자연주의적 탐구조사(Naturalistic Inquiry)

On Symbolic Interactionism

/pdf/becoming-critical-education-knowledge-and-action-research-v9w7t6i8zs.pdf

Becoming Critical: education, knowledge and action research

https://jech.bmj.com/content/jech/51/6/733.1.full.pdf

Action Research for Health and Social Care: a guide to practice

Qualitative health research.

Aims and objectives. To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality.
Background. Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization. In Part One of this article presented here, a strategy of community empowerment to plan to take action to prevent maternal mortality is discussed. Part Two examines evaluation of the actions planned in Part One.
Design. Participatory action research was utilized.
Methods. Volunteers were recruited as co-researchers into the study through purposive and snowball sampling. Following orientation workshop, participatory data collection was undertaken qualitatively with consequent thematic analysis which formed basis of the plan of action.
Results. Community members attributed maternal morbidities and deaths to superstitious causes, delayed referrals by traditional birth attendants, poor transportation and poor resourcing of health facilities. Following critical reflection, actions were planned to empower the people to prevent maternal deaths through: community education and
2
advocacy meetings with stakeholders to improve health and transportation infrastructures;
training of existing traditional birth attendants in the interim and initiating their
collaboration with skilled birth attendants.
Conclusion. The community is a resource which if mobilized through the process of
participatory action research, can be empowered to plan to take action in collaboration with
skilled birth attendants to prevent maternal mortality.
Relevance to clinical practice. InterventioAims and objectives. To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality.
Background. Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization. In Part One of this article presented here, a strategy of community empowerment to plan to take action to prevent maternal mortality is discussed. Part Two examines evaluation of the actions planned in Part One.
Design. Participatory action research was utilized.
Methods. Volunteers were recruited as co-researchers into the study through purposive and snowball sampling. Following orientation workshop, participatory data collection was undertaken qualitatively with consequent thematic analysis which formed basis of the plan of action.
Results. Community members attributed maternal morbidities and deaths to superstitious causes, delayed referrals by traditional birth attendants, poor transportation and poor resourcing of health facilities. Following critical reflection, actions were planned to empower the people to prevent maternal deaths through: community education and
2
advocacy meetings with stakeholders to improve health and transportation infrastructures;
training of existing traditional birth attendants in the interim and initiating their
collaboration with skilled birth attendants.
Conclusion. The community is a resource which if mobilized through the process of
participatory action research, can be empowered to plan to take action in collaboration with
skilled birth attendants to prevent maternal mortality.
Relevance to clinical practice. InterventioAims and objectives. To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality.
Background. Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization. In Part One of this article presented here, a strategy of community empowerment to plan to take action to prevent maternal mortality is discussed. Part Two examines evaluation of the actions planned in Part One.
Design. Participatory action research was utilized.
Methods. Volunteers were recruited as co-researchers into the study through purposive and snowball sampling. Following orientation workshop, participatory data collection was undertaken qualitatively with consequent thematic analysis which formed basis of the plan of action.
Results. Community members attributed maternal morbidities and deaths to superstitious causes, delayed referrals by traditional birth attendants, poor transportation and poor resourcing of health facilities. Following critical reflection, actions were planned to empower the people to prevent maternal deaths through: community education and
2
advocacy meetings with stakeholders to improve health and transportation infrastructures;
training of existing traditional birth attendants in the interim and initiating their
collaboration with skilled birth attendants.
Conclusion. The community is a resource which if mobilized through the process of
participatory action research, can be empowered to plan to take action in collaboration with
skilled birth attendants to prevent maternal mortality.
Relevance to clinical practice. InterventioInterventions to prevent maternal deaths should include
community empowerment to have better understanding of their circumstances as well as
their collaboration with health professionals.

/pdf/empowering-members-of-a-rural-southern-community-in-nigeria-249a3cxd53.pdf

Empowering members of a rural southern community in Nigeria to plan to take action to prevent maternal mortality: A participatory action research project

Introduction: Knowledge of cultural diversity is important for nursing/midwifery care as these address ethnic and racial differences between providers and consumers of health care, thus, can strengthen and broaden the healthcare delivery system. In a typical nurse/midwife-patient/client encounter globally, there is interplay of three Cultural systems namely, culture of the nurse/the profession, culture of the patient/client and that of the health care system. Multicultural nature of Nigeria influences birth practices. This paper presents findings of a 'fact-finding' phase of action research project which explored understanding of childbirth practices as part of prevention of maternal mortality study in a rural community. Methods: Ethnography design was utilized informed by participatory action research. Data were generated through twenty-nine in-depth individual interviews of childbearing-age women, four focus group discussions with other childbearing-age women, menopausal women/mothers-in-law and traditional birth attendants. Practices of five traditional birth attendants and one midwife were observed. Participants were selected through purposive and snowball sampling. Results: Thematic data analysis revealed diversity in childbirth practices between the traditional indigenous culture and nursing/midwifery culture depicted in the following themes: children having children; nutritional taboos; imposition of decision on care; preference for traditional birth attendants; spirituality as source of safe childbirth; position for delivery; utilization of traditional sanitary towels; care in delivery emergencies; midwives ethnocentrism and culture-imposition. Findings were inputted into the planning phase of the action research for critical reflection and action. Conclusion: Cultural diversity explicitly exists in the nurse/midwife and client interaction in this setting. It is recommended that nurses/midwives should deliberately seek to understand the culture of the people and adopt the harmless ones. Where culture is inimical to health, clients should be democratically and collaboratively motivated to critique their practices with the hope of possible repudiation. This study has implication for the provision of culturally competent care in childbirth.

