Social relationships and postpartum depression in South Asia: a systematic review

Background: Evidence suggests a much higher prevalence of postpartum depression in South Asia than in ‘western’ contexts. Aim: To conduct a rapid systematic review of evidence on the association between social relationships and postpartum depression in South Asia. Methods: Five databases were searched to identify relevant studies. Studies meeting the selection and quality criteria were analysed and integrated in a narrative review. Results: Nine mostly quantitative studies were included in the review. Low support and poor relationships with the husband and parents-in-law were associated with postpartum depression, although associations were weakened in multivariate analyses. The different dimensions of support have not yet been systematically investigated and the likely complex interrelationships between social relationship risk factors are not yet well understood. Conclusions: Findings mirror those from ‘western’ contexts, showing the key role of social relationships in the aetiology of postpartum depression. Yet, they also reinforce the hypothesis that the social and cultural context influences the association. The importance of relationships with the extended family, as well as the husband, in South Asia is highlighted. Further research is recommended to develop an understanding of these relationships to better inform interventions

Best practice model for community capacity-building: A case study of community-based tourism enterprises in Kenya

As tourism continues to play a major role in the global economy, key international organisations, such as the United Nations World Tourism Organisation and the World Bank, have endorsed it as a tool for poverty alleviation particularly in sub-Saharan Africa. To address this endorsement, local community involvement in tourism development is now urgent. The Local Agenda 21, for instance, advocates for participative and collaborative approaches in which the local communities play a significant role in defining their development priorities. Community-based tourism enterprises (CBTEs), have been touted as a potential route through which local community involvement in tourism can be enhanced and that they significantly contribute to socio-economic development and consequently poverty alleviation. A previous study in Kenya confirms this but reveals that CBTEs face significant capacity challenges, including deficiencies in vision and leadership for tourism product development and marketing, entrepreneurial skills, business management skills and access to credit facilities or the mobilisation of resources. This paper, through a critical review of literature on capacity-building best practice, seeks to develop a best practice model for community capacity-building suitable for Kenyan CBTEs. The paper is developed using a multiple case study of six CBTEs and in-depth semi-structured interviews with CBTE managers and leaders, tourism academics, and representatives of support organizations and the Kenyan government. The respondents’ views are integrated into a unified best practice model using constructive and choice ordering projective techniques. The paper concludes with the identification of essential components for ensuring the effectiveness of community capacity-building – community approach, leadership approach, sustainable approach and an appropriate policy and legislative framework

Reviews

Rob Phillips, The Developer's Handbook to Interactive Multimedia, London: Kogan Page, 1997. ISBN: 0–7494–2121–5.241 pages. £22.50

Care-seeking for birth in urban India

The thesis examines care-seeking for first births in low-income settlements of urban India. Care-seeking is framed as a dynamic, social process. The thesis shifts the research focus from non-use of maternity services to a more holistic notion of care-seeking strategies, and examines how they are shaped by patterned social relationships and their content. The study combines a prospective, qualitative design with multiple household perspectives. Seventy-seven in-depth interviews were conducted in 16 households. Matched data were collected for primiparous women and other household members, and interviews were conducted prospectively during pregnancy with a follow-up after birth. The study was conducted in Indore, a large city in the central Indian state of Madhya Pradesh, where a range of maternity care providers operate in a complex urban health system. This population could be characterised as strategic care-seekers, aware and discriminating across the range of care options available. Managing perceived risks was central to strategies, but solutions differed due to variation in perceptions of risks and their management. The notion that childbirth requires medical management was dominant. Yet, health facilities were also regarded as a potential source of risk. Strategies were plural and contingent, combining different providers across and within sectors, giving households control and flexibility in dealing with unfolding circumstances. Local narratives apportion responsibility for care-seeking to the household in which the woman is staying for the birth. The value placed locally on household-level ‘responsibility’ contrasts with the focus on women’s autonomy in the literature on maternal health. A corollary of responsibility is blame in the event of an adverse outcome, which impels households to seek care that meets expectations among their social ties. The thesis generates new insight on an issue that has previously been examined largely with static approaches, underpinned by individual rational actor assumptions. Findings reveal care-seeking strategies that go beyond a decision on whether or not to use a health facility. This partly derives from a complex urban health system providing choice, but it is also a response to the challenges households face in negotiating the health system to receive care they perceive to be ‘safe.’ The findings have implications for the policy goals of increasing births with a skilled attendant and improving quality of care

Migrant Adolescent Girls in Urban Slums India: Aspirations, Opportunities and Challenges

Migrant adolescent girls in India’s fast-growing urban-slum population face multiple intersecting vulnerabilities, including gender, poverty and migrant-status. The study aims to understand the opportunities and challenges for migrant adolescent girls in low-income urban slum settings. Qualitative data were collected through interviews with girls aged 12-19 who migrated during the past two years and non-migrant adolescent girls for comparison to explore their experiences in fast-growing Indore. A groupinterview with slum women’s group members discussedways to address challenges. Push/pull factors linked with different employment/educational opportunities between rural and urban areas motivated families of unmarried girls to migrate. Recently married girls joined city-based families or accompanied husbands who were labor migrants. Neither married nor unmarried girls played decision-making roles in migration. Married migrant adolescent girls faced challenges in accessing education, employment, social opportunities and services owing to restrictions on freedom of movement, weak social networks, and little awareness of opportunities and services. Childbearing migrant girls faced particular risks. Contact with their natal families being limited, the quality of relationship with husbands and marital families was crucial for married girls’well-being. Unmarried girls attending schools were positive about the migration experience, perceiving the city to offer greater educational opportunities. Through school, they accessed opportunities for new relationships and social activities. Not all unmarried adolescent-girls wereable to access opportunities owing to family restrictions and economic circumstances. These girls’ worlds remained small despite moving to a large city. Where girls’ economic and/or family and social circumstances allowed, migration entailed a positive change that enhanced their opportunities. Specific challenges of this population segment need focus in policies and programs, prioritizing three particularly vulnerable groups: girls who are neither in education nor employment, pregnant girls or new mothers, and those with difficult relationships in marital homes. Proactive outreach to raise awareness about opportunities and services and fostering social networks through front-line workers and slum women’s groups are recommended

