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Kathono J, Nyongesa V, Mwaniga S, Obonyo G, Yator O, Wambugu M, Banerjee J, Breuer E, Duffy M, Lai J, Levy M, Njuguna S, Kumar M. Adolescent perspectives on peripartum mental health prevention and promotion from Kenya: Findings from a design thinking approach. PLoS One 2024; 19:e0290868. [PMID: 38165879 PMCID: PMC10760697 DOI: 10.1371/journal.pone.0290868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/17/2023] [Indexed: 01/04/2024] Open
Abstract
In Kenya, approximately one in five girls aged 15-19 years old are pregnant or already a mother. Adolescent girls and young women experience significant mental health vulnerabilities during the pregnancy and postpartum periods, leading to poor antenatal and postnatal care attendance and inferior infant and maternal health outcomes. Pregnant adolescents often experience stigma and disenfranchisement due to their pregnancy status and at the same time lack access to mental health support within health settings, schools, religious institutions, and communities. This paper presents the results of qualitative interviews embedded within the human-centered design (HCD) process used to adapt the Helping Adolescents Thrive (HAT) program for Kenyan peripartum adolescents including young fathers. This qualitative study used two phases. First, a HAT advisory group participated in a series of four workshops to help identify and articulate mental health promotion needs and deepened the team's understanding of youth-centered thinking. Second, qualitative interviews were conducted with 39 pregnant and parenting adolescents to understand their perspectives on mental health prevention and promotion. Pregnant and parenting adolescents articulated different needs including poor support, stigma, and psychological disturbances. Parenting adolescents reported disturbed relationships, managing motherhood, poor health, and social empowerment. Participants highlighted sources of stress including economic challenges, fear of delivery, strained relationships, rejection, and stigma. Participants described psychological disturbances such as feeling stressed, worthless, withdrawn, and suicidal. Coping mechanisms reported by participants included engaging in domestic activities, hobbies, and social networking. Peers, family and spirituality were identified as important sources of support, as well as school integration, livelihoods, support groups and mentorships. Findings from this study can be used to strengthen and adapt HAT program, policy and practice for mental health prevention and promotion for pregnant and parenting adolescents.
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Affiliation(s)
| | | | | | | | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | | | - Erica Breuer
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Malia Duffy
- St Ambrose University, Davenport, Iowa, United States of America
- Health Across Humanity, LLC, Boston, Massachusetts, United States of America
| | - Joanna Lai
- UNICEF Headquarters, New York, NY, United States of America
| | - Marcy Levy
- UNICEF Headquarters, New York, NY, United States of America
| | - Simon Njuguna
- Division of Mental Health, Ministry of Health, Nairobi, Kenya
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, United States of America
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Erzse A, Desmond C, Hofman K, Barker M, Christofides NJ. Qualitative exploration of the constraints on mothers' and pregnant women's ability to turn available services into nutrition benefits in a low-resource urban setting, South Africa. BMJ Open 2023; 13:e073716. [PMID: 37993159 PMCID: PMC10668265 DOI: 10.1136/bmjopen-2023-073716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVES Despite free primary healthcare services and social protection system for mothers and children, significant nutrition inequalities occur across the globe, including in South Africa. This study aimed to explore what determines mothers' ability to access and turn available services into nutrition benefits. DESIGN An exploratory qualitative study was conducted including semistructured interviews with employees from community-based organisations and focus groups with pregnant women and mothers. Discussions focused on existing services perceived as important to nutrition, differences in mothers' ability to benefit from these services, and the underlying unmet needs contributing to these disparities. Data were analysed thematically using a novel social needs framework developed for this study where social needs are defined as the requisites that can magnify (if unmet) or reduce (if met) variation in the degree to which individuals can benefit from existing services. SETTING A resource-constrained urban township, Soweto in Johannesburg. PARTICIPANTS Thirty mothers of infants (<1 year old) and 21 pregnant women attending 5 primary healthcare facilities participated in 7 focus groups, and 18 interviews were conducted with employees from 10 community-based organisations. RESULTS Mothers identified social needs related to financial planning, personal income stability, appropriate and affordable housing, access to government services, social support and affordable healthier foods. The degree to which these needs were met determined mothers' capabilities to benefit from eight services. These were clinic-based services including nutrition advice and social work support, social grants, food aid, community savings groups, poverty alleviation projects, skills training workshops, formal employment opportunities and crèches/school feeding schemes. CONCLUSION Findings demonstrate that while current social protection mechanisms and free health services are necessary, they are not sufficient to address nutrition inequalities. Women's social needs must also be met to ensure that services are accessed and used to improve the nutrition of all mothers and their children.
