Partner Organization: NYU Langone Medical Center and Regional Institute of Population Studies (RIPS)
Diabetes prevalence in many African countries is increasing rapidly. Neglect of the social and psychological dimensions of the diabetes experience in current research presents an opportunity to better understand the perceptions and knowledge of the urban poor who are largely suffering from diabetes mellitus in cities like Accra, Ghana. Results from individual qualitative interviews identify perceptions of diabetes that are interrelated with an individual’s behavior and support networks. Knowledge and perceptions appear related to health‐seeking behaviors, an absence of psychosocial support and to health outcomes. Our findings suggest a need for: population‐based approaches to educate the community about diabetes and pre‐diabetes risk; lifestyle interventions to reduce glucose levels below the threshold criteria for pre‐diabetes; increased access to medications and monitoring of diagnosed patients; and programs that bridge gaps between health professionals and religious leaders to improve health outcomes.
Partner Organization: Population Council
Ghana is subject to periodic flooding during the major rainy season in April-July. The urban poor in the capital of Accra are especially vulnerable to the effects of flooding due to poorly and often illegally built structures, overcrowded living conditions, and inadequate sewage and drainage systems that are often clogged with refuse. To better understand the concerns of those living in the slums and identify measures to reduce the impact of future floods, we conducted in-depth interviews, focus group discussions and community participatory mapping sessions in the coastal slum communities of Chorkor and Sukura. Our results suggest that inadequate water and sanitation infrastructure and inattention to the problems by government officials are perceived as primary drivers of flooding. Unexpectedly, we also identified a weak sense of community, partially a result of distrust of neighbors, unauthorized building and land disputes. Recommendations for community building and community-based flood mitigation strategies are presented.
Partner Organization: NYU Center for Healthful Behavior Change
Cardiovascular diseases (CVD) have become a leading cause of mortality in Ghana. Given Ghana's resource constraints, a cost-effective, population-based primary prevention strategy is needed. This project examined the feasibility of using community health workers (CHW) to implement a CVD prevention program in faith-based organizations (FBO) in Accra. We utilized a mixed-method study design, including qualitative and quantitative data collection. We evaluated the following: 1) capacity of FBOs in health program delivery; 2) feasibility to have CHWs deliver a CVD prevention program in FBOs; 3) potential barriers in CVD program implementation and sustainability, and 4) church members' level of CVD knowledge. Results indicate that FBOs play an important role in community members' health in Accra, and the proposed FBO preventive approach is feasible. However, there are several social-cultural as well as existing health-care factors that need to be considered in CVD program and policy planning.
Partner Organization: The Longevity Project
Maternal mortality is a problem worldwide, but is particularly devastating in developing countries. A large number of determinants contribute to maternal mortality rates. In addition to the obvious direct obstetric and medical factors, innumerable socioeconomic, cultural, and structural factors play a role. Some research suggests increasing women's knowledge regarding pregnancy, labor, and delivery may positively influence a number of the factors contributing to maternal mortality. On this premise, this study investigated the status of antenatal education and the antenatal learning needs in Accra, Ghana. Through the use of qualitative methods, the Capstone team conducted participant observation, key informant interviews, focus group discussion with local midwives, and semi-structured interviews with pregnant and recently-delivered Ghanaian women. The final report addresses three key themes: perceived and observed antenatal knowledge gaps; use of storytelling as a method of knowledge transfer within this population; and the emerging role of the hospital as a key supporter in pregnancy and childbirth
Partner Organization: New York City Poison Control Center, as an affiliate of the Department of Emergency Medicine, New York University School of Medicine
Poisoning is a common cause of morbidity and mortality throughout the developing world. An assessment of household poisons including exposure to unintentional poisoning and barriers to safe storage was conducted during a field study in Accra, Ghana in January 2009. In conjunction with the NYC Poison Control Center and the Ghana Poison Information Consultation Centre, this Capstone team examined health-seeking behaviors in the Greater Accra community. Mixed method interviews with community members revealed incidences of kerosene exposure in children due to improper storage practices. Key findings also included the widespread use of palm oil as a first aid technique for kerosene ingestion. Other exposures included ingestion of adult medications, alcohol poisoning, and accidental ingestion of pesticides and rodenticides. A prevention campaign addressing storage of toxic substances and appropriate first aid is essential in improving health outcomes. Successful intervention campaigns must also address deeply held cultural beliefs and health behaviors.
