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  1. Article ; Online: The Impact of Introducing Midwives and also Mentoring on the Quality of Sexual, Reproductive, Maternal, Newborn, and Adolescent Health Services in Low- and Middle-Income Countries

    Rondi Anderson / Sojib Bin Zaman / Mark Limmer

    Methods and Protocols, Vol 6, Iss 48, p

    An Integrative Review Protocol

    2023  Volume 48

    Abstract: Introduction: Midwives have the potential to significantly contribute to health-delivery systems by providing sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) care. However, scant research finds barriers to understanding what ... ...

    Abstract Introduction: Midwives have the potential to significantly contribute to health-delivery systems by providing sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) care. However, scant research finds barriers to understanding what midwives need to realize their full potential. There are gaps in the definition of a midwife and an understanding of effective means to support the implementation of midwifery care. Mentorship has been found to support systems and healthcare providers to improve care availability and quality. Objectives: We describe the methodology of an integrative review that aims to generate evidence of the impact of introducing midwives and also on-site facility mentoring to better understand facilitators and barriers to implementation of the quality and availability of SRMNAH services in low- and middle-income countries (LMICs). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be used to carry out the integrative review. Four electronic bibliographic databases, PubMed MEDLINE, EMBASE, Scopus, and CINAHL, will be used to identify eligible studies. All types of qualitative or quantitative studies will be considered. Eligible studies will be screened according to Population, Intervention, Comparison, and Outcome (PICO) inclusion criteria, and data will be extracted against a predetermined format. The aspects of health system strengthening in providing improved SRMNCH care will be examined in this review to generate evidence on how midwives and mentorship can improve routine care and health outcomes using the World Health Organization’s Six Building Blocks approach. The quality of the articles will be thematically analyzed in four areas: coherence and integrity, appropriateness for answering the question, relevance and focus, and overall assessment using the Gough weight-of-evidence framework. Expected results: The literature review will consider assessing both upstream health systems regulators and downstream effectors for ...
    Keywords midwives ; mentoring ; maternity care ; quality ; health systems strengthening ; Biology (General) ; QH301-705.5
    Subject code 360
    Language English
    Publishing date 2023-05-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: HIV risk behaviours among women who inject drugs in coastal Kenya

    Gitau Mburu / Mark Limmer / Paula Holland

    Harm Reduction Journal, Vol 16, Iss 1, Pp 1-

    findings from secondary analysis of qualitative data

    2019  Volume 15

    Abstract: Abstract Background Injecting drug users are at high risk of HIV infection globally. Research related to female drug users is rare in Kenya, yet it is required to inform the development of gender-sensitive HIV prevention and harm reduction services in ... ...

    Abstract Abstract Background Injecting drug users are at high risk of HIV infection globally. Research related to female drug users is rare in Kenya, yet it is required to inform the development of gender-sensitive HIV prevention and harm reduction services in East Africa, where injecting drug use is on the rise. Methods This study aimed to document the nature of HIV risks encountered by women who inject drugs in the Mombasa and Kilifi, Kenya. Secondary data analysis was conducted on an existing dataset from a 2015 primary qualitative study involving 24 interviews and 3 focus group discussions with 45 women who inject drugs. These were complemented with five interviews with key stakeholders involved in the provision of services to women who inject drugs. Guided by the social ecology theory, a thematic analysis was conducted to identify the nature of HIV risks and their underlying determinants. Results HIV risk behaviours fell into two broad categories: unsafe injecting and unprotected sex. These risks occurred in the form of sharing of needles, unprotected oral, anal, and vaginal sex, sexual assaults, injecting drug use during sex, sex work, and other types of transactional sex. The primary determinants underlying these risks were a low-risk perception, inequitable gender power, economic pressures, and poor availability of needles and condoms. These social-ecological determinants did not exist in isolation, but intersected with each other to create powerful influences which exposed women to HIV. Social-ecological determinants exerted constant influence and created a persistent ‘HIV risk environment’ that was involuntarily experienced by women. Conclusion Individual, interpersonal, and societal-structural factors intersect to produce HIV risk behaviours. As a minimum, these risks will require a combination of multifaceted micro-level interventions including self-efficacy training, risk assessment skills, couple counselling, and universal access to the recommended harm reduction package. In addition, the current focus on ...
    Keywords HIV ; Injecting drug use ; Female ; Heroin ; Qualitative ; Kenya ; Public aspects of medicine ; RA1-1270
    Subject code 360 ; 300
    Language English
    Publishing date 2019-02-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: “I Don’t Shag Dirty Girls”

    Mark Limmer MA, PhD

    American Journal of Men's Health, Vol

    2016  Volume 10

    Abstract: Understanding and addressing the sexual risk taking of young men remains a key research, policy, and practice concern in attempts to improve the emotional and physical sexual health of young men and their sexual partners. This article explores one of the ...

