Homeless women and children's access to health care: a paradox

Homeless women and children who reside in shelters experience many health-related problems. The aim of the qualitative study reported here was to (a) explore how shelter staffs manage health problems among their residents and assist them in accessing health services, and (b) identify clinical strategies for community health nurses working with this population. Findings demonstrate a paradox whereby homeless shelter staffs try to gain access to care for their residents through a system that is designed to keep them out. In addition, findings indicate a need for increased community health nursing services in homeless shelters. Strategies for resolving this paradox include providing assessment, policy development, and assurance of health care for homeless women and children.     

Managing Health Problems among Homeless Women with Children in a Transitional Shelter

Purpose: To describe health problems among homeless women with children living in a transitional shelter, analyze how they managed various ailments and when and how they sought care.
Design: Qualitative using grounded theory and dimensional analysis.
Sample: During 1992 and 1993, data were gathered from a convenience sample of 13 Latina, 11 White, and 6 African American women (n=30) who lived in a transitional shelter in California, USA.
Methods: In-depth, semi-structured interviews
Findings: Despite many supportive services in transitional shelter, respondents had difficulty managing health problems. Typically, a woman reported she managed a health problem by overcoming it alone.
Conclusions: The pattern of overcoming it alone existed years before transitional shelter life, and, in many instances, persisted during shelter years.
Clinical Implications: Clinical nursing interventions that address shame, fear, lack of information, and eligibility for services could improve health outcomes among women and children living in transitional shelters.     

Quality of healthcare services provided in disaster shelters: An integrative literature review

BackgroundGlobally, shelters are a resource to promote critical health and safety in disasters, particularly for vulnerable populations (e.g., children, elderly, chronically ill). This study examines the nature and quality of healthcare services rendered in disaster and emergency shelters.ObjectivesTo determine based upon systematic and accurate measurement the scope and quality of health care services rendered in disaster shelters and to describe the health outcomes experienced by shelter residents.MethodsAn integrative review of English-language literature pertaining to the assessment, evaluation, and systematic measurement of healthcare quality and client outcomes in disaster and emergency shelters was undertaken. Articles were identified using a structured search strategy of six databases and indexing services (PubMed, CINAHL, EMBase, Scopus, Web of Science, and Google Scholar).ResultsLimited literature exists pertaining specifically to metrics for quality of health care in acute disaster and emergency shelters, and the literature that does exist is predominately U.S. based. Analysis of the existing evidence suggests that nurse staffing levels and staff preparedness, access to medications/medication management, infection control, referrals, communication, and mental health may be important concepts related to quality of disaster health care services.ConclusionsA small number of population-based and smaller, ad hoc outcomes-based evaluation efforts exist; however the existing literature regarding systematic outcomes-based quality assessment of disaster sheltering healthcare services is notably sparse.     

Homeless children: the lives of a group of Brazilian street children

Homeless children: the lives of a group of Brazilian street children Aim. To evaluate the life trajectories of a group of school‐age street children frequenting two São Paulo city public shelters. Background. A large proportion of the Brazilian child population suffers extreme disadvantage, although the Brazilian government gave the issue ‘absolute priority’ in 1990. Maternal and Under 5 mortality rates remain unacceptably high. In the metropolitan region of São Paulo an estimated 200 000 minors do not live with their mothers. Brazilian street children live lives of extreme personal and social risk. Study method. The data were collected through individual, semi‐structured interviews, with 14 school age (7–12 years) participants frequenting two city public refuges, with their legal guardians’ consent. Data analysis was based on Social Representation Theory and used content analysis. Findings. The children’s most meaningful experiences were grouped into the thematic categories of family, the street, friends, drugs, the police, the shelters and the future. Synthesis of these categories showed the lives of these children to be permeated by violence, resulting in experiences restricting their full development. Conclusion. The solution to their problems depends on pressure being put on the State by the civilian community in order to establish social and health policies that conform to the Child and Adolescent Statute (ECA). We consider that assisting street children involves attitudes that go beyond professional performance and demands acts of citizenship. Recommendations. The development of an ethical‐political attitude by professionals to the problems of homeless street children is essential, and educational curricula should be appropriately constituted. Political projects to develop health and welfare policies and education should be directed to these children and their relatives, and include participation by health professionals to provide the necessary preventive and curative services.     