Partner Organization: Africare Liberia
The maternal mortality ratio in Liberia is one of the highest in the world. Despite services being free, women’s clinic utilization rate remains low. To better understand what motivates women to seek care at health facilities, this study explored factors and patterns of maternal healthcare services utilization with a focus on individual and program‐level indicators. The study utilized a mixed methods approach consisting of quantitative surveys and focus group discussions with women of reproductive age, and in‐depth interviews with healthcare providers in Bong County. Motivating factors identified by this study fall under one of the following categories: awareness/education, accessibility, autonomy, and availability. Our results suggest that community outreach and health education efforts, as well as good quality care and services were important factors that motivated women to utilize clinic‐based services. Women’s autonomy, age, and knowledge of family planning also played a role in shaping their healthcare utilization patterns.
Partner Organization: Concern Worldwide Liberia
While Liberia is not characterized by the extremely high HIV prevalence of some other African countries, HIV remains a pressing health concern for this West African nation. The 2007 Liberian Demographic Health Survey indicated that 1.5% of Liberians aged 15‐49 are infected with HIV, with women and urban dwellers disproportionately affected. To inform evaluation efforts of future HIV/AIDS prevention programs, an HIV/AIDS Knowledge, Attitudes and Practices (KAP) survey was designed and implemented in consultation with Concern Worldwide Liberia. Ten trained local interviewers collected data from 876 study participants residing in 8 identified communities within Montserrado County that had been the focus of HIV/AIDS information and outreach campaigns by Concern Worldwide. The survey instrument was refined using insights from local research partners and enumerators. Study findings underscore the disconnect between knowledge and practice. Compared to knowledge about risk factors for HIV/AIDS transmission, demographic variables were stronger predictors of risk‐taking behavior.
Partner Organization: Africare Liberia
Approximately 22.4 million people are living with HIV/AIDS in sub-Saharan Africa. Poverty and inadequate human resources prevent many in Liberia and other rural areas of Africa from accessing treatment. HIV prevalence in Liberia remains low for the region at 1.5 percent, but rates are growing. It is an opportune moment for Liberia to establish effective programs for People Living with HIV/AIDS (PLWHA). In collaboration with Africare, a formative, qualitative evaluation of existing services and HIV care needs was conducted in the community of Bong County, Liberia. Focus groups and key informant interviews were conducted with community health volunteers, community members, HIV-positive individuals, and community stakeholders. A grounded theory approach was used in data analysis. Themes that emerged regarding barriers to health care access include: lack of basic resources, HIV stigma, and social support needs of PLWHA. Results from this evaluation informed our recommendations for scaling up HIV services in Bong County.
Partner Organization: University of Cuttington
Monrovia and Bong County, Liberia
The aim of this study was to assess the relative importance of socio-cultural and health service factors that influence women's decisions regarding the place of delivery (home vs. hospital) which, in turn, have a great impact on maternal mortality. We conducted a qualitative study consisting of interviews and focus groups with pregnant women attending antenatal clinics, family members of women who died during childbirth, and health providers. All interview transcripts were analyzed using a qualitative thematic content approach. A number of themes emerged with regard to the care-seeking behavior of women during pregnancy and childbirth - behavior that is influenced by transport and distance to care; economic constraints; the process of labor; risk perceptions, and the knowledge of possible complications during childbirth. Implications for maternal health are discussed, highlighting the need to improve the quality and accessibility of available maternal care and to address the underlying educational and attitudinal issues of women and health providers.