    Abstract Understanding and addressing the sexual risk taking of young men remains a key research, policy, and practice concern in attempts to improve the emotional and physical sexual health of young men and their sexual partners. This article explores one of the ways in which young men attempt to mitigate sexual risk through the assigning of labels to particular young women and using these as a basis for their decisions in relation to sexual activity, contraception, and condom use. The article uses the lens of hegemonic masculinities theory to increase understanding of the role played by the construction and performance of marginalized masculinities and how these in turn are influenced by social exclusionary processes. The article draws on focus group and interview data from 46 young men aged 15 to 17 years living in the northwest of England, purposively selected on the basis of the prevailing policy definitions of social inclusion and exclusion. The article describes a form of marginalized masculinity pertaining to socially excluded young men, which as a result of limited access to other tenets of hegemonic masculinity, is disproportionately reliant on sexual expertise and voracity alongside overt demonstrations of their superiority over women. It is in this context that young women are assigned the labels of “dirty” or “clean” on the basis of a selection of arbitrary judgments relating to dress, demeanor, area of residence, and perceived sexual activities. The motivations of the young men, the impact on young women, and the policy and practice implications are all discussed.
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2016-03-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: School-based peer education interventions to improve health

    Steven Dodd / Emily Widnall / Abigail Emma Russell / Esther Louise Curtin / Ruth Simmonds / Mark Limmer / Judi Kidger

    BMC Public Health, Vol 22, Iss 1, Pp 1-

    a global systematic review of effectiveness

    2022  Volume 13

    Abstract: Abstract Introduction Peer education, whereby peers (‘peer educators’) teach their other peers (‘peer learners’) about aspects of health is an approach growing in popularity across school contexts, possibly due to adolescents preferring to seek help for ... ...

    Abstract Abstract Introduction Peer education, whereby peers (‘peer educators’) teach their other peers (‘peer learners’) about aspects of health is an approach growing in popularity across school contexts, possibly due to adolescents preferring to seek help for health-related concerns from their peers rather than adults or professionals. Peer education interventions cover a wide range of health areas but their overall effectiveness remains unclear. This review aims to summarise the effectiveness of existing peer-led health interventions implemented in schools worldwide. Methods Five electronic databases were searched for eligible studies in October 2020. To be included, studies must have evaluated a school-based peer education intervention designed to address the health of students aged 11–18-years-old and include quantitative outcome data to examine effectiveness. The number of interventions were summarised and the impact on improved health knowledge and reductions in health problems or risk-taking behaviours were investigated for each health area separately, the Mixed Methods Appraisal Tool was used to assess quality. Results A total of 2125 studies were identified after the initial search and 73 articles were included in the review. The majority of papers evaluated interventions focused on sex education/HIV prevention (n = 23), promoting healthy lifestyles (n = 17) and alcohol, smoking and substance use (n = 16). Papers mainly reported peer learner outcomes (67/73, 91.8%), with only six papers (8.2%) focussing solely on peer educator outcomes and five papers (6.8%) examining both peer learner and peer educator outcomes. Of the 67 papers reporting peer learner outcomes, 35/67 (52.2%) showed evidence of effectiveness, 8/67 (11.9%) showed mixed findings and 24/67 (35.8%) found limited or no evidence of effectiveness. Of the 11 papers reporting peer educator outcomes, 4/11 (36.4%) showed evidence of effectiveness, 2/11 (18.2%) showed mixed findings and 5/11 (45.5%) showed limited or no evidence of effectiveness. Study ...
    Keywords Peer education ; School-based interventions ; Systematic review ; School health ; Adolescents ; Public aspects of medicine ; RA1-1270
    Language English
    Publishing date 2022-12-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: School culture and student mental health

    Patricia Jessiman / Judi Kidger / Liam Spencer / Emma Geijer-Simpson / Greta Kaluzeviciute / Anne–Marie Burn / Naomi Leonard / Mark Limmer

    BMC Public Health, Vol 22, Iss 1, Pp 1-

    a qualitative study in UK secondary schools

    2022  Volume 18

    Abstract: Abstract Background There is consistency of evidence on the link between school culture and student health. A positive school culture has been associated with positive child and youth development, effective risk prevention and health promotion efforts, ... ...

    Abstract Abstract Background There is consistency of evidence on the link between school culture and student health. A positive school culture has been associated with positive child and youth development, effective risk prevention and health promotion efforts, with extensive evidence for the impact on student mental health. Interventions which focus on socio-cultural elements of school life, and which involve students actively in the process, are increasingly understood to be important for student mental health promotion. This qualitative study was undertaken in three UK secondary schools prior to the implementation of a participative action research study bringing students and staff together to identify changes to school culture that might impact student mental health. The aim was to identify how school culture is conceptualised by students, parents and staff in three UK secondary schools. A secondary aim was to explore which components of school culture were perceived to be most important for student mental health. Methods Across three schools, 27 staff and seven parents participated in in-depth interviews, and 28 students participated in four focus groups. The Framework Method of thematic analysis was applied. Results Respondents identified elements of school culture that aligned into four dimensions; structure and context, organisational and academic, community, and safety and support. There was strong evidence of the interdependence of the four dimensions in shaping the culture of a school. Conclusions School staff who seek to shape and improve school culture as a means of promoting student mental health may have better results if this interdependence is acknowledged, and improvements are addressed across all four dimensions.
    Keywords School culture ; School climate ; Mental health ; Qualitative ; Children ; Young people ; Public aspects of medicine ; RA1-1270
    Subject code 370
    Language English
    Publishing date 2022-03-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Understanding How School-Based Interventions Can Tackle LGBTQ+ Youth Mental Health Inequality

