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    Food security: complexities in the lives of women living with disabilities.
    (2022) Lister, Helga Elke.; Pillay, Mershen.
    Background Food insecurity is a significant public health challenge affecting vulnerable populations globally. Currently, it is not known how health sciences educators train future professionals on the intervention of persons with disabilities who are food insecure. There is also a lack of understanding of food insecurity and disability, where there is additional disadvantage and marginalisation (such as having HIV or being a woman). This study explored how women living with disability in vulnerable contexts experience food security. Methods Firstly, an exploratory cross-sectional online survey was conducted in the School of Health Sciences, University of KwaZulu-Natal, South Africa. Through this, a baseline of the knowledge, attitudes and practices of educators regarding teaching of food security and disability in health care sciences was obtained. Secondly, a qualitative life history methodology was used to conduct open-ended interviews with three participants sourced through purposive sampling. Data collection, analysis and interpretation occurred concurrently over a five-year period. This was followed by a process of narrative configuration to produce the stories of the three women. Following this, the paradigmatic mode of analysis was used to describe the findings of three themes in the first two women’s narratives relevant to the research question. After this, the third narrative was analysed over the researcher’s changing understanding and insights developed within the community oriented primary care (COPC) approach. Results Educators from diverse disciplines completed the questionnaire (n=35). They had a partial understanding of the link between food security and disability. Few educators incorporated disability and food security into their training (12% theoretically and 20% practically). They indicated that more should be taught on this topic. Through the qualitative analysis, the three themes which influenced the food security of women living with HIV and disability were resilience; systemic failures; and questions around food security measures. The factors that emerged relevant to COPC engagement in households were the life history interview method for CHWs; improved training in mental health for CHWs and community-based health practitioners; improved care coordination between services; and improved understanding of interrelated HH complexity. This led to the development of the Household Complexity Model (HHCM). Conclusion The connection between food insecurity and disability, as experienced by women, must be thoroughly understood in health care. Beyond this, complexity should be addressed directly. Doing so will facilitate an improved understanding of the interrelatedness of household members and thus ensure that intervention can be more sustainable in improving overall wellbeing.