Fierce Autonomy: How Girls and Young Women Impacted by Commercial Sexual Exploitation Perceive Health and Exercise Agency in Health Care Decision-Making.
Ontology highlight
ABSTRACT:
SUBMITTER: Godoy SM
PROVIDER: S-EPMC8262511 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:OBJECTIVE: To use the natural experiment created by the Medicare interim payment system (IPS) to study supply change behavior of home health agencies (HHAs) in local market areas. DATA SOURCES: One hundred percent Medicare home health claims for 1996 and 1999, linked with Medicare Provider of Service and Denominator files, and the Area Resource File. STUDY DESIGN: Medicare home health care (HHC) claims data were used to distinguish HHAs that changed the local market supply of Medicare HHC by their market exit or by significant expansion or contraction of their geographic service area between 1996 and 1999 from other HHAs. Multinomial logit models were estimated to analyze how characteristics of agencies and the market areas in which they served were associated with these different agency-level supply changes. PRINCIPAL FINDINGS: Changes in local HHA supply stemming from geographic service area expansions and contractions rivaled those owing to agency closures and market entries. Agencies at greater risk of closure and service area contraction tended to be smaller, newer, freestanding agencies, operating with more visit-intensive practice styles in markets with more competitor agencies. Except for having much less visit-intensive practice styles, similar attributes characterized agencies that increased local supply through service area expansion. CONCLUSIONS: Supply changes by HHAs largely reflected rational market responses by agencies to significant changes in financial incentives associated with the Medicare IPS. Recently certified agencies were among the most dynamic providers. Supply changes were more likely among agencies operating in more competitive market environments.
| S-EPMC1955289 | biostudies-other
Project description:ObjectivesThe aim of this study was to determine the association between women's decision-making power and utilisation of maternal healthcare services (MHS) among Bangladeshi women.SettingsThis is a nationally representative survey that encompassed Dhaka, Rajshahi, Rangpur, Chittagong, Khulna, Barisal and Sylhet in Bangladesh. Sample households were selected by a two-stage stratification technique. First, 207 clusters in urban areas and 393 in rural areas were selected for 600 enumeration areas with proportional probability. In the second stage, on average 30 households were selected systematically from the enumeration areas. Finally, 17 989 households were selected for the survey of which 96% were interviewed successfully.ParticipantsCross-sectional data on 4309 non-pregnant women were collected from Bangladesh demographic and health survey 2014. Decision-making status on respondent's own healthcare, large household purchases, having a say on child's healthcare and visiting to family or relatives were included in the analysis.ResultsPrevalence of at least four antenatal attendance, facility delivery and postnatal check-up were respectively 32.6% (95% CI 31.2 to 34), 40.6% (95% CI 39.13 to 42.07) and 66.3% (95% CI 64.89 to 67.71). Compared with women who could make decisions alone, women in the urban areas who had to decide on their healthcare with husband/partner had 20% (95% CI 0.794 to 1.799) higher odds of attending at least four antenatal visits and those in rural areas had 35% (95% CI 0.464 to 0.897) lower odds of attending at least four antenatal visits. Women in urban and rural areas had respectively 43% (95% CI 0.941 to 2.169) and 28% (95% CI 0.928 to 1.751) higher odds of receiving postnatal check-up when their health decisions were made jointly with their husband/partner.ConclusionNeither making decisions alone, nor deciding jointly with husband/partner was always positively associated with the utilisation of all three types of MHS. This study concludes that better spousal cooperation on household and health issues could lead to higher utilisation of MHS services.
| S-EPMC5595179 | biostudies-literature
Project description:Cervical cancer is currently the fourth leading cause of cancer death among women worldwide, with most cases occurring in low- and middle-income countries. Safe, highly effective vaccines against HPV have been on the market since 2006, yet only 6% of girls worldwide have received this life-saving cancer prevention intervention. International organizations, including PATH, Gavi, and the pharmaceutical companies Merck and GlaxoSmithKline, have provided support to eligible low- and middle-income countries to implement national HPV vaccination programs. Still, glaring disparities in the availability of national HPV vaccination programs and the coverage of the primary target population between the global north and south persist. We illustrate worldwide HPV vaccine implementation and coverage using an online data visualization, which is publicly available and can be used to gain unique insights. We also present three emerging solutions to transform future HPV vaccine delivery in low- and middle-income countries: low-cost generics, single-dose vaccination, and co-administration with other adolescent vaccines. By rapidly expanding access to HPV vaccination to girls everywhere, vaccine-type HPV infections can be virtually eliminated. At high vaccination-coverage levels, more than 80%-or approximately 230 000-of the cervical cancer deaths that occur each year can be averted.
