How do health professionals acknowledge Web-based knowledge in pregnancy consultations?

ABSTRACT

Websites for pregnancy health are an important source of information for pregnant women, but how different cadres of health professionals value and utilize pregnant women's e-health literacy (e-HL) and Web-based knowledge in pregnancy consultations is not well understood. Using a qualitative research design and pelvic girdle pain as a tracer condition, we explored how Norwegian doctors, midwives and physiotherapists manage women's e-HL and Web-based knowledge in pregnancy consultations. The recognition of pregnant women's e-HL and Web-based knowledge differed across professional groups and produced dismissive, reactive and proactive attitudes depending on time pressure, professional identity and Internet experience.     

Women's Perceptions of the Relationship Between Recent Life Events,Transitions, and Diet in Midlife: Findings from a Focus Group Study

Research indicates that history and early life events and trajectories influence women's dietary behaviors. Yet the social context in which recent life changes occur requires greater understanding, particularly regarding changes that embody the interconnectedness of women and their families, and how those changes affect women's dietary decisions and behaviors. The data presented here were the product of eight focus groups conducted in one Maryland county in the fall of 2009. The participants were 43 women with limited financial resources aged 40–64 years. In this analysis, the researchers focus on women's perceptions of the relation of recent life transitions and events to the dietary decisions they made for themselves and their families. The findings suggested that transitions and events related to household structure, health status, phases of motherhood, and shifts in financial and employment status all had the potential to have profound and immediate effects on women's dietary decisions and resulting dietary behaviors. The focus group data was used to consider implications for developing intervention strategies designed to improve self-efficacy and negotiation skills around dietary issues as a means of promoting healthy decision making among women in midlife, particularly in times of familial upheaval and in circumstances where financial resources are limited.     

Metaphorical mediation in women's perceptions of risk related to osteoporosis: A qualitative interview study

When risks affecting the body are identified and made visible through medical technologies, individuals need to find ways to communicate and express them through metaphorical projection. We used cognitive metaphor theory to explore women's conceptions of the risk inherent in osteoporosis. Data were drawn from focus group discussions with women who had no personal experience of osteoporosis, and individual interviews with women perceiving themselves to be at risk of osteoporosis. Women described osteoporosis as a hazard implying physical deviation from the healthy norms. This sense of risk was specifically couched in the metaphorical terms of a collapsing building and loss of the upright position. This image embraced a variety of perceptions of the body related to the hazards of osteoporosis. Findings revealed metaphors about the construction of the skeleton and the material of the bones, explaining the notion of danger. The perception of risk related to osteoporosis was framed by imagery of the destruction of the skeleton, the porous bones, frail bodies, a collapsing backbone and lack of trust in the body. Metaphors can be transformative, shaping the perception of a concrete health risk and changing the meaning of the risk. The metaphorical conception of osteoporosis may have a fundamental impact on women's perception of their bodily identity being at risk and thereby affect the image of their bodily capacities as vulnerable and create negative expectations of old age and health. Women's use of metaphors invites reflections on the use of metaphors in risk communication.     

“They're Made in Factories and Not by Witches on the Allotment”: A Qualitative Study of Midlife Women in the United Kingdom,Exploring Their Approaches to Complementary and Alternative Medicines

This article explores midlife women's experiences and approaches related to complementary and alternative therapies (CAMS). Ninety-six midlife women were asked about their use of CAMs as part of their overall approach to midlife health. Qualitative thematic analysis was combined with a case-based approach. Women set their experience of CAMs in the context of conventional medicine taking and discussed their safety and different uses. For treatments requiring direct contact with a practitioner, accessibility and quality of the relationship were crucial. Four overall approaches could be discerned (political–critical, pragmatic, careful and wellbeing-oriented) that dynamically interacted with women's experiences.     

