APPLICATION OF FEMINIST THEORY IN NURSING RESEARCH: THE CASE OF WOMEN AND CARDIOVASCULAR DISEASE

Researchers have provided evidence that women recover from and live with heart disease in very distinct ways from men. The challenge for researchers has been to discuss women in a manner that allows their differences to emerge but does not depict them as inferior to men. Our goal is to review current cardiovascular research on women from a feminist theoretical perspective. We believe that a feminist perspective in cardiovascular research will advance the knowledge and recognition of women's health. We examined nine qualitative research articles in depth and applied a model of feminist research critique to them (Bunting, 1997). Historical androcentric notions in women's health and cardiovascular research are discussed. Also included are recommendations for future research to influence social change in women's cardiac health.     

Understanding gendered influences on women's reproductive health in Pakistan: Moving beyond the autonomy paradigm

Recent research and policy discourse commonly view the limited autonomy of women in developing countries as a key barrier to improvements in their reproductive health. Rarely, however, is the notion of women's autonomy interrogated for its conceptual adequacy or usefulness for understanding the determinants of women's reproductive health, effective policy formulation or program design. Using ethnographic data from 2001, including social mapping exercises, observation of daily life, interviews, case studies and focus group discussions, this paper draws attention to the incongruities between the concept of women's autonomy and the gendered social, cultural, economic and political realities of women's lives in rural Punjab, Pakistan. These inadequacies include: the concept's undue emphasis on women's independent, autonomous action; a lack of attention to men and masculinities; a disregard for the multi-sited constitution of gender relations and gender inequality; an erroneous assumption that uptake of reproductive health services is an indicator of autonomy; and a failure to explore the interplay of other axes of disadvantage such as caste, class or socio-economic position. This paper calls for alternative, more nuanced, theoretical approaches for conceptualizing gender inequalities in order to enhance our understanding of women's reproductive wellbeing in Pakistan. The extent to which our arguments may be relevant to the wider South Asian context, and women's lives in other parts of the world, is also discussed.     

Gender bias in health research: implications for women's health in Kerala (India) and Sri Lanka

Indian state of Kerala, and Sri Lanka have a special place in global health discourses, although there has been a relatively little systematic analysis of women's health in these societies. Moreover, there are a number of dimensions of women's health that have been underappreciated by public health researchers and development experts due to systematic gender biases in health research. This article seeks to provide a more complete picture of women's health in Kerala and Sri Lanka by explicitly addressing three key gender biases: inattention to health issues that particularly affect women, incomplete approaches to understanding the health of women and insufficient attention paid to the interactions between gender and other social stratification, such as class, ethnicity or caste.     

A FEMINIST CRITIQUE OF RESEARCH ON WOMEN'S WORK AND HEALTH

Research on women's work and health largely has failed to incorporate gender into the models of the processes through which work influences well-being. In this article, the research on women's work and health is critiqued from a feminist perspective; male-oriented and ethnocentric views on women's work are negated, and gender and socioeconomic issues are highlighted and included in the picture of women's work. Male-centered and ethnocentric views and assumptions on women's work are prevalent in the whole research process, and methodological limitations due to the distorted views are indicated. Based on the critique, some implications for future research on women's work and health are proposed.     

ILLUMINATING SOCIAL DETERMINANTS OF WOMEN'S HEALTH USING GROUNDED THEORY

Emphasis in health policy has shifted from curative intervention to prevention and health promotion through personal responsibility for lifestyle choices and, most recently, to the social determination of health. These shifts draw attention to and legitimize women's health research that moves beyond biomedical, epidemiological, and subjective knowledge to question previously unquestioned societal norms and structures that influence women's health. The challenge is to avoid relying solely on population-based studies that support relationships between social determinants and indicators of women's health and to find ways to illuminate the processes by which social determinants interact with the health of specific groups of women. Without such research, our knowledge of how social factors that underpin women's health interact will be faceless and will not address the interplay of health and social policy within women's lives. One research method that may be useful for exploring the interplay between such policies and women's health is grounded theory. Grounded theory is a widely used approach in women's health research. The goal of grounded theory is the discovery of dominant social and structural processes that account for most of the variation in behavior in a particular situation. Despite the usefulness of this method for capturing the interaction between social conditions and women's health experiences, many grounded theory researchers restrict themselves to women's subjective experiences as a source of data for theory development. Consequently, the resultant theory's capacity to illuminate the effects of the social determinants of health is limited. The purpose of this article is to discuss how the grounded theory method can be used in a participatory way to theoretically sample structural conditions at many levels. Using examples from completed and ongoing women's health research where data have and have not been collected primarily from women themselves, we outline the benefits and process for using grounded theory to influence health and public policy in women's health.     

