Migration, Health and Help-seeking in Childhood

Migration, be it voluntary or forced, can have multiple consequences for the mental and physical health of the individuals concerned. In addition, it is not uncommon for these consequences to be passed on from one generation to the other. In this thesis we described how migration can influence mental health, health-related quality of life and help-seeking in childhood. We confirm the findings of previous research by showing that disparities between migrants and non-migrants in mental health and health-related quality of life exist, even in the preschool years. It is of importance to address these disparities early in life to prevent them from getting larger. Qualitative research allowed us to explore more profoundly perceptions of mental health help-seeking among adolescent girls and mothers with different ethnic backgrounds. Barriers were identified in both Dutch and non-Dutch focus group discussions which shows that access to mental health services by youth in need should be reassessed and improved. Scaling up preventive and treatment programs in schools may be a first step. In ethnic minority groups, additional efforts should be made to reduce the stigmas and taboos associated with mental health problems. In conclusion, this thesis underlines the important influence migration can have on health, even in early life. The results of the presented studies provide potential directions for the development of strategies that tackle disparities in child health such as, a focus on improving family circumstances

Help-seeking behaviour for internalizing problems

Objective Although adolescent girls from ethnic minorities are at an increased risk of internalizing problems (e.g. depression), only a small fraction seeks formal help for these problems. To enhance help-seeking for internalizing problems among ethnic minority adolescent girls, insight into their help-seeking behaviour is required. This study explored the perceptions of adolescent girls from different ethnic backgrounds regarding their help-seeking behaviour for internalizing problems. Design A qualitative study using focus group discussions (FGDs) was employed. Eight ethnic-specific FGDs were conducted with 50 adolescent girls of mostly Turkish (n=23), Moroccan (n=13), and Dutch (n=10) backgrounds recruited in Rotterdam, a multicultural city in the Netherlands. FGDs were conceptually framed within a help-seeking model, facilitated by a vignette and analysed using NVivo software. Results When describing the internalizing problems presented in the vignette, participants of non-Dutch FGDs tended to state the causes of the problems (e.g. lack of attention) whereas participants of Dutch FGDs mentioned the emotional state. Participants did not perceive the presented internalizing problems as severe. If participants were to face internalizing problems of their own, their decision to seek help would be hampered by negative attitudes towards professionals and school-based services. Particularly in non-Dutch FGDs the fear of parental and friend's reactions was identified as a barrier. Participants identified their mother and a good friend as primary sources of help.ConclusionIn this study, adolescent girls of Turkish, Moroccan and Dutch backgrounds had difficulty recognizing the severity of internalizing problems, and various barriers could hamper their decision to seek help. To enhance utilization of mental health services by youth, promoting a change in their attitudes towards mental health/school-based services is recommended. Guaranteeing confidentiality within school-based services, and training for professionals in communicating with adolescent girls, may also prove beneficial. In ethnic minorities, tackling the negative reactions of family/friends requires attention

The role of maternal perceptions and ethnic background in the mental health help-seeking pathway of adolescent girls

Mothers play a crucial role in the help-seeking pathway of adolescents. This study examined how mothers with different ethnic backgrounds perceive the issue of help-seeking for internalizing problems (e.g. depression) in adolescent girls. Seven focus group discussions were conducted with 41 Dutch, Moroccan and Turkish mothers with a teenage daughter. Discussions were conceptually framed within a model of help-seeking and facilitated by a vignette. The internalizing problems sketched in the vignette were recognized as severe nonetheless; identified long term consequences varied per ethnic group. Negative attitudes towards General Practitioners, inaccessible mental health services and denial by daughters would hamper help-seeking. Fear of negative judgments/gossiping was considered a barrier by Turkish and Moroccan participants. Participants identified themselves and schools as primary sources of help. Turkish participants also named chaplains. To enhance utilization of mental health services by (minority) youth it is important to also address maternal barriers

Neighborhood Ethnic Diversity and Behavioral and Emotional Problems in 3 Year Olds: Results from the Generation R Study

Background:Studies suggest that neighborhood ethnic diversity may be important when it comes to understanding ethnic inequalities in mental health. The primary aim of this study was to investigate whether neighborhood ethnic diversity moderated the association between the ethnic minority status and child behavioral and emotional problems.Methods:We included 3076 preschoolers participating in the Generation R Study, a birth cohort study in Rotterdam, the Netherlands. At child age 3-years, parents completed the Child Behavior Checklist (CBCL/1,5-5). Individual-level data

Health-related quality of life of infants from ethnic minority groups: the Generation R Study