Partner Organization: Siyakhana Bezuidenhout Park Permaculture Project, University of Witswatersrand
This capstone team was invited to perform an evaluation of the Siyakhana Bezuidenhout Park Permaculture Project with particular emphasis on the effect the program has had on the lives of the gardeners employed by the project. The research was undertaken in collaboration with the University of Witwatersrand (Wits) School of Public Health. The Siyakhana Food Garden Project, an inner-city food garden, aims to offer life skills, healthy lifestyles, permaculture and income generation to children attending Early Childhood Development Centers and people living with HIV/AIDS. The evaluation of the garden took place over the course of a 7 month period, including a 10 day visit to Johannesburg to meet with the gardeners and other key actors related to the program. The goal was to provide insight as to how to improve the function of the garden and promote long term sustainability of the project.
Partner Organization: International Help Uganda Grow (iHUG) and the Kabalagala Community Academy
Many parents living in Kabalagala, Kampala, Uganda experience poverty, low literacy rates, unemployment, chronic infectious disease and mental health problems. These problems, combined with a shortage of health care services and providers, may lead to psychological distress. Parents who suffer from psychological distress have difficulty nurturing their children, which impacts normal growth and development. At Kabalagala Community Academy, teachers and staff are attuned to changes in a child's behavior and performance in school that may signal problems at home. Enlisting the help of schools in providing basic mental health and supportive resources for parents is a novel way of assisting the family unit. This descriptive, qualitative study utilized key informant interviews with parents, teachers, staff and local mental health care professionals to identify factors that they perceive as contributing to parental psychological distress. Content analysis of key themes provides suggestions for potential school-based mental health and supportive services.
Partner Organization: Global Business Coalition on HIV/AIDS, TB, and Malaria
Malaria is a significant global health problem, especially in Sub-Saharan Africa where it continues to be a major cause of morbidity and mortality. Ninety percent of the global malaria burden is concentrated in the Sub-Saharan region, presenting a severe obstacle to economic development. Access to preventive and interventive strategies including anti-malarial drugs, insecticide-treated bed nets (ITNs), and long lasting insecticide-treated bed nets (LLINs) have been central to the promotion of malaria health. LLINs are unique in that the netting material is impregnated with insecticide, eliminating the need for re-treatment of ITNs. This Capstone project involved seeking information from experts in the field of malaria control to assess suitable strategies that might be adopted to ensure proper usage of bed nets and replacement of LLINs after their expiry. Specifically the team studied treatment-seeking behaviors as well as the usage and maintenance of ITNs and LLINs by cement factory employees and community members in Kasese, Uganda.
In partnership with Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria
Partner Organization: Concern Worldwide Zambia
Concern Zambia, a branch of the non-governmental organization Concern Worldwide, implemented the "Positive Living Program" for People Living with HIV/AIDS (PLWHA) four years ago in the Western Province of Zambia. The current rate of HIV infection in this district is around 14 percent. With approximately 200 functional support groups of around 20 members each, Concern estimates they are reaching 7-10 percent of the HIV population in this area with this program of psycho-social support, health/nutrition education, and resource distribution. The purpose of this project was to evaluate the program's implementation and efficacy, and to provide recommendations for future programming and curriculum development. The evaluation was based on key informant interviews of staff and program participants, and direct observation of support groups. Program recommendations are made based on the following key themes identified through the evaluation: stigma reduction/psycho-social support; health and nutrition; agricultural assistance/resource distribution; male participation, and future programming/sustainability.
Partner Organization: Concern Worldwide Zambia
HIV prevalence rates in the Western Province of Zambia continue to rise despite the lowering national trend. Studies implicate traditional beliefs and cultural practices as associative factors despite high levels of HIV-related knowledge. To investigate this paradox we teamed up with Concern Zambia to embark on an exploratory study involving both community members and local leadership to determine the link between HIV knowledge and behavior in three Western Province districts. The research focused on individual risk practices and the social and cultural context in which they occurred. The decision to engage in risky behavior for HIV transmission within the Western Province in Zambia is multifactorial. Initial analyses of fieldwork data indicate that gender relations, socioeconomic factors and a lack of infrastructure are important emerging themes. The goal of the research aims to identify strategies that can help mitigate conditions for engagement in HIV risk behavior in the Western Province.
