Beliefs about health and illness: a comparison between Ugandan men and women living with Diabetes Mellitus

Background: The diabetes mellitus (DM) pandemic greatly affects developing countries. Self‐care is an important part of management, guided by beliefs about health and illness. Dissimilarities in health‐related behaviour in men and women have been described but not comparisons of their beliefs about health and illness. Aim: To explore beliefs about health and illness that might affect self‐care practice and healthcare‐seeking behaviour in men and women with DM in Uganda. Methods: This was an exploratory study with a consecutive sample from an outpatient diabetes clinic at a university hospital. Semi‐structured interviews were conducted with 15 women and 10 men aged 21–70 years. Data analysis was conducted by qualitative content analysis. Findings: Men's and women's beliefs about health and illness indicated limited knowledge about the body and DM. Dissimilar were men's focus on socio‐economic factors, particularly affordability of drugs, sexual function and lifestyle, while women valued well‐being, support in daily life and household activities and had a higher risk‐awareness of DM. Irrespective of gender, limited self‐care measures were used, and health professionals were consulted about health problems. Conclusion: Similarities and dissimilarities were found between men and women in beliefs about health and illness that affect self‐care practice and healthcare seeking. Underlying living conditions, with different gender roles, appear to determine the beliefs about health and illness, which are based on individual knowledge. Measures to increase knowledge about DM are urgently needed in Uganda. In diabetes care, it is important to search for individual beliefs and consider gender and living conditions.     

Beliefs about AIDS, health, and illness among low-income Latina women.

The purposes of this study were to describe (a) the health beliefs of Latina women about acquired immunodeficiency syndrome (AIDS); and (b) the relationship of these beliefs to the subjects' traditional beliefs about illness and its treatment. The sample consisted of 59 low-income Latina women attending nutrition programs in Los Angeles. A qualitative approach was used to gather the data in semi-structured focus group interviews. Content analysis was used to classify data according to causes of AIDS and prevention and treatment of AIDS. Causes of AIDS included all of the current biomedical and public health explanations of transmission, current popular beliefs and misconceptions about transmission, and long-standing traditional beliefs about the causes of illness. Prevention and treatment of AIDS reflected these same three perspectives. The women's beliefs consisted of accurate, inaccurate, and incomplete information about AIDS. Implications were drawn from the findings for AIDS education and prevention programs which are congruent with the participants' cultural beliefs, values, attitudes, and expectations.     

Context-based advocacy for HIV-positive women making reproductive decisions.

As the number of HIV-positive women of childbearing age continues to rise, and treatments available to manage HIV become more accessible, the issue of HIV-positive women's reproductive decision making is gaining importance for nurses in AIDS care. Nurses and other health professionals care for these women as they decide whether to bear children. The decision whether to have children is complex and influenced by a number of individual and societal factors, creating an ethical tension between the interests of HIV-positive women and those of society. This article proposes a six-step, context-based advocacy process for nurses and other health professionals who interact with HIV-positive women of childbearing age. The advocacy process described is grounded in a review of literature on HIV/AIDS, factors influencing HIV-positive women's reproductive choices, and nursing advocacy. The proposed advocacy process enables nurses to support women's self-determination and decision making in a way that is informative and empowering.     

A metaphor for HIV-positive Mexican and Puerto Rican women

Human Immunodeficiency Virus (HIV) represents an overwhelming disruption for Hispanic women. This Grounded Theory (GT) (Glaser & Strauss, 1967) study sought to explore how culture guided health practices and to identify health and folkcare activities used by HIV+ Hispanic women. La Protectora (The Protectress), a theoretical framework, emerged to describe the process by which cultural beliefs guided Hispanic women's health practices and how they dealt with life after their affirmation of HIV status. Five main categories emerged to describe the process. Knowledge about how culture influences HIV+ Hispanic women obtain and/or make decisions about health care will contribute to a foundation for theory development and subsequent theory testing.     

