Adaptation and application of the Parent Attitudes About Childhood Vaccines survey tool in the Vietnamese language: a cross-sectional study.

BACKGROUND: Parental vaccine hesitancy could lead to outbreaks of vaccine-preventable diseases. Although parental vaccine hesitancy exists in the Vietnamese community, no research has directly investigated this social phenomenon in Vietnam. Among the validated measures, the 15-item Parent Attitudes About Childhood Vaccines survey tool (PACV) was reliable for predicting vaccine-hesitant parents. However, the PACV was not available in Vietnamese. This study aimed to develop a Vietnamese version of the PACV and examine factors associated with parental vaccine hesitancy in Hue city, Vietnam. METHODS: This study was a cross-sectional study. The English PACV was translated into Vietnamese with content and face validation. Self-administered questionnaires were distributed to 400 parents at ten commune health centres in Hue city, Vietnam. The parents were asked to answer the questionnaire again after two weeks for the test-retest reliability. The Vietnamese PACV reliability was assessed using Cronbach's alpha and McDonald's omega, and the intra-class correlation (ICC) coefficients were used for the test-retest reliability. The construct validity was tested by the hypothesis that parental vaccine hesitancy would be related to the intention of getting the children vaccinated. Exploratory factor analysis was also undertaken to determine the construct validity. Bivariate and multivariable logistic regression were used to identify the factors associated with parental vaccine hesitancy. RESULTS: The Vietnamese PACV final version (PACV-Viet) contained 14 items. Three hundred and fifteen parents returned completed questionnaires, giving a response rate of 78.8%. The Cronbach's alpha and McDonald's omega were 0.72 and 0.70, respectively. Out of 315 parents, 84 responses were returned for test-retest reliability. All ICCs were good to excellent, ranging from 0.81 to 0.99. The PACV-Viet was confirmed to have construct validity. Using the PACV-Viet, 8.9% of the parents were found hesitant to childhood vaccination. Being unemployed and having seen the news about adverse events following immunisation were associated with parental vaccine hesitancy, with AOR = 3.2 (95% CI 1.3-8.0) and AOR = 4.5 (95% CI 1.2-16.7), respectively. CONCLUSIONS: The PACV-Viet is a valid and reliable tool. Community outreach is necessary to alleviate parents' concerns about childhood vaccination.

What are the factors affecting primary care choice when the access under health insurance scheme is limited?: a cross-sectional study in Bandung, Indonesia.

BACKGROUND: Ensuring equal access to primary care services is crucial, as the gateway to a higher level of care. Indonesia has been trying to increase financial access to medical care by administering national health insurance known as BPJS-Health (Badan Penyelenggara Jaminan Sosial Kesehatan) since 2014. However, BPJS-Health beneficiaries can only use their benefits at a limited number of registered primary care providers (BPJS-Health partners). This study investigated the geographical coverage of BPJS-Health and BPJS-Health beneficiaries' primary care choices, based on their characteristics and healthcare preferences in the target areas of Bandung, Indonesia. METHODS: The setting of this cross-sectional study was the areas with low physical access to BPJS-Health partners but high physical access to non-BPJS-Health partners. Physical access was determined by spatial network analysis, resulting in a geographical coverage map. A total of 216 adults were recruited and they completed the questionnaire about their primary care choice. All participants had been registered with the BPJS-Health system and living in the study areas. Their participation in non-BPJS-Health was also evaluated. Participants' choice of care was assessed in three different scenarios, when the individual was experiencing mild, chronic, and serious illnesses. RESULTS: BPJS-Health partners' geographical coverage was unequally distributed in Bandung. Being registered with non-BPJS-Health company was negatively associated with the more frequent choice of using BPJS-Health partners' services (AOR = 0.18; 95% CI, 0.06-0.58, P = 0.004) among BPJS-Health beneficiaries. For serious illnesses, having a high income was associated with choosing non-BPJS-Health partners and hospitals (AOR = 4.90; 95% CI, 1.16-20.77, P = 0.031). When dealing with mild and chronic illnesses, participants were concerned about the quality of treatment they would receive as a major factor in choosing a primary care provider. However, receiving better treatment quality was negatively associated with choosing BPJS-Health partners in all cases of illness severities. CONCLUSIONS: Sociodemographic characteristics, healthcare preference factors, and health insurance status were associated with participants' primary care choices in the target areas of Bandung, Indonesia. BPJS-Health partners' coverage map and the preference factors are potentially important for policymakers, especially for the development of future BPJS-Health partnerships.

