Experiences of women with impaired physical mobility during pregnancy, childbirth and postpartum: A case study.

INTRODUCTION: The research deals with a little-studied topic in Estonia: the experiences of women with impaired physical mobility (IPM) during pregnancy, childbirth, and in the postpartum period. Women with IPM, a vulnerable group, have a higher risk of complications and a higher probability of missing out on comprehensive maternity care. METHODS: The method of the present research is qualitative. It is a case study of three women with IPM with whom semi-structured interviews were conducted. RESULTS: It was found that women with IPM encountered several obstacles and problems during pregnancy, childbirth, and the postpartum period; despite this, women's experiences with maternity care were mostly positive. Furthermore, there are several areas for improvement to ensure more comprehensive maternity care. Women with IPM need more support and help, and midwives are expected to have additional knowledge regarding the specifics or limitations resulting from mobility impairments. CONCLUSIONS: In the future, the topic needs greater attention and improvement in the Estonian context to ensure more comprehensive maternity care for women with IPM. It is important to provide midwives the knowledge and skills to assist women with IPM during pregnancy, childbirth, and the postpartum period.

Existing Health Practices in Shaping the Decision to Participate During Breast Cancer Screening Among 50-69 Years Old Women in Estonia.

Introduction: Breast cancer is easily detectable by mammography and many countries run national screening programs for women as a target group. Yet, the majority of these countries have screening participation rates below the recommended level of 70%. Objective: The aim of the present article was to examine a connection between existing health practices and a decision to participate during breast cancer screening. Methods: Methodologically, this research was a web panel and quantitative telephone survey. The survey was conducted among 1200 Estonian women in the age group 50-69 years. Statistical data analysis was performed with SPSS using a descriptive and logistic regression model. Results: The findings revealed that among different background variables, age and existing health practices significantly influenced the decision-making for participating in the screening. Results also highlighted that the possibility to participate in the screening increased with existing supportive health practices and with the increasing age. Other sociodemographic factors did not have a significant influence on the decision-making of participation. Conclusions: There is a need to educate people from an early age about the developments in health practices that could support a healthy lifestyle in terms of individual responsibility. Thus, public health campaigns should not only call for action but also focus on health education in terms of the role of preventive medicine and health practices.

Frontline Healthcare Professionals' Views Regarding the Impact of COVID-19 on Ethical Decision-Making: A Multicentre Mixed-Methods Study from Estonia.

BACKGROUND: The objective of the study was to investigate frontline healthcare professionals' experiences and attitudes in relation to the COVID-19 pandemic's ethical and psychosocial aspects in Estonia. There were two research foci: first, ethical decision-making related to treating patients in the context of potential medical resource scarcity, and second, other psychosocial factors for healthcare professionals pertaining to coping, role conflicts, and the availability of institutional support. METHODS: An online survey was conducted in the fall of 2020 amongst the frontline healthcare professionals working in the three most impacted hospitals; respondents were also drawn from two ambulance services. The focus of the survey was on the first wave of COVID-19 (spring 2020). A total of 215 respondents completed the quantitative survey and qualitative data were gathered from open comments. RESULTS: Over half of the surveyed healthcare professionals in Estonia expressed confidence in their roles during the pandemic. More than half cited the complex ethical aspects related to their decisions as their main source of doubt and uncertainty. In response to this uncertainty, Estonian healthcare professionals drew on their previous training and experience, the policies and guidelines of their institution, and support from their colleagues, to aid their decision-making during the pandemic. CONCLUSIONS: Although frontline healthcare professionals faced difficult decisions during the first wave of the pandemic, overall, most agreed that experiencing the pandemic reconfirmed that their work mattered greatly.

Ethnic Identity in Transition: the Potential Impact of Ethnicity on Chronic Illness' Medication Adherence in Post-Soviet Country.

Previously, it has been shown that factors like ethnicity and proficiency of state's official language not only influence self-management abilities and medication adherence but may also indicate the level of trust in physicians, medication, and healthcare system. This research aims to examine the potential impact of ethnicity on medication adherence based on the example of a post-Soviet country. The research was carried out as a quantitative survey among 303 hypertension and type 2 diabetes patients in Estonia, involving participants from ethnic majority and minority. Research was conducted in community pharmacies and data analysed statistically with SPSS. The findings were opposite to previous research. Although members of the ethnic minority used less illness-related sources, these sources relied more on evidence-based medicine compared to the ethnic majority. Because of this, medication adherence was also slightly higher for the ethnic minority compared to the majority. Therefore, these findings indicate trust in medical authorities, their decisions, and recommendations. There was a statistically significant relationship between general and illness-related information-seeking activity; however, medication adherence was not related to information-seeking activity. The research outlines that in addition to ethnolinguistic aspect, also potential cultural influence might determine the trust in medicine and medication adherence.