Describing an explanatory model of HIV illness among aboriginal women

This article describes the explanatory model of human immunodeficiency virus (HIV) illness used by aboriginal women in northern Alberta. Using Kleinman's explanatory model framework, eight women who were HIV positive were interviewed to determine their perspectives on the etiology, pathophysiology, symptomology, course of illness, and methods of treatment for HIV. A comparative analysis was done between the explanatory model of HIV illness as described by participants and the conventional biomedical paradigm of HIV disease. As described by aboriginal women, several aspects of the explanatory model of HIV were congruent with the biomedical paradigm. It was also found that the findings related to etiology and treatment of HIV illness was incongruent with the conventional biomedical paradigm of HIV disease. These findings highlight the relevance of knowing models of illness for health care professionals, particularly nurses who work in communities with a high incidence of HIV/AIDS. These models make care planning of patients with HIV and AIDS more focused and directed.     

Men and health help-seeking behaviour: literature review

AIM: This paper reviews the key research literature regarding men's health-related help seeking behaviour. BACKGROUND: There is a growing body of research in the United States to suggest that men are less likely than women to seek help from health professionals for problems as diverse as depression, substance abuse, physical disabilities and stressful life events. Previous research has revealed that the principle health related issue facing men in the UK is their reluctance to seek access to health services. METHOD: The investigation of men's health-related help seeking behaviour has great potential for improving both men and women's lives and reducing national health costs through the development of responsive and effective interventions. A search of the literature was conducted using CINAHL, MEDLINE, EMBASE, PsychINFO and the Cochrane Library databases. RESULTS: Studies comparing men and women are inadequate in explaining the processes involved in men's help seeking behaviour. However, the growing body of gender-specific studies highlights a trend of delayed help seeking when they become ill. A prominent theme among white middle class men implicates "traditional masculine behaviour" as an explanation for delays in seeking help among men who experience illness. The reasons and processes behind this issue, however, have received limited attention. CONCLUSIONS: Principally, the role of masculine beliefs and the similarities and differences between men of differing background requires further attention, particularly given the health inequalities that exist between men of differing socio-economic status and ethnicity. Further research using heterogeneous samples is required in order to gain a greater understanding of the triggers and barriers associated with the decision making process of help seeking behaviour in men who experience illness.     

Enhancing the perceived health of HIV seropositive men

The purpose of this study was to examine the relationships between hope, social support, uncertainty in illness, and spirituality and their effect on the perceived health of HIV seropositive men. A prospective design was used to test a causal model on a sample of 125 HIV seropositive men recruited from urban HIV/AIDS outpatient clinics. A goodness of fit index of .90 and a comparative fit index of .79 indicated minimal fit of the theorized model with the data. Findings revealed significant, positive paths from hope to perceived health and from spirituality to hope. Significant negative paths were found between social support and uncertainty in illness and uncertainty in illness and hope. The level of hope may play an important role in enhancing health of HIV seropositive men.     

An Australian study on the sociocultural context of menopause: directions for contemporary nursing practice

This research project by Berger (1997) investigates the physical, psychological, and sociocultural menopause experiences of a group of seventy women aged 45-70 years from Brisbane, Australia. Thus far the narrative provided for mid-life women shows a preoccupation with medical/biological perspectives that emphasize negative images of menopausal women as estrogen deficient and diseased. This new study is considered to be one of the few more recent attempts that investigates menopausal women within a sociocultural context and explores women's views about menopause as a normal, natural transition part of the ageing process. A qualitative approach (comprising focus groups and interviews) was aimed at women in mid-life who were willing to share their insights of this complex phase, to document individual variations and broad patterns. Findings provided enhanced understanding of many menopause aspects (such as appropriate treatment) that remain controversial. Content analysis uncovered three emerging themes: 1) contrary to popular beliefs menopause usually signified wellness; 2) apart from biological changes, the sociocultural context played a pivotal role in modifying menopause experiences; and 3) women did not feel adequately supported by health professionals. The findings signify that nurses are ideally placed to assist menopausal women in a variety of health care settings.     

