Effects of technology-based interventions on dietary intake or anthropometrics among adolescents and adults in South Asia-A systematic review of intervention studies

Introduction: Mobile technology has been increasingly used as part of dietary interventions, but the effects of such interventions have not been systematically evaluated in the South Asian context. The systematic review aimed to determine the effects of technology-based interventions on dietary intake or anthropometrics among adolescents and adults in South Asia. Methods: Five electronic databases were searched (PubMed, Scopus, Web of Science, Global Health Library and Health Technology Assessment). Studies published in English between 1st January 2011 and 31st December 2021were included. Interventions that evaluated the effects of dietary interventions using technology on dietary outcomes and anthropometrics in adolescents or adults in the age group of 13-44 years (or a broader age group) from South Asia were eligible for inclusion. The risk of bias was assessed using the Cochrane Risk-of-bias 2 tool and ROBINS-I tool. A narrative synthesis was conducted. Results: Twenty-one studies met the inclusion criteria (20,667 participants). Eleven of the 17 randomised controlled trials (RCTs) had a high overall risk of bias. The four non-randomised intervention studies had a serious or critical overall risk of bias. When including studies with low risk or some concern for bias, the interventions had a beneficial effect on at least one dietary outcome in four of the six RCTs that measured changes in diet, and no effect on the anthropometric outcomes in the six RCTs that measured changes in anthropometric outcomes.Discussion: Technology-based dietary interventions have had some positive effects on dietary intake, but no effects on anthropometry in South Asia. More evidence is needed as the overall risk of bias was high in a majority of the studies.Peer reviewe

Assessing young unmarried men's access to reproductive health information and services in rural India

Peer reviewe

Male Involvement in Family Planning and Reproductive Health in Rural Central India

