Health education and agency: A comprehensive program for young women in the Mixteca region of Mexico

Abstract

The Si yo estoy bien, mi familia también (“If I am OK then so is my family”) is a health and agency education program that was provided over a period of 3 years to 39,000 rural women in Oaxaca, Mexico. The purpose of the article is to describe the development, implementation and evaluation of the program. The theoretical rationale and strategy of this intervention are described, as well as the construction of the program and the implementation. Moreover, an evaluation of the various stages of the program is provided, to enable an assessment of its efficacy, and the scope for dissemination and scaling up.

Keywords:

• Agency
• community
• cervical cancer
• health rural
• women

Acknowledgments

The program reported in this article was funded by Glaxo-SmithKline (formerly Smithkline Beecham), under the Community Partnership Division's program. We are specially grateful to Marco Botey, Medical Advisor; Adrian Cruz, Vice-President for Latin America and Xavier Reyes Ponce, General Director of GSK Mexico. For their work in the implementation of the program we wish to express our thanks to IMSS-Oportunidades (former IMSS-Solidaridad), specially Dr. Javier Cabral, General Coordinator of IMSS-Oportunidades; Dr. Angel Flores, Coordinator of the Community Action Department at IMSS-Oportunidades, Marisela Quezada, Advisor to the Office of Community Orientation, as well as José Guadalupe Ríos and Melquíades Ramírez, the regional Community Action Supervisors of the two regions of intervention, together with their teams of Community Action Promoters, Rural Health Assistants and Social Volunteer Promoters. The IMSS-Oportunidades team also made sure the contents of the program were in accordance with their institutional norms. In addition, we would like to mention the support of the late Ms Guadalupe Hinojosa de Murat and her husband Jose Murat, Governor of Oaxaca. Our acknowledgement goes to Norma Morales for the careful fieldwork, Iwin Leenen and Rocío Martinez for their detailed care of the data analysis stage. Lastly, we wish to express our very special thanks to Ype H. Poortinga for his very valuable comments.

Notes

1. The bags showed the campaign's logo on one side and the logos of the financial sponsors, IMSS-Oportunidades and IMIFAP on the other side.

2. Community action promoters are IMSS-Oportunidades's employees in charge of health education and health prevention programs in several communities at a time. Rural health assistants receive from IMSS-Oportunidades a symbolic payment to act as health providers in communities where there are no doctors. Social volunteer promoters are voluntary individuals from rural communities who educate the population in health issues.

3. One of these stations was Radio INI (the official radio station of the National Indigenous Institute that reaches the whole state of Oaxaca), the other was a commercial station. The broadcasts were in the following languages: Mixteco alto, Mixteco bajo, Triqui alto, Triqui bajo and Spanish.

4. Instead of a MANOVA on the community means, one could analyze the current data set making use of multivariate multilevel models, which from a theoretical point of view definitely would be a superior analysis. However, given that this type of model has been developed only recently (and software was not generally available) and given the large number of missing values in the dependent variables, we resorted to the less sophisticated MANOVA.

5. The effect of time between Pre- and Post-1 was modeled through a binary variable Time 1 that assumes a value of 0 at baseline and a value of 1 for all Post-1 and Post-2 applications. Similarly, the effect of time between Post-1 and Post-2 was modeled through a binary variable Time 2 that assumes a value of 1 for all Post-2 applications. Differential effects of time in the experimental group were modeled through the interactions Time 1×Treatment and Time 2×Treatment, with Treatment being identically defined as in the MANOVA.