广西壮族自治区确诊HIV感染的孕产妇母婴阻断服务利用情况分析

目的了解广西壮族自治区（广西）预防艾滋病母婴传播综合干预措施服务利用情况。方法收集信息管理系统中广西分娩日期为2017年7月1日至2018年6月30日感染人类免疫缺陷病毒（HIV）的产妇及所生婴儿的干预服务利用情况信息，将HIV感染的孕产妇分为孕前确诊组和孕后确诊组，使用SPSS 22.0软件比较两组孕产妇及所娩儿童预防母婴传播服务利用与差异情况。结果共纳入HIV感染孕产妇595例，HIV暴露儿童598例。 其中孕前确诊组孕产妇454例，HIV暴露儿童456例；孕后确诊组孕产妇141例，HIV暴露儿童142例。 HIV感染孕产妇的年龄为（30.8±5.4）岁；孕前确诊组和孕后确诊组孕产妇在年龄、文化程度、婚姻状况、孕次及产次等人口学特征构成比差异有统计学意义；民族和职业构成比差异无统计学意义。 两组对于预防母婴传播干预服务利用均存在不足，但孕前确诊组的孕产期保健、抗病毒治疗、婴儿HIV检测等服务利用均优于孕后确诊组。结论广西HIV感染孕产妇对于预防艾滋病母婴传播综合干预措施利用不足，孕期保健服务利用晚、抗病毒治疗利用不足是工作的薄弱环节；加强宣教，提高预防母婴传播知识的知晓率，进而提高综合干预措施服务利用率，是实现消除母婴传播目标的关键措施。     

Children of battered women: worries about their mothers

Children of battered women report a variety of worries about their mothers. In a study of 50 children (ages 10-17 years) from 5 battered women's shelters, children revealed worries about potential hazards and actual health hazards regarding their mothers. Nursing attention to worries provides information about the emotional lives of these children and helps them deal with expressed concerns.     

Exploring telehealth opportunities in domestic violence shelters

PURPOSE: To determine the degree of interest in using a computer for the purpose of accessing services from a nurse practitioner (NP) at domestic violence shelters (DVSs); and to identify issues of privacy and confidentiality that might arise from participation by victims of intimate partner violence (IPV) in a Telehealth intervention. DATA SOURCES: Focus groups with 19 women residing in two DVSs. Interviews were recorded, transcribed and themes were identified that answered the questions posed in the interviews. CONCLUSIONS: Most of the women understood the term NP and were favorably inclined to seek services from one. Over half of the women were not familiar with computer use, but were willing to learn in order to receive health care services, both for episodic needs and for maintenance of chronic conditions. After learning of the method proposed to allow them to access an NP through the internet while still protecting their privacy and confidentiality, the women felt comfortable with this approach to meeting their health care needs. IMPLICATIONS FOR PRACTICE: Results from this study can be used to support the development and testing of Telehealth interventions for these victims of IPV.     

Health‐promoting lifestyle behaviours in pregnant women in Turkey

This study aims to describe the health‐promoting lifestyle behaviours of pregnant women. The study was carried out with pregnant women who applied to the polyclinics in different maternity and children hospitals located in Adana, Turkey, between 1 March and 30 May 2009. The data collection tools used in the study were (i) a questionnaire that was used to collect sociodemographic data from the participants and (ii) the Health Promoting Lifestyle Profile II (HPLP II). The results obtained from the study showed that total HPLP II scores were moderate; the highest scores were obtained on the spiritual growth dimension and the lowest scores on the physical activity dimension. Pregnant women with older age, those with a higher educational level, those with a better socioeconomic status and those living in a nuclear family were found to be more likely to have health‐promoting lifestyles. Health promotion and healthy lifestyle need to be an integral part of health services provided for pregnant women. Midwives and nurses have prominent roles in encouraging pregnant women to engage in health‐promoting behaviours.     

