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Zoonoses, or diseases that pass between animals and humans, represent a major threat to global health and global economies. In Guinea, zoonotic diseases (e.g. rabies, Lassa fever) have been at the forefront due to recent outbreaks and government priorities. Much like many other diseases, zoonotic disease prevention demands a thorough and culturally nuanced understanding of the factors that influence preventive behaviors. To gain this knowledge and enhance risk communication for priority zoonotic diseases, this qualitative study conducted focus group discussions, in-depth interviews, and observations in three Guinean prefectures. Study participants included individuals who interact with animals or influence human-animal interactions, (e.g., veterinarians, local leaders, human health providers, butchers, hunters, general population). A total of 229 individuals participated in the study. Data analysis, which combined deductive and inductive coding, found that although individuals generally had basic knowledge about zoonotic diseases, a gap existed between knowledge and practice. In exploring possible reasons behind this gap, several key themes arose, the two most novel being the focus of this paper. First, participants described living in an uncertain world where they lack control over the behaviors of others. Many participants described uncertainty over the vaccine status of stray dogs or even those of their neighbors, making them feel powerless over rabies. Second, animals serve as a main source of livelihood (income, investment, or savings) for individuals. The value placed on livestock may, in turn, drive and impede prevention behaviors such as vaccinating animals or avoiding the sale of unsafe meat. Given that the Guinean government's list of priority zoonotic diseases continues to evolve, the need to discover ways to effectively promote multiple related prevention behaviors remains pertinent. The insights from this study can inform existing and future programs for the prevention, control, and surveillance of zoonotic disease in Guinea and other similar countries.

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OBJECTIVES: To determine how African-American caregivers living in a food desert navigate neighborhood resources to procure foods for their children and to identify actions to improve those resources. DESIGN: Using the Photovoice approach, we conducted two sets of individual in-depth interviews with 16 African-American primary caregivers of children (total of 32 interviews) and one culminating workshop (n=10 participants). Data were systematically analyzed according to the Social Ecological Framework to evaluate the role of different environments in shaping individual decisions. SETTING: Urban, low-income and geographically marginalized neighborhoods. RESULTS: Despite the challenges of living in a food desert, caregivers perceived that they were providing the foods that they wanted for their children. These perceptions were based on their own health concerns, food customs, time and convenience, and responses to their children's food preferences. Caregivers were resourceful in how they procured these foods, searching for quality and better-priced foods. They relied on their friends, family, and local/national programs to mitigate the challenges of the food desert. Caregivers were interested in taking action to improve the underlying determinants of food access and choice (eg, affordable housing, job training, nutrition knowledge, food shopping experience). CONCLUSION: These African-American caregivers procured foods they thought were best for their children by relying on their strong social relationships and national and local food programs to navigate the food desert. Public health nutrition interventions that aim to reduce diet-related disparities should look beyond the presence or absence of supermarkets in food deserts to address multisectoral determinants of access while shaping food choices.

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Twitter, a popular social media, helps users around the world quickly share and receive information. The way in which Twitter frames health issues - especially controversial issues like emergency contraception (EC) - can influence public opinion. The current study analyzed all English-language EC-related tweets from March 2011 (n = 3535). Variables measured user characteristics (e.g. gender), content (e.g. news, humor), Twitter-specific strategy (e.g. retweet), and certain time periods (e.g. weekends). The analysis applied chi-square and regression analyses to the variables. Tweets most frequently focused on content related to news (27.27%), accessing EC (27.27%), and humor (25.63%). Among tweets that were shared, however, the most common content included humor, followed by personal/vicarious experience. Although only 5.54% of shared tweets mentioned promiscuity, this content category had the strongest odds for being shared (OR = 1.51; p = 0.031). The tweet content with lowest odds of being shared were side effects (OR = 0.24; p < 0.001), drug safety (OR = 0.44; p < 0.001), and news (OR = 0.44; p < 0.001). Tweets with the greatest odds of having been sent on a weekend sought advice (OR = 1.94; p = 0.012), addressed personal or vicarious experience (OR = 1.91; p < 0.001), or contained humor (OR = 1.56; p < 0.001). Similar patterns occurred in tweets sent around St. Patrick's Day. Only a few differences were found in the ways in which male and female individuals discussed EC on Twitter. In particular, when compared to males, females mentioned birth control (p = 0.002), EC side effects (p = 0.024), and issues related to responsibility (p = 0.003) more often than expected. Study findings offer timely and practical suggestions for public health professionals wanting to communicate about EC via Twitter.