Understanding competency of nursing students in the course of case-based learning in Cambodia: a convergent mixed method study.

BACKGROUND: In the last decade, nursing education has begun to reform to competency-based education worldwide, including in low-and middle-income countries. Case-Based Learning (CBL), an approach to delivering competency-based education, contributes to acquiring critical thinking competency, problem-solving, higher knowledge, professional value and attitude. However, it needs to be taught in a culturally appropriate manner. In Cambodia, CBL was initiated in a classroom and clinical practicum by faculty and preceptors who graduated from the upgrading course. This study examined the factors associated with the competency level of nursing students, explored the practice and perceptions of teaching-learning activities among students, faculty members and preceptors and assessed the coherence of qualitative and quantitative findings. METHODS: This was a convergent, mixed methods study. Data were collected from eight educational institutions for quantitative and qualitative studies and seven hospitals for qualitative studies. From June to September 2019, a cross-sectional survey of nursing students in the third year of the three-year programme (n = 719), eight focus group discussions (FGDs; n = 55) with 6-8 members and 15 FGDs with faculty (n = 38) and clinical preceptors (n = 37) with 4-7 members were conducted to elicit the teaching-learning experience and perceptions. Multiple linear regression was performed to investigate the factors associated with student competency. Moreover, the study conducted thematic content analysis on the qualitative data. The integrated analysis was presented as side-by-side joint displays. RESULTS: First, the quantitative and qualitative findings confirmed each other 's CBL learning experiences. Students had higher levels of nursing competencies if they had CBL experiences, both in the classroom and clinical practicum, both in a group manner. Next, the quantitative and qualitative findings complemented students' academic satisfaction with the teaching by faculty members and preceptors. Finally, the quantitative and qualitative findings were expanded to explain students' academic satisfaction with the programme. CONCLUSIONS: The finding of CBL experiences in a group and students' satisfaction with faculty members' and preceptors' teaching improved nursing students' competency development. Meanwhile, students' satisfaction with the design and delivery of the educational programme provides implications for policy level to narrow the theory and practice gaps in low- and middle-income countries.

Determinants of health-related quality of life among patients with systemic lupus erythematosus in Hanoi, Vietnam.

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which impacts patients' lives. Many studies in high-income countries have focused on their health-related quality of life (HRQoL). However, evidence of awareness of SLE and HRQoL in low- and middle-income countries is lacking. Therefore, this study aimed to identify the determinants of HRQoL of SLE patients in Vietnam, a lower-middle income country. METHODS: This cross-sectional study was conducted at the National Hospital of Dermatology and Venereology in 2019. A pre-tested structured questionnaire was used to collect data. It consisted of Short Form-36 to assess HRQoL which comprised physical and mental component summaries, Multidimensional Scale of Perceived Social Support, Satisfaction with Life Scale, and Mental Adjustment to SLE. Multiple linear regression was used to identify the determinants of HRQoL. RESULTS: One hundred thirty four patients with SLE participated in this study. The majority of the patients were women (n = 126, 94.0%). The mean age of all participants was 37.9 years old (standard deviation [SD] 12.5). Of 134 participants, 104 (77.6%) were married. Older patients were more likely to have a lower score of mental component summary (B=-0.45, 95% CI -0.73, -0.17). Patients with more children were more likely to have a lower score of physical component summary (B=-5.14, 95% CI -9.27, -1.00). Patients who felt more helplessness or hopelessness were more likely to have lower scores of physical and mental component summaries (B=-1.85, 95% CI -2.80, -0.90; B=-1.69, 95% CI -2.57, -0.81). Also, patients who felt more anxious were more likely to have a lower score of mental component summary (B=-1.04, 95% CI -1.77, -0.32). Patients who were more satisfied with their lives were more likely to have higher scores of physical and mental component summaries (B = 1.07, 95% CI 0.50, 1.64; B = 1.08, 95% CI 0.55, 1.61). CONCLUSION: Factors associated with lower HRQoL in Vietnam were feelings of helplessness or hopelessness, and burdens of parenting roles. However, social support can contribute to a higher HRQoL, such as information support, self-support groups, and daycare services provided at the community level.

