Experiences of and attitudes towards HIV/STI prevention among holidaymaking men who have sex with men living in Sweden: a cross-sectional Internet survey.

AIM: Foreign travellers and men who have sex with men (MSM) are prioritised groups for human immunodeficiency virus/sexually transmitted infection (HIV/STI) prevention efforts in Sweden because of high prevalence of sexual risk-taking. This study aims to describe experiences of and attitudes towards HIV/STI prevention efforts, prior to travelling abroad, among MSM, and to investigate the kinds of prevention efforts that are desirable. METHODS: The study is based on survey responses from 656 MSM who had travelled abroad. Recruitment took place through a Nordic website, and had a cross-sectional design. The analysis has mainly been descriptive, but bivariate analyses were performed using the chi-square test. The level of significance was p <.05. RESULTS: Only a few of the participants had encountered HIV/STI prevention efforts in Sweden (5%) and abroad (23%), and a majority (58%) felt that it should be more prevalent. Having free access to condoms and lubricants was preferred among 68% of the men. Furthermore, having written information, as opposed to oral, was also preferred (68% vs. 26%). MSM felt that it was easy to find out information (79%) and claimed they would use the Internet to do so (87%). CONCLUSIONS: Service providers who offer their services to travellers are encouraged to provide helpful links to information about sexual health. Information that is geared towards risk groups such as young adults should be presented with awareness that MSM are also part of that group. It is important for information to be conveyed respectfully to everyone, but perhaps MSM in particular, since they may have experienced feelings of being stigmatised or discriminated against previously.

Perceptions of HIV/STI prevention among young adults in Sweden who travel abroad: a qualitative study with focus group and individual interviews.

BACKGROUND: Young adults are at risk for HIV/STIs because they generally have an active sex life with multiple sexual partners; moreover, they use condoms to a lesser extent. Travelling increases sexually risky behaviour, and among both women and men, sexual contacts abroad are common. Better knowledge of how young adults experience prevention efforts prior to travelling, and what they prefer, is important when planning prevention efforts to this group. Experiences of and attitudes towards prevention efforts against HIV/STI among young adults in Sweden who have travelled abroad were investigated. METHOD: We conducted 12 focus-group interviews and four individual interviews with young adults (20-29 years) who had travelled abroad within the last 12 months. The interviews were recorded, transcribed verbatim, and analysed using thematic content analysis. Results were discussed from a salutogenic perspective. RESULTS: Only a few had any experience of prevention efforts against HIV/STIs. The majority welcomed the idea of prevention efforts prior to travelling and would have welcomed more, preferably short reminders or links to reliable websites, or someone professional to discuss the issue with. Most of the young adults would use the Internet to search for information. They proposed the possibility of reaching young adults through social media, and the importance of better basic knowledge in school. CONCLUSION: It is difficult to reach young adults before their trips abroad. Prevention efforts on HIV/STI must therefore focus on the use of established forums. Setting the foundation for a positive attitude towards condom use is needed during school years. Even social media, where there is the possibility for dialogue, should be used as an information source.

Midwives experiences of caring for immigrant women at antenatal care.

OBJECTIVE: The aim of this study was to describe Swedish midwives' experiences of caring for immigrant women at antenatal care clinics. METHODS: Five group interviews and one individual interview were conducted with 16 midwives working in the maternity care. The interviews were transcribed and analysed with latent content analysis. RESULTS: Three main categories emerged: 1) Be able to convey and receive information. Communication was influenced by the women's educational level and previous experiences. The interpreter's competence was of great importance, but also if the midwife was able to create a trusting relationship with the woman. 2) Experience other cultures. The midwife's duties and responsibilities differed from the woman's expectations of the visit. The woman's family was of great importance and influential. 3) Midwife's role and work situation. Midwives' working conditions were challenged and they developed strategies to cope with this; however, they desired support and time for reflection and processing. CONCLUSION: Communication difficulties were cultural and linguistic in nature, and required extra care. This can be achieved if the midwife has time, but also support in managing cultural differences. In the future, new communication tools and ways of communicating must be developed.

