Exploring the Subconcepts of the Wittmann-Price Theory of Emancipated Decision-Making in Women's Health Care

What women want: the effect of health agency advertising on patient-doctor communication

Purpose

The purpose of this study is to investigate the relationship between women’s sexual health agency and their intent to initiate communications with their doctors. The research questions examined the effect sexual health agency has on patient-doctor communication, women’s emotional responses to health advertisements encouraging patient communication with their doctors, attitude toward the message and behavioral intentions after exposure to the advertising message.

Design/methodology/approach

An experimental design was implemented via an online questionnaire instrument to test the differences between younger-aged women (25 to 45 years) and mature-aged women (46 to 70 years). It was observed that 188 women who reported their status as single and sexually active in the past 12 months were exposed to a health advertisement that encouraged patient-doctor communication. Analyses were conducted to compare between-group measures on sexual health agency, emotional response and attitude toward the ad and behavioral intention.

Findings

No statistical difference existed between younger and older women. In general, women expect their doctor to lead conversations about sexual health but are positively reinforced by health messages that encourage their assertiveness as patients.

Research limitations/implications

The small sample size also may have limited the study’s potential to evaluate differences between age segments. Future research should explore this further.

Practical implications

The study provides evidence that sexual health advertising can reinforce women’s intent to initiate conversations with doctors regardless of age.

Social implications

Health communications can bolster women’s sexual health agency and improve patient-initiated conversations with doctors.

Originality/value

The study is the first to explore advertising messaging’s potential for applying health agency as a communication strategy for encouraging sexual health communications between women and their doctors.

Social norms as possible causes of stillbirths

OBJECTIVE

High stillborn rates are a concern in developing countries. Hence, this article aims to describe the sociocultural norms contributing to the high number of stillbirths as perceived by mothers, significant others, midwives and records of the Pregnancy Problem Identification Programme (PPIP).

DESIGN & SETTING

A multimethod qualitative descriptive study was conducted in a district in the Free State, South Africa. Each of the five sub-districts has a district hospital where most pregnant women give birth. Eighty per cent of the community is black of which about a quarter live in poor conditions below the poverty line.

PARTICIPANTS

The first author conducted unstructured in-depth interviews with 36 mothers and their significant other who gave birth to a stillborn. She also extracted relevant data from the PPIP record of each mother. A skilled moderator conducted three focus group interviews with a convenience sample of midwives. The data were inductively analysed to identify subthemes under the central theme of social norms.

KEY CONCLUSIONS

The authors concluded that traditional practices, traditional role players (traditional healer, mother-in-law, partner), abuse, and prescriptive social norms might contribute to stillbirths. Pregnant women are oppressed as they adhere to traditional social norms and are unable to make independent, informed healthcare decisions. The midwives, who are mostly female, may find it difficult to empower pregnant women because they are under the same social oppression as their clients.

IMPLICATIONS FOR PRACTICE

It is imperative that healthcare providers consider social determinants of health, including social norms, when providing healthcare, especially to pregnant women as some social practices may have detrimental outcomes for the mother and/or baby.

The Impact of Choice and Control on Women's Childbirth Experiences

Women's choice and control impact birthing experiences. This study used a qualitative, descriptive approach to explore how women develop their initial birth plan and how changes made to the plan affect overall birth experiences. Narrative, semistructured interviews were conducted with 15 women who had given birth in Waterloo Region, Ontario, Canada, and data were analyzed using a phenomenological approach. Findings showed that women relied on many resources when planning a birth and that changes made to a woman's initial birth plan affected her recollection of the birth experience. Conclusions are that women's positive and negative recollections of their birth experiences are related more to feelings and exertion of choice and control than to specific details of the birth experience.

Analyzing "Decision to Change" in Order to Improve Health Care Behavior in Adult Chronic Disease

Objetivo: a fin de contribuir con la clarificación y el desarrollo de conceptos útiles para la ciencia de enfermería en su práctica, este trabajo utilizó la metodología de Rodgers con el fin de proporcionar una definición del concepto “decisión de cambio” (DC) para el mejoramiento de conductas de salud en el contexto de las enfermedades crónicas (obesidad, hipertensión arterial y diabetes). Método: se realizó el análisis de evidencia empírica en bases de datos para identificar atributos, términos subrogados, antecedentes y consecuencias en relación con el concepto DC. De forma complementaria se aplicaron entrevistas semiestructuradas con codificación abierta. Resultados: la decisión de cambio es definida, entonces, como el proceso de elección que requiere de intención y actitud para comprometerse con responsabilidad en el mejoramiento de la conducta de salud, de manera efectiva y permanente respecto de las condiciones sociales y emocionales a las que una persona es sometida ante la presencia de una enfermedad crónica y que requiere de manera impostergable el apoyo familiar y profesional de salud. Conclusión: la decisión de cambio es un juicio de elección que requiere de voluntad permanente para cambiar las conductas de salud y resolver las posibles contingencias que pueda provocar una enfermedad crónica

Women's decision-making regarding medication use in pregnancy for anxiety and/or depression

AIM

To increase understanding of women's decision-making process concerning the medication use for anxiety and/or depression while pregnant.

