Showing papers in "Health Care for Women International in 2004"

Guilt and emptiness: women's experiences of miscarriage

Abstract: Women who lose an early pregnancy are shocked when they are first given the information that they have miscarried. Later they feel guilt and emptiness. Heideggerian interpretive phenomenology has been used with 13 women from southwest Sweden to uncover their lived experience of miscarriage. Women plan their future with a child during early pregnancy. When miscarriage occurs it is not a gore, an embryo, or a fetus they lose, it is their child. They feel that they are the cause of the miscarriage through something they have done, eaten, or thought. They feel abandonment and they grieve for their profound loss; they are actually in bereavement.

Protective strength factors, resources, and risks in relation to depressive symptoms among childbearing women of Mexican descent.

Abstract: As an immigrant population becomes more prominent in an established culture, research strategies for examining intragroup differences are needed to understand their health care risks and strengths. However, acculturation also must be taken into account. Our objective in this secondary analysis was to identify the most useful acculturation parameter for examining depressive symptoms in relation to strengths and resources among women of Mexican descent living in the United States during the vulnerable perinatal period and to examine other intragroup differences among the women by childbearing status (pregnant or postpartum). Our secondary analysis was done with a subsample of 129 women from a larger cross-sectional study of 315 women of Mexican descent who were recruited from three urban community health centers and an associated bilingual school in the United States. Exposure to the United States in childhood, a poor sense of mastery, and dissatisfaction with life were more related to depressive symptom ex...

Fighting back--struggling to continue life and preserve the self following a stroke.

Abstract: The aim of this longitudinal phenomenological study was to explore how female stroke survivors experienced their life following a stroke and how they managed their altered situation. Twenty-five women suffering first-time stroke were interviewed in depth three times during the first one and a half years after the stroke. Applying the method of Giorgi, we found that there was a lengthy struggle to continue life and preserve the self following the stroke. The struggle was closely related to their deeply rooted identity as mothers, wives, grandmothers, and housewives. The situation of women following a stroke needs particular attention because their needs may conflict with their female caring roles. On the other hand, supporting them in transforming these roles may secure their sense of self and a continued meaningful life.

A systematic review of questionnaires measuring the health of resettling refugee women.

Abstract: Because many ethnically diverse refugee women resettle in industrialized countries, several biopsychosocial factors need to be considered in caring for them. This systematic review of studies conducted with female refugees, asylum-seekers, or “unspecified” immigrants based on six electronic databases was conducted to determine which questionnaires best measure relevant variables. Questionnaires were reviewed for measurement properties, application of translation theory, and quality of representation. Studies must have included ⋛1 measure of the following: general health; torture, abuse, sex-and-gender-based violence (SGBV); depression; stress; posttraumatic stress disorder (PTSD); anxiety; somatization; migration history; social support; socioeconomic status; discrimination; or mother–child interactions. Fifty-six studies using 47 questionnaires were identified; only five had strong evidence for use with resettling refugee women. Thus, few high-quality tools are available to measure concepts relevant to r...

Impact of Peer Group Education on HIV Prevention Among Women in Botswana

Abstract: A peer group HIV prevention intervention based on social–cognitive learning theory, gender inequality, and the primary health care model for community-based health promotion was developed for more than 300 urban employed women in Botswana. All women volunteered to participate in the intervention. To control for self-selection, matched workplaces were assigned to the intervention group or to the delayed control group. Compared with women in the delayed control group, women in the intervention group had significantly higher postintervention levels of knowledge of HIV transmission, sexually transmitted diseases (STDs), and HIV prevention behaviors; positive condom attitudes and confidence in condom use; personal safer sex behaviors; and positive attitudes toward persons living with HIV/AIDS and community HIV/AIDS-related activities. The peer group leaders have sustained the program for more than 5 years after the end of research funding. Peer groups are a low-cost and sustainable intervention that can change...

