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Global Health > Small Group Interventions > Flashcards

Small Group Interventions Flashcards

1
Q

SMALL GROUP INTERVENTIONS

A
  • change towards thinking about how people can change situations/health w/focus on small group interventions
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2
Q

KEY PRINCIPLES

A
  1. health beh = not really about correct knowledge; while it’s a prerequisite for health beh, it’s not sufficient
  2. health beh = linked to people’s identities/behs; meaningful to individuslas (even unhealthy)
  3. identities = constructed in situations NOT of people’s choosing; material/symbols/institutional contexts shape possibilities of people’s identities/behs
  4. powerlessness = important aspects of poor health
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3
Q

2 CRITIQUES

A
  1. technological solutions oft seen as solution to poor health BUT require people’s identites to change (ie. COVID-19 vaccines; uptake in people’s identities/alienation)
  2. health promotion interventions oft focus on either scaring into change (ie. smoking/alcohol) OR assume people lack knowledge/otherwise have deficit to fill
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4
Q

GRAM (2020): CLASSROOM, CLUB OR COLLECTIVE?

A
  • suggests 3 types of interventions to promote health = common:
    1. CLASSROOM
  • focused on transfer of knowledge/skills
    2. CLUBS
  • tranfer knowledge OR problem-solving
    3. COLLECTIVE
  • problem-solving & group action
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5
Q

THEORY OF WHY THEY WORK (I)

A
  • creation of “safe social spaces” via small groups; compromise 2 facets:
    1. space = safe; aka. trust/privacy/openness = possible
    2. dialogical communication can occur (in contrast to didactic communication); -> conscientisation; comprises of 3 aspects:
    i. KNOWLEDGE
  • correct/relevant knowledge introduced
    ii. DIALOGUE
  • open/honest discussion w/linked/trusted peers about sensitive topics
    iii. REFLECTION
  • reflect on knowledge/meaning; integrate it into current knowledge/identities
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6
Q

THEORY OF WHY THEY WORK (II)

A
  • participatory activities promote transfer of knowledge/dialogue/reflection -> dialogical communication
  • processes led by “facilitator”
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7
Q

PAULO FREIRE: KEY CONCEPTS

A

BANKING EDUCATION
PROBLEM-POSING EDUCATION
CONSCIENTISATION/CRITICAL CONSCIOUSNESS

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8
Q

FREIRE: BANKING EDUCATION

A
  • didactic education
  • students = empty vassals to be filled w/teacher’s wisdom
  • aka. knowledge = gift bestowed by the “knowledgable” upon those they consider to know nothing
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9
Q

FREIRE: PROBLEM-POSING EDUCATION

A
  • dialogue = heart
  • people’s knowledge/ideas = important BUT no real dif between teachers/students; rather knowledge = constructed BETWEEN people
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10
Q

FRIERE: CONSCIENTISATION/CRITICAL CONSCIOUSNESS

A
  • via dialogue (problem-posing) people understand “real” causes of their issues & how they may come together to challenge/change them
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11
Q

AUGUSTO BOAL: KEY CONCEPTS

A

FORUM THEATRE
- actors act out oppression scene
- spectators come up to try & change story once finished
REHEARSAL FOR REALITY
- aspects of illuminating how change can/may happen in safe spaces

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12
Q

TRANSFERRING IDEALISM OF FREIRE -> GLOBAL HEALTH PRACTICALITIES

A
  • how do we take Freire & others to implement in ways to use to improve people’s health & measure such changes?
  • via peer education & SGIs focusrd on problem solving approached underpinned by Freirian ideas
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13
Q

CASE STUDY: STEPPING STONES & CREATING FUTURES (BACKGROUND)

A
  • young people in urban informal settlements in South Africa experience multiple overlapping challenges (ie. high IPV perpetration & experience/poor mental health/substance abuse/HIV-incidence) driven by poverty (2/3rds young people = unemployed)/gender inequitable norms supporting of men’s power over women/other violence experiences in childhood/adulthood
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14
Q

CASE STUDY: STEPPING STONES & CREATING FUTURES (CONCEPT)

