-demographic variables (b) perceived threat (c) lockdown compliance and behaviour change (d) coping strategies. Descriptive statistical analysis was done for the evaluation of data. Results: The responses of 1068 participants with a mean age of 32.92±12.88 years were included for analysis. Nearly half (51%) of the participants reported feeling 'very high' anxiety and about 34% reported to have 'high' anxiety about the spread of coronavirus, on the other hand many (41.6%) of them believed that they had very less chances of getting infected with coronavirus. A large population (89.3%) reported complying to the nationwide lockdown. The major coping mechanism being used by the people is distractions, socializing as well as adaptive coping mechanisms. Conclusion: In the current scenario, there is a concern for India, as due to surge in persons infected with COVID 19 and an indication towards 'optimism bias ' prevalent in people there are chances of poor compliance with government guidelines on behaviour change. The findings of the study will be helpful in designing programs and government measures for the people aimed at ensuring compliance with the guidelines related to social distancing and sanitization and using adaptive coping strategies

Dietitians’ Perceptions of Developing Best Practice in Communication Skills.

Background: The communication skills of health care practitioners, such as Registered Dietitians (RDs) are increasingly recognised as fundamental to patient care and monitoring the effectiveness of these skills is recommended [1,2]. The aim of this study was to explore experienced RDs views on best practice in relation to the use of communication skills for behaviour change (CSBC) and the assessment of these skills in practice. Methods: This qualitative study recruited eight RDs from the East Midlands and Yorkshire to participate in semi-structured interviews. The study was part of a larger mixed methods study which developed and validated a tool for the assessment of CSBC in dietetic consultations, DIET-COMMS. The details of sampling, recruitment, ethics and research methods including data collection, data management and data analysis have been reported elsewhere [3]. Participants had viewed and assessed 20 video recorded mock dietetic consultations. This study is a preliminary report of their opinions of those consultations, the importance of CSBC in dietetics, what best practice is and possible methods for professional development in this area. Interviews were transcribed verbatim and subject to inductive thematic analysis. Results: Preliminary analysis identified three main themes. Theme 1: Concern about consultations viewed. Although there was great variation, participants were disappointed and sometimes ‘shocked’ by the poor skill level observed in some consultations. They felt passionately that RDs should be highly skilled in CSBC throughout patient consultations to be effective. Theme 2: Communication skill development and assessment: ready or not? Participants felt that post-registration training and assessment of CSBC was desirable throughout the profession at all levels and in all specialities but they had strong reservations about the acceptability of this and perceived it needed to be ‘handled very sensitively’. Theme 3: Knowledge versus communication skills: one or the other or both? This theme related to the development and use of knowledge and/or CSBC. Participants perceived that knowledge was more highly valued and CSBC sometimes neglected. Poor ability to implement CSBC throughout the whole patient consultation was observed and thought to have a negative effect on patient dietitian relationships and patient outcomes. Discussion: Despite concerns at some of the communication skills viewed participants were still not overwhelmingly supportive of radical action such as regular, compulsory assessment in practice. Concern for how RDs would ‘feel’ about assessment was stronger than concern about the effectiveness and outcomes of consultations. Theme 3 suggests that participants recognise that both knowledge and skills are important but observed a lack of ability to use CSBC beyond ascertaining the patients’ reason for attending the consultation. This suggests a need to support RDs to integrate these skills throughout the consultation for optimal effectiveness and patient outcomes. Post-registration training and development of these skills, including tailored assessment, may be beneficial, if challenging to implement. A change in the behaviour of RDs may be necessary in order to facilitate more behaviour change in their patients. Conclusion: Although it may be challenging to implement in practice, the development and assessment of CSBC in RDs post-registration is an area for improvement in dietetics.

An Exploration into the Attitudes of University Students Regarding the Implementation of A Tax on Unhealthy Foods to Improve the Nation’s Health.