In-home intervention for depressive symptoms with low-income mothers of infants and toddlers in the United States

Abstract: Depressive symptoms in low-income mothers negatively affect infant-toddler development. This pilot study tested a short-term, home-based depressive symptom intervention with 16 African American and White, Non-Hispanic mothers in Early Head Start (EHS) programs who were randomly assigned to intervention and usual care/waiting list conditions. Mothers met in their homes with master's-prepared psychiatric mental health nurses who worked with them to improve their management of depressive symptoms and life issues, use of social support, and parenting. The intervention group showed a significantly greater decrease from baseline in depressive symptom severity at 8 and 16 weeks in contrast to the mothers receiving usual care. Observations of maternal interactions showed improvement in the intervention mothers. The results support testing on a larger scale.

Muslim culture and female self-immolation: implications for global women's health research and practice

Abstract: Self-immolation among young Muslim women in parts of the Middle East and Central Asia increasingly is becoming a cause of death and disability. Very little is known about this phenomenon. Thus, in this article we (1) examine, from the perspective of Muslim culture, the phenomenon of self-immolation among young Islamic women in the Muslim countries of Central Asia and the Middle East; (2) describe current international activities regarding Islamic female self-immolation; and (3) discuss the implications of Islamic female self-immolation for global women's heath research and practice.

Norwegian families: transition to parenthood

Abstract: Our purpose in conducting this study was to explore relationships among family dynamics, parent-fetal attachment, and infant temperament in 230 mother-father pairs from the third trimester of pregnancy to when their infant was 7 to 9 months old. Mothers reported increased role conflict during this time, as well as more role conflict than their partners. First-time parents (n = 133) perceived more positive family dynamics than second-time parents (n = 97), as well as greater parent-fetal attachment. Maternal-fetal attachment was greater than paternal-fetal attachment. Health care providers can provide support for new parents as they negotiate new role relationships.

Taking care of self: health care decision making of american indian women

Abstract: In this article, I report a component of a qualitative grounded theory study on health care decision making of American Indian women (AIW) residing in the Northeastern United States. Analysis was based upon data collected from 20 women who self-identified as American Indian. Taking care of self was a primary factor influencing health care decisions among this sample of AIW. As women moved between their Native, traditional health practices and conventional Western health practices, efforts toward taking care of self were especially salient. The properties of taking care of self include knowing family history; balancing mind, body, and spirit; understanding the body; and integrating natural practices. I also address some implications of the study findings for practitioners working with Native women.

Adaptation of health care seeking behavior during childbirth: focus group discussions with women living in the suburban areas of Luanda, Angola.

Abstract: The aim of this study was to explore how various factors influenced women's decisions regarding place of confinement in Luanda, Angola. Ten focus group discussions were conducted with pregnant and ...

Why do women stop smoking during pregnancy? Cigarettes taste and smell bad.

Abstract: There are high rates of cigarette smoking resumption among women who have quit smoking while pregnant, and the reasons for this are poorly understood. Our purpose in this study was to obtain an in-depth description of the context surrounding smoking behaviors during pregnancy and the first 3 months after women give birth in order to gain insight into the reasons women resume smoking. We used a longitudinal qualitative descriptive approach with in-depth interviews conducted early in pregnancy, at 36 weeks of pregnancy, and 3 months postpartum. Our purposive sample consisted of 15 pregnant women who had stopped smoking without assistance by their first prenatal visit. All women smoked mentholated cigarettes prior to pregnancy and 40% were primiparas. A thematic content analysis of 43 interviews revealed that the majority of women experienced an aversion to the taste or smell of tobacco smoke while pregnant and attributed these sensation changes to being pregnant. The taste and smell of tobacco smoke returned to prepregnancy states postpartum, and by 3 months postpartum 73% of the women had resumed smoking. This physiologic change can be conceptualized as a pregnancy-specific motivation for smoking cessation that can inform our efforts toward relapse prevention.

