文章基本信息

标题：Contextual Influences on Reproductive Wellness in Northern India
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作者：Rob Stephenson ; Amy Ong Tsui
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2003
卷号：93
期号：11
页码：1820-1829
语种：English
出版社：American Public Health Association
摘要：Objectives. There has been a growing recognition of the importance of contextual influences on health outcomes. This article examines community-level influences on 5 reproductive wellness outcomes in Uttar Pradesh, India. Methods. Multilevel modeling is used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff. Results. The household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities. Conclusions. Communities influence wellness outcomes through the socioeconomic environment and the characteristics of the health infrastructure. The specific dimensions of the community and health infrastructure varied between the outcomes. A recent growth of interest in measuring community-level effects on health outcomes has given rise to the increased availability of community-level data and a recognition that the determinants of health extend beyond individual factors to the community in which the individual lives. The development of multilevel modeling techniques has provided the means for estimating community effects on health. 1– 3 This focus on the community places the health outcomes and behaviors of individuals in their socioeconomic context and provides a policy tool for measuring group-level effects on individual health. 1 This has important implications for public health initiatives; information on the interaction between the individual and the community can be used to inform the development of community-based health programs. This report adds to the existing literature by examining 5 different, although interrelated, reproductive wellness outcomes in Uttar Pradesh, India, facilitating a comparison of community-level effects across a range of wellness outcomes. It examines influences on wellness outcomes at the household, facility, and community levels, extending the work of previous studies that have focused on effects operating at each of these levels in isolation. The study thus provides an opportunity to understand the hierarchy of influences operating to influence an individual’s health.