    Elizabeth McDermott / Alex Kaley / Eileen Kaner / Mark Limmer / Ruth McGovern / Felix McNulty / Rosie Nelson / Emma Geijer-Simpson / Liam Spencer

    International Journal of Environmental Research and Public Health, Vol 20, Iss 4274, p

    A Realist Approach

    2023  Volume 4274

    Abstract: Globally, research indicates that LGBTQ+ young people have elevated rates of poor mental health in comparison with their cisgender heterosexual peers. The school environment is a major risk factor and is consistently associated with negative mental ... ...

    Abstract Globally, research indicates that LGBTQ+ young people have elevated rates of poor mental health in comparison with their cisgender heterosexual peers. The school environment is a major risk factor and is consistently associated with negative mental health outcomes for LGBTQ+ young people. The aim of this UK study was to develop a programme theory that explained how, why, for whom, and in what context school-based interventions prevent or reduce mental health problems in LGBTQ+ young people, through participation with key stakeholders. Online realist interviews were conducted in the UK with (1) LGBTQ+ young people aged between 13–18 years attending secondary schools ( N = 10); (2) intervention practitioners ( N = 9); and (3) school staff ( N = 3). A realist retroductive data analysis strategy was employed to identify causal pathways across different interventions that improved mental health outcomes. The programme theory we produced explains how school-based interventions that directly tackle dominant cisgender and heterosexual norms can improve LGBTQ+ pupils’ mental health. We found that context factors such as a ‘whole-school approach’ and ‘collaborative leadership’ were crucial to the delivery of successful interventions. Our theory posits three causal pathways that might improve mental health: (1) interventions that promote LGBTQ+ visibility and facilitate usualising, school belonging, and recognition; (2) interventions for talking and support that develop safety and coping; and (3) interventions that address institutional school culture (staff training and inclusion polices) that foster school belonging, empowerment, recognition, and safety. Our theoretical model suggests that providing a school environment that affirms and usualises LGBTQ+ identities and promotes school safety and belonging can improve mental health outcomes for LGBTQ+ pupils.
    Keywords mental health ; LGBTQ+ youth ; adolescence ; sexual/gender minority ; Medicine ; R
    Subject code 360
    Language English
    Publishing date 2023-02-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Participatory Action Research on School Culture and Student Mental Health

    Greta Kaluzeviciute / Tricia Jessiman / Anne–Marie Burn / Tamsin Ford / Emma Geijer–Simpson / Judi Kidger / Mark Limmer / Sheena E. Ramsay / Liam Spencer

    International Journal of Qualitative Methods, Vol

    A Study Protocol

    2021  Volume 20

    Abstract: Background : Young people spend a large proportion of their time in school, which presents both risk and protective factors for their mental health. A supportive school culture can promote and protect good mental health by creating experiences of safety ... ...

    Abstract Background : Young people spend a large proportion of their time in school, which presents both risk and protective factors for their mental health. A supportive school culture can promote and protect good mental health by creating experiences of safety and belonging amongst staff and students. In this qualitative study, we seek to explore whether a participatory action research (PAR) approach is an effective way to promote and improve student mental health. Methods : Participatory action research is an approach in which people collaboratively research their own experience: the researched communities become co-researchers of their own experiences in a specific context. We will work with four secondary schools in the UK to develop PAR projects. In each school, a group of 2–4 staff and 6–8 students will work together to develop a shared understanding of their school culture and to introduce activities or changes to make the culture more supportive of student mental health. We will evaluate the effectiveness of the PAR approach through i) a review of school documents pertaining to mental health (e.g., policies and Ofsted reports), ii) interviews with staff members ( n = 40), parents ( n = 8) and students ( n = 24–40) before and after the PAR intervention, iii) observations and reports of the PAR group meetings and iv) interviews with members of the PAR groups after the PAR intervention. Discussion : We anticipate that our research findings will advance knowledge on effective methods to develop a positive school culture that will contribute to the improvement of young people’s mental health and well-being. We will seek to identify the mechanisms through which school culture can have a positive impact on mental health and develop a logic model and a school culture toolkit that can be utilised as a resource to inform public health interventions to promote mental health in a range of educational settings.
    Keywords Social sciences (General) ; H1-99
    Subject code 370
    Language English
    Publishing date 2021-10-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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