ORCID Profile
0000-0002-2335-160X
Current Organisations
Graduate Institute of International and Development Studies
,
University of Newcastle Australia
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Publisher: Public Library of Science (PLoS)
Date: 12-08-2020
Publisher: Oxford University Press (OUP)
Date: 21-03-2005
DOI: 10.1093/HER/CYH022
Abstract: Theory-based intervention programmes to support health-related behaviour change aim to increase health impact and improve understanding of mechanisms of behaviour change. However, the science of intervention development remains at an early stage. We present a causal modelling approach to developing complex interventions for evaluation in randomized trials. In this approach a generic model links behavioural determinants, causally through behaviour, to physiological and biochemical variables, and health outcomes. It is tailored to context, target population, behaviours and health outcomes. The development of a specific causal model based on theory and evidence is illustrated by the ProActive programme, supporting increased physical activity among in iduals at risk of Type 2 diabetes. The model provides a rational guide to appropriate measures, intervention points and intervention techniques, and can be tested quantitatively. Causal modelling is critically compared to other approaches to intervention development and evaluation, and research directions are indicated.
Publisher: BMJ
Date: 11-2018
DOI: 10.1136/BMJGH-2018-001183
Abstract: Different methodological approaches for implementation research in global health focusing on how interventions are developed, implemented and evaluated are needed. In this paper, we detail the approach developed and implemented in the COmmunity HEalth System InnovatiON (COHESION) Project, a global health project aimed at strengthening health systems in Mozambique, Nepal and Peru. This project developed innovative formative research at policy, health system and community levels to gain a comprehensive understanding of the barriers, enablers, needs and lessons for the management of chronic disease using non-communicable and neglected tropical diseases as tracer conditions. After formative research, COHESION adopted a co-creation approach in the planning of interventions. The approach included two interactions with each type of stakeholder at policy, health system and community level in each country which aimed to develop interventions to improve the delivery of care of the tracer conditions. Diverse tools and methods were used in order to prioritise interventions based on support, resources and impact. Additionally, a COHESION score that assessed feasibility, sustainability and scaling up was used to select three potential interventions. Next steps for the COHESION Project are to further detail and develop the interventions propositioned through this process. Besides providing some useful tools and methods, this work also highlights the challenges and lessons learned from such an approach.
Publisher: Informa UK Limited
Date: 09-10-2019
DOI: 10.1080/17441692.2019.1668453
Abstract: Chronic conditions are an increasing problem in Low- and Middle-Income Countries (LMICs) yet, the challenges faced by low-income populations with these conditions in such countries are not well understood. Based on in-depth interviews with people affected by chronic conditions and their family members, this paper describes the experience of patients suffering from diabetes or hypertension in rural communities of Mozambique, Nepal, and Peru. We analysed our data using the concepts of disruption and adaptive strategies, finding that despite being very different countries, the implications in daily lives, interpersonal relationships, and family dynamics are similar, and that oftentimes such impact is defined along gender lines. We show that adjustments to living with a chronic disease are not always easy, particularly when they imply changes and reconfiguration of roles and responsibilities for which neither the in idual nor their families are prepared. The study adds to the literature on the disruptive effects of chronic conditions and stresses the importance of contextualising disruptive experiences among disadvantaged populations within weak health systems. Our findings highlight the relevance of understanding the challenges of developing adaptive solutions to chronic care in resource-scarce contexts.
