Validation study of LQAS-2 in Uttar Pradesh behavior change management project

India’s Uttar Pradesh Behavior Change Management project studied the potential of community mobilization through Self Help Groups (SHGs) to improve healthy behaviors that may have a direct bearing on maternal, newborn, and child health outcomes. Multiple rounds of Lot Quality Assurance Sampling (LQAS) surveys were undertaken to monitor project activities and take corrective measures to improve project indicators. The surveys also evaluated the diffusion of health messages in the project area. The LQAS-2 validation study aimed to examine the accuracy of LQAS-2 data and understand the process of administering the LQAS. The study, which documented the process of survey administration, accuracy of data, and effects of mentor support, used two approaches: a validation survey among a subsample of women who participated in LQAS-2, and observation of the sampled interviews during the LQAS-2 survey. The following programmatic recommendations were made: A longer training of the interviewers is necessary. Prolonged mentor support should be replaced by limited mentoring, but better mentor training is necessary so individuals can properly interview even without mentoring support

Contraceptive use dynamics in India: A prospective cohort study of modern reversible contraceptive users

This report highlights the contraceptive use dynamics among 2,699 married women in India who began using one of four reversible contraceptive methods over one year. Women aged 15-49 were enrolled into the study from Odisha and Haryana states within one month of starting their reversible method—interval intrauterine device (IUD), postpartum IUD (PPIUD), injectable contraceptive, or oral contraceptive pill (OCP)—and were interviewed at four time points: at enrollment into the study, and three, six, and 12 months after enrollment. Study findings include the quality of care received at the time of method adoption, experience and management of side effects, reasons for discontinuation of the enrollment method, dynamics of contraceptive use after one year, changes in fertility preferences, and the method-specific experiences related to contraceptive use and pregnancy over the course of the study. The findings from this study will be useful to program designers, policymakers, and health care professionals in delivering voluntary family planning services in India

Physical Activity and Screen Time Sedentary Behaviors in College Students

It is well established that Americans are not meeting physical activity (PA) guidelines and college students are no exception. Given the lack of regular PA, many health promotion professionals seek to discover what barriers to PA may exist. A common explanation is screen time (ST), which is comprised primarily of television viewing, computer use, and the playing of video games. The purpose of this study was to present descriptive data on college students’ PA and sedentary behavior and to assess if any evidence exists to suggest displacement between sedentary behaviors and PA in college students. Students completed an online health survey specific to time spent in PA and sedentary behavior. Students were categorized into one of three PA groups based on their activity level. Males were significantly more physically active than females in terms of days per week engaged in aerobic exercise (p=.022) and strength training (p\u3c.001). When categorized by activity level, a greater percentage of male students met recommended PA levels than did females (p\u3c.001). Males reported significantly higher levels of overall ST (p=.004) and television viewing (p\u3c.001), whereas females reported significantly higher levels of time spent engaged in homework (p\u3c.001). When categorized by activity level, physically active students reported significantly fewer minutes of total ST than inactive students (p=.047). Implications of this study suggest that within a college population, television and PA are not competing behaviors in either gender

Understanding demand for family planning and reproductive health services through the Indian National Health Insurance Scheme in Uttar Pradesh

The Indian National Health Insurance Scheme, Rashtriya Swasthya Bima Yojana (RSBY), was launched by the Ministry of Labour and Employment in 2008 to promote equitable access to health services through the private and public sectors. This scheme is intended to offer economically disadvantaged families living below the poverty line in urban and rural areas access to a pre-specified package of health services including: general surgery, general medical care, pediatric care, gynecological care, family planning (FP) and other reproductive health (RH) services, dental, ophthalmology, urology, neurosurgery, and oncology. Almost eight years into the program, this is an opportune time to examine usage levels and barriers and facilitators to the program’s effectiveness. The Evidence Project conducted a study among the urban poor in Uttar Pradesh to look at awareness and use of RSBY for FP/RH services, understand concerns of those administering the program and providing services, and provide programmatic recommendations for improvement

Addressing supply side factors to improve family planning and reproductive health services in the Indian National Health Insurance Scheme in Uttar Pradesh

The Indian National Health Insurance Scheme, Rashtriya Swasthya Bima Yojana (RSBY), was launched by the Ministry of Labour and Employment, Government of India in 2008 to promote equitable access to health services through the private and public sectors. Almost eight years into the program, it was an opportune time to examine usage levels and barriers and facilitators to the program’s effectiveness. The Evidence Project conducted a study among the urban poor in Uttar Pradesh to look at awareness and use of the RSBY program and family planning/reproductive health (FP/RH) services, examine concerns of those administering the program and providing services, and provide programmatic recommendations for improvement. This study identified several supply side factors of the insurance scheme that hinder knowledge of and access to services, including FP/RH services, among enrollees and potential enrollees, some of which are highlighted in this study brief

Utilization of national health insurance for family planning and reproductive health services by the urban poor in Uttar Pradesh, India

In 2008, the Government of India launched the National Health Insurance Scheme, Rashtriya Swasthya Bima Yojana (RSBY), to enable families living below the poverty line in both urban and rural areas to access a range of private health services. The available evidence suggests several limitations and barriers that may affect the utilization of RSBY services and warrants a more in-depth examination of the contexts of family planning/reproductive health (FP/RH) services. The Population Council, under the Evidence project, conducted a study among the urban poor to: 1) determine RSBY awareness and barriers to enrollment; 2) identify barriers and facilitating factors to utilizing RSBY for FP/RH services; 3) assess the concerns and limitations of administrators and providers at RSBY-empaneled private hospitals for providing FP/RH services under RSBY; and 4) provide programmatic recommendations to improve the delivery and utilization of RSBY for various FP/RH services. Based on the results of this study, this report suggests a number of programmatic recommendations to improve the supply-side and demand-side barriers of the RSBY program, including for FP/RH services

Is economic inequality in family planning in India associated with the private sector?

