Legitimacy is an overlooked precondition for a tactic's availability within social movement repertoires. Drawing on semi-structured interviews with 37 Movement for Black Lives activists in Minneapolis and St. Paul, Minnesota, this article identifies a three-step process through which activists legitimize riots. First, activists reclassify riots as protest by lumping them with revered tactics, thereby splitting them from criminality. Second, activists engage in moral legitimation: they acknowledge the harm riots can cause to Black communities but frame them as justified counterviolence to state repression. Third, activists use instrumental legitimation. Despite potential reputational risks, they argue that riots impose costs on capitalism, delegitimize the state and lend credibility to subsequent nonviolent protests. By tracing how activists legitimate a controversial movement tactic, this article argues that legitimation work shapes tactical availability. This challenges views of the repertoire of contention as a fixed toolkit from which activists choose tactics they regard as strategically effective or aligned with their collective identities.
Black women have a long history of engaging in activism and community advocacy as both a political imperative and a survival strategy (Hill Collins, 2000; Ransby, 2003). Activism may confer psychological benefits such as increased meaning in life, identity affirmation, and social connection (Hope et al., 2019; Klar and Kasser, 2009); simultaneously, activism can involve sustained stress exposure, burnout, and heightened vulnerability to surveillance and (re)traumatization (Gorski, 2019). Biological indicators offer one avenue for examining how social conditions are embodied particularly when psychosocial experiences involve chronic threat, vigilance, and cumulative stress exposure. Given growing attention to activism as a health-relevant practice, this study is framed though an intersectional and critical medical anthropology lens to explore how activism may relate to both psychosocial and biological stress processes among Black women. Using an embedded mixed-methods pilot design, this study evaluated the feasibility of assessing psychosocial indicators and the Conserved Transcriptional Response to Adversity (CTRA) at baseline (T1) and ~2-month follow-up (T2) during a self-selected intentional activism period among Black women, with baseline semi-structured interviews contextualizing interpretation of T1→T2 patterns. Participants (N = 29; M age = 39.4 years, SD = 11.7; range = 21-63) completed online surveys, a baseline interview, and coached dried blood spot (DBS) collection at T1, then completed follow-up surveys and DBS collection at T2. Analyses followed a three-part workflow: (1) feasibility metrics (enrollment/retention and useable DBS returns), (2) within-person quantitative change (paired-samples t tests for psychosocial measures; mixed-effects linear models of a 53-gene CTRA set), and (3) thematic analysis of baseline interviews with integration via joint display (convergence/complementarity/divergence). Procedures supported remote biobehavioral assessment; useable DBS/CTRA data were available for most participants (T1 n = 28; T2 n = 27). Psychosocial scores decreased from T1 to T2 for psychological distress, activist orientation, and meaning in life (presence and search), with activist identity/commitment also decreasing but not reaching conventional thresholds. At the sample level, mean CTRA showed no net change from T1 to T2; however, within-person increases in activist identity/commitment and increases in search for meaning were associated with more favorable CTRA change. Baseline qualitative themes (Activism's Paradox; Identity Dialectics; Resistance and Restoration; Community-Rooted Well-being) highlighted co-occurring strain, meaning, identity negotiation under misogynoir, and relational coping infrastructure. Findings support feasibility and provide hypothesis-generating evidence that biobehavioral responses may be contingent on identity and meaning processes rather than uniform mean shifts in a heterogeneous activism window.
Underestimating the burden of Chronic respiratory diseases (COPD-Asthma) is a past error that needs to be remedied, and cases with these diseases are to be screened and diagnosed! Current health policies primarily focus on other NCDs like diabetes and cardiovascular diseases, indicating a need for more targeted interventions for CRDs. A thorough literature review was conducted to analyse the evidence for probable solutions to address the CRD's and available models for screening and diagnosis at primary health care. Based on this, an implementation model is proposed- Screening by Accredited Social Health Activist (ASHAs)and diagnosis by Community Health officers (CHOs)of Asthma and COPD at the primary health care System- A Novel Strategy- SHVASAN (local meaning breathing). To assess the feasibility of implementation of a " SHVASAN " model for screening and diagnosis of COPD and Asthma at the primary health care level. Methodology: Mixed methods to assess feasibility, including the Delphi technique. Implementation will begin with the training of ASHAs, CHOs, and equipment will be provided for setting up the screening and diagnosis across one rural PHC in Pune district, India. All 35 villages and ASHAs would be screening the population above 30 years of age. And CHOs across all Health and wellness centres (06 + 02 at PHC and one at RH) will diagnose the CRDs. Feasibility would be assessed after one year of the SHVASAN model implementation. A Delphi study would be conducted to formulate the feasibility dimensions and formulate the feasibility index. Considering feasibility dimensions, qualitative and quantitative data would be collected to assess the feasibility of the model, which includes the population screened by the ASHAs and the number of diagnostic tests conducted at health wellness centers. And focused group discussions, in-depth interviews will be conducted to understand the facilitators and operational challenges of the SHVASAN implementation. SHVASAN builds on the NPCDCS Govt of India guidelines. This is a novel, low-cost adaptation for peripheral workers with limited specialist access.​This research will inform potential feasibility and the development of implementation strategies as public health services prepare for broader rollout in the near future. CTRI/2025/10/095547.