Publisher: Springer Science and Business Media LLC
Date: 30-11-2020
DOI: 10.1186/S12889-020-09800-4
Abstract: Male partners are rarely present during PMTCT (Prevention-Mother-To-Child-Transmission) services in Sub-Saharan Africa (SSA). Male involvement is increasingly recognised as an important element of women’s access to care. This study aims to identify the socio-demographic characteristics, HIV-Knowledge, Attitude and Practice (KAP) among women accompanied and not accompanied by their male partners. We included pregnant women enrolled in PMTCT programme between August 2018 and November 2019 in the Southern Region of Malawi. Eligible women were aged 18 years or older, living with a male partner, enrolled for the first time in one of the four selected facilities. We provided a KAP survey to women and their partners attending the facilities. Our primary objective was to assess and analyse the proportion of women who were accompanied by their partner at least once. We applied descriptive statistics and logistic regressions to study the association between being accompanied and explanatory variables. We enrolled 128 HIV-positive women: 82 (64.1%) were accompanied by their male partners and 46 (35.9%) were alone. In the multivariable model, women’s unemployment and owning a means of transport are negatively associated with male attendance (respectively adjusted OR 0.32 [95% CI, 0.11–0.82] and 0.23 [95% CI, 0.07–0.77]), whereas, in the univariable model, high women’s level of knowledge of HIV is positively associated with male attendance (OR 2.17 [95% CI, 1.03–4.58]). Level of attitude and practice toward HIV were not significantly associated to our study variable. Our study shows a high male attendance in Malawi compared to other studies performed in SSA. This study highlights that women’s level of knowledge on HIV and their economic condition (employment and owning a means of transport) affects male attendance. Moreover, the study points out that gender power relationships and stringent gender norms play a crucial role thus they should be considered to enhance male involvement.
Publisher: Cold Spring Harbor Laboratory
Date: 23-04-2020
DOI: 10.1101/2020.04.18.20070714
Abstract: Male partners are rarely present during PMTCT (Prevention-Mother-To-Child-Transmission) services in Sub-Saharan Africa (SSA). The involvement of men is increasingly recognised as an important element of women’s access to care. The study aims to identify the socio-demographic characteristics, HIV-Knowledge, Attitude and Practice (KAP) among women accompanied and not accompanied by the male partners to the facilities. We included pregnant women enrolled in PMTCT programme between August 2018 and November 2019 in the Southern Region of Malawi. Eligible women were aged 18 years or older, lived with a male partner, enrolled for the first time in four DREAM facilities. We provided a KAP survey to women and their partners attending the facilities. Our primary outcome was to assess and analyse the proportion of women who were accompanied by their partner at least once. We applied descriptive statistics, and logistic regressions to study the association between being accompanied and explanatory variables. We enrolled 128 HIV-positive women : 82 (64.1%) were accompanied by their male partners and 46 (35.9%) were alone. Women with high level of knowledge on HIV/AIDS are more likely to be accompanied by the male partners (53.7% vs 34.8%,p=0.040). Level of attitude and practice were not different between women accompanied or not. Patients owning a mean of transport were more likely to go alone to facility (OR 4.16, 95% CI 1.02-16.94). Women who travelled more than 90 minutes to get to the facilities (OR 0.10, 95% CI 0.02-0.49) with high HIV-knowledge (OR 0.38, 95% CI 0.16-0.91) are more likely to be accompanied. Our study showed a good male partner involvement compared to other studies performed in SSA. To our knowledge this is the first study outlining the relationship between male partner involvement in care with socio determinant of health. This is crucial to design and implement effective interventions.
Publisher: Public Library of Science (PLoS)
Date: 12-04-2023
DOI: 10.1371/JOURNAL.PGPH.0000808
Abstract: A growing body of work clearly documents the gendered inequalities in health. The COVID-19 pandemic further exposed these deep inequities: men appear to be more vulnerable to poorer outcomes, but most of the global health workforce is female who are at increased risk of exposure to hospital infection. However, researchers often fail to adequately embed gender as part of the public health research. This paper reports findings from a synthesis exercise that identified some of the challenges of integrating gender in the design and processes of research studies in four projects conducted in six low- and middle-income countries. Through a collective retrospective meta-synthesis process with researchers from each project, we identified two main themes (i) we deep e on two of the structural pillars of conducting public health research (design and process) and (ii) we describe some of the underlying opportunities and resistances to the integration of a gender perspective in these research projects. In conclusion, we suggest that public health funding bodies require researchers to integrate gender in public health research from early on as part of the design and to conduct gendered analysis, as part of the overall drive towards more equitable health systems delivery.