孕产妇围产期服务需求量表的研制

目的 研制孕产妇围产期服务需求量表.方法 2007年11-12月对北京某妇产医院住院分娩后3～5 d即将出院的产妇进行访谈,根据访谈录音内容及书面记录结果整理形成孕产妇围产期服务需求量表.结果 孕产妇围产期服务需求量表包含60个条目,按内容归纳为4个维度,生理需求9项、心理需求8项、环境和设备需求15项、医院服务需求28项.量表的内容效度为0.877,内部一致性系数0.984.结论 孕产妇围产期服务需求量表具有较好的信效度,从孕产妇生理需求、心理需求、环境和设备需求及服务需求四个方面反映孕产妇在围产期的需求状况,可用于临床工作中评估孕产妇在围产期的需求,根据孕妇的意愿制定切实可行的服务计划,使围产期保健工作更加深入地开展.     

SCHIP: State Children's Health Insurance Program

After the flurry of legislative activity in the late 1980's to expand Medicaid for pregnant women and children, the move from federalism to states' rights led to incremental health care program expansion. Despite the increased coverage in current programs, the number of uninsured women and children has increased since 1990. During 1997, 13.7 percent of all pregnant women (about 465,000) were uninsured (March of Dimes, 1999) as were 11.3 million children under the age of 18 (Children's Defense Fund, 1998).     

孕产妇围产期服务需求的调查分析

目的了解孕产妇围产期的服务需求。方法在2008年6—8月便利抽取全国7个省,2个直辖市中29家医院2436名孕妇,在产后3—5d即将出院时填写一般资料及自行设计的孕产妇围产期服务需求量表。结果孕产妇围产期服务需求反映在生理需求、心理需求、环境和设备需求及服务需求4个纬度,多数需求条目得分大于3分,处于需要至极需要之间。结论产科护理人员应从孕产妇生理、心理、环境和设备及服务需求4个方面了解孕产妇围产期的需求状况．以便根据孕妇的意愿制订切实可行的服务计划,使围产期保健工作更加深入地开展。     

2011－2020年广东省HIV感染孕产妇不良妊娠结局情况及其影响因素分析

  目的   描述广东省人类免疫缺陷病毒（HIV）感染孕产妇不良妊娠结局的情况,分析导致不良妊娠结局的影响因素,促进艾滋病感染孕产妇及暴露儿童的健康。  方法   对广东省2011—2020年所有区/县确认的3 438例HIV感染孕产妇的相关信息进行χ2检验和非条件logistic回归分析。  结果   共3 438例HIV感染孕妇纳入研究, 955例孕妇发生不良妊娠结局,不良妊娠结局发生率为27.78%。 不同的文化程度、初检时期、传播途径、产次和确认感染时期和妊娠高血压会影响HIV感染孕产妇不良妊娠结局的发生,差异有统计学意义（P<0.05）。 多因素logistic回归分析显示,注射毒品感染、产时或产后确认感染和患有妊娠高血压的HIV感染孕产妇发生不良妊娠结局的OR值分别是1.65（1.04～2.58）、0.61（0.48～0.78）和2.27（1.35～3.80）。  结论   传播途径、确认感染时期及妊娠高血压和HIV感染孕产妇发生不良妊娠结局有关。 需要高度重视HIV感染孕妇的生殖健康,提供优质的咨询服务和孕期保健服务,保障HIV感染孕产妇的健康,改善妊娠结局。     

A public health nursing initiative to promote antenatal health

At least one in 10 pregnant women experiences depression. Other health risks during pregnancy include family violence, substance abuse, inadequate nutrition, financial challenges, environmental hazards and lack of social support. Public health nurses are in a unique position to enhance perinatal health by assessing for antenatal psychosocial risk factors. During 2005-06 in a suburban/rural community near Edmonton, Alberta, public health nurses initiated a one-year demonstration project with the goal of increasing the number of health and community services accessed by pregnant women as a result of an interactive appointment with a public health nurse. Eight family physicians in WestView Primary Care Network and three midwives from WestView's Shared Care Maternity Program referred local pregnant clients to the public health nursing unit at WestView Health Centre in Stony Plain. Each woman was assessed by a public health nurse for a variety of psychosocial risk factors. Results of the assessment determined the type of additional health services to which the pregnant women were referred. Care providers were unanimous in their support for public health nurses' continuing to provide antenatal assessments to an expanded population of suburban/rural communities in the Capital Health region.     