Given concerns about the mental health of young people, there has been a growing body of research aimed at understanding strengths, resilience, and protective factors. The current study utilizes latent profile analysis to examine different combinations of strengths. Group differences on demographics, social determinants of health (SDoH), and mental health indices are examined across the identified latent classes. Project Lift Up is a longitudinal, national study of youth and young adults designed to understand bystander behaviors for self-directed violence. 4,981 adolescents and young adults aged 13-22 years were recruited online between June 13, 2022 - October 30, 2023. Three additional waves of data were collected, approximately 6 months apart: Wave 2 (collected between January 13, 2023 - February 26, 2024); Wave 3 (June 13, 2023 - November 19, 2024); and Wave 4 (December 15, 2023 - May 8, 2025). The qualifying longitudinal cohort, defined as completing baseline and either the 6- or 12-month surveys, was 3,360. A total of 2,049 participants completed all four survey waves and are the analytic sample for the current paper (61% of the qualifying cohort). Latent profile analysis identified seven strength profiles: Despondent (5.5%), Isolated (14.2%), Pessimistic (14.3%), Support-Focused (26.8%), Self-Reliant (8.9%), Multi-faceted Strengths (23.8%), and Resilient Activists (6.3%). Profiles differed in both overall strength levels and configurations across regulatory, interpersonal, meaning making, and environmental domains. Depressive symptoms and self-directed violence were highest in the Despondent and Pessimistic profiles and lowest in the Self-Reliant and Multi-faceted Strengths profiles, with Resilient Activists showing intermediate risk. Despite high strengths, Resilient Activists experienced uniquely elevated SDoH adversity, including discrimination, food insecurity, and structural hardship. In contrast, Self-Reliant and Multi-faceted Strengths profiles showed the lowest SDoH risk across domains. Females, sexual-minority, and gender-minority participants were overrepresented in profiles with poorer mental health and greater adversity and underrepresented in the most robust strength profiles. Practitioners should incorporate assessment of strengths portfolios when working with young people. Programs to prevent mental health problems, including suicide and self-injury, should include specific strengths-based components across the four domains of the Resilience Portfolio Model - regulatory, interpersonal, meaning making and environmental.
While mainstream public health has recognized the prime role of social determinants of health (SDOH) in shaping patterns of health and disease, the field has struggled to find meaningful ways to tackle these fundamental causes of health and health inequities. Though often overlooked within the field of public health, activist campaigns have been a vital force for securing advances in confronting and modifying SDOH, from obtaining wage increases to expanding reproductive health care to securing health care for millions through the expansion of Medicaid. These examples show that social movement activism can encourage public officials to make tackling the SDOH a priority on their policy agendas and contribute to reducing the influence of the special interests who often oppose these changes. To integrate activism with public health practice more consistently, researchers, practitioners, and activists need a robust body of evidence that enables them to leverage activism to address social determinants. This narrative review seeks to explore the role that evaluation can play in strengthening health activism aimed at SDOH and making it a more accepted and familiar component of public health practice. We offer definitions of several key terms, review relevant literature on evaluation of health activism, and propose guiding questions along with real-life examples of corresponding evaluations. We aim to encourage public health practitioners to recognize the role of activism in advancing public health and to find ways to use evaluation to partner with activist campaigns seeking to modify SDOH.
This article explores the representation of sexual health in black and brown communities in London during the early COVID-19 pandemic. I examine the 'Sex & the Coronavirus' (2020) health comic series and interviews with HIV activists to demonstrate how they shifted the focus of COVID-19 health promotion away from the hegemonic white middle class and towards black and brown experiences. I use textual and visual analysis to trace the construction of practical information about COVID-19 and STI prevention-including biomedical, public health and relationship advice-and demonstrate how the imagery and language of mutual aid and interdependence enact counterhegemonic strategies. I argue that these materials and activist experiences set out key principles for counterhegemonic health promotion practice at the intersection of sexual health and COVID-19 prevention. I suggest that these principles should be further trialled for inclusive health promotion theory and practice.