Association between the person-centered maternity care experience and mental health after delivery in urban and rural Dhading, Nepal: a cross-sectional study.

BACKGROUND: Person-centered maternity care is a component of quality care, which includes effective communication, respect, and dignity. Supportive care has a positive effect on mothers' perinatal experience. In contrast, negative childbirth experiences can cause psychological problems. However, the impact of person-centered maternity care experience on mothers' mental health after delivery remains unknown. Therefore, in this study, we examined the association between person-centered maternity care experience at healthcare facilities and maternal mental health after delivery among Nepali women. METHODS: We conducted a cross-sectional study in urban and rural areas in Dhading District, Nepal. Participants were women who gave birth at public healthcare facilities, and their baby's age was between 1 and 12 months. After purposively selecting the target areas, we recruited the women from July to August 2019 and interviewed them using questionnaires. We conducted multiple regression analyses to analyze the association between delivery care experience and depressive symptoms and the association between delivery care experience and mental well-being. RESULTS: In total, 595 women were included in the data analysis. The experience of better person-centered maternity care was associated with lower depressive symptom scores in urban (unstandardized coefficient [B]= - 0.09, p < 0.001) and rural areas (B= - 0.10, p < 0.001). Moreover, the experience of better person-centered maternity care was associated with higher mental well-being scores in both urban (B= 0.30, p < 0.001) and rural areas (B= 0.15, p = 0.017). CONCLUSIONS: Person-centered maternity care was associated with lower depressive symptom scores and higher mental well-being, regardless of the setting in Nepal. Person-centered maternity care during childbirth can potentially improve mental health after delivery. Maternity care should be improved with more attention to person-centered maternity care aspects.

Identifying positive and negative deviants and factors associated with healthy dietary practices among young schoolchildren in Nepal: a mixed methods study.

BACKGROUND: School-based interventions have been implemented in resource-limited settings to promote healthy dietary habits, but their sustainability remains a challenge. This study identified positive deviants (PDs) and negative deviants (NDs) from the control and treatment groups in a nutrition-sensitive agricultural intervention in Nepal to identify factors associated with healthy dietary practices. METHODS: This is an explanatory mixed methods study. Quantitative data come from the endline survey of a cluster randomized controlled trial of a school and home garden intervention in Nepal. Data were analyzed from 332 and 317 schoolchildren (grades 4 and 5) in the control and treatment group, respectively. From the control group, PDs were identified as schoolchildren with a minimum dietary diversity score (DDS) ≥ 4 and coming from low wealth index households. From the treatment group, NDs were identified as schoolchildren with a DDS < 4 and coming from high wealth index households. Logistic regression analyses were conducted to identify factors associated with PDs and NDs. Qualitative data were collected through in-depth phone interviews with nine pairs of parents and schoolchildren in each PD and ND group. Qualitative data were analyzed thematically and integrated with quantitative data in the analysis. RESULTS: Twenty-three schoolchildren were identified as PDs, and 73 schoolchildren as NDs. Schoolchildren eating more frequently a day (AOR = 2.25; 95% CI:1.07-5.68) and whose parents had a higher agricultural knowledge level (AOR = 1.62; 95% CI:1.11-2.34) were more likely to be PDs. On the other hand, schoolchildren who consumed diverse types of vegetables (AOR = 0.56; 95% CI: 0.38-0.81), whose parents had higher vegetable preference (AOR = 0.72; 95% CI: 0.53-0.97) and bought food more often (AOR = 0.71; 95% CI: 0.56-0.88) were less likely to be NDs. Yet, schoolchildren from households with a grandmother (AOR = 1.98; 95% CI: 1.03-3.81) were more likely to be NDs. Integrated results identified four themes that influenced schoolchildren's DDS: the availability of diverse food, the involvement of children in meal preparation, parental procedural knowledge, and the grandmother's presence. CONCLUSION: Healthy dietary habit can be promoted among schoolchildren in Nepal by encouraging parents to involve their children in meal preparation and increasing the awareness of family members.

Accommodation and disability-specific differences in nutritional status of children with disabilities in Kathmandu, Nepal: A cross-sectional study.