Traditionalism and its relationship to disease risk and protective behaviors of women living on the Hopi reservation.

Abstract: The fundamental aim of this study was to identify factors crucial for the development of effective cancer prevention programs for American Indian (AI) populations. Toward that end, we developed an instrument to assess the influence of traditionalism on health risks such as smoking, consumption, and obesity. A population-based survey was conducted among 559 randomly selected women living on the Hopi reservation aged 18 years and older, from July through December 1993. To construct a traditionalism score, we conducted focus groups in the community. A multidimensional approach was adopted by assessing three dimensions of native culture: language usage; cultural participation, or participation in such activities as Hopi ceremonies; and percentage of life spent off-reservation. A mean score of the three dimensions was computed for each respondent. High levels of traditionalism were significantly associated with disease protective behaviors, such as practicing traditional Hopi activities to keep healthy (OR = 3.07), and significantly inversely associated with disease risk factors such as smoking (OR = 0.26) and obesity (OR = 0.60) independent of age, marital status, and education. As these data provide a strong rationale for the promotion of traditions in public health programs aimed at decreasing rates of chronic disease among AI women, we conclude this paper with a discussion of the importance of traditionalism and how it might be accurately assessed.

The meaning of health: Perspectives of Anglo and Latino older women

Abstract: This qualitative study, utilizing the dimensional analysis approach, was conducted to generate a substantive theory about the description and meaning of functional health from the perspectives of older Anglo and Latino women. Through focus group interviews with older Anglo and Latino women and data analysis, the investigators learned that the women's perceptions of functional health were vastly different. As planners and providers, we usually are trained in a health culture that is predominantly based on White, middle-class values. This ethnocentrism can act as a barrier leading us to disregard the notion that concepts such as health are not universally perceived. Findings from this study may enable us to achieve a closer approximation of the real experiences of our clients and to sensitize us to different world views.

Psychological functioning in women with fibromyalgia: a grounded theory study.

Abstract: The aim of this study was to elucidate psychological functioning and psychological processes in women with fibromyalgia. Twenty-one females with fibromyalgia (aged 26-72 years) were interviewed in-depth. The interviews were analysed in line with grounded theory. A core concept, "unprotected self," mirroring childhood conditions and adult psychological functioning, was identified. Intense activity or hypomanic helpfulness often was used as self-regulation in adult life. Later an increased exposure to mental load is accompanied by reduction of cognitive functioning and generalised pain. The phase of persistence of fibromyalgia is marked by reduction of cognitive functions, unprotected psychological functioning, and increased mental load as from crisis and somatic symptoms.

Widening the cervical cancer screening net in a South African township: Who are the underserved?

Abstract: Cervical cancer screening services in South Africa have failed to reach the majority of the population and to significantly reduce mortality. A household survey in a predominantly Black African population living in a low-income township on the outskirts of Cape Town was undertaken to ascertain the characteristics of women reporting never having been screened. In our group of 664 representatively sampled women, 45% of women reported having had a cervical screening test. However, in what at first glance appears to be a fairly homogeneous population, there were significant differences in the types of women who access and who do not access cervical smear services. The underserved tend to be the older, poorer, less educated, and unemployed (or working in the informal sector) women. They tend to live in nonpermanent dwellings without a partner, they do not know anyone else who has had a cervical smear, and they have not recently sought care for other ailments, or used contraception. Cervical cancer is a slow-to...

Home alone: the experience of women with type 2 diabetes who are new to intensive control.

Abstract: Using an inductive interpretive approach we examined the early experiences of women learning intensive self-management of type 2 diabetes. The women expressed feelings of being very much “home alone” during their initial self-management experience, in spite of having requisite knowledge and skills from completing a state-of-the-art multidisciplinary diabetes educational program. Invariably, engagement in the self-management process resulted in strong emotional responses, self-blame, and negative characterizations of self. Conditions associated with ways of being engaged in intensive self-management are described and provide practitioners with needed personal and contextual information to inform clinical care.