Lisääntymisterveyden parissa työskentelevät tutkijat, terveysalan ammattilaiset ja terveysohjelmien suunnittelijat, sekä päätöksentekijät ovat viime aikoina tulleet yhä tietoisemmisksi siitä, että miehet ovat avainasemassa lisääntymisterveyden edistämiseen tähtäävissä terveysohjelmissa. Miesten jättäminen tämän aluueen (mm. perhesuunnitteluohjelmien) ulkopuolelle johtaa siihen, että toivottuja tuloksia ei saavuteta. Tämä tutkimus toteutettiin maaseutualueella Madhya Pradeshin osavaltiossa Keski-Intiassa. Tutkimuksen tavoitteena on tarkastella miesten erityistarpeita perhesuunnittelu- ja lisääntymisterveysohjelmissa patriarkaalisessa ja patrilineaarisessa yhteiskunnassa. Tutkimuksessa selvittiin syitä, jotka estävät miehitä parantamaan omaasa ja kumppaninsa lisääntymisterveyttä. Tutkimuksessa käytettiin monitahoista lähestymistapaa, jossa yhdistyivät laadulliset ryhmäkeskustelut ja syvähaastattelut sekä tieto, asenne ja käytäntö (KAP) haastattelulomakeella tehdyt poikkileikkaustutkimukset. Ensisijaisina tutkimuskohteina olivat miehet, jotka olivat naimisissa 18-45-vuotiaiden naisten kanssa, sekä naimattomat 17-22-vuotiaat miehet. Toisena kohdetyhmänä olivat henkilöt, joilla oli olennaisesti vaikutusvaltaa pariskuntien perhesuunnittelu- ja lisääntymisterveysvalintoihin esim. anopit ja terveydenhuollon ammattilaiset Intian maaseudulla. Tämä väitöskirja on koostuu neljästä osatyöstä. Ensimmäisessä osatyössä analysoitiin miesten käyttämiä käsitteitä, tietoa, näkemyksiä perhesuunnittelusta yleensä ja erityisesti liittyen naisten sterilisaatioon. Tutkimusaineisto koostuu seitsemästä ryhmäkeskustelusta ja KAP poikkileikkaustutkimuksesta (n =793), jossa haastateltiin naimisissa olevia miehiä. Toisessa osatyössä haastatteluissa keskityttiin perheen keskinäisiin suhteisiin ja kommunikaatioon, sekä siihen miten nämä vaikuttavat ehkäisymenetelmän valintaan ja käytön ajoitukseen. Syvähaastattelut tehtiin 60 perheessä siten, että samanaikaisesti hasstateltiin miehiä, heidän 15-45-vuotiaita vaimojaan, sekä anoppeja (miehen äiti). Kolmas osatyössä arvioitiiin lisääntymisterveystiedon ja palveluiden saatavuutta 17-22-vuotiaiden naimattomien miesten parissa. Aineisto koostui neljästä ryhmäkeskustelusta sekä KAP- poikkileikkaustutkimuksesta (n= 316). Neljäs osatyö kartoitti terveystyöntekijöiden asenteita, vuorovaikutustaitoja ja motivaatiota osallistaa miehet olemassa olevissa lisääntymisterveysohjelmissa. Yhteensä 52 syvähaastattelua tehtiin maaseudulla toimivan terveydenhoitohenkilöstön keskuudessa. Intian maaseudulla asuvat miehet ovat kiinnostuneita lisääntymisterveydestä ja motivoituneita käyttämään mm. perhesuunnittelupalveluita jos niiden saatavuutta parannettaisiin. Miehet tarvitsevat lisää tietoa lisääntymisterveydestä ja palvelujen saatavuutta on parannettava erityisesti huomioiden miesten tarpeet ja asema perheen päätöksentekijänä. Tutkimustulokset osoittavat, että miesten näkemysten mukaan termi perhesuunnittelu (family planning) tarkoittaa naisen sterilisaatiota, joka on myös suosituin ja parhaiten tunnettu ehkäisymenetelmä miesten keskuudessa. Miehet liittivät muut tiedossaan olevat raskauden ehkäisymenetelmät vain raskauksien suunnitelmalliseen ajoittamiseen (child spacing). Perheissä anopeilla (miehen äiti) on vahva vaikutus naisten sterilisaation puolustajana. Anopin mielipiteen vaikutus muiden ehkäisymenetelmien käytössä on vähäisempi. Nuorilla naimattomilla miehillä ei ole riittävästi tietoa ehkäisymenetelmistä ja ehkäisymenetelmien saatavuus (kondomit) oli erityisen huono tässä ryhmässä. Intian valtion perheiden hyvinvointiin tähtäävät ohjelmat eivät huomioi riittävässä määrin miehiä. Julkisella sektorilla toimivaa terveydenhoitohenkilöstöllä ei ole riittävästi koulutusta ja keinoja osallistaa miehiä perhesuunnitteluohjelmissa. Terveyssektorilla tarvitaan lisää ohjausta, koulutusta ja tukea miesten osallistamiseksi lisääntymisterveysohjelmissa Intiassa ja vastaavissa maissa.Male involvement in reproductive health and family planning has recently been understood as an important area among reproductive health programme designers, policy makers, and population researchers for the overall reproductive well-being of the couple. Non-involvement of males in such areas contributes to major initiatives failing to achieve their desired objectives. To implement effective programmes to include men, it is therefore essential to first understand whether men are at all interested to be part of reproductive health programmes, and the barriers that they face while accessing services and how best can these be overcome. Despite almost two decades since the call to involve men actively in such programmes, men still feel ignored or are missing from such initiatives in India and other developing societies. The present study was conducted in rural central India in the state of Madhya Pradesh and the overall objective of this research was to examine men s family planning and reproductive health needs and constraints in an ideologically patriarchal and patrilineal society. The study investigated major factors that hindered men from seeking reproductive health information and services for enhancing their own and their partner s reproductive health situation. A mixed-methods approach was used, with a combination of qualitative focus group discussions and in-depth interviews, and quantitative Knowledge, Attitude, Practice surveys among different primary and secondary subjects. The primary research subjects were currently married (with wives in the reproductive age group of 15 45 years) and unmarried (aged 17 22 years) men. Secondary audiences included the mothers-in-law, wives of married men and the health care providers in rural India. This thesis is a compilation of four sub-studies. Sub-study I analysed male conceptualisation and perceptions of family planning, paying special attention to male knowledge, decision making and reliance on female sterilisation. A total of seven focus group discussions and 793 structured interviews among a representative sample of currently married men constituted this study. In sub-study II, intra-family relationships and communication, and their influence on choice of contraceptive method and timing of use were discussed. Family triad interviews were conducted among currently married men, their wives aged 15 45 years, and their mothers. A total of 60 family triads were conducted using in-depth interviews. Sub-study III assessed the accessibility of reproductive health information and services, and analysed the vulnerabilities of young, unmarried men aged 17 to 22 years. Four focus group discussions and 316 structured interviews in a representative sample were conducted among this group of respondents. Sub-study IV examined the extent, motivation and prevalence of village-level health workers interaction with men concerning reproductive health issues in rural central India and studied the existing public health care system and the reasons for the non-involvement of men in reproductive health care information and services. A total of 52 in-depth interviews among a range of rural health care providers were conducted. The study results bring out the following: a. Men conceptualised family planning to mean female sterilisation while contraception connoted spacing methods, and pointed to a clear male preference for female sterilisation as the preferred family planning method. b. The mother-in-law s role with regard to female sterilisation acceptance by the daughter-in-law continued to pre-dominate. However, her role with regard to couple s decision to accept reversible methods had considerably reduced. c. Young unmarried men lacked information on reproductive health issues and access to condoms, even in their own settings. d. Men felt ignored by the government health care providers who were yet not oriented towards involving men in reproductive health and family planning services. The results indicated that men were indeed interested and willing to be part of the broader reproductive health programme. However, they lacked sufficient knowledge to accomplish the same. Also, they lacked information and access to specific family planning services, for example, inter-personal discussions with health care providers on sexual and reproductive health. While government policies are in place to encourage male involvement in reproductive health, these policies have failed to be put in practice. A set of guiding principles needs to be developed to support those involved in the health sector to mainstream male involvement into reproductive health strategies in India and in comparable Eurasian developing societies