BACKGROUND: Worldwide, more than 150 million children < 18 years live with disabilities. These children are more vulnerable to malnutrition regardless of institutional care that they receive, such as daycare or residential care. In Nepal, little is known about the status of malnutrition and factors associated with malnutrition among children with disabilities. This study was conducted to investigate the factors associated with malnutrition based on the types of disability and accommodation. METHODS: This institution-based, cross-sectional study was conducted in 22 institutions in the Kathmandu Valley, Nepal. From these institutions, parents/guardians of all children with disabilities were recruited who were present there on the day of data collection. They were interviewed using a structured questionnaire. The questionnaire included questions on demographic characteristics, disability type and severity, accommodation place, feeding practices, and dietary patterns. The outcome variables, stunting, underweight, and obesity were measured using height-for-age, weight-for-age, and body mass index-for-age, respectively. A generalized linear model was used to investigate the factors associated with stunting and underweight, and multinomial logistic regression was used to identify the factors associated with overweight and obesity. RESULTS: Among the 345 children with disabilities, 45% were stunted, 33% were underweight, 19% were thin, and 12% were overweight. Children with physical disabilities (relative risk ratio = 1.88, 95% confidence interval [CI] = 1.26-2.81) were more likely to be stunted than those with sensory disabilities. Children with autism (adjusted odds ratio [aOR] = 5.56, 95% CI: 1.23-25.23) and intellectual disabilities (aOR = 5.84, 95% CI: 1.59-21.51) were more likely to be overweight and obese than those with sensory disabilities. No evidence was found regarding an association between accommodation type and malnutrition. CONCLUSION: Children with disabilities are vulnerable to malnutrition in several ways. Different types of disabilities are associated with different forms of malnutrition. Considering the types of disabilities, tailor-made approaches should be adopted to improve malnutrition status.

Cutting the Chain of Discrimination during COVID-19 Pandemic by Health Literacy.

The coronavirus disease 2019 (COVID-19) pandemic resulted in discrimination against patients and healthcare workers in the beginning. As more information about COVID-19 prevention became available, discrimination toward the patients and healthcare workers gradually reduced. Instead, people wearing masks in the general public were heavily discriminated when mask-wearing was recommended only for healthcare workers. After the universal use of masks was recommended, discrimination against those who were wearing masks decreased and increased among those who do not wear masks. However, due to the introduction of vaccine passports, the target for discrimination has shifted to people who have not received COVID-19 vaccines. Narrowing vaccine disparity could prevent discrimination toward unvaccinated people. However, some people are hesitating vaccination or cannot be vaccinated because of their health status. These people will remain targets for discrimination even if vaccines were equally distributed. To prevent discrimination during the COVID-19 pandemic, improving health literacy of the population could be effective in two ways. First, health literacy could reduce vaccine hesitancy by enabling people to critically evaluate vaccine information. Second, health literacy enables people to respect decisions of others to avoid vaccination. Therefore, interventions improving health literacy have the potential to contribute to cutting the chain of discrimination during the COVID-19 pandemic.

Factors influencing physical distancing compliance among young adults during COVID-19 pandemic in Indonesia: A photovoice mixed methods study.

The spreading of the coronavirus disease (COVID-19) is growing out of control in Indonesia since the first two confirmed cases were announced in March 2020. Physical distancing measures are key to slowing down COVID-19 transmission. This study investigated factors associated with physical distancing compliance among young adults in the Jakarta Metropolitan Area, Indonesia. A convergent photovoice mixed methods design was used. Quantitatively, using data from 330 young adults in Jakarta Metropolitan Area, Indonesia, physical distancing compliance scores and its associated factors were analyzed with hierarchical linear regression. Responses from 18 young adults in online focus group discussions and 29 young adults in photovoice were analyzed with thematic analysis. Then, the findings were integrated using joint displays. The mean compliance score of young adults was 23.2 out of 27.0. The physical distancing compliance score was higher among those who worked or studied from home (ß = 0.14, p <0.05), compared with those who resumed work at an office or study at school. Celebrating religious days (ß = -0.15, p <0.05) and having hometown in the Jakarta Metropolitan Area (ß = -0.12, p <0.05) were negatively associated with higher physical distancing compliance scores. Joint displays expanded the reasons for workplace policy, awareness, and social pressure as facilitators and barriers to compliance. Young adults' physical distancing compliance scores were high, but they are at risk of not complying due to religious events and changes in workplace policies. Beyond individual efforts, external factors, such as workplace policies and social pressure, play a major role to influence their physical distancing compliance.