Reviews

Steve McDowell and Phil Race, 500 Computing Tips for Trainers, London: Kogan Page, ISBN: 0–7494–2675–6. Paperback, 160 pages, £15.99

Interventions to provide culturally-appropriate maternity care services: factors affecting implementation

Background The World Health Organization recently made a recommendation supporting ‘culturally-appropriate’ maternity care services to improve maternal and newborn health. This recommendation results, in part, from a systematic review we conducted, which showed that interventions to provide culturally-appropriate maternity care have largely improved women’s use of skilled maternity care. Factors relating to the implementation of these interventions can have implications for their success. This paper examines stakeholders’ perspectives and experiences of these interventions, and facilitators and barriers to implementation; and concludes with how they relate to the effects of the interventions on care-seeking outcomes. Methods We based our analysis on 15 papers included in the systematic review. To extract, collate and organise data on the context and conditions from each paper, we adapted the SURE (Supporting the Use of Research Evidence) framework that lists categories of factors that could influence implementation. We considered information from the background and discussion sections of papers included in the systematic review, as well as cost data and qualitative data when included. Results Women’s and other stakeholders’ perspectives on the interventions were generally positive. Four key themes emerged in our analysis of facilitators and barriers to implementation. Firstly, interventions must consider broader economic, geographical and social factors that affect ethnic minority groups’ access to services, alongside providing culturally-appropriate care. Secondly, community participation is important in understanding problems with existing services and potential solutions from the community perspective, and in the development and implementation of interventions. Thirdly, respectful, person-centred care should be at the core of these interventions. Finally, cohesiveness is essential between the culturally-appropriate service and other health care providers encountered by women and their families along the continuum of care through pregnancy until after birth. Conclusion Several important factors should be considered and addressed when implementing interventions to provide culturally-appropriate care. These factors reflect more general goals on the international agenda of improving access to skilled maternity care; providing high-quality, respectful care; and community participation

Perceived risk and risk-relievers in online travel purchase intentions

Although the Internet offers numerous benefits, some consumers are still reluctant to purchase travel products online due to perceived risk. Travel products are associated with higher risk not only because of their tangibility, but also because they typically involve higher cost and complex choices. Additionally, the perceived risk of purchasing travel products online is magnified by privacy and risk involved. This study investigates perceived risk associated with online travel purchasing by Taiwanese consumers with a special focus on their reaction to risk-relievers provided on travel websites. Data were collected through participant observation of the searching/purchasing process of online travel products by the Taiwanese consumers. The results show some risk-relievers are considered to be more effective in reducing perceived risk related to online travel purchase. Based on this finding, it is suggested that travel websites should try and develop risk-relievers aimed at supporting consumers in the prepurchase phase in order to reduce perceived risk, which may lead to positive online travel purchasing intentions. © Taylor & Francis Group, LLC

Problemau Awduraeth a Dilysrwydd y Cerddi a Briodolir i Dafydd ap Gwilym.

Bwriad y traethawd hwn yw edrych yn feirniadol ar rai o'r meini prawf a ddefnyddiodd Thomas Parry with lunio ei gasgliad o waith Dafydd ap Gwilym. Mae rhai beirniaid wedi codi cwestiynau ynghylch methodoleg Parry, yn eu plith Helen Fulton, a ganddi hi y ceir y syniad o ddadl gylch sy'n greiddiol i'r traethawd. Mae'r traethawd yn ceisio ymateb i'r cwestiwn sylfaenol a godir gan Fulton, sef, i ba raddau yr oedd Parry yn dewis a dethol cerddi i'w cynnwys yn y canon gan ddefnyddio tystiolaeth hollol wrthrychol ac i ba raddau yr oedd ei benderfyniadau wedi'u dylanwadu gan ei ragdybiaethau am y math o fardd oedd Dafydd ap Gwilym a'r math o waith a ganai? Mae'r traethawd yn edrych ar y ddadl gylch o sawl cyfeiriad. Yn gyntaf, mae'n crynhoi ac yn dadansoddi tystiolaeth y llawysgrifau cynharaf ac yn cynnig craidd o gerddi sydd i'w cael yn y llawysgrifau hynny. Defnyddir y dystiolaeth hon i edrych ar rai enghreifftiau penodol o'r anghysondeb sydd i'w weld yn y modd y cymhwysodd Thomas Parry y maen prawf hwn. Trafodir hefyd lawysgrif Hafod 26, a diddorol gweld cyfraniad y llawysgrif hon i'r canon. Yna, ystyrir rhai o'r casgliadau llai o waith Dafydd ap Gwilym mewn ymgais i greu craidd o gerddi poblogaidd neu graidd y tybir eu bod yn dangos canu Dafydd ar ei orau. Y cam naturiol wedyn yw gweld faint o orgyffwrdd sydd yna rhwng y ddau graidd o gerddi a gofyn a yw'r naill graidd neu'r llall yn cynnig modd o dorri'r ddadl gylch? Mae'r traethawd yn gorffen trwy ystyried elfennau mwy haniaethol gan ofyn a yw personoliaeth y bardd a'r weledigaeth a geir yn ei waith yn cynnig i ni ryw fodd o adnabod ei gerddi pan fo ystyriaethau eraill yn methu