Do Chinese parents with HIV tell their children the truth? A qualitative preliminary study of parental HIV disclosure in China

Background With the extended lifespan of people living with human immunodeficiency virus (HIV) due to the advent of antiretroviral therapy, the disclosure of HIV serostatus to their uninfected children is becoming more critical. However, limited data are available regarding parental HIV disclosure to children in China. We explore patterns of parental HIV disclosure and the reasons for disclosure or non‐disclosure to children. Methods A preliminary study was conducted using open‐ended questions in Guangxi, China in 2011 with 39 parents living with HIV. Results A majority of participants (77%) had not disclosed their HIV serostatus to their children. Participants who voluntarily disclosed tended to be older and were more likely to disclose to their adult children. Among parents who disclosed, reasons included a need for emotional and financial support, as well as feelings of obligation to their children. Among non‐disclosing parents, primary reasons included concerns that children were too young to understand, fear of being stigmatized, and fear of increased psychological burden to children. Conclusions Few parents with HIV disclosed their HIV status to their children. These data indicate the need for future research to explore disclosure issues in relation to children's age and the implementation of developmentally appropriate interventions and support systems for parents and children affected by HIV in China.     

Parents’ experiences of conducting a goal-directed intervention based on children’s self-identified goals,a qualitative study

Aim/objective: To explore and describe parents’ perceptions and experiences of conducting a goal-directed intervention focused on children’s self-identified goals.

Material and methods: Individual semi-structured interviews were performed with nine parents (8 mothers, 1 father). All the parents had participated actively in conducting a goal-directed intervention addressing their children’s self-identified goals. The interviews were analyzed using qualitative content analysis.

Results: From a parental perspective, working on children’s self-identified goals was a positive experience. The findings revealed three categories: Goals challenged the parents describes the parents’ experiences of the complexity of goal setting. The intervention demanded an intensive and flexible parental engagement; here the parents expressed the importance of active parental engagement, which for some parents could be challenging. The child’s personal goals gave more than anticipated describes the parents’ experiences of how the children’s personal goals positively influenced the children’s self-esteem, increased the children’s motivation for practice, and helped the children develop more than the parents had anticipated.

Conclusions and significance: In the parents’ experience, goal-directed intervention comprehensively relies on their engagement. Follow up’s from the occupational therapist motivated the parents and their own child’s personal goals gave them more than they could have expected. This indicates the importance of supporting parents and letting children actively participate in the goal setting process.     

Arab American parents’ perceptions of their children’s experience in the USA: a qualitative study

The purpose of this study was to examine Arab American parents’ perceptions of difficulties their children experience in the USA. Both Arab American children born outside the USA who later moved to the country and children born in the USA to Arab parents were examined. Fifty Arab American families were interviewed in two areas in the State of Michigan. Data were translated from Arabic to English, and then analysed according to specific themes. Results revealed that the most common difficulties are language acquisition and emotional and social adjustments. The least frequent problem is using technology. Additionally, results showed that children who live in concentrated populations of Arab immigrants have fewer problems than those who live in less concentrated areas. The implications of results for educators, school psychologists and new Arab immigrants are presented.     

Children and news: opinions of children’s news program creators in Israel

Although standard television news is often perceived as inappropriate for children, studies suggest that news consumption is important for children’s social and political socialization. Accordingly, children’s news programs have been developed with the aim of adapting news for children. Research examining program creators’ perspectives on news adaptation for children has primarily focused on the creators’ views of wars or on others crisis coverage. The current study addresses the production of routine children’s news by examining the unique context of Israel. Interviews with 15 creators reflect the belief that news should be adapted to children’s cognitive and emotional abilities by ensuring that such news is comprehensible and palatable, featuring both standard news items and content pertaining to children’s lives, achieving a balance between heavier and lighter content, and generating a youthful atmosphere. The implications of these findings and the questions that arise are discussed.     

Gendered power dynamics and women’s negotiation of family planning in a high HIV prevalence setting: a qualitative study of couples in western Kenya

In sub-Saharan Africa, high burdens of HIV and unmet need for contraception often coexist. Research emphasises the need to engage men and couples in reproductive health, yet couples’ negotiations around fertility and family planning in the context of HIV have been sparsely studied. This study examined the gendered power dynamics that frame women’s and couples’ negotiations of contraceptive use in western Kenya. We conducted 76 in-depth interviews with 38 couples, of whom 22 couples were concordant HIV-positive. Qualitative data were analysed using a grounded theory approach. Direct communication around contraception with men was often challenging due to perceived or expressed male resistance. A substantial minority of women avoided male reproductive decision-making authority through covert contraceptive use, with concern for severe consequences when contraceptive use was discovered. Many men assumed that family planning use signified female promiscuity and that infidelity motivated covert use. Men were more willing to use condoms to avoid HIV re-infection or on the recommendation of HIV care providers, which allowed some women leverage to insist on condom use. Our findings highlight the tension between male dominated reproductive decision making and women’s agency and point to the need for gender transformative approaches seeking to challenge masculinities that negatively impact health.     