Health-seeking behaviours in a malaria endemic district in Lao People's Democratic Republic: a mixed methods study.

OBJECTIVES: This mixed methods study was conducted to explore the barriers and facilitators for health-seeking behaviours in a malaria endemic district in Lao PDR. DESIGN: A convergent mixed methods design. SETTING: Two malaria endemic villages in Thapangthong district, Savannakhet Province, Lao PDR. PARTICIPANTS: Villagers and healthcare workers in the two villages in Thapangthong district. METHODS: In the quantitative part, a pretested questionnaire was used to identify the health-seeking behaviours of the villagers. In the qualitative part, focus group discussions were employed to explore health-seeking behaviours of the villagers and in-depth interviews were used to explore the perceptions of the healthcare workers. Descriptive statistics were computed and multiple logistic regressions were used to identify the factors associated with perceived severity and perceived susceptibility. Thematic analysis was used to analyse the qualitative data. Quantitative and qualitative results were integrated in joint displays. RESULTS: In the quantitative part, data were collected from 313 villagers from both villages. For malaria, 96.0% and 98.2% of villagers from villages A and B, respectively, would first seek treatment at public health facilities. Villagers who have not experienced malaria before were more likely to perceive that the consequences of malaria were serious compared with those who have experienced malaria before (adjusted OR=1.69, 95% CI: 1.03 to 2.75). However, qualitative data showed that villagers faced problems such as lack of medicines and medical equipment. Healthcare workers also mentioned the lack of manpower and equipment in the in-depth interviews. Nevertheless, villagers still preferred to seek treatment at the health center as the National Health Insurance was introduced. CONCLUSIONS: Public health facility usage was high but barriers existed. Effective policy and enabling environment such as the introduction of the National Health Insurance could help accelerate the progress towards the malaria elimination goal. Moreover, the benefits could go beyond the context of malaria.

Multilevel factors influencing contraceptive use and childbearing among adolescent girls in Bara district of Nepal: a qualitative study using the socioecological model.

OBJECTIVES: This study aimed to identify the multilevel factors that influence contraceptive use and childbearing decisions in Nepal and examine relationships among these factors. DESIGN: The study drew on qualitative data collected through in-depth interviews (IDIs) and key informant interviews (KIIs) and triangulated results. SETTING: An urban municipality and a rural municipality in Bara district, Nepal. PARTICIPANTS: We recruited a total of 60 participants (e.g., 20 married adolescent girls aged 15-19, 20 husbands, 20 mothers-in-law) for IDIs and 10 (e.g., four healthcare providers, three health coordinators, three female community health volunteers) for KIIs. RESULTS: Married adolescent girls faced a range of barriers that are inter-related across different levels. Patriarchal norms and power imbalances between spouses limited their decision-making power regarding contraception. Social pressures to give birth soon after marriage drove the fear of infertility, abandonment and the stigmatisation of childless married couples, which leads to lack of women's autonomy in making decisions about family planning. Mothers-in-law and religion exerted considerable influence over couples' decisions regarding contraception. Limited access to information about the benefits and methods of family planning contributed to fear of the side effects of contraceptives and low awareness about the risks involved in adolescent pregnancy. CONCLUSIONS: The convergent results from triangulation confirm that the decision to postpone childbearing is not merely the personal choice of an individual or a couple, highlighting the importance of targeting families and communities. The study underscores the need to challenge restrictive sociocultural norms so that adolescent girls become empowered to exercise greater control over contraceptive use.

Positive deviance for promoting dual-method contraceptive use among women in Uganda: a cluster randomised controlled trial.

