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Social capital insights from Healthy Settings needs assessment in Malawi.

ABSTRACT: Despite global health improvements, substantial challenges in social determinants of health and poverty remain in rural communities in low-income countries. Public health theorists suggest that communities with high social capital are less vulnerable to such challenges and more likely to participate in community development. This research examines levels of social capital amongst rural communities in southern Malawi through data gathered as part of a participatory needs assessment for a Healthy Settings project, and discusses the potential benefits of having access to such data before project implementation. Social capital data was collected during 108 focus group discussions in 18 communities (split by gender, age, status) by adapting an existing mixed methods measurement tool, the Schutte tool. Five indicators were measured: sense of belonging, friendship, reliance, ability to work together and influence. Mean results showed all 18 communities had medium-high levels of social capital. Means from each group in the 18 communities highlighted the lowest social capital among the youth groups and the highest with the leaders. A more detailed breakdown highlighted that all groups had a strong sense of belonging to the community, while youth and women had lower social capital levels in terms of influence over local decisions and ability to rely on other community members. Incorporating social capital tools into community health needs assessments in low-income settings provides a valuable overview of community dynamics before project implementation, and Monitoring & Evaluation indicators which allow changes in social capital to be measured at different stages of the project.

SUBMITTER: Rippon S

PROVIDER: S-EPMC6195280 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Social capital insights from Healthy Settings needs assessment in Malawi.

Rippon Sarah S Beattie Tara K TK Lungu Kingsley K Kumwenda Save S Morse Tracy T

PloS one 20181019 10

Despite global health improvements, substantial challenges in social determinants of health and poverty remain in rural communities in low-income countries. Public health theorists suggest that communities with high social capital are less vulnerable to such challenges and more likely to participate in community development. This research examines levels of social capital amongst rural communities in southern Malawi through data gathered as part of a participatory needs assessment for a Healthy ...[more]

PMID: 30339678

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Project description:ObjectivesChildcare practices determine the child nutritional outcomes, but resources for good practices are unequally distributed across socioeconomic status (SES). This study first examined the associations between social capital and childcare practices separately across SES groups. It then investigated the mediation effect of social capital between SES and childcare practices.DesignThis cross-sectional study used the Short Version of the Adapted Social Capital Assessment Tool to measure structural social capital (group membership, social support and citizenship activities) and cognitive social capital of mothers. Data were analysed using multilevel logistic regressions with random intercepts and mediation modellings.SettingRural Lilongwe, Malawi.ParticipantsA total of 320 mothers with a child aged between 12 months and 23 months.Primary outcome measuresChildcare practice outcomes included were minimum dietary diversity, handwashing and complete vaccination.ResultsAmong structural social capital dimensions, social support was found to be positively associated with minimum dietary diversity (adjusted OR (AOR)=1.44, 95% CI 1.22 to 1.71; p<0.001) and handwashing for all mothers (AOR=1.42, 95% CI 1.23 to 1.64; p<0.001). In the subgroup analysis, the higher SES group had higher odds of meeting the minimum dietary diversity (AOR=1.63, 95% CI 1.18 to 2.26; p=0.01) and handwashing with increased social support (AOR=1.53, 95% CI 1.13 to 2.08; p=0.01) than the lower SES. The mediation effect of social support accounted for 27.3% of the total effect between SES and minimum dietary diversity. Cognitive social capital was negatively associated with vaccination for the lower SES group (AOR=0.07, 95% CI 0.01 to 0.68; p=0.03).ConclusionsTo improve feeding and handwashing practices and to reduce health inequalities in rural Malawi, governments and organisations should consider promoting the value of social support and health. Future research is needed to explain the negative association between cognitive social capital and vaccination among the lower SES group.