Partner Organization: Streetwise Education Foundation
More than 250,000 children live and work on the streets of Dhaka, Bangladesh. StreetWise Education Foundation provides educational and medical services, food and board, and an income to street‐involved children. This Capstone project assessed the program’s implementation, target population, and important contextual factors, additionally providing activities to build program capacity. The formative process evaluation included focus groups, qualitative interviews, observations, and surveys. Analysis of qualitative data utilized a constant‐comparative method. Survey data were triangulated with qualitative data to increase validity. Results showed that StreetWise is a small program in rapid evolution. Contextual factors that impact the program include the children’s social connections with their former street lives and challenges in the family environment. Findings suggest that increasing social capital, community participation in the program, and the provision of vocational training may enhance communication with children and their families and mitigate challenges in the social environment.
Partner Organization: Helen Keller International
Helen Keller International (HKI) tasked NYU's Capstone Team to expand on work that was currently being done on the creation of a centralized, organization-wide monitoring and evaluation system to describe its work, and to measure its progress in achieving its mission. The team was responsible for defining and updating a list of 137 indicators, developing a handbook that would accompany the final indicator list, and making recommendations for the development of a long-term global system that could describe and monitor the work of HKI around the world. The team researched and assimilated the existing literature on the subject, and also reached out to other international NGOs facing similar challenges. The group also conducted a pilot survey and visited the HKI Cambodia office to field test the survey and conduct qualitative research.
Partner Organization: Shree Bidada Sarvodaya Trust
Childhood tooth decay continues to be a significant public health problem in both developed and developing countries. The Shree Bidada Sarvodaya Trust holds yearly dental outreach camps to address the problem in rural India. The overall objectives of this Capstone project were to evaluate the burden of dental caries and risk factors among school students in Mandvi county, Kutch district, Gujarat State, India. We analyzed data from oral health examinations performed during the Trust's 2008 outreach camp. In 2011 we supplemented this data with surveys, interviews and field observations to assess risk factors for dental caries among children attending school. Our results showed a significant burden of dental caries among school students as well as penetration and diffusion of standard teeth cleaning methods. Limited access to dental care, suboptimal oral hygiene practices, and preference for high sugar-containing beverages by adolescents were identified as risk factors for dental caries among students.
Partner Organization: Shree Bidada Sarvodaya Trust
Soil-transmitted helminth (STH) infections, caused by parasites such as roundworms (Ascaris lumbricoides), hookworms (various species), and whipworms (Trichuris trichiura), are known to infect more than one billion people worldwide, with over two billion people being at risk for contracting such infections. Although typically not fatal, chronic STH infections can lead to significant pathologies including anemia, malnutrition, and/or impaired cognitive development, especially in school-age children, the group at highest risk for STH infections. In coordination with the Shree Bidada Sarvodaya Trust, a charitable organization in northwestern India, our team utilized a mixed-research methodology to assess the relevant health knowledge and attitudes, health behaviors, risk factors and socio-ecological variables that are associated with STH infections among school-age children in the rural regions of Kutch, India.
Partner Organization: National Telehealth Center, University of Phiippines
Rural doctors delivering healthcare in the Philippines are faced with numerous challenges. Geographic isolation and remoteness of areas served make it increasingly difficult to provide quality healthcare. In response, the National Telehealth Center (NThC) facilitates SMS and e‐mail communications between rural doctors (DTTBs) and medical specialists to provide specialty care to rural populations. The purpose of this project was to evaluate the telemedicine program to determine the perceived value among its users, its adaptability and acceptability, and the program’s potential to address health access inequities. We conducted key informant interviews with 17 rural doctors, NThC staff and medical specialists situated in rural sites and Manila. Results indicate that telemedicine was most valuable for referring difficult cases and soliciting second opinion and providing improved quality of service that would have been otherwise unavailable. Recommendations include stronger delineation between the NThC and Department of Health responsibilities, inclusion of other healthcare providers, such as nurses and community health workers, in the program, and expansion of the program to additional sites.