Transgender women in Malaysia,in the context of HIV and Islam: a qualitative study of stakeholders’ perceptions

Background

Globally, one of the key groups considered to be at high risk of acquiring HIV are transgender women, often a marginalised group. In the Malaysian context there has been a scarcity of published research relating to transgender women, a sensitive issue in a Muslim majority country, where Islam plays an influential role in society. Furthermore, there has been a paucity of research relating to how such issues relate to HIV prevention in transgender women in Malaysia.Thus, the aim of this study is to explore the attitudes of stakeholders involved in HIV prevention policy in Malaysia towards transgender women, given the Islamic context.

Methods

In-depth interviews were undertaken with stakeholders involved in HIV prevention, Ministry of Health, Religious Leaders and People Living with HIV, including transgender women. Thirty five participants were recruited using purposive sampling from June to December 2013 within Kuala Lumpur and surrounding vicinities. Interviews were in person, audiotaped, transcribed verbatim and used a framework analysis.

Results

Five central themes emerged from the qualitative data; Perceptions of Transgender women and their place in Society; Reaching out to Transgender Women; Islamic doctrine; ‘Cure’, ‘Correction’ and finally, Stigma and Discrimination.Discussion: Islamic rulings about transgenderism were often the justification given by participants chastising transgender women, whilst there were also more progressive attitudes and room for debate. Pervasive negative attitudes and stigma and discrimination created a climate where transgender women often felt more comfortable with non-governmental organisations.

Conclusion

The situation of transgender women in Malaysia and HIV prevention is a highly sensitive and challenging environment for all stakeholders, given the Muslim context and current legal system. Despite this apparent impasse, there are practically achievable areas that can be improved upon to optimise HIV prevention services and the environment for transgender women in Malaysia.

     

Association between serum cholesterol levels and Alzheimer’s disease in China: a case-control study

To examine the association between blood cholesterol concentrations and Alzheimer’s disease (AD) in the Chinese elderly. A case-control study was implemented between November 2011 and November 2017. Elderly patients aged ≥?55?years with (n?=?117) and without AD (control participants; n?=?117) were recruited from the Neurology Central Hospital of Tianjin, China. The associations between AD and blood parameters were assessed using multiple binary logistic regression analyses adjusted for multiple covariates. Higher serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels and lower serum high-density lipoprotein cholesterol (HDL-C) levels associated with AD risk in the models adjusted for (1) age, sex and education; and (2) further adjusted for body mass index, smoking status, stroke, hypertension, type 2 diabetes mellitus and heart disease. Increased serum TC and LDL-C levels and lower HDL-C levels were independently associated with the risk of AD.     

Perceived parental sex discrimination,happiness and self-esteem: children’s perspective

This study examines parents’ sex discrimination through the perspectives of their children and its relationship to their daughter’s happiness and self-esteem. Questionnaires were collected from 805 secondary school students at eight Chinese Independent Schools in Malaysia. The results showed that perceived parental sex discrimination (PPSD) was negatively correlated with happiness and self-esteem. Importantly, this relationship only occurred among female but not male respondents. These results suggest that significantly negative psychological impact is possible due to PPSD, and, thus, the introduction of laws to ban the abuse of the sex-selection techniques is not enough to tackle this complicated phenomenon.     

Responses to donor proliferation in Ghana’s health sector: a qualitative case study