Identitarian progressivism has become the public face of institutional psychological science. Masking the diverse perspectives within our field, these single-minded expressions have two trust-related implications: reinforcing 'ingroup' trust among a progressive activist cohort within our science, while evoking mistrust from an 'outgroup' public that -to an overwhelming extent- does not share their views. Given the predominant role of taxpayers in funding our research, we should be concerned that the voting public may justifiably perceive our science as emphasizing activist visions of what should be over the empirical complexities of what is. Ensuring public trust will depend on re-embracing persuasive intellectual humility and eschewing the identitarian vernacular and deficit model pedagogy that currently characterizes our public-facing messaging.
The interest in psychedelics for health-related purposes has grown significantly over the past decade. However, there is an insufficient representation of stakeholders (eg, Indigenous groups, activists, policymakers) in discussions about research and regulation. Many psychedelics originate from traditional practices historically developed in low- and middle-income countries, but these regions are seldom represented in stakeholder perspectives research. The present study will examine the barriers, facilitators, and perspectives identified by a wide array of key stakeholders regarding the research and regulation of psychedelics in Brazil. Twenty-six stakeholders, including Indigenous leaders, formal industry actors, clinicians, activists, policymakers, and informal sellers, were interviewed. The data were analyzed using inductive thematic analysis. Code-group co-occurrence indexing was used to capture the relevance of each theme across stakeholder groups. Thematic analysis revealed 4 barriers ("accessibility," "regulation," "limited knowledge," and "risks"), 3 facilitators (1need for innovation," "scientific advancements," and "legal loopholes"), and 4 perspectives ("integration of ancestral knowledge," "idealization, mysticism and scientific rigor," "user autonomy," and "tangible social benefits"). Themes were similarly present among stakeholders' discourse, though with varying frequencies and weights, allowing comparisons of the particular relevance of themes for each group. We detail cultural, political, scientific, and clinical barriers, facilitators, and perspectives for psychedelic research and regulation within a region with a rich history of traditional psychedelic use, and discuss their ethical, regulatory, and clinical implications.
In the past decade in France, several cases of mistreatment and abuse of Black women within the healthcare system have made headlines, sparking much-needed conversations among activists, and some medical personnel, on medical racism. In this article, I share insights from my work as an anthropologist, health consultant, and feminist activist in France and Mexico. I focus on one aspect of medical racism, the so-called "Mediterranean syndrome," and its impact on the reproductive care (or lack thereof) offered to Black, Arab, and other-than-White women. I also reflect on the trainings I provide to medical personnel on medical racism. These trainings reveal the complexities faced by personnel who seek change, though subject to their own bias and that of their superiors.
Political ideology has increasingly entered clinical psychology training through the incorporation of decolonial and activist-oriented frameworks. While attention to social inequities is essential to culturally competent care, integrating politicized models into applied clinical training raises concerns about scientific neutrality, professional pluralism, and the emergence of identity-based bias. This article examines how decolonial psychology and related activist frameworks have contributed to the development of antisemitic dynamics within professional clinical psychology training. We argue that these dynamics emerge not only from specific political narratives but from a broader shift toward ideologically driven models of care that prioritize moral frameworks over empirical reasoning. This shift has contributed to fractures within the profession and introduces potential public health risks by influencing clinical judgment, professional relationships, and standards of care. These challenges are described, and a programmatic approach to addressing them is provided.
Over the past 2 decades, bystander-focused violence prevention programs have proliferated across various sectors, yet bystander programs that are expressly gender-transformative remain understudied, particularly on U.S. college campuses. Casey et al. argue that outreach and recruitment efforts and whether these programs foster identities as social change agents over time are especially understudied components of gender-transformative programs. Based on a non-quasi-experimental, single-group, repeated-measures design without a control group, this pilot study engages these questions by investigating participant characteristics and leadership program outcomes of one gender-transformative bystander program-the Mentors in Violence Prevention (MVP) program-as applied to student leaders in athletics, fraternity and sorority life, and residential life. We found that student leaders came to the training with varying gender ideologies and leadership experience that are important considerations in future outreach and recruitment efforts. The 1-day MVP program also produced significant improvements from pre- to posttest in activist outcomes for women and men and for the three student leadership groups. Yet, on several program outcomes, training effects waned 3 months later, women benefitted more than men, and gender ideology interacted with peer group to shape program gains. The article concludes with reflections on the implications of these findings for gender-transformative work with college peer groups often labeled "at higher risk" for sexual assault; the centrality of gender, gender ideology, and other peer group characteristics to recruitment and outreach efforts; and future research and practical applications for sustaining activist education on college campuses.