Gender-related concerns of rural women with severe and persistent mental illnesses

This study used focus groups to investigate the perceptions of rural women with severe and persistent mental illness (SPMI) about their gender-related health concerns. In a series of five focus groups conducted with 16 women at rural psychosocial clubhouses, women with SPMI discussed many gender-related issues, including unresolved grief over loss of children, isolation from family members, lack of sexual partners, diminished sexuality, and bodily changes secondary to medication side-effects. Women with mental illness felt like their roles as women was superseded by their role as mentally ill individuals. Rural women with SPMI have unmet needs for women's health. Psychiatric nurses have the optimal background for addressing gender-related concerns of rural women with SPMI.     

Women in the 'developing world' and their perceptions of health: an area for examination by the nurse from the 'developed world'

The aim of this paper is to consider how nurses from the 'developed world', in this instance Great Britain, may assist women from the 'developing world', specifically from Pakistan, to meet their and others' health needs To explore nurses' understanding of women from Pakistan and its translation into delivery of nursing care, a number of topics require exploration These include culture, health, origins of Pakistani women who have settled in Britain, clarification of the geographical area under discussion and a brief introduction to two studies that have investigated the health beliefs of communities in Pakistan, in particular the health beliefs of women Appreciation of studies that illustrate women's beliefs about health can provide a basis upon which further examination can take place Ideas can then be assimilated into a framework for nursing care centred around anthropological and holistic approaches to women from Pakistan The outcome of this should be an examination of women's beliefs within a cultural context in relation to nursing care and management     

Creating healthy environments: household-based health behaviors of contemporary Mexican American women

This article describes the household-based health behaviors of a sample of contemporary Mexican American women.1 Using the Household Production of Health (HHPH) as a conceptual framework and ethnographic methods of inquiry, 13 moderately to highly acculturated women of Mexican ancestry participated in multiple interviews about their health beliefs and household health behaviors. This article examines the findings related to the following research question: What are the health-producing and help-seeking behaviors (proximate determinants of health) used by Mexican American women to produce health? Themes focusing on creating healthy environments and treating illness are discussed. Awareness of the activities that women use to create and support household health can enhance the practice of nurses interested in supporting women's health work and improving health outcomes in the Mexican American community.     

Inner strength among HIV-infected women: nurses can make a difference.

The purpose of this qualitative study was twofold. First, the authors examined the phenomenon of inner strength as a resource that women infected with HIV use to cope with and manage their difficult lives. Second, the authors sought the women's views on the potential impact health care workers, specifically nurses, can have on the activation of inner strength. This study was phenomenologically informed and qualitatively structured. The goal was to construct an analytical understanding of inner strength as it is perceived, defined, experienced, and activated by women infected with HIV. Data were collected by means of 19 conversational, biographical interviews. These interviews were conducted with a stratified (by ethnicity and social class) sample of women infected with HIV. The data were elicited in terms of respondents' stories of living with HIV. The women listed a number of definitions for inner strength such as "the ability to fight" and "the motivation to go on and do better." The women recommended that nurses working with them be sensitive to the following patient concerns: validation, reality, sensitivity, and autonomy. The concept of inner strength can be of great scholarly and clinical value if it is defined as follows: Inner strength refers to the different ways women with serious illnesses experience and talk about the deepest, existential resources available to and used by them to manage severe risks to self-integrity. The recommendations, although somewhat critical of nurses, are plausible because they incorporate nurses' traditional approaches to caring for patients.     

