Urban women's negotiation strategies for safer sex with their male partners.

Heterosexual transmission of HIV is growing at an increasing rate. One primary prevention strategy is to consistently use condoms. With the exception of female condoms, women do not "wear" condoms and therefore must negotiate condom use with their male partners. This present study examines the strategies women believe they would use in a safer sex negotiation with a male partner including (1) initiating negotiations, (2) resolving conflict, and (3) maintaining the intention to practice safer sex. The findings highlight the importance of understanding women's patterns of negotiation as well as their repertoire of negotiation skills prior to their exposure to behavioral interventions and prevention programs.     

A survey of teenage pregnant women and their male partners in the Grampian region

This paper describes an exploratory pilot study of the male partners of teenagers presenting for either termination of pregnancy (TOP) or antenatal care (ANC). Seventy-five teenage pregnant women were recruited into the study and were asked to complete a questionnaire. The results suggest that the male partners tended to be older than their teenage partners. Teenage pregnant women presenting for termination of pregnancy had statistically significant higher levels of education, compared to those presenting for antenatal care. An association was found between the women's decision to continue or not with the pregnancy and her chosen form of contraception. In the antenatal group, women tended to state that their male partner's indication of support had influenced their decision to continue with the pregnancy. In-depth research should be conducted on the male partners of teenage pregnant women if effective sex education interventions are to be developed.     

Quality of life and depression in women abused by their partners

OBJECTIVE: To evaluate quality of life and depression among women who suffer domestic violence and to describe the socioeconomic profile of women who were abused by their partners and aspects of these abuses. METHODS: The study sample comprised 100 women who were abused by their partners and filed a complaint at the Police Office for Women of the state of Ceara, Brazil. Three questionnaires were applied: one for collecting demographic and violence data; the second one (GHQ-28) one to evaluate general quality of life; and the third one (Beck) to quantify depression. RESULTS: Abused women are young, married, Catholic, have children, low schooling and low family income. Alcohol use and jealousy were the main reported factors leading to partner's abuse. Of all, 84% of women suffered physical attacks. It was observed that 72% had depression symptoms; 78% had anxiety symptoms and insomnia; 39% had already thought of killing themselves, and 24% started taking anxiety medications after been abused. CONCLUSIONS: Data analysis suggests that domestic violence is associated with a negative perception by women of their mental heath.     

Appalachian women's perceptions of their community's health threats.

CONTEXT: Decades of behavioral research suggest that awareness of health threats is a necessary precursor to engage in health promotion and disease prevention, findings that can be extended to the community level. PURPOSE: We sought to better understand local perspectives on the main health concerns of rural Appalachian communities in order to identify the key health priorities. While Kentucky Appalachian communities are often described as suffering from substandard health, resource, and socioeconomic indicators, strong traditions of community mobilization make possible positive, home-grown change. METHODS: To assess what women, the key health gatekeepers, perceive as the most significant health threats to their rural communities, 10 focus groups were held with 52 Appalachian women from diverse socioeconomic backgrounds. Tape-recorded narratives were content analyzed and a codebook was developed. Measures designed to increase data trustworthiness included member checks, negative case evidence, and multiple coding. FINDINGS: The following rank-ordered conditions emerged as posing the greatest threat to the health of rural Appalachian communities: (1) drug abuse/medication dependence; (2) cancer; (3) heart disease and diabetes (tied); (4) smoking; (5) poor diet/overweight; (6) lack of exercise; and (7) communicable diseases. These health threats were described as specific to the local environment, deriving from broad ecological problems and were connected to one another. CONCLUSION: Drawing on participants' community-relevant suggestions, we suggest ways in which rural communities may begin to confront these health concerns. These suggestions range from modest, individual-level changes to broader structural-level recommendations.     

"He won't use condoms": HIV-infected women's struggles in primary relationships with serodiscordant partners

We investigated the sexual behaviors of 55 HIV-infected women in Wisconsin who narrated their lives in 10 interviews over 2 years during 2000 to 2003. We sought to examine the interpersonal situations in which sexual risk occurred. During the prospective period, 58% (32) were abstinent and 24% (13) practiced safe sex exclusively. The remaining 18% (10) engaged in unprotected sexual intercourse, but only in primary partnerships, almost all of which were with serodiscordant partners. We focused on experiential detail and narrative depth of 10 women who had sex without condoms. These narratives demonstrate how the women attempted to initiate condom use but engaged in unprotected sexual intercourse regularly at the insistence of their partners. Consequently, these women lived in trepidation of causing their partners' sickness and death.     

Embodied metaphor in women's narratives about their experiences with cancer

Many scholars and medical professionals argue over the importance of metaphor in thinking about, and speaking of, cancer and other illnesses. Our study presents an analysis of the metaphors used by 6 women in their narratives of their experiences with cancer. We claim from our analyses that metaphorical talk about cancer reflects enduring metaphorical patterns of thought. Women used multiple, sometimes contradictory metaphors to conceptualize their complex cancer experiences. Many of their metaphors used to understand cancer are actually based on ordinary embodied experiences such that people still refer to the healthy body in trying to understand cancer even when their own bodies have been disrupted. We discuss the importance of our findings for understanding the relation between language and thought in regard to human illness.     