Maternal and child health services for medically indigent children and pregnant women

Millions of low-income children and women of childbearing age are completely uninsured. Medicaid, the nation's largest public health financing program for the poor, is an inadequate resource for uninsured families with children. By 1984, the program served only 46% of the poor and near-poor, down from 65% in 1976. To assess the availability of maternity and pediatric services for low income uninsured women and children, a survey of 51 Title V Maternal and Child Health agency officials was conducted in 1986. While nearly all states (48) offer some prenatal care programs for indigent women, restrictive eligibility requirements and limited distribution meant that these programs reached only a small proportion of those in need. Only one state, Massachusetts, offered a truly statewide program to all uninsured pregnant women with incomes under 185% of the poverty level. Twenty-three states reported the existence of inpatient maternity programs for indigent women. Yet these, too, were extremely limited. Sixteen programs restricted funds either to women who participated in certain designated maternity programs or else only to those who were identified as high risk prior to the labor and delivery period. Fifteen state agencies reported that hospitals were denying admission to women about to deliver. Another 13 reported that hospitals were denying admission to women not yet in "active" labor. Six additional states were aware of patient dumping but did not identify the specific populations that were affected. Forty-six states reported the existence of pediatric outpatient programs. However, the majority (30) offered only "well-child" care. Seven states maintained pediatric programs limited to only certain ages of children; three of these imposed an age requirement as low as 2 years or younger. Only two states reported the availability of any pediatric inpatient programs financed or administered by Title V agencies other than those for children with special health care needs.     

Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A multi-centre randomised controlled trial

BackgroundOral health care during pregnancy is important for the health of the mother and child. However, pregnant women have limited knowledge about maternal oral health and seldom seek dental care. Further, due to limited training antenatal care providers like midwives rarely discuss oral health with pregnant women. The Midwifery-Initiated Oral Health Dental Service program was developed to address current gaps in oral promotional interventions during pregnancy.ObjectivesTo assess the effectiveness of a Midwifery-Initiated Oral Health Dental Service program in improving uptake of dental services, oral health knowledge, quality of oral health, oral health status and birth outcomes of pregnant women.DesignMulti-centre randomised controlled trial.SettingThree large metropolitan public hospitals in Sydney, Australia.ParticipantsPregnant women attending their first antenatal appointment who were at least 18 years old and had a single low risk pregnancy between 12 and 20 weeks gestation.Methods638 pregnant women were allocated to three groups using block randomisation (n = 211) control group, intervention group 1 (n = 215), intervention group 2 (n = 212) and followed up till birth. Study investigators and data collectors were blinded to group allocation. Intervention group 1 received a midwifery intervention from trained midwives involving oral health education, screening and referrals to existing dental pathways. Intervention group 2 received the midwifery intervention and a dental intervention involving assessment/treatment from cost free local dental services. The control group received oral health information at recruitment. Primary outcome was uptake of dental services. Secondary outcomes included oral health knowledge, quality of oral health, oral health status and birth outcomes.ResultsSubstantial improvements in the use of dental services (20.2% Control Group; 28.3% Intervention group 1; 87.2% Intervention group 2; Odds Ratio Intervention group 2 vs Control Group = 29.72, 95% CI 15.02–58.53, p < 0.001), women’s oral health knowledge (p = 0.03); quality of oral health (p < 0.001) and oral health outcomes (sulcus bleeding, dental plaque, clinical attachment loss, decayed/filled teeth- p < 0.001) were found in Intervention group 2. No difference in the rate of preterm or low-birth weight was found.ConclusionsThe Midwifery-Initiated Oral Health Dental Service program (Intervention group 2) improved the uptake of dental services and oral health of pregnant women and is recommended during antenatal care. A cause and effect relationship between this intervention and improved birth outcomes was not supported.     

