Paternal depressive symptoms and factors associated among expectant fathers in a northeastern province of Thailand.

Globally, depression is a major mental health problem among expectant fathers. Therefore, factors associated with paternal depressive symptoms (PDS) need investigation. This hospital-based cross-sectional study was aimed to investigate the prevalence of and factors associated with PDS among expectant fathers in a northeastern province of Thailand. In the north-eastern province, Sakon Nakhon, 440 expectant fathers from eight hospitals participated in the study by completing a questionnaire related to socio-demographic characteristics, the Edinburgh Postnatal Depression Scale (EPDS), psychosocial factors and social support. An EPDS score of at least eleven out of 30 was interpreted as having PDS. Multivariable linear regression analysis was applied with a statistical significance at 0.05, and the coefficient ß was presented. In total, 81 expectant fathers (18.4%, 95% confidence interval 14.6-22.3) had PDS, and the mean (standard deviation) of the EPDS score was 6.65 (4.25). Insufficient money (ß = - 0.099, p = 0.016), marital adjustment (ß = - 0.098, p = 0.027), self-esteem (ß = - 0.150, p < 0.001), wife's stress (ß = 0.079, p = 0.049), and expectant father's stress (ß = 0.400, p < 0.001) were factors independently associated with PDS. In conclusion, screening expectant fathers during the pregnancy period of their wives is essential, and factors associated with PDS should not be neglected by healthcare providers. Also, there is need of an intervention program to prevent the symptoms, especially for expectant fathers having insufficient money or having stress.

Oral health knowledge, literacy and behavior of pregnant women: a qualitative study in a northeastern province of Thailand.

BACKGROUND: Pregnancy is a unique period of women's lives, and oral health is an important public health indicator during this period. Pregnant women have increased vulnerability to oral health problems. The study aimed to describe oral health knowledge, literacy and behavior of pregnant women in a northeastern province of Thailand. METHODS: A descriptive study was used. Twenty pregnant women who attended antenatal care clinics of eight public hospitals in the province were recruited by use of purposive sampling. They participated voluntarily in individual interview. The Health Belief Model was used as conception framework. All data were transcribed and subjected to content analysis. RESULTS: Five categories emerged: Misbelief and lack of knowledge, Oral health problems and dental care seeking, Oral health information from different persons, Self-care management of oral health, and Fear of and anxiety towards dental treatment. The findings showed that low knowledge of need for treatment, little importance to oral health and low priority of dental needs affect the demand for dental care. Fear of and anxiety towards dental treatment were the results of negative past experiences of neglecting dental care. Some women perceived health benefits of practicing self-care of oral health during pregnancy. CONCLUSION: The findings help to better understand the oral health issues of pregnant women and provide baseline information for oral health promotion. Such promotion and culturally appropriate care should be integrated in maternal health education classes.

Life satisfaction, body image and associated factors among women with breast cancer after mastectomy.

BACKGROUND: Women having undergone mastectomy due to breast cancer have experiences which are very much individual and contextual. In order to understand the women and improve their quality of life, the aim of this study was to investigate life satisfaction, body image and associated factors among Swedish women with breast cancer after mastectomy. METHODS: This descriptive cross-sectional study enrolled 481 Swedish women with breast cancer after mastectomy who completed a questionnaire comprising socio-demographic characteristics, sources of information, and life satisfaction and body image (outcome variables). Multiple linear regression analyses were used to estimate relationships between socio-demographic characteristics, information support, sources of information, treatment variables, and outcome variables. RESULTS: All dimensions of life satisfaction were associated with body image. Treatment options were factors associated with life satisfaction, while sources of information were a factor that increased life satisfaction in the dimensions of physical symptoms, sickness impact and quality of close-friend relationship. Underlying disease, age 31-45 years, chemotherapy and breast reconstruction increased body image dissatisfaction. CONCLUSION: The finding that some socio-demographic characteristics, treatment options and sources of information were associated with life dissatisfaction and body image dissatisfaction can increase healthcare professionals' understanding of women with breast cancer after treatment. They should provide accurate and realistic information, focus attention on the women's needs, and prepare psychological intervention programs that make the women cope with their life situations during follow-up care.

Life situations of Swedish women after mastectomy due to breast cancer: A qualitative study.