OBJECTIVE: To examine the effects of a positive deviance intervention on dual-method contraceptive use among married or in-union women. DESIGN: Open-label cluster randomised controlled trial. SETTING: 20 health facilities in Mbarara District, Uganda. PARTICIPANTS: 960 married or in-union women aged 18-49 years using a non-barrier modern contraceptive method. INTERVENTIONS: A combination of clinic-based and telephone-based counselling and a 1-day participatory workshop, which were developed based on a preliminary qualitative study of women practising dual-method contraception. PRIMARY OUTCOME MEASURE: Dual-method contraceptive use at the last sexual intercourse and its consistent use in the 2 months prior to each follow-up. These outcomes were measured based on participants' self-reports, and the effect of intervention was assessed using a mixed-effects logistic regression model. RESULTS: More women in the intervention group used dual-method contraception at the last sexual intercourse at 2 months (adjusted OR (AOR)=4.12; 95% CI 2.02 to 8.39) and 8 months (AOR=2.16; 95% CI 1.06 to 4.41) than in the control group. At 4 and 6 months, however, the proportion of dual-method contraceptive users was not significantly different between the two groups. Its consistent use was more prevalent in the intervention group than in the control group at 2 months (AOR=14.53; 95% CI 3.63 to 58.13), and this intervention effect lasted throughout the follow-up period. CONCLUSIONS: The positive deviance intervention increased dual-method contraceptive use among women, and could be effective at reducing the dual risk of unintended pregnancies and HIV infections. This study demonstrated that the intervention targeting only women can change behaviours of couples to practise dual-method contraception. Because women using non-barrier modern contraceptives may be more reachable than men, interventions targeting such women should be recommended. TRIAL REGISTRATION NUMBER: UMIN000037065.

Understanding frailty among older people living in old age homes and the community in Nepal: A cross-sectional study.

INTRODUCTION: Frailty is a state of being vulnerable to adverse health outcomes such as falls, delirium, and disability in older people. Identifying frailty is important in a low-income setting to prevent it from progressing, reducing healthcare costs, increasing the chances of reversibility, and implementing effective interventions. The factors affecting frailty in older people living in old age homes could differ from those living in the community. This study was conducted to identify the factors associated with frailty in older people residing in old age homes and communities in Kathmandu Valley, Nepal. METHODS: This is a cross-sectional study conducted from April to June 2019 in three districts of Kathmandu Valley, Nepal. Data were collected from 193 older people residing in old age homes and 501 residing in communities aged 60 and above using convenience sampling. Frailty was measured using the Groningen Frailty Indicator. Data were collected via face-to-face interviews. Multiple linear regression analyses were used to examine the association between independent variables and frailty. RESULTS: Frailty was more prevalent among older people in old age homes (71.5%) compared to those in the community (56.3%). Older people who were satisfied with their living environment had lower frailty scores in both old age homes (ß = -0.20, p<0.01) and the community (ß = -0.15, p<0.001). Those who had self-rated unhealthy lifestyle had higher frailty scores in both old age homes (ß = 0.45, p<0.001) and the community (ß = 0.25, p<0.001). In the community, those over 80 years of age had higher frailty scores (ß = 0.15, p<0.01) and those with higher education had lower scores (ß = -0.13, p<0.05). CONCLUSION: The living environment and lifestyle are key modifiable risk factors of frailty, both in old age homes and the community. The findings suggest a need for lifestyle modification and reforms in building standards, especially in old age homes, to promote age-friendly communities.

Correction: Parental migration and psychological well-being of left-behind adolescents in Western Nepal.

[This corrects the article DOI: 10.1371/journal.pone.0245873.].

Identifying the causal effect of child marriage on unmet needs for modern contraception and unintended pregnancy in Nepal: a cross-sectional study using propensity score matching.

OBJECTIVES: This study aimed to investigate whether child marriage had causal effects on unmet needs for modern contraception, and unintended pregnancy, by estimating the marginal (population-averaged) treatment effect of child marriage. DESIGN: This study used secondary data from the Nepal Demographic and Health Survey 2016. Applying one-to-one nearest-neighbour matching with replacement within a calliper range of ±0.01, 15-49 years old women married before the age of 18 were matched with similar women who were married at 18 or above to reduce selection bias. SETTING: Nationally representative population survey data. PARTICIPANTS: The sample consisted of 7833 women aged 15-49 years who were married for more than 5 years. OUTCOME MEASURES: Unmet needs for modern contraception and unintended pregnancy. RESULTS: The matching method achieved adequate overlap in the propensity score distributions and balance in measured covariates between treatment and control groups with the same propensity score. Propensity score matching analysis showed that the risk of unmet needs for modern contraception, and unintended pregnancy among women married as children were a 14.3 percentage point (95 % CI 10.3 to 18.2) and a 10.1 percentage point (95 % CI 3.7 to 16.4) higher, respectively, than among women married as adults. Sensitivity analysis indicated that the estimated effects were robust to unmeasured covariates. CONCLUSIONS: Child marriage appears to increase the risk of unmet needs for modern contraception and unintended pregnancy. These findings call for social development and public health programmes that promote delayed entry into marriage and childbearing to improve reproductive health and rights.

