Exploring the Experiences of Middle Income Mothers in Practicing Exclusive Breastfeeding in Nairobi, Kenya.

Objectives To establish exclusive breastfeeding (EBF) practice, women are encouraged to initiate breastfeeding of their newborns within one hour of delivery and breastfeed exclusively for the first 6 months of the infant's life. Research in Kenya has shown evidence of a reduced rate of EBF with an increase in socio-economic class (SES). This study explores the experiences of middle-income women so as to understand their attitudes and practices of EBF and to contribute toward the Baby Friendly Hospital (BFHI) and Baby Friendly Community Initiatives (BFCI) programs in Kenya. Methods A qualitative study using nine in-depth interviews and two focus group discussions were conducted with middle-income women with a child < 2 years. Thematic content analysis was used to analyze the data. Results The majority of the women interviewed did not achieve EBF and this was attributed to many challenges that they encountered such as; inadequate workplace support including short maternity leave, lack of designated breast feeding facilities flexible hours and breastfeeding breaks. Support structures were highlighted as either inadequate or lacking while the internet was preferred by most of the women for breastfeeding information. Mass media was seen as more credible, though some women indicated that there was lack of depth in the information it provided. Conclusion The study showed that majority of women were unable to EBF for the first 6 months. Women experienced inadequate social, healthcare and workplace support and preferred online sites for information on breastfeeding than the healthcare professionals or mass media. Recommendation There is need to implement policies at the workplace that promote a breastfeeding friendly environment. There is also a need for more research on role of mass media in promotion of optimal breastfeeding practices, especially how to reach this population. There is a need for continued advocacy on social support including spousal, relatives, and other community members at the community level.

Perspectives on cervical cancer screening among educated Muslim women in Dubai (the UAE): a qualitative study.

BACKGROUND: Cervical cancer (CC) is the seventh leading cause of death among women in the United Arab Emirates (UAE), with most deaths attributed to late detection of this cancer. The UAE lacks a national CC screening programme. Thus, cervical screening is only performed opportunistically during women's visits to health facilities. CC screening rates in the UAE are as low as 16.9 %, and little is known about the perspectives of the nation's educated Muslim women regarding screening. Consequently, the aim of this study is to explore Muslim women's perspectives towards cervical screening in Dubai to promote strategies for increasing its uptake, thereby leading to a decrease in morbidity and mortality associated with CC. METHODS: Interpretivist and social constructivist epistemological approaches were applied for this qualitative study. Data were obtained through 13 in-depth interviews. Purposive and snowballing methods were used to recruit six South Asian women and seven Emirati women living in Dubai. Thematic content analysis was concurrently applied with comparative analysis to the data. RESULTS: Four themes regarding women's perceptions of CC emerged from the data. First, CC was considered a 'silent disease' that could be detected with early screening. However, it was also associated with extramarital sexual relations, which negatively influenced screening uptake. Second, women's fear, pain and embarrassment, along with cultural influences, deterred them from undergoing screening. Third, a growing mistrust of allopathic medicine and impersonal healthcare promoted a negative view of screening. Last, women became aware of screening mainly when they were pregnant or receiving fertility treatment. CONCLUSIONS: The study highlighted a number of important factors relating to cultural, religious and sexual behaviour that shaped educated Muslim women's perspectives on CC screening. Evidently, the current opportunistic approach to screening is flawed. A national awareness programme on CC screening should be developed, tailored to the sociocultural norms of the Muslim community, to promote knowledge regarding the causes of CC and the importance of screening.

Exploring health care professionals' and women's perspectives on the barriers to maternal health services: a qualitative study in Eku Town of Delta State, Nigeria.

