Primary Outcomes (end points)
a. Mental health status:
We quantify mental health of clients using two measures: (i) the 12 item General Health Questionnaire (GHQ-12) (Goldberg & Williams, 1988) and (ii) the 7 item General Anxiety Disorder (GAD-7) (Spitzer, Kroenke, Williams and Lowe 2006).
(i) General Health Questionnaire: The objective of using GHQ will be to quantify psychiatric well-being of clients. It has been used extensively in the literature as a screening device for common mental disorders. The scale will be used to gauge the overall mental health of the client over the past few weeks for a 12 item list. Clients will be asked to rank each item on a likert scale of 0 (never) to 3 (always). These items are: Over the past few weeks have you: (i) been able to concentrate on what you're doing? (ii) lost much sleep over worry; (iii) Felt you were playing a useful part in things? (iv) felt capable of making decisions about things (v) felt constantly under strain, (vi) felt you couldn't overcome your difficulties; (vii) been able to enjoy your normal day-to day activities, (viii) been able to face up to your problems (ix) been feeling unhappy and depressed (x) been losing confidence in yourself (xi) been thinking of yourself as a worthless person; (xii) been feeling reasonably happy, all things considered. Positive statements will be reverse coded so that for these statements (0) will denote always while (3) will denote never. The overall scale will range between 0-36 with higher scores denoting poor mental health and vice versa. Variable names are: ghq1, ghq2, ghq3, ghq4, ghq5, ghq6, ghq7, ghq8, ghq9, ghq10, ghq11, ghq12 (of which ghq1, ghq3, ghq4, ghq7, ghq8, ghq12 will be reverse coded).
(ii) Generalized Anxiety disorder (GAD-7) scale: This is a standardized self-reported clinical scale used to identify individuals who may suffer or be likely to experience generalized anxiety disorder. Respondents are asked if how often, over the past 2 weeks, they have been bothered by the following problems: (i) Feeling nervous, anxious, or on edge; (ii) not being able to stop or control worrying; (iii) worrying too much about different things (iv) trouble relaxing (v) being so restless that it's hard to sit still (vi) becoming easily annoyed or irritable and (vii) feeling afraid as if something awful might happen. Respondents are asked to rank each of these problems on a likert scale where 0 denotes (not at all) while 3 represents (nearly every day). The overall scale will be a sum of responses to each of these 7 items and will range between 0 and 21, with higher scores implying that the respondent is prone (or experiences) generalized anxiety disorder. The variables to be used for constructing this scale are: (gad1, gad2, gad3, gad4, gad5, gad6, gad7).
b. Physical health status
We will use a series of discrete dummy variables to capture physical health status of the clients. Clients will be asked to report if (i) How they felt on most days of the last week (1 if the client felt tired, weak, sick or extremely sick and 0 if the client felt alright or well); (ii) whether they suffered from any symptoms of illness or injury in the last 30 days (1 if the client reports yes, 0 otherwise) and (iii) whether the illness or injury prevented them from performing daily activities (1 if the client reports yes, 0 otherwise). (variable names: feel, sufferill, preventwork)
We will use the following dummy variables as a measure of empowerment:
Whether the woman is allowed to go alone to a relative’s house; How often the husband listens to the woman and respects her opinion; whether the woman has the freedom to make decisions about her own health and the health of her children on her own or in joint consultation with her husband.
(variable names: goalone; husblisten; healthdec)