A GLOWING footprint: Developing an index of wellbeing for low to middle income countries

Our world faces unprecedented, intense and rapid change. As such, it is difficult to fathom how we might monitor related impacts on the wellbeing of population(s) affected. In the past, the world has typically relied upon measures of economic health or wellbeing such as gross domestic product (GDP). As the world ends its commitment to the Millennium Development Goals (MDGs), and embarks on a commitment to the Sustainable Development Goals, questions about where we as a global society should continue our investments in wellbeing and efforts to measure those outcomes are now up for debate. These questions are particularly poignant for those populations most vulnerable to change: low to middle income countries (LMICs). This paper reviews existing “beyond GDP” measures of population wellbeing as a foundation for developing a truly global index of wellbeing (GLOWING) that can be used by LMICs to document change, and measure the impact of policy, across space and over time. The paper describes a proposed index of wellbeing that is simple, meaningful, and built on the use of available secondary data at the ecological level. It is built on the foundation of the innovative Canadian Index of Wellbeing, and hinges on plans for a proof of concept inEast Africafollowed by a scaling up, all of which is founded on the twin pillars of capacity building and empowerment

Biopsychosocial risk factors and knowledge of cervical cancer among young women: A case study from Kenya to inform HPV prevention in Sub-Saharan Africa

Background: Cervical cancer is the second most common female reproductive cancer after breast cancer with 84% of the cases in developing countries. A high uptake of human papilloma virus (HPV) vaccination and screening, and early diagnosis leads to a reduction of incidence and mortality rates. Yet uptake of screening is low in Sub-Saharan Africa and there is an increasing number of women presenting for treatment with advanced disease. Nine women in their twenties die from cervical cancer in Kenya every day. This paper presents the biopsychosocial risk factors that impact on cervical cancer knowledge among Kenyan women aged 15 to 24 years. The findings will highlight opportunities for early interventions to prevent the worrying prediction of an exponential increase by 50% of cervical cancer incidences in the younger age group by 2034. Methods: Data from the 2014 Kenya Demographic and Health Survey (KDHS) was analysed using complex sample logistic regression to assess biopsychosocial risk factors of knowledge of cervical cancer among young women aged 15 to 24 years (n = 5398). Findings: Close to one third of the participants were unaware of cervical cancer with no difference between participants aged 15–19 years (n = 2716) and those aged 20–24 years (n = 2691) (OR = 1; CI = 0.69–1.45). Social predisposing factors, such as lack of education; poverty; living further from a health facility; or never having taken a human immunodeficiency virus (HIV) test, were significantly associated with lack of awareness of cervical cancer (p<0.001). Young women who did not know where to obtain condoms had an OR of 2.12 (CI 1.72–2.61) for being unaware of cervical cancer. Psychological risk factors, such as low self-efficacy about seeking medical help, and an inability to refuse unsafe sex with husband or partner, perpetuated the low level of awareness about cervical cancer (p<0.001). Conclusions: A considerable proportion of young women in Kenya are unaware of cervical cancer which is associated with a variety of social and psychological factors. We argue that the high prevalence of cervical cancer and poor screening rates will continue to prevail among older women if issues that affect young women’s awareness of cervical cancer are not addressed. Given that the Kenyan youth are exposed to HPV due to early sexual encounters and a high prevalence of HIV, targeted interventions are urgently needed to increase the uptake of HPV vaccination and screening

Assessing the psychometric properties of a modified global wellbeing measure in Ghana

We live in a world faced by unprecedented environmental change. As such, it is difficult to fathom how we might define, measure, and monitor related impacts on population wellbeing. This is especially the case in low to middle income countries that lack holistic national wellbeing measures but are the most impacted by global environmental changes. As part of a larger research program that aims to develop a Global Index of Wellbeing (GLOWING), this paper reports the assessment of the psychometric properties of a community wellbeing measure, using Ghana as a case study. Informed by the ecosocial and capabilities frameworks and in-depth qualitative and focus group discussions, survey data (n = 1036) were collected from three regions in Ghana to assess population wellbeing across several domains. Using structural equation modelling, psychometric properties of this modified wellbeing measure were tested to show the relative contribution of each domain to overall wellbeing. Pathways between domains and overall wellbeing were also investigated. The modified wellbeing measure showed good sensitivity, validity, and reliability which makes it suitable as a valuable tool for measuring wellbeing in Ghana and perhaps other LMIC settings. Furthermore, while the range of wellbeing constructs showed significance across the three regions studied, their relative importance differed, underscoring the importance of place to the measurement of wellbeing. Multivariate analysis shows a multiple range of factors [living conditions, sense of community, perception of environmental quality and political participation] were associated with wellbeing, requiring innovative, flexible and action-oriented approaches to improving population wellbeing. In this regard, we propose modifications to the scale to enable it to capture the role of place, while allowing for comparisons across space