ObjectiveTo investigate how donors and government agencies responded to a proliferation of donors providing aid to Ghana’s health sector between 1995 and 2012.MethodsWe interviewed 39 key informants from donor agencies, central government and nongovernmental organizations in Accra. These respondents were purposively selected to provide local and international views from the three types of institutions. Data collected from the respondents were compared with relevant documentary materials – e.g. reports and media articles – collected during interviews and through online research.FindingsGhana’s response to donor proliferation included creation of a sector-wide approach, a shift to sector budget support, the institutionalization of a Health Sector Working Group and anticipation of donor withdrawal following the country’s change from low-income to lower-middle income status. Key themes included the importance of leadership and political support, the internalization of norms for harmonization, alignment and ownership, tension between the different methods used to improve aid effectiveness, and a shift to a unidirectional accountability paradigm for health-sector performance.ConclusionIn 1995–2012, the country’s central government and donors responded to donor proliferation in health-sector aid by promoting harmonization and alignment. This response was motivated by Ghana’s need for foreign aid, constraints on the capacity of governmental human resources and inefficiencies created by donor proliferation. Although this decreased the government’s transaction costs, it also increased the donors’ coordination costs and reduced the government’s negotiation options. Harmonization and alignment measures may have prompted donors to return to stand-alone projects to increase accountability and identification with beneficial impacts of projects.     

Visceral politics: obesity and children’s embodied experiences of food and hunger

Children have been made a priority in Australian government obesity interventions, with programmes tending to focus on promoting behaviour change in food and exercise practices. This paper reports findings from ethnographic research with a group of Australian children aged 10–14 years living in a low socio-economic suburban setting. We propose that central to these children’s experiences of food and eating is the negotiation and management of hunger. Historically, disadvantage has been embodied and inscribed on children’s bodies in very visible ways, and the coexistence of hunger and obesity is part of this continuum. Despite considerable evidence of food insecurity in our research site, issues of hunger were absent in an obesity intervention underway at the time. We examine how hunger was felt in children’s lives, how it was managed and the ways in which messages about eating less, while eating more ‘healthy foods’, were at odds with the children’s experiences of hunger. Moreover, we argue that hunger and obesity in this context were doubly stigmatised, as children were very aware of how their hunger and their bodies marked them as different and disadvantaged. Attention to both the embodied and social impacts of hunger on children and their everyday relationships is key in formulating more sensitive, contextualised public health interventions.     

Emergency Department waiting times in a tertiary children’s hospital in Israel: a retrospective cohort study

Background

The purpose of this study was to assess ethnic differences in Emergency Department (ED) waiting times between Jewish and Arab children in a tertiary childrens’ hospital in Israel.

Methods

This was a retrospective cohort study of all children who were admitted to the pediatric ED of the largest hospital in northern Israel, between January 2011 and December 2015. Univariate and multivariate analyses were used to assess the strength of association between ethnicity category and waiting time. The following were tested as possible confounders: triage category, age, gender, time of arrival category. The effect of nurse-patient ethnic concordance was assessed.

Results

Full data were available in 82,883 patients, 55,497 (67.0%) Jews and 27,386 (33.0%) Arabs. Jews and Arabs had a similar median waiting time of 38 min (interquartile range [IQR] 22–63 and IQR 21–61, respectively). Ethnicity was not associated with a change in waiting time (p?=?0.36). Factors that most influenced shorter waiting time were triage category 1 (change in waiting time: ?25.5%; 95% confidence interval [CI]: ?29.3 to ?21.7), or triage category 2 (change in waiting-time: ?21.8%; 95% CI: -23.7 to ?20.05). Factors that most influenced longer waiting time were patient arrival during the morning shift period (change in waiting time: 5.45%; 95% CI: 4.59 to 6.31), or during the evening shift period (change in waiting time: 4.46%; 95% CI: 3.62 to 5.29). Ethnic discordance between triage nurses and patients did not yield longer waiting times.

Conclusion

In this large pediatric cohort, ethnic differences in ED waiting time were not found.

     

Use of online health information to manage children’s health care: a prospective study investigating parental decisions

Background

The use of the internet to access information is rapidly increasing; however, the quality of health information provided on various online sites is questionable. We aimed to examine the underlying factors that guide parents’ decisions to use online information to manage their child’s health care, a behaviour which has not yet been explored systematically.

Methods

Parents (N?=?391) completed a questionnaire assessing the standard theory of planned behaviour (TPB) measures of attitude, subjective norm, perceived behavioural control (PBC), and intention as well as the underlying TPB belief-based items (i.e., behavioural, normative, and control beliefs) in addition to a measure of perceived risk and demographic variables. Two months later, consenting parents completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their use of online information to manage their child’s health care during the previous 2 months.

Results

We found support for the TPB constructs of attitude, subjective norm, and PBC as well as the additional construct of perceived risk in predicting parents’ intentions to use online information to manage their child’s health care, with further support found for intentions, but not PBC, in predicting parents’ behaviour. The results of the TPB belief-based analyses also revealed important information about the critical beliefs that guide parents’ decisions to engage in this child health management behaviour.

