Understanding Self-Construction of Health among the Slum Dwellers of India : A Culture-Centered Approach

Disembarking from a traditional approach of narrow hazardous environmental and structural conditions in understanding urban slums' health problems and moving towards a new notion of what constitutes health for slum dwellers will open a new avenue to recognise whether and how health is being prioritised in disadvantaged settings. Drawing on in-depth semi-structured interviews with a total of 67 men and 68 women from Kolkata slums and 62 men and 48 women from Bangalore slums, this study explored how knowledge, social realities, material and symbolic drivers of a place interweave in shaping slum-dwellers' patterned way of understanding health, and the ways health and illnesses are managed. The current study adds to the growing evidence that ordinary members of the urban slums can articulate critical linkages between their everyday sociocultural realities and health conditions, which can support the design and delivery of interventions to promote wellbeing. The concept of health is not confined to an abstract idea but manifested in slum-dwellers' sporadic practices of preventive and curative care as well as everyday living arrangements, where a complex arrangement of physical, psychological, financial, sociocultural and environmental dimensions condition their body and wellbeing

Business Model Innovation for Inclusive Health Care Delivery at the Bottom of the Pyramid

This article investigates business models innovation for delivering health care at the base of the pyramid (BoP). The examination of six health care organizational cases suggests that co-creation of patient needs, community engagement, continuous involvement of customers, innovative medical technology, focus on human resources for health, strategic partnerships, economies of scale, and cross-subsidization are business model innovation strategies that enable inclusive health care delivery. Based on these findings, we propose a four-dimensional framework. A process of value discovery, leading BoP patients and communities to recognize a health need and seek for an acceptable treatment, precedes the identification of a successful value proposition. Value creation and value appropriation then follow to warrant patient affordability and organizational sustainability. A “business model mechanism” for BoP health care hence emerges, where interdependencies among these dimensions are highlighted. This article sheds new light on how market-based approaches can improve equitable health care access and hence contribute to poverty alleviation

Exploring solutions to improve antenatal care in resource-limited settings : an expert consultation

BACKGROUND: Shortage or low-quality antenatal care is a complex and "wicked" problem relying heavily on contextual, socio-cultural, environmental and intersectional aspects. We report the outcome of an expert consultation discussing solutions to improve antenatal care quality, access and delivery in low- and middle-income countries, and providing recommendations for implementation. METHODS: The social ecological model was used as an analytical lens to map and interpret discussion points and proposed solutions. In addition, a conceptual framework for maternal and neonatal health innovation based on the building blocks of the World Health Organization health system and the Tanahashi Health Systems Performance Model provided a logical overview of discussed solutions. RESULTS: Many barriers and norms continue to hinder antenatal care access. From values, beliefs, traditions, customs and norms, to poor resource allocation, there is a need of reshaping health systems in order to provide high quality, respectful maternal and childcare. The burden of poor maternal health, morbidity and mortality is concentrated among populations who are vulnerable due to gender and other types of discrimination, have financial constraints and are affected by humanitarian crises. CONCLUSIONS: In order to address maternal health issues, good quality and evidence-based services should be guaranteed. Investments in strengthening health systems, including data and surveillance systems and skilled health workforce, should be considered an essential step towards improving maternal health services

Effect of Covid‑19 on antenatal care: Experiences of medical professionals in the Netherlands

COVID-19 has greatly affected the delivery of all health care services globally. Antenatal care is one area of care that has been impacted, despite the fact that attending antenatal check-ups is essential for pregnant women and cannot be postponed. Little is known about how exactly ANC provision has changed in the Netherlands, or how the changes have impacted midwives and gynaecologists providing those services. This study used a qualitative research design to investigate changes in individual and national practice following the onset of the COVID-19 pandemic. The study involved a document analysis of protocols and guidelines for ANC provision to evaluate how those changed following the onset of the COVID-19 pandemic and semi-structured interviews with ANC care providers (i.e., gynaecologists and midwives)

Integrating poverty alleviation and environmental protection efforts : A socio-ecological perspective on menstrual health management

Apt menstrual health management is crucial to the livelihood of low-income, bottom of the pyramid (BOP) women as well as to environmental conservation. However, knowledge is still scant about the factors underpinning women's preferences towards menstrual products, and whether and how the environmental impact of different solutions matter to women's choices. We address this gap by proposing a socio-ecological perspective to understand whether a product's low environmental impact enhances low-income women's uptake of sanitary napkins, thereby supporting poverty alleviation objectives but also efforts geared towards environmental protection. Results from a discrete-choice experiment involving 164 women (n = 1148) in two Indian slums in Delhi and Ahmedabad show that sanitary products' biodegradability is the most important attribute affecting women's preferences towards menstrual hygiene management solutions, which also significantly interacts with women's socio-economic and socio-cultural characteristics. Our findings highlight the potential for business models to find positive synergies between environmental protection and poverty alleviation goals and to situate solutions within the larger socio-ecological context of receiving communities

The COVID-19 wicked problem in public health ethics : conflicting evidence, or incommensurable values?

