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PROCESS: a multimethods protocol to develop principles to operationalise community engagement, equity and sustainability in South Asian Health Research in Canada

Por: Banerjee · A. T. · Ismail · I. · Sarwar · A. · Parvez · M. · Desai · P. · Arora · M. · Jayaprakash · T. · Kalra · B. · Dulai · J. · Khan · B. · Chiu · M. · Rukh-E-Qamar · H. · Sabharwal · S. · Kaur · A. · Lal · A. · Khan · M. · Hassen · N. · Jassal · J. · Dasgupta · K. · Hafeez · H. · Arneja
Introduction

While health research about persons of South Asian ancestry has been conducted for decades in Canada, it often uses pathologising approaches that fail to consider historical, social and political factors shaping health disparities. Further, this research rarely engages South Asian communities in meaningful ways, reinforcing feelings of disconnect and longstanding mistrust. Greater collaboration and transparency are needed to build trust and generate credible findings. The aims of this research protocol are to (1) examine how community engagement has been implemented in health research involving South Asian populations, (2) explore the experiences of both South Asian community members and academics involved in community-engaged research and (3) develop a framework guiding health research with and for South Asian communities in Canada, titled PRinciples to Operationalize Community Engagement, Equity, and Sustainability in South Asian Health Research in Canada (PROCESS).

Methods and analysis

This ongoing codesigned concurrent multimethods study is being conducted with community partners across Canadian provinces. First, the scoping review is examining how community engagement has been operationalised in health research involving South Asian populations in Canada. We are performing a search in Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Web of Science, Scopus and PsycINFO databases for articles published between 2003 and 2024 referring to the concept of community engagement in South Asian health research. Two reviewers are independently completing abstract and full-text reviews based on preselected eligibility criteria. Data are being extracted from peer-reviewed studies using a data extraction framework. Findings will be aggregated and synthesised using descriptive content analyses. Second, a qualitative descriptive study is being conducted to explore the experiences of diverse stakeholders, including academics and community partners who are partaking in academic health research focused on South Asians. Semistructured interviews are being analysed using an inductive thematic content analysis. Results from the scoping review and qualitative interviews will be triangulated to detect emerging themes and patterns, which will enable the identification of principles to be incorporated within a draft of the PROCESS framework. In the final phase, we will use a modified Delphi process to iteratively codevelop the PROCESS framework with community partners and researchers across Canada.

Ethics and dissemination

The Faculty of Medicine and Health Sciences Institutional Review Board at McGill University approved the study’s protocol (24-05-080). Results will be submitted for publication in peer-reviewed journals and presented in academic and community forums. Results will also be shared with diverse audiences across Canada through multiple formats, including articles, conferences, infographics and social media, with the aim of raising awareness and promoting the adoption of research principles and practices for engaging South Asian communities in health research. This research received funding from the Canadian Institutes of Health Research (Grant #507768).

Prevalence and determinants of unintended pregnancy among female sex workers (FSW) in Jashore, Bangladesh

by Md. Masud Reza, Hasibul Hasan Shanto, Samira Dishti Irfan, A. K. M. Masud Rana, Mohammad Niaz Morshed Khan, Golam Sarwar, Mohammad Sha Al Imran, Mahbubur Rahman, Md. Safiullah Sarker, Muntasir Alam, Md. Abu Hena Chowdhury, Mustafizur Rahman, Sharful Islam Khan

Background

Unintended pregnancy among female sex workers (FSW) is a pressing reproductive health concern attributable to risky sexual behaviors, healthcare inequities and poor negotiation powers with male sex partners. However, evidence is scarce on the prevalence and determinants of unintended pregnancies among FSW, which is crucial for enhancing reproductive healthcare. This analysis aims to measure the prevalence of lifetime unintended pregnancies and their associated factors.

Methods

A cross-sectional study was conducted on 327 FSW in Jashore (a border belt district of Bangladesh) from September 2022 to March 2023. Participants were recruited through take-all sampling. Data were collected on the lifetime history of unintended pregnancies and other relevant variables through face-to-face interviews. Chi-square statistic was used to compare the characteristics of FSW reporting unintended pregnancies. To assess the net association of factors associated with unintended pregnancy, multiple logistic regression was applied.