Conclusions

This theory-based investigation to understand parents’ motivations and online information-seeking behaviour is key to developing recommendations and policies to guide more appropriate help-seeking actions among parents.

     

The Parents Plus Children’s Programme—a qualitative study exploring parents’ experiences of participation and cognitive factors mediating outcome

This article presents the findings of a qualitative study of parents’ perceptions of a video-modelling assisted group-based parent training programme, the Parents Plus Children’s Programme (PPCP). PPCP was developed in Ireland and is culturally sensitive to the Irish context. PPCP aims to reduce emotional and behavioural difficulties in children aged 6–11 years. Twenty-one caregivers of children attending a child and adolescent mental health service in Dublin with significant behavioural problems were interviewed five months following completion of PPCP. Thematic analysis was used to explore caregivers’ perceptions of changes in their children, benefits of participation and effective programme strategies, with a view to identifying cognitive factors mediating outcome. Improvements observed included children being calmer, being better able to communicate feelings and needs, and having better emotional regulation. “Tuning in” to children, engaging in play, explaining rules, communicating calmly and planned sanctions were identified as effective programme strategies. Group support emerged as the main benefit of participation. Perceived parental control, ability to reframe children’s misbehaviour, consistency with discipline and hopefulness differentiated participants who observed improvements and those who did not. The findings were interpreted within a social-cognitive theoretical framework with reference to self-efficacy beliefs. Implications for clinical practice are also discussed.     

The process of opting for female permanent contraception: A qualitative study of women’s experiences in Sweden

ObjectivesWe aimed to explore Swedish women's decision-making experiences regarding permanent contraception.Study designIn this study, we included 17 women aged 30–48 who were scheduled to undergo female permanent contraceptive procedures. We conducted semistructured interviews using two broad open-ended questions. We analyzed these data using systematic text condensation based on the principles of psychological phenomenological analysis.ResultsThe interviewees experienced no counseling or support from health care workers regarding permanent contraception until they specifically asked for it. Participants reported that they themselves place the responsibility of permanent contraception solely on women. Consequently, our participants described feeling hesitancy and ambivalence in the process of deciding to have the procedure. Once the decision was made and the women were on the waiting lists for surgery, they experienced relief and empowerment.ConclusionsOur findings suggest that health care providers in Sweden miss opportunities to support patient-centered decision-making regarding permanent contraception. This study indicates that women make deliberate and considered decisions regarding permanent contraception and are best positioned to know when the procedure should take place in their reproductive lives.Implication statementsHealth care professionals should discuss permanent contraception as an option with all women desiring contraception to allow them to decide if that method is right for them.     

Changing attitudes and beliefs towards a woman’s right to protect against HIV risk in Malawi

Female empowerment and positive attitudes towards women’s rights in sexual relationships have been found to be key elements of successful behaviour-based HIV prevention programmes. However, HIV prevention programmes that do not specifically engage with gender issues may also affect attitudes and beliefs towards women’s rights within sexual relationships. Using data from the Malawi Longitudinal Study of Families and Health we compare measures of female empowerment and changing gender norms between intervention participants and non-participants. Results suggest that female intervention participants were more likely than non-participants to believe that: (1) women have more rights within sexual relationships in general and (2) women have the right to protect themselves against HIV risk (indicating possible increases in female self-efficacy in making HIV prevention decisions). Male intervention participants showed no substantial positive change in attitudes towards women’s rights. These results highlight an important positive effect of HIV prevention programmes on women’s attitudes towards their own rights.     

Educators’ experiences with governance in curriculum change processes; a qualitative study using rich pictures

Advances in Health Sciences Education - In the midst of continuous health professions curriculum reforms, critical questions arise about the extent to which conceptual ideas are actually put into...     

Young children’s emergent science competencies in everyday family contexts: a case study

To address the lack of research in early science learning and young children’s informal science experiences, this exploratory case study investigated a 7-year-old girl’s (Abigail) emergent science competencies and how they are related to her science experiences in everyday family contexts. Data sources included observations, interviews, parent journals, and the child’s digital journals that were collected over six months. Open-ended coding and constant comparison were used to analyse data. Findings revealed that Abigail’s emergent science competencies were naïve but playful and included a developing, but sophisticated, understanding of the nature of science; family learning included both spontaneous and purposeful learning that contributed to her naïve theories and islands of expertise; and her mother’s scaffolding played an important role in her emergent science competencies. The study suggests ways to connect formal science learning with informal science engagement to further young children’s science competencies.