Understanding Reciprocity Among University Students in Low-Resource Settings: Validation and Measurement Using a Mixed-Methods Approach

Abstract

ObjectivesThis study aimed to investigate reciprocity among university students in low-resource settings using a convergent mixed-methods approach in Jordan. The study operationalized the effort-reward imbalance (ERI) model which is a sociological framework used to predict occupational-related health outcomes. The basic theory of ERI model assumes that an imbalance of effort and reward predicts adverse health outcomes.MethodsThe research involved two studies, Study I (n = 833) to quantitatively measure ERI and Study II to collect qualitative data (n = 44) on the drivers of ERI among university students. In Study I, a modified Arabic version of the ERI questionnaire was used. The study measured ERI and investigated the reliability and validity of the Arabic version of the ERI model questionnaire. In Study II, data were collected from focus groups and personal interviews and thematic analysis was used.ResultsThe results suggested that ERI was associated with poor academic performance (OR=2.31, 95% CI 1.60–3.32), absenteeism (OR=1.66, 95% CI 1.21–2.27), low exercise level (OR=2.02, 95% CI 1.49–2.74) and poor self-reported health (OR=1.12, 95% CI 1.08–1.30). Three major themes emerged, namely high academic load, financial pressures and negative influence on the students' performance, wellbeing and health to explain effort-reward imbalance.ConclusionsResults suggest that ERI among university students is multi-faceted and is not bound only to academic-related demands and that the extrinsic factors such as the economic context of Jordan is among drivers of ERI.

Trends in birth attendants in Sudan using three consecutive household surveys (from 2006 to 2014)

“…Health visitors have been assigned supervisory duties over locally certified midwives, and their roles further included the training of locally certified midwives and the management of midwifery schools ( 22 , 23 , 46 ). Practicing health visitors are often stretched, and many struggle to fulfil their supervisory duties that often cover geographically widespread regions ( 46 , 47 ). This likely left health visitors with limited time and resources to attend births in the community.…”

“…In 2014, they attended more than half of all births and were three times more likely to attend births in the community than in 2006 (aOR: 3.42; 95%CI: 2.74–4.27), effectively replacing other birth attendants. The training of this important cadre has historically attracted older applicants (40+ years old) with basic, if any, educational background and many were previously traditional birth attendants ( 23 , 43 , 47 ). The low literacy levels of students limited the scope of training they could receive ( 47 ).…”

“…The training of this important cadre has historically attracted older applicants (40+ years old) with basic, if any, educational background and many were previously traditional birth attendants ( 23 , 43 , 47 ). The low literacy levels of students limited the scope of training they could receive ( 47 ). Studies assessing the care provided by certified midwives found that they have retained knowledge and skills directly relevant to labour care ( 23 , 48 ), but had limited knowledge and skills in aspects they did not encounter regularly, such as post-abortion care ( 24 ).…”

“…Since the last survey round of the SHHS in 2014, two new training programmes for midwives were introduced in Sudan to advance midwifery practice: (1) community midwives who complete a 2-year apprenticeship programme, and (2) professional midwives who complete a 4-year university Bachelor of Science in Midwifery ( 47 ). A recent study that assessed the competencies of community midwives identified low knowledge in diagnosing high-risk pregnancies requiring referral for health facility births and in measuring women's vital signs ( 47 ). It is likely that they do not meet international definitions of midwives and of SBAs.…”