Cultural Diversity in Childbirth Practices in a Rural Community in Southern Nigeria

THE UNIVERSITY OF MANCHESTERABSTRACT OF THE THESIS submitted by Ekpoanwan Esienumoh Esienumoh for the degree of Doctor of Philosophy titled Prevention of maternal mortality: A community action research in Bakassi Local Government Area, Cross River State, Nigeria.January, 2011.Maternal mortality in Nigeria is one of the highest in the world. The rate is higher in the rural communities than in the urban. Given the complexity of causes of maternal mortality, it appears that the community is an important resource that is frequently overlooked. The contribution of which could be explored through collaboration with professional healthcare providers, to bring about reduction in maternal mortality.This study, proposed to empower members of the community to take action to prevent maternal mortality. Action research design was utilised, comprising cycles of fact-finding, planning/action, and evaluation with the aim of working towards a change in the status quo.In collaboration with the action research group, data were generated through 29 interviews, 8 focus group discussions and observation of 7 persons. Women of childbearing age were interviewed to gain understanding of their knowledge, attitude and practice towards maternal mortality. Focus group discussions were carried out with a cross section of the community. Observations were undertaken of skilled and traditional birth attendants (TBAs) in their places of practice. Altogether, there were 86 general participants and 12 action research group members in the study.Thematic data analysis and critical reflection were undertaken with emphasis on data which promote learning and change. The study revealed childbirth fallacies as evidenced in the causes of maternal deaths being attributed to superstitious beliefs. Other findings included religious beliefs/practices, birth practices, negative attitudes, lack of money, lack of transportation and health facilities issues as contributory factors. These findings were critically reflected upon by the action research group and actions based on the findings, aimed at empowering the people to take action to prevent maternal deaths were undertaken. The actions included community education, TBA training and development of a common forum between skilled birth attendants and TBAs.Participatory evaluation was undertaken from the perspectives of the participants to identify what made sense to them from the actions. Findings included some degree of empowerment and emancipation of the people evidenced in the acquisition of new knowledge which led to the repudiation of certain superstitious beliefs. Other findings include resumed utilisation of the service of skilled birth attendants at the local health facility by the women. The findings of this study have demonstrated implications for practice, policy and research to prevent maternal mortality in Bakassi LGA, Nigeria.Conclusion drawn is that, the community is an important resource which if mobilised through the process of action research, would be empowered to take action to prevent maternal mortality. The process will also foster the collaboration between skilled birth attendants and traditional birth attendants to improve maternal health care in the rural community.

Prevention of maternal mortality : a community action research in Bakassi Local Government Area, Cross River State, Nigeria

All women deserve humane, considerate, sensitive and respectful care in childbirth. Respectful maternity care (RMC) is human right and standard midwifery practice. However there have been general public complaints about lack of respectful behaviour by midwives. To determine clients' experience of respectful maternity care and midwives' caring behaviour, two hospitals in Calabar, Nigeria were selected for this study. This descriptive study collected data from 83 purposively selected postnatal women who had spontaneous vaginal delivery, and 51 midwives caring for them. Ethical clearance was obtained from the HREC of Cross River State Ministry of Health and informed consent from participants. Clients and midwives identified respectful maternity care received/practiced from the RMC checklist. Data were analyzed using SPSS version18.0. RMC was reported by 58 (69.9%) clients while 25 (30.1%) reported lack of it in different categories. Non-respectful care reported included lack of privacy, lack of information about progress of labour, denying preference and choice of childbirth position, lack of sensitivity towards clients' pain and culture, verbal abuse, detention in facility for non-payment of bill. Attending midwives confirmed not adequately screening or draping women (because of lack of screens and drapes); restricting women to deliver in the dorsal position and detaining women if they cannot pay the bill (because of hospital policy). Common acts of disrespectful care experienced by women in this study fit into some of the categories identified in literature. Appropriate maternity care must be respectful and rights-based in order to enhance utilization of maternity services and access to skilled care.

Ekpoanwan Esienumoh

Papers

Empowering members of a rural southern community in Nigeria to plan to take action to prevent maternal mortality: A participatory action research project

Cultural Diversity in Childbirth Practices in a Rural Community in Southern Nigeria

Prevention of maternal mortality : a community action research in Bakassi Local Government Area, Cross River State, Nigeria

Respectful Maternity Care and Midwives' Caring Behaviours During Childbirth in Two Hospitals In Calabar, Nigeria

Cultural Diversity in Childbirth Practices in a Rural Community in Southern Nigeria