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We explored the process through which two income-generation programs that include health education empower indigenous Guatemalan women artisans. Both artisans (n = 44) and program staff (n = 11) participated in semistructured interviews. Respondents expressed that women gained support about personal issues and experienced an awakening of the mind (despertar la mente). Through active participation, women's fear of strangers and speaking in public decreased. Women also gained mobility, awareness of their rights as women, and self-confidence from earning and managing their own income. Given our findings, we suggest that programs combining income generation and health education have the potential to empower women.

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Social networking sites provide virtual environments in which individuals and organizations exchange real-time information on a multitude of topics, including health promotion and disease prevention. The January 2010 earthquake in Haiti has been posited as a turning point in the way in which organizations use social media, such as Twitter, for crisis communication. The purpose of this content analysis was to explore whether organizations' use of Twitter changed after the 2010 Haiti earthquake. A team of 13 coders analyzed all English-language tweets (N = 2,616) during the 3 months before and post earthquake from 6 leading organizations in the Haiti disaster relief efforts. Study findings indicate that the ways in which organizations used Twitter changed over time. Chi-square analyses demonstrated that organizations decreased in their use of certain strategies to disseminate information through Twitter, such as the use of links. Organizations did not change in their use of techniques to involve users (e.g., retweet, call to action), with the exception of using tweets as a fundraising mechanism. Study findings highlight missed opportunities among organizations to maximize Twitter in order to encourage more interactive and immediate communication with the global community.

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Assessing predictors of intention to circumcise can help to identify effective strategies for increasing uptake of voluntary medical male circumcision (VMMC). Grounded in the theory of reasoned action (TRA), the current study of uncircumcised males ages 13-29 in Swaziland (N = 1,257) employed multivariate logistic regression to determine predictors of VMMC intention. The strongest predictors were strongly disagreeing/disagreeing that sex was more painful for a circumcised man (odds ratio [OR] = 4.37; p = < .007), a Christian man should not get circumcised (OR = 2.47; p < .001), and circumcision makes penetration more painful and difficult (OR = 2.44; p = .007). Several beliefs about enhanced sexual performance, normative beliefs (parents, sexual partner, and friends), and non-TRA-related factors (e.g., importance of plowing season to daily schedule) were also statistically significant predictors. TRA proved a useful theory to explore young men's intention to circumcise and can help inform interventions aimed at increasing uptake of VMMC.

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Gender-based violence is pervasive and poses unique challenges in conflict-affected settings, with women and girls particularly vulnerable to its sequelae. Furthermore, widespread stigmatization of gender-based violence promotes silence among survivors and families, inhibiting access to services. Little evidence exists regarding effective gender-based violence prevention interventions in these settings. Through Our Eyes, a multi-year participatory video project, addressed gender-based violence by stimulating community dialogue and action in post-conflict settings in South Sudan, Uganda, Thailand, Liberia and Rwanda. The present qualitative analysis of project evaluation data included transcripts from 18 focus group discussions (n = 125) and key informant interviews (n = 76). Study participants included project team members, representatives from partner agencies, service providers and community members who either participated in video production or attended video screenings. Study findings revealed that the video project contributed to a growing awareness of women's rights and gender equality. The community dialogue helped to begin dismantling the culture of silence gender-based violence, encouraging survivors to access health and law enforcement services. Furthermore, both men and women reported attitude and behavioral changes related to topics such as wife beating, gender-based violence reporting and girls' education. Health education professionals should employ participatory video to address gender-based violence within conflict-affected settings.

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An unmet need for family planning among Ugandan women remains. Our research team conducted qualitative research to identify Ugandan perspectives about family planning. We facilitated interviews with Ugandan women and health care providers. Using grounded theory, our team analyzed the data to identify themes from the transcripts. The researchers identified the cross-cutting theme as the influence of money on women and health care providers. Although affordability and accessibility were recognized as determinants of ensuring family planning uptake, we found that money impacts the decision making via additional mechanisms. For women, monetary concerns associated with assuring family needs were prioritized. For health care providers, they discussed that money created barriers as well as incentives to family planning service provisions.