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Affiliation(s)
- Agnes Erzse
- SAMRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Chris Desmond
- SAMRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Nicola Joan Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Riyanti, Salim LA, Heriteluna M, Legawati. Development of pregnancy class with husband's assistance on the outcome of teenage pregnancy. J Public Health Res 2023; 12:22799036231197195. [PMID: 37746517 PMCID: PMC10515537 DOI: 10.1177/22799036231197195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/30/2023] [Indexed: 09/26/2023] Open
Abstract
Background Teenage pregnancy is an international phenomenon without a definite solution to date. Globally, an estimated 16 million girls aged 15-19 give birth each year. Husbands need to play their assistance role in order to thwart the negative impact of the outcome of teenage pregnancy. Research objective To identify the effect of the development of Pregnancy Classes with the Husband's Assistance on the Outcome of Teenage Pregnancy in the Dayak community, Central Kalimantan. Research methods This was a quasi-experimental study with the posttest-only non-equivalent control group design involving the husband's assistance in pregnancy classes. The respondents were 60 individuals where 30 of them were given the pregnancy class assistance intervention while the other 30 were not given any intervention (control group). Results and discussion Pregnancy class with Assistance by the husband increases positive pregnancy outcomes 2.4 times compared to without the husband's assistance. Family support increases positive pregnancy outcomes 2.5 times compared to pregnant women without support from the family. Pregnant women that are highly motivated regarding antenatal care are likely to have positive pregnancy outcomes 5.4 times greater than pregnant women with low motivation. Based on the analysis, then the variables that have no effect are the history of antenatal care, frequency of antenatal care, and support from health workers. Conclusions Pregnancy class with husband's assistance affects positive outcomes of teenage pregnancy. Other factors with meaningful influence on pregnancy outcomes include family support and motivation to seek teenage antenatal care. Furthermore, other factors that have no influence include the teenager's age, history of antenatal care, frequency of antenatal care, and support from health workers. An intervention is needed that involves the husband/partner in the form of active assistance.
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Affiliation(s)
- Riyanti
- Faculty of Public Health, UNAIR, Surabaya, Jawa Timur, Indonesia
| | - Lutfi Agus Salim
- Department of Epidemiology, Population Biostatistics and Health Promotion, Faculty of Public Health, UNAIR, Surabaya, Jawa Timur, Indonesia
| | - Marselinus Heriteluna
- Diploma IV Program of Nursing, Politeknik Kesehatan Kemenkes Palangka Raya, Palangka Raya, Kalimantan Tengah, Indonesia
| | - Legawati
- Diploma III Program of Midwifery, Politeknik Kesehatan Kemenkes Palangka Raya, Palangka Raya, Center of Kalimantan, Indonesia
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Maffei B, Menezes M, Krenkel S, Crepaldi MA. REDES SOCIAIS SIGNIFICATIVAS DE GESTANTES DE ALTO RISCO: UM ESTUDO QUALITATIVO. PSICOLOGIA EM ESTUDO 2022. [DOI: 10.4025/psicolestud.v27i0.48904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As redes sociais significativas constituem importantes recursos de enfrentamento diante de períodos de transição, em que são exigidas adaptações frente a situações difíceis, como no caso de uma gestação de alto risco. Este estudo objetivou compreender a dinâmica relacional das redes sociais significativas de gestantes de alto risco. Trata-se de uma pesquisa qualitativa, da qual participaram 13 mulheres que estavam sendo acompanhadas em um ambulatório de pré-natal de alto risco, localizado na região Sul do Brasil. A coleta dos dados ocorreu por meio de um roteiro de entrevista semiestruturada e da construção de mapas de rede. Os dados foram submetidos à análise de conteúdo proposta por Bardin e organizados com auxílio do software Atlas.ti 7.0. Os resultados mostraram que houve predomínio de redes grandes, com maior concentração de membros da família, em especial do companheiro e da mãe. Destaca-se o apoio emocional como principal função desempenhada pelos integrantes da rede, a centralidade do médico nos cuidados de alto risco e a importância do apoio prestado às gestantes, na prática de hábitos saudáveis e no autocuidado.
