Exploring Community Radio Programming Practices to Inform Environmental Education at Livingstone Museum in Zambia

This paper reports on a study (Muloongo, 2010) that investigated how participatory radio programming might be used to inform and extend museum-based community engagement in environment and sustainability concerns. Preliminary research on museum education practices established that these are primarily expert-led and centred on exhibitions and outreach, with limited participation by the community. The study was initiated after a brief experience of working on community radio that revealed a contrasting approach, including the community in discussing locally relevant content that was followed by the addition of the knowledge of a mediating expert.A collective case study (multi-site) design was used to probe educational programming practices used in community radio. The paper explores how community radio station programming engages listeners in community generated education programmes that are produced through collaborative work with radio listener clubs. Research on three cases of community radio programming concludes that community radio provides opportunities for community-led social learning which the Livingstone Museum could make use of to extend and localise its engagement with the community in environmental learning

Post-election challenges for Zambia

The two leading candidates in Zambia’s presidential election are in a tight race. The result will have a big influence on the country’s future economic directio

Policies Addressing Barriers to Low-Income Women and Children’s Health Care Utilization in the United States and Kenya: The Role of Physician Payments and Cash Transfer Programs

This dissertation examined two policies to improve low-income women and children’s healthcare utilization: physician payments and cash transfer programs. Higher physician payments increase the supply of healthcare services while cash transfers increase individuals’ demand for healthcare services. Cash transfer programs can improve health outcomes, yet the extent to which they are a cost-effective strategy is largely understudied. Therefore, this dissertation examines three overarching research questions: Are Medicaid physician fees associated with access to substance abuse disorder (SUD) treatment among low-income women of reproductive age? Do economic preferences moderate cash transfer program effects on children’s health care utilization? Evidence from a randomized field experiment in Kenya. Are cash transfer programs cost-effective in reducing infectious diseases amongst orphans and vulnerable children in Kenya? Broadly, the evidence from these papers suggests that supply and demand driven public policies increase the use of healthcare services for low-income women and children. Specifically, higher state Medicaid physician payments improve access to SUD treatment for low-income non-Hispanic Black women of reproductive age. Further, cash transfer programs improve the use of preventative healthcare services for children, and this impact is moderated by a caregiver’s time preference. Additionally, a cash transfer program is cost-effective in reducing illnesses amongst children compared to the status-quo. Policy makers should invest resources in policies supporting increased physician payments and cash transfers to improve low-income women and children’s health

Community radio and museum outreach: a case study of community radio practices to inform the environment and sustainability programmes of Livingstone Museum

This is a qualitative study whose purpose was to investigate the community radio education practices and the museum outreach education activities with a view to understanding how a museum-radio partnership may be used to engage the Livingstone community in environment and sustainability learning. Environment and sustainability issues require a community approach in order to bring about sustained responses to environmental challenges. As such, the study worked with social learning ideas of engaging the community in environment and sustainability learning. The data was generated mainly from face-to-face semi-structured interviews involving three community radio stations, Radio Listener Clubs and museum experts. The data generated was then presented to a strategy workshop involving the Livingstone Museum and Radio Musi-otunya staff. Arising from this workshop, recommendations were made about the possibility of the museum working in partnership with the radio to engage the community in environmental education. The study has shown that much of the museum environmental education activities have been confined to exhibitions and lectures within the museum building, which has affected the number of people being serviced by the museum. These education activities are arranged such that museum expert-led knowledge is presented to the audience with minimal community engagement on the environmental learning content. The study has also shown that community radio programming provides opportunities for community-led social learning which the Livingstone Museum could make use of to engage the community in environmental learning. Community radio programming allows community participation through Radio Listener Clubs, in identification and presentation of local environmental issues. This makes it a suitable tool to address locally relevant environmental issues, by the local community. Environmental issues are different from one place to another. Therefore environmental education approaches that bring issues into the museum may fail to address the different environmental education issues in different community context. The study concludes by recommending that Livingstone Museum should explore the use of community radio so that their expert knowledge and that of the radio producers could be used to shape environmental education programmes to go beyond awareness-raising

Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa

Introduction: We aimed to quantify and identify associated factors of linkage to HIV care following home-based HIV counselling and testing (HBHCT) in the ongoing ANRS 12249 treatment-as-prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa. Methods: Individuals ]16 years were offered HBHCT; those who were identified HIV positive were referred to cluster-based TasP clinics and offered antiretroviral treatment (ART) immediately (five clusters) or according to national guidelines (five clusters). HIV care was also available in the local Department of Health (DoH) clinics. Linkage to HIV care was defined as TasP or DoH clinic attendance within three months of referral among adults not in HIV care at referral. Associated factors were identified using multivariable logistic regression adjusted for trial arm. Results: Overall, 1323 HIV-positive adults (72.9% women) not in HIV care at referral were included, of whom 36.9% (n488) linked to care B3 months of referral (similar by sex). In adjusted analyses (n1222), individuals who had never been in HIV care before referral were significantly less likely to link to care than those who had previously been in care (B33% vs. 42%, pB0.001). Linkage to care was lower in students (adjusted odds-ratio [aOR] 0.47; 95% confidence interval [CI] 0.240.92) than in employed adults, in adults who completed secondary school (aOR0.68; CI 0.490.96) or at least some secondary school (aOR0.59; CI 0.410.84) versus 5 primary school, in those who lived at 1 to 2 km (aOR0.58; CI 0.440.78) or 25 km from the nearest TasP clinic (aOR0.57; CI 0.410.77) versus B1 km, and in those who were referred to clinic after ]2 contacts (aOR0.75; CI 0.580.97) versus those referred at the first contact. Linkage to care was higher in adults who reported knowing an HIV-positive family member (aOR1.45; CI 1.121.86) versus not, and in those who said that they would take ART as soon as possible if they were diagnosed HIV positive (aOR2.16; CI 1.134.10) versus not. Conclusions: Fewer than 40% of HIV-positive adults not in care at referral were linked to HIV care within three months of HBHCT in the TasP trial. Achieving universal test and treat coverage will require innovative interventions to support linkage to HIV care

The role of unrealistic absolute optimism in willingness to be treated and pay for medical services: The role of unrealistic absolute optimism

A large body of literature has shown that unrealistic absolute optimism plays an important role in the medical decisions. Yet, previous studies have largely overlooked how it might impact peoples’ willingness to pay and wiliness to treat for themselves and, importantly, for their child. In this online study with N = 355 participants were asked to rate how likely that both they and their child will experience the risks associated with several different medical procedures, and, thereafter, their willingness to pay and willingness to treat both themselves and their child. Participants generally exhibited unrealistic absolute pessimism, rating the likelihood of getting the side effect for themselves and for their child higher than the mid-point of the range of probabilities provided. Furthermore, participants who exhibited unrealistic absolute pessimism were more likely to agree to treatment while those who showed unrealistic absolute optimism were less likely to agree to treatment and had a lower willingness to pay for treatment. Our data reveals that, unrealistic absolute pessimism, rather than unrealistic absolute optimism, might be associated with greater intention to undergo treatment and willingness to pay for medical treatments

Acceptability of community-based adherence clubs among health facility staff in South Africa: a qualitative study

Patient retention in care for HIV/AIDS is a critical challenge for antiretroviral treatment programs. Community-based adherence programs (CBAPs) as compared to health care facility-based adherence programs have been considered as one of the options to provide treatment maintenance support for groups of patients on antiretroviral therapy. Such an approach provides a way of enhancing self-management of the patient’s condition. In addition, CBAPs have been implemented to support antiretroviral treatment expansion in resource-limited settings. CBAPs involve 30 patients that are allocated to a group and meet at either a facility or a community venue for less than an hour every 2 or 3 months depending on the supply of medication. Our study aimed to establish perceived challenges in moving adherence clubs from health facilities to communities

Acceptability of community-based adherence clubs among health facility staff in South Africa: a qualitative study