| S-EPMC6221992 | biostudies-literature
Project description:PURPOSE:This study investigates the relationship between adolescent girls' agency and social norms regarding early marriage, girls' education, and nutrition in West Hararghe, Ethiopia. METHODS:We conducted a cross-sectional study involving adolescent girls aged between 13 and 17 years in 2016. A two-stage cluster sampling procedure was followed to identify eligible respondents at the household level. A total of 114 clusters in four districts and 30 households from each cluster were randomly selected. Data were collected using a structured and pretested questionnaire. The agency composite score was measured based on 21 previously validated items. Descriptive and injunctive norm composite scores regarding education, marriage, and nutrition were constructed based on context-relevant items. The weighted mean and standard errors were calculated for the agency and social norms composite scores. The relationship between girls' agency and descriptive and injunctive norms were examined using a multivariable linear regression model that accounted for a complex sample survey design. RESULTS:A total of 3,186 adolescent girls participated in this study. The multivariable linear regression analysis revealed that adolescent girls' agency score significantly and favorably associated with education (? = .19, p < .001), marriage (? = .13, p < .01), and nutrition (? = .20, p < .01) descriptive norms after adjusting for individual and household characteristics. Similarly, adolescent girls' agency was significantly and favorably associated with marriage (? = .21, p < .001) injunctive norms; however, positive injunctive norms around education (? = .09, p > .05) and nutrition (? = .12, p > .05) did not have a statistically significant association with girls' agency. The domains of agency scale related to the belief in women's health rights related to contraception use and the belief in women's right to refuse sex showed poor prosocial views. CONCLUSIONS:Favorable descriptive and injunctive norms around marriage were significantly associated with greater adolescent girls' agency, which indicates the need to incorporate interventions that address social norms in efforts aimed to enhance adolescent girls' sexual and reproductive health status. Furthermore, attention should be given to monitor which domain of agency is improved by the interventions.
| S-EPMC6426719 | biostudies-literature
Project description:Synchronous variations in the abundance of geographically distinct marine fish populations are known to occur across spatial scales on the order of 1,000 km and greater. The prevailing assumption is that this large-scale coherent variability is a response to coupled atmosphere-ocean dynamics, commonly represented by climate indexes, such as the Atlantic Multidecadal Oscillation and North Atlantic Oscillation. On the other hand, it has been suggested that exploitation might contribute to this coherent variability. This possibility has been generally ignored or dismissed on the grounds that exploitation is unlikely to operate synchronously at such large spatial scales. Our analysis of adult fishing mortality and spawning stock biomass of 22 North Atlantic cod (Gadus morhua) stocks revealed that both the temporal and spatial scales in fishing mortality and spawning stock biomass were equivalent to those of the climate drivers. From these results, we conclude that greater consideration must be given to the potential of exploitation as a driving force behind broad, coherent variability of heavily exploited fish species.
| S-EPMC4961161 | biostudies-literature
Project description:Conceptual ambiguity in how we define reproductive empowerment has left the field with inconclusive evidence of its relationship to key reproductive outcomes. Our study aimed to develop and test a measure of reproductive decision-making agency, which is a critical component of reproductive empowerment, in a sample of married women from two Nepalese districts. Initial measures were developed based on theory and previous literature. Next, we used cognitive interviewing techniques to explore local meanings of reproductive empowerment and decision making through eight focus group discussions and 24 in-depth interviews. This process resulted in four core questions used to assess decision making across three domains of reproductive behavior: when to have children, whether to use family planning, and which family planning method to use. We combined these questions to develop an overall assessment of decision-making agency. These measures were included in a quantitative survey conducted with 1000 women, split evenly between the two districts. The combined measure of overall reproductive decision-making agency was internally consistent across the three domains examined (Cronbach's alpha?=?0.6416), performed well across a range of validity assessments, including those aimed at assessing construct and criterion validity, and was predictive of a range of reproductive outcomes, particularly those related to feelings of reproductive control. The results suggest that the measures developed here provide insight into the nuances of joint versus sole decision making beyond those provided by standard measures. With better measures of reproductive agency, we can better design interventions for men and women, to meet their reproductive needs.
| S-EPMC6978488 | biostudies-literature
Project description:BackgroundA substantial proportion of adolescent girls in Zambia lack the ability to decide their reproductive future. We examined the role of agency in early and unwanted adolescent childbearing.MethodsUsing latent transition analysis, we characterized a multi-dimensional profile of adolescent agency annually over a four-year period. We investigated the influence of early life access to resources and time-varying predictors (school retention, violence, early marriage and unwanted/mistimed pregnancy and childbearing) on agency profile membership as well as transitions in agency status over time.ResultsFour agency profiles were identified, with differences by age cohort (10-14 years vs. 15-19 years). Three profiles identified in both age cohorts were: Low-moderate agency, Self-assured gender conformers, and High agency. Unique to younger girls was the Gender conscious, low belief in abilities status, while among older girls was the Self-assured selective gender conscious status. While younger girls were likely to transition to the highest agency status over time, high agency membership declined among older girls. Early life resources were associated with augmented agency while exposure to negative events, particularly early marriage, were associated with detraction from high agency status. Girls who expressed high self-efficacy but gender-conforming values were most at risk of early marriage and unwanted/mistimed pregnancy while High agency girls were at comparatively low risk.ConclusionsResults show agency is dynamic but less mutable with increasing age. Early adolescent strategies which address inequitable gender norms and limit early marriage, may guard against losses to agency which contribute to unwanted fertility outcomes.
