In this study, we aimed to clarify the socio-cultural factors affecting the mental and physical health of pregnant and puerperal Brazilian women living in Japan. The study participants were 18 pregnant and puerperal Brazilian women living in two prefectures with large Brazilian populations. A Japanese investigator and a Portuguese interpreter comprised the team, and conducted semi-structured interviews at the participants’ homes. The study period was between 2013 and 2014. The interviews were carried out using the Cultural Determinants of Help Seeking theory. Analytical ethnography was used for data coding and theme extraction.
The results revealed that “worry” and “shoulder and back pain” were the most common mental and physical symptoms, followed by “headache,” “irritability and anger,” “insomnia and sleeplessness,” and “anxiety.” The reasons given for these included: “pregnancy and child rearing;” “anxiety about work and income;” “complications of being a foreigner;” and “the absence of someone to depend upon.” Moreover, the following five core categories of socio-cultural factors influencing these causes were extracted: “equal and deeply connected family;” “strength to continue working;” “choosing the right conditions to settle down in;” “low satisfaction with the healthcare system;” and “the blessings of God.”
Pregnant and puerperal Brazilian women living in Japan have various mental and physical distress symptoms, and our findings revealed that differences between Brazilian and Japanese patterns of family life and religion were the major influencers on these. These findings must be understood to provide intervention in order to lead pregnant and puerperal Brazilian women to appropriate health behaviors.
The training for “Strengthening Human Resource Development for Nursing and Midwifery in Southeast Asia” was implemented in order to strengthen the nursing education system in Cambodia, Laos, Myanmar and Vietnam. The purpose of this study was to evaluate the training using the training evaluation guide suggested by WHO; and to explore factors for training program to be effective, issues, and lessons.
The WHO training evaluation guide which has five evaluation levels was modified as a tool to evaluate the training. Data were collected from training evaluations questionnaire, meeting records during training, and records of interviews conducted during follow-up visits. The factors for training to be effective, issues, and lessons were inductively identified by methodological triangulation from the results of training evaluations, the summary of training feedback from participants and the results of action plan progress.
Results and Discussion
The training was evaluated as effective that not only achieved “Level 1: Reaction and Satisfaction” and “Level 2: Learning”, but also “Level 3: Behavior”. The factors for training to be effective were (1) practical content through sharing experiences among multi-country participants in neighboring countries, (2) selection of suitable trainees by setting the training language as the native language of each participating country, (3)lecture documents in native language facilitated sharing of the learning with relevant people in one’s own country, (4) maintain trainees’ motivation to implement action plans following an agreement with trainees during the training to confirm action plan progress through follow-up visits, and (5) pre-visiting each participating country to explain the training outline makes relevant people’s much understanding of the training and interest in the action plan. Lessons learned were the importance of the definitions of technical terminology in each country’s native language and the efficacy of follow-up visits. Future issues are: “Level 4: Results”, support for each participant’s needs and “Level 5: Impact”, the development of mechanisms for continued sharing of experiences.
Our evaluation confirmed the effective factors for training, issues, and lessons. These are needed to be considered for the future training.
The Direction Office of Healthcare Activities (DOHA) started around 1998 in Vietnam offers training provision for all lower- and higher-ranked hospitals. An understanding of the factors responsible for the success of this unique training provision system can be useful in implementing appropriate human resource development strategies in the health sector. Furthermore, the reviews about the changes in the training provision styles can offer us clues on how to connect training provision with visible clinical improvement.
We reviewed the policy papers from the ministry of health in Vietnam, the activity reports of DOHA in the training center of Bach Mai hospital, which is a high-ranking hospital, JICA (Japan International Cooperation Agency) reports, and NCGM (National Center For Global Health and Medicine) reports from 1997 to 2015.
DOHA was founded as a government-led health provision system in Vietnam with strong policy guidelines. However, to expand their activities, strengthen the capacity of training in hospitals, and establish a financial mechanism for training, there was a need to empower lower-ranked hospitals.
To enhance the training impact of the clinical field in lower-ranked hospitals after training provision, staff of higher-ranked hospitals were dispatched to lower-ranked hospitals to provide on-the-job training (1816 project) and training provision with equipment preparation in lower-level hospitals to overcome environmental difficulties in implementing techniques that they had learned (Satellite hospital project).
“Strong policy commitments”, “a viable financial system”, and “bottom-up empowerment” were needed to establish nation-wide continuous medical education system in Vietnam. To connect training provision with improvement in the clinical field, “integrated approaches for multiple factors in clinical fields like clinical environment changes and extended follow-ups“ by providing training are needed.