Publisher: BMJ
Date: 04-2020
Publisher: Oxford University Press (OUP)
Date: 16-05-2015
Publisher: Research Square Platform LLC
Date: 16-02-2021
DOI: 10.21203/RS.3.RS-240060/V1
Abstract: Background Noncommunicable diseases (NCD) are the leading cause of morbidity and mortality worldwide with a disproportionate burden affecting low- and middle-income countries (LMIC). Mozambique, is a low income country situated in Southern Africa with an emerging burden of NCDs, but still facing a large challenge with regards to communicable diseases. Using the policy prioritisation framework developed by Shiffman and Smith this study aims to present the different elements that have shaped the current policy landscape for NCDs in Mozambique. Results The policy review identified 18 documents, and seven KIs were interviewed. The policy community could be seen as cohesive in that a few leading experts in Mozambique agreed on both the challenges of NCDs and the possible response, but overall leadership was lacking. Although the Ministry of Health and its NCD Department were seen as the guiding institutions the Department was not resourced to be able to fulfil its mandate. Some external resources were available to assist, but these were insufficient. In addition civil society mobilisation was missing. With regards to ideas three disconnects were present: language used in overarching government documents and their translation into practice the views of experts and the perceptions of NCDs in a context like Mozambique in contrast to other health issues. The NCD Department and different strategies and government documents laid out the governing structure, but again a lack of resources h ered progress. This was compounded by a lack of understanding of the problem and solutions, as well as barriers to integrate the NCD response with HIV/AIDS for ex le. Conclusions This study shows that despite gaining prominence on the global health agenda, NCDs have yet to truly gain a strong foothold on the policy agenda of LMICs such as Mozambique. In order to do this both governments and donors need to be sensitised to this issue as well as clear guidance developed to enable countries to have practical solutions to address both prevention and treatment of NCDs in underfunded and weak health systems, but also be able to build on existing initiatives to improve the health and well-being of populations.
Publisher: Springer Science and Business Media LLC
Date: 06-03-2021
DOI: 10.1186/S12961-020-00646-1
Abstract: Addressing the uptake of research findings into policy-making is increasingly important for researchers who ultimately seek to contribute to improved health outcomes. The aims of the Swiss Programme for Research on Global Issues for Development (r4d Programme) initiated by the Swiss National Science Foundation and the Swiss Agency for Development and Cooperation are to create and disseminate knowledge that supports policy changes in the context of the 2030 Agenda for Sustainable Development. This paper reports on five r4d research projects and shows how researchers engage with various stakeholders, including policy-makers, in order to assure uptake of the research results. Eleven in-depth interviews were conducted with principal investigators and their research partners from five r4d projects, using a semi-structured interview guide. The interviews explored the process of how stakeholders and policy-makers were engaged in the research project. Three key strategies were identified as fostering research uptake into policies and practices: (S1) stakeholders directly engaged with and sought evidence from researchers (S2) stakeholders were involved in the design and throughout the implementation of the research project and (S3) stakeholders engaged in participatory and transdisciplinary research approaches to coproduce knowledge and inform policy. In the first strategy, research evidence was directly taken up by international stakeholders as they were actively seeking new evidence on a very specific topic to up-date international guidelines. In the second strategy, ex les from two r4d projects show that collaboration with stakeholders from early on in the projects increased the likelihood of translating research into policy, but that the latter was more effective in a supportive and stable policy environment. The third strategy adopted by two other r4d projects demonstrates the benefits of promoting colearning as a way to address potential power dynamics and working effectively across the local policy landscape through robust research partnerships. This paper provides insights into the different strategies that facilitate collaboration and communication between stakeholders, including policy-makers, and researchers. However, it remains necessary to increase our understanding of the interests and motivations of the different actors involved in the process of influencing policy, identify clear policy-influencing objectives and provide more institutional support to engage in this complex and time-intensive process.