Parental migration and psychological well-being of left-behind adolescents in Western Nepal.

INTRODUCTION: International migration is increasing rapidly around the world mostly to obtain a job. International migrant workers usually leave their children back in their country of origin, and among family members, adolescents may experience greater psychological distress from parental separation. However, limited evidence is available on the relationship between parental international migration and psychological well-being of left-behind adolescents. Nepal has a relatively higher and increasing number of international migrants, and this study was conducted to examine the association between parental international migration and the psychological well-being of left-behind adolescents in Nepal. METHODS: A school-based cross-sectional study was conducted among 626 adolescents in two districts of Western Nepal, where international migration is common. Adolescents were recruited through random sampling. Pre-tested "Strengths and Difficulties Questionnaire" was used to measure their psychological well-being and simple and multiple linear regression were used to examine the association between parental international migration and the psychological well-being of left-behind adolescents. RESULTS: Adolescents with none of the parents living abroad were more likely to have higher total difficulties score compared to those with one of the parents living abroad (B: 1.02; 95% CI: 0.18, 1.86; p = 0.017). Adolescents with the following factors were more likely to have higher total difficulties score in comparison to their counterparts: adolescents in their late adolescence period, female adolescents, adolescents from ethnicities other than Brahmin and adolescents studying in private schools. CONCLUSION: In rural districts of Nepal, where international migration is common, adolescents living with the parents were more likely to have poorer psychological well-being compared to those with one of the parents living abroad. Adolescents' adaptation mechanism for the absence of parents for international migration might be explored in the future studies.

Factors associated with breast cancer screening intention in Kathmandu Valley, Nepal.

BACKGROUND: Breast cancer burden is increasing in low-income countries (LICs). Increasing incidence and delayed presentation of breast cancer are mainly responsible for this burden. Many women do not participate in breast cancer screening despite its effectiveness. Moreover, studies are limited on the barriers associated with low utilization of breast cancer screening in LICs. This study identified breast cancer screening behavior and factors associated with breast cancer screening intention among women in Kathmandu Valley, Nepal. METHODS: A cross-sectional study was conducted among 500 women living in five municipalities of Kathmandu Valley, Nepal. Data were collected from July to September 2018, using a structured questionnaire. Interviews were conducted among women selected through proportionate random household sampling. This study was conceptualized using the theory of planned behavior, fatalism, perceived susceptibility, and perceived severity. The outcome variables included: the intention to have mammography (MMG) biennially, the intention to have clinical breast examination (CBE) annually, and the intention to perform breast self-examination (BSE) monthly. Analysis was conducted separately for each outcome variable using partial proportional odds model. RESULTS: Out of 500 women, 3.4% had undergone MMG biennially, 7.2% CBE annually, and 14.4% BSE monthly. Women with a positive attitude, high subjective norms, and high perceived behavioral control were more likely to have the intention to undergo all three screening methods. Similarly, women were more likely to have intention to undergo CBE and MMG when they perceived themselves susceptible to breast cancer. Conversely, women were less likely to have intention to undergo CBE when they had high fatalistic beliefs towards breast cancer. CONCLUSION: Women in this study had poor screening behavior. The practice of breast self-examination was comparatively higher than clinical breast examination and mammography. Multidimensional culturally sensitive interventions are needed to enhance screening intentions. Efforts should be directed to improve attitude, family support, and fatalistic belief towards cancer. Furthermore, the proper availability of screening methods should be ensured while encouraging women to screen before the appearance of symptoms.

Seeking connection: a mixed methods study of mental well-being and community volunteerism among international migrants in Japan.