THE IMPORTANCE OF SYMBOLIC INTERACTION IN GROUNDED THEORY RESEARCH ON WOMEN'S HEALTH

A variety of grounded theory studies are presented in this issue of Health Care for Women International that attend to different factors and situations impacting women's health. In this paper I will provide the basic principles of symbolic interactionism (SI) for the reader unfamiliar with the conceptual underpinnings of the grounded theory research method. I will discuss why SI is a fitting perspective for use in the study of women, women's perspectives, and women's health. I will conclude with a brief discussion of challenges to researchers maintaining the symbolic interaction perspective in grounded theory research.     

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.     

The postconventional body: Retheorising women's health

We propose that women's health—both theory and practice—is a powerful arena in which to re-align and change the modernist theoretical underpinnings of current biomedical paradigms, which limit our understanding both of concepts of health and illness and of the impact of health care technologies on the body. We highlight the necessity of a move to a more dynamic paradigm for health and illness in the clinic, as well as a theoretical fluidity that allows for the real messiness of lived bodies. We argue that postmodernist thought, within wider feminist theory, is one of many perspectives that can contribute to contemporary biomedicine by providing theoretical underpinnings to develop 1) an understanding of bodies in context, 2) an epistemology of ignorance, and 3) an openness to the risk of the unknown. While these all entail a commitment to self-reflection and a willingness to be unsettled, which may not seem practical in the context of medical practice, we argue that self-reflection and unsettledness will provide pathways for grappling with chronic conditions and global bodies. Overall, we suggest that women's health practice can serve as a site in which both sides of the humanistic/scientific divide can engage with a human self in all its corporeal variety, contingency, and instability. More specifically, by providing a space within the clinic to examine underlying ontological, epistemological, and ethical assumptions, women's health can continue to contribute to new forms of biomedical practice.     

Women's Health Bridges and Barriers: A Qualitative Study

The authors aimed to understand the social bridges and social barriers to women's health in Iran. We used a qualitative content analysis method and interviewed 22 women. The participants identified appropriate employment, physical exercise, and cultural and educational development as social bridges to women's health. Social barriers to women's health included gender inequalities, burden of responsibility, and financial difficulties. Based on the results of this study, we suggest an interdisciplinary approach to plan social-based health programs in order to improve women's health outcomes in the developing countries such as Iran.     

Frauen und Gesundheit Ein Einstieg in die Gesundheitsberichterstattung

In the FRG community health promotion and policy development rarely focus on women's health. Reports on women's health do not serve as an incentive for a specific policy action for women. Most often these data are irrelevant to the everyday reality of women. For this reason Hamburg has chosen a participatory approach by initiating meetings and workshops. Both, professional experts women acted as and founded an alliance to improve women's health during pregnancy and early motherhood. A widely supported declaration purports the quality of health care and social services, the accessibility of services and the deficits in the official support system. Priorities of public action are formulated and participation is encouraged. Problems, methods and preliminary results will be described.     

Mainstreaming gender into global health programming to improve women’s health

Abstract

In this paper, a case is made for mainstreaming gender into global women's health programming and policies. The potential implications of conflating "gender" with "women'" in the design and evaluation of women's health programming are first considered. HIV/AIDS case studies are then used to depict examples of (a) where gender has been well integrated and (b) where policies fall short of gender mainstreaming. Finally, practical approaches to mainstream gender in a meaningful way into the design and evaluation of women's health programming and policies are provided for practitioners and researchers.     

