Male Involvement in Reproductive and Maternal and New Child Health: An Evaluative Qualitative Study on Facilitators and Barriers From Rural Kenya

Frontiers in Public Health, Volume 9, Year 2021

Interpretation

Male involvement in reproductive, maternal, newborn and child health (RMNCH) is known to improve maternal and child health outcomes. However, there is sub-optimal adoption of male involvement strategies in several low- and middle-income countries such as Kenya. Aga Khan University implemented Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), a project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC), between 2016 and 2020 in rural Kisii and Kilifi counties, Kenya. A central element in the interventions was increasing male engagement in RMNCH. Between January and March 2020, we conducted an endline qualitative study to examine the perspectives of different community stakeholders, who were aware of the AQCESS project, on the facilitators and barriers to male involvement in RMNCH. We found that targeted information sessions for men on RMNCH are a major facilitator to effective male engagement, particularly when delivered by male authority figures such as church leaders, male champions and teachers. Sub-optimal male engagement arises from tensions men face in directly contributing to the household economy and participating in RMNCH activities. Social-cultural factors such as the feminization of RMNCH and the associated stigma that non-conforming men experience also discourage male engagement. A qualitative study. The evaluation study was conducted in AQCESS implementation target areas of Kilifi and Kisii counties. Detailed social–cultural characteristics of the study area can be found in our previous papers (12, 13). We conducted 10 focus group discussions (FGDs) and 11 key informant interviews (KIIs) across the two study sites. All participants were individuals who were familiar of the AQCESS project and had lived in the AQCESS area in the past 1 year. Participants were purposively sampled by AQCESS field project coordinators. Key informants were males and females at the county, sub-county and health facility levels. FGDs were conducted separately with female and male CHC members, male and female adult community members, and female and male adolescent community members. The qualitative evaluation explored their perceived and observed barriers to male participation in RMNCH services at the household and at the community levels as well as factors that may hinder men participation. Data collection was led by a Kenyan qualified social scientist with over 15 years of experience in research, a qualified qualitative consultant and a team of experienced research assistants. The study was conducted between January and March 2020 after ethics clearance from the Aga Khan University (AKU) and the National Commission for Science Technology and Innovation (NACOSTI/P/19/2768). Additional permission and consent for this study was sought from the local communities including the local Health Facility (HF) and CHCs in both the study sites. Before commencing data collection, research assistants were trained on the approved protocol requirements. Parental/guardian assent was sought for adolescents <18 years of age. All participants provided written consent prior to participating in the study. Interviews were collected in local Swahili language, face to face and after providing the study participants with full disclosure and information on the study objectives, risks and benefits. Interviews and FGDs were conducted with facilitators who were the same gender. Interviews were conducted in the community spaces including facilities and schools that were deemed convenient and confidential for interviews to share their experiences. All interview audio recordings and reflective notes were transferred to a password protected computer at AKU's Monitoring Evaluation and Learning Unit (MERL). Audio recordings were deleted after all data was transcribed verbatim by a qualified transcriber from Swahili to English. During transcription process, all transcripts were anonymized by deleting all identifiers such as names to safeguard participants' confidentiality. Translated and transcribed data was checked by the study PI and study consultant who are Swahili native speakers. All the transcripts and reflective notes were uploaded into NVivo 12 Data Analysis Software. To address reliability and validity, first, the research team, conversant in both Kiswahili and English randomly selected a few audio recordings and complimenting transcripts to verify as well as validate the content of the transcribed data. Secondly, a quarter of the transcripts was coded by two researchers after which they developed a coding framework that was used to code the remaining data, identify categories and main themes. A data interpretation workshop was held with the research team and the key stakeholders in the AQCESS implementing areas and some of the barriers and facilitators to male engagement presented in this paper were confirmed during these sessions as illustrated in the following table.

AI Digest

Study Justification:

– Male involvement in reproductive, maternal, newborn, and child health (RMNCH) is known to improve maternal and child health outcomes.
– Sub-optimal adoption of male involvement strategies in low- and middle-income countries, including Kenya.
– The need to evaluate the effectiveness of male engagement interventions in rural areas of Kenya.

Study Highlights:

– Conducted an endline qualitative study to examine the perspectives of community stakeholders on the facilitators and barriers to male involvement in RMNCH.
– Found that targeted information sessions for men on RMNCH, delivered by male authority figures, are a major facilitator to effective male engagement.
– Tensions men face in contributing to the household economy and participating in RMNCH activities hinder male engagement.
– Social-cultural factors, such as the feminization of RMNCH and associated stigma, discourage male engagement.

Study Recommendations:

– Increase targeted information sessions for men on RMNCH, delivered by male authority figures such as church leaders, male champions, and teachers.
– Address tensions men face in contributing to the household economy and participating in RMNCH activities.
– Address social-cultural factors that discourage male engagement, such as the feminization of RMNCH and associated stigma.