'I do not need to... I do not want to... I do not give it priority...'--why women choose not to attend cervical cancer screening.

OBJECTIVE: To describe and interpret why women with no cervical smear taken during the previous 5 years choose not to attend a cervical cancer screening (CCS) programme. BACKGROUND: CCS programme is a service for early detection of cervical cancer. Today, some women choose not to attend the programme. DESIGN: Data were collected by tape-recorded interviews and analysed by qualitative inductive content analysis. SETTING AND PARTICIPANTS: Purposive sample of 14 women in southeast Sweden, who had chosen not to attend CCS during the previous 5 years. FINDINGS: The following themes were revealed: I do not need to..., I do not want to... and I do not give it priority.... The women had a positive attitude to CCS but as long as they felt healthy, they chose not to attend. A negative body image, low self-esteem, feelings of discomfort when confronted with the gynaecological examination and fear of the results also influenced their non-attendance. The women prioritized more important things in life and reported various degrees of lack of trust in health-care. CONCLUSION: Women's choice not to attend CCS were complex and influenced by present and earlier intra- and inter-personal circumstances. They had a positive attitude to CCS, but other things in life were more important. Health-care professionals have to facilitate a co-operative discussion with the women in order to contribute to a mutual understanding for the perspectives of the women and the professionals.

Reasons for non-attendance at cervical screening as reported by non-attendees in Sweden.

PURPOSE: To describe reasons for non-attendance at cervical screening, as reported by non-attendees, in Sweden. METHODS: Four hundred women were randomized from a population-based register, of which 133 non-attendees answered the Cervical Screening Questionnaire (CSQ) in telephone interviews. Pearson's Chi2 and Mann-Whitney U-test were used to analyze differences between groups. Logistic regression was used to study the relationship between explanatory variables and a binary response variable. RESULTS: The most common reasons for non-attendance were: feeling healthy, lack of time, and feelings of discomfort with the gynecologic examination. Non-attendees, who reported non-attendance due to experiences of discomfort associated with the gynecologic examination, estimated great discomfort at their latest examination. A history of sexual abuse was reported by 16.5%, but there were no differences regarding non-attendance due to experiences of discomfort associated with the gynecologic examination, between non-attendees who had no history of sexual abuse and those who had. CONCLUSION: It seems as though non-attendees did not attend cervical screening as they felt healthy, and thereby did not give time to preventive efforts. Earlier negative experiences such as discomfort during earlier gynecologic examinations seem to guide their decision not to attend.

From passive passenger to participating co-pilot - Pregnant women's expectations of being able to access their online journal from antenatal care.

OBJECTIVE: The aim of the study was to describe pregnant women's expectations of being able to access their electronic health records from antenatal care. METHODS: Nine pregnant women passing 25 full gestational weeks were interviewed individually. Collected data were analysed with an inductive approach using content analysis. The study was performed in antenatal care units in southern Sweden. RESULTS: The following five categories emerged from the analysis: Being able to achieve increased participation, being able to have more control, being more knowledgeable about the pregnancy, identification of possible risks, and perceptions of one's own well-being can predict usage. The five categories led to one main category: 'Shift in power - from passive passenger to participating co-pilot'. CONCLUSION: The pregnant women expected that having access to electronic health records would give them more control, make them more knowledgeable and increase their participation. Access to electronic health records may empower pregnant women and contribute to a more person-centred approach. This could provide greater knowledge for the woman and her partner about her health, thus, allowing them to make evidence-based choices in relation to the newborn baby and the woman's health.

Promotion of cervical screening among nonattendees: a partial cost-effectiveness analysis.