ISSUES IN AN INTERNET SURVEY AMONG MIDLIFE ASIAN WOMEN

Because a limited amount of women's health research using Internet-based data collection methods has been done, very little is known about the methodological and ethical issues that are unique to this emerging research practice. The purpose of this article is to inform the future directions of Internet usage in women's health research based on the practical issues raised in an Internet survey of 62 midlife Asian women in the United States. The issues include (a) potential selection biases, (b) ethical concerns, (c) a low response rate, (d) frequent consultations, and (e) potential data entry errors. Based on the discussion of the issues, future directions for Internet research are proposed.     

Moral work in women's narratives of breastfeeding

Women's narratives of their breastfeeding experiences are sites of construction and reconstruction of self as they undertake moral work in relation to feeding their baby. We engaged Foucault's ‘technologies of the self’ and his notion of ethics (the relationship with self) to examine that moral work (individual actions rather than adherence to universal moral codes) in relation to women's subjectivity constructed in interviews with 49 women from the UK. Four categories of moral work were identified: biographical preservation, biographical repair, altruism and political action. We describe each of these and conclude that women's embodied experience and sense of self are disciplined within current, limited, often punishing discourses by undertaking painful moral work in order to maintain or repair their subjective positions. We suggest the development of new subject positions around infant feeding practices.     

Health professionals’ beliefs about domestic abuse and the issue of disclosure: a critical incident technique study

Domestic abuse is increasingly recognised as a serious, worldwide public health concern. There is a significant body of literature regarding domestic abuse, but little is known about health professionals’ beliefs about domestic abuse disclosure. In addition, the intersection between health professionals’ beliefs and abused women's views remains uninvestigated. We report on a two‐phase, qualitative study using Critical Incident Technique (CIT) that aimed to explore community health professionals’ beliefs about domestic abuse and the issue of disclosure. We investigated this from the perspectives of both health professionals and abused women. The study took place in Scotland during 2011. The study was informed theoretically by the Common Sense Model of Self‐Regulation of Health and Illness (CSM). This model is typically used in disease‐orientated research. In our innovative use, however, CSM was used to study the social phenomenon, domestic abuse. The study involved semi‐structured, individual CIT interviews with health professionals and focus groups with women who had experienced domestic abuse. Twenty‐nine health professionals (Midwives, Health Visitors and General Practitioners) participated in the first phase of the study. In the second phase, three focus groups were conducted with a total of 14 women. Data were analysed using a combination of an inductive classification and framework analysis. Findings highlight the points of convergence and divergence between abused women's and health professionals’ beliefs about abuse. Although there was some agreement, they do not always share the same views. For example, women want to be asked about abuse, but many health professionals do not feel confident or comfortable discussing the issue. Overall, the study shows the dynamic interaction between women's and health professionals’ beliefs about domestic abuse and readiness to discuss and respond to it. Understanding these complex dynamics assists in the employment of appropriate strategies to support women post‐disclosure.     

Women with HIV and their burden of caring

It is argued that the survival time of women with AIDS is connected to these women's values and beliefs about health and AIDS, which in turn affect how they care for themselves and others. Moreover, their values and beliefs result from the interrelationship between economic conditions and cultural and social norms. Consequently, women's experience of HIV infection is affected by both their inferior role and status in society and the lack of acknowledgment of HIV and AIDS as women's health issues. This situation has the fatal consequence that women with AIDS have a shorter survival time than do men with AIDS.     

Ultrasound as a technology of reassurance? How pregnant women and health care professionals articulate ultrasound reassurance and its limitations

The premise that ultrasound technologies provide reassurance for pregnant women is well‐rehearsed. However, there has been little research about how this reassurance is articulated and understood by both expectant mothers and health care professionals. In this article, we draw on two qualitative UK studies to explore the salience of ultrasound reassurance to women's pregnancy experiences whilst highlighting issues around articulation and silence. Specifically, we capture how expectant parents express a general need for reassurance and how visualisation and the conduct of professionals have a crucial role to play in accomplishing a sense of reassurance. We also explore how professionals have ambiguities about the relationship between ultrasound and reassurance, and how they subsequently articulate reassurance to expectant mothers. By bringing two studies together, we take a broad perspectival view of how gaps and silences within the discourse of ultrasound reassurance leave the claims made for ultrasound as a technology of reassurance unchallenged. Finally, we explore the implications this can have for women's experiences of pregnancy and health care professionals’ practices.     