| S-EPMC8733315 | biostudies-literature
Project description:ObjectiveThe aim of the study was to describe and explore patient agency through resistance in decision-making about cardiovascular preventive drugs in primary care.DesignSix general practitioners from the southeast of Sweden audiorecorded 80 consultations. From these, 28 consultations with proposals from GPs for cardiovascular preventive drug treatments were chosen for theme-oriented discourse analysis.ResultsThe study shows how patients participate in decision-making about cardiovascular preventive drug treatments through resistance in response to treatment proposals. Passive modes of resistance were withheld responses and minimal unmarked acknowledgements. Active modes were to ask questions, contest the address of an inclusive we, present an identity as a non-drugtaker, disclose non-adherence to drug treatments, and to present counterproposals. The active forms were also found in anticipation to treatment proposals from the GPs. Patients and GPs sometimes displayed mutual renouncement of responsibility for decision-making. The decision-making process appeared to expand both beyond a particular phase in the consultations and beyond the single consultation.ConclusionsThe recognition of active and passive resistance from patients as one way of exerting agency may prove valuable when working for patient participation in clinical practice, education and research about patient-doctor communication about cardiovascular preventive medication. We propose particular attentiveness to patient agency through anticipatory resistance, patients' disclosures of non-adherence and presentations of themselves as non-drugtakers. The expansion of the decision-making process beyond single encounters points to the importance of continuity of care. KEY POINTS Guidelines recommend shared decision-making about cardiovascular preventive treatment. We need an understanding of how this is accomplished in actual consultations.This paper describes how patient agency in decision-making is displayed through different forms of resistance to treatment proposals. •The decision-making process expands beyond particular phases in consultations and beyond single encounters, implying the importance of continuity of care. •Attentiveness to patient participation through resistance in treatment negotiations is warranted in clinical practice, research and education about prescribing communication.
| S-EPMC5592349 | biostudies-literature
Project description:The consequences for women "left behind" by virtue of temporary male migration are mixed. On the one hand, concomitant changes in fertility, participation in the labor force, and social norms are often associated with increased independence for women. On the other hand, women left behind can be vulnerable to increased dependency on members of their husbands' family or face limited access to social institutions. These shifts in women's capacity for decision making can have important implications for their health and well-being. Focusing on the state of Kerala in southern India, we examine the conditions under which the remittances that migrants send home have an impact on the health of women left behind. Specifically, we assess the extent to which the timing of remittance sending can support women's autonomy and improve their ability to make autonomous healthcare decisions. We use evidence from migrant households in Kerala, a region deeply engrained in the world labor migration system for more than five decades. Analysis is conducted with data from the 2016 wave of the Kerala Migration Survey (KMS), a representative household survey, and paired with in-depth qualitative interviews with women in Kerala whose husbands and other family members have migrated to the Gulf. We show that the positive effect of remittances on women's autonomy manifests primarily through the timing of remittance receipt, not the amount of money remitted. Regular remittances are associated with higher levels of autonomy than remittances received at irregular intervals, net of amount remitted. This finding challenges the usual emphasis on remittance volume as the driving factor of social and behavioral change in sending communities. Analytical efforts should be refocused on the social-interactional component of remittance sending and how these interactions can impact women's health and autonomy.
| S-EPMC6978472 | biostudies-literature
Project description:Involvement of dopamine in regulating exploration during decision-making has long been hypothesized, but direct causal evidence in humans is still lacking. Here, we use a combination of computational modeling, pharmacological intervention and functional magnetic resonance imaging to address this issue. Thirty-one healthy male participants performed a restless four-armed bandit task in a within-subjects design under three drug conditions: 150 mg of the dopamine precursor L-dopa, 2 mg of the D2 receptor antagonist haloperidol, and placebo. Choices were best explained by an extension of an established Bayesian learning model accounting for perseveration, directed exploration and random exploration. Modeling revealed attenuated directed exploration under L-dopa, while neural signatures of exploration, exploitation and prediction error were unaffected. Instead, L-dopa attenuated neural representations of overall uncertainty in insula and dorsal anterior cingulate cortex. Our results highlight the computational role of these regions in exploration and suggest that dopamine modulates how this circuit tracks accumulating uncertainty during decision-making.
| S-EPMC7266623 | biostudies-literature