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Santos MLC, Reis JF, Silva RDP, Santos DF, Leite FMC. Sintomas de depressão pós-parto e sua associação com as características socieconômicas e de apoio social. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo verificar a prevalência de sintomas de depressão pós-parto em puérperas atendidas em uma maternidade pública e sua associação com características socioeconômicas e de apoio social. Método estudo epidemiológico, analítico, do tipo transversal, em uma maternidade pública conduzido de agosto a outubro de 2017. A amostra de 330 puérperas foi entrevistada por meio da aplicação de um formulário, para mensuração da presença de sintomas de depressão pós-parto. Foi utilizada a escala de depressão pós-natal de Edimburgo. Já para mensuração do apoio social, foi utilizado o instrumento Medical Outcomes Study. A medida de associação adotada foi a razão de prevalência (RP) com intervalos de confiança de 95% (IC95%), e aplicada a regressão de Poisson ajustada. Resultados a prevalência de sintomas de DPP foi de 29,7%. A idade entre 14 e 24 anos (PR:1,60; 95%CI: 1,10–2,34), ter até 8 anos de escolaridade (RP:1,39; IC95%:1,01–2,14) e o baixo nível de suporte social afetivo (RP:1,52; IC95%:1,07–2,14) e emocional (RP:2,12; IC95%:1,41-3,19) estiveram associados à maior prevalência de sintomas de DPP. Conclusão e implicações para a prática nesse contexto, os profissionais de saúde podem possuir um papel essencial no qual podem desenvolver, em conjunto, um plano de cuidados de acordo com as necessidades da mulher em período gravídico-puerperal.
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Coleman JN, Milford C, Mosery N, Choi KW, Greener LR, Matthews LT, Harrison A, Bangsberg DR, Safren SA, Smit JA, Psaros C. "I did not plan … that is what hurts": Pregnancy intentions and contraceptive use among pregnant young women in KwaZulu-Natal, South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2021; 20:149-157. [PMID: 34003077 PMCID: PMC9996636 DOI: 10.2989/16085906.2021.1914693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Unintended pregnancy impacts many young women in South Africa, and rates of consistent contraceptive use among this population are suboptimal. Limited empirical work has investigated reasons for inconsistency between pregnancy intention and contraceptive use behaviour with data collected during pregnancy. We explored pregnancy intentions and discordance between intentions and contraceptive use prior to conception among young pregnant women in KwaZulu-Natal, South Africa. In-depth qualitative interviews were conducted with 35 women during pregnancy (mean age = 19.3; range = 18-21) in 2011 and 2012. Data were analysed using content analysis. All participants reported unintended pregnancies; almost half were not using contraception near conception. Reasons for not intending to become pregnant spanned personal, social, health, and economic domains. Participants living with HIV (n = 13) expressed specific concerns related to impacts of pregnancy on HIV disease management and fear of transmission of HIV to the infant. Discordance between pregnancy intentions and contraceptive use prior to conception was attributed to personal, social, health and structural domains. Findings indicate a need for interventions that address barriers to contraceptive use in order to minimise unintended pregnancy and support safe, desired pregnancies among young women.
