Global health

Impact on men's attitudes and behaviours of a multi-component, gender-informed, father-inclusive intervention for early child development in Vietnam

Fisher J, Tran T, Nguyen T, Tran H.

Gender-based violence is prevalent in rural Vietnam, a country in which traditional gender norms are still widely adhered to. Overall, 27.3% of women who are pregnant have experienced at least one form of violence perpetrated by an intimate partner. In addition, during pregnancy, 32% of women report food insecurity, 20% have a BMI < 18.5, 80% are iodine deficient, 17% have iron deficiency anaemia and a third have clinically significant symptoms of the common mental disorders of depression and anxiety. Women in rural Vietnam are poor with average annual per capita incomes of USD2,800. These biological, psychological and social risks interact and lead to adverse maternal outcomes and compromised foetal and infant health and development.

The overall aim of this project is to ascertain whether participation in Learning Clubs, a multicomponent, gender-informed, father-inclusive program to improve early childhood development is associated with men having more equitable attitudes towards infant care and household work, and whether there are lower rates of gender-based violence perpetrated by men against their wives during pregnancy and in the first two postpartum years. This study is nested in the cRCT of the Learning Clubs program which aims to improve the health, growth and development of toddlers and the health of their mothers. The partners of women who are participating in the cRCT are being recruited for the sub-study.

Professor Fisher and colleagues received a World Bank Group’s Development Innovation Marketplace Award, via a competitive process from a global field of 240 applicants.

Living with COVID-19 restrictions in Australia

Fisher J, Kirkman M, Tran T, Hammarberg K, Sastry J, Nguyen, Rowe H, Popplestone S,
Stocker R, Stubber C.

During 2020, Global and Women’s Health conducted two anonymous online surveys to see how people in Australia were experiencing the COVID-19 pandemic and the restrictions that were necessary to contain it.

The first survey was launched in April 2020, four days after significant restrictions to limit the spread of COVID-19 were mandated in Australia. It attracted almost 14,000 responses from people aged from 18 to 90 years, from all Australian states and territories and from rural and urban areas.

This was the largest survey undertaken during the nationwide lockdown in Australia and the first to quantify the mental health impact of the restrictions. The survey found a widespread increase in psychological symptoms, including anxiety, depression, irritability and thoughts of being better off dead. The paper reporting the findings has been accepted for publication in the Medical Journal of Australia.

A second survey was conducted in July and August 2020 and secured 9,000 responses. The survey replicated the questions posed in the first survey and added questions asking what governments can do to help recovery. The findings of the survey will be made available soon on the Global and Women’s Health website.

This research was made possible by a generous donation from Professor John McBain and Dr Penny Foster. Neither the researchers nor the donors have any conflict of interest in the research.

Jane Fisher is supported by the Finkel Family Foundation which supports her position as the Finkel Professor of Global Health. Thach Tran is supported by a Monash University Senior Bridging Postdoctoral Fellowship.

Website

monash.edu/medicine/living-with-covid-19-restrictions-survey

Learning clubs to improve women’s health and infant’s health and development in Vietnam: a cluster randomised controlled trial of a low-cost, evidence-informed, structured psycho-educational program

Fisher J, Biggs B, Tran T, Luchters S, Tran TD, Hipgrave D, Tran H, Simpson J, Hanieh S, Nguyen T.

Optimal early childhood development is an international priority. Risks during pregnancy and early childhood have lasting effects because growth is rapid. We are testing whether a complex intervention addressing multiple modifiable risks: maternal nutrition, mental health, parenting capabilities, infant health and development and gender-based violence, is effective in reducing deficient cognitive development among children aged two in rural Vietnam.

The Learning Clubs intervention is an evidence-based program combining perinatal stage-specific information, learning activities and social support. It comprises 20 modules, in 19 accessible, facilitated groups for women at a community centre and one home visit. Content has been translated and culturally adapted for Vietnam and acceptability and feasibility established in pilot testing. This is, to our knowledge, the first trial to address eight risks to the early development of children in a multicomponent intervention in a resource-constrained setting.

Each of the program's 19 community-based facilitated group sessions provides mothers, fathers, and grandparents with access to learning activities, educational DVDs, and social support. The program's effectiveness is being investigated in a cluster randomised controlled trial in rural Vietnam.

We have partnered with the Research and Training Centre for Community Development (RTCCD)-Vietnam, University of Melbourne, Burnet Institute, and UNICEF for this project, which is funded by the National Health and Medical Research Council (NHMRC).

Protocol

Fisher J, Tran T, Luchters S, Tran TD, Hipgrave DB, Hanieh S, Tran H, Simpson J, Nguyen T, Le M, Biggs BA. Addressing multiple modifiable risks through structured community-based Learning Clubs to improve maternal and infant health and infant development in rural Vietnam: protocol for a parallel group cluster randomised controlled trial. BMJ Open. 2018 Jul 17;8(7):e023539. doi: 10.1136/bmjopen-2018-023539.