BACKGROUND: International migration is a stressful process for which non-Western nations are a growing destination. However, little attention has been paid to the psychological well-being of international residents or their local integration in such settings. Prosocial behavior, like volunteering in one's local community, has been demonstrated to improve mental health in native populations. Volunteerism may be a mental health promotion strategy applicable to non-native migrants as well. In order to assess such a hypothesis, this study investigated the mental well-being of international migrants living in Tokyo, Japan, who did or did not participate in formal volunteering. METHODS: This convergent mixed-methods study assessed mental well-being with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and qualitative follow-up interviews. Migrants who contributed their time to structured volunteering roles (formal volunteers, n = 150) were recruited from local non-profit organizations. Migrants who did not formally volunteer (n = 150) were recruited from social media sites. In parallel, a nested participant sample from both groups (n = 20) were interviewed about their satisfaction with life in Tokyo. RESULTS: After adjusting for sociodemographic characteristics, volunteering was not associated with higher mental well-being score (p = 0.215), but instead, not feeling isolated (p = 0.008), feeling connected to Japan (p = 0.001) and employment satisfaction (p < 0.001) were significantly associated with mental well-being. Follow-up interviews similarly demonstrated that migrants participated in various social activities to promote personal well-being and deeper social connections with Japanese, regardless of volunteering status. CONCLUSIONS: Volunteering status itself was not significantly associated with mental well-being score among international migrants in Japan after adjusting for potential confounding variables. Beyond volunteering, having deeper social connections with the Japanese community is a key to promoting migrant mental well-being.

Positive Deviance for Dual-Method Promotion among Women in Uganda: A Qualitative Study.

Dual-method use is the most reliable form of protection against unintended pregnancies and human immunodeficiency virus/sexually transmitted infections (HIV/STIs). Although dual-method use remains uncommon among women in stable relationships, some women do practice it. In this study, we explored the barriers that make dual-method use rare and the behaviors of women who practice dual-method use using a positive deviance framework in Uganda. We screened 150 women using highly effective contraceptives at five health facilities. We identified nine women who practiced dual-method use and 141 women who did not. In a qualitative study, we conducted in-depth interviews with all nine women practicing dual-method use and 10 women randomly selected out of the 141 who did not. We performed a thematic analysis using the positive deviance framework. Regardless of practicing dual-method use or not, women faced perceived barriers against dual-method use, such as partner's objection, distrust, shyness about introducing condoms into marital relationships, and limited access to condoms. However, women practicing dual-method use had higher levels of risk perception about unintended pregnancies and HIV/STIs. They also engaged in unique behaviors, such as influencing their partners' condom use by initiating discussions, educating their partners on sexual risks and condom use, and obtaining condoms by themselves. These findings will be useful in developing effective community-led and peer-based interventions promoting dual-method use to reduce the dual burden of unintended pregnancies and HIV/STIs among women in Uganda.

Positive deviance for dual-method promotion among women in Uganda: study protocol for a cluster randomized controlled trial.

BACKGROUND: Dual-method use is known as the most reliable protection against unintended pregnancies and sexually transmitted infections, including HIV. However, it is not commonly used in sub-Sharan Africa, especially among women using highly effective contraceptives. This article describes a protocol to evaluate the effect of an intervention formulated under the positive deviance approach for promoting dual-method use in Uganda. METHODS: A total of 150 women will be interviewed using a structured questionnaire to find those practicing dual-method use. In-depth interviews will then be conducted with all women using the dual method and 10 women using only highly effective contraceptives to identify their unique practice. Then, a cluster randomized controlled trial will be conducted to examine the effect of an intervention formulated under the positive deviance approach on dual-method uptake and adherence. Twenty health facilities will be randomized to an intervention or control arm and 480 women will be enrolled in each group. The participants will be followed up for 8 months. DISCUSSION: This trial focuses on women who already adapted dual-method use and identifies their unique solutions to promote dual-method use. This trial could tackle barriers for dual-method use, which expert outsiders may fail to recognize, by analyzing and promulgating their unique behaviors. This study could provide evidence that the positive deviance approach can address unintended pregnancies and sexually transmitted infections as well as other health problems which usual approaches have failed to address. TRIAL REGISTRATION: UMIN-CTR Clinical Trial, UMIN000037065. Registered on 14 June 2019.