Multiple Sexual Partners and Condom use among 10 - 19 Year-olds in four Districts in Tanzania: What do we Learn?

Although some studies in Tanzania have addressed the question of sexuality and STIs among adolescents, mostly those aged 15 - 19 years, evidence on how multiple sexual partners influence condom use among 10 - 19 year-olds is limited. This study attempts to bridge this gap by testing a hypothesis that sexual relationships with multiple partners in the age group 10 - 19 years spurs condom use during sex in four districts in Tanzania. Secondary analysis was performed using data from the Adolescents Module of the cross-sectional household survey on Maternal, Newborn and Child Health (MNCH) that was done in Kigoma, Kilombero, Rufiji and Ulanga districts, Tanzania in 2008. A total of 612 adolescents resulting from a random sample of 1200 households participated in this study. Pearson Chi-Square was used as a test of association between multiple sexual partners and condom use. Multivariate logistic regression model was fitted to the data to assess the effect of multiple sexual partners on condom use, having adjusted for potential confounding variables. STATA (10) statistical software was used to carry out this process at 5% two-sided significance level. Of the 612 adolescents interviewed, 23.4% reported being sexually active and 42.0% of these reported having had multiple (> 1) sexual partners in the last 12 months. The overall prevalence of condom use among them was 39.2%. The proportion using a condom at the last sexual intercourse was higher among those who knew that they can get a condom if they want than those who did not. No evidence of association was found between multiple sexual partners and condom use (OR = 0.77, 95% CI = 0.35 - 1.67, P = 0.504). With younger adolescents (10 - 14 years) being a reference, condom use was associated with age group (15 - 19: OR = 3.69, 95% CI = 1.21 - 11.25, P = 0.022) and district of residence (Kigoma: OR = 7.45, 95% CI = 1.79 - 31.06, P = 0.006; Kilombero: OR = 8.89, 95% CI = 2.91 - 27.21, P < 0.001; Ulanga: OR = 5.88, 95% CI = 2.00 - 17.31, P = 0.001), Rufiji being a reference category. No evidence of association was found between multiple sexual partners and condom use among adolescents in the study area. The large proportion of adolescents who engage in sexual activity without using condoms, even those with multiple partners, perpetuates the risk of transmission of HIV infections in the community. Strategies such as sex education and easing access to and making a friendly environment for condom availability are important to address the risky sexual behaviour among adolescents

Factors influencing the experience of sexual and reproductive healthcare for female adolescents with perinatally-acquired HIV: a qualitative case study

Background: Young people living with perinatally-acquired HIV require age-appropriate support regarding sex and relationships as they progress towards adulthood. HIV affects both genders but evidence suggests that young women are particularly vulnerable to sexual abuse and more prone to engaging in sexual behaviours to meet their daily survival needs. This can result in poor sexual and reproductive health (SRH) outcomes. HIV services in Malawi provide support for young women’s HIV-related clinical needs, but it is unclear whether there is sufficient provision for their SRH needs as they become adults. This paper explores the sex and relationship experiences of young women growing up with perinatally-acquired HIV in order to understand how to improve SRH care and associated outcomes. Methods: A qualitative case study approach was adopted in which each ‘case’ comprised a young woman (15–19 years) with perinatally acquired HIV, a nominated caregiver and service provider. Participants were purposively selected from three multidisciplinary centres providing specialised paediatric/adolescent HIV care in Malawi. Data was collected for 14 cases through in-depth interviews (i.e. a total of 42 participants) and analysed using within-case and cross-case approaches. The interviews with adolescents were based on an innovative visual method known as ‘my story book’ which encouraged open discussion on sensitive topics. Results: Young women reported becoming sexually active at an early age for different reasons. Some sought a sense of intimacy, love, acceptance and belonging in these relationships, noting that they lacked this at home and/or within their peer groups. For others, their sexual activity was more functional – related to meeting survival needs. Young women reported having little control over negotiating safer sex or contraception. Their priority was preventing unwanted pregnancies yet several of the sample already had babies, and transfer to antenatal services created major disruptions in their HIV care. In contrast, caregivers and nurses regarded sexual activity from a clinical perspective, fearing onward transmission of HIV and advocating abstinence or condoms where possible. In addition, a cultural silence rooted in dominant religious and traditional norms closed down possibilities for discussion about sexual matters and prevented young women from accessing contraception. Conclusion: The study has shown how young women, caregivers and service providers have contrasting perspectives and priorities around SRH care. Illumination of these differences highlights a need for service improvement. It is suggested that young women themselves are involved in future service improvement initiatives to encourage the development of culturally and socially acceptable pathways of care