Uptake of maternal health services (MHS) have been shown to improve maternal health outcomes. In Nigeria, the maternal outcomes are classified among the poorest worldwide, despite the provision of free MHS to all pregnant women by many Nigerian state governments. The work was aimed at exploring the barriers to the uptake of MHS, from the perspectives of both women and health care professionals (HCP) in Eku Town of Delta State Nigeria, in order to gain a better understanding on views of MHS, and to guide future interventions, effective programs and policy strategies. Using an interpretivist and social constructivist epistemology approach, a qualitative study using 13 in-depth interviews were conducted. Seven women and six HCPs were recruited using purposive and snowballing sampling methods. Thematic content analysis was applied to the data. Three themes emerged. (1) Perspectives to free MHS. The majority of women preferred non-skilled Traditional Birth Attendants (TBAs) over the hospital heath service, as TBAs were viewed as more caring; with orthodox practice not being socially, culturally and religiously friendly. (2) Barriers to utilization: HCPs saw the barriers to hospital MHS as misconceptions by the women; the women mentioned the negative attitude of the HCPs and deficits in the free MHS scheme. (3) Enhancing utilization: HCPs stated that improved uptake of MHS required synergy between the community, government/hospital management through awareness, cultural/religious sensitivity, and HCP/TBA training. For the women, a change of HCPs hostile attitude and provision of more conducive hospital environment was required. There are a number of supply and demand factors that influence HCPs and women's perspectives of the uptake of MHS. Interventions and policies need to address both factors with the aim of improving the access and uptake of MHS in Nigeria.

"Tu" or "Vous?" A European qualitative study of dignity and communication with older people in health and social care settings.

OBJECTIVE: To examine the experiences of communication between older people and health and social care providers in six European countries. METHODS: Focus groups were carried out with groups of older people (91 focus groups, 391 participants), and health and social care professionals (85 focus groups, 424 participants), in order to gain insights into concepts of good communications. Data collection and analysis continued concurrently according to the method of constant comparison. RESULTS: Different styles of communication between professionals and older people were found to be capable of enhancing or jeopardising dignity. The use of appropriate forms of address, listening, giving people choice, including them, respecting their need for privacy and politeness, and making them feel valued emerged as significant ways to maintain older peoples' sense of self-worth and dignity. Despite being aware of good communication practices, health and social care professionals often failed to implement them. Lack of time, staff, resource scarcity, regulation and bureaucracy were cited as barriers, as was a lack of awareness and effort. CONCLUSIONS AND PRACTICE IMPLICATIONS: The findings have important implications for health and social care professionals when they engage with older people.

Supporting young mothers into education, employment and training: assessing progress towards the target.

The government has set a target of increasing the participation of teenage mothers in education, employment and training (EET) to 60% by 2010 to reduce their risk of long-term social exclusion. This paper presents the findings of a qualitative research project conducted in the South West region of England to establish the tracking practices employed by practitioners working with young parents to ascertain whether and to what extent teenage parents are engaged in EET. The range of support that is currently needed by and provided to teenage parents when returning to or continuing their EET was also investigated. Semi-structured telephone interviews were conducted with 24 participants from a unitary authority, county and city within the region; participants were working in a variety of professional roles with responsibilities for teenage parents. The results show that in the South West there are currently no standard procedures or practices in place for effectively tracking the participation of teenage parents in EET. There was evidence of a good understanding of the needs of young parents amongst practitioners and that a variety of support was being provided to them. However, it needs to be understood, and addressed, that having contact with young parents and providing them with support does not necessarily lead to the standardised information that is needed in order to assess progress towards the target. We conclude that in order to assess in a meaningful way progress towards the target of 60% participation by 2010, a clear protocol for the collection and collation of information--and responsibility for this--needs to be developed and implemented.

Dignity under threat? A study of the experiences of older people in the United Kingdom.

Theoretical accounts have offered a general understanding of the social significance and importance of dignity and suggest that older age may threaten dignity by structuring and limiting the opportunities for participation and/or social recognition. Micro-sociological research has shown how older people negotiate their identity, in the face of its erosion by the aging body and disability and the domination of health and social care workers. These theoretical approaches inform the study presented here, which explores the meaning and experience of dignity for older people in their daily lives. Older people's accounts were elicited through a series of focus groups with participants living in England and Wales. Participants were selected according to predefined criteria to represent a range of different socio-economic and ethnic backgrounds, levels of fitness, and home circumstances. Personal identity and autonomy were the aspects of dignity most meaningful to the participants, and discussions tended to focus mainly on when personal identity and autonomy were threatened or violated in the context of the provision of health and social care. The authors discuss the extent to which older people's discourse on dignity resonates with the theoretical discourse.