PURPOSE: To assess whether the health-related quality of life of infants from ethnic minority groups differs from the health-related quality of life of native Dutch infants and to evaluate whether infant health and family characteristics explain the potential differences. METHODS: We included 4,506 infants participating in the Generation R Study, a longitudinal birth cohort. When the child was 12 months, parents completed the Infant Toddler Quality of Life Questionnaire (ITQOL); ITQOL scale scores in each ethnic subgroup were compared with scores in the Dutch reference population. Influence of infant health and family characteristics on ITQOL scale scores were evaluated using multivariate regression models. RESULTS: Infants from ethnic minority groups presented significantly lower ITQOL scale scores compared to the Dutch subgroup (e.g., Temperament and Moods scale: median score of Turkish subgroup, 70.8 (IQR, 15.3); median score of Dutch subgroup, 80.6 (IQR, 13.9; P < 0.001)). Infant health and family characteristics mediated an important part of the association between the ethnic minority status and infant health-related quality of life. However, these factors could not fully explain all the differences in the ITQOL scale scores. CONCLUSIONS: Parent-reported health-related quality of life is lower in infants from ethnic minority groups compared to native Dutch infants, which could partly be explained by infant health and by family characteristics

Health-related quality of life of infants from ethnic minority groups: The Generation R Study

Purpose: To assess whether the health-related quality of life of infants from ethnic minority groups differs from the health-related quality of life of native Dutch infants and to evaluate whether infant health and family cha

Systematic development of a self-regulation weight-management intervention for overweight adults

Background. This paper describes the systematic development of an intervention for the prevention of obesity among overweight adults. Its development was guided by the six steps of Intervention Mapping (IM), in which the establishment of program needs, objectives and methods is followed by development of the intervention and an implementation and evaluation plan. Methods. Weight gain prevention can be achieved by making small changes in dietary intake (DI) or physical activity (PA). The intervention objectives, derived from self-regulation theory, were to establish goal-oriented behaviour. They were translated into a computer-tailored Internet-delivered intervention consisting of four modules. The intervention includes strategies to target the main determinants of self-regulation, such as feedback and action planning. The first module is intended to ensure adults' commitment to preventing weight gain, choosing behaviour change and action initiation. The second and third modules are intended to evaluate behaviour change, and to adapt action and coping plans. The fourth module is intended to maintain self-regulation of body weight without use of the program. The intervention is being evaluated for its efficacy in an RCT, whose protocol is described in this paper. Primary outcomes are weight, waist circumference and skin-fold thickness. Other outcomes are DI, PA, cognitive mediators and self-regulation skills. Discussion. The IM protocol helped us integrating insights from various theories. The performance objectives and methods were guided by self-regulation theory but empirical evidence with regard to the effectiveness of theoretical methods was limited. Sometimes, feasibility issues made it necessary to deviate from the original, theory-based plans. With this paper, we provide transparency with regard to intervention development and evaluation. Trial registration. NTR1862

Strengthening Continuous Professional Development for Sustainable Capacity Development of School Leaders in Rwanda

Globally, the education sector is faced with a number of adversities including recruitment and retention of qualified school leaders, enhancement of the capacity of school leaders to deliver quality education vis a vis the aspirations for sustainable development by different countries.&nbsp; The National long term and short-term development trajectories for Rwanda aspire for a fast economic transformation enabled by a knowledge based society. Despite major gains by the Ministry of education in Rwanda, particularly training and recruitment of teachers and introduction of a coordination system to ensure professional development and management of teachers, the education sector is still struggling to ensure that school leaders have the capacity to lead and deliver the new competence-based curriculum in schools. Our understanding of Continuous Professional Development, building on the definition by the Rwanda Education Board is “learning continuously throughout one’s career to improve performance. CPD is an umbrella term that covers all formal, non-formal and informal professional learning experiences over the duration of a teacher’s career”(REB, 2015). We therefore define CPD programmes as certified, formal professional development programmes provided by an accredited learning institution building on existing practices and interventions in Rwanda, with formal learning and practicing activities and excluding one-off, one day or short residential trainings. In this paper, we explore how the partnership established in 2014 between URCE, REB and VVOB Rwanda developed and implemented the certified CPD programmes for primary schools. This partnership has enabled the REB Department for Teacher Professional Development and Management, to streamline the required professional development of school leaders as well as increasing the capacity of the URCE to deliver CPD certification at higher learning level, based on the academic requirements by the University of Rwanda. The partnership has enabled Leaders in Education, including sector education officers, (deputy) head teachers and teachers to acquire new competences for leading a school as well as the management and implementation of CPD activities at sector and school level. While it has been observed that best practices in the pilot initiatives in primary schools could be scaled up at secondary level, the same initiatives could be replicated by other partners in Rwanda to enhance professional development of leaders in education in Rwanda and in other countries