The validity and reliability study of the first-time fathers questionnaire in Turkish.

The father's participation in the birth contributes significantly to the mother's birth experiences as well as to the fatherhood process. Since fathers have traditionally not been allowed to attend childbirth in Turkish public hospitals, which now is changing, there is a lack of research in this area. To remedy this shortcoming, a questionnaire that explores the Turkish fathers' experiences of childbirth is needed. The study aims to translate, validate, and adapt the pre-existing First-Time Fathers' Questionnaire to the Turkish language and culture. In the first stage of the study, the questionnaire was translated to Turkish. Expert opinions of the First Time Father Questionnaire were taken, and the content validity was checked. The revised questionnaire was then completed by 110 fathers. The average age of the fathers participating in the study was 32.12 ± 6.8 and 80 % of them were found to be middle class. The construct validity of the questionnaire was tested with explanatory factor analysis and confirmatory factor analysis, finally a test-retest was performed. The Cronbach's alpha coefficient for each dimension of the 20-items questionnaire was as follows: knowledge = 0.90, acceptance = 0.90, anxiety = 0.88, and emotional support = 0.66. All sub-dimensions correspond to 68.5 % of the total variance. The confirmatory factor analysis model showed consistency for the data (X2/DF = 1.078; RMSA = 0.027; CFI = 0.992; GFI = 0.900; AGFI.0.829). Therefore, the adaptation of the First Time Fathers Questionnaire is a valid and reliable instrument in evaluating the childbirth experiences of first-time fathers in Turkish culture.

Syrian women's experiences of being pregnant and receiving care at antenatal clinics in Sweden for the first time after migration.

OBJECTIVE: To describe Syrian women's experiences of being pregnant and receiving care at antenatal clinics for the first time after migration. METHODS: A phenomenological lifeworld approach was used. Eleven women from Syria enrolled at antenatal clinics, who were experiencing their first pregnancy in Sweden but who may have given birth before in other countries, were interviewed in 2020. The interviews were open and based on one initial question. Data were inductively analysed using a phenomenological method. RESULTS: The essence of Syrian women's experiences of being pregnant and receiving care at antenatal clinics for the first time after migration was the importance of being met with understanding to create trust to build a sense of confidence. The following four constituents capture the essence of the women's experiences: "It was important to feel welcomed and to be treated like an equal"; "A good relationship with the midwife strengthened self-confidence and trust"; "Good communication despite language difficulties and cultural differences was important"; and "Previous experience of pregnancy and care influenced the experience of the care received". CONCLUSION: Syrian women's experiences reveal a heterogeneous group with different experiences and background. The study highlights the first visit and emphasises the importance of this visit for future quality of care. It also points out the negative occurrence of the transferring guilt from the midwife to the migrant woman in case of cultural insensitivity and clashing norm systems.

A Lifestyle Intervention During Pregnancy and Its Effects on Child Weight 2.5 Years Later.

AIM: The aim of this study was to evaluate if overweight and obesity in the offspring is reduced by a low-intensity antenatal primary care intervention with focus on diet and physical activity for pregnant women with obesity, comparing children to mothers receiving the intervention with children to mothers who did not. METHODS: This study is a follow-up of children 2.5 years of age after their mothers' participation in a non-randomised controlled intervention intending to limit gestational weight gain. All study participants received standard antenatal care. The intervention group received lifestyle support via motivational talks with midwife and support from dietician. Data on child weight were collected by medical records, letter and phone. RESULTS: There was no significant difference between the groups 2.5 years after intervention (International Obesity Task Force ISO-BMI 25 (child BMI corresponding to adult BMI of 25): 20% vs. 21%; ISO-BMI 30: 4.6% vs. 1.3%). The mother's BMI at the beginning of pregnancy significantly influenced child BMI at 2.5 years (r = 0.13, p = 0.014, r2 = 0.017). For each unit of increase in maternal BMI at enrollment, the probability of child ISO-BMI ≥ 25 increased by 7.5% (p = 0.021) and of ≥ 30, by 12.9% (p = 0.017). CONCLUSION: The frequency of overweight and obesity of the children at 2.5 years of age was significantly correlated to the mother's BMI, but not correlated to the mothers' participation in the antenatal lifestyle intervention. Thus, it seems important to address obesity and lifestyle issues before and between pregnancies. Trial registration The study has been registered at ClinicalTrials.gov, Identifier: NCT03147079.

Cost effectiveness of a controlled lifestyle intervention for pregnant women with obesity.

