Painting the Way Forward: An Ecological Cultural Visual Analysis of Anti-VAW Public Art in Rural Ecuador.

Despite efforts within Ecuador to combat violence against women (VAW), the country still claims some of the highest rates of violence in the Americas. In this study, we complete a cultural visual analysis of anti-VAW public art in a small Ecuadorian city. Visual data is examined and interpreted by way of the social-ecological model (SEM). Specifically, our analysis considers how murals engage with the depiction of (a) VAW, (b) agentic responses to VAW, and (c) the different layers of the SEM. Our analysis identifies four specific strategies for constructing public art messaging to help achieve freedom from VAW.

Prevention of exposure to zoonoses in rural Latin America: Social ecological factors in a diverse regional context.

Zoonotic diseases have serious impacts on human health and well-being, but they are often overlooked in rural Latin America. The design of effective preventive interventions is complex and requires an integrative approach from evidence-based information analyzed through robust theoretical frameworks. We conducted a systematized literature review and qualitative framework-guided thematic analysis to identify social ecological factors affecting the prevention and exposure to zoonotic diseases. Although resources for research are limited in Latin America, we found several studies with relevant results. We extracted and interpreted 8 themes as factors affecting the prevention, transmission, and exposure to zoonosis. These themes included knowledge and misconceptions, low risk perception, gaps in knowledge and communication, psychological effect of diseases, culture and traditions, inequality, disarticulated prevention programs, and organizational responsibility. Alongside this, we compiled and present the recommendations for actions to reduce the impact of zoonoses in these populations. The factors and recommendations here presented can be adapted to inform the design and improvement of preventive programs, focused on One Health and aiming to reduce the impact of zoonotic diseases in rural settings.

Barriers and facilitators for colorectal cancer screening in a low-income urban community in Mexico City.

BACKGROUND: Colorectal cancer (CRC) incidence and mortality are increasing in many low- and middle-income countries (LMICs), possibly due to a combination of changing lifestyles and improved healthcare infrastructure to facilitate diagnosis. Unfortunately, a large proportion of CRC cases in these countries remain undiagnosed or are diagnosed at advanced stages, resulting in poor outcomes. Decreasing mortality trends in HICs are likely due to evidence-based screening and treatment approaches that are not widely available in LMICs. Formative research to identify emerging opportunities to implement appropriate screening and treatment programs in LMICs is, therefore, of growing importance. We sought to identify potential barriers and facilitators for future implementation of fecal immunochemical test (FIT)-based CRC screening in a public healthcare system in a middle-income country with increasing CRC incidence and mortality. METHODS: We performed a qualitative study with semi-structured individual and focus group interviews with different CRC screening stakeholders, including 30 lay people at average risk for CRC, 13 health care personnel from a local public clinic, and 7 endoscopy personnel from a cancer referral hospital. All interviews were transcribed verbatim for analysis. Data were analyzed using the constant comparison method, under the theoretical perspectives of the social ecological model (SEM), the PRECEDE-PROCEED model, and the health belief model. RESULTS: We identified barriers and facilitators for implementation of a FIT-based CRC screening program at several levels of the SEM. The main barriers in each of the SEM levels were as follows: (1) at the social context level: poverty, health literacy and lay beliefs related to gender, cancer, allopathic medicine, and religion; (2) at the health services organization level: a lack of CRC knowledge among health care personnel and the community perception of poor quality of health care; and (3) at the individual level: a lack of CRC awareness and therefore lack of risk perception, together with fear of participating in screening activities and finding out about a serious disease. The main facilitators perceived by the participants were CRC screening information and the free provision of screening tests. CONCLUSIONS: This study's findings suggest that multi-level CRC screening programs in middle-income countries such as Mexico should incorporate complementary strategies to address barriers and facilitators, such as (1) provision of free screening tests, (2) education of primary healthcare personnel, and (3) promotion of non-fear-based CRC screening messages to the target population, tailored to address common lay beliefs.

Socioecological determinants of community resource utilisation among low-income women in Mexico City who experienced male-to-female intimate partner violence.