BACKGROUND

Anxiety and depression affects many pregnant women, yet the decision to take psychotropic medication is complex and possibly subject to social oppression.

DESIGN

Cross-sectional descriptive survey design.

METHODS

A web-based survey was used to collect data from a convenience sample of 143 pregnant women over 3 months beginning in early 2011. An independent t-test was conducted to determine differences in satisfaction between women with high and low levels of emancipated decision-making (EDM). A multiple regression analysis was conducted to determine which subscales of the emancipation scale best predict level of satisfaction with the decision.

FINDINGS

The majority of respondents were White, between 25-34 years of age. The group with lower levels of emancipation reported lower mean satisfaction scores compared with those with higher levels of emancipation. Regression analysis showed that the three subscale emancipation model was a statistically significant predictor of satisfaction with the decision and accounted for 54% of the variance in satisfaction. The subconcept of personal knowledge was most predictive of satisfaction with decision.

CONCLUSIONS

Women may be able to overcome oppressive forces by using an EDM process. EDM allows them to make a decision that feels right for them and to feel satisfied with the decision.

Empowerment beliefs and intention to uptake cervical cancer screening: three psychosocial mediating mechanisms

Three studies tested if the associations between women's empowerment beliefs and intentions to attend cervical cancer screening could be explained by mediating psychological mechanisms: control-related beliefs, well being-related beliefs, and beliefs and evaluations referring to social functioning. Data were collected from January to March 2011 in the rural and urban areas across regions of Poland. Study 1 (N = 386) indicated that women with strong empowerment harbored stronger self-efficacy and beliefs that screening participation would make them feel in control of their own health and body. These two types of cognitions were, in turn, associated with stronger cervical cancer screening intentions. Results of Study 2 (N = 527) confirmed three significant well being-related mediators in the relationship between empowerment beliefs and cervical cancer screening: perceived benefits of screening related to well being, appearance satisfaction, discomfort- and shame-related barriers for screening. Finally, Study 3 (N = 424) showed that empowerment enabled receiving higher social support for cervical cancer screening, promoted perceiving fewer barriers for cervical cancer screening-related communication and more social benefits of engaging in cervical cancer screening. Support for cervical cancer screening, social barriers, and benefits were, in turn, related to screening intentions. Across the studies similar shares of intention variance were explained, and thus the hypothesized mediating mechanisms may have similar explanatory power.

Patient decision making among older individuals with cancer

Patient decision making is an area of increasing inquiry. For older individuals experiencing cancer, variations in health and functional status, physiologic aspects of aging, and tension between quality and quantity of life present unique challenges to treatment-related decision making. We used the pragmatic utility method to analyze the concept of patient decision making in the context of older individuals with cancer. We first evaluated its maturity in existing literature and then posed analytical questions to clarify aspects found to be only partially mature. In this context, we found patient decision making to be an ongoing process, changing with time, reflecting individual and relational components, as well as analytical and emotional ones. Assumptions frequently associated with patient decision making were not consistent with the empirical literature. Careful attention to the multifaceted components of patient decision making among older individuals with cancer provides guidance for research, supportive interventions, and targeted follow-up care.

Elective Cesarean births: are women making emancipated decisions?

This mixed method study investigated the extent to which women used emancipated decision making when selecting a birth method, whether they perceived they had a choice, and if they were satisfied with their decision. Findings suggest that vaginal birth is still the preferred method of delivery for these study participants.

Reexploring the subconcepts of the Wittmann-Price Theory Of Emancipated Decision Making in women's healthcare

This study explored the 5 subconcepts (empowerment, flexible environment, personal knowledge, reflection, and social norms) of the Wittmann-Price Theory of Emancipated Decision Making (EDM) in women's healthcare, a theoretical model. Pain management for labor was the clinical exemplar. The correlation of EDM and satisfaction with the decision (SWD) was measured, and flexible environment was the subscale with the highest mean score. There was a significant relationship between EDM and SWD (r = 0.70, P < .001). Personal knowledge and flexible environment were the best predictors of satisfaction. This study advances the theory of EDM for the nursing care of women.