Empowerment in the process of health messaging for rural low-income mothers: an exploratory message design project

Breastfeeding trends, influences, and perceptions among Italian women: a qualitative study

Purpose: Breastfeeding behaviours are routinely assessed in worldwide capacities, and the World Health Organization (WHO) European Region has the lowest rates of exclusive breastfeeding. Rates in Italy are not well documented but suggest breastfeeding rates are rising since the early 2000s. Professional recommendations suggest exclusive breastfeeding should persist until the infant is at least six to twelve months of age. However, barriers to adhering to this recommendation exist, often resulting in a lack of initiation or premature cessation of breastfeeding behaviours. This study explored women's perceptions, attitudes, and experiences with breastfeeding living in Florence, Italy. Methods: Participants were 44 reproductive-aged (M = 31.7 ± 6.14; Range = 19 to 45 years) women currently utilizing the Italian healthcare system. All participants completed an in-depth, individual interview between June and August 2017 on topics related to reproductive health, including breastfeeding. Results: Resulting themes relate to breastfeeding trends and influences, the role of identity and empowered choice, as well as perspectives on public breastfeeding. Conclusions: Findings provide practical recommendations for future exploration and social marketing campaign application related to breastfeeding decision-making empowerment. Results can also be used for between-country comparison of breastfeeding behaviours and attitudes.

Moving Oral Contraceptives over the Counter: Theory-based Formative Research to Design Communication Strategy

The American College of Obstetricians and Gynecologists (ACOG) recommends that oral contraceptives (OC) should be available over the counter (OTC). This study explored women's attitudes toward OC OTC in rural South Carolina. In-depth, individual interviews were conducted with 52 women ages 18-44 years old. Data analysis was informed by a reproductive justice theoretical framework and included an inductive, constant-comparative approach using HyperRESEARCH 3.7.5. Participants self-identified as either Black (62%) or White (28%). Participants believed that OC OTC would prevent unintended pregnancy by improving anonymity, convenience, and access to contraception. Many participants faced barriers to receiving a prescription, including time, transportation, cost, stigma, embarrassment, and clinician refusal based on religious reasons. Participants believed OC OTC would improve women's control over their fertility and emphasized the importance of health insurance coverage for OC OTC. Some participants expressed concerns about the risk of side effects, contraindications, and the potential for abuse. Some participants believed women, especially adolescents, required physician guidance and an annual exam to use OC. Findings suggest that a lack of knowledge and misinformation about the risks of OC serve as a barrier among some women in rural areas. Widespread acceptance of OC OTC will require messaging strategies to dispel safety concerns about OC OTC and empower women.

Shaping Core Health Messages: Rural, Low-Income Mothers Speak Through Participatory Action Research

Rural, low-income families are disproportionately impacted by health problems owing to structural barriers (e.g., transportation, health insurance coverage) and personal barriers (e.g., health literacy). This paper presents a Participatory Action Research (PAR) model of co-created Core Health Messages (CHMs) in the areas of dental health, food security, health insurance, and physical activity. The research project engaged a multi-disciplinary team of experts to design initial health messages; rural, low-income mothers to respond to, and co-create, health messages; and stakeholders who work with families to share their insights. Findings reveal the perceptions of mothers and community stakeholders regarding messages and channels of message dissemination. By using PAR, a learner engagement approach, the researchers intend to increase the likelihood that the CHMs are culturally appropriate and relevant to specific populations. The CHM-PAR model visually illustrates an interactive, iterative process of health message generation and testing. The paper concludes with implications for future research and outreach in a technological landscape where dissemination channels are dynamic. This paper provides a model for researchers and health educators to co-create messages in a desired format (e.g., length, voice, level of empathy, tone) preferred by their audiences and to examine dissemination methods that will best reach those audiences.

Piloting Health Text Messages for Rural Low-Income Mothers

Approximately 85% of people living in rural settings own a cell phone, and of those, 76% send or receive text messages. Thus, text messaging may be an effective way to reach rural low-income mothers with important information and resources that will improve their health and well-being. This exploratory study examined the utility of using text messaging for disseminating health information to rural low-income mothers. Researchers tested messages that were personalized and sent from a source similar to participants, a mom named Ms. Peg. Ms. Peg sent text messages about physical activity, oral health, nutrition, and health insurance—facts and tips that addressed barriers and lifestyles in rural low-income contexts—over a 4-week period. Participants completed a prequestionnaire assessing healthy behaviors, text message use and preference, and demographic information. Participants then received two text messages for 4 weeks. Findings indicated that participants were satisfied receiving information through text messages, with half finding it “easy” and “convenient.” The majority reported being highly motivated by the messages, and for 41% the messages were associated with self-efficacy and intention to act. Close to half of the participants found the use of personalization effective and perceived the messages as “relatable.”