Partner Organizations: Chinatown YMCA and NYU Center for Study of Asian-American Health
Asian American youth are underrepresented in the extant literature related to adolescent health and well‐being. One important and increasingly growing Asian American subgroup is Chinese youth in NYC. To better characterize the health and wellness needs of this population, we conducted a community‐based assessment of Chinese youth residing in Manhattan’s Chinatown area, together with a case study of the Chinatown YMCA. Our qualitative approach integrated an ecological systems perspective with adapted grounded theory. Data collection involved in‐depth interviews with key informants, focus groups with Asian youth and their families, and community mapping of existing health and social welfare services. Recommendations center on two core findings: 1) Greater attention should be paid to the development of family‐focused interventions in order to best address the needs of Chinese youth; and 2) Ongoing change to the environmental context in which the Chinatown YMCA operates highlights the importance of strategic planning and staff development.
Partner Organization: NYU B Free CEED
Hepatitis B Virus infection (HBV) is a major public health problem among Asian and Pacific Islanders (API) living in the United States. In 2007, the NYU B Free CEED Project developed a social marketing campaign to eliminate hepatitis B disparities in the API communities of New York City. The campaign, ‘B Certain’ was formally launched in 2011. The primary focus of this Capstone research project was to develop methods of evaluating this campaign. Through an analysis of previously collected focus group data and a review of literature, the Capstone team developed an evaluation that included post‐ implementation focus group guides, street intercept surveys, and a comprehensive community survey to evaluate the B Certain campaign. Furthermore, a landing page displaying culturally sensitive information regarding hepatitis B was also created. The next stage of the initiative will be to execute the assessment of the ‘B Certain’ campaign.
Partner Organization: African Refuge, Inc.
African Refuge, Inc., a grassroots organization based on Staten Island, NY, seeks to improve access to health resources for Liberian refugees. In collaboration with African Refuge, we conducted a health needs assessment among Liberian refugees living in the Park Hill section of Staten Island. The aim of the assessment was to identify the three major health needs in this community. The health needs assessment followed an iterative mixed-method approach. We conducted three focus group discussions as well as twelve key informant interviews. Furthermore, we analyzed public use data such as the NYC Department of Health and Mental Hygiene Community Health Survey, as well as data provided by the collaborating organization. Major health needs identified by the community included: health insurance, accessible health/social services in the neighborhood, and self-management tools related to chronic diseases. The results of this study are summarized in the form of a curriculum for health literacy workshops and are meant to support African Refuge in its efforts to improve disease prevention and health care among Liberian refugees. These workshops take the different levels of health literacy among the community members into account.
Partner Organization: Brownsville Multi-Service Family Health Center
Diabetes is an emerging global public health problem and a leading cause of mortality worldwide. In the United States, an estimated 23.6 million adults have diabetes. Evidence suggests that higher rates of diabetes, diabetes-related complications, morbidity, and mortality disproportionately affect African Americans, Latinos, and the socio- economically disadvantaged. In New York City, diabetes was the fourth leading cause of death in 2006. Diabetes disproportionately affects Central Brooklyn and East New York as compared to other neighborhoods in New York City, with approximately 16% of the population diagnosed with diabetes. This Capstone project was an assessment of diabetes quality of care at the Brownsville Multi-Service Family Health Center. Using a mixed methods approach involving electronic medical record extraction, patient diabetic-care surveys and key informant interviews, the project considered structural and systemic gaps in diabetic health care delivery and provided recommendations for improvement.
Organization: Instituto de Saúde Coletiva (ISC) of the Universidade Federal da Bahia (UFBA)
In the 1990s Brazil reformed mental health treatment in order to move from a hospital-based to a community-based model. As part of this reform, Brazil established a new network of mental health ambulatory treatment centers known as Psychosocial Community Centers, which were linked to the primary care centers, linked to the Family Health Program. The purpose of this Capstone was to evaluate the impact of the mental health reform in Salvador. Using a mixed methods approach, we conducted focus groups and key informant interviews with health care providers, community health workers and administrative professionals in order to assess referral patterns, satisfaction with the new system, and challenges associated with providing mental health care services. We also analyzed Salvador's ambulatory services and hospitalization database to determine the most common reasons for patients using the system. Our analysis suggested that reform has succeeded in increasing usage of ambulatory services, but we also identified persistent systematic deficiencies in the mental health network in Salvador.
