A qualitative study of barriers to postpartum sterilization and women's attitudes toward unfulfilled sterilization requests

BACKGROUND: This longitudinal, qualitative study explores barriers to postpartum sterilization from the perspective of low-income minority women. We examine women's feelings and attitudes regarding a canceled or postponed procedure over time. STUDY DESIGN: We conducted structured, in-depth baseline interviews with 34 postpartum women with unfulfilled sterilization requests in a university hospital setting. Follow-up phone interviews were conducted at 6 weeks and 6 months postpartum. RESULTS: Reasons for unfulfilled sterilization requests included last-minute misgivings, maternal medical complications, lack of a valid Medicaid consent form, fear of the procedure and provider influence. Sense of autonomy regarding sterilization decision making and ability to obtain interval sterilization or initiate and/or successfully use reversible contraception influenced subsequent attitudes regarding an unfulfilled request. CONCLUSIONS: Sterilization counseling should include comprehensive information regarding the surgical procedure and associated risks and the development of a backup contraceptive plan, with particular emphasis on increasing contraceptive self-efficacy and autonomy in sterilization decision making.     

'Real men don't diet': an analysis of contemporary newspaper representations of men, food and health

Little research to date has focused on the meanings men attach to food and the relationship between diet and health. This is an important topic in light of the current ‘crisis’ in men's health and the role of lifestyle factors such as diet in illness prevention. Since the mass media is a powerful source of information about health matters generally, media representations bear critical examination. The present paper reports on an in-depth qualitative analysis of contemporary UK newspaper articles on the topic of men and diet (N=44)$(N=44)$. The findings indicate a persistent adherence to hegemonic masculinities predicated on health-defeating diets, special occasion cooking of hearty meals, and a general distancing from the feminised realm of dieting. At the same time, men are constructed as naïve and vulnerable when it comes to diet and health, while women are viewed as experts. The implications for health promotion with men are discussed.     

Governing the healthy male citizen: men, masculinity and popular health in Men's Health magazine

Recent commentators have noted the potential of newer neo-liberal discourses of health care to position responsibility for the management of well-being with the individual. Often promoted through the inculcation of risk avoidance and management, such discourses are played out in myriad settings, including the popular media. Magazines are one such media site in which diverse exhortations for the achievement of health, well-being and the perfectible body are made, and Bunton [1997. Popular health, advanced liberalism and good housekeeping magazine. In A. Petersen & Bunton R. (Eds.) Foucault, health and medicine (pp. 223-247). London: Routledge] has identified 'magazine medicine' as a significant manifestation of more dedifferentiated models of health care. Recent discussions have placed men's health high on research and policy agendas, with a concomitant interest in more popular realms. The UK magazine Men's Health (MH) is indicative of these trends, and represents a site at which discourses of men, health and masculinity are constructed. Typically reflecting neo-liberal models of health, here men are constructed as active and entrepreneurial citizens able to maintain their own health and well-being through the judicious management of risk in contexts appropriate to dominant discourses of hegemonic masculinity. Data which resulted from a critical discourse analysis of a 2-year sample (21 issues) of MH are considered and findings related to medicalisation, individualisation and risk discussed. It is suggested that magazine texts such as MH reflect newer individualised models of health care and neo-liberal strategies of health governance premised upon constructing a healthy male citizen, willing and able to take responsibility for their own well-being.     

‘Don't fix what ain't broke’: evaluating the effectiveness of a Men's Shed in inner‐regional Australia

Men's Sheds and similar community programmes are known to encourage help‐seeking behaviour and thus improve the health and well‐being outcomes for the men who attend. This paper investigates this issue through a community needs assessment of a Men's Shed programme in inner‐regional Australia. The immediate purpose of this research was to help direct future funding initiatives, and provide recommendations for potential changes and improvements to the programme. A community‐level needs assessment is a systematic process used to determine and address gaps or needs between current and desired conditions within a particular community. We sought to explore how particular formats and structures of Men's Sheds programmes contribute to improve social and medical well‐being, and whether there are key programme characteristics that could be emulated. In total, 22 surveys and 20 interviews were conducted with the men who participated in the programme. The report finds 95% of men are satisfied with the current running of the programme. While there were areas that have been identified for improvement, most men reported that they are content with the current format and would not like to see major changes to its implementation. The results of this research confirm the known benefits of these types of programmes. This paper provides other community programmes with some insight into the key success factors for running a Men's Shed.     

Men's Sheds: enabling environments for Australian men living with and without long‐term disabilities

The health of Australian men has recently received greater attention. Men's Sheds are named in national policy as an exemplar community‐based organisation for the betterment of men's psychosocial health; yet, the evidence base to support this is limited. This study investigates the comparative experience of men with long‐term disabilities and men without long‐term disabilities who go to a Men's Shed and to what extent this provides these men with an enabling, as opposed to disabling, environment. Data were collected from 12 individual interviews with men with long‐term disabilities (5) and men without long‐term disabilities (6), including 1 interview with the male Men's Shed Coordinator (MSC); participant observation within the shed; and a document received from the female MSC regarding the funding the Shed receives. Interviews explored the men's experiences at the Shed and their sense of belonging and social inclusion. Participants had any type of long‐term disability and had been attending the shed for a minimum of 1 month. Data were collected between May and September 2013 and were analysed using the constant comparative method of grounded theory. The core theme that emerged was an enabling community space. The four sub‐themes were: a community and social hub; an equalising space; a safe and supportive male environment; and meaningful male activities. The current literature exemplifies Men's Sheds to be important community‐based organisations beneficial to men's health and well‐being. For men living with long‐term disabilities, this study illuminates that Men's Sheds offer an environment of equality, facilitating a collegial and egalitarian culture. Men can partake in enabling activities and enjoy the company of other men enhancing their sense of belonging and social inclusion as well as interact with other community groups that occupy the same space as the Men's Shed.     

