Inuit women's health in Nunavut, Canada: a review of the literature.

OBJECTIVES: Inuit women face challenging health and wellness issues in Northern communities. Literature examining these contexts and the processes through which health is affected is virtually non-existent. The objective [corrected] of this review is to examine and consolidate the available literature on Inuit women's health issues from the last decade in order to identify priorities for future research. STUDY DESIGN: This study is a review of literature from the last decade. Inuit women's health issues that have been raised in the literature and in various reports are examined within a health-determinants framework. METHODS: Government reports and statistics, publications by Inuit organizations and publications available on MEDLINE were examined for this review. RESULTS: Inuit women's health is a crucial part of the health of their communities. Inuit women face serious health issues related to reproductive and sexual health, such as high rates of sexually transmitted infections and challenging circumstances surrounding childbirth. Wellness, suicide and stress are more significant issues for Inuit women compared with non-Inuit women. Food security and accessibility is an issue for all Northerners. Alcohol and substance abuse and exposure to violent situations endanger both the health and safety of Inuit women in many Northern communities. CONCLUSIONS: There exists an urgent need to better understand the mechanisms through which determinants of health affect Inuit women. As well as adding to the body of knowledge on health determinants in Canada, further examining these issues will provide valuable information for health policy decision-makers and program development in the North and facilitate the direction of resources to the necessary areas of health services provision in Nunavut.

Women's health resources: facilitating a community of care for midlife women.

Since 1981 research has explored the role of women's health centres in providing health information and education to women in a non-traditional setting. These settings have been designed to provide more appropriate, and often more comprehensive, care by responding to the specific health issues and needs of women across the age continuum. The type of care and resources provided by these centres make a significant contribution to women's capacity for participation in decisions and action around their own, health. This article examines the service delivery and perceived roles of one such centre, the Women's Health Resources (WHR) centre in Calgary, Canada. Data for this paper were extracted from WHR evaluation forms for 199 midlife women seeking individual consultation, as well as personal interviews that were conducted with four female staff members. Clients of the WHR cited numerous reasons for seeking service at the centre, the most common being for emotional health care, nutritional consultation or more comprehensive information on a specific illness. Three major components of service provision at the centre were identified: information, psychological care and complementarity of services. Women used the information they gained from WHR services to aid in health decision-making and as a resource for empowerment in being partners in their own health. Clients noted that the WHR was a valuable source of additional information beyond what their own family physician and/or specialist were able to provide. The feminist and woman-centred care at WHR, in conjunction with the emphasis on education, offers an invaluable source of information and services for women. Through the shared experiences of both the clients and staff of this centre, this article provides an outline of how such services are perceived and utilized.

Women's perceptions of future risk after low-energy fractures at midlife.

PURPOSE: Low-energy fractures experienced by women at midlife and beyond place them at increased risk of future fractures and may be early indicators of low bone density. We report here on women's postfracture narratives to provide insight into how family physicians might tailor their messages to patients in communicating risk. METHODS: An interview guide was used in face-to-face interviews with women aged 40 years and older. Patients were asked to describe their fracture experience and recovery during the subsequent year. Interviews were audiorecorded and transcribed verbatim. Analysis was done initially using an immersion-crystallization approach. RESULTS: Twenty-two women participated in this research. The analysis showed women's reactions to information about their risk fell into 3 groups. The first took a laissez faire approach, preferring to wait and see what the future held. The second group recognized some of the things they should be doing but were inconsistent in maintaining changes or seeking relevant information. The third group saw information about future risk as salient and important to their daily lives. They actively sought out information, including discussions with their family physicians. CONCLUSIONS: Discovering whether patients have had an injury and, if so, how they perceive future risk is important because the invisibility of this health hazard calls for vigilance early on in women's lives. Family physicians can help patients move from perceiving the fractures as isolated accidents to understanding them as indicators of future risk by discussing the importance of bone health in the short and long term.

Reports of preventable medical errors from the Alberta Patient Safety Survey 2004.

The Health Quality Council of Alberta (HQCA) is charged with reporting to Albertans on the quality, safety and performance of the healthcare system. In 2004, the HQCA conducted a telephone survey (response rate: 55%) of 1,500 adult Albertans to assess their perceptions of and personal experiences with preventable medical errors (PMEs). A total of 559 (37.3%) respondents reported that they or a family member had ever experienced a PME. The most common PMEs were related to clinical performance (n=128), medication (n=123), diagnosis (n=121) and communication (n=73). Through this research, patients have provided an orientation to interventions to improve patient care and prevent medical errors.

Breaking--bad news: women's experiences of fractures at midlife.

OBJECTIVE: To gain understanding of the experiences and sequelae of fractures in women aged 40-65 years and to assess whether it is linked to overall bone health assessment. METHOD: A qualitative study using face-to-face indepth interviews. FINDINGS: Contrary to the common belief that fractures are benign, for middle-aged women, fractures have a significant impact on their well-being in both the short and long-term. Women report significant pain as well as an immediate need for help from family and professional caregivers. They experience interruptions to daily and leisure activities, employment, daily life and mobility. Only a minority of women and/or their family physicians initiated follow up to investigate bone health subsequent to the fracture. CONCLUSIONS: Bone health is often examined in the context of already established bone disease. This study suggests a need for a closer examination of fracture treatment in the context of preventive care, and early detection of osteoporosis.

Keeping up appearances: using qualitative research to enhance knowledge of dental practice.