Measures to increase attendance rate in cervical screening programmes have been suggested, but few have been evaluated in terms of value for money. The aim of this study was to describe the cost-effectiveness of a resource-intensive intervention to promote attendance at cervical screening among women with no registered cervical smear during the last 5 years. Among all 56 644 women (28-65 years) in Kalmar County, January 2004, a total of 6565 women had no registered cervical smear during the last 5 years. From this population, 400 women were randomly selected to a study group and another 400 women to a control group. The intervention was composed of a variety of efforts intended to promote attendance at cervical screening. We included, for example, all costs for identifying the women, sending out invitation letters, making phone calls and helping to make arrangements. Data on registered cervical smears at follow-up were collected from a data register within 1 year. In the study group, 118 women had a registered cervical smear compared with 74 in the control group (P=0.000). In the study group, the cost per cervical smear taken was 66.87 euro compared with 16.63 euro in the ordinary screening programme. The incremental cost per additional registered cervical smear was calculated at 151.36 euro in an area with high coverage, efforts to promote attendance at cervical screening were related to high costs per extra cervical smear gained and is not considered as reasonable from a cost-effectiveness perspective.

The first pelvic examination.

PURPOSE: To describe adolescents' experiences of their first pelvic examination. METHODS: Data were collected by tape-recorded interviews with 15 adolescents, who had had their first pelvic examination (PE) performed by a midwife at a Youth Clinic. Data were analyzed by qualitative latent content analysis. RESULTS: The result is presented in terms of the themes: Emotional ambivalence, Being in control and A step into women's world. The adolescents generally believed that PE was beneficial to their health and they were curious to see how they would manage. On the other hand they also felt embarrassed about getting undressed. They described several factors which contributed to feelings of being in control of the situation, e.g., when the examiner shared the process of decision making, thoroughly explained the PE procedure in advance, and assured them that the PE could be discontinued at any time. They considered their first PE as a step into a women's world. It seems important that the examiners perform the first PE in a manner that empowers the adolescents so they can enter womanhood with a positive attitude to their bodies. Furthermore, this empowering process may lay the foundation for subsequent PEs to be educational events for the adolescents.

Midwifery students' experiences of simulation- and skills training.

BACKGROUND: In Sweden, simulation- and skills training are implemented in midwifery education in order to prepare students for clinical practice. Research regarding the use of both low to high levels of fidelity in simulation in midwifery programme is limited. AIM: The aim of this study was to explore midwifery students' experiences of simulation- and skills training. METHODS: Midwifery students (n=61), at advanced level, were interviewed in 13 group interviews from 2011 to 2105. A semi-structured interview guide was used, and data were analysed by content analysis. RESULTS: The results are presented in four main categories: develops hands on skills and communication, power of collaborative learning, highly valued learning environment and facilitates clinical practice. The majority of students felt that the simulation- and skills training were necessary to become familiar with hands on skills. Having repetitive practices in a safe and secure environment was viewed as important, and students highly valued that mistakes could be made without fear of comprising patient safety. Student's collaboration, reflections and critical thinking increased learning ability. Simulation- and skills training created links between theory and practice, and the lecturer had an important role in providing instructions and feedback. Students felt prepared and confident before their clinical practice, and simulation- and skills training increased safety for all involved, resulting in students being more confident, as patients in clinical practice became less exposed. Furthermore, mentors were satisfied with students' basic skills. CONCLUSION: Simulation- and skills training support the development of midwifery skills. It creates links between theory and practice, which facilitates students' learning ability. Training needs to include reflections and critical thinking in order to develop their learning. The lecturer has an important role in encouraging time for reflections and creating safe environment during the skills and simulation training.

A two-decade perspective on mothers' experiences and feelings related to breastfeeding initiation in Sweden.

