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Global Health > Facilitators > Flashcards

Facilitators Flashcards

1
Q

QUESTIONS ANSWERED

A
  • if peers resist then depends on facilitator skill (max 20/min 5 per group)
  • possibly work w/couples; working assumption if health issue/identity = dyadic components/social relations (ie. families)
  • addressing poor mental health = components of skills building around them
  • single sex is issues = strongly gendered as may work better BUT also opportunities to engage w/others
  • may not work for specific issues (ie. 1-off traumas)
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2
Q

EG. NEONATAL/CHILD MORTALITY

A
  • meta-analysis; 7 trials evaluating women’s groups practicing participatory learning/action (PLA) stages:
    1. identify/prioritise common maternal/newborn health issues in community
    2. discuss potential solutions & prioritise
    3. groups implemented chosen solutions
    4. evaluate progress & plan for future
  • found 20% reduction in neonatal mortality
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3
Q

EG. SELF-HELP GROUPS

A
  • impriving maternal/child/community health
  • 10-20 pps; 1-3y length
  • some evidence on risky sexual beh/knowledge of family planning services & methods
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4
Q

EG. MENTAL HEALTH

A
  • problem management & transdiagnostic psychological intervention for common mental health issues
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5
Q

EG. IPV

A
  • 30 studies on 27 unique RCTs
  • meta-analyses suggest community-lvl/group-based interventions reduced odds of women experiencing IPV in past year
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6
Q

EG. TYPE 2 DIABETES & INTERMEDIATE HYPERGLYCAEMIA

A
  • large reduction in combined prevalence of type 2 diabetes & intermediate hyperglycaemia in PLA group compared w/control at end of study
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7
Q

STEPPING STONED & CREATING FUTURES PLUS: INTERVENTION FLOWCHART

A
  1. TELLING MY STORY
  2. UNDERSTANDING MY NETWORKS
  3. BEING BETTER PARTNER
  4. MAKING LIVING
  5. POSSIBLE SELF
  6. SUPPORT GROUP
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8
Q

STEPPING STONED & CREATING FUTURES PLUS: INTERVENTION FLOWCHART (TELLING MY STORY)

A
  • listening skills
  • supporting conversations
  • deep breathing/centering/relaxatiin
  • understanding strengths
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9
Q

STEPPING STONED & CREATING FUTURES PLUS: INTERVENTION FLOWCHART (UNDERSTANDING MY NETWORKS)

A
  • who are your people?
  • how do we support each other?
  • strengthening such relations via better communication
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10
Q

STEPPING STONED & CREATING FUTURES PLUS: INTERVENTION FLOWCHART (BEING BETTER PARTNER)

A
  • sex & love
  • reducing conflict/violence
  • practicing communication
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11
Q

STEPPING STONED & CREATING FUTURES PLUS: INTERVENTION FLOWCHART (MAKING A LIVING)

A
  • generating resources
  • managing resources
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12
Q

STEPPING STONED & CREATING FUTURES PLUS: INTERVENTION FLOWCHART (POSSIBLE SELF)

A
  • goals/dreams/wishes
  • needs/wants
  • letting go of things that don’t work for you
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13
Q

STEPPING STONED & CREATING FUTURES PLUS: INTERVENTION FLOWCHART (SUPPORT GROUP)

A
  • supporting each other
  • making dif in community
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14
Q

JEWKES ET AL. (2021): EFFECTIVE VAWG PREVENTION STRATEGY FACTORS

A
  1. ESSENTIAL FEATURES OF DESIGN
  2. ESSENTIAL FEATURES OF IMPLEMENTATION
  3. ELEMENTS OF INTERVENTION DESIGN NECESSARY WHERE RELEVANT TO APPROACH
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15
Q

JEWKES ET AL. (2021): EFFECTIVE VAWG PREVENTION STRATEGY FACTORS (DESIGN)

A
  1. rigorously planned interventions w/robust theory of change rooted in knowledge of local context
  2. focused on multiple VAWG drivers (ie. gender inequity/poor communication)
  3. integrated support for violence survivors
  4. works w/women/men/(some) families
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16
Q

JEWKES ET AL. (2021): EFFECTIVE VAWG PREVENTION STRATEGY FACTORS (IMPLEMENTATION)

A
  1. optimal intensity; duration/frequency of sessions & overall programme length enabling time for reflection/experimential learning
  2. implementation by staff/volunteers; selected for gender equitable attitudes & non-violent beh; thoroughly trained/supervised/supported
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17
Q

JEWKES ET AL. (2021): EFFECTIVE VAWG PREVENTION STRATEGY FACTORS (NECESSARY WHERE RELEVANT)

A
  1. gender/social empowerment w/group activities & fostering positive interpersonal relations
  2. used group-based participatory learning methods (whether for adults/children) emphasising empowerment/critical reflection/communication/conflict resolution skill building
  3. carefully designed user-friendly manuals/materials supporting all intervention components to accomplish goals
  4. age-appropriate design for children w/longer time for learning/engaging pedagogy ie. sports/play
18
Q

WHEN DO INTERVENTIONS NOT WORK?