Women who experience intimate partner violence (IPV) face multiple barriers to seeking help from community resources, but little research has examined the impact of ecological influences on community resource utilisation among women living in low- and middle-income countries. The current study investigated individual-, relationship-, family-, and community-level influences on community resource utilisation among Mexican women experiencing IPV. Using baseline data from 950 women in Mexico City enrolled in a clinic-based randomised controlled trial, multilevel regressions were performed to assess associations between socioecological factors and women's community resource utilisation. 41.3% women used at least one resource. At the individual-level, every additional resource that women were aware of, was associated with a 20% increase in the total number of resources used (p < .001). Every additional lethal risk factor was associated with a 5% increase in the total number of resources used (p = .004). At the family-level, women who reported having an in-law encourage IPV used 46% more resources (p < .001). At the community-level, stronger supportive norms around community resource utilisation was associated with a 6% increase in the total number of resources (p = .01). These findings suggest the importance of addressing family and community factors in the broader ecological context of Mexican women's help-seeking behaviours.

Gender differences in theory-based predictors of physical activity in university students with disabilities / Diferencias de género en predictores teóricos de la actividad física en alumnado universitario con discapacidad

Abstract University students with disabilities engage in physical activity to a lesser extent than their able-bodied peers, with women reporting less physical activity than men. The present study aimed to examine gender differences in theory-based predictors of physical activity in this population. Spanish university students with different disabilities (n = 1076) completed measures of the Theory of Planned Behaviour constructs and the reduced Spanish version of the Barriers to Physical Activity Questionnaire for People with Mobility Impairments. Self-efficacy and controllability were significantly lower in women and gender differences on the barriers predicting controllability were obtained. In conclusion, the present results could be useful in order to implement physical activity behaviour change interventions which differently target men and women with disabilities.

Resumen El alumnado universitario con discapacidad participa en actividad física en menor medida que el alumnado sin discapacidad, reportando las mujeres menor actividad física que los hombres. Este artículo tuvo por objetivo examinar las diferencias de género en predictores teóricos de la actividad física en esta población. Una muestra de alumnado universitario con diferentes discapacidades (n = 1076) completó medidas de los constructos de la teoría de la conducta planeada y la versión reducida en español del instrumento Barriers to Physical Activity Questionnaire for People with Mobility Impairments. La autoeficacia y la controlabilidad fueron significativamente menores en las mujeres y se encontraron diferencias de género en las barreras que predijeron la controlabilidad. En conclusión, los presentes resultados pueden ser útiles para desarrollar intervenciones de cambio de comportamiento en la actividad física que aborden de forma diferente a los hombres y las mujeres con discapacidad.

Micronutrient powder use in Arequipa, Peru: Barriers and enablers across multiple levels.

In Peru, nearly half of children aged 6-36 months were diagnosed with anaemia in 2017. To address this disease, the Peruvian Ministry of Health implemented a national programme in 2014, distributing free micronutrient powders (MNPs) to all children of this age. However, rates of childhood anaemia remain high. The aim of this study was to explore factors at all levels of the Social-Ecological Model that affect MNP use and adherence in Arequipa, an Andean city with childhood anaemia rates higher than the national average. We conducted in-depth interviews with 20 health personnel and 24 caregivers and 12 focus group discussions with 105 caregivers. We identified numerous barriers, including negative side effects (constipation, vomiting, and diarrhoea), poor taste of MNP, lack of familial and peer support for its use, insufficient informational resources provided by the health system, and limited human resources that constricted health personnel abilities to implement MNP programming successfully. Facilitators identified included concern about the long-term effects of anaemia, support from organizations external to the health system, well-coordinated care within the health system, and provision of resources by the Ministry of Health. We found that community or organizational and societal factors were key to limited MNP use and adherence, specifically the limited time health personnel have to address caregivers' doubts during appointments and the lack of informational resources outside of these appointments. Potential policy implications could be to increase informational resources available outside of individualized counselling by strengthening existing collaborations with community organizations, increasing media coverage, and providing group counselling.

[Validation of a short Spanish version of the instrument Barriers to Physical Activity Questionnaire for People with Mobility Impairments.] / Validación de una versión reducida en español del instrumento Barriers to Physical Activity Questionnaire for People with Mobility Impairments.