Publisher: Wiley
Date: 09-08-2019
Publisher: Elsevier BV
Date: 03-2019
Publisher: Royal College of General Practitioners
Date: 10-2010
Publisher: Oxford University Press (OUP)
Date: 09-2020
DOI: 10.1093/EURPUB/CKAA165.1249
Abstract: Claire Somerville, PhD (Gender Centre, Graduate Institute of International and Development Studies, Geneva) will present research that investigates how gender and intersectionality analysis of NCDs is integrated into different levels of health policy and programming and within country level health systems and services by the World Health Organization (WHO). The research is the first of its kind and is based on a WHO document analysis and key informant interviews with key representatives working on issues of gender and NCDs within WHO. The findings of Somerville's investigation reveal how gender and its intersections is understood and mainstreamed at all three organizational levels of the WHO (headquarters (HQ), regions, and country level offices) and what the key impediments are not only in terms of mainstreaming a more relational and intersectional understanding of gender in general, but specifically in relation to NCDs.
Publisher: Public Library of Science (PLoS)
Date: 12-09-2019
Publisher: Informa UK Limited
Date: 18-05-2022
Publisher: Oxford University PressOxford
Date: 24-02-2022
DOI: 10.1093/OSO/9780192848758.003.0006
Abstract: The United Nations 2015 Sustainable Development Goal (SDG) for Gender Equality is an ex le of more than a century of global-level codification and commitment to the rights of women and equality of the sexes. Feminist activism and women’s movements of the past 150 years have contributed to ensuring issues around the position, conditions, and status of all women, men, and non-binary persons have remained present and on the agenda throughout the international system, from its margins to the center. The journey is far from over and this chapter adds a historical lens to contemporary concern around gender and decolonization, grassroots activism, and Black Lives Matter, and finally the gendered impact of the global pandemic.
Publisher: Oxford University Press (OUP)
Date: 06-2019
Abstract: Although non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, the global policy response has not been commensurate with their health, economic and social burden. This study examined factors facilitating and h ering the prioritization of NCDs on the United Nations (UN) health agenda. Shiffman and Smith’s (Generation of political priority for global health initiatives: a framework and case study of maternal mortality. The Lancet 370: 1370–9.) political priority framework served as a structure for analysis of a review of NCD policy documents identified through the World Health Organization’s (WHO) NCD Global Action Plan 2013–20, and complemented by 11 semi-structured interviews with key informants from different sectors. The results show that a cohesive policy community exists, and leaders are present, however, actor power does not extend beyond the health sector and the role of guiding institutions and civil society have only recently gained momentum. The framing of NCDs as four risk factors and four diseases does not necessarily resonate with experts from the larger policy community, but the economic argument seems to have enabled some traction to be gained. While many policy windows have occurred, their impact has been limited by the institutional constraints of the WHO. Credible indicators and effective interventions exist, but their applicability globally, especially in low- and middle-income countries, is questionable. To be effective, the NCD movement needs to expand beyond global health experts, foster civil society and develop a broader and more inclusive global governance structure. Applying the Shiffman and Smith framework for NCDs enabled different elements of how NCDs were able to get on the UN policy agenda to be disentangled. Much work has been done to frame the challenges and solutions, but implementation processes and their applicability remain challenging globally. NCD responses need to be adapted to local contexts, focus sufficiently on both prevention and management of disease, and have a stronger global governance structure.