A

DELIVERY ISSUES
- facilitation/implementation challenges
THEORY ISSUES
- poorly conceptualised/adapted
- poorly understood issue
- addressing (wrong) drivers
CONTEXT ISSUES
- impact of social/political/institutional contexts

19
Q

MULTIPLE METHODOLOGIES & APPROACHES FOR PROMOTING DIALOGUE

A
  • Freire’s small groups (generative pictures)
  • Boal’s Theatre of the Oppressed/Forum Theatre
  • photovoice
  • participatory photography/video
  • drawings for social change
  • body mapping
  • spider diagrams
  • short sketches
  • community mapping
20
Q

MULTIPLE METHODOLOGIES, SIMILAR AIMS

A
  • make grand claims about impact on people’s lives
  • all approaches seek to do v similar things:
    1. draw out people’s own individual experiences (ie. recognition language NOT always best)
    2. encourage people to see similarities between one another
    3. encourage people to discuss similarities/difs/potential causes
    4. support people to reflect on this in lives
    5. try out dif ways of being in safe spaces
    6. act on social world
21
Q

WANG & BURRIS (1997): PHOTOVOICE

A
  • process via which people identify/represent/enhance community via specific photographic technique
  • places cameras into pps’ hands; immediatcy of visual images to “furnish evidence & promote effective participatory means of sharing expertise/knowledge”
  • emerged through 3 strands:
    1. health education based on Freire’s problem posing education (images created by people themselves)
    2. feminist theory (critiques of Freire aka. overly focused on men)
    3. documentary photography
22
Q

WANG & BURRIS (1994): EMPOWERMENT VIA PHOTO NOVELLA

A
  • more explicit about empowerment/social change aspects of photo novella:
    1. EMPOWERMENT VIA GROUP ACTIVITIES
  • photo novella; rural Chinese women discover common/dif views of world via large/small group discussions; talking about photos allows to find similarities/difs in how they’re raised as young girls/treated as wives/regarded as mothers
  • goal = large/small group dialogues to cultivate people’s activity to take individual/collective action for social change
    2. EMPOWERMENT VIA ENGAGING SOCIAL WORLD
  • empowerment incl. communicating identified needs to policymakers
23
Q

CAMPBELL & CORNISH (2012): EMPOWERMENT VIA PHOTO NOVELLA

A
  • explicit emphasis on ensuring photos = seen by people w/”power”
  • worked to create exhibitions & slide shows w/policy makers at them
  • pictures/words = evocative & create spaces for listening
  • require receptive listening environments (aka. where those w/power = willing to listen to “the poor”)
24
Q

LIEBENBERG (2018)

A
  • multiple reflective experiences -> making photographs + collective interpretation + dissemination (<- co-constructed meaning + themes/theories + issues/resources)
  • dissemination -> knowledge + action -> catalyst for change
25
Q

CRITIQUES OF PHOTOVOICE & SIMILAR PROCESSES

A
  1. SHORT RUN PROCESS
  2. LIMITED CONSIDERATION OF HOW GROUPS MAY NOY BE EQUAL
  3. LIMITED FOCUS ON SOCIAL ACTION
  4. EMPOWERMENT ASSUMED
  5. LITTLE SUSTAINED EVALUATION
26
Q

CRITIQUES OF PHOTOVOICE & SIMILAR PROCESSES: SHORT RUN PROCESS

A
  • pps require time to reflect on lives/experiences w/o which they simply replicate “dominant” narratives aka. reification of lived experience
  • one-off rathern than sustained engagement
  • individual/collective change takes time
27
Q

CRITIQUES OF PHOTOVOICE & SIMILAR PROCESSES: LIMITED FOCUS ON SOCIAL ACTION

A
  • focus on pretty pictures/photos rsther than social change
  • action = oft focused on “exhibitions” in wider world (aka. IRL change?)
28
Q