Obese women's perceptions of their physicians' weight management attitudes and practices

BACKGROUND: Obesity has reached epidemic proportions in the United States. Primary care physicians will see increasing numbers of patients with long-term weight management problems. OBJECTIVE: To examine obese women's perceptions of their physicians' weight management attitudes and practices. DESIGN AND SETTING: Women who participated in obesity trials at a university clinic completed a questionnaire that assessed their views of weight control provided by their primary care physician. PARTICIPANTS: The patients were 259 women whose age was 44.0 +/- 10.0 years; weight, 96.7 +/- 13.2 kg; and body mass index (calculated as weight in kilograms divided by the square of height in meters), 35.2 +/- 4.5 (all data given as mean +/- SD). MAIN OUTCOME MEASURES: Using 7-point scales (1 indicates low; and 7, high), patients rated their satisfaction with care provided for their general health and that for their obesity. They also identified methods their physician recommended for weight management and the frequency of negative interactions with their physician concerning weight control. RESULTS: Participants were generally satisfied with the care they received for their general health and with their physicians' medical expertise (mean scores, 6. 1 and 6.2, respectively). They were significantly (P<.001) less satisfied with care for their obesity and with their physicians' expertise in this area (mean scores, 4.1 and 4.3, respectively). Almost 50% reported that their physician had not recommended any of 10 common weight loss methods, and 75% indicated they looked to their physician a "slight amount" or "not at all" for help with weight control. Only a small minority of patients (0.4%-8.0%) reported frequent, negative interactions with physicians concerning their weight. CONCLUSIONS: The last finding helps allay concerns that obese patients are routinely treated disrespectfully by physicians when discussing weight. The challenge, however, for primary care physicians appears to be providing patients better assistance with weight management.     

Adjusted control: An explanation for women's positive perceptions of their pregnancies

This article presents the results of a research study that investigated factors that explain why some women perceive their pregnancies in a positive manner. Using an inductive method of investigation, the researchers found a salient concept that emerged from the data. This concept, termed “adjusted control,”; provides one explanation for why some women see their pregnancies positively. The analytic process employed in delineating the concept is described.     

Unraveling the mysteries of timing: women's perceptions about time to treatment for cardiac symptoms

Women in the USA are at disproportionate risk of dying from a myocardial infarction (MI), of suffering disabilities following an MI, and of reinfarcting and dying within a year of their initial MI. Various explanations, including women's older age at clinical manifestation of coronary heart disease (CHD) and higher likelihood of co-morbidities, have been offered for women's heightened risk of poor outcomes. Less frequently, research has focused on examining women's prolonged time elapse between symptom onset and biomedical treatment, a phenomenon that renders women less likely to undergo lifesaving reperfusion strategies. [1] To explore factors and circumstances that may shape CHD time to treatment, 40 middle age and older women living in Kentucky, USA, half with diagnosed CHD and half with chronic conditions considered to be risk factors for CHD, participated in a series of in-depth interviews. While much of the existing CHD literature implicates individual responsibility as the determining feature in time to treatment, these women's narratives suggested that treatment decisions inextricably are linked to broader social and structural constraints. Such supra-individual forces that shape the CHD experiences of women include the social construction of "standard" cardiac symptoms based on male norms that ultimately confuse symptom detection, women's negative encounters with health care providers who discount their knowledge, the competing social demands women face when threatened by a serious illness, and structural barriers delimiting women's health care choices.     

Children's perceptions about their health-related quality of life: effects of a health education-social skills program

The perception about one's health includes feelings about physical and psychological characteristics as well as ways of managing interpersonal relationships. The purpose of this study was to examine the effect of the Health Education Program 'Skills for primary school children' (KE.TH.E.A.-Ministry of Education of Greece. 1998. Educational Program of Prevention: Skills for Elementary Students [Eκπαιδευτικ? υλικ? πρ?ληψη?: Δεξι?τητε? για Παιδι? του Δημοτικο?]. Athens: KE.TH.E.A, 1998) on children's perceptions about certain dimensions of their quality of life: physical well-being, mental well-being, moods and emotions, self-concept, leisure-autonomy, family life, financial resources, friends, school environment and social acceptance (bullying). Two hundred and eighty-six students of fifth and sixth grade, from schools of Northern and Southern Greece participated. One hundred and twenty-eight (n = 128) formed the experimental group and 158 the control group (n = 158). The experimental group followed the skills program for 23 weeks (one 45 min lesson/week), whereas the control group did not. The Kidscreen Questionnaire (Kim S, Laird M. An Outcome Evaluation of Lions Quest 'Skills for growing' Grades K-5, 1993. Available at: http://www.Lions-quest.org. Accessed: 2 April 2009) was applied to assess health-related quality of life. Results from multivariate analysis of variance with repeated measures indicated that children in the experimental group significantly improved their perceptions of physical well-being, family life, financial aspects, friends, school life and social acceptance. On the other hand, children in the control group significantly improved their perceptions for physical well-being, whereas they deteriorated them significantly for family life, mood and feelings and social acceptance. Also, children as a whole improved their self-concept. Furthermore, analysis of covariance showed that the experimental group had better perceptions of autonomy than the control group in the final measurement. It can be concluded that such a program could lead to the improvement of (i) physical well-being, (ii) family life, (iii) financial resources, (iv) friends, (v) school environment, (vi) social acceptance and (vi) Leisure-Autonomy and to stable perceptions about mood and feelings, dimensions of health-related quality of life.     