Improving pre- and postmenarcheal 12-year-old girls' attitudes toward menstruation

Abstract: Adolescence is a time of rapid changes, including risk for unwanted pregnancies and sexually transmitted infections Education may improve understanding and attitudes toward menstruation among adolescents thus increasing their awareness of risks and enabling them to protect themselves accordingly To investigate effects of education on attitudes, two interventions were compared in 345 12-year-old girls The new, active intervention given to premenarcheal girls just before menarche resulted in improvements in attitudes toward menstruation compared with standard intervention Thus, just before menarche girls should be offered education modeled after the active intervention The education must be concrete and based on multisensory learning

Factors that influence vulnerability to STDs and HIV/AIDS among Hispanic women.

Abstract: Self-esteem, motivation for sexual health, and sexual risk behaviors as indicated by condom use and number of sex partners was explored in a sample of 140 Hispanic women of childbearing age (18-44 years). The researchers used Cox's Interaction Model of Client Health Behavior (IMCHB) as the conceptual framework for the study. They found that 70% (n = 79) of single women reported condom use with their most recent sexual partner, and 49% (n = 55) of single women reported more than one sexual partner in the last 12 months. Self-esteem and motivation for sexual health were significantly associated (r =.42, p =.001), although only the latter was related to condom use among single women (r =.29, p =.01). Women who reported higher self-esteem were less likely to worry about acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Despite public information about STDs, including HIV/AIDS, a proportion of these women and their partners are vulnerable to these diseases. Health promotion implications are discussed.

Identifying risk factors for low back pain (LBP) in Chinese middle-aged women: a case-control study.

Abstract: This case-control study was to identify major risk factors, such as natural menopausal transition, physical strain to the lower back, and psychosocial and lifestyle stress, for low back pain (LBP) prevalence among noninstitutional Chinese middle-aged women. A total of 182 cases and 235 controls participated. Data were collected at face-to-face interviews and body measurements were obtained. The data included exclusive criteria: descriptions of their LBP, sociodemographic factors, menopausal status and reproductive factors, physical strain activities, psychosocial stress, lifestyle factors, and anthropometric parameters. Our results indicated that LBP was prevalent among (a) women who experienced stressful life events in the past 12 months; (b) women who had high psychological stress related to housework or work; (c) women who performed some physical strain activities, such as prolonged squatting or moderate physical activities in the previous year; and (d) women who had a low waist-to-hip ratio. Our resul...

Heat balance humors and ghosts: postpartum in Cambodia.

Abstract: In Cambodia, where postpartum maternal mortality and morbidity is high, cultural views about causation of postpartum complications are different from biomedical views. This ethnographic study used focus groups and in-depth interviews to explore the postpartum beliefs and practices of Khmer women. Specific emic taxonomies (those used by cultural insiders, i.e., Khmer women) used to describe postpartum conditions and practices used to prevent mortality and morbidity are described. Beneficial and harmful practices are detailed. Recommendations are made regarding strengthening beneficial cultural practices as well as use of emic taxonomies in developing health education and communication messages and in the preservice education and in-service training of providers who care for postpartum women.

The encounters that rupture the myth: contradictions in midwives' descriptions and explanations of circumcised women immigrants' sexuality

Abstract: The purpose of the study was to analyze how Swedish midwives (n = 26) discuss sexuality in circumcised African women patients. In focus groups and interviews, discussions concentrated on care provided to circumcised women, training received for this care, and midwives' perceptions of female circumcision. An analytic expansion was performed for discussions pertaining to sexuality and gender roles. Results from the analysis show the following: (1) ethnocentric projections of sexuality; (2) a knowledge paradox regarding circumcision and sexuality; (3) the view of the powerless circumcised women; and (4) the fact that maternity wards function as meeting places between gender and culture where the encounters with men allow masculine hegemonic norms to be ruptured. We conclude that an increased understanding of cultural epistemology is needed to ensure quality care. The encounters that take place in obstetrical care situations can provide a space where gender and culture as prescribed norms can be questioned.