Current issues in dentistry including a focus on patients' wishes for outcomes and dentists' role in that process raise important questions that cannot be addressed by quantitative, statistical study alone. The intriguing complexities and ambiguities that are emerging with ever-improving techniques and materials in dentistry, as well as competing demands for attention in dental health, require a range of research methodologies to address important existing and future research questions. Qualitative research, much like what a dentist does in an office visit, can seem intuitive and almost common sense in nature. Yet behind that research, when it is done well, lie years of training and practice, rules of evidence, guidelines for rigor, and various subspecializations in its pursuit. Qualitative research begins with a clearly defined problem; identifies the appropriate strategy to gather data from people, existing documents, and other sources of information that will help address the problem; uses a multifaceted tool kit of analytic methods to work with those data; and proceeds to investigate the data for their insight into the research problem and interpretation of the findings. This article provides an overview of common approaches to qualitative methods and resources to explore their potential for dental research.

The role of the media in public participation: framing and leading.

This article focuses on the framing of women's health services in the context of restructuring dictated by health system regionalization. By examining the archives of a local newspaper and the minutes and documents of one of the key organizations involved in restructuring after regionalization, it was possible to examine the public discourse of the time and subsequently the journalists' and the readerships' understandings of women's health. The evidence suggests that the Salvation Army was instrumental in setting the tone that was taken by the media in framing the issues around the closure and move of its Grace Women's Health Centre. While the Calgary Health Region was successful in bringing the Grace under its mandate and organizational control, it was the Salvation Army, with its highly visible and powerful fundraising arm and its advocacy for holistic women's health that caught the public's attention. The internal discourse tracked some of the emerging issues, known only to those involved at managerial levels within the health system, but the public discourse kept women centered in decisions regarding the partnership. Women from many constituencies must continue to participate in the public policy realm to ensure that women's health remains an issue in health reform.

Public participation for women's health: strange bedfellows or partners in a cause?

A major focus of health system reform in Canada has been the regionalization of health services administration. With a goal of bringing decision-making closer to the community, there has been a commitment to public participation in planning by some health authorities. Women, however, often feel that their participation is minimal or their needs are not addressed. During regionalization of the Alberta health system, the Calgary Health Region (CHR) negotiated an agreement with the Salvation Army to provide women's health services through the Grace Women's Health Centre, a major part of the region's women's health program. We present a case study exploring the process and final agreement and the impact of this agreement on women's participation in health policy development. The historical context and the nature and impact of the agreement are described and several participation strategies that occurred within the partnership are discussed. The development of a formal partnership agreement, a governance model, was a success for public participation in this case; however, the greatest success for women was maintenance of a political space in which women's health as a priority could be discussed in a context where the forces against gender equity talk are strong.

Embodied minds, restless spirits: mid-life rural women speak of their health.

This manuscript explores mid-life women's views of corporeality and the links that these have to their health. Using ethnographic interview techniques, community based interviewers talked with 24 women from rural settings. Our findings suggest that mid-life women have an embodied view of their minds and spirits, and that dualism is generally reserved for thinking about and interacting with the biomedical system. They have a sense of themselves as unique individuals who have a large role in caregiving, multiple other roles, and have luck but also agency in and control of their health and well-being. Motion was a strong theme throughout the interviews. Women embraced this mobility as a characteristic of their well-being as they coped with multiple changes associated with mid-life. In contrast to what some philosophers maintain, women seem to partner both corporeal changes and metaphor. While the sample was limited in scope, the findings support the importance to women's health of understanding the intersections between compositional and contextual variables in various settings.

Sexuality in palliative care: patient perspectives.

This qualitative study investigated the meaning of sexuality to palliative patients. Face-to-face interviews were conducted with ten patients receiving care in a tertiary palliative care unit, a hospice or by palliative home care services in their homes. Several themes emerged. Emotional connection to others was an integral component of sexuality, taking precedence over physical expressions. Sexuality continues to be important at the end of life. Lack of privacy, shared rooms, staff intrusion and single beds were considered barriers to expressing sexuality in the hospital and hospice settings. Only one subject had previously been asked about sexuality as part of their clinical care, yet all felt that it should have been brought up, especially after the initial cancer treatments were completed. Home care nurses and physicians were seen as the appropriate caregivers to address this issue. Subjects unanimously mentioned that a holistic approach to palliative care would include opportunities to discuss the impact of their illness on their sexuality.

After the fall: women's views of fractures in relation to bone health at midlife.

Past research has established the link between low energy fractures and the risk for future fractures. These fractures are potential markers for investigation of bone health, and may be precursors for osteoporosis. In spite of its significant public health burden, including burden of illness and economic costs, many individuals are not aware of the risk factors for and consequences of osteoporosis. This is a study of women aged 40 and older who experienced low energy fractures (e.g., from non-trauma sources and falls from no higher than standing height). We gathered data, using focus group interviews, about their experiences and understanding of the fractures in relation to bone health. Women often attributed the fractures to particular situations and external events (e.g., slipping on ice, tripping on uneven ground), and viewed the fractures as accidents. Women often felt that others are at risk for poor bone health, but believed that they themselves are different from those really at risk. Although the fractures are potential triggers for preventive efforts, few women connected their fracture to future risk. What is perceived by women (and others) as random and an accident is often a predictable event if underlying risk factors are identified. Only when there is more awareness of poor bone health as a disease process and fractures as markers for bone fragility will women, men and health care providers take action to prevent future fractures and established bone disease.