Nurse-led projects for people experiencing homelessness and other inclusion health groups: a realist evaluation

Nursing service development or innovation projects, even small-scale ones, can be difficult to deliver and evaluate, due to a lack of resources and support. Results can also be difficult to disseminate, limiting transfer of learning. This paper presents findings from a realist evaluation of 10 small projects supported by the Queen's Nursing Institute Homeless and Inclusion Health Programme to deliver innovation in health care for people experiencing homelessness and other marginalised groups. These nurse-led projects were funded by the Queen's Nursing Institute and the Oak Foundation, and were largely successful in achieving outcomes to support the improved health of people experiencing homelessness and other marginalised groups. This realist evaluation explores the factors that contributed to the delivery of positive outcomes. All were impacted by the context and the response (mechanisms) of people experiencing homelessness and staff within these settings. It is hoped that the lessons learned will enable better support for nurse innovation projects in the future.

Prevalence of blindness and distance vision impairment in the Gambia across three decades of eye health programming

Background/aimsThe 1986 Gambia National Eye Health Survey provided baseline data for a National Eye Health Programme. A second survey in 1996 evaluated changes in population eye health a decade later. We completed a third survey in 2019, to determine the current state of population eye health, considering service developments and demographic change.MethodsWe estimated prevalence and causes of vision impairment (VI) in a nationally representative population-based sample of adults 35 years and older. We used multistage cluster random sampling to sample 10 800 adults 35 and above in 360 clusters of 30. We measured monocular distance visual acuity (uncorrected and with available correction) using Peek Acuity. Participants with either eye uncorrected or presenting (with available correction) acuity <6/12 were retested with pinhole and refraction, and dilated exams were completed on all eyes by ophthalmologists using a direct ophthalmoscope, slit lamp and 90 D lens.ResultsWe examined 9188 participants (response rate 83%). The 2013 census age–sex adjusted prevalence of blindness (presenting acuity<3/60 in better seeing eye) was 1.2% (95% CI 0.9 to 1.4) and of moderate or severe VI (MSVI,<6/18 to ≥3/60) was 8.9% (95% CI 9.1 to 9.7). Prevalence of all distance VI (<6/12) was 13.4% (12.4–14.4). Compared with 1996, the relative risk of blindness decreased (risk ratio 0.7, 95% CI 0.5 to 1.0) and MSVI increased (risk ratio 1.5, 95% CI 1.2 to 0.17).ConclusionSignificant progress has been made to reduce blindness and increase access to eye health across the Gambia, with further work is needed to decrease the risk of MSVI.

Understanding the impacts of humanitarian Menstrual Health Management for women’s confidence and agency: A case study on the Thai/Burma border

<p>Menstrual Health Management (MHM) is a growing focus within global humanitarian and development work. MHM aims to increase women and girls’ ability to care for their menstruating bodies through period products, hygiene facilities and education. It also seeks to challenge wider barriers that women face during menstruation – stigma, shame and ‘period poverty’ (the lack of access to menstrual products). NGOs promote ‘menstrual activism’ campaigns to ‘Reduce the stigma’ and ‘Help women and girls. Period.’ They tell stories of girls who, with their menstrual products, can now attend school during their period. Academic studies into the complexities of such programmes are sparse, however; particularly studies which privilege the experiences of the women involved and affected. Research on menstruation within the humanitarian field is also limited. This is despite the fact that women living in refugee camps and precarious spaces can have heightened difficulties due to scarcity of menstrual resources, disruption of support networks and facilities with inadequate privacy. Contextually and culturally embedded research that recognises the contributions and perspectives of these women can strengthen humanitarian MHM programmes and scholarship so that menstruating women can feel confidence and agency rather than stigma and shame. In light of these gaps, this study investigates Partners Relief & Development’s (Partners) ‘Days for Girls’ menstrual health programme in Thailand. The programme employs migrant women from Burma to make reusable menstrual hygiene kits and donates these kits to women in conflict-affected areas. The research worked within a feminist epistemology and mixed-methods methodology informed by principles of Appreciative Inquiry, to explore what is working well and what could be improved in Partners’ menstrual health programme. It involved refugees and migrants from Myanmar living over the border in Thailand, as well as the programme’s staff. Through thematic analysis, I found that the Days for Girls programme improves women’s agency (through increased community participation) and confidence (through menstrual literacy and menstrual provision). For the women who sew the Days for Girls kits, confidence and agency are also gained through income and skills-education. The strengths and challenges of Partners’ programme reveal the importance of menstrual literacy education, the use of women’s knowledge in NGO work with women, and a whole-of-community response to menstruation needs. The research also informs wider understandings of how MHM discourse and development practice affects menstrual stigma.</p>

Understanding the impacts of humanitarian Menstrual Health Management for women’s confidence and agency: A case study on the Thai/Burma border