Project description:BackgroundDespite significant progress in the field of implementation science (IS), current training programs are inadequate to meet the global need, especially in low-and middle-income countries (LMICs). Even when training opportunities exist, there is a "knowledge-practice gap," where implementation research findings are not useful to practitioners in a field designed to bridge that gap. This is a critical challenge in LMICs where complex public health issues must be addressed. This paper describes results from a formal assessment of learning needs, priority topics, and delivery methods for LMIC stakeholders.MethodsWe first reviewed a sample of articles published recently in Implementation Science to identify IS stakeholders and assigned labels and definitions for groups with similar roles. We then employed a multi-step sampling approach and a random sampling strategy to recruit participants (n = 39) for a semi-structured interview that lasted 30-60 min. Stakeholders with inputs critical to developing training curricula were prioritized and selected for interviews. We created memos from audio-recorded interviews and used a deductively created codebook to conduct thematic analysis. We calculated kappa coefficients for each memo and used validation techniques to establish rigor including incorporating feedback from reviewers and member checking.ResultsParticipants included program managers, researchers, and physicians working in over 20 countries, primarily LMICs. The majority had over 10 years of implementation experience but fewer than 5 years of IS experience. Three main themes emerged from the data, pertaining to past experience with IS, future IS training needs, and contextual issues. Most respondents (even with formal training) described their IS knowledge as basic or minimal. Preferences for future training were heterogeneous, but findings suggest that curricula must encompass a broader set of competencies than just IS, include mentorship/apprenticeship, and center the LMIC context.ConclusionWhile this work is the first systematic assessment of IS learning needs among LMIC stakeholders, findings reflect existing research in that current training opportunities may not meet the demand, trainings are too narrowly focused to meet the heterogeneous needs of stakeholders, and there is a need for a broader set of competencies that moves beyond only IS. Our research also demonstrates the timely and unique needs of developing appropriately scoped, accessible training and mentorship support within LMIC settings. Therefore, we propose the novel approach of intelligent swarming as a solution to help build IS capacity in LMICs through the lens of sustainability and equity.

Project description:BackgroundChildren with medical complexity (CMC) have inter-related health and social needs; however, interventions to identify and respond to social needs have not been adapted for CMC. The objective of this study was to evaluate the feasibility of implementing social needs screening and assessment within pediatric complex care programs.MethodsWe implemented systematic social needs assessment for CMC (SSNAC) at two tertiary care centers in three phases: (1) pre-implementation, (2) implementation, and (3) implementation monitoring. We utilized a multifaceted implementation package consisting of discrete implementation strategies within each phase. In phase 1, we adapted questions from evidence-informed screening tools into a 21-item SSNAC questionnaire, and we used published frameworks to inform implementation readiness and process. In phases 2-3, clinical staff deployed the SSNAC questionnaire to parents of CMC in-person or by phone as part of usual care and adapted to local clinical workflows. Staff used shared decision-making with parents and addressed identified needs by providing information about available resources, offering direct assistance, and making referrals to community agencies. Implementation outcomes included fidelity, feasibility, acceptability, and appropriateness.ResultsObservations from clinical staff characterized fidelity to use of the SSNAC questionnaire, assessment template, and shared decision-making for follow-up on unmet social needs. Levels of agreement (5-point Likert scale; 1 = completely disagree; 5 = completely agree) rated by staff for key implementation outcomes were moderate to high for acceptability (mean = 4.7; range = 3-5), feasibility (mean = 4.2; range = 3-5), and appropriateness (mean = 4.6; range = 4-5). 49 SSNAC questionnaires were completed with a 91% response rate. Among participating parents, 37 (76%) reported ≥ 1 social need, including food/nutrition benefits (41%), housing (18%), and caregiver needs (29%). Staff responses included information provision (41%), direct assistance (30%), and agency referral (30%).ConclusionsIt was feasible for tertiary care center-based pediatric complex care programs to implement a standardized social needs assessment for CMC to identify and address parent-reported unmet social needs.

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Social capital insights from Healthy Settings needs assessment in Malawi.

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Social capital insights from Healthy Settings needs assessment in Malawi.

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