PURPOSE: Breast cancer is a significant health issue all around the world and the most frequent type of cancer among Swedish women. The aim of this study was to explore and describe life situations of Swedish women with breast cancer after mastectomy. METHODS: A qualitative study with semi-structured interviews was conducted by using an interview guide concerning experiences of changes in the women's daily lives and functions. Thirty-three women with breast cancer having undergone mastectomy participated. The data from the interviews were subjected to content analysis. RESULTS: Six categories emerged: Embarrassment with body image and loss of femininity; Feelings of fear, worry and anxiety; Better appreciation of life; Support from different sources; Experiences of care from health care professionals; and Need of information and follow-up care. CONCLUSION: The women's body image limits their daily lives, and psychological distress reminds them of their disease. Reception of support from family and healthcare professionals and perception of positive life are important. Sometimes there is a lack of information and follow-up from healthcare professionals, who should be aware of the women's feelings and needs.

Psychological distress and health-related quality of life among women with breast cancer: a descriptive cross-sectional study.

PURPOSE: Breast cancer is the most common type of cancer found in women in Sweden and worldwide. Treatment leads to increased survival of patients, but they are at risk to experience psychological distress, including anxiety and depressive symptoms, and decreased health-related quality of life (HRQoL). This study investigated the relationship between psychological distress and HRQoL and related factors among women with breast cancer in Sweden. METHODS: This descriptive cross-sectional study was conducted in Sweden. A total of 481 women with breast cancer answered voluntarily a questionnaire about sociodemographic and support factors, psychological distress, and HRQoL. Data were subjected to Pearson's correlation and linear regression analyses. RESULTS: Psychological distress was related to HRQoL in terms of body image, future perspective, side effects of systemic therapy, breast symptoms, arm symptoms, and hair loss. Women with lower age were associated with increased symptoms of anxiety, while those having undergone breast reconstruction were associated with increased symptoms of depression. Breast reconstruction and chemotherapy worsened body image, low support from partner decreased sexual functioning and enjoyment, and low support from physicians and nurses worsened future perspective, side effects of systemic therapy, breast symptoms, and indignation about hair loss. CONCLUSIONS: Psychological distress was correlated with the HRQoL. Increased support from physicians, nurses, and husband/partner may increase the HRQoL among women with breast cancer. Breast cancer treatments such as breast reconstruction and chemotherapy were factors that decreased the psychological distress and increased the HRQoL.

Contraception practices among young unmarried women seeking abortion following unintended pregnancy in Ho Chi Minh City, Vietnam.

The aim of this study was to explore and describe contraception practices among young unmarried Vietnamese women seeking abortion after an unintended pregnancy. A qualitative study was conducted with voluntary participation of 42 women at a hospital in Ho Chi Minh City. Interview data were subjected to content analysis from which five categories were identified: (1) attitudes towards sexuality and contraception, (2) knowledge about contraception, (3) use of contraceptive methods, (4) cultural and traditional issues concerning sexuality and contraception, and (5) abortion as a solution to unwanted pregnancy. Prior to their abortion, women had viewed premarital sex as a means of maintaining a relationship with their boyfriends. Misconceptions, misbeliefs, fear of side effects and limited knowledge were reasons for not using contraception and, in case of unintended pregnancy, abortion was the solution. Boyfriends played an important role in influencing the use (or non-use) of contraceptives. Sexual and reproductive health education including counselling for gender equality, safer sex practices and the prevention of unintended pregnancy should be provided to both women and men in ways which combine traditional and modern views of sexuality. Intervention research to develop sexual and reproductive health education programmes, including contraception counselling, should be carried out.

Knowledge, attitude and self-efficacy program intended to improve public health professionals' ability to identify and manage perinatal depressive symptoms: a quasi-experimental study.