Car-Sharing Subscription Preferences and the Role of Incentives: The Case of Copenhagen, Munich, and Tel Aviv-Yafo

Car-sharing services provide short-term car access, contributing to sustainable urban mobility and generating positive societal and environmental impacts. Attraction and retention of members are essential for the profitability and survival of these services in cities. Yet, the relevance of a variety of possible business models’ features for car-sharing subscriptions is still under-explored. This study examines individuals’ preferences for subscribing to different car-sharing business models, focusing on the attractiveness of car-sharing-related features and incentives in different contexts. We designed a stated preference experiment and collected data from three different urban car-sharing settings: Copenhagen, Munich, and Tel Aviv-Yafo. A mixed logit model was estimated to uncover the determinants of each city’s car-sharing plan subscription. The achieved insights pave the road for the actual design of car-sharing business models and attractive incentives by car-sharing companies in the studied or similar cities. Our findings reveal that although some car-sharing intrinsic features are likely to be relevant everywhere (e.g., pricing, parking conditions), the local context affects the preferences of others. In Munich, respondents prefer car-sharing services with fleets composed of electric vehicles and value high accessibility to shared cars, so marketing campaigns focusing on the positive environmental impacts of car-sharing and strategic distribution of shared cars (e.g., hubs) are expected to be very appealing there. As for Copenhagen, a high probability of finding a car, the opportunity to book a shared car in advance, and having plans including other modes are more appreciated, making hubs in high-demand areas and Mobility-as-a-Service (MaaS) plans very attractive. Finally, in Tel Aviv, our findings highlight the advantages of exploring different pricing schemes and offering dynamic incentives to users for fleet rebalancing to positively contribute to car-sharing subscriptions and ridership

Aligning users’ and stakeholders’ needs: How incentives can reshape the carsharing market

Carsharing services provide users with a new way of approaching mobility and accessing shared vehicles. Since the initial pilot studies in the early 90s, technological innovations (e.g., advances in mobile technology, increased range of electric cars) and the establishment of new business models (e.g, station–based, free–floating, peer-to-peer, packages by time and/or kilometers) helped branding carsharing as a sustainable yet flexible and personalized mobility alternative. On the other hand, the carsharing market today is extremely scattered, as it can include multiple operators, which are often in competition among each other. While this variety of operators provides the user with a variety of travel options, without proper coordination, this competition can reduce the efficiency of the carsharing market and, in extreme cases, of the entire transportation system. In this context, this paper studies the needs of travellers, local authorities, and carsharing service providers, and analyzes how incentives can be used to align their goals. Taking Munich, Copenhagen, and Tel Aviv-Yafo as case studies, focus groups were used to identify thirteen different travellers’ needs, which are grouped into five main categories: ownership issues, coverage area, financial aspects, vehicle settings, and integration of carsharing with other modes. Moreover, to understand the needs of service providers and public authorities, in-depth interviews were conducted. The results indicate that regulatory barriers, integration with other transport modes, and social equity issues are the most critical elements for the thriving of carsharing services. Our results also suggest that incentives can be divided into two main categories, namely direct and indirect incentives. With regards to direct incentives, parking stood out as the most important incentive. Among indirect incentives, those associated with the integration of carsharing with other transport services, were prominent. As part of the methodology, the results of the qualitative study are validated through a quantitative analysis. A bigger sample of the population answered an online survey, which was used to validate the list of potential incentives that can help aligning the goals of stakeholders and users