Ndumiso Tshuma,1,2 Ofentse Mosikare,1,2 Jessica A Yun,1 Olufunke A Alaba,3 Meera S Maheedhariah,4 Keith Muloongo,1,2 Peter S Nyasulu2,5,61Community AIDS Response, Johannesburg, South Africa; 2School of Health Sciences, Monash University South Africa, Johannesburg, South Africa; 3School of Public Health and Family Medicine, University of Cape Town, South Africa; 4Department of Human Behaviour, College of South Nevada and University of California, Los Angeles, CA, USA; 5School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 6Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South AfricaBackground: Patient retention in care for HIV/AIDS is a critical challenge for antiretroviral treatment programs. Community-based adherence programs (CBAPs) as compared to health care facility-based adherence programs have been considered as one of the options to provide treatment maintenance support for groups of patients on antiretroviral therapy. Such an approach provides a way of enhancing self-management of the patient’s condition. In addition, CBAPs have been implemented to support antiretroviral treatment expansion in resource-limited settings. CBAPs involve 30 patients that are allocated to a group and meet at either a facility or a community venue for less than an hour every 2 or 3 months depending on the supply of medication. Our study aimed to establish perceived challenges in moving adherence clubs from health facilities to communities.Methods: A qualitative study was conducted in 39 clinics in Mpumalanga and Gauteng Provinces in South Africa between December 2015 and January 2016. Purposive sampling methods was used to identify nurses, club managers, data capturers, pharmacists and pharmacy assistants who had been involved in facility-based treatment adherence clubs. Key-informant interviews were conducted. Also, semi-structured interviews were used and thematic content analysis was done.Results: A total of 53 health care workers, 12 (22.6%) males and 41 (77.4%) females, participated in the study. Most of them 49 (92.5%) indicated that participating in community adherence clubs were a good idea. Reduction in waiting time at the health facilities, in defaulter rate, improvement in adherence to treatment as well as reduction in stigma were some of the perceived benefits. However, security of medication, storage conditions and transportation of the prepacked medication to the distribution sites were the areas of concern.Conclusion: Health care workers were agreeable to idea of the moving adherence clubs from health facilities to communities. Although some challenges were identified, these could be addressed by the key stakeholders. However, government and nongovernmental organizations need to exercise caution when transitioning to community-based adherence clubs.Keywords: adherence clubs, antiretroviral therapy, HIV, health facility, chronic clubs, cohorts, patient retentio

The mediating role of self-efficacy in the relationship between premotivational cognitions and engagement in multiple health behaviors: a theory-based cross-sectional study among township residents in South Africa

Ndumiso Tshuma,1,2 Keith Muloongo,1,2 Emile S Nkwei,3 Olufunke A Alaba,4 Maheedhariah S Meera,5,6 Maboe G Mokgobi,2 Peter S Nyasulu2,7 1Community AIDS Response, Norwood, Johannesburg, 2School of Health Sciences, Monash South Africa, Johannesburg, 3Osmoz Consulting, Johannesburg, 4School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; 5Department of Human Behaviour, College of Southern Nevada, Henderson, NV, 6University of California, Los Angeles, Los Angeles, CA, USA; 7School of Public Health, University of the Witwatersrand, Johannesburg, South Africa Background: Noncommunicable diseases (NCDs) are one of the major global health challenges in developed countries and are rapidly increasing globally. Perception of self-efficacy is important for complex activities and long-term changes in health behavior. This study aimed to determine whether self-efficacy mediates the effect of individual beliefs (perceived severity, susceptibility, benefits and barriers) among informal settlement residents’ health behavior in relation to the prevention and management of NCDs. Methods: A cross-sectional survey was conducted using a closed-ended questionnaire among informal settlement residents in Diepsloot, Johannesburg. The proposed model was tested using structural equation modeling (AMOS software). Results: A total of 2,277 participants were interviewed during this survey, consisting of 1,236 (54.3%) females, with the majority of them aged between 20 and 29 years. All constructs in the questionnaire had a good reliability with a Cronbach’s alpha of >0.7. Perceived benefits and perceived barriers were the strongest predictors of self-efficacy, with the highest beta values of 0.14 and 0.15, respectively. Once associated with perceived self-efficacy, the direct effect of perceived susceptibility and perceived benefits on health behavior was statistically nonsignificant (P=0.0894 and P=0.2839, respectively). Perceived benefits and perceived susceptibility were totally mediated by self-efficacy. The indirect effects of perceived severity and perceived barriers (through self-efficacy) on health behavior were significant. Thus, perceived severity and perceived barriers were partially mediated by self-efficacy. Conclusion: Perceived susceptibility and perceived benefits did not affect health behavior unless associated with self-efficacy. In contrast, individual perception of the seriousness of NCDs and perceived barriers might still have a direct influence on health behavior even if the person does not feel able to prevent NCDs. However, this influence would be more significant when perceived severity and perceived barriers of NCDs are associated with self-efficacy. Keywords: perceptions, Diepsloot township, health belief model, noncommunicable diseases, perceived susceptibility, perceived barrier