Views on dignity in providing health care for older people.

AIM: The aim of this study was to explore the salience and meaning of dignity and dignified care for care providers and the implications for the proviosion of care. The project forms part of an international study being undertaken in different European countries comparing health and social care workers' views on dignity. METHOD: Focus groups were chosen as the primary method of data collection. Twelve focus groups were carried out involving a total of 52 participants representing a range of occupational groups. RESULTS: All participants stated that dignity and respect were important for people of all age groups. The evidence that emerged from these focus groups showed that, in spite of the appropriate intentions of providers, older people were not consistently provided with dignified care. CONCLUSION: In order to ensure dignity in providing care for older people, tasks need to be organised around older people's needs and time frames. Without such changes there is a danger that 'institutional ageism' will persist in the health service.

'Questerviews': using questionnaires in qualitative interviews as a method of integrating qualitative and quantitative health services research.

OBJECTIVES: Multi-method approaches are increasingly advocated in health services research (HSR). This paper examines the use of standardised self-completion questionnaires and questions, during in-depth interviews, a technique termed 'questerviews'. METHODS: 'Questerview' techniques were used in four empirical studies of health perceptions conducted by the authors. The studies included both standardised self-completion questions or questionnaires and in-depth interviews. Respondents were tape-recorded while they completed the standardised questionnaires and were encouraged to discuss their definitions of terms and responses to items in-depth. In all studies, 'questerviews' were fully transcribed and data analysis involved the scrutinising of transcripts to identify emergent themes. RESULTS: Responses to the standardised items led to rich sources of qualitative data. They proved to be useful triggers as respondents discussed their understanding and definitions of terms, often explaining their responses with stories from their own experiences. The items triggered detailed exploration of the complex factors that comprise health, illness and healthcare seeking, and gave considerable insight into the ways in which people respond to standardised questions. Apparently simple questions and response categories conceal considerable complexity. CONCLUSIONS: Inclusion of standardised survey questions in qualitative interviews can provide an easy and fruitful method to explore research issues and provide triggers to difficult or contested topics. Well designed and validated questionnaires produce data of immense value to HSR, and this value could be further enhanced by their use within a qualitative interview. We suggest that the technique of 'questerviews' is a tangible and pragmatic way of doing this.

Older people. Courtesy entitles.

A study of 72 people, with an average age of 72, showed that dignity--and lack of it--were key issues in their estimation of care. Concerns about lack of dignity centred on lack of privacy, mixed sex wards, forms of address and loss of independence. The study suggested that older people do not complain about care for fear of retaliation.

Night pain in hip and knee osteoarthritis: a focus group study.

OBJECTIVE: To explore the experience of night pain in people with hip or knee osteoarthritis (OA). METHODS: Twenty-eight focus groups were conducted in 6 centers in 4 countries, with a total of 130 men and women with hip or knee OA. Two focus groups were excluded from the analysis, leaving 26 groups comprising 123 participants. Sampling was performed to ensure approximately equal representation of individuals with mild, moderate, and severe pain, hip OA, and knee OA. Format and methodology were standardized across centers, and participants described and discussed their experience of night pain. The focus groups were audio-recorded and transcribed. Data were analyzed by identifying emergent codes that were grouped and compared, resulting in the identification of key themes. RESULTS: The majority of participants (81%) experienced night pain; the remaining 19%, who reported no night pain, were from the moderate or severe pain focus groups. Similar night pain experiences were expressed by the hip and knee OA participants. Night pain was also present regardless of the stage of OA, but severity increased as the disease progressed. Night pain was variable and intermittent. Three key themes were identified: prediction of night pain, sleep disturbance, and adaptations and treatment regimens. CONCLUSION: Due to its variability and complexity, the assessment of night pain should take into account the importance of the patient narrative. Also, night pain may not be a distinct marker of disease severity, and this may have implications for its use as a priority indicator for total joint replacement.