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Affiliation(s)
- Jessica N Coleman
- Department of Psychology and Neuroscience, Duke University, Durham, USA
| | - Cecilia Milford
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Nzwakie Mosery
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Karmel W Choi
- School of Public Health, Harvard University, Boston, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Letitia Rambally Greener
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
- Wits Reproductive Health and HIV Institute, Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lynn T Matthews
- Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, USA
| | - Abigail Harrison
- Department of Behavioral Sciences, School of Public Health, Brown University, Providence, USA
| | - David R Bangsberg
- School of Public Health, Oregon Health Sciences University – Portland State University, Portland, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, USA
| | - Jennifer A Smit
- MatCH Research Unit, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
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Nakamura A, El-Khoury Lesueur F, Sutter-Dallay AL, Franck JÈ, Thierry X, Melchior M, van der Waerden J. The role of prenatal social support in social inequalities with regard to maternal postpartum depression according to migrant status. J Affect Disord 2020; 272:465-473. [PMID: 32553390 DOI: 10.1016/j.jad.2020.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/09/2020] [Accepted: 04/20/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND An advantaged socioeconomic position (SEP) and satisfying social support during pregnancy (SSP) have been found to be protective factors of maternal postpartum depression (PDD). An advantaged SEP is also associated with satisfying SSP, making SSP a potential mediator of social inequalities in PPD. SEP, SSP and PPD are associated with migrant status. The aim of this study was to quantify the mediating role of SSP in social inequalities in PPD regarding mother's migrant status. METHODS A sub-sample of 15,000 mothers from the French nationally-representative ELFE cohort study was used for the present analyses. SEP was constructed as a latent variable measured with educational attainment, occupational grade, employment, financial difficulties and household income. SSP was characterized as perceived support from partner (good relation, satisfying support and paternal leave) and actual support from midwives (psychosocial risk factors assessment and antenatal education). Mediation analyses with multiple mediators, stratified by migrant status were conducted. RESULTS Study population included 76% of non-migrant women, 12% of second and 12% of first generation migrant. SEP was positively associated with support from partner, regardless of migrant status. Satisfying partner support was associated with a 8 (non-migrant women) to 11% (first generation migrant women) reduction in PPD score. LIMITATIONS History of depression was not reported. CONCLUSIONS Partner support could reduce social inequalities in PPD. This work supports the need of interventions, longitudinal and qualitative studies including fathers and adapted to women at risk of PPD to better understand the role of SSP in social inequalities in PPD.
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Affiliation(s)
- Aurélie Nakamura
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; French School of Public Health (EHESP), Doctoral Network, Rennes, France.
| | - Fabienne El-Khoury Lesueur
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France
| | - Anne-Laure Sutter-Dallay
- INSERM, UMR 1219, Bordeaux Population Health, Bordeaux University, France; University Department of Adult Psychiatry, Charles-Perrens Hospital, 33000, Bordeaux, France
| | - Jeanna-Ève Franck
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France
| | - Xavier Thierry
- UMS Elfe Team, Institut National d'Etudes Démographiques (INED), F75000 Paris, France
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; French collaborative Institute on Migration (ICM), Paris, France
| | - Judith van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France
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Cohen E, Richter LM, Chidumwa G, Abdalla S, Weber AM, Darmstadt GL, Norris SA. Relationships Between Maternal Factors and Weight Loss Attempts Among Urban Male and Female Adolescents Living in Soweto, Johannesburg, South Africa. J Adolesc Health 2020; 66:S17-S24. [PMID: 31866033 DOI: 10.1016/j.jadohealth.2019.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE South Africa is undergoing rapid urban transition favoring ideals of thinness, which increases eating disorders risk for female adolescents, whereas older women continue to uphold corpulence as a female cultural value. This study aimed to assess the potential conflicting relationship between urban male and female adolescents' weight loss attempts (WLA) and maternal body image norms within households. METHODS The study included a longitudinal sample of mother-daughter and mother-son pairs from the Birth to Twenty Plus Cohort (N = 1,613), using data collected at 13, 17, and 22 years. Sociodemographic characteristics, eating attitudes, WLA, and body mass index were assessed in mothers and their offspring. Relationships between maternal factors and offspring's WLA were assessed using both logistic regression and structural equation modeling. RESULTS More females had WLA compared with their male counterparts at 13, 17, and 22 years. Multivariable models showed an independent positive association between maternal household socioeconomic status and boys' WLA at 13 years, whereas independent negative associations were found between mothers' body mass index and boys' WLA at 17 and 22 years. Mothers' age and sons' WLA at 22 years showed an independent positive association. No association was found between maternal factors and daughters' WLA. CONCLUSIONS Strong gender-differentiated intergenerational patterns were observed between maternal factors and offspring's WLA from early adolescence to early adulthood. The lack of relationship between maternal factors and daughters' behavior in contrast to that of sons suggests that Western acculturation may pose a greater risk for females to modern body image disturbances and eating disorders.
