Exploring patient-provider interactions and the health system’s responsiveness to street-connected children and youth in Kenya: a qualitative study

BACKGROUND: In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other. METHODS: This qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness. RESULTS: Through three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness. CONCLUSIONS: This study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY’s experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions

An intersectional analysis of socio-cultural identities and gender and health inequities among children and youth in street situations in western Kenya

Research has uncovered substantial gender, social, and health disparities among children and youth in street situations (CYSS) in Eldoret, Kenya. From 2013-2014 we engaged CYSS aged 11-24 years in a qualitative study to explore the sexual language and practices used in the street subculture in Eldoret, Kenya. We engaged 65 CYSS in 25 in-depth interviews and 5 focus group discussions. This work uncovered stark gender inequities, which result in girls and young women in street situations experiencing profound levels of sexual and gender-based violence and harmful sexual and reproductive health outcomes. To comprehend the underlying drivers of these inequities and to appropriately and adequately intervene, we sought to comprehend how CYSS’s social identities intersect with systems of oppression and privilege to produce and maintain these inequities. We therefore sought to reanalyze the original data from this study using intersectionality as a theoretical framework to explore how systems of oppression in Kenya have shaped the street subculture, construct CYSS’s street and resistance social identities, and how these social identities and the street subculture intersect with macro-level structural factors to produce health and gender inequities. Our analysis identified three distinct social identities that are given to CYSS in Eldoret: Chokoraa (garbage pickers), Mshefa (hustlers), and Mboga ya jeshi (vegetables for soldiers). Our findings revealed how these identities and the street subculture intersect with the Patriarchy, the political-economic context, and social cultural forces in Kenya, resulting in hegemonic masculinity and detrimental gender roles and norms for young men and women. Our findings show that CYSS are a product of the oppressive systems that construct their circumstances and shape their social identities. This population urgently requires policies and programs that intervene at multiple levels to halt the harmful practices within street subculture and associated with street-involvement

Alfalfa hay quality in Oregon

New grading standards for hay have been proposed by the American Forage and Grassland Council and the Federal Grain Inspection Service. This publication traces the development of these standards, describes new terminology, and reports on research conducted at Oregon State University to evaluate these new standards. Alfalfa hay samples obtained from five distinct geographical areas in Oregon were subjected to various chemical analyses (crude protein, neutral detergent fiber, acid detergent fiber, in vitro dry matter digestibility, calcium, and phosphorous). Differences between values for regions and cuttings were quite small, with mean values falling within the limits presently defined as Grade 2 alfalfa hay. This indicates that management factors are more important than geographical region or cutting in determining hay quality. These results also point out the importance of hay testing in providing an objective measure of hay quality. Animal production studies also were conducted on alfalfa hays of varying quality. Acid detergent fiber was found to be a good predictor of both animal intake and digestibility. Milk production was greatest from cows fed rations containing high-quality hay when rations contained 45 percent hay, but no significant differences were observed when cows were fed rations containing only 30 percent hay.Published October 1981. Facts and recommendations in this publication may no longer be valid. Please look for up-to-date information in the OSU Extension Catalog: http://extension.oregonstate.edu/catalo

Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo

Meeting Abstracts: Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo Clearwater Beach, FL, USA. 9-11 June 201

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations

Effects on Outpatient and Emergency Mental Health Care of Strict Medicaid Early Periodic Screening, Diagnosis, and Treatment Enforcement

We investigated enforcement of mental health benefits provided by California Medicaid’s Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Enforcement, compelled by a consumer-driven lawsuit, resulted in an almost 4-fold funding increase over a 5-year period

An intersectional analysis of socio-cultural identities and gender and health inequities among children and youth in street situations in western Kenya

Research has uncovered substantial gender, social, and health disparities among children and youth in street situations (CYSS) in Eldoret, Kenya. From 2013-2014 we engaged CYSS aged 11-24 years in a qualitative study to explore the sexual language and practices used in the street subculture in Eldoret, Kenya. We engaged 65 CYSS in 25 in-depth interviews and 5 focus group discussions. This work uncovered stark gender inequities, which result in girls and young women in street situations experiencing profound levels of sexual and gender-based violence and harmful sexual and reproductive health outcomes. To comprehend the underlying drivers of these inequities and to appropriately and adequately intervene, we sought to comprehend how CYSS’s social identities intersect with systems of oppression and privilege to produce and maintain these inequities. We therefore sought to reanalyze the original data from this study using intersectionality as a theoretical framework to explore how systems of oppression in Kenya have shaped the street subculture, construct CYSS’s street and resistance social identities, and how these social identities and the street subculture intersect with macro-level structural factors to produce health and gender inequities. Our analysis identified three distinct social identities that are given to CYSS in Eldoret: Chokoraa (garbage pickers), Mshefa (hustlers), and Mboga ya jeshi (vegetables for soldiers). Our findings revealed how these identities and the street subculture intersect with the Patriarchy, the political-economic context, and social cultural forces in Kenya, resulting in hegemonic masculinity and detrimental gender roles and norms for young men and women. Our findings show that CYSS are a product of the oppressive systems that construct their circumstances and shape their social identities. This population urgently requires policies and programs that intervene at multiple levels to halt the harmful practices within street subculture and associated with street-involvement