Decision making in childbirth: the influence of traditional structures in a Ghanaian village

BACKGROUND: The regional health administration of the Brong-Ahafo Region in Ghana identified that although informed about the advantages of both aspects of care, pregnant women made use of antenatal services but not of the supervised delivery. Quantitative studies have identified economic factors that influence the decisions of pregnant women. AIM: To describe and understand the traditional structures of childbirth in Kwame Danso/Ghana and to explore why the pregnant women do not make use of supervised deliveries in the modern institutions. METHODS: A mini-ethnographic study, using participant observation and ethnographic interviews. FINDINGS: Cultural and social factors have a significant influence on the decisions related to childbirth. One of the most important factors identified was that the responsible persons for decisions related to a delivery were the older female relatives, rather than the mothers themselves. Older females used rational judgements to weigh up the possibilities of risks, interests and advantages related to their cultural, spiritual and social system. Other factors were staff behaviour that was characterized as unfriendly and lacking for respect as to the living conditions and thinking of the pregnant women in the village. CONCLUSIONS: Ethnographic research provided an understanding of traditional structures that have an influence on the decisions and behaviour of the community related to childbirth. Appreciation of these structures enabled health promotion and structured health services to be delivered in a more culturally appropriate way.     

Behaviour of pregnant women towards the use of prenatal care services: A comparative study between China and the Democratic Republic of Congo

The present study aims to highlight and describe the elements of difference and/or similarity between China (Changchun) and the Democratic Republic of Congo (Kinshasa) concerning the behaviour of pregnant women in the use of prenatal care services. A cross‐sectional investigation with a self‐designed survey was carried out from September 2011 to March 2012 among pregnant women attending antenatal visits in Changchun and Kinshasa. Sixty pregnant women of childbearing age, with an uncomplicated pregnancy, attending prenatal visits in two hospitals and two community care centres were eligible for the study. Data were analysed using SPSS 13.0 software. Kinshasa 86.6% vs. Changchun 26.6% of pregnant women attended prenatal health education. In Changchun none of the responders (0%) have received tetanus vaccine, whereas in Kinshasa 90% were vaccinated against tetanus. Kinshasa 73.3% vs. Changchun 23.3% of pregnant women confirmed that they have performed the HIV test. The elements of difference found in our results were statistically significant P < 0.05. Prenatal health education can help pregnant women to have an appropriate awareness and improve their behaviour in the use of prenatal care services.     

Barriers to accessing safe motherhood and reproductive health services: the situation of women with disabilities in Lusaka, Zambia

Purpose: To ascertain how well health services in Lusaka, Zambia currently meet the safe motherhood and reproductive health care needs of women who have physical impairment leading to disability.

Methods: A qualitative study was conducted in Lusaka, Zambia. In-depth tape-recorded interviews were conducted with 24 purposively selected women with disabilities and with 25 safe motherhood/reproductive public sector health service providers. Qualitative analysis was conducted using NVivo software.

Results: Women with disabilities encounter various social, attitudinal and physical barriers to accessing safe motherhood and reproductive health (RH) services in this particular setting. The strong desire for children and affection can increase vulnerability to sexual exploitation. At the same time, a generalized assumption among reproductive health service providers that women with disabilities will not be sexually active, and not require RH services, leads to increased vulnerability to sexually transmitted infection including HIV. Once pregnant, traditional beliefs about transmission of disabilities can create barriers to integration in ante-natal clinics. Nurse-midwives' fear of delivery complications in women with physical impairments can also result in routine over-referral to a tertiary maternity facility which is outside the locality and harder for women with mobility limitations to get to.

Conclusion: Greater understanding of the influences underpinning societal attitudes towards sexuality and disability in this setting, and more extensive communication between health care staff and women with disabilities would facilitate positive action towards improving safe motherhood and reproductive health services for women with disabilities.