Key Role Players:

– Male authority figures (church leaders, male champions, teachers) to deliver information sessions.
– Community health workers and healthcare providers to support and encourage male involvement.
– Local government officials to provide resources and support for male engagement initiatives.
– NGOs and community-based organizations to collaborate on male involvement programs.

Cost Items for Planning Recommendations:

– Training and capacity building for male authority figures, community health workers, and healthcare providers.
– Development and dissemination of educational materials and resources for targeted information sessions.
– Community outreach and awareness campaigns to address social-cultural factors and stigma.
– Monitoring and evaluation of male involvement programs to assess effectiveness and make necessary adjustments.

Strength of Evidence

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is based on a qualitative study conducted in specific target areas in Kenya. The study used a combination of focus group discussions and key informant interviews to gather data. The participants were purposively sampled and the data collection was led by a qualified social scientist with extensive research experience. The study obtained ethics clearance and permission from relevant authorities. The data was transcribed, coded, and analyzed using NVivo software. The findings highlight the facilitators and barriers to male involvement in reproductive, maternal, newborn, and child health (RMNCH) in the study area. The evidence is strong as it provides detailed information on the perspectives of different community stakeholders. However, to improve the evidence, it would be beneficial to include information on the sample size, the demographic characteristics of the participants, and any limitations of the study.

Abstract

A qualitative study. The evaluation study was conducted in AQCESS implementation target areas of Kilifi and Kisii counties. Detailed social–cultural characteristics of the study area can be found in our previous papers (12, 13). We conducted 10 focus group discussions (FGDs) and 11 key informant interviews (KIIs) across the two study sites. All participants were individuals who were familiar of the AQCESS project and had lived in the AQCESS area in the past 1 year. Participants were purposively sampled by AQCESS field project coordinators. Key informants were males and females at the county, sub-county and health facility levels. FGDs were conducted separately with female and male CHC members, male and female adult community members, and female and male adolescent community members. The qualitative evaluation explored their perceived and observed barriers to male participation in RMNCH services at the household and at the community levels as well as factors that may hinder men participation. Data collection was led by a Kenyan qualified social scientist with over 15 years of experience in research, a qualified qualitative consultant and a team of experienced research assistants. The study was conducted between January and March 2020 after ethics clearance from the Aga Khan University (AKU) and the National Commission for Science Technology and Innovation (NACOSTI/P/19/2768). Additional permission and consent for this study was sought from the local communities including the local Health Facility (HF) and CHCs in both the study sites. Before commencing data collection, research assistants were trained on the approved protocol requirements. Parental/guardian assent was sought for adolescents <18 years of age. All participants provided written consent prior to participating in the study. Interviews were collected in local Swahili language, face to face and after providing the study participants with full disclosure and information on the study objectives, risks and benefits. Interviews and FGDs were conducted with facilitators who were the same gender. Interviews were conducted in the community spaces including facilities and schools that were deemed convenient and confidential for interviews to share their experiences. All interview audio recordings and reflective notes were transferred to a password protected computer at AKU's Monitoring Evaluation and Learning Unit (MERL). Audio recordings were deleted after all data was transcribed verbatim by a qualified transcriber from Swahili to English. During transcription process, all transcripts were anonymized by deleting all identifiers such as names to safeguard participants' confidentiality. Translated and transcribed data was checked by the study PI and study consultant who are Swahili native speakers. All the transcripts and reflective notes were uploaded into NVivo 12 Data Analysis Software. To address reliability and validity, first, the research team, conversant in both Kiswahili and English randomly selected a few audio recordings and complimenting transcripts to verify as well as validate the content of the transcribed data. Secondly, a quarter of the transcripts was coded by two researchers after which they developed a coding framework that was used to code the remaining data, identify categories and main themes. A data interpretation workshop was held with the research team and the key stakeholders in the AQCESS implementing areas and some of the barriers and facilitators to male engagement presented in this paper were confirmed during these sessions as illustrated in the following table.

Materials

N/A

Innovations

Based on the information provided, here are some potential recommendations for innovations to improve access to maternal health:

1. Targeted Information Sessions: Conduct information sessions specifically designed for men on reproductive, maternal, newborn, and child health (RMNCH). These sessions can be delivered by male authority figures such as church leaders, male champions, and teachers, who can effectively engage and educate men on the importance of their involvement in RMNCH.

2. Male Engagement Programs: Implement programs that actively involve men in RMNCH activities. This can include initiatives like male support groups, where men can share experiences and learn from each other, as well as participate in activities such as antenatal visits, childbirth preparation classes, and postnatal care.

3. Addressing Economic Tensions: Recognize and address the tensions men face in directly contributing to the household economy while participating in RMNCH activities. This can be done by providing economic incentives or support for men who actively engage in RMNCH, ensuring that their participation does not negatively impact their financial responsibilities.