OBJECTIVE: To validate a short Spanish version of the instrument Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI), applicable to different types of disability. MATERIALS AND METHODS: The questionnaire was administered to 791 university students with disabilities. The factorial structure was validated by confirmatory factor analysis and Spearman correlations were carried out to assess criterion validity. Reliability was assessed using Cronbach's alpha coefficient. RESULTS: The proposed model showed good adjustment indexes and an excellent internal consistency (α= 0.920). Negative relationships emerged between the experienced barriers and time spent in physical activity. CONCLUSIONS: The short Spanish version of the BPAQ-MI proves to be a valid and reliable instrument to identify, from a socio-ecological perspective, the barriers to physical activity experienced by students with disabilities. The results provide valuable information to develop programs to promote physical activity in this group.

OBJETIVO: Validar una versión reducida en español del instrumento Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI), aplicable a diferentes tipos de discapacidad. MATERIAL Y MÉTODOS: El cuestionario fue aplicado a 791 universitarios con discapacidad. La estructura factorial se validó mediante un análisis factorial confirmatorio y, para valorar la validez criterial, se llevaron a cabo correlaciones de Spearman. La fiabilidad se evaluó mediante el coeficiente alfa de Cronbach. RESULTADOS: El modelo propuesto reveló buenos índices de ajuste y una excelente consistencia interna (α=0.920). Surgieron relaciones negativas entre las barreras experimentadas y el tiempo de actividad física. CONCLUSIONES: La versión reducida y en español del BPAQ-MI resulta un instrumento válido y fiable para identificar, desde un enfoque socioecológico, las barreras que los estudiantes con discapacidad experimentan para realizar actividad física. Los resultados aportan información valiosa para desarrollar programas de promoción de la actividad física en este colectivo.

Validación de una versión reducida en español del instrumento Barriers to Physical Activity Questionnaire for People with Mobility Impairments / Validation of a short Spanish versión of the instrument Barriers to Physical Activity Questionnaire for People with Mobility Impairments

Resumen: Objetivo: Validar una versión reducida en español del instrumento Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI), aplicable a diferentes tipos de discapacidad. Material y métodos: El cuestionario fue aplicado a 791 universitarios con discapacidad. La estructura factorial se validó mediante un análisis factorial confirmatorio y, para valorar la validez criterial, se llevaron a cabo correlaciones de Spearman. La fiabilidad se evaluó mediante el coeficiente alfa de Cronbach. Resultados: El modelo propuesto reveló buenos índices de ajuste y una excelente consistencia interna (α=0.920). Surgieron relaciones negativas entre las barreras experimentadas y el tiempo de actividad física. Conclusiones: La versión reducida y en español del BPAQ-MI resulta un instrumento válido y fiable para identificar, desde un enfoque socioecológico, las barreras que los estudiantes con discapacidad experimentan para realizar actividad física. Los resultados aportan información valiosa para desarrollar programas de promoción de la actividad física en este colectivo.

Abstract: Objective: To validate a short Spanish version of the instrument Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI), applicable to different types of disability. Materials and methods: The questionnaire was administered to 791 university students with disabilities. The factorial structure was validated by confirmatory factor analysis and Spearman correlations were carried out to assess criterion validity. Reliability was assessed using Cronbach's alpha coefficient. Results: The proposed model showed good adjustment indexes and an excellent internal consistency (α= 0.920). Negative relationships emerged between the experienced barriers and time spent in physical activity. Conclusions: The short Spanish version of the BPAQ-MI proves to be a valid and reliable instrument to identify, from a socio-ecological perspective, the barriers to physical activity experienced by students with disabilities. The results provide valuable information to develop programs to promote physical activity in this group.

Passengers at risk: a multi-level analysis of the decision to travel with a drunk driver.