Learning Clubs to improve women’s health & infant’s health and development in Vietnam: a cluster randomised controlled trial to inform transition to scale

Fisher J, Luchters S, Tran TD, Le M, Nguyen T, Tran T, Tran H, Biggs B, Hanieh S, Nguyen V.

Grand Challenges Canada was supported by the Canadian Government to fund Bold Idea with Big Impact. One of their initiatives, Saving Brains, supports promising programs to improve the development of young children in resource-constrained settings throughout the first 1000 days of a child's development.

The Learning Clubs program was selected by Grand Challenges Canada for support. They provided funds to match the National Health and Medical Research Council funding to evaluate the economic impacts of the program, and to undertake additional analyses to identify how Learning Clubs works and what is needed to take it to scale in Vietnam. Grand Challenges Canada has provided active support to assist us to take the program to scale upon completion of the trial.

Protocol

Fisher J, Nguyen T, Tran TD, Tran H, Tran T, Luchters S, Hipgrave D, Hanieh S, Biggs BA. Protocol for a process evaluation of a cluster randomized controlled trial of the Learning Club intervention for women's health, and infant's health and development in rural Vietnam. BMC Health Services Research. 2019 Jul 23;19(1):511. doi: 10.1186/s12913-019-4325-5.

Health capability in a rural Swazi community caring for children affected by AIDS

Brear M (PhD candidate), Fisher J, Hammarberg K (Supervisors).

This was an ethnographic account of qualitatively-driven mixed-methods participatory action research (PAR) for health capability. The research aims were to generate knowledge about: (1) the process and outcomes of PAR, including empowerment; and (2) health capability, its enablers and deprivations; in a community caring for children affected by HIV and AIDS.

The research was conducted over an 18-month period, in partnership with lay “co-researchers” from a rural Swazi community caring for children affected by HIV and AIDS. The findings demonstrate that, from the perspective of community members and co-researchers, empowerment, as a multidimensional theoretical construct should be conceived as: a process of human development towards; and/or an outcome representing the realisation of, health capability for all. Extensive participation in PAR can enhance scientific knowledge creation and contribute to the empowerment of co-researchers. However, it does not negate the need for improved access to material resources to create enabling environments and secure empowerment, that is, health capability for all, in communities caring for children affected by HIV and AIDS.

Reported in:

Brear MR, Hammarberg K, Fisher J. Community participation in health research: an ethnography from rural Swaziland. Health Promotion International. 2020 Feb 1;35(1):e59-e69. doi: 10.1093/heapro/day121.

Brear MR, Shabangu PN, Hammarberg K, Fisher J, Keleher H. Community-based care of children affected by AIDS in Swaziland: a gender-aware analysis. Primary Health Care Research & Development. 2019 Jan;20:e15. doi: 10.1017/S1463423618000774.

Brear MR, Shabangu PN, Fisher JR, Hammarberg K, Keleher HM, Livingstone C. Health Capability Deprivations in a Rural Swazi Community: Understanding Complexity With Theoretically Informed, Qualitatively Driven, Mixed-Method Design, Participatory Action Research. Qualitative Health Research. 2018 Oct;28(12):1897-1909. doi: 10.1177/1049732318768236.

Brear M, Hammarberg K, Fisher J. Community participation in research from resource-constrained countries: a scoping review. Health Promotion International. 2018 Aug 1;33(4):723-733. doi: 10.1093/heapro/dax010.

Translation, cultural verification and formal validation of the Centre for Epidemiologic Studies Depression Scale – Revised (CESD-R) for young people in Indonesia

Fisher J, Tran TD, Le M, Azzopardi P, Kaligis F, Wiguna T.

The primary goal of this project was to improve the mental health of young people in Indonesia. In order to identify people needing mental health and social care, and to establish population burden, each country requires local language, culturally appropriate and psychometrically robust screening measures that are acceptable to members of the community, health professionals and policy-makers. This project contributed two translated, culturally verified, pilot-tested and formally validated psychometric instruments (the Centre for Epidemiological Studies Depression Scale – Revised and the Kessler psychological distress scale) for the identification of common mental disorders among young people in Indonesia. This project was funded by The Australia-Indonesia Centre. Our partner organisations for this project were: The Australian-Indonesia Centre, Burnet Institute, Universitas Indonesia.

Reported in:

Tran TD, Kaligis F, Wiguna T, Willenberg L, Nguyen HTM, Luchters S, Azzopardi P, Fisher J. Screening for depressive and anxiety disorders among adolescents in Indonesia: Formal validation of the centre for epidemiologic studies depression scale - revised and the Kessler psychological distress scale. Journal of Affective Disorders. 2019 Mar 1;246:189-194. doi: 10.1016/j.jad.2018.12.042.

Fisher J, Kaligis F, Tran T, Wiguna T. How we can help detect depression in our teens. The Conversation. 2018 Sep 10.

Strengthening mental health capacity and service integration in primary postnatal care in Victoria

Rowe H, Fisher J, Weller C, Campbell D, Meggetto K, Robertson J.