Result

The lifetime prevalence of unintended pregnancies was reported at 75.8% (95%CI: 71.0–80.1). Among those who reported unintended pregnancies, 37.1% (95%CI: 30.8–43.8) had no education, 39.9% (95%CI: 32.8–47.5) were 25–34 years old, 49.6% (95%CI: 39.3–59.9) were currently married and 62.9% (95%CI: 49.7–74.4) earned ≤10,000 BDT per month compared to those who did not report lifetime unintended pregnancies. The likelihood of unintended pregnancies was significantly higher among those who reported having sex with non-transactional male sex partners (AOR: 2.4, 95%CI: 1.1–5.3, p = 0.036) than those who never had sex with any non-transactional male sex partner. The likelihood was also higher among those who reported rape in their lifetime (AOR: 2.0, 95%CI: 1.0–3.8, p = 0.037) and who self-reported mental health problems (AOR: 2.1, 95%CI: 1.0–4.2, p = 0.045) within the past year, compared to their counterparts.

Conclusion

This study highlights the considerable prevalence and associated determinants of unintended pregnancies among FSW in Jashore. These determinants need to be considered to strengthen reproductive healthcare interventions and policies for FSW. Reproductive health of FSW cannot be improved unless these factors are addressed in the ongoing interventions.

Exploring the feasibility and acceptability of DIALOG+ (a structured digital communication tool) in strengthening psychiatric care in India and Pakistan: a qualitative pilot study

Por: Qureshi · O. · Divya · K. · Dawood · M. · Davis · S. · Venkatraman · L. · Baig · M. · Priya · K. · Peppl · R. · Pari · M. · Ramachandran · P. · Pasha · A. · Sajun · S. Z. · Sarwar · H. · Shahab · A. · Bird · V. J.
Objectives

To assess the implementation feasibility and acceptability of a structured digital psychosocial communication tool (DIALOG+) to strengthen the quality of person-centric care in psychiatric settings within Pakistan and India.

Design

A hybrid inductive and thematic qualitative analysis using individual interviews (IDIs) and focus group discussions (FGDs).

Setting

Two psychiatric hospitals (Karwan-e-Hayat and Jinnah Postgraduate Medical Centre) in Karachi, Pakistan and one psychiatric care organisation (Schizophrenia Research Foundation) in Chennai, India

Participants

Interviews were conducted with 8 mental health clinicians and 40 patients who completed the DIALOG+ pilot as well as wider stakeholders, that is, 12 mental health clinical providers, 15 caregivers of people with psychosis and 13 mental health experts.

Intervention

A technology-assisted communication tool (DIALOG+) to structure routine meetings and inform care planning, consisting of monthly sessions over a period of 3 months. The intervention comprises a self-reported assessment of patient satisfaction and quality of life on eight holistic life domains and three treatment domains, followed by a four-step solution-focused approach to address the concerns raised in chosen domains for help.

Outcome measures

Key insights for the implementation feasibility and acceptability of DIALOG+ were assessed qualitatively using inductive thematic analysis of 22 IDIs and 8 FGDs with 54 individuals.

Results

Clinicians and patients ascribed value to the efficiency and structure that DIALOG+ introduced to consultations but agreed it was challenging to adopt in busy outpatient settings. Appointment systems and selective criteria for who is offered DIALOG+ were recommended to better manage workload. Caregiver involvement in DIALOG+ delivery was strongly emphasised by family members, along with pictorial representation and relevant life domains by patients to enhance the acceptability of the DIALOG+ approach.

Conclusion

Findings highlight that the feasibility of implementing DIALOG+ in psychiatric care is closely tied to strategies that address clinician workload. Promoting institutional ownership in strengthening resource allocation is essential to reduce the burden on mental health professionals in order to enable them to provide more patient-centric and holistic care for people with psychosis. Further research is required to explore the appropriateness of including caregivers in DIALOG+ delivery to adapt to communal cultural attitudes in South Asia.

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