By Dr. Deema Saeed, Monitoring, Evaluation, Accountability & Learning (MEAL) Officer, HSF
Garima*, a 28-year-old participant in Healthy Homes, started off her training unaware that a high-sugar diet is a risk factor for various diseases. She was not alone, as only 51% of the participants were aware of the risks of high sugar, and only 29% of participants were able to identify the reasons why our bodies need food. These baseline results call for the promotion of healthy diets for the women in Bhaskar Nagar and increasing awareness about the role of high-sugar diets in diseases that include diabetes, tooth decay, and heart disease.
Garima stated that her first session in the program on Oral Health was very eye-opening, which did not come as a surprise, as one of the most repetitive misconceptions on oral health among the participants was, ‘When you have tooth pain, it is best to first try to treat the tooth of concern with remedies like gul (tobacco) on the gums and teeth, biting on clove, putting petrol on tooth, packing the tooth with Colgate powder, and pouring hot oil on the tooth.’
Unawareness about oral and general health and lack of healthy habits in Bhaskar Nagar call for a well-tailored intervention with an interactive and common risk factor approach. Healthy Homes – a collaborative project of Humble Smile Foundation (HSF), Indian Dental Association (IDA), and Gabriel Project Charitable Trust (GPCT) – aims to promote health and hygiene both at an individual and household level. The intervention addresses the increasing burden of disease in Bhaskar Nagar based on evidence from research. It also facilitates women-empowering-women through self-help gatherings and health promotional home visits.
Women living in low-income areas often tend to prioritise the health of their children and husbands over their own. Through the Healthy Homes program, women learn to take responsibility for their own health with trainings and guidance on making well-informed decisions regarding their health and the health of their families. Research shows that receiving information about health increases the participation, involvement and willingness of women aged 25-60 years to promote their own health. Health education also encourages women to protect themselves, their families, and their societies from disease through preventive measures, and aids in the facilitation of achieving positive outcomes in health (Nasrabadi et al., 2015) (Kassim, 2021). Our Healthy Homes project is built on the common risk factor approach – a method that identifies and tackles risk factors that are common between different diseases and conditions (Sheiham and Watt, 2000). In the program participants acquire knowledge and skills to adopt a collaborative, holistic approach to health that addresses their diet, tobacco-using habits, alcohol habits, water safety, menstrual health, oral health, and hygiene as a whole.
Garima mentioned that her biggest barriers to oral health and hygiene were laziness to take care of her mouth, and lack of information about oral health. She has also never been to a dentist due to geographic barriers and dentists’ reputation of being overly expensive. Laziness appeared to be a common barrier to maintaining oral health among more women in Bhaskar Nagar, as it was reported as a barrier by 65% of the participants in both cohorts of the program. Other common obstacles to oral health and hygiene for the participants and their households included ‘Uncooperative Husbands’ and ‘Lack of Knowledge about Oral Hygiene’. Garima learned methods she can use to overcome those barriers and make a fun habit out of brushing her teeth twice a day with fluoridated toothpaste. She also received Humble Oral Care Kits, containing an eco-friendly bamboo toothbrush and fluoridated toothpaste, in addition to a list of registered dentists in the area, many of whom are relatively affordable and/or offer discounts. Trained Community Health Workers (CHWs) encouraged Garima to include her husband in their bi-monthly home visits and to discuss and share different methods for overcoming common barriers with other women during the sessions.
To further address the social determinants of health inequality, participants learn about the different types of barriers to health; including general, nutritional, menstrual and oral. They also train on actively applying mechanisms and strategies to overcome the barriers, right in line with the UN’s 2030 Agenda for Sustainable Development. The agenda is built on the revolutionary Principle 2 of the UN’s Sustainable Development Cooperation Framework, ‘Leave No One Behind’ (UNICEF, 2021). Moreover, Healthy Homes promotes menstrual health and hygiene in line with World Health Organization’s 2021 commitment at the Generation Equality Forum to ‘facilitate menstrual hygiene and promote awareness’. Additionally, our CHWs actively encourage women in Bhaskar Nagar to break the taboo and silence around menstruation and promote healthy menstrual habits among the women and girls in their households and surroundings (WHO, 2021). Built around the concept of ‘women empowering women’ and self-governed groups, the program contributes towards a self-sufficient community care system where women actively take part in reclaiming and prioritising their own health. This approach also encourages women to address families’ health concerns, promote health and hygiene within the community, reduce the burden of disease, break cultural taboos and to be an advocate for health and for women within their own societies.
Today, two months into the program, Garima reports significant improvement in her health habits; particularly in brushing her teeth twice a day, reducing food and drink sugar content for herself and her household members, and safe storage of water. Just like her fellow group members, she is looking forward to the remaining 4 months of the program. And so are we, as Healthy Homes has given us the opportunity to study and identify the health needs of an underprivileged community, to ensure tailored, evidence-based, and sustainable health solutions.
* Garima is a fictive person. Anonymized and significant data from HSF’s research was used to represent female project participants in Bhaskar Nagar with comparable stories.
Nikbakht Nasrabadi, A., Sabzevari, S., & Negahban Bonabi, T. (2015). Women Empowerment through Health Information Seeking: A Qualitative Study. International journal of community-based nursing and midwifery, 3(2), 105–115
Kassim, M. (2021), A qualitative study of the maternal health information-seeking behaviour of women of reproductive age in Mpwapwa district, Tanzania. Health Info Libr J, 38: 182-193. https://doi.org/10.1111/hir.12329