Assessing chronic joint pain: lessons from a focus group study.

OBJECTIVE: To explore the pain experience of persons with chronic pain of the hip or knee in the context of self-assessment instruments commonly used to assess pain severity in individuals with osteoarthritis. METHODS: Participants who reported that they currently had either hip or knee pain were recruited from the UK Somerset and Avon Survey of Health. A total of 28 participants (14 men and 14 women, ages 57-89 years) took part in 6 focus groups stratified according to pain site and severity. Using the "questerviews" technique, participants described and discussed their experience of joint pain in the context of standard self-assessment questionnaires: the Hip Disability and Osteoarthritis Outcome Score and the Knee Injury and Osteoarthritis Outcome Score. The focus groups were audio recorded and transcribed. Data were analyzed by identifying emergent codes that were grouped and compared, resulting in the identification of key categories. RESULTS: Both knee pain and hip pain participants expressed similar pain experiences. Four key categories were identified, all of which impacted upon participants' responses to the standardized questionnaires: pain is intermittent and variable, pain elsewhere in the body influences the experience of joint pain, pain is inextricable from function, and adaptation and avoidance strategies modify the experience of pain. CONCLUSION: The assessment or measurement of pain should take into account the importance of pain experience as well as severity through use of patient narrative accounts.

"Me's me and you's you": Exploring patients' perspectives of single patient (n-of-1) trials in the UK.

BACKGROUND: The n-of-1 trial offers a more methodologically sound approach to determining optimum treatment for an individual patient than "trials of therapy" routinely conducted in clinical practice. However, such methodology is rarely used in the UK. This pilot study explores the acceptability of n-of-1 trials to patients in the UK. METHODS: Patients with osteoarthritis of the knee were recruited to their own 12-week n-of-1 trial comparing either two knee supports or an NSAID with simple analgesic. Patients were interviewed at the start and completion of their trial to explore reasons for participation, understanding of the trial design and experiences of participation. Daily diaries were completed to inform future treatment. RESULTS: Nine patients participated (5 supports, 4 drugs). Patients were keen to participate, believing that the trial may lead to personal gains such as improved symptom control and quality of life. However, recruitment to the pharmacological comparison was more difficult since this could also entail risk. All patients were eager to complete the trial, even when difficulties were encountered. Completing the daily diary provided some patients with greater insight into their condition, which allowed them to improve their self-management. The n-of-1 trial design was viewed as a 'logical' design offering an efficient method of reaching a personalised treatment decision tailored to suit individual needs and preferences. CONCLUSION: This pilot study suggests that patients perceive the n-of-1 trial as an acceptable approach to the individualisation of treatment. In addition, further benefits over and above any gained from the interventions can be derived from involvement in such a study.

Dignity in older age: what do older people in the United Kingdom think?

BACKGROUND: Dignity is a complex concept and there is little empirical research to show how older people view dignity. This study, using qualitative methods, explored the concept of dignity from the older person's perspective. METHODS: 15 focus groups and two individual interviews were conducted in 12 different settings, with a total of 72 participants. Participants were purposively sampled to ensure a mix of socio-economic status, ethnicity, gender, age (65+) and level of fitness. Focus groups were audio-taped and transcribed. The method of constant comparison was used to analyse the data. RESULTS: There was strong evidence to suggest that dignity was salient to the concerns of older people. Dignity was seen as a multi-faceted concept: (i). dignity of identity (self-respect/esteem, integrity, trust); (ii). human rights (equality, choice); and (iii). autonomy (independence, control). Examples of dignity being jeopardised rather than being enhanced were given. A loss of self-esteem arose from being patronised, excluded from decision-making, and being treated as an 'object'. Lack of integrity in society meant that there was an inability to trust others and an increased vulnerability. Equality was an important issue but many felt that government policies did not support their rights. CONCLUSIONS: This work identifies the different ways dignity is conceptualised by older people. The evidence showed that person centred care for older people needs to be specifically related to communication, privacy, personal identity and feelings of vulnerability. It provides evidence for policy makers and professionals to tailor policies and practices to the needs of the older person.