BACKGROUND: During the perinatal period women lack screening and treatments for perinatal depressive symptoms, while public health professionals (PHPs) in primary care centres (PCCs) need training for identification and management of such symptoms. This quasi-experimental study was aimed at evaluating knowledge, attitudes and self-efficacy among PHPs after participating in a Knowledge, Attitude, and Self-efficacy (KAS) program for identification and management of perinatal depressive symptoms. METHOD: The KAS-program, carried through in Sakonnakhon in north-eastern Thailand, comprised one day of theory and a four-week period of field practice. Thirty-three PHPs from PCCs participated in the program. Twenty-three of them participated in focus group discussions (FGDs). Chi-square for trend, paired-sample T-tests and content analysis were used. RESULTS: Knowledge, attitude and self-efficacy scores increased after the PHPs had fully participated in the KAS-program. Four categories emerged from the FGDs: increased understanding and knowledge, being aware and having a positive attitude, having confidence and ability to work, and need of regular training and feedback. CONCLUSION: The KAS-program may contribute to giving PHPs in PCCs the knowledge, positive attitude and self-efficacy they need to identify and manage perinatal depressive symptoms. Implementation of the KAS-program to other healthcare professionals such as nurses/midwives is great of interest.

Life situation and support during pregnancy among Thai expectant mothers with depressive symptoms and their partners: a qualitative study.

BACKGROUND: Expectant parents may have positive and negative emotions during pregnancy and receive support from different sources. Studies on life situation and support among couples have rarely been conducted. This study aims to explore life situation and support during pregnancy among expectant mothers with depressive symptoms and their partners. METHODS: Twenty-seven expectant mothers, in the last trimester of pregnancy with depressive symptoms (Edinburgh Postnatal Depression Scale score ≥ 7) from seven public antenatal care clinics in Sakonnakhon, a north-eastern province of Thailand, and their partners were interviewed. In total, 54 semi-structured interviews were subjected to content analysis. RESULTS: Four categories emerged: (1) Having obstacles in life, (2) Facing life transition, (3) Enhancing confidence, and (4) Dissatisfaction with support. The informants described obstacles regarding economy, fear of health problems, getting an abnormal child and partners' behaviours. They received support from family members and social networks, but some were dissatisfied with the support from the healthcare. For example, expectant fathers wished to receive more health information and be more involved. CONCLUSIONS: Healthcare professionals should be aware of the influence of cultural and contextual factors when providing antenatal care to expectant parents. Male involvement in the care must not be neglected.

Intervention intended to improve public health professionals' self-efficacy in their efforts to detect and manage perinatal depressive symptoms among Thai women: a mixed-methods study.

BACKGROUND: Targeting perinatal depressive symptoms among women can reduce premature mortality. However, public health professionals (PHPs) in primary healthcare settings often have low self-efficacy for detection and management of perinatal depressive symptoms among women. This mixed-methods study was aimed at developing and evaluating a self-efficacy improvement programme (SIP) intended to increase PHPs' self-efficacy in efforts to detect and manage perinatal depressive symptoms. METHODS: The SIP consisted of 1 day of theory and 4 weeks of practice. Sixty-six PHPs from sub-district health promotion hospitals (primary health care level) in Sakonnakhon, a north-eastern province in Thailand, were randomised into an intervention group (n = 33) and a control group (n = 33). Twenty-three of the intervention group participants also took part in focus group discussions (FGDs). Multiple linear regression and qualitative content analysis were used to analyse the data. RESULTS: After the SIP, the intervention group participants had higher self-efficacy score than those in the control group (p = 0.004). The FGDs resulted in four categories emerging: Having confidence, Changing knowledge and attitudes, Increasing perception of an important role, and Increasing awareness of performed function. CONCLUSIONS: To enhance the ability of PHPs to detect and manage perinatal depressive symptoms, an intervention programme based on self-efficacy modification is recommended.

Perinatal depressive symptoms among Thai women: A hospital-based longitudinal study.

The authors of this longitudinal study investigated risk factors for postpartum depressive symptoms and differences in depressive symptoms at late pregnancy and at 1 and 3 months postpartum. In Sakhonnakhon Province, in northeastern Thailand, 449 women were recruited during late pregnancy and followed at 1 and 3 months postpartum with the use of psychosocial factors. Depressive symptom scores were measured using the Edinburgh Postnatal Depression Scale (EPDS). The scores were compared using dependent-samples t-tests, and multiple linear regression analyses were used to identify risk factors for depressive symptoms at 1 and 3 months postpartum. EPDS scores decreased from late pregnancy to 1 month postpartum and remained on the same level until 3 months postpartum. Low psychological well-being scores and low personal monthly income were risk factors for increased EPDS scores at 1 and 3 months postpartum. Pregnant women in Thailand who have a low income, have limited social support, and report low psychological well-being are at increased risk for postpartum depression. Results of this study suggest they should be screened for depressive symptoms during pregnancy, referred for diagnosis, and provided treatment to reduce the risk of ongoing depressive symptoms during the postpartum period.

