"Because it eases my Childbirth Plan": a qualitative study on factors contributing to preferences for caesarean section in Thailand.

BACKGROUND: Although caesarean section (CS) rates have increased rapidly in Thailand, the upward trend is not supported by significant maternal or perinatal health benefits. The appropriate use of CS through QUALIty DECision-making by women and providers (QUALI-DEC project) aims to design and implement a strategy to optimize the use of CS through non-clinical interventions. This study aimed to explore the factors influencing women's and health professionals' preferences for CS delivery in Thailand. METHODS: We conducted a formative qualitative study by using semi-structured in-depth interviews with pregnant and postpartum women, and healthcare staff. Purposive sampling was used to recruit participants from eight hospitals across four regions of Thailand. Content analysis was used to develop the main themes. RESULTS: There were 78 participants, including 27 pregnant and 25 postpartum women, 8 administrators, 13 obstetricians, and 5 interns. We identified three main themes and seven sub-themes of women and healthcare providers' perceptions on CS: (1) avoiding the negative experiences from vaginal birth (the pain of labor and childbirth, uncertainty during the labor period); (2) CS is a safer mode of birth (guarantees the baby's safety, a protective shield for doctors); and (3) CS facilitates time management (baby's destiny at an auspicious time, family's management, manage my work/time). CONCLUSIONS: Women mentioned negative experiences and beliefs about vaginal delivery, labor pain, and uncertain delivery outcomes as important factors influencing CS preferences. On the other hand, CS is safer for babies and facilitates multiple tasks in women's lives. From health professionals' perspectives, CS is the easier and safer method for patients and them. Interventions to reduce unnecessary CS, including QUALI-DEC, should be designed and implemented, taking into consideration the perceptions of both women and healthcare providers.

Factors influencing the implementation of labour companionship: formative qualitative research in Thailand.

INTRODUCTION: WHO recommends that all women have the option to have a companion of their choice throughout labour and childbirth. Despite clear benefits of labour companionship, including better birth experiences and reduced caesarean section, labour companionship is not universally implemented. In Thailand, there are no policies for public hospitals to support companionship. This study aims to understand factors affecting implementation of labour companionship in Thailand. METHODS: This is formative qualitative research to inform the 'Appropriate use of caesarean section through QUALIty DECision-making by women and providers' (QUALI-DEC) study, to design, adapt and implement a strategy to optimise use of caesarean section. We use in-depth interviews and readiness assessments to explore perceptions of healthcare providers, women and potential companions about labour companionship in eight Thai public hospitals. Qualitative data were analysed using thematic analysis, and narrative summaries of the readiness assessment were generated. Factors potentially affecting implementation were mapped to the Capability, Opportunity, and Motivation behaviour change model (COM-B). RESULTS: 127 qualitative interviews and eight readiness assessments are included in this analysis. The qualitative findings were grouped in four themes: benefits of labour companions, roles of labour companions, training for labour companions and factors affecting implementation. The findings showed that healthcare providers, women and their relatives all had positive attitudes towards having labour companions. The readiness assessment highlighted implementation challenges related to training the companion, physical space constraints, overcrowding and facility policies, reiterated by the qualitative reports. DISCUSSION: If labour companions are well-trained on how to best support women, help them to manage pain and engage with healthcare teams, it may be a feasible intervention to implement in Thailand. However, key barriers to introducing labour companionship must be addressed to maximise the likelihood of success mainly related to training and space. These findings will be integrated into the QUALI-DEC implementation strategies.

How Thai men cope with depression: A qualitative study.

PURPOSE: This study aimed to describe how Thai men cope with depression while receiving treatment. DESIGN AND METHODS: This qualitative study used in-depth interviews with 23 Thai men with major depressive disorder. Retrieved data were analyzed using thematic analysis. FINDINGS: The findings are presented in four themes: responding to the diagnosis, finding ways to cope with depression, letting go, and progressing toward adjustment. PRACTICE IMPLICATIONS: These findings can help psychiatric nurses develop gender-specific psychoeducation curriculum for men, including mental health knowledge, engaging in gender-specific counseling, and recognizing the adjustment process and the masculine perspective.

Prisoners' perceptions of the healthcare service: A qualitative study.

It is recognized that the health of those in prison is poorer than the general population. The objective of this research is to understand the perceptions of the prisoners of the health care that they received at a district level prison in Thailand. We conducted a qualitative study, using in-depth interviews. Content analysis was used for data analysis. The participants were 13 prisoners. The findings reveal the prisoners have positive attitudes toward health services. They think that they are receiving the same standard of care as the general population. However, they are concerned about getting a communicable disease and accessibility to emergency care. There is limited dental care. The female prisoners have more trouble accessing health care than male prisoners. Suggestions for solving the inequality of care for prisoners includes increasing the collaboration with the community hospitals, using telehealth, adding female health providers, and developing inmate health volunteers among the prisoners.

Attempted Suicide Triggers in Thai Adolescent Perspectives.