Background: The UK Government are considering introducing a tax on unhealthy foods to reduce their consumption in order to improve the nation’s health and fund National Health Service (NHS) costs for obesity related co-morbidities and treatments. They suggest that the evidence supporting a food tax needs to be investigated before its implementation [1]. Mytton, Clarke and Rayner [2] state that food taxes may improve public health, however, American research shows that there is no correlation between existing taxes and a reduction in obesity [3]. This study aimed to investigate the attitudes of university students regarding the implementation of a tax on unhealthy foods to improve the nation’s health. Methods: This research employed an exploratory qualitative methodology based on grounded theory to gain an insight of student attitudes towards a food tax. Convenience sampling was used to recruit twelve university students consisting of eleven female health care profession students, representing nursing, occupational therapy and dietetic cohorts and one male engineering student. Data was collected from two, one hour focus groups which were audio recorded and transcribed verbatim. The six stages of thematic analysis used to analyse the data and identify themes [4]. Ethical approval was granted by the Coventry University Research Ethics Committee. Findings: The predominant emergent themes were: acceptance of taxes, behaviour changes, accountability and a combination of approaches. Most participants felt that an unhealthy food tax would only be acceptable if the revenue was specifically used to fund the NHS to assist with the costs of obesity and subsidise healthy foods. The overarching perception was that a food tax alone would not reduce the participants’ purchases of unhealthy food due to its desirability. However, it was suggested that if other interventions were used alongside a tax this may bring about behaviour change. Discussion: Participants felt that a combination of interventions including education, subsidies, food taxes, clear nutritional labelling, availability of healthier options and appropriate marketing alongside the consideration of low income groups would be required to bring about a change in eating behaviours to address the prevalence of obesity. These findings are consistent with public health expert views [5] and concur with a study conducted with Danish residents [6]. Due to the small sample size of this study generalisation to the wider population is not possible; therefore further research is necessary to provide stronger evidence to evaluate the impact that existing taxes and interventions may have on behaviour change and health outcomes. This will enable policy makers to establish the effectiveness of taxes and other strategies before their implementation in the UK. Conclusion: This study concluded that a holistic approach may be necessary in order to have an impact on eating behaviours and ultimately obesity.

Health promotion for prevention and control of non-communicable diseases: Unfinished agenda.

The magnitude of Non Communicable diseases demands urgent attention. Common, preventable risk factors underlie most NCDs. These include behavioural risk factors and metabolic risk factors. The prevalence of these, varies between income groups and differs with gender. Majority of events occur in individuals with modest elevations of multiple risks rather than with significant elevation of a single risk factor. The need of the hour is to adopt a process which addresses the upstream determinants through enabling people, to increase control over their health and its determinants, thereby promoting and sustaining good health The answer lies in Health Promotion which involves changing behaviour at multiple levels. In order to change, there is need to understand and apply the models which have been widely used to empower people to make healthy choices. These include the Health Belief, Self-Efficacy, Social Learning and Self-empowerment models.Changing behaviour, however, is a process, not an event. Different strategies are most effective at different Stages of Change. The contextual determinants of health and health behaviouralso significantly influence the risks of NCDs.Till date, there has been limited focus on these issues. We urgently, need aclose look at policies and their impact on health. With increasing burden of NCDs, the Health Sector will face strain on services delivery and budgets. Special policies and programs are necessary for the disadvantaged poor to address their differential vulnerabilities and risks. The unfinished agenda of NCD prevention and control needs to be addressed urgently with an integrated comprehensive framework of Health Promotion

Introduction to Motivational Interviewing (MI)

Changing our patients’ health behaviour has always been difficult. To enhance their intrinsic motivation to change, we need to explore and resolve their ambivalence through motivational interviewing (MI). The four broad principles in MI are expressing empathy, developing discrepancy, rolling with resistance and supporting self-efficacy. Key skills in the practice of MI include using open ended questions, reflective listening and pulling change. While full blown MI may not be practical in our primary care setting, understanding the concept and principles of MI can help us be more patient-centred and collaborative which will help build motivation for change. Though time is a limiting factor for using MI in medical and public health settings, brief strategies like the Elicit-Provide-Elicit model can be used to give patients feedback and information about their health.

Evidence based communication for health promotion: Indian lessons of last decade.

Good health promotion programs which help achieve public health goals are derived from using a mix of epidemiological and social and behavioral science research information. Social data informed by behavioral theories provides a lens of understanding how recommended behaviors are adopted by different individuals within the population over a period of time. In addition to social and epidemiological data, evidence based and scientifically planned and monitored strategic communication interventions have to be linked to available service components of the program. Communication is increasingly understood as an enabler of individual and social level change to achieve established developmental goals including health. Democratization movements and the advent of the internet have changed the environment around any program communication from top-down, expert-to-consumer (vertical) communication towards non-hierarchical, dialogue-based (horizontal) communication, through which the public increasingly questions recommendations of experts and public institutions on the basis of their own, often web based, research. The amount of information available has increased greatly, including scientifically valid data and evidence-based recommendations alongside poor quality data, personal opinions, and misinformation. Evidence-based approaches include engagement with and listening to stakeholders, and being transparent about decision making, and honest and open about uncertainty and risks. Decision and policy makers cannot assume what the public wants without undertaking social science and decision science research. The Global Polio Eradication Initiative and Integrated Disease Surveillance Projects (IDSP) in India haves shown that monitoring of public concerns needs to be continuous and responsive, and hand in hand with the monitoring of technical strategies and appropriate Information Technology support for, not only data transmission but also for videoconferencing and community involvement through toll free 24×7 call service with universal access. This article elucidates the vital role of Health Promotion, a research based communication process, in achieving developmental, particularly health goals. It underscores that communication is as much a science as an art, as much process as it is about outcomes. It advocates for increased linkages between epidemiological research and social science research in planning effective health promotion interventions with quality service delivery.