Building middle-range theories from case studies

Peer reviewe

Constructing a Distant Future: Imaginaries in Geoengineering

We develop the concept of the distant future as a new way of seeing the future in collective efforts. While a near future is represented in practical terms and concerned with forming expectations and goals under conditions of uncertainty, a distant future is represented in stylized terms and concerned with imagining possibilities under conditions of ambiguity. Management research on future-oriented action has developed around problems of the near future. To explore distant futures, we analyze the case of geoengineering, a set of planetary-scale technologies that have been proposed as solutions to the threat of climate change. Geoengineering has increasingly been treated as if it were a reality, despite continued controversy and in the absence of any implementation. We find that societal-level imaginaries that were built on deeply-held moral bases and cosmologies underpinned the conception of geoengineering, and that a dialectic process of discursive attempts to reconcile oppositional imaginaries increased the concreteness and credibility of geoengineering so that it increasingly has been treated as an ‘as-if’ reality. We suggest that distant futures orient collective efforts in distinctive ways, not as concrete guides for action but by expressing critiques and alternatives, that can become treated as ‘as-if’ realities

The transformative role of interaction rituals within therapeutic communities

Mental health settings are fraught with emotion as clients address difficult life experiences and relational patterns. Clients spend a substantial amount of time together outside of structured therapy, but little is known about how these moments are potentially therapeutic, especially as sites of emotional change. We draw on interaction ritual chain theory to explore how negative emotions in situations outside of formal therapy can be transformed into positive emotions and facilitate personal change. The research is based upon a narrative ethnography of two therapeutic communities for individuals with a diagnosis of personality disorder. Despite the presence of negative transient emotions in these rituals, clients experienced positive feelings of solidarity and belonging, and the majority of clients reported increased feelings of confidence and positive change. Conversely, dynamics between clients showed clients were not always supportive of one another and at times, could exclude others, resulting in isolation and alienation. We argue interactions that generate feelings of inclusion or exclusion over time area key component in whether clients gain positive or negative emotional feeling and experience personal change

Patient-centered insights: using health care complaints to reveal hot spots and blind spots in quality and safety

Health care complaints contain valuable data on quality and safety; however, there is no reliable method of analysis to unlock their potential. We demonstrate a method to analyze health care complaints that provides reliable insights on hot spots (where harm and near misses occur) and blind spots (before admissions, after discharge, systemic and low‐level problems, and errors of omission). Systematic analysis of health care complaints can improve quality and safety by providing patient‐centered insights that localize issues and shed light on difficult‐to‐monitor problems. Context The use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, which we developed, was used to analyze a benchmark national data set, conceptualize a systematic analysis, and identify the added value of complaint data. Methods We analyzed 1,110 health care complaints from across England. “Hot spots” were identified by mapping reported harm and near misses onto stages of care and underlying problems. “Blind spots” concerning difficult‐to‐monitor aspects of care were analyzed by examining access and discharge problems, systemic problems, and errors of omission. Findings The tool showed moderate to excellent reliability. There were 1.87 problems per complaint (32% clinical, 32% relationships, and 34% management). Twenty‐three percent of problems entailed major or catastrophic harm, with significant regional variation (17%‐31%). Hot spots of serious harm were safety problems during examination, quality problems on the ward, and institutional problems during admission and discharge. Near misses occurred at all stages of care, with patients and family members often being involved in error detection and recovery. Complaints shed light on 3 blind spots: (1) problems arising when entering and exiting the health care system; (2) systemic failures pertaining to multiple distributed and often low‐level problems; and (3) errors of omission, especially failure to acknowledge and listen to patients raising concerns. Conclusions The analysis of health care complaints reveals valuable and uniquely patient‐centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry‐exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files