Postnatal mental health problems among women are associated with morbidity, reduced social participation, impaired infant development and family functioning, and constitute an Australian public health priority. Universal primary care health services (Maternal and Child Health and General Practice) are at the forefront of promotion, prevention and early intervention for postnatal mental health. However, they are under-resourced for these roles, and the two sectors are organisationally segregated. Health service reform to increase consistency of care and service integration, supporting a comprehensive stepped-care model of prevention, early intervention and treatment, is required.

What Were We Thinking (WWWT) is an evidence-informed, effective, acceptable, psycho-educational model of postnatal care that addresses known but neglected risks for mental health at this phase of life. It is non-stigmatising, and facilitates clinician professional development, parent skill-building, and identification of, and early intervention for, mental health problems. The Department of Health and Human Services Victoria commissioned Rowe and Fisher to implement WWWT in the Latrobe Valley (2018-2020).

The Flagship leveraged this project to bring implementation science experts and consumers together with key government, primary care, and community health partners to translate and scale up successful implementation of the reform. The Theoretical Domains Framework guided the investigation of stakeholder perspectives about required modifications and how to achieve and measure changes in barriers and enablers for implementation. The Flagship outcome was rigorously evaluated, producing practical implementation tools specifically for consumers, clinicians, and health services. The tools supported WWWT scale-up across Victoria and are readily transferrable to the implementation of other complex interventions and health settings.

This project was led by Global and Women's Health's Dr Heather Rowe. The project was funded through the 2019 Monash Partners Medical Research Future Fund (MRFF) Rapid Applied Research Translation funding round.

Actions louder than words: development of curriculum and course for health professionals and a mobile phone app for intrapartum women to actualize Respectful Maternal Care (RMC) in India

Fisher J, Sastry J.

In collaboration with JIPMER, a federally run medical college and hospital in Pondicherry, India, we worked to prevent the disrespect and abuse of mothers during childbirth, which had been widely reported from several low- and middle-income countries (LMICs), including India. The World Health Organisation had redefined the standards of respectful maternity care and had encouraged countries to adhere to them. Our intervention was to develop a core course to improve respectful maternity care through undergraduate training of health professionals and as continuing medical education for qualified professionals in India (and other LMICs).

In this project, we used mixed research methods to ascertain experiences of disrespectful care at JIPMER through surveys of women who had recently given birth and interviews with birth companions, labour room staff including interns, nurses, doctors, and senior faculty members, to understand factors that drove disrespectful care.

This project was funded by the Government of India – Ministry of Human Resource Development. This project was awarded to Dr Jayagowri Sastry and Prof Jane Fisher through an international competition of 25 countries around the world.

Safe Families multi-component qualitative research study – Solomon Islands

Trembath A, Greenwood K, Fulu E, Fisher J, Lees S, Dicker K, Puiahi D, Honda T, Tran T.

The Solomon Islands has one of the highest rates of family violence in the world. Safe Families is the first long-term, intensive, locally-developed community mobilisation-based violence prevention program to be implemented in Solomon Islands.

We aimed to evaluate the implementation of the Safe Families intervention, and to understand the processes of change to harmful social norms that drive family and sexual violence in two provinces in the Solomon Islands.

We sought to better understand and describe the context-specific responses of individuals, communities and agencies to the Safe Families model for violence prevention in the Solomon Islands, in order to inform optimisation and scale-up of the intervention. Additionally, we aimed to advance our understanding of how to conduct research on violence against women that is ethical, safe and rigorous in the context of small, geographically-disparate island communities where violence is relatively normalised.

Led by Oxfam Australia, other partners included Monash University and the Equality Institute. The project is funded by the World Bank’s Sexual Violence Research Initiative.

Defining the impact of universal iron interventions in young children: a randomised controlled trial in rural Bangladesh

Biggs B, Dibley M, Pasricha S, Arifeen S, Spelman T, Hamadani J, Grantham-Mcgregor S, Fisher J.

The World Health Organization (WHO) recommends universal distribution of anaemia control iron supplements or iron-containing multiple micronutrient powders (MMPs), with the goal of restoring developmental potential, health and wellbeing. However, it is increasingly uncertain whether universal iron interventions are a safe, beneficial and cost-effective public-health strategy in children in low-income (especially malaria endemic) settings. There is an urgent need to quantify the magnitude of benefit in functional outcomes from these interventions.

Although nearly half of the world's young children are anaemic, evidence regarding the best approaches to correct this problem is limited. New data even suggests that the conventional approaches (iron supplements, multiple micronutrient powders) may be harmful. We performed the definitive trial to confirm the existence and magnitude of any benefit (and harm) from these interventions in young Bangladeshi children. This trial informed global policy on anaemia control.

This University of Melbourne was the lead in this project, and partnered with Monash University, University of Sydney, International Center for Diarrhoeal Disease Research, Bangladesh, Burnet Institute, and the University College London (UCL). This project was funded by the National Health and Medical Research Council (NHMRC).