The mental health of youths in developed nations has been declining for at least two decades. Fear of climate change is one of the most prevalent causes of youth distress directly associated with declining function. We argue that the introduction of climate change activist materials into primary and secondary school curricula put children and adolescents at risk of harm. Preventing mental distress in children should be a higher priority for health and education professionals than combatting climate change, so these materials should be removed until they have been demonstrated to be safe for all students.
Abortion is a common reproductive healthcare process that is often stigmatised. Research on abortion stigma has grown significantly since the last major review over a decade ago, and there is a pressing need for an updated, comprehensive systematic review. The purpose of this review is to examine the extent and subjective experiences of abortion stigma among those seeking an abortion in high-income countries. We aim to explore the theoretical conceptualisations of abortion stigma in relevant studies. We conducted a mixed-method systematic review following the JBI and PRISMA guidelines. PubMed, CINHAL, PsychINFO, LIVIVO, and the Cochrane Library were searched for peer-reviewed articles. Quantitative studies were summarised narratively. Qualitative studies were synthesised using the JBI meta-aggregative approach. We included 41 qualitative, nine quantitative, and three mixed methods studies. Most studies lacked a substantial theoretical conceptualisation of abortion stigma. Quantitative studies reported prevalence rates of perceived abortion stigma ranging from 37% to 60%, suggesting that stigma remains a common experience among abortion seekers. Findings also indicate associations between abortion stigma and various sociodemographic factors (e.g., religion, race, age), as well as adverse mental health outcomes. In the qualitative studies, people seeking abortion care reported experiencing and anticipating judgment from healthcare professionals, anti-abortion activists, and their close social circle. Their experiences also centered on the internalisation of shame and guilt. Some studies highlighted the mitigating effect of social support. Longitudinal and mixed methods approaches with consistent assessment would be useful to better understand the developmental pathways of abortion stigma. This understanding is necessary to provide individual and structural support for people seeking abortion care. Abortion is a common healthcare procedure, but it often faces stigma. Despite many recent studies on this topic, there hasn't been an updated overview since 2016. We reviewed 53 research articles to understand how and to what extent abortion stigma is experienced in high-income countries. Quantitative studies mainly looked at how common abortion stigma can be and how it relates to mental health and decision-making. Qualitative studies provided a more profound insight. They showed that people seeking abortions often feel judged by healthcare workers, anti-abortion activists, and their friends and family. Qualitative studies underline how people who seek an abortion feel ashamed and guilty. However, having support from loved ones could help lessen these feelings. In conclusion, we found that abortion is a stigmatised process. Future research should explore the support systems available to people seeking abortions. Understanding these supports can help improve structural-level care and ensure better assistance for people navigating abortion access.
Accredited Social Health Activists (ASHAs) play a vital role in bridging the gap between rural communities and the public healthcare system. Through the Mobile Solutions Aiding Knowledge for Health Improvement (M-SAKHI) clustered randomized controlled trial, ASHAs were equipped with a mobile application for real-time data collection and face-to-face counselling. This study evaluates the app's impact on participants' knowledge, skills, and acceptance in the intervention arm using a pre‑post evaluation design. Knowledge was assessed using multiple-choice pre and post-test questionnaires. ASHA skills were continuously evaluated across five domains: (1) participation in meetings/trainings, (2) server monitoring of activities, (3) App and phone operating skills, (4) 5% random checks, and (5) field supervision feedback. ASHA's Performance was graded as poor, satisfactory, or good based on performance scores. Feedback was collected on M-SAKHI training, mobile and App usability, and preferred features in the App using a 3-point Likert scale. Knowledge assessment showed a significant decline in the ASHAs' scoring in "Poor" category 18.7% (p < 0.001) [pretest 32% (48/150) vs post-test 13.3% (20/150)] and a 14% (p < 0.001) increase in the number of ASHAs scoring "Good" category [pretest 4.7% (7/150) vs post-test 19.3% 29/150)]. Only a fifth displayed poor performance in skills assessment across attributes. Data or device misuse was limited to 6.7% (10/150). Over 90% (139/150) of ASHAs could operate the device and App independently; nearly all found the App's content user-friendly and easy to understand. The M-SAKHI app was associated with improvements in ASHAs' knowledge and enhanced their implementation capacity. With the very high acceptance of mHealth technology by ASHA workers, this shows promise in empowering ASHAs to deliver services more effectively in rural settings. Trial Registration Number: CTRI/2018/02/011915 [Registered on: 15/02/2018] https://ctri.nic.in/Clinicaltrials/searchbyctri.php.
