Love Shouldn't Hurt - E le Saua le Alofa: Co-designing a theory of change for preventing violence against women in Samoa.

Despite the widespread adoption of Theories of Change (ToC) for programme evaluation, the process of collaboratively developing these theories is rarely outlined or critical analysed, limiting broader methodological discussions on co-production. We developed a ToC as part of E le Saua le Alofa ('Love Shouldn't Hurt') - a participatory peer-research study to prevent violence against women (VAW) in Samoa. The ToC was developed in four phases: (1) semi-structured interviews with village representatives (n = 20); (2) peer-led semi-structured interviews with community members (n = 60), (3) community conversations with 10 villages (n = 217) to discuss causal mechanisms for preventing VAW, and (4) finalising the ToC pathways. Several challenges were identified, including conflicting understandings of VAW as a problem; the linearity of the ToC framework in contrast to intersecting realities of people's lived experiences; the importance of emotional engagements, and theory development as a contradictory and incomplete process. The process also raised opportunities including a deeper exploration of local meaning-making, iterative engagement with local mechanisms of violence prevention, and clear evidence of ownership by communities in developing a uniquely Samoan intervention to prevent VAW. This study highlights a clear need for ToCs to be complemented by indigenous frameworks and methodologies in post-colonial settings such as Samoa.

Body and head position effects on regional lung ventilation in infants: An electrical impedance tomography study.

OBJECTIVE: To determine the effects of body and head positions on the spatial distribution of ventilation in nonintubated spontaneously breathing and mechanically ventilated infants using electrical impedance tomography (EIT). DESIGN AND SETTING: Prospective study in a neonatal intensive care unit. PATIENTS: Ten spontaneously breathing (gestational age 38 weeks, postnatal age 13 days) and ten mechanically ventilated infants (gestational age 35 weeks, postnatal age 58 days). INTERVENTIONS: Supine and prone postures with different head positions (midline and rotated to the left and right side). MEASUREMENTS AND RESULTS: The distribution of ventilation in the chest cross-section was repeatedly determined from EIT data in each body/head position studied. During spontaneous breathing the tidal volumes in the left lung region were reduced in the supine posture with the head turned to the left as well as in the prone posture with the head rotated to either side when compared with the supine posture with the head in the midline position. During mechanical ventilation the tidal volumes in the left lung region were unaffected by the body and head position except for the prone posture combined with the leftward head rotation which reduced them. In both types of ventilation the tidal volumes in the right lung region were unaffected by the change in body/head position. CONCLUSION: The results indicate that the spatial distribution of ventilation is influenced by the body and head position in spontaneously breathing infants. Prone posture with the leftward head rotation has the most prominent effect which is detectable even during mechanical ventilation.