Communicating about breast cancer: rural women's experience of interacting with their surgeon

Objective: This study examined rural women's satisfaction with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Differences in satisfaction were investigated between treatment groups (mastectomy and breast conservation surgery) and demographic variables (age, marital status, education level, employment status and place of residence). Practice was compared with clinical practice guidelines. Design: The study was designed as a cross‐sectional survey. Setting: The study was set in Eastern regional Victoria, Australia. Participants: Seventy women diagnosed with early breast cancer participated in the study. Main outcome measures: The main outcome measures used by the study were satisfaction in three areas of practice: (i) telling a woman she has breast cancer; (ii) providing information and involving the woman in the decision‐making; and (iii) preparing the woman for specific management. Results: No differences in satisfaction were found between treatment groups and demographic variables. Overall, women in this study were highly satisfied (>93%) with the interaction and communication with their surgeon. Women reported that the surgeon created a supportive environment for discussion, that they were provided with adequate information and referrals, and that they were actively involved in the decision‐making. Practice could have been improved for women who were alone at diagnosis as women without a partner made a quicker decision about treatment. Conclusion: Rural women in Victoria Australia were largely satisfied with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Current practice was predominately in line with clinical practice guidelines.     

Physician-reviewers' perceptions and judgments about quality of care.

OBJECTIVE: Although Peer Review Organizations (PROs) and researchers rely on physicians to assess quality of care, little is known about what physicians think about when they judge quality. We sought to identify features of individual cases that are associated with physicians' judgments. DESIGN: Using 1994 Medicare data, we selected hospitalizations for 1134 beneficiaries in 42 acute care hospitals in California and Connecticut. The sample was enriched with 17 surgical and six medical complications identified using diagnosis and procedure codes. PRO physicians confirmed quality problems using a structured implicit chart review instrument and provided written open-ended comments about each case. We coded physicians' comments for factors presumed to influence judgments about quality. RESULTS: In crude and adjusted comparisons, reviewers questioned quality more frequently in cases with serious or fatal outcomes, technical mishaps and inadequate documentation. Among surgical (but not medical) patients, they were less likely to record poor quality among patients presenting with an acute illness. CONCLUSION: Factors other than the adequacy of key processes of care are associated with physician-reviewers' judgments about quality.     

Choice of female-controlled barrier methods among young women and their male sexual partners

CONTEXT: Little is known about the factors associated with the choice of female-controlled, over-the-counter barrier contraceptive methods among women and their male sexual partners. METHODS: Predictors of method choice were assessed following an educational presentation on contraceptive use and risk reduction among 510 sexually active females aged 15-30 who were recruited in the San Francisco Bay Area. In addition, the primary partners of 160 of these women participated in the survey RESULTS: Twenty-two percent of women who enrolled in the study alone, 25% of those who enrolled with their main partner and 18% of these male partners chose female-controlled, over-the-counter barrier methods alone. The strongest predictor of this choice was current use of a hormonal contraceptive both for women who participated in the study on their own (odds ratio, 2.1) and for those who enrolled their partner in the study (odds ratio, 6.3). Female-controlled methods were also chosen significantly more often by teenagers than by older women; for example, among those who enrolled with a male partner, the odds ratio for selection of a female-controlled barrier method by women younger than 18 was 6.0. Among women who enrolled without a partner, those who had had multiple partners in the previous six months and those who were current users of male condoms were less likely to choose female-controlled methods (odds ratios, 0.7 and 0.5, respectively). CONCLUSIONS: Although the majority of participants did not choose female-controlled, over-the-counter barrier methods without also choosing male condoms, such female-controlled methods appear to offer an acceptable alternative for prevention of sexually transmitted infections. They may be a particularly attractive option for individuals using hormonal contraceptives and for teenage women.     

Sheltered women's perceptions of their abusive marital relationship: Conflictual themes of dominance and submissiveness

The Core Conflictual Relationship Themes (CCRT) approach was applied in order to examine the conflictual nature of sheltered women's perceptions of their marital relationship following domestic violence in Israel. Thirty-six sheltered women and 89 community-based women were compared. The CCRT method was useful in revealing that battered women, when thinking retrospectively about their relationships with their abusive partners, are concerned with conflictual themes of dominance and submissiveness. The sheltered women reported a desire to be more dominant and less submissive in their relationships with their abusive spouse, despite being less dominant than they wished in practice. These findings help clarify the emotional conflicts that battered women may be dealing with after leaving an abusive relationship and imply that interventions should promote their empowerment.