Health and human rights: epistemological status and perspectives of development

The health and human rights movement (HHR) shows obvious signs of maturation both internally and externally. Yet there are still many questions to be addressed. These issues include the movement’s epistemological status and its perspectives of development. This paper discusses critically the conditions of emergence of HHR, its identity, its dominant schools of thought, its epistemological postures and its methodological issues. Our analysis shows that: (a) the epistemological status of HHR is ambiguous; (b) its identity is uncertain in the absence of a validated definition: is it an action movement, an interdisciplinary field, a domain, an approach, a setting or a scientific discipline? (c) its main schools of thoughts are defined as “advocacists”, “ethicists”, “interventionists”, “normativists”; (d) the movement is in the maturation process as a discipline in which “interface”, “distance”, “interference” and “fusion” epistemological postures represent the fundamental steps; (e) parent disciplines (health sciences and law) competences, logics and cultures introduce duality and difficulties in knowledge production, validation and diffusion; (f) there is need to re-write the history of the HHR movement by inscribing it not only into the humanitarian or public health perspectives but also into the evolution of sciences and its social, political and economical conditions of emergence. The ambiguous epistemological status of this field, the need to re-write its history, the methodological duality in its research, the question of the competence of the knowledge validation, as well as the impact of HHR practice on national and international health governance are the challenges of its future development. To meet those challenges; we call for the creation and implementation of an international research agenda, the exploration of new research topics and the evaluation of the movement’s contribution to the national and global public health and human rights governance.     

Smoking in pregnancy: smokescreen or risk factor? Towards a materialist analysis

This paper considers the topic of women's smoking in pregnancy within the general context of the current health promotion concern about smoking as a public health issue. Drawing on data from an ongoing research project which is investigating the interrelationships between‘risk’, social support and reproductive health, the paper argues that smoking in pregnancy constitutes an area of women's behaviour which is linked in systematic ways with aspects of their material and social position. Consequently, conventional individualist models of smoking behaviour both fail to explain why pregnant women smoke and are unable adequately to account for the health consequences of this behaviour. The reason for singling out smoking in this analysis inheres not in any detrimental health effect directly attributable to it, but rather to the way in which pregnancy smoking has been socially constructed as a reprehensible feature of women's life-styles.     

Pakistan's health policy: Appropriateness and relevance to women's health needs

The interface between national health policy and women's health needs is complex in developing countries like Pakistan. This paper aims to assess if Pakistan's national health policy 2001 is relevant and appropriate to women's health needs.Through review of existing data on women, a profile of women's health needs was developed which was transformed into framework of analysis. This framework indicates that Pakistani women's health needs are determined by gender disparities in health and health-related sectors.Comparison of national health policy with women's health needs framework reveals that although policy focuses on women's health through prioritization of gender equity, it is however addressed as an isolated theme without acknowledging the vital role gender inequalities in health and health-related sectors play in defining women's health needs. Moreover, gender equity is translated as provision of reproductive health services to married mothers, ignoring various critical overarching issues of women's life such as sexual abuse, violence, induced abortion, etc. Health systems strengthening strategies are though suggested but these fails to recognize main obstacles of utilization of healthcare services by women including non-availability of female healthcare providers and gender-based obstacles to healthcare utilization such as illiteracy, lack of empowerment to make decisions related to health, etc.In order to be relevant and appropriate to women's health needs the policy should: (1) use gender equity in health and health-related sectors as an approach to develop a healthy policy (2) expand the focus from reproductive health to life cycle approach to address all issues around women's life (3) strengthen health systems through creation of gender equity among all cadres of health providers (4) tailoring health interventions to counter gender-based obstacles to utilization of healthcare services and (5) dissemination interventions for behavior change.     