Health care providers' influence on HIV-infected women's beliefs and intentions related to AZT therapy

This study examined how women's relationship with their primary health care provider (PHP) and their perceptions about how effective their PHPs believe zidovudine (AZT) to be in decreasing perinatal transmission related to women's AZT beliefs and intentions. It used a cross-sectional design to collect data from 59 HIV-infected African American women. Almost half the women (45%) had given birth since HIV diagnosis. Most of the babies born to HIV-infected mothers (87%) were seronegative. Data analysis with Pearson's r indicated that the quality of the women's relationship with their PHP was positively correlated to how important the PHP would be in decision making related to AZT therapy. Significant positive correlation was observed between women's perceptions about how effective their PHPs believed AZT to be in decreasing perinatal HIV transmission and the women's own beliefs about AZT, their intent to take AZT if pregnant, and intent to give AZT to a newborn.     

The quest for ordinariness: transition experienced by midlife women living with chronic illness

AIMS: This paper reports the findings of research that aimed to elucidate the meaning of midlife women's experiences of living with chronic illness. BACKGROUND: A lack of awareness by health professionals of the context in which women must live with chronic illness often results in women feeling overwhelmed, alienated and without voice within the delivery of health care. This inquiry privileged women's voices. DESIGN: The construct of 'transition' in chronic illness experience evolved from this collaborative and participatory research with midlife women living with adult onset chronic illness. Over a 1-year timeframe, 81 women were asked to tell their stories of living with a chronic illness. These correspondence data were thematically analysed to provide storied accounts. Guided by feminist principles, women were empowered through research processes and have actively participated in the development of the transition construct. FINDINGS: The research revealed that when women are first confronted with a chronic illness they appear to move through a complex trajectory that involves an 'extraordinary' phase of turmoil and distress; however, they may then make the transition toward an 'ordinary' phase that involves incorporating chronic illness into their lives. Transitions in chronic illness experience involve movement from extraordinariness to ordinariness and sometimes back again and were found to be processes that are nonlinear, sometimes cyclical and potentially recurring throughout a woman's life. Four major constructs emerged from women's narratives: How quickly life changes; extraordinariness: confronting life with illness; The illness experience as transforming and ordinariness: reconstructing life with illness. CONCLUSION: Nurses are in a position where they may make a difference to women who live with chronic illness. Understanding illness transitions offers a framework that will enable nurses to move beyond the bio-medically orientated concepts of nursing practice, towards a holistic approach to the provision of nursing care.     

My Wife Has Breast Cancer: The Lived Experience of Arab Men

ObjectivesBreast cancer is a leading cause of mortality and morbidity among women in Middle Eastern countries. In Bahrain, breast cancer is the second-leading cause of death and first among women. Prior research has shown that Middle Eastern women will often delay seeking treatment for breast cancer and subsequently hide the diagnosis from friends and family. As a result, women rely heavily on their spouses for support and care. There is limited research on spouses’ experience of breast cancer, especially in the Middle East. This study explored the lived experience of Arab men following their wives’ diagnosis and treatment for breast cancer in Bahrain.Data SourcesData from semi-structured interviews with Arab men (n = 6) were analyzed using the interpretative phenomenological approach (IPA). Participants’ wives had completed their treatment 3 to 6 months prior to the interviews.ConclusionThree main themes emerged: Perceptions of breast cancer diagnosis and treatment, coping strategies, and impact on quality of life. Findings revealed that Arab men in Bahrain relied on family and friends for support and drew on religious beliefs to give them hope so they could better support their wives. Findings also highlighted the unique culturally related coping strategies used by Arab men. This study highlights the specific needs of Arab men following their wives’ diagnosis and treatment for breast cancer. Faith and beliefs were overwhelmingly a foundation for coping and support. Therefore, this must be considered within the health care service to improve support strategies for Arab patients and their spouses in treatment and care plans encompassing a holistic interprofessional, multidisciplinary, and communicative approaches including the need for culturally sensitive care pathways that are cognizant of the care needs through help-seeking and information-sharing throughout the illness. Nurses should provide the education and encourage open communication among the couple and their family.Implications for Nursing PracticeFindings can be used by nurses and other health care professionals to provide better support and holistic care to Arab women with breast cancer and their spouses.     