Who me, angry? Patterns of anger diversion in women.

Abstract: Researchers suggest that women's experience of anger is very complex and may not be accounted for by existing anger models. The current study was an attempt to clarify a model of women's anger proposed by Cox, Stabb, and Bruckner in Women's Anger: Clinical and Developmental Perspectives, 1999. Anger diversion focuses on women's attempts to bypass anger awareness, to use indirect means to cope with anger, or both. A sample of predominantly college and graduate student women (N = 514) completed a vignette questionnaire assessing diversionary anger styles as well as instruments evaluating symptoms, anger behaviors, emotional expression, and tendencies to respond in socially desirable ways. The results of the study partially support Cox and colleagues' model, particularly in distinguishing between diverting anger and expressing anger assertively. We found that women who divert anger are more vulnerable to symptoms such as depression, anxiety, and somatization than are women who use an assertive approach to coping with anger.

The Eating Disorder Inventory: a test of the factor structure and internal consistency in a nonclinical sample.

Abstract: My objective was to investigate the factor structure and internal consistency of the Eating Disorder Inventory (EDI) among a nonclinical sample. Previous research has indicated that although the EDI appears to be psychometrically sound when used with a clinical sample, the relevance of the measure for a nonclinical population is uncertain. Six hundred forty-seven female university students, average age of 23.3 years, completed a questionnaire including the EDI. I found that the factor structure was supported when items from just five subscales of the EDI were included in the analysis, but when items pertaining to all eight subscales were analysed the factor structure was not supported. The current results cast doubt on the factor structure and internal consistency of the EDI when used with a nonclinical sample, unless just five subscales (drive for thinness, perfectionism, bulimia, interpersonal distrust, and maturity fears) are included. More research is needed to clarify the implications of these findings.

A study of knowledge, attitude, and practice of cervical screening among female primary care physicians in the United Arab Emirates.

Abstract: Cancer is the third leading cause of death In the United Arab Emirates (UAE), which is situated in the Arabian Gulf. A national programme for cervical cancer screening is likely to be implemented in the future. In this study, we assessed the knowledge, attitude, and practice of UAE female primary care physicians of cervical screening through a self-administered questionnaire. Of the 98 physicians who participated in the study only 40% reported ever having performed a Pap smear. In the study, we identified various training needs, and a training programme on cervical screening currently is being developed based on the results of this study.

Practice of and attitudes toward breast self-examination (BSE): a cross-cultural comparison between younger women in Scotland and Greece.

Abstract: Breast self-examination (BSE) is a method of early detection of breast cancer. Although BSE is recommended for all women, it is mostly suitable and readily available for younger women. BSE beliefs and practices of women in Scotland, a country with organised health campaigns about BSE, were compared with those of women in Greece, a country without such campaigns. Our sample consisted of 68 university students in Scotland and Greece, aged 18 to 26 years old. All participants completed a questionnaire assessing demographics, health history, knowledge, BSE practice, health beliefs, and health-related personality. BSE practice was found to be associated with different variables across the two cultural groups. Adherence rates were found particularly higher than previous reports and BSE practice did not differ significantly between women in Scotland and Greece. Nevertheless, the two groups differed significantly in their knowledge, attitudes toward BSE, and health-related personality. On the basis of these findings, cultural factors should be considered in organising BSE campaigns. Also the present findings identified BSE-related beliefs and practices specific to younger age groups. These could be considered and addressed in order to organise BSE campaigns in Greece and improve future UK programs especially tailored for this age group.

Rethinking literacy and women's health: a Bangladesh case study.