Embodied expertise: women's perceptions of the contraception consultation

This research, based on qualitative interviews and non-participant observation, emerges from a larger study investigating what factors influence the 'contraceptive careers' of British women in their 30s. The women informants recognized that contraceptive products often impacted on their health, but viewed them as distinct from 'medical matters'. Rather than doctors being seen as having expertise, it was women health professionals, be they nurses, midwives, health visitors or doctors, who were perceived as the ones who 'know' about contraception, through an assumption that they are contraception users. This embodied knowledge is valued by the women above their formal medical training. I will also show how general practice surgeries and family planning clinics were viewed as gendered spaces, which altered the expectations and experiences of the women during contraceptive consultations. This study found that as 'real' expertise over contraception stems from embodied rather than textual knowledge, the women's choices were grounded by a gendered sense of trust.     

Experiencias emocionales en la interrupción voluntaria del embarazo

ObjectiveTo explore women's emotional accounts of induced abortion, analyzing qualitative scientific publications.MethodQualitative systematic review of 19 studies published in PubMed, Science Direct and Scopus from 2010 onwards. The articles based on qualitative research design were revised using inductive content analysis.ResultsThe analysis identified three main themes regarding women's emotional experiences: access to abortion, emotional impact during medical assistance, and individual, relational and sociocultural determinants. The studies showed the variability in women's emotional accounts, mainly determined by the following factors: Access and waiting times, health system, type of intervention, degree of awareness and participation regarding the use of technical and medical technologies, interaction with health professionals, and specificity of individual, relational and sociocultural context. The main emotional difficulties were related to the ethical conflict, the decision-making, the relation with the social and health system and stigma. As main facilitating aspects, women highlighted autonomy in decision-making and emotional support, while barriers referred to social rejection and negative messages perceived from the political, social and health system.ConclusionsThe emotional accounts around induced abortion depend on individual and relational factors, as well as on health assistance, all mediated by gender inequalities and bias. Improvements in health assistance refer to an integral and individualized attention, adapted to women's needs.     

Gender,self and pleasure: young women's discourse on masturbation in contemporary Shanghai

This study examines views and experiences of young Shanghai women with respect to masturbation. Through in-depth interviews with forty young women in Shanghai aged 22 to 39 from May 2004 to July 2007, the study explores women's understandings of masturbation, their desires and their lives as modern Chinese women. The focus of the analysis is on how women talk about their masturbation experiences and make sense of their experiences in the context of their sexual relationships and lifestyle choices. By analysing women's narratives about masturbation, the paper suggests that women's self-articulation is actually an engagement in self-image construction. The strategies they use to position themselves in relation to different social discourses on masturbation, how they describe and perform the acts and how they articulate their experiences of masturbation are examined to illustrate how young women in Shanghai perform gender and sexual intimacies in a fast changing city.     

The Process of Losing and Regaining Credibility When Coming-Out at Midlife

The purpose of this research was to investigate the coming-out process for women at midlife, and to understand how this process of coming-out affects women's health and health care relationships. Using feminist grounded theory, from the interview data we elicited an understanding of how women experienced the coming-out process, how the process influenced their health and health care, what they considered problematic about the process, and how they managed or resolved problematic issues. The basic social process (BSP) of confronting the taken for granted illustrated how the central problem of credibility was experienced. The BSP has three phases: facing scary love, finding me, and settling in. Variables that impact on these phases are support and the concomitant microprocess of enduring perpetual outing. The findings provide a theoretical framework needed for health care providers to understand the coming-out process for midlife women and how it influences their health and health care. The theory provides new insights into the complexity for women transitioning to lesbian at midlife.     