Machismo sustains health and illness beliefs of Mexican American men

PURPOSE: To inform nurse practitioners (NPs) about Mexican American men's health and illness beliefs and the ways in which these are influenced by their masculine identity and how they view themselves as men in their culture. DATA SOURCES: The data sources used were based on a selected review of the literature about Mexican American men's health and illness beliefs and the concept of machismo. Several studies, including the author's study on Mexican American men's healthcare-seeking beliefs and behaviors and experience in providing primary health care to men across cultures, contributed new data. CONCLUSIONS: The meaning of manhood in the Mexican American culture is critical in understanding how men perceive health and illness and what they do when they are ill. Machismo enhances men's awareness of their health because they have to be healthy to be good fathers, husbands, brothers, sons, workers, and community members. Pain and disability are motivating factors in finding ways to regain their health. IMPLICATIONS FOR PRACTICE: Men's health beliefs across cultures need further investigation by nurse researchers and NPs. How culture influences healthcare delivery to men should be better understood. If NPs are aware of men's views on masculinity, they are better prepared to understand and assist men in becoming more aware of their health status and to seek health care when appropriate.     

Educational intervention to decrease stigmatizing attitudes of undergraduate nurses towards people with mental illness

Health professionals can hold stigmatizing views about people with mental illness. In addition to being discriminatory, these beliefs cause anxiety that can affect learning in the clinical environment. A review of an undergraduate nursing curriculum introduced the Modern Apprenticeship curriculum model and provided an opportunity for an educational intervention designed to address stigmatizing beliefs about people with mental health and addiction problems. The aim of the present study was to measure the extent to which an educational intervention – guided clinical experience in an acute mental health unit during the first year of the curriculum – decreased stigmatizing beliefs of undergraduate nurses towards those with mental health and addiction issues. In a before‐and‐after design, Corrigan's Attribution Questionnaire was used to collect data pre‐ and post‐guided clinical experience in an acute mental health unit. The intervention resulted in a significant positive change in stigmatizing attitudes for four of the nine factors tested. There was a non‐significant positive change in three factors, while two factors showed a non‐significant negative change. Using guided clinical experience as an educational intervention in the first year of an undergraduate nursing curriculum can contribute to positive change in undergraduate nurses’ stigmatizing beliefs. The findings have implications for teaching of mental health content in undergraduate nursing programmes.     

Mental health professionals' attitudes towards people who have experienced a mental health disorder

The aim of this study was to gain information about the attitudes of mental health professionals towards people who have experienced a mental illness. The study involved a survey of 266 mental health professionals employed in a range of mental health treatment settings. Respondents were administered a questionnaire based on one of two vignettes describing a person with schizophrenia or depression. Attitudes were represented as beliefs about prognosis and long-term outcomes in relation to the two vignettes. Professional groups were found to be less optimistic about prognosis, and less positive about likely long-term outcomes, when compared with the general public. Medical staff were less optimistic about outcomes than other professional groups, with mental health nurses generally most optimistic. Most professionals based their attitudes on their experiences of working with people with mental health problems.     

Meaning of illness for women with breast cancer

The meaning that women with breast cancer ascribe to their disease may well have an impact on the effectiveness of coping strategies used to come to terms with breast cancer Health rare professionals need to know what meanings women with breast cancer are ascribing to their disease if they are to identify maladaptive coping strategies and ensure that women receive the support that they need in order to promote physical and psychological recovery This study involved assessing meaning of illness for a group of women with breast cancer at two points in time, the time of diagnosis and a mean of 21 months from diagnosis The eight meanings of illness devised by Lipowski were depicted by the following words challenge, enemy, punishment, loss, strategy, relief, weakness and value The most popular choice of meaning for the women was challenge, although some women's choices indicated that maladaptive coping strategies were being used The implications of the study for nurses and other health care professionals are discussed