Partner Organization: Instituto de Saúde Coletiva (ISC) of the Universidade Federal da Bahia (UFBA)
This Capstone was a collaborative effort from both NYU and Instituto de Saúde Coletiva (ISC) of the Universidade Federal da Bahia (UFBA) to study several aspects of violence suffered by adolescents in the city of Salvador, the capital of Bahia, Brazil. The team evaluated trends of mortality rates due to violence in 10-19 year-olds in Bahia and attempted to identify potential risk factors including measures of urbanization and education. The group also collected and analyzed qualitative data to explore the context of violence and violent deaths in the young population in Salvador. The group traveled to Salvador in March, 2008 to analyze multiple Brazilian databases and conduct key informant interviews.
One goal of primary care is to provide better health for all. One method of assessing the impact of primary care is via "primary care-sensitive hospitalizations", a set of conditions for which effective outpatient care can reduce hospitalization risk. These are important to measure, describe and monitor in order to develop quality improvement actions, evaluate the impact of investments, and develop monitoring and evaluation tools for the public health system. Using a mixed-methods approach, we assessed the impact of Brazil’s Family Health Program on hospitalization trends in three common causes of hospitalizations for children under age 5 in metropolitan Salvador. A quantitative analysis (for 1999-2007) via an ecological study design, using panel data with fixed effects, indicated positive correlations for pneumonia and negative correlations for asthma and gastroenteritis. Qualitative data provided a richer context to better understand the trends in hospitalization rates and the associated impact on public health in Bahia.
Partner Organization: Pan American Health Organization
Equity in health across the Americas is a major concern of the Pan American Health Organization (PAHO). PAHO considers the measurement and monitoring of socio-economic (SE) inequalities in health an important step towards developing effective health policies and reducing equity gaps within and between countries. This study was conducted to develop a tool for the assessment of health disparities in terms of SE inequality. Using the 2003 and 1994 DHS Bolivia datasets, the Capstone team constructed an asset-based index of SE status including education as an indicator. They employed the Slope Index of Inequality and Relative Index of Inequality measures to analyze SE inequalities in health across the population groups. A key discovery of the research was the methodological process whereby socio-economic inequalities in health can be measured; furthermore, this process tool can be implemented by Ministries of Health in Latin America towards evaluation efforts and policy-making.
Partner Organization: BasicHealth - El Salvador
Students collaborated with BasicHealth to conduct research in order to provide information to the El Salvador Ministry of Health regarding the implementation of Visual Inspection with Acetic Acid (VIA), a type of cervical cancer screening, in El Salvador. The research project was designed to investigate why Salvadorian health care providers who have been trained by BasicHealth are not incorporating the VIA screening and cryotherapy treatment into their practice. The study consisted of a mixed method approach (qualitative and quantitative elements) with the following five components: health care provider interviews, program trainer interviews, national and local stakeholder interviews, a health promoter meeting, and a patient exit survey. In November 2007, one research team member accompanied a BasicHealth delegation to El Salvador to observe VIA training. The research team member witnessed the training and delivery of services to women receiving VIA. These observations laid the groundwork for identifying themes and questions that would be used in subsequent interviews and meetings with providers, trainers, stakeholders and health promoters, including a visit to El Salvador by the entire team in January of 2008.
Partner Organization: Naturopathic Medicine for Global Health
In 2011, Naturopathic Medicine for Global Health began to implement a community health worker (CHW) program, which aims to improve health outcomes among the underserved Indigenous Mayans. This study assessed the implementation, fidelity, usefulness, and community perceptions of a naturopathic medicine‐based CHW program in Panajachel, Guatemala. We conducted in‐depth interviews and focus groups with the program’s CHWs, other key informants, and patients enrolled in the program. Our interviews show that the CHW program can potentially fill a vital role in the community, particularly serving the marginalized Indigenous Mayan population. A general acceptance of naturopathic medicine dovetails well with an overall scarcity of resources in the health system. However, loosely structured protocols for CHWs, inconsistent enrollment criteria for patients, and blurred program autonomy currently constrain program success. The naturopathic‐based CHW program has the potential to provide accessible and culturally acceptable, low cost health care to vulnerable populations.