A
  • 2 components:
    1. transforming gender norms
    2. livelihood strengthening
  • 21 sessions; each 3h; primarily single sex
  • men/women AREN’T in relationships
  • delivered by trained peer-facilitarors
  • based on assumptions of participatory methodologies
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15
Q

CASE STUDY: STEPPING STONES & CREATING FUTURES (KEY CONCEPTS)

A
  • leanrer centred
  • participatory
  • skill-building (ie. communication/livelihood)
  • experience based
  • role plays/discussions/games
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16
Q

CASE STUDY: STEPPING STONES & CREATING FUTURES (METHODOLOGY)

A
  • ongoing qualitative process & outcomes evaluation incl.
    1. in-depth interviews w/20 men & women
    2. photovoice w/10 young women on reproductive choices
    3. facilitator observations/interviews
  • integrated cost-effectiveness analysis
17
Q

CASE STUDY: STEPPING STONES & CREATING FUTURES (FLOWCHART)

A
  • 34 clusters (n = 1360)
  • control = 17 clusters (340 women/men)
  • intervention = ^
  • intervention -> receive intervention
  • control/intervention = 12 & 24 month follow-up
18
Q

CASE STUDY: STEPPING STONES & CREATING FUTURES (MEN’S OUTCOMES)

A
  • self-reported IPV perpetration/alcohol use
  • sig reduction in past year physical/sexual perpetration (p = .019)
  • sig reduction in past year economic IPV perpetration (p = .035)
  • marginal reduction in past year non-partner rape perpetration (p = .1)
  • sig reduction in overall alcohol consumption in past year (p = .041)
  • sig increase in savings (totals & past month)
  • sig increase in past year work consistency (p < .001)
19
Q

CASE STUDY: STEPPING STONES & CREATING FUTURES (WOMEN’S OUTCOMES)

A
  • sig increase in working in past 3 months (p = .002)
  • sig increase in past year work consistency (p = .006)
  • sig increase in past month earnings
  • increased total amount saved
20
Q

WASHINGTON, JEWKES & GIBBS: ANALYSIS OF MEN CHANGING IN SSCF (CREATION OF SAFE SOCIAL SPACES)

A
  • establishment of egalitarian relations between facilitators/pps; aka:
    1. non-judgemental; open to speak/discuss freely
    2. sharing own stories/experiences
    3. emergence of brotherhood
21
Q

WASHINGTON, JEWKES & GIBBS: ANALYSIS OF MEN CHANGING IN SSCF (KNOWLEDGE)

A
  • practical skills to navigate livelihoods (ie. basic livelihood skills shared; experience of trying/receiving positive feedback)
  • communiation skills (ie. “I” statements)
22
Q

WASHINGTON, JEWKES & GIBBS: ANALYSIS OF MEN CHANGING IN SSCF (DIALOGUE & REFLECTION)

A
  • emotional impact/masculinity; challenged dominant ideas of non-expressive masculinities via sharing stories of shame/building trust, etc.
  • deconstructing ideals & managing anger/shame; many resisted unideal work; personal failings = collective challenge shaped by wider context; encouraged to accept other work; helped reduce shame/anger about position
  • shifts in relations w/women; recognised impact of power/control over others
23
Q

SSCF: WHY DIDN’T IT IMPACT WOMEN MORE?

A
  • little “space” for women to assert change in relations; intervention failed to engage women’s sexual partners
  • exceedingly high rates of poor mental health compounded by multiple/repeitive traumas; must be addressed before engaging in other life changes
  • high poverty rates; while earnings sig increased post intervention, overall earnings = still v low; aka. change = hard
24
Q

SSCF: NOT IMPACTING MEN EQUALLY

A
  • aka. limits of SGIs
  • LCA of SSCF to group men into 3:
    1. most violent (29.4%)
    2. medium violence (50.2%)
    3. lowest violence (NOT peaceful; 20.5%)
  • trial outcomes show impact of SSCF = on most violent (p = .014)
25
Q

SUMMARY

A
  • small group interventions = key approach to intervening to improve health BUT must:
    1. create safe spaces
    2. provide factual knowledge
    3. support pps to engage in dialogue about topic in open way
    4. support pps to reflect on new knowledge & integrate it into current world views (aka. rehearsal for reality)

Global Health (11 decks)

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