4. Addressing Social-Cultural Factors: Address social-cultural factors that discourage male engagement, such as the feminization of RMNCH and the associated stigma that non-conforming men may experience. This can be achieved through community awareness campaigns, education programs, and challenging gender norms and stereotypes.

5. Collaboration with Health Facilities and Community Health Committees (CHCs): Foster collaboration between health facilities, CHCs, and community stakeholders to create an enabling environment for male involvement in RMNCH. This can include training healthcare providers on how to effectively engage men, establishing male-friendly spaces within health facilities, and involving CHCs in promoting male participation.

These recommendations are based on the findings of the qualitative study conducted in rural Kisii and Kilifi counties, Kenya, and aim to address the facilitators and barriers to male involvement in RMNCH identified in the study.

AI Innovations Description

Based on the information provided, the recommendation to improve access to maternal health is to increase male involvement in reproductive, maternal, newborn, and child health (RMNCH) services. This recommendation is supported by the findings of the qualitative study conducted in rural Kisii and Kilifi counties, Kenya, as part of the AQCESS project.

The study identified several facilitators and barriers to male involvement in RMNCH. One major facilitator is targeted information sessions for men on RMNCH, particularly when delivered by male authority figures such as church leaders, male champions, and teachers. These sessions can help educate men about the importance of maternal health and encourage their active participation.

On the other hand, sub-optimal male engagement arises from tensions men face in directly contributing to the household economy and participating in RMNCH activities. Social-cultural factors, such as the feminization of RMNCH and the associated stigma that non-conforming men experience, also discourage male engagement.

Based on these findings, the recommendation is to develop innovative strategies to increase male involvement in RMNCH. Some possible innovations could include:

1. Male-focused information campaigns: Develop targeted campaigns that specifically address the concerns and barriers faced by men in accessing and participating in RMNCH services. These campaigns can be delivered through various channels, such as community meetings, social media, and mobile messaging.

2. Male champions and role models: Identify and train male champions within the community who can serve as role models and advocates for RMNCH. These champions can share their own positive experiences and encourage other men to get involved.

3. Engaging male authority figures: Collaborate with male authority figures, such as religious leaders, community leaders, and teachers, to promote male involvement in RMNCH. These figures can use their influence and credibility to encourage men to prioritize maternal health.

4. Addressing economic barriers: Develop interventions that address the tensions men face in balancing their economic responsibilities with their involvement in RMNCH. This could include providing economic incentives or support for men who actively participate in RMNCH activities.

5. Challenging social-cultural norms: Work towards challenging and changing social-cultural norms that discourage male engagement in RMNCH. This can be done through community dialogues, awareness campaigns, and education programs that promote gender equality and shared responsibilities in reproductive and maternal health.

It is important to note that these recommendations should be tailored to the specific context and needs of the community. Continuous evaluation and monitoring of the implemented strategies will help assess their effectiveness and make necessary adjustments for improved access to maternal health.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Targeted Information Sessions: Conduct targeted information sessions for men on reproductive, maternal, newborn, and child health (RMNCH). These sessions should be delivered by male authority figures such as church leaders, male champions, and teachers, who can effectively engage men and address their concerns.

2. Address Economic Tensions: Develop strategies to address the tensions men face in directly contributing to the household economy while participating in RMNCH activities. This could include providing economic incentives or income-generating opportunities for men who actively engage in RMNCH.

3. Challenge Social-Cultural Factors: Address social-cultural factors that discourage male engagement, such as the feminization of RMNCH and the associated stigma that non-conforming men experience. This could involve community awareness campaigns, education programs, and promoting positive masculinity norms.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Baseline Data Collection: Collect baseline data on the current level of male involvement in RMNCH in the target areas. This could include surveys, interviews, and focus group discussions with community members, health facility staff, and key stakeholders.

2. Intervention Implementation: Implement the recommended interventions, such as targeted information sessions and strategies to address economic tensions and social-cultural factors. Ensure proper monitoring and documentation of the implementation process.

3. Data Collection Post-Intervention: Conduct post-intervention data collection to assess the impact of the interventions on improving access to maternal health. This could involve similar methods used in the baseline data collection, comparing the results before and after the interventions.

4. Data Analysis: Analyze the collected data to identify any changes or improvements in male involvement in RMNCH. This could include quantitative analysis of survey data and qualitative analysis of interviews and focus group discussions.

5. Evaluation and Reporting: Evaluate the findings and prepare a report summarizing the impact of the interventions on improving access to maternal health. This report can be shared with stakeholders, policymakers, and the community to inform future interventions and decision-making.

It is important to note that this methodology is a general framework and can be adapted based on the specific context and resources available for the evaluation.

Author

Dima Health

Statistics:

Citations: 4

Identifiers:

DOI: 10.3389/fpubh.2021.644293

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Technology and Innovations

Study Countries:

Kenya

Study Design:

Grounded Theory

Study Approach:

Qualitative

Participants Gender:

Male & Female