AIMS: To assess the impact of demographic, intrapersonal and environmental factors on the likelihood in Chile of becoming a passenger of an alcohol-impaired driver (PAID). DESIGN: Multi-level cross-sectional study. SETTING: Data were acquired from two large-scale household surveys of representative samples of Chile's Metropolitan Region. PARTICIPANTS: The study included 1341 individuals ≥ 16 years; 696 of them reported engaging in PAID. MEASUREMENT: The primary outcome was self-reported frequencies of having accepted a ride with an alcohol-impaired driver. FINDINGS: PAID was associated significantly with 'age' [odds ratio (OR) = 0.99, 95% confidence interval (CI) = 0.98-0.99, P = 0.03], 'traffic safety beliefs' (OR = 0.17, 95% CI = 0.078-0.44, P = 0.00), 'time exposure as passenger' (OR = 1.00, 95% CI = 1.00-1.01, P = 0.00) and 'sex' (OR = 0.67, 95% CI = 0.53-0.87, P = 0.00). In women, PAID was associated with 'age' (OR = 0.98, 95% CI = 0.97-0.99, P = 0.02), 'traffic safety beliefs' (OR = 0.17, 95% CI = 0.05-0.59, P = 0.00) and 'low quality of public bus stops' (OR = 0.97, 95% CI = 0.98-0.99, P = 0.01). Younger women with high education levels were more likely to engage in PAID than younger women with low education levels. In men, PAID was associated with 'traffic safety beliefs' (OR = 0.13, 95% CI = 0.02-0.63, P = 0.01) and 'time exposure as passenger' (OR = 1.00, 95% CI = 1.00-1.01, P = 0.02). CONCLUSIONS: In Chile, men are at higher risk of becoming a passenger of an alcohol-impaired driver (PAID) than women. In women, PAID appears to be associated with lower traffic safety beliefs, lower quality of public bus stations and an interaction between education and age. In men, PAID is associated with lower traffic safety beliefs and higher time exposure as passenger.

Brazilian Immigrant Mothers' Beliefs and Practices Related to Infant Feeding: A Qualitative Study.

BACKGROUND: Exclusive breastfeeding for the first 6 months of life and timely introduction of appropriate solid foods are important determinants of weight status in infancy and later life stages. Disparities in obesity rates among young children suggest that maternal feeding practices during the first 2 years of life may contribute to these disparities. Brazilians are a growing immigrant group in the United States, yet little research has focused on parental beliefs and behaviors affecting the health of Brazilian immigrant children in the United States. Research aim: This study aimed to explore beliefs and infant-feeding practices of Brazilian immigrant mothers in the United States. METHODS: Focus group discussions were conducted with Brazilian immigrant mothers. Transcripts were analyzed using thematic analysis and themes categorized using the socioecological model. RESULTS: Twenty-nine immigrant Brazilian mothers participated in the study. Analyses revealed that all participants breastfed their infants. The majority initiated breastfeeding soon after childbirth. However, most mothers did not exclusively breastfeed. They used formula and human milk concomitantly. Family and culture influenced mothers' infant-feeding beliefs and practices in early introduction of solid foods. CONCLUSION: As the number of children in the United States growing up in families of immigrant parents increases, understanding influences on Brazilian immigrant mothers' infant-feeding practices will be important to the development of effective interventions to promote healthy infant feeding and weight status among Brazilian children. Interventions designed for Brazilian immigrant families should incorporate an understanding of social context, family, and cultural factors to develop health promotion messages tailored to the needs of this ethnic group.

Personal, social and environmental correlates of physical activity in adults from Curitiba, Brazil.

BACKGROUND: Leisure-time physical activity is a complex behavior influenced by factors at multiple levels. OBJECTIVE: To examine the associations between intrapersonal, interpersonal, environmental factors and leisure-time walking (LTW) and leisure-time physical activities (LTPA), excluding walking. We also examined the moderating effect of sociodemographic characteristics on these associations. METHODS: A cross-sectional study was conducted with 1461 adults from Curitiba, Brazil (63.7% women). LTW and LTPA were assessed through the International Physical Activity Questionnaire (IPAQ), and a cutoff point of ≥ 150 min/week was used. Associations were examined through multilevel logistic regressions. RESULTS: LTW was positively associated with self-efficacy, enjoyment, social support from family and friends, presence of public places for leisure and neighborhood esthetics. LTPA was associated with self-efficacy, enjoyment, social support from family and friends, safety from crime and neighborhood esthetics. Safety from crime was a predictor of LTPA among older adults only. CONCLUSIONS: Factors at multiple levels were associated with LTW and LTPA. Interventions to promote LTPA would likely benefit from considering personal, social and environmental factors and different levels of influence.