The study goal was to describe attempted suicide triggers in Thai adolescents. A descriptive exploratory qualitative study approach was used utilizing in-depth interviews with twelve adolescents who had attempted suicide and six of their parents. Content analysis was conducted. Attempted suicide triggers were (1) severe verbal criticisms and expulsion to die by a significant family member, (2) disappointed and unwanted by boyfriend in first serious relationship, (3) unwanted pregnancy, and (4) mental illness leading to intense emotions and irresistible impulses. These attempted suicide triggers should be of concern and brought into suicide prevention management programs such as emotional management, effective communication for adolescents and family.

Buddhist group therapy for diabetes patients with depressive symptoms.

The objective of this study was to assess the effect of Buddhist group therapy on patients with type 2 diabetes who had depressive symptoms. A quasi-experimental design study using a control group with matching technique was conducted. After informed consent was obtained, the "Nine questions for assessing depressive disorder symptom" (Isan language) was used to determine the patient's condition. A total of 62 patients with type 2 diabetes who had depressive symptoms were assigned to either the experimental group (n = 32) or the control group (n = 32). Patients in the experimental group were divided further into four groups (8 patients per group) and attended the Buddhist group therapy. The intervention consisted of a weekly Buddhist group gathering lasting 2 hours for 6 weeks plus home meditation practices. Patients in the control group received treatment as usual. Both groups received standard physician treatment, including medication. Physicians did not know who was in either the control or experimental groups. Results show that 6 months after the intervention, 65.6% and 100% of patients in the control group and experimental group, respectively, returned to normal level. The intention-to-treat analysis, which included two participants in the experimental group lost follow-up, yielded a small reduction in the number of patients who returned to normal level (93.8%). With intention-to-treat analysis, the relative risk on depressive symptoms between the experimental and control groups was 6.5 (95% confidence interval, 1.4-30.6). Qualitative data from the experimental group supported that there were therapeutic group factors involved. However, patients realized the truth of being oneself and also accepted their current living condition. In conclusion, this program is effective in reducing depressive symptoms.

Enhancing a health-related quality-of-life model for Laotian migrant workers in Thailand.

We undertook this action research study to enhance the health-related quality of life (HRQOL) of Laotian migrant workers, and to conceptualize a practical model for workers for use in similar situations. Seventy Laotian migrant workers, 3 researchers, and 18 stakeholders took part in the study. Several data collection methods were utilized, including in-depth interviews, focus groups, participant observations, and field notes. Content analysis was employed to analyze qualitative data. Findings suggest that because of their participation in the study, the workers improved certain aspects of their HRQOL through participation, consciousness raising, and empowerment, which enabled them to become more self-reliant, confident, and competent, and have greater strength to overcome their difficulties. The Enhancing Laotian Workers' HRQOL Model was conceived as a practical model that could be used by community health nurses working with migrant workers in various contexts.

Perception of stress in Laotian migrant workers in Thailand.

Globalization and the movement of workers across borders in search of a better life or employment are presenting healthcare systems and researchers with problems of increasing complexity. This study focused on how migrant workers in Thailand from the Lao People's Democratic Republic conceptualized their stress and stressing factors. Participant observation, in-depth interviews, and field notes were employed in the study, which analyzed data from seventy subjects through qualitative content analysis. The migrant workers in this sample perceived stress as a state of being unable to fulfill their preferences or expectations revolving around issues of: living with poverty, employment, loneliness, poor relationships, competition in the workplace combined with job uncertainty, and invisibility. To provide care for the minority migrant workers, nurses need to focus on identifying how these users perceive stress, and urgent action and further research are needed.

The psychological impact of Buddhist counseling for patients suffering from symptoms of anxiety.

The purpose of this study was to examine the outcomes of individual Buddhist counseling interventions for patients suffering from symptoms of anxiety. A single-group pretest and posttest design was used to measure outcomes. Twenty-one patients participated in the study as voluntary subjects, all of whom completed two sessions of Buddhist counseling interventions. The individual Buddhist counseling program was developed by the investigators based on the Buddhist doctrine. The outcomes were evaluated with the use of the State-Trait Anxiety Inventory. Data were analyzed using the Friedman test, which provides an indicator for evidence-based outcomes related to anxiety reduction scores. The results revealed that the scores on the state anxiety test in relation to the trait anxiety test had been reduced at the 1-month follow-up. The findings from content analysis showed that when the patients practiced mindfulness, they were able to accept unpleasant situations calmly. Sixteen patients were prescribed lower doses of antianxiety medications. Furthermore, medication was discontinued for two patients, and three other patients continued their prescribed medication regimen completely. The study indicates that counseling as a basis from Buddhist principles has the potential to benefit patients with emotional anxiety-based problems.

Psychological morbidity of Thai families of a person with schizophrenia.

The paper presents data on families of a person with schizophrenia in rural Thailand, using the resiliency model of family stress, adjustment, and adaptation. The aim is to assess the impact of family factors on psychological morbidity of the mothers and relatives of a person with schizophrenia. One hundred and eight Thai families were interviewed based on family assessment instruments. Multiple regression analysis was performed. The findings suggest that in a stable stage of illness, other stresses of family life may have stronger impact on psychological status of family members, than the illness. Implications for clinical nurses and researchers are presented.