Cervical and breast cancer are the leading causes of women's cancer mortality in Ghana and India. Using an integrated, scalable approach of screening, diagnosis, and treatment, 2 real-world programs were independently designed and conducted in Ghana and India. Each program was adapted to the local healthcare infrastructure to increase screening and management of breast and cervical cancers. Government, healthcare, industry, non-governmental organization, and community leader partnerships in Ghana and India created a comprehensive patient engagement framework. Cascade training in cervical and breast cancer for healthcare workers, cancer awareness community outreach, screening, and follow-up for women were instituted. Patient navigators and accredited social health activists supported patients throughout the program. Human papillomavirus (HPV) DNA testing and HPV DNA self-sample collection were introduced. In the Bekwai municipality of Ghana, 20 facilities participated in the screening program. Sixteen trainers and 70 providers were trained. Of 5730 women screened for breast cancer; 100% of 113 with confirmed breast abnormalities had diagnostic services and treatment if necessary. For cervical cancer screening, 4997 women provided samples (80% self-collected); 811 were HPV-positive, 609 (75%) returned for further assessment, and of those, 100% were treated. In Amethi, India, 19 facilities participated. Forty trainers and providers were trained. Collectively, 4505 women were screened for breast cancer; 28/123 with abnormalities (23%) were referred for further management. Of 10,141 women who provided cervical samples (75% self-collected), 370 were HPV-positive, and 193/370 women (52%) returned for treatment or referral to tertiary centers. Establishing multiple-stakeholder partnerships resulted in cervical and breast cancer screening programs that were successfully implemented into routine clinical service in diverse environments and resulted in large numbers of women receiving cancer screening and treatment.
The rapid growth of digital health initiatives has heightened reliance on frontline health workers (FLHWs) to deliver, document, and manage services through digital tools, particularly in low- and middleincome countries (LMICs). In India, the widespread rollout of platforms under the Ayushman Bharat Digital Mission (ABDM) is not yet matched by a standardized digital health competency framework (DHCF) for FLHWs, hindering systematic skill development, assessment, and integration. This study designed, developed, and evaluated a theory-driven, evidence-based, and scalable DHCF for India's health workforce. Framed as a feasibility and proof-ofconcept study, it was piloted among FLHWs in Uttar Pradesh using a three-stage approach comprising design, implementation, and evaluation. The framework development drew on a systematic literature review and the Government of India's Framework for Roles, Activities, and Competencies (FRAC). A cadre-agnostic competency dictionary was created, spanning functional, behavioral, domainspecific, and intervention-specific skills across graded proficiency levels. Competencies were mapped to FLHW roles, and aligned training materials and assessments were developed. The framework was piloted through in-person, instructor-led sessions for Auxiliary Nurse Midwives (ANMs) in two districts (n = 70), alongside baseline assessments for Accredited Social Health Activists (ASHAs; n = 32). The resulting DHCF comprises a three-component package: (i) a cadre-agnostic competency dictionary with progressive proficiency levels; (ii) systematic role-tocompetency mapping using the FRAC methodology; and (iii) integrated training content and assessment scaffolding designed for institutional embedding. The framework defined 10 core competencies, enabling role-specific mapping across cadres. Feasibility testing demonstrated significant gains in ANMs' knowledge and digital skills: Wilcoxon signed-rank tests showed significant improvements in two of four competency levels (C1L1 and C2L1; both P < .001), with the largest effect for data collection basics (r = 0.84). ASHA baseline assessments revealed substantial foundational literacy gaps (mean total score 11.97/30 [39.9%]; data collection was the weakest competency at 32.5%, with no ASHA scoring above 60% on C2L1). Stakeholders affirmed the framework's relevance, feasibility, and adaptability, while identifying the need for hybrid training models and stronger institutional embedding.The DHCF offers a structured, scalable approach to standardizing digital health training for FLHWs and strengthening workforce preparedness in resource-limited settings during India's digital health transition. This feasibility study establishes the framework's relevance and applicability; future work is needed to evaluate effectiveness at scale, long-term competency retention, and linkage to service delivery outcomes. Parallel attention to digital tool design and usability will be essential to complement competency-building efforts.
Digital peer support has gained momentum as mental health services have increasingly incorporated technology. The term digital peer support remains poorly defined, however, risking appropriation by commercial developers, resulting in a lack of clarity in the research on digital peer support, and posing reputational risks for technology developers and the emerging peer support profession. By drawing on established peer support principles and lived expertise, the authors developed a five-domain framework to clarify what constitutes authentic digital peer support. This framework was built to guide technology developers, researchers, service providers, and peer supporters in ensuring that digital tools remain true to peer support's activist roots and relational foundations.