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      Urban young women's preferences for intervention strategies to promote physical and mental health preconception: A Healthy Life Trajectories Initiative (HeLTI)

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          Abstract

          This study aimed to qualitatively investigate young women's preferences for preconception intervention strategies to promote physical and mental health in a rapidly transitioning, urban setting. Four semi-structured focus group discussions were conducted with young women (n = 29, 18–24 years old) from Soweto, South Africa. Qualitative data were thematically analysed. Two main themes were identified: 1) challenges and needs of intervention beneficiaries; and 2) preferences for intervention strategies (content and delivery). The challenges participants mentioned could be classified as those relating to social pressure, identity, and socioeconomic circumstances. Mental health support appeared to be a greater need than physical health, and this featured in their preferences for intervention content, although a number of physical health topics were also mentioned (healthy eating and contraception). Participants had mixed preferences for intervention materials, ranging from printed to electronic and mobile resources. Their preferences for intervention activities ranged from educational sessions, to fun and interactive practical activities, and activities they could take home. Community health workers (CHWs) were the preferred agent of delivery for interventions, though participants emphasised the importance of CHWs having appropriate interpersonal skills and own life experience. Some women preferred one-on-one sessions with a CHW, while others preferred group sessions. While recognising the value of family sessions, young women were less enthusiastic about this approach. These findings provide valuable formative data for developing effective interventions to optimise young women's preconception health in urban Africa. These contextual realities should be acknowledged when addressing key physical and mental health issues facing young women.

          Highlights

          • Social pressure is a major challenge for young women in urban South Africa.

          • Mental health should be a key feature of preconception interventions.

          • Community health workers are the preferred agent of delivery in this context.

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          Most cited references19

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          Social and emotional support and its implication for health.

          Recent research findings from selected publications focusing on links between social support and physical health are summarized. Current research is extending our understanding of the influences of social support on health. Many epidemiological studies have concentrated on further linking measures of social support to physical health outcomes. A few studies are now moving into newer areas, such as emphasizing health links with support receipt and provision. Researchers are also interested in outlining relevant pathways, including potential biological (i.e. inflammation) and behavioral (i.e. health behaviors) mechanisms. Interventions attempting to apply basic research on the positive effects of social support are also widespread. Although the longer term effects of such interventions on physical health remain to be determined, such interventions show promise in influencing the quality of life in many chronic disease populations. Recent findings often show a robust relationship in which social and emotional support from others can be protective for health. The next generation of studies must explain, however, why this relationship exists and the specificity of such links. This research is in its infancy but will be crucial in order to better tailor support interventions that can impact on physical health outcomes.
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            Intervention strategies to improve nutrition and health behaviours before conception

            The nutritional status of women and men before conception has profound implications for the growth, development and long-term health of their offspring. Evidence of the effectiveness of preconception interventions in improving outcomes for mothers or babies is scarce, though given the large potential health return, relatively low costs and risk of harm, intervention is still warranted. We identify three promising strategies for intervention that are likely to be scalable and to have positive effects on a range of health outcomes: supplementation and fortification; cash transfers; and behaviour change interventions. Based on this, we suggest a model specifying pathways to effect. Pathways are incorporated into a lifecourse framework using individual motivation and receptiveness at different ‘preconception action phases’ to guide design and targeting of preconception interventions. Interventions with those not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women’s nutritional status and health behaviours at all preconception action phases need to take account of social and environmental determinants to avoid exacerbating health and gender inequalities, and should be underpinned by a social movement that touches the whole population. A dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly, is proposed. The engagement of modern marketing techniques points to a social movement based on an emotional and symbolic connection between improved maternal nutrition and health prior to conception and offspring health. We suggest that speedy and scalable public health benefit might be achieved through strategic engagement with the private sector. Political theory supports the development of an advocacy coalition of groups interested in preconception health, to harness the political will and leadership necessary to turn high-level policy into effective co-ordinated action.
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              Diet and mortality rates in Sub-Saharan Africa: Stages in the nutrition transition

              Background During the last century we have seen wide-reaching changes in diet, nutritional status and life expectancy. The change in diet and physical activity patterns has become known as the nutrition transition. At any given time, a country or region within a country may be at different stages within this transition. This paper examines a range of nutrition-related indicators for countries in Sub-Saharan Africa (SSA) and attempts to develop a typical model of a country in transition. Methods Based on the availability of data, 40 countries in SSA were selected for analysis. Data were obtained from the World Health Organisation, Demographic and Health Surveys and the Food and Agriculture Organisation of the United Nations. Multiple linear regression analysis (MLRA) was used to explore the determinants of infant mortality. A six point score was developed to identify each country's stage in the nutrition transition. Results MLRA showed that underweight-for-age, protein and the percentage of exclusively breastfed infants were associated with the infant mortality rate (IMR). The majority of countries (n = 26) used in the analysis had nutrition transition scores of zero and one. Most of them had a high prevalence of infant mortality, children that were stunted or underweight-for-age, small percentages of women that were overweight and obese, and low intakes of energy, protein, and fat. Countries with the highest scores include South Africa, Ghana, Gabon, Cape Verde and Senegal which had relatively low IMRs, high levels of obesity/overweight, and low levels of underweight in women, as well as high intakes of energy and fat. These countries display classic signs of a population well established in the nutrition-related non-communicable disease phase of the nutrition transition. Conclusions Countries in SSA are clearly undergoing a nutrition transition. More than half of them are still in the early stage, while a few have reached a point where changes in dietary patterns are affecting health outcomes in a large portion of the population. Those in the early stage of the transition are especially important, since primordial prevention can still be introduced.
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                Author and article information

                Contributors
                Journal
                Prev Med Rep
                Prev Med Rep
                Preventive Medicine Reports
                Elsevier
                2211-3355
                15 March 2019
                June 2019
                15 March 2019
                : 14
                : 100846
                Affiliations
                [a ]South African Medical Research Council Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
                [b ]Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Department of Obstetrics and Gynecology, Department of Physiology and Medicine, University of Toronto, Toronto, ON, Canada
                Author notes
                [* ]Corresponding author at: MRC/Wits Developmental Pathways for Health Research Unit, Chris Hani Baragwanath Hospital, 26 Chris Hani Road, Soweto, 1864 Johannesburg, South Africa. catherine.draper@ 123456wits.ac.za
                Article
                S2211-3355(18)30241-9 100846
                10.1016/j.pmedr.2019.100846
                6458479
                31008026
                afd8a5fd-0a3e-4d8e-b6ce-13cf4358b648
                © 2019 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 15 October 2018
                : 24 February 2019
                : 14 March 2019
                Categories
                Regular Article

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