Publisher: PeerJ
Date: 17-10-2017
DOI: 10.7287/PEERJ.PREPRINTS.3350V1
Abstract: Background. Social marketing influences behaviors to improve the health and wellbeing of in iduals and society, and this approach could be used in the field of public health for the prevention and control Neglected Tropical Diseases (NTDs). NTDs are diseases of poverty that place a burden in in iduals, communities and health systems, and that exacerbate the cycle of poverty. Differences in risk and socio-cultural factors make women and children differently vulnerable. Guided by the Hierarchical Model of Social Marketing, this systematic review will assess the breadth of coverage of social marketing interventions about the 17 World Health Organization’s priority NTDs. Additionally, it will use the WHO Gender Assessment Tool (GAT) to assess the gender responsiveness of the included interventions. Methods. This protocol follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Searches will be conducted in the databases of PubMed, EbscoHost, ProQuest, Web of Science (WOS), Global Index Medicus and Virtual Health Library (VHL) Regional Portal, and there will be no language restriction. Social marketing interventions implemented at the community, health facility and public policy settings will be included if they target an NTD it applies at least 1 of the 4 core social marketing concepts, and 1 of the 5 social marketing techniques as described in the Hierarchical Model of Social Marketing. Data management of records will be done in Covidence, a Cochrane systematic review platform, and of data extracted in Excel. The QATSDD Critical Appraisal Tool will be used to assess the quality of in idual studies in terms of how they report their research processes. Discussion. The results of this review will contribute to understand the social marketing concepts and techniques that have been used to address NTDs, and their behavioral determinants and behavioral outcomes. Furthermore, the results of this review will bring together the strengths from multidisciplinary fields by integrating gender, social marketing and NTDs in a systematic manner. Systematic review registration. PROSPERO CRD42017063858
Publisher: Informa UK Limited
Date: 02-01-2021
Publisher: Informa UK Limited
Date: 13-04-2022
Publisher: Elsevier BV
Date: 09-2016
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.SOCSCIMED.2007.12.010
Abstract: Symptoms play a crucial part in the formulation of medical diagnoses, yet the construction and interpretation of symptom narratives is not well understood. The diagnosis of angina is largely based on symptoms, but a substantial minority of patients diagnosed with "non-cardiac" chest pain go on to have a heart attack. In this ethnographic study our aims were to understand: (1) how the patients' accounts are performed or enacted in consultations with doctors (2) the ways in which ambiguity in the symptom narrative is managed by doctors and (3) how doctors reach or do not reach a diagnostic decision. We observed 59 consultations of patients in a UK teaching hospital with new onset chest pain who had been referred for a specialist opinion in ambulatory care. We found that patients rarely gave a history that, without further interrogation, satisfied the doctors, who actively restructured the complex narrative until it fitted a diagnostic canon, detaching it from the patient's interpretation and explanation. A minority of doctors asked about chest pain symptoms outside the canon. Re-structuring into the canonical classification was sometimes resisted by patients who contested key concepts, like exertion. Symptom narratives were sometimes unstable, with central features changing on interrogation and re-telling. When translation was required for South Asian patients, doctors considered the history less relevant to the diagnosis. Diagnosis and effective treatment could be enhanced by research on the diagnostic and prognostic value of the terms patients use to describe their symptoms.
Publisher: Springer International Publishing
Date: 2022
Publisher: BMJ
Date: 11-2021
DOI: 10.1136/BMJGH-2021-007225
Abstract: Since sex-based biological and gender factors influence COVID-19 mortality, we wanted to investigate the difference in mortality rates between women and men in sub-Saharan Africa (SSA). We included 69 580 cases of COVID-19, stratified by sex (men: n=43 071 women: n=26 509) and age (0–39 years: n=41 682 40–59 years: n=20 757 60+ years: n=7141), from 20 member nations of the WHO African region until 1 September 2020. We computed the SSA-specific and country-specific case fatality rates (CFRs) and sex-specific CFR differences across various age groups, using a Bayesian approach. A total of 1656 deaths (2.4% of total cases reported) were reported, with men accounting for 70.5% of total deaths. In SSA, women had a lower CFR than men (mean C F R d i f f = −0.9% 95% credible intervals (CIs) −1.1% to −0.6%). The mean CFR estimates increased with age, with the sex-specific CFR differences being significant among those aged 40 years or more (40–59 age group: mean C F R d i f f = −0.7% 95% CI −1.1% to −0.2% 60+ years age group: mean C F R d i f f = −3.9% 95% CI −5.3% to −2.4%). At the country level, 7 of the 20 SSA countries reported significantly lower CFRs among women than men overall. Moreover, corresponding to the age-specific datasets, significantly lower CFRs in women than men were observed in the 60+ years age group in seven countries and 40–59 years age group in one country. Sex and age are important predictors of COVID-19 mortality globally. Countries should prioritise the collection and use of sex-disaggregated data so as to design public health interventions and ensure that policies promote a gender-sensitive public health response.
Publisher: Informa UK Limited
Date: 20-01-2020
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: Switzerland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Claire Somerville.