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Affiliation(s)
- Emmanuel Cohen
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa.
| | - Linda M Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Glory Chidumwa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa; Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ann M Weber
- School of Community Health Sciences, University of Nevada, Reno, Nevada
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Margaret MC, Patricia MK, Mutinta M, Concepta K, Victoria KM, Musenge E, Odland JO, Stray-Pedersen B. Women’s Experience with Socio-Economic Factors Associated with Perinatal Morbidity and Mortality in Lusaka and Mumbwa Districts of Zambia. Health (London) 2019. [DOI: 10.4236/health.2019.116061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mlotshwa L, Manderson L, Chasela C, Merten S. Talking about sex in pregnancy: reflections from the field in urban South Africa. CULTURE, HEALTH & SEXUALITY 2018; 20:1157-1170. [PMID: 29381125 DOI: 10.1080/13691058.2017.1420233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Qualitative research with close engagement in the field allows researchers and participants to build relationships and establish trust, enabling researchers to collect meaningful and sensitive information. Drawing on findings from a study conducted in an urban setting in South Africa, we discuss the challenges faced when interviewing pregnant women with HIV infection, retaining them in the study, and extending the study to include their partners. We discuss the dynamics of pregnancy and draw lessons from interviews concerned with personal, sensitive issues. The study on which we draw was conducted in Johannesburg, South Africa, and was nested in a larger prospective cohort study of women and their infants, which in turn was part of a case control study. Sensitive topics are difficult and complex, but to ignore these and stay in safe territory is to ignore some of the most pressing questions of our time. It is important that those who conduct interviews are well trained and able to engage empathetically with participants, and that some form of counselling is available for both participants and researchers.
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Affiliation(s)
- Langelihle Mlotshwa
- a Epidemiology and Public Health , Swiss Tropical and Public Health Institute, University of Basel , Basel , Switzerland
- b Epidemiology and Biostatistics, School of Public Health , University of the Witwatersrand , Johannesburg , South Africa
| | - Lenore Manderson
- c School of Public Health , University of the Witwatersrand , Johannesburg , South Africa
| | - Charles Chasela
- b Epidemiology and Biostatistics, School of Public Health , University of the Witwatersrand , Johannesburg , South Africa
- d Right to Care, EQUIP Health , Johannesburg , South Africa
| | - Sonja Merten
- a Epidemiology and Public Health , Swiss Tropical and Public Health Institute, University of Basel , Basel , Switzerland
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A qualitative study of nulliparous women's decision making on mode of delivery under China's two-child policy. Midwifery 2018; 62:6-13. [PMID: 29626722 DOI: 10.1016/j.midw.2018.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/14/2018] [Accepted: 03/11/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To explore nulliparous women's perceptions of decision making regarding mode of delivery under China's two-child policy. DESIGN Qualitative descriptive design with in-depth semi-structured interviews. SETTING Postnatal wards at a tertiary specialized women's hospital in Shanghai, China. PARTICIPANTS 21 nulliparous women 2-3 days postpartum were purposively sampled until data saturation. METHODS In-depth semi-structured interviews were conducted between October 8th, 2015 and January 31st, 2016. RESULTS Two overarching descriptive categories were identified: (1) women's decision-making process: stability versus variability, and (2) factors affecting decision making: variety versus interactivity. Four key themes emerged from each category: (1) initial decision making with certainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise, anticipated caesarean delivery; (2) initial decision making with uncertainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise; (3) internal factors affecting decision making: knowledge and attitude, and childbirth self-efficacy; and (4) external factors affecting decision making: social support, and the situational environment. CONCLUSION AND IMPLICATIONS FOR PRACTICE At the initial period of China's two-child policy, nulliparous women have perceived their decision-making process regarding mode of delivery as one with complexity and uncertainty, influenced by both internal and external factors. This may have implications for the obstetric setting to develop a well-designed decision support system for pregnant women during the entire pregnancy periods. And it is recommended that care providers should assess women's preferences for mode of delivery from early pregnancy and provide adequate perinatal support and continuity of care for them.
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