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Mobile health (mHealth) technologies and telecommunication have rapidly been integrated into the health care delivery system, particularly in developing countries. Resources have been allocated to developing mHealth interventions, including those that use mobile technology for behavior change communication (BCC). Although the majority of mobile phone users worldwide live in the developing world, most research evaluating BCC mHealth interventions has taken place in developed countries. The purpose of this study was to conduct a systematic review of the literature to determine how much evidence currently exists for mHealth BCC interventions. In addition to analyzing available research for methodological rigor and strength of evidence, the authors assessed interventions for quality, applying a set of 9 standards recommended by mHealth experts. The authors reviewed 44 articles; 16 (36%) reported evaluation data from BCC mHealth interventions in a developing country. The majority of BCC mHealth interventions were implemented in Africa (n = 10) and Asia (n = 4). HIV/AIDS (n = 10) and family planning/pregnancy (n = 4) were the health topics most frequently addressed by interventions. Studies did not consistently demonstrate significant effects of exposure to BCC mHealth interventions on the intended audience. The majority of publications (n = 12) described interventions that used two-way communication in their message delivery design. Although most publications described interventions that conducted formative research about the intended audience (n = 10), less than half (n = 6) described targeting or tailoring the content. Although mHealth is viewed as a promising tool with the ability to foster behavior change, more evaluations of current interventions need to be conducted to establish stronger evidence.

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The practice of concurrent sexual partnerships (CP) is posited to be a contributor to the elevated risk of HIV transmission among youth in Malawi. The lens through which Malawian youth conceptualize the practices of CP and condom use has yet to be fully explored. The current study--a secondary data analysis of semi-structured in-depth interviews (n = 19) with Malawian youth aged 18 to 22 years--addresses this gap. Participants were interviewed about their sexual relationships and behavior, as well as their perceptions and knowledge regarding condom use and CP. In order to ensure that youth engaged in CP were oversampled, the recruitment process asked potential respondents to self-identify whether they currently participated in CP. Of the total sample (n = 19), 13 self-identified as currently engaging in CP. Data were analyzed using a grounded theory approach. This qualitative study highlights a disconnect between the high level of knowledge youth exhibit about HIV prevention methods and their actual reported condom use and CP behaviors. While some youth claimed to use condoms, their discourse demonstrated fluidity in that use changed over time, or interest in changing behavior was expressed, or was inconsistent between partnerships. The disconnect between knowledge of the consequences of risky sexual behavior and actual behavior was most evident among inconsistent condom users engaged in CP. This finding indicates knowledge alone has a limited role in the adoption of lower risk behaviors such as condom use and reduction of CP among youth. Moreover, findings from this study can inform HIV prevention programs operating in Malawi and the sub-Saharan Africa region by enabling them to provide tailored, more persuasive health promotion and prevention messaging.

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Assuring quality health care services to limited English proficient patients requires certain skills, including the ability to communicate through interpreters. This study identifies predictors of appropriate use of interpreters by maternal labor and delivery service providers. Clinical labor and delivery staff (N=200) at five hospitals in an Eastern U.S. city completed a survey about providing care to Latinas. Multivariate logistic regression identified significant predictors for appropriate use of interpreters. The strongest association with appropriately using interpreters was relying less often on general mass media for medical information (OR=2.25; p=.03). Other statistically significant variables included agreeing that learning about Latino history and culture could improve quality of care (OR=2.07; p=02) and seeking medical information from colleagues at the same hospital (OR=1.83; p=.03). Study findings have implications for training professionals about working with interpreters.

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Due to the influx of Latino immigration in the United States, health care services are faced with the challenge of meeting the needs of this growing population. In this qualitative study, we explored Latina immigrants' experiences with maternal health care services. We found that despite enduring language barriers and problems, Spanish-speaking women expressed satisfaction with their care. Factors influencing women's perceptions of care included sociocultural norms (respeto, personalismo, and familismo), previous experiences with care in their countries of origin, having healthy babies, and knowledge about entitlement to interpreter services. We offer recommendations for public health practice and research.

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