Antenatal depressive symptoms during late pregnancy among women in a north-eastern province of Thailand: Prevalence and associated factors.

BACKGROUND: Globally, depression is prevalent during pregnancy and several factors have been associated with antenatal depressive symptoms (ADS). However, ADS have rarely been investigated in Thailand. This study aimed at exploring the prevalence of ADS and factors associated with these symptoms among Thai women in late pregnancy. METHODS: A cross-sectional study including 449 women in late pregnancy was carried out. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect depressive symptoms with a score of 10 points or higher. Socio-demographic characteristics and psychosocial risks were measured in association with ADS. Percentage and 95% confidence interval (CI) were used to assess the prevalence of ADS. Odds ratio (OR) and 95%CI were used to determine ADS-related risk factors among women. RESULTS: The prevalence of ADS was 46.8% (95%CI 42.3-51.4). Pregnant women aged less than 20 years (OR 2.58, 95%CI 1.14-5.84) and those not having enough money (OR 2.71, 95%CI 1.22-6.05) had an increased risk of ADS. Psychosocial risks related to ADS for women were low psychological well-being (OR 3.12, 95%CI 1.75-5.58), low self-esteem (OR 2.08, 95%CI 1.24-3.49), and low sense of coherence (OR 1.82, 95%CI 1.12-2.95). CONCLUSIONS: The prevalence of ADS among Thai women in their late pregnancy is high. Socio-demographic characteristics and psychosocial factors are independently associated with ADS. Healthcare providers in Thailand should consider EPDS as a standardised screening tool for ADS and use it at antenatal care clinics. Implementing programs focusing on both pregnant women and their family might increase the prevention of perinatal depression.

Self-care management of Thai Buddhists and Muslims with type 2 diabetes after an empowerment education program.

The aim of the present study was to explore self-care management of Thai Buddhists and Muslims with type 2 diabetes and inadequate blood glucose levels, after they had been subjected to a 6-month diabetes empowerment education program. Twenty-seven participants (male and female) were selected through purposive convenience sampling for an explorative qualitative study. Semistructured focus group interviews with four open-ended questions were used to study the participants' self-care behavior at the beginning and the end of the program, and the data obtained were subjected to content analysis. At the end, one third of the participants had been able to reduce their blood glucose to acceptable levels. Most of the others had achieved reduced but irregular blood glucose levels; however, some did not achieve any reduction. Diet was the most difficult problem, and economic difficulties, incorrect knowledge, and misleading beliefs were barriers. In conclusion, an empowerment education program can substantially improve the outcome of self-care management for many people with type 2 diabetes. In the planning of such programs, barriers should be taken into account.

Caregiving to persons living with HIV/AIDS: experiences of Vietnamese family members.

AIMS AND OBJECTIVES: To examine the experiences of caregiving among Vietnamese family members of persons living with HIV/AIDS. BACKGROUND: As the number of persons living with HIV/AIDS increases, the need of family caregivers who can take responsibility for the home care of these persons increases. Vietnam has one of the fastest growing HIV epidemics in Asia. DESIGN: A descriptive cross-sectional study with quantitative and qualitative methods was used. METHODS: A purposive sample of 104 family caregivers, both male and female, participated voluntarily by answering a questionnaire of caregiver burden, and 20 of them participated in in-depth interview. RESULTS: Female caregivers were mainly mothers and wives while male caregivers were mainly husbands, fathers and siblings. The largest group of family caregivers reported moderate to severe burden. There was no difference between genders in total caregiver burden, but there were several differences between older and younger caregivers in some items of caregiver burden. Five categories of experiences emerged: Different types of caregiving to persons living with HIV/AIDS, cultural and religious issues associated with caregiving, keeping secret to avoid stigma and discrimination, lack of knowledge about disease and provision of care, and fear, anxiety and frustration. CONCLUSIONS: Stigma and discrimination should be decreased by providing knowledge to the general public about HIV/AIDS, in particular about ways of transmission and protection. Special knowledge should be given to family caregivers to enable them to give care to persons living with HIV/AIDS at home. This could be done through culturally appropriate training/intervention programmes in which coping methods should be included. Support group interventions should also be carried through. The results obtained can be used as baseline information. RELEVANCE TO CLINICAL PRACTICE: Health care providers should consider gender, age and culture of family members of persons living with HIV/AIDS. Knowledge about HIV/AIDS, provision of care at home and in hospital, and support groups should be developed and implemented.