Abstract: Health and literacy are two major areas of women's development in the Third World. Although health and literacy have been recognized as essential elements for improving the quality of women's lives, questions emerge from Eurocentric and colonial assumptions about development, including the following: Does literacy have an impact on women's health? If it does, what are the mechanisms whereby literacy could have an impact on women's health? Using Bangladesh as a case study, I question the Eurocentric and colonial nature of dominant discourses in the answers to questions about literacy and women's health. I argue that literacy and women's health need to be reconsidered from the local women's standpoint since dominant discourses fail to take into consideration local women's worldviews, indigenous knowledge, and oral traditions. Finally, I make some recommendations for future research and programming in literacy and women's health in Bangladesh and in health care in Third World contexts.

Women's postnatal experience following a medically complicated pregnancy.

Abstract: Within the social science literature on reproduction, relatively little attention has been paid to the areas of major illness during pregnancy and postnatal physical health. In this paper I present the results of a qualitative study of the postnatal health experiences of 15 women who had suffered a serious illness during pregnancy, the onset of which either predated or developed during pregnancy. Recently delivered women with continuing health problems face additional difficulties at a time when they are recovering from the physical and psychological processes of birth and are adjusting to the care of the new baby or grieving a loss. A few women in this study had experienced health problems that were resolved at or soon after the birth. Those with continuing or chronic illness described attempts to regain normality that involved both restoring bodily health and reestablishing their control over symptoms of the illness. Professional help with this process was often reported to be limited.

Women behind bars: could neurobiological correlates of past physical and sexual abuse contribute to criminal behavior?

Abstract: Trauma, especially physical and sexual abuse inflicted by others, is often part of the personal histories of female prison inmates. These traumatic events have also been associated with neuropsychiatric conditions commonly found in female inmate populations. The purpose of this article is to provide a review of the literature and research findings about physical and sexual abuse perpetrated against female prison inmates predating their crimes, the neurobiological correlates, and related factors that could have contributed to criminal behaviors. This information is critical for abuse and crime prevention and rehabilitation of female victims who have become criminal offenders.

Toward critical research ethics: transforming ethical conduct in qualitative health care research.

Abstract: Based on research conducted with women injection drug users (WIDUs), I discuss the ethical conflicts that researchers and sub-contractors face in gaining access to the life narratives of WIDUs. Foremost among these is the potentially exploitative nature of the study participant-researcher relationship. I suggest that federal and institutional guidelines for human subject research must incorporate additional safeguards to protect study populations such as WIDUs. Moreover, the ethical concerns related to health care research should be addressed in guidelines for ethical conduct with human subjects, research ethics seminars, and required training programs for researchers and subcontractors separately.

Giving birth in the hospital: childbirth experiences of Thai women in northern Thailand.

Abstract: In this article, I examine how Thai women perceive and experience childbirth in hospitals. The article is based on in-depth interviews with 30 women living in Chiang Mai, Thailand. The women's narratives reveal that childbirth was managed within the medical system. The women believed that safety was the primary reason for their choice of birth in the hospital. Women's embodied experiences with hospital birth reveal the "passivity" discourse; women accord total trust to their doctors and very rarely question the many routine procedures in hospitals. It seems that in northern Thai hospitals the involvement of women's partners or their significant others is kept to a minimum. Of interest among postpartum care provided in Thai hospitals in the north is the use of a spotlight to help heal the episiotomy wound. This is an adaptation of Thai traditional confinement practices in the era of modernity. The use of a spotlight in hospital not only provides the women with symbolic ritual but also is believed to assist them in the healing process. Women in general were satisfied with postpartum care received during their hospital stay, except for rooming-in practice. The data suggest some differences between rural poor and urban middle-class women in terms of hospitals of birth, the opportunity to have a family member at birth, and so on. It is clear that middle-class educated women are able to exercise their choices and control over their childbirth experiences much more than rural poor women. I argue that care provided to women during birth needs to take into account women's emotional and subjective experience so that sensitive birthing care can be achieved. This will only make childbirth of many women a more positive one.