In addition, given that our study used published validated tools as a base of comparison, our study could not assess the coverage for more recent constructs related to patients' experience, such as self-efficacy, shared-decision making, participation and enablement.
While decision-making participation model is quite common, advocacy NGOs have not constructed a universal and institutional path for participation, despite their occasional successes.
Questions on household decision-making participation were asked to currently married women only, thus unmarried women were dropped from the analysis.
For example, a meta-analysis found that household decision-making participation was positively associated with SBA use in 31 countries (including 21 African countries) [ 22].
Women who participated in at least one household decision-making factor had higher odds of receiving four or more ANC visits compared to women who had no decision-making participation.
For example, household decision-making participation was the only measure that is significantly associated with SBA use in Tanzania, such that for every additional household decision in which women participated, they had 12.9 % higher odds of using SBA.
In terms of participation in decision making, the participation of young people in decisions that affect their lives inside their families, in educational institutions, at work and in the community at large is limited.
Both instruments were pre-tested in Nigeria to ensure their accuracy in assessing participants' understanding of issues surrounding informed consent and decision making regarding participation in the genetic epidemiological study of breast cancer.
Most importantly, these considerations will become "locally rooted" through decision making and participation at the community and municipal scale, allowing residents to foster a healthy relationship with the river.