Religion and self-management of Thai Buddhist and Muslim women with type 2 diabetes.

AIMS AND OBJECTIVES: To report of a qualitative study of how religion affects the self-management of Thai Buddhist and Muslim women with type 2 diabetes. BACKGROUND: The importance of diabetes self-management is well recognised. However, research on such self-management in Thailand is scarce, in particular on the influence of religion on the self-management of Thai Buddhist and Muslim women with type 2 diabetes. DESIGN: A descriptive qualitative study was conducted. METHODS: Purposive convenience sampling was used, and 48 women, 19 Buddhist and 29 Muslim, aged from 28-80 years, participated. Data were collected in 2008-09 and analysed by use of manifest and latent content analysis. RESULTS: Four themes of the influence of religion on the self-management among Thai women with type 2 diabetes emerged: religion - a way of coping with diabetes, spiritual practice - a help for disease control, spiritual practice - an effort to struggle with everyday life, and support from family - a cultural practice. CONCLUSIONS: The Buddhist and Muslim women had self-management capabilities that were often related to their religions. However, many of them had poor control of their blood sugar levels and needed assistance. RELEVANCE TO CLINICAL PRACTICE: Reference to religion and spiritual practice can be an effective means of helping diabetes patients better manage their disease and change their lifestyles. Furthermore, family and economic and social environments should be taken into account both in care and in interventions aimed at helping patients cope and empowering them to control their disease.

Type 2 diabetes: how do Thai Buddhist people with diabetes practise self-management?

AIMS: This paper is a report of a study of how Thai Buddhist people with type 2 diabetes practice self-management. BACKGROUND: The importance of diabetes self-management is recognized in the literature. However, research on self-care management in Thailand, in particular concerning Buddhist people with type 2 diabetes, is scarce. METHODS: A descriptive qualitative study was conducted. Purposive convenience sampling was used, and thirty men and women with diabetes, aged 28-79 years, participated. Data were collected from June to August 2009 and analysed by use of manifest and latent content analysis. FINDINGS: Five themes of self-management among Thai Buddhist people with type 2 diabetes were identified: cultural influence on disease control, Buddhism and Thai culture, struggle for disease control, family support and economy a high priority. CONCLUSION: Even though the Buddhist people with diabetes had certain self-management capabilities, many had poor control of their blood sugar levels and needed assistance. Reference to Buddhist moderation can be an effective means of helping the people with diabetes better manage their disease and change their lifestyles. In addition to cultural and religious traditions, family, economy and social environment should be taken into account both in the care and in interventions aimed at helping people with diabetes cope and empowering them to control their disease.

Breast-feeding attitudes and practices among Vietnamese mothers in Ho Chi Minh City.

OBJECTIVE: to describe breast-feeding attitudes and practices among Vietnamese women in Ho Chi Minh City. DESIGN: a descriptive qualitative study was used. The theory of planned behaviour provided the conceptual framework. SETTING: the Well-baby Clinic, Department of Obstetrics and Gynaecology of a university hospital in Ho Chi Minh City, Vietnam. PARTICIPANTS: 23 voluntary Vietnamese mothers. DATA COLLECTION AND ANALYSIS: semi-structured in-depth interview with five open-ended questions and observation was used. The interviews were tape-recorded and transcribed verbatim. The data from the interviews and observations were analysed by use of content analysis. FINDINGS: five categories of breast-feeding attitudes and practices were identified: breast-feeding best but not exclusive, cultural and traditional beliefs, infant feeding as a learning process, factors influencing decision to breast feed, and intention to feed the child. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: cultural and traditional beliefs and practices, and socio-economic situation, influenced the Vietnamese mothers' breast feeding. Health-care professionals should consider cultural context and socio-economic issues when preparing infant feeding education and intervention programmes. Appropriate knowledge about cultural values should be included in health-care education in order to provide culturally congruent care to Vietnamese mothers in Vietnam as well as in Western countries.