This study examined the pattern of economic disparity in the modern contraceptive prevalence rate (mCPR) among women receiving contraceptives from the public and private health sectors in India, using data from all four rounds of the National Family Health Survey conducted between 1992–93 and 2015–16. The mCPR was measured for currently married women aged 15–49 years. A concentration index was calculated and a pooled binary logistic regression analysis conducted to assess economic disparity (by household wealth quintiles) in modern contraceptive use between the public and private health sectors. The analyses were stratified by rural–urban place of residence. The results indicated that mCPR had increased in India over time. However, in 2015–16 only half of women—48% (33% from the public sector, 12% from the private sector, 3% from other sources)—were using any modern contraceptive in India. Over time, the economic disparity in modern contraceptive use reduced across both public and private health sectors. However, the extent of the disparity was greater when women obtained the services from the private sector: the value of the concentration index for mCPR was 0.429 when obtained from the private sector and 0.133 when from the public sector in 2015–16. Multivariate analysis confirmed a similar pattern of the economic disparity across public and private sectors. Economic disparity in the mCPR has reduced considerably in India. While the economic disparity in 2015–16 was minimal among those accessing contraceptives from the public sector, it continued to exist among those receiving services from the private sector. While taking appropriate steps to plan and monitor private sector services for family planning, continued and increased engagement of public providers in the family planning programme in India is required to further reduce the economic disparity among those accessing contraceptive services from the private sector

Prevalence and associates of natural menopause and surgical menopause among Indian women aged 30 to 49 years: An analysis of the National Family Health Survey

This study estimates the prevalence of natural and surgical menopause among Indian women aged 30 to 49 years, examines the secular trend in prevalence, and identifies different correlates of menopause in India based on multiple rounds of nationally representative samples. The age-adjusted prevalence of menopause significantly declined from 17.3% in 2005–2006 to 15.7% in 2015–2016. The current prevalence of natural menopause and surgical menopause were 9.5% and 6.2%, respectively. The determinants and trends in menopause in India are different for natural and surgical menopause, which require separate attention for the planning and implementation of reproductive and postreproductive health services

Reaching the unreached through community mobilization in an innovative and sustainable way

This study shows the potential of Self Help Groups (SHGs) to deliver health messages that increase women’s knowledge. The intervention for this operations research (OR) study included a day-long training for Swasth Sakhis in the experimental area. A total of 11 trainings were organized, all conducted by Population Council staff. Before the intervention, at baseline, 803 women from eligible households were interviewed for the quantitative assessment. At endline, 470 women were followed up. Additionally, 16 in-depth interviews with women, Swasth Sakhis, and Rajiv Gandhi Mahila Vikas Pariyojana staff were conducted in the experimental area to understand how the intervention was working. A total of 30 SHG meetings were observed. Findings indicate SHG’s usefulness in delivering health messages, as net changes in women’s knowledge were significant for most health messages. In a sample of study participants who delivered a child within two months prior to endline, a higher percentage of women from the experimental area correctly practiced maternal and newborn health behaviors compared to their counterparts in the control area. For most maternal and newborn health topics, the net change in knowledge from baseline to endline was statistically higher in the experimental area than in the control, confirming the intervention’s effectiveness

Corrective equations to self-reported height and weight for obesity estimates among U.S. adults: NHANES 1999–2008

Purpose: Estimating obesity prevalence using self-reported height and weight is an economic and effective method and is often used in national surveys. However, self-reporting of height and weight can involve misreporting of those variables and has been found to be associated to the size of the individual. This study investigated the biases in self-reporting of height and weight in the U.S. adult population and generated age-adjusted correction equations for self-reported height and weight separately for each ethnic group\u27s specific height and weight quartile sample. Validity of the body mass index (BMI) classification calculated from corrected self-reported height and weight was also examined. Method: Data on self-reporting and direct measurement of height and weight from National Health and Nutrition Examination Survey 1999–2008 were analyzed. The final sample included 11,521 men and 10,905 nonpregnant women who were all U.S. citizens aged 20 years or older. Results: A variation in misreporting of self-reported height and weight depended on the gender, ethnicity, age, and size of the individual. The results from sensitivity and specificity analyses showed that the BMI calculated from corrected values of self-reported height and weight provided more accurate estimations of overweight and obesity than did BMI calculated from self-reported height and weight. Conclusion: In spite of some methodological concerns, the correction equation of self-reported height and weight generated in this study can be utilized as a method for quick assessment of estimating the obesity and overweight prevalence in the U.S. adult population