CRITIQUES OF PHOTOVOICE & SIMILAR PROCESSES: EMPOWERMENT ASSUMED

A
  • assumption that simply being part of process = beneficial
  • social worlds = NOT changed (aka. TAC body mapping)
29
Q

EMPOWERMENT

A
  • empowerment at dif lvls:
    1. INDIVIDUAL
  • feel listened to/heard/more confident/sense of self-efficacy
    2. GROUP
  • start to change identities/beh
    3. COLLECTIVE
  • start acting in world to make wider change/social action
30
Q

FACILITATORS DEFINITION

A
  • hidden people behind social change w/lives
  • academics oft play role of facilitators BUT…
    1. social world = dif
    2. language barriers
    3. not enough academics to go around
31
Q

ROLES IN SMALL GROUP INTERVENTIONS

A
  1. creation of safe spaces
  2. build relations w/pps & keep them happy
  3. use problem posing approaches rather than lectures
  4. provide correct knowledge
  5. check everyone participates in sessions
  6. potentially challenge people’s views
    - despite this v little research done to understand challenges of facilitating interventions in complex settings
32
Q

GIBBS ET AL. (2015)

A
  • implementing pilot of SSCF
  • 6 facilitators selected:
    1. 1 = from community BUT older (slightly better off)
    2. 5 = from outside
    3. all = some experience of group work (facilitation & FGDs)
  • trained over 5 weeks w/regular support
  • attended debrief sessions over weeks
33
Q

GIBBS ET AL. (2015): FACILITATORS

A
  • knew idea that participation = key ingredient
  • research project had multiple ideas of “success” beyond good facilitation
  • struggled w/role as facilitator rather than expert (aka. own histories)
  • wanting tangible success; demonstrations of beh change
  • had internalised many key ideas about what good “participatory” intervention programme work looks like BUT stuggled to achieve this:
    1. role of individual autonomy VS social structure (aka. basic ideas of what shapes beh)
    2. educational experiences in South Africa
    3. research project within which intervention is set
34
Q

GIBBS ET AL. (2015): HOW DO WE ADDRESS FACILITATORS?

A
  • training/support for facilitation
  • trying to balance competing demands of projects
35
Q

FACILITATORS & SOCIAL IDENTITIES

A
  • fundamental goal = to establish/maintain social identity
  • how do you do this within intervention setting?
  • how do facilitators navigate competing roles/positions they play?
36
Q

GIBBS ET AL. (2020): CONSTRUCTING, REPRODUCING & CHALLENGING MASCULINITIES

A
  • SSCF trial; 6 male facilitators
  • identified/privided w/training
  • data from:
    1. intervention observations (22 obvs)
    2. in-depth interviews (n = 8)
    3. FGDs (n = 4)
37
Q

GIBBS ET AL. (2020): TELLING STORIES

A

BONDING
- assert heterosexuality/relative financial wellbeing:
1. insulted by drunkard while sitting outside home
2. had few beers
3. facilitator(s) slept w/his gf; drinking/eating food on Florida Road

38
Q

GIBBS ET AL. (2020): JOKES

A
  • way of keeping people engaged
  • way of introducing sensitive topics
  • assert facilitators’ masculinity
  • assert dominance
39
Q

FACILITATORS & MASCULINITY

A
  • broadly suggest key aspect of facilitation lay in facilitators working to establish/maintain particular form of successful masculinity & deply this to encourage pps to change
  • 1st task = overt; set by intervention; namely challenging elements of pps’ youthful masculinity (ie. exerting violent power over women)
  • 2nd task = covert; specifically establishing credibility as men in pps’ eyes
40
Q

MCGEENEY (2015): COLLUSION

A
  • analysis; 1 group discussion; 6 young people (17-21y); all hetero
  • 3 adults/youth workers
  • discussion of “good”/”bad” sex in North London
  • safe space = subverted/taken over:
    1. conventional ground rules = thrown out
    2. inability to challenge discriminatory/sexist language
    3. choosing to engage > challenge (aka. laugh/approve)
41
Q

SUMMARY

A
  • range of activities can promote social change
  • limits to such activities:
    1. short run
    2. less focus on social action
    3. dif lvls of empowerment (ie. individual/group/collective)
  • facilitators = critical process:
    1. own histories make process challenging
    2. own social identities shape interactions
    3. may struggle to challenge dominant norms (aka. risk of collusion)

Global Health (11 decks)

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