Vietnamese women's cultural beliefs and practices related to the postpartum period.

OBJECTIVE: to describe cultural beliefs and practices related to the postpartum period among Vietnamese women in Ho Chi Minh City. DESIGN: a descriptive cross-sectional study using triangulation. SETTING: the Postpartum Clinic, Department of Obstetrics and Gynaecology of a university hospital in Ho Chi Minh City, Vietnam. PARTICIPANTS: 115 Vietnamese women, 95 in the first group and 20 in the second group. DATA COLLECTION AND ANALYSIS: a questionnaire was used with the first group and a semi-structured in-depth interview was used with the second group. Both groups were subjected to the same four open-ended questions. The data obtained were first analysed separately by use of qualitative content analysis and then cross-checked. FINDINGS: four categories were identified: hygiene, behavioural precautions (lying by a fire, keeping warm after birth, staying indoors and resting in bed, and avoiding house work and sexual activity), dietary precautions, and breast feeding and lactation. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: traditional beliefs and practices, often beneficial to the women and their babies but sometimes potentially harmful, greatly influenced the Vietnamese women during the postpartum period. Therefore, health-care professionals need to give appropriate information and care to the women and their families while paying due attention to the cultural context. These demands make it imperative that knowledge about cultural values be included in their education, not least in Western countries which have become multicultural.

Spiritual care provided by Thai nurses in intensive care units.

AIM: The aim of this study was to explore how Thai nurses in intensive care units of a university hospital in Bangkok provided spiritual care to their patients. BACKGROUND: The function of nursing is to promote health, prevent illness, restore health and alleviate suffering. An holistic approach to this promotion includes spirituality. DESIGN: An explorative qualitative study was used. METHOD: Thirty Thai nurses, selected through purposive sampling with the snowball technique, participated voluntarily. Semi-structured interviews with open-ended questions were carried out, taped-recorded, transcribed verbatim and subjected to content analysis. RESULTS: Five themes related to the provision of spiritual care emerged: giving mental support, facilitating religious rituals and cultural beliefs, communicating with patients and patients' families, assessing the spiritual needs of patients and showing respect and facilitating family participation in care. Several ways of improving the spiritual care were suggested by the nurses. CONCLUSIONS: Spirituality was an important part of the care for the nurses when meeting the needs of their patients and the patients' families. Therefore, nursing education should enhance nurses' understanding and awareness of spiritual issues and prepare them to respond to human spiritual needs. RELEVANCE TO CLINICAL PRACTICE: Nurses should consider spirituality as an important component of holistic care. During their professional career, they should expand their knowledge and understanding of spirituality and develop tools for assessment of spiritual needs.

Experiences from pregnancy and childbirth related to female genital mutilation among Eritrean immigrant women in Sweden.

OBJECTIVE: to explore Eritrean immigrant women's experiences of female genital mutilation (FGM) during pregnancy, childbirth and the postpartum period. DESIGN: qualitative study using an ethnographic approach. Data were collected via tape-recorded interviews. SETTING: interviews in the Eritrean women's homes located in and around Uppsala, Sweden. PARTICIPANTS: 15 voluntary Eritrean immigrant women. DATA COLLECTION AND ANALYSIS: Semi-structured interview and open-ended questions were used. The interviews were tape-recorded, transcribed verbatim and then analysed. FINDINGS: six themes of experiences of FGM among Eritrean women during pregnancy and childbirth were identified. They are (1) fear and anxiety; (2) extreme pain and long-term complications; (3) health-care professionals' knowledge of circumcision and health-care system; (4) support from family, relatives and friends; (5) de-infibulation; and (6) decision against female circumcision of daughters. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: the Eritrean women had experiences of FGM and had suffered from its complications during pregnancy, childbirth and the postpartum period. Midwives and obstetricians should have competence in managing women with FGM, and they need increased understanding of cultural epistemology in order to be able to provide quality care to these women. At antenatal centres, circumcised women should be advised to de-infibulate before pregnancy. Special courses about anatomical differences should be offered to these women and their husbands. It is also important to inform them about Swedish law, which prohibits all forms of FGM.