A qualitative study of the challenges in rearranging community pharmacy service provision during the COVID-19 public health emergency: The prism of social practice theory.

OBJECTIVES: While healthcare systems struggle to manage the COVID-19 pandemic, community pharmacies have changed the way in which they serve society by ensuring the availability of primary-level medical care. This study aims to examine the rearrangement of service provision at community pharmacies through the prism of social practice theory. STUDY DESIGN: Qualitative in-depth semi-structured interviews. METHODS: In total, 21 community pharmacists, 3 hospital pharmacists and 10 experts in Estonia were interviewed. For data analysis, two-dimensional thematic textual analysis was performed according to four types of practices proposed in social practice theory and based on temporal distinction. RESULTS: The findings of this study reveal that, in order to maintain and improve community pharmacy service provision during the pandemic, there have been changes to all aspects of practice elements, including practical understandings, rules and teleological structures. The majority of challenges were experienced because of necessary changes to the habitual ways of providing pharmacy services, indicating resistance to these changes and reinforcing the need to continue existing 'practice-bundles'. Limited access to healthcare services during the COVID-19 pandemic has resulted in community pharmacists becoming the primary (and only) accessible healthcare contact; thus, leading to a shift in awareness about the role of pharmacists. CONCLUSIONS: Although large-scale changes may result in the dissolvement of practice-bundles and require readiness to adjust current methods of service provision, dissolution is a gradual process. There is an urgent need to support pharmacists in managing the challenges of rearranging service provision, such as immediate organisational changes, lack of information and changing resources.

Practice theoretical approach on the reasons why target group women refrain from taking breast cancer screening.

OBJECTIVE: Breast cancer is the most common cancer in women. Despite the availability of effective breast cancer screening programmes, there are only six countries in the European Union reaching the recommended target rate of 70% screened. In addition to the individual reasons for refraining from breast cancer screening, this research aims to follow earlier suggestions to use a practice theoretical approach. METHODS: The study sites were Estonia and Latvia, where 9 and 12 semi-structured interviews were conducted, respectively. Convenience and snowball sampling methods were used. The research was approved by ethics committees in both countries. The interviews passed textual analysis and coding. RESULTS: The findings revealed that there are three major types of reasons - habitual, practical, and emotional - that influence the formation of the final decision to participate in breast cancer screening. CONCLUSION: The implementation of an individualistic approach is not sufficient to bring along desired health behaviour. All groups of reasons, individual and societal context are involved in the decision formation. Thus, structurally provided approaches and messages should be re-conceptualised and re-designed accordingly. PRACTICE IMPLICATIONS: Future screening related campaigns and public health education should address the concerns derived from different types of reasons for refraining from screening.

The rising impact of civic activism on health policy: The analysis of the closure of smaller obstetric units in Estonia.

In 2017, the Estonian government performed an administrative reform with the promise to keep vital services available for people. In March 2018, the closure of two smaller obstetrics units (OU) was announced, thereby raising resistance by community members. The aim of the research is to identify public perceptions and information needs during the closure process of smaller maternity units, and examine it in the context of recently performed administrative reform. Data was collected from 226 respondents via a web-based questionnaire. To evaluate the level of information seeking activity for pregnancy- and birth-giving-related information, new aggregated index variables were constructed. For authorities and lay-people "near home" and "safety" had different meanings in the context of childbirth. Findings revealed strong correlations between perceived information availability and sufficiency (for pregnancy, birth-giving and transfer to the hospital). The subjective lack of information appeared in recognition of the start of the labour and how, when, and where to go. Respondents considered both the medical capability and personal aspects to be equally important. Considering the lack of knowledge and hesitancy among Estonians, the arguments of civic activists presented in the debate were well-grounded. To conclude, public communication must be consistent and people need clearer instructions for activities related to labour-period and security that necessary features of medical help and personal approach to be both available.

The adaptation of everyday practices in the adoption of chronic illness.

This article uses social practice theory to examine the role of information-seeking in the maintenance of existing lifestyle and illness-related adjustments in the context of chronic illnesses. The research findings are derived from a thematic analysis of 16 semi-structured in-depth interviews with Estonian Parkinson's disease patients. The coding scheme bases on the four practice elements outlined by Schatzki (practical understandings, rules, teleological structures and general understandings) and other categories related to chronic illness self-management skills, bodily movements, daily routines and information-seeking practices. The findings reveal that people with chronic illness value maintaining their existing lifestyles as long as possible and the willingness to seek out illness-related information is related to the severity and duration of the disease. These findings suggest that effective illness-related communication that supports self-management should provide patients with possibilities to adjust and switch between practices in a time and a pace that is natural and acceptable to them.