OBJECTIVE: The purpose was to examine mothers' experiences and feelings related to breastfeeding initiation from a two-decade perspective. METHODS: A repeated cross-sectional survey was conducted at a maternity ward before and after introduction of Baby Friendly Hospital Initiative (BFHI) and in a follow-up survey. Women participated in 1992 (n = 83), 1993 (n = 74) and 2011 (n = 94). RESULTS: The duration of time at the first suckling differed; in 2011, the baby sucked 24.4 minutes compared to 12.7 minutes in 1992 (p < .001) and 13.6 minutes in 1993 (p < .001). In 1992, 34.6% of the women reported using supplementary formula compared with 5.9% in 1993 and 9.3% in 2011 (p < .001). The mothers' contacts with the child or the father as well as their moods did not vary during the years. Mothers rated their feelings towards breastfeeding as being lower in 2011 than in 1992 and 1993 (p = .008). In 2011, mothers experienced breastfeeding as being more difficult and reported a higher degree of tension, insecurity and anxiety. CONCLUSIONS: Supplementation was given to healthy newborn infants, which does not conform to BFHIs intentions. Routines and support in relation to breastfeeding initiation need to be continuously evaluated in order to strengthen and sustain the BFHI.

Young women's decision-making process for HPV vaccination.

OBJECTIVES: To explore young women's decision-making process for HPV vaccination and to identify their beliefs about HPV vaccination. METHODS: This study employs a qualitative design. Data was collected by audio-taped interviews with 16 HPV vaccinated Swedish women, 17-26 years old. The data was analysed using latent content analysis. RESULTS: Three themes emerged from the data: "Fear of cancer", "Reliance on vaccination" and "Mother--the main motivational factor". One of the major reasons for taking the decision to be HPV vaccinated was fear of cancer: vaccination was seen as a way to protect oneself against this. The young women's decision-making surrounding HPV vaccination was based on reliance on vaccination and trust in health care. Support from the mothers of the young women and mothers' sponsorship of costs initiated HPV vaccination. Other motivational factors were advertisements and friends. Despite having been vaccinated, the young women were unaware of the relation between cervical cancer, sexual behaviour and HPV. CONCLUSION: These HPV vaccinated young women had limited knowledge about HPV. Therefore it is important that health professionals provide comprehensible information about HPV vaccination in attaining informed consent. In order to avoid misunderstandings, health care professionals in youth clinics and schools need to initiate discussion with young women, clarifying the relation between cervical cancer, HPV and sexual transmission.

Midwives at youth clinics attitude to HPV vaccination and their role in cervical cancer prevention.

OBJECTIVE: To explore youth clinic midwives role in cervical cancer prevention and their attitude to HPV vaccination. STUDY DESIGN: Individual interviews with 13 midwives working at youth clinics in Sweden. The interviews were recorded, transcribed, and analysed by qualitative content analysis. RESULTS: Three themes were identified in the qualitative content analysis: "Cervical cancer prevention not a prioritised area", "Ambivalence to the HPV vaccine", and "Gender and socioeconomic controversies". Few midwives talked spontaneously about cervical cancer prevention. The responsibility for providing information about HPV vaccination was considered as primarily that of school health nurses and parents. Midwives were positive about the HPV vaccination, but recognised certain risks, such as its potential negative impact on cervical cancer screening and increased sexual risk taking. The midwives expressed concerns with medical risks, such as side effects and unknown long-term effects of the HPV vaccine. The midwives in the study had ethical concerns that boys were not included in the program and not all families had the financial resources to vaccinate their children. Thus, weak socioeconomic groups might be excluded. CONCLUSION: The midwives considered cervical cancer prevention as important, but did not integrate information on the HPV vaccine into their routine work, mainly because young people visiting youth clinics had had their sexual debut and they were concerned about the medical risks and that the vaccine was too expensive.

Nonattendance in a cervical cancer screening program - what happens if women's requirements are met?

In this study we focus on women who have no registered cervical smear during the previous 5 years, their requirements for attendance, and promotive efforts performed. Of the 400 women randomly selected to answer a telephone-based questionnaire about future attendance at cervical cancer screening (CCS), 120 would consider having a cervical smear taken, and 50 of them wanted help to accomplish that. When meeting the women's requirements, such as being assured friendly treatment and a suitable appointment time, the numbers of registered cervical smears were higher for the study group compared with a control group. Still, the most highly resistant women did not attend.