Use, characteristics and influence of lay consultation networks on treatment-seeking decisions in slums of Nigeria : a cross-sectional survey.

To describe the use, characteristics and influence of lay consultants on treatment-seeking decisions of adults in slums of Nigeria. Cross-sectional survey using a pre-piloted questionnaire. Two slum communities in Ibadan city, Nigeria. 480 adults within the working age group (18-64). Most respondents (400/480, 83.7%) spoke to at least one lay consultant during their last illness/health concern. In total, 683 lay consultants were contacted; all from personal networks such as family and friends. No respondent listed online network members or platforms. About nine in 10 persons spoke to a lay consultant about an illness/health concern without intending to seek any particular support. However, almost all (680/683, 97%) lay consultants who were contacted provided some form of support. Marital status (OR=1.92, 95% CI: 1.10 to 3.33) and perceiving that an illness or health concern had some effects on their daily activities (OR=3.25, 95% CI: 1.94 to 5.46) had a significant independent association with speaking to at least one lay consultant. Age had a significant independent association with having lay consultation networks comprising non-family members only (OR=0.95, 95% CI: 0.92 to 0.99) or mixed networks (family and non-family members) (OR=0.97, 95% CI: 0.95 to 0.99), rather than family-only networks. Network characteristics influenced individual treatment decisions as participants who contacted networks comprising non-family members only (OR=0.23, 95% CI: 0.08 to 0.67) and dispersed networks (combination of household, neighbourhood and distant network members) (OR=2.04, 95% CI: 1.02 to 4.09) were significantly more likely to use informal than formal healthcare, while controlling for individual characteristics. Health programmes in urban slums should consider engaging community members so, when consulted within their networks, they are able to deliver reliable information about health and treatment-seeking. [Abstract copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

Systematic review of lay consultation in symptoms and illness experiences in informal urban settlements of low-income and middle-income countries

Objectives: Lay consultation is the process of discussing a symptom or an illness with lay social network members. This can have positive or negative consequences on health-seeking behaviours. Understanding how consultation with lay social networks works in informal urban settlements of low-income and middle-income countries (LMICs) is important to enable health and policy-makers to maximise its potential to aid healthcare delivery and minimise its negative impacts. This study explored the composition, content and consequences of lay consultation in informal urban settlements of LMICs. Design: Mixed-method systematic review. Data sources: Six key public health and social science databases, Google Scholar and reference lists of included studies were searched for potential articles. Eligibility criteria: Papers that described discussions with lay informal social network members during symptoms or illness experiences. Data analysis and synthesis: Quality assessment was done using the Mixed Methods Appraisal Tool. Data were analysed and synthesised using a stepwise thematic synthesis approach involving two steps: identifying themes within individual studies and synthesising themes across studies. Results: 13 studies were included in the synthesis. Across the studies, three main categories of networks consulted during illness: kin, non-kin associates and significant community groups. Of these, kin networks were the most commonly consulted. The content of lay consultations were: asking for suggestions, negotiating care-seeking decisions, seeking resources and non-disclosure due to personal or social reasons. Lay consultations positively and negatively impacted access to formal healthcare and adherence to medical advice. Conclusion: Lay consultation is mainly sought from social networks in immediate environments in informal urban settlements of LMICs. Policy-makers and practitioners need to utilise these networks as mediators of healthcare-seeking behaviours. PROSPERO registration number: CRD42020205196

Systematic review of educational interventions to improve the menstrual health of young adolescent girls

Objectives: To systematically review interventions that include an element of menstrual education delivered to young adolescent girls. Design: This was a systematic review and meta-analysis. Selected articles were quality assessed using the Mixed Methods Appraisal Tool quality appraisal checklist. A meta-analysis was conducted on a subset of articles, and the effect size of the intervention was calculated using Cohen’s d. A logic model was constructed to frame the effect of menstrual education interventions on menstrual health. Setting: Papers reporting on interventions in high-income and low-income and middle-income countries were sought. Information sources: Seven electronic databases were searched for English-language entries that were published between January 2014 and May 2020. Participants: The interventions were aimed at younger adolescent girls aged 10–14 years old. Interventions: The interventions were designed to improve the menstrual health of the recipients, by addressing one or more elements of menstrual knowledge, attitude or practices (KAP). Eligibility criteria: Interventions that had not been evaluated were excluded. Primary and secondary outcomes: The most common type of output was a difference in knowledge or skill score ascertained from a pre and post test. Some studies measured additional outcomes, such as attitude or confidence. Results: Twenty-four eligible studies were identified. The number of participants varied from 1 to 2564. All studies reported improvements in menstrual KAP. The meta-analysis indicates that larger effect sizes were attained by those that encouraged discussion than those that distributed pamphlets. Conclusions: Education interventions are effective in increasing the menstrual knowledge of young adolescent girls and skills training improves competency to manage menstruation more hygienically and comfortably. Interactive interventions are more motivating than didactic or written. Sharing concerns gives girls confidence and helps them to gain agency on the path to menstrual health. Trial registration number: For this review, a protocol was not prepared or registered

Lay consultation for treatment-seeking decisions in slums of Nigeria : a mixed methods study

Background Informal networks are important for social support for slum residents of Low and Middle-Income Countries (LMICs), where maintaining health is crucial for household income and formal healthcare provision is scarce. Consulting personal or online-based networks (known as lay consultation) during illness can influence personal treatment decisions, but there was scarce evidence from slums. This thesis aimed to (i) examine the use, characteristics and influence of lay consultation networks in slums of Nigeria, and (ii) explore experiences of using the networks. Methods A mixed-methods approach was adopted. A systematic review was initially conducted to synthesize evidence on lay consultation for symptoms and illnesses in slums of LMICs. A cross-sectional survey was conducted among adults in two slums in Nigeria to describe their lay consultation networks. This was followed by interviews to explore experiences of lay consultation in more depth. Key findings Most participants spoke to lay consultants during illness. The lay consultants used per illness episode were few and were mostly close network members. Use of online sources of advice was scarce largely due to poor access to smart devices and poor digital health literacy. Lay consultation was multi-dimensional, involving casual reporting of health concerns as part of daily bonding, exchanging advice and information about health, emotional and practical support. Lay consultation networks significantly influenced participants' choice of health care services. However, lay consultation had negative aspects, including facilitating the transfer of unhelpful advice, discriminating and stigmatizing people with certain characteristics and intruding on a patient’s privacy, contributing to worse health outcomes. Participants were strongly agentic in how they selected lay consultants and adopted advice from others. Conclusion This thesis highlights the potential of engaging lay consultation networks in health education interventions and creating a formal health resource as cost-effective means to support treatment decisions in slums