<p>Menstrual Health Management (MHM) is a growing focus within global humanitarian and development work. MHM aims to increase women and girls’ ability to care for their menstruating bodies through period products, hygiene facilities and education. It also seeks to challenge wider barriers that women face during menstruation – stigma, shame and ‘period poverty’ (the lack of access to menstrual products). NGOs promote ‘menstrual activism’ campaigns to ‘Reduce the stigma’ and ‘Help women and girls. Period.’ They tell stories of girls who, with their menstrual products, can now attend school during their period. Academic studies into the complexities of such programmes are sparse, however; particularly studies which privilege the experiences of the women involved and affected. Research on menstruation within the humanitarian field is also limited. This is despite the fact that women living in refugee camps and precarious spaces can have heightened difficulties due to scarcity of menstrual resources, disruption of support networks and facilities with inadequate privacy. Contextually and culturally embedded research that recognises the contributions and perspectives of these women can strengthen humanitarian MHM programmes and scholarship so that menstruating women can feel confidence and agency rather than stigma and shame. In light of these gaps, this study investigates Partners Relief & Development’s (Partners) ‘Days for Girls’ menstrual health programme in Thailand. The programme employs migrant women from Burma to make reusable menstrual hygiene kits and donates these kits to women in conflict-affected areas. The research worked within a feminist epistemology and mixed-methods methodology informed by principles of Appreciative Inquiry, to explore what is working well and what could be improved in Partners’ menstrual health programme. It involved refugees and migrants from Myanmar living over the border in Thailand, as well as the programme’s staff. Through thematic analysis, I found that the Days for Girls programme improves women’s agency (through increased community participation) and confidence (through menstrual literacy and menstrual provision). For the women who sew the Days for Girls kits, confidence and agency are also gained through income and skills-education. The strengths and challenges of Partners’ programme reveal the importance of menstrual literacy education, the use of women’s knowledge in NGO work with women, and a whole-of-community response to menstruation needs. The research also informs wider understandings of how MHM discourse and development practice affects menstrual stigma.</p>

Multicentre randomised controlled trial of a group psychological intervention for postnatal depression in British mothers of South Asian origin (ROSHNI-2): study protocol

Background In the UK, postnatal depression is more common in British South Asian women than White Caucasion women. Cognitive–behavioural therapy (CBT) is recommended as a first-line treatment, but there is little evidence for the adaptation of CBT for postnatal depression to ensure its applicability to different ethnic groups. Aims To evaluate the clinical and cost-effectiveness of a CBT-based positive health programme group intervention in British South Asian women with postnatal depression. Method We have designed a multicentre, two-arm, partially nested, randomised controlled trial with 4- and 12-month follow-up, comparing a 12-session group CBT-based intervention (positive health programme) plus treatment as usual with treatment as usual alone, for British South Asian women with postnatal depression. Participants will be recruited from primary care and appropriate community venues in areas of high South Asian density across the UK. It has been estimated that randomising 720 participants (360 into each group) will be sufficient to detect a clinically important difference between a 55% recovery rate in the intervention group and a 40% recovery rate in the treatment-as-usual group. An economic analysis will estimate the cost-effectiveness of the positive health programme. A qualitative process evaluation will explore barriers and enablers to study participation and examine the acceptability and impact of the programme from the perspective of British South Asian women and other key stakeholders.

Impact of Osun Elementary School Feeding and Health Programme (OMEALS) on the Enrolment and Retention of Rural Primary School Pupils in Osun State, Nigeria

School Feeding Programmes are social safety net interventions providing educational and health benefits to vulnerable children in developing countries. This study assessed the impact of Osun Elementary School Feeding and Health Programme (O-MEALS) on the enrolment and retention of rural primary schools in Osun State. Multi stage sampling technique was used to select 188 respondents while data was collected through interview schedule. Percentages, Chi-square, PPMC and T-test were used for data analysis. Findings revealed that over half (51.6%) of the respondents were male, aged 9.38 &plusmn; 1.84 years and majority (83.0%) had a family size of 6-10 people. Food incentives (=1.25), health challenge (=0.69), and peer influence (=0.67) were major factors affecting school attendance. More than half (53.2%) of the respondents had unfavourable perception towards the school feeding programme. Results showed a significant difference between pupils&rsquo; enrolment (t = 5.332, p = 0.006) and retention rate (t = 58.386, p = 0.000) before and after the commencement of O-MEALS. Furthermore, pupils&rsquo; enrolment and retention (r = 0.993, p = 0.001) after the commencement of O-MEALS was significantly related. Food incentive was a major factor affecting school attendance, which fostered an improvement in the poor enrolment and retention previously experienced. Since a good number of the pupils possessed unfavourably perception towards the school feeding programme, it was recommended that effective monitoring be established to checkmate food vendors&rsquo; activities in delivering quality and satisfactory services. Likewise, the Government&rsquo;s policies on school restructuring and levy, which had proved counterproductive, should be reviewed.