While the world was facing a rapidly progressing COVID-19 second wave, a policy paradox emerged. On the one side, much more was known by Autumn 2020 about the mechanisms underpinning the spread and lethality of Sars-CoV-2. On the other side, how such knowledge should be translated by policymakers into containment measures appeared to be much more controversial and debated than during the first wave in Spring. Value-laden, conflicting views in the scientific community emerged about both problem definition and subsequent solutions surrounding the epidemiological emergency, which underlined that the COVID-19 global crisis had evolved towards a full-fledged policy “wicked problem”. With the aim to make sense of the seemingly paradoxical scientific disagreement around COVID-19 public health policies, we offer an ethical analysis of the scientific views encapsulated in the Great Barrington Declaration and of the John Snow Memorandum, two scientific petitions that appeared in October 2020. We show that how evidence is interpreted and translated into polar opposite advice with respect to COVID-19 containment policies depends on a different ethical compass that leads to different prioritization decisions of ethical values and societal goals. We then highlight the need for a situated approach to public health policy, which recognizes that policies are necessarily value-laden, and need to be sensitive to context-specific and historic socio-cultural and socio-economic nuances

Social media “stars” vs “the ordinary” me : influencer marketing and the role of self-discrepancies, perceived homophily, authenticity, self-acceptance and mindfulness

Purpose: Social media influencers have become constant companions of a large audience of young consumers, but a crucial yet underexplored area of examination relates to the implications of exposure to influencers for an individual’s self-concept. This study aims to examine if and how individuals experience self-discrepancies when exposed to influencers and the impact of such discrepancies on their affect, cognition and behaviors toward the influencers and the brands they endorse. Design/methodology/approach: The authors thematically analyze 17 semistructured interviews, develop a conceptual model and present a set of hypotheses. The hypotheses are tested by analyzing survey data from 503 respondents using structural equation modeling. Findings: Individuals actively engage in comparisons with influencers’ virtual self-presentation and treat them as emblematic of an ideal self. The associated self-discrepancy can lead to both negative and positive affect, but while the latter has a positive impact on e-word of mouth (WOM) and purchase intent, the former has a negative impact. Perceived homophily dampens the impact of exposure to influencer content on discrepancy and strengthens the link between discrepancy and positive affect. Self-acceptance and mindfulness positively moderate the impact of discrepancy on positive affect and negatively on negative affect. Perceived authenticity strengthens the impact of positive affect on e-WOM and dampens the impact of negative affect on purchase intention. Research limitations/implications: The authors contribute to the literature on self-discrepancies by identifying a consumer context where, in addition to the theoretically predicted negative affect, an individual may experience more positive emotions like feeling motivated or inspired because of the perceived attainability of an influencer as an ideal self. The authors contribute to the influencer marketing literature by examining the influencer–follower relationship and its implications for an individual’s self-concept, including the role played by perceived homophily and authenticity. The authors also contribute to the literature on consumer well-being and identify the role of self-acceptance and mindfulness in shaping consumer experiences. Practical implications: The authors provide a nuanced analysis of the impact of influencer marketing on consumer behavior with a focus on its impact on an individual’s self-concept. The authors argue for the role of perceived homophily and authenticity in shaping favorable consumer behavior outcomes and offer evidence for more inclusive approaches to marketing. Originality/value: The authors identify the influencer–follower relationship as a unique social exchange where the source of self-discrepancy is also a homophilic solution provider for achieving one’s ideal self and report both positive and negative effects as outcomes of experiencing a self-discrepancy induced by a target perceived as more attainable. The authors situate understandings of perceived homophily and authenticity along these relationships and identify self-acceptance and mindfulness as mechanisms used by individuals to deal with discrepancies

Socio-cultural sustainability of private healthcare providers in an indian slum setting: A bottom-ofthe- pyramid perspective

Delivery of affordable healthcare services to communities is a necessary precondition to poverty alleviation. Co-creation approaches to the development of business models in the healthcare industry proved particularly suitable for improving the health-seeking behavior of BOP patients. However, scant research was conducted to understand BOP consumers' decision-making process leading to specific healthcare choices in slum settings, and the relative balance of sociocultural and socio-economic factors underpinning patients' preferences. This article adopts a mixedmethod approach to investigate the determinants of BOP patients' choice between private and public hospitals. Quantitative analysis of a database, composed of 436 patients from five hospitals in Ahmedabad, India, indicates that BOP patients visit a public hospital significantly more than topof- the-pyramid (TOP) patients. However, no significant difference emerges between BOP and TOP patients for inpatient or outpatient treatments. Qualitative findings based on 21 interviews with BOP consumers from selected slum areas led to the development of a grounded theory model, which highlights the role of aspirational demand of BOP patients toward private healthcare providers. Overall, healthcare provider choice emerges as the outcome of a collective socio-cultural decision-making process, which often assigns preference for private healthcare services because of the higher perceived quality of private providers, while downplaying affordability concerns. Implications for healthcare providers, social entrepreneurs, and policy-makers are discussed

Measuring the reasons that discourage medical students from working in rural areas

The sharply uneven distribution of human resources for health care across urban and rural areas has been a long-standing concern globally. The present study aims to develop and validate an instrument measuring the factors deterring final year students of Bachelor of Medicine and Bachelor of Surgery (MBBS) in 3 northern states of India, from working in rural areas. The medical student's de-motivation to work in rural India (MSDRI) scale was developed using extensive literature review followed by Delphi technique. The psychometric properties of the questionnaire were assessed in terms of content validity, construct validity, data quality and reliability. Exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA) was performed to identify the primary deterrents. Thirty-three items were generated from literature search followed by Delphi exercise. After assessing psychometric properties, the final instrument included 29 items whereas the EFA and CFA highlighted 5 main factors, namely lack of professional challenge, social segregation, socio-cultural gap, hostile professional environment, and lack of financial incentives as underpinning students' demotivation towards working in rural areas. The MSDRI instrument is the first valid and reliable measure for identifying deterring factors for MBBS students to work in rural areas of India. The use of it may be very helpful for policymakers as well as healthcare organizations in formulating effective measures to encourage medical students to work in rural areas, which suffer from a chronic shortage of medical personnel