Steps towards evidence‐based foot‐care for children: Behaviour and opinions of health professionals

Allied health professionals (AHPs) working with children need the appropriate knowledge, skills and experiences to provide high‐quality care. This includes using research to drive improvements in care and ensuring that knowledge and practices are consistent and build upon the best available evidence. The aim of this work was to understand more about the shared behaviours and opinions of health professionals supporting children's foot health care; how they find information that is both relevant to their clinical practice as well as informing the advice they share. A qualitative design using semi‐structured, one‐to‐one, telephone interviews with AHPs was adopted. Thematic analysis was used to generate meaning, identify patterns and develop themes from the data. Eight interviews were conducted with physiotherapists, podiatrists and orthotists. Five themes were identified relating to health professionals: (a) Engaging with research; (b) Power of experience; (c) Influence of children's footwear companies; (d). Dr Google – the new expert and (e) Referral pathways for children's foot care. The findings indicate that the AHPs adopted a number of strategies to develop and inform their own professional knowledge and clinical practice. There could be barriers to accessing information, particularly in areas where there is limited understanding or gaps in research. The availability of online foot health information was inconsistent and could impact on how AHPs were able to engage with parents during consultations.     

Bodies of risk: Constructing motherhood in a Mexican public hospital

This article addresses the connection between risk and motherhood at an urban obstetrics hospital in Mexico. It primarily aims to explore the ways that clinicians define risk as well as how they conflate risk with bad motherhood. It discusses how clinicians' perceptions of their patients' social lives shape their interactions and decisions about the women's health. The study was based on interviews and participant observation in June 2008 and June–July 2011 with 71 obstetrical patients, 30 physicians, 9 nurses, and 12 midwives in the city of Puebla. Results show that birth itself was defined as a risky event, clinicians conflated social factors with biological factors in their management of risk, and the patients were a priori classified as bad mothers. This article proposes a reproductive habitus to explain the connection between health institutions, class, responsibility, blame, and clinical decision-making to analyze how risk is managed and blame enacted upon women's bodies.     

Participation in self-care based on the sufficiency economy philosophy among midlife women in Thailand

This study aimed to explore the process of participation in self-care based on the sufficiency economy philosophy among midlife women in Thailand. The study design used a participatory action research approach. The participants were 30 community-dwelling Thai midlife women (aged 35–60 years) who participated in developing self-care processes and exchanging information in a group. However, there were 20 women who were willing and available to participate an interview. Demographic data were collected. Two in-depth interviews were conducted with each participant, and observation notes were recorded. Data were analysed by using content analysis. The following six major themes emerged that described the participatory process in self-care: (a) Assessing health status and self-care practice; (b) Brainstorming, setting priorities for health problems and selecting problem-solving methods; (c) Performing selected self-care activities following the plan and using available community resources; (d) Sharing knowledge and experience in performing self-care; (e) Evaluating health outcomes after self-care and (f) Sustaining self-care by continuing to perform self-care and influencing others to perform self-care. In conclusion, the success of self-care based on the sufficiency economy philosophy among midlife women was determined by the women's participation in self-care activities. Midlife women with the intention to regularly perform self-care experienced good health outcomes.     

Correction to: The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial

Objective To explore women’s perceptions of the risks and benefits associated with medication use during pregnancy and to better understand how women make decisions related to medication use in pregnancy. Methods We conducted online focus groups with 48 women who used medication during pregnancy or while planning a pregnancy, and 12 in-depth follow-up interviews with a subset of these women. Results We found that women were aware of general risks associated with medication use but were often unable to articulate specific negative outcomes. Women were concerned most about medications’ impact on fetal development but were also concerned about how either continuing or discontinuing medication during pregnancy could affect their own health. Women indicated that if the risk of a given medication were unknown, they would not take that medication during pregnancy. Conclusion This formative research found that women face difficult decisions about medication use during pregnancy and need specific information to help them make decisions. Enhanced communication between patients and their providers regarding medication use would help address this need. We suggest that public health practitioners develop messages to (1) encourage, remind, and prompt women to proactively talk with their healthcare providers about the risks of taking, not taking, stopping, or altering the dosage of a medication while trying to become pregnant and/or while pregnant; and (2) encourage all women of childbearing age to ask their healthcare providers about medication use.