PROMOTING WOMEN'S HEALTH-SEEKING BEHAVIOR: RESEARCH AND THE EMPOWERMENT OF WOMEN

Despite advances in medical knowledge, commentators agree that the greatest gains in health will come through behavioral change. Women must change their health-seeking behavior; worldwide, health advocates find that even though services may be provided for women, it does not guarantee that women use them. The purpose of this article is to help researchers, as women's advocates, understand why. Specifically, we present a tool that helps identify barriers to, as well as facilitators of, women's health seeking. Unlike conventional approaches that focus on psychological or personal facilitators of health seeking, we use a method that locates the individual within her sociocultural context. Such an approach helps us differentiate women's practical needs for health care from their strategic interest in gender equity; in doing so, we advance a distinctly feminist approach to women's health promotion.     

Nursing,therapy, and social control: Feminist science and systems‐based family therapy

This paper discusses the implications of the feminist critique of science for the treatment of women in the context of systems‐based family therapy (SFT). The issues raised are of special concern to nurses interested in women's health. As recent critiques of mainstream science have repeatedly demonstrated, there is no neutral, value‐free position from which to do science or to put science to work in clinical practice (Bleier, 1986; Keller, 1985; Cartwright, 1983; Habermas, 1971; Allen, 1985; Chinn, 1985; Ehrenreich, 1978). The theoretical position one adopts for research and practice carries important value implications. Nowhere is this more evident than in the field of women's health, which was born out of dissatisfaction with current medical science and the clinical practice it spawned (Ehrenreich & English, 1979; Boston Women's Health Collective, 1976). Consequently, for a practice area like women's health, consciousness of feminist critiques of science and systems therapy is a necessity.

The discussion is in three main sections: the first is a brief overview of the feminist critiques of science, the second focuses on how those critiques impact on systems‐based family therapy, and the third discusses implications for research and practice.     

BEING FEMALE: THE PORTRAYAL OF WOMEN'S HEALTH IN PRINT MEDIA

In this article, we examine the portrayal of women's health issues in two of Melbourne's print media: The Age and the Herald Sun . In particular, we aim to examine the patterns of coverage of women's health and the underlying message in articles on women's health issues. We employed an unobtrusive method, and the study was conducted over a three-month period: May to July 1998. We found that many of the articles and public reactions centred on women and reproduction. This implies that women are still seen in relation to their reproductive role in Australian society. In addition, there are many issues regarding women and their health missing from the media's publication during the research period. The message emerging from the analysis implies that if women do not fit into the "ideal women" framework of the society, their health needs are given little attention by the print media and, therefore, their health is likely to suffer. This can be interpreted as one form of women's oppression in Australian society.     

Communicating the Occupational Self: A Qualitative Study of Oldest-Old American Women

This paper reviews continuity theory as it applies to the field of ageing and reports the findings of a qualitative study aimed at understanding the personal meanings of ageing and well-being from the perspective of oldest-old women. Transcribed ethnographic interviews of 23 Caucasian and African-American community-dwelling women over the age of 85, who live in the midwestern United States, were analysed through the combined theoretical perspective of symbolic interactionism [1] and continuity theory [2, 3]. The women's communication about ageing and well-being leads the researchers to conclude that personal competence in the "feminine sphere" is key to understanding older women's health beliefs and behaviours in late life. Findings also point to the importance of occupational competence as a predictor of well-being in late life. This study underscores the importance of public communication of self and the role of occupational therapists in facilitating alternative visions of a meaningful occupational self.     

PRECARIOUS ORDERING: TOWARD A FORMAL THEORY OF WOMEN'S CARING

Given the current societal and political trends toward increasing demands on women to provide care, a conceptualization of caring that captures the common processes of diverse women's caring experiences, and makes the consequences of caring for women's health visible, is critical for the development of a health and social policy that is responsive to women. The findings of this feminist grounded theory study go beyond the current theoretical understandings of women's caring, framed as either burden or fulfilment. The complex strategies women use to manage the dissonance created by competing and changing caring demands are revealed as a process I have named precarious ordering. This middle range theory demonstrates the power and resilience in women's management through the interdependent processes of setting boundaries, negotiating, and repatterning care. In addition, the method of theoretical sampling used in this study is explicated to move toward a formal theory applicable to diverse women's caring in a wide range of health, illness, and developmental situations.