Men's Sheds: A conceptual exploration of the causal pathways for health and well‐being

Although men have a lower life expectancy than women, and are more susceptible to illness, they have been found to be less likely to engage in health‐seeking behaviour. Men's Sheds, as a gendered intervention, has been identified as an effective way to engage men in meaningful activity and gain social support from others. However, links between sheds and health and well‐being are not well‐documented, and evidence is lacking of the potential causal pathways to health generation. This study aims to develop a plausible empirically based causal theory of how Men's Sheds influence the health and well‐being of their participants and to set out future research directions to test this theory. Drawing on a scoping review of academic, peer‐reviewed journal articles published between 1990 and 2018, potential causal linkages between shed activity and health and well‐being outcomes are synthesised into a logic model framework. Sixteen relevant peer‐reviewed journal were identified from the academic literature. The data from the articles are predominantly self‐reported, and characterised by small sample sizes and/ or low response rates. Further, information is lacking on the demographics of Men's Shed participants and the contexts in which they exist. Most notably, while there is some evidence on the potential mental health and social well‐being impacts of shed activities, physical health is less documented. The study shows that there is a lack of reliable and systematic evidence of the potential causal pathways between Men's Shed activities and health and well‐being outcomes. In order to address research gaps, further research is required to test and develop the proposed theory and logic model.     

贵州省群众关于艾滋病自愿咨询检测的定性研究

目的：了解艾滋病综合防治示范区和非示范区群众对艾滋病和自愿咨询检测的态度，为开展艾滋病自愿咨询检测项目提供依据。方法：在示范区和非示范区采用专题小组讨论和个人深入访谈的方法．了解场所主要知情人员和群众对艾滋病和开展艾滋病自愿咨询检测的态度以及实施中应考虑的问题等。结果：示范区和非示范区普通群众对艾滋病和自愿咨询检测的认识有待于提高，对自愿咨询检测的接受程度较低。不愿意做检测的最主要原因是认为没必要做和社会对检测者的歧视态度。结论：应进一步加大针对艾滋病和自愿咨询检测的宣传力度，消除社会对艾滋病感染者和检测者的歧视。在实施艾滋病自愿咨询检测活动时应注意针对可能的障碍因素采取相应的措施。     

Bedouin-Arab women's access to antenatal care at the interface of physical and structural barriers: A pilot study

Since 2000, the Israeli Public Health Services have established eight Maternal-and-Child-Health (MCH) stations in unrecognised Bedouin-Arab villages in South Israel in order to reduce barriers to healthcare.

The goals of this pilot study were: (1) to explore the new MCH stations’ impact on antenatal care (ANC) accessibility; and (2) to compare access to ANC between women from villages with MCH stations and women from villages without MCH stations.

The study combined quantitative and qualitative methods including structured interviews with 174 MCH service users, review of 158 ANC records and 16 in-depth interviews with Bedouin-Arab women.

The establishment of MCH stations in unrecognised villages has improved physical access to ANC and secondarily diminished other barriers related to financial and sociocultural dimensions of women's access to healthcare, thus enhancing women's options for independent healthcare-seeking; yet, limited opening hours, staff shortages and communication problems hamper ANC delivery at the new MCH stations.

This pilot study indicates that the MCH stations’ establishment in unrecognised villages was a successful intervention, which improved women's access to ANC. Even though current service delivery challenges need to be overcome to achieve the intervention's full potential, its replication should be considered in further villages.     

Social disparities in women's health service use in the United States: a population-based analysis

PurposePoor and disparate reproductive health outcomes in the United States may be related to inadequate and differential receipt of women's health care. We investigated trends in and determinants of adult U.S. women's health service use, 2006–2010.MethodsWe analyzed population data from 7897 women aged 25–44 years in the National Survey of Family Growth from 2006 to 2010 using multivariable logistic regression.ResultsWomen's health service use in the past year was reported by 74% of the sample. Among noninfertile, sexually active women, 47% used contraceptive services; fewer used pregnancy (21%) and sexually transmitted infection (14%) services. In multivariable models, the odds of service use were greater among older, poor, unemployed women and women with less educational attainment than younger and socioeconomically advantaged women. Black women had greater odds of using pregnancy, sexually transmitted infection and gynecologic examination services than white women (odds ratio, 1.4–1.6). Lack of insurance was associated with service use in all models (odds ratio, 0.4–0.8).ConclusionsAlthough age-related differences in women's health service use may reflect fertility transitions, social disparities mirror reproductive inequalities among U.S. women. Research on women's health service use and outcomes across the reproductive life course and forthcoming sociopolitical climates is needed.