Assessing young unmarried men's access to reproductive health information and services in rural India

Abstract Background We investigated the accessibility of reproductive health information and contraceptives in a relatively less developed area of rural central India and assessed the risks facing young unmarried men. Methods This cross-sectional study used both qualitative and quantitative methods. Participants included 38 unmarried rural men in four focus-group discussions and a representative sample of 316 similarly profiled men, aged 17-22 years, in a survey. Information was collected on the men's socioeconomic characteristics; awareness, knowledge, and perceptions of family planning; attitudes toward future contraceptive use; intra-family communication; knowledge about STIs/HIV/AIDS; and access and use of condoms. Content analysis for qualitative information and descriptive analysis for survey data were used to draw conclusions. Results Young unmarried rural Indian men's sexual and reproductive health (SRH) knowledge is limited, although the majority is familiar with condoms (99%). The young men identified electronic mass media (67%) as the prime source of reproductive health information, yet they lacked detailed knowledge of various contraceptives and felt ignored by health providers, who, they felt, would be capable of providing SRH information through interpersonal communication. Young men are more concerned about avoiding infections and securing sexual pleasure and less concerned about avoiding potential pregnancies. For example, 68% of the young men were aware of condoms and their HIV/AIDS preventive role, but only about two-fifths mentioned condom use to prevent unwanted pregnancies. Although most young men (96%) knew where to access a condom, they felt uncomfortable or embarrassed doing so in their own villages or close by because of socio-cultural norms that prevented them from using contraceptives. Very few respondents (4%) disclosed using condoms themselves, but 59% said they knew someone from their peer group who had used them. Conclusions Young unmarried men in rural India are underserved with regard to SRH information and services, because they are not recognized as key targets under the public health system, and they receive their limited knowledge and information mainly from the mass media; this situation could be greatly improved by public health service providers. It is important that programmers involve young men with effective communication strategies to enable them to act responsibly with regard to their own sexual health needs.</p