BACKGROUND: The Mighty Mums antenatal lifestyle intervention is a person-centered behavioral intervention focusing on nutrition and physical activity for pregnant women with obesity (body mass index [BMI] ≥30). The aim of this study was to evaluate the costs and clinical outcomes of adding the Mighty Mums intervention to standard antenatal care. METHODS: Participants in the intervention group (n = 434) received motivational talks with their midwife and a selection of physical and/or nutritional activities in addition to antenatal care. Control participants (n = 867) from adjacent geographic areas received standard antenatal care. Costs for staff, unit costs for specific activities, and registered costs for specialized antenatal care were analyzed for associations with gestational weight gain and self-reported health. Results are reported for the intention-to-treat (ITT) population and a per protocol (PP) population identified by participation in the intervention. Analyses included bootstrapped linear regressions adjusted for background characteristics that differed significantly between groups. RESULTS: The average costs were SEK 9727 higher (95% confidence interval [CI]: 6677 to 12,777) among participants in the intervention group than in the control ITT population and SEK 8655 (95% CI 4586 to 12,724) higher than in the PP population. The cost increase per 1 kg reduction in gestational weight gain was SEK 12,369 in the ITT population and SEK 7209 for the PP population. CONCLUSION: Participation in the Mighty Mums intervention was associated with higher costs, but also reduced gestational weight gain. The cost per kilogram reduction in gestational weight gain was low, particularly in the PP population. A future decision to implement this behavioral intervention in standard care should take into account society's willingness to pay per unit reduction in gestational weight gain. TRIAL REGISTRATION: The study is registered at ClinicalTrials.gov , Identifier: NCT03147079 .

Physicians' experiences of video consultation with patients at a public virtual primary care clinic: a qualitative interview study.

OBJECTIVE: To describe physicians' experiences of video consultation with new patients visiting a publicly owned virtual primary care clinic. DESIGN: In this qualitative study, data were collected from semi-structured individual interviews and analysed by systematic text condensation. SETTING: A publicly owned virtual primary care clinic in Region Västra Götaland, Sweden. SUBJECTS: Ten primary care physicians working at the clinic. RESULTS: Connecting with a patient over video could be either straightforward or deficient, depending on communication and the patient's condition. Clinical experience, communication skills, and involving patients throughout the consultation and examination were crucial for assessments over video where patients were guided to perform self-examination. The flexibility of work and the regulated assignment online were positive for the physicians' work situation and wellbeing. Providing video consultation within the same organisation as the patient's regular health centre was considered to facilitate patient care and safety. Video consultation was considered suitable for some diagnoses and for some patients not able to reach a primary healthcare centre, though doubts were expressed about the healthcare and social benefits of this virtual care service. CONCLUSION: For the physicians, video consultation induced changes in the basis for assessment of primary care patients. The limitations on informational exchange demanded an extended form of patient involvement founded upon consultation skills, clinical experience and new skills for virtual examination. Combining virtual care with traditional general practice has the potential to reduce the workload for the individual physician and ensure medical competence in virtual primary care. Video consultation experienced suitable in some situations, but easy access to it expressed problematic in terms of medical prioritisation in healthcare.KEY POINTSVideo consultation is suitable for primary care visits for some patients, but physicians' experiences of this are rarely studied. •Clinical experience and consultation skills are important for video assessment of primary care patients which involves physician-guided patient self-examination.•Video consultation facilitates care in some situations and could benefit from the provider being connected to patient's regular health centre.•Virtual care offers a flexible way of working but challenges healthcare prioritisation from the primary care physician's perspective.

Prognostic factors for future mental, physical and urogenital health and work ability in women, 45-55 years: a six-year prospective longitudinal cohort study.

BACKGROUND: Impaired health due to stress is a common cause of long-term illness in women aged 45-55 years. It is a common cause for visits to primary health care (PHC) and may influence work-ability. The aim of this study was to investigate prognostic factors for future mental, physical and urogenital health as well as work-ability in a population of average women aged 45-55 years. METHODS: This longitudinal cohort study initially assessed 142 women from PHC centers in southwestern Sweden. One houndred and ten accepted participation and were followed for 6 years. They were assessed using the self-reported questionnaires: the Menopause Rating Scale (MRS), the Montgomery-Asberg Depression Rating Scale (MADRS-S), the Short-Form Health Survey (SF-36). Descriptive data are presented of health, education, relationships and if they are working. Multicollinearity testing and logistic regression were used to test the explanatory variables. RESULT: Severity of symptoms in the MRS somatic and urogenital domains decreased while they increased in the psychological and depressive domains. Having tertiary education was associated with decreased overall mental health, vitality and social role functioning. Living with a partner was associated with increased physical role functioning, social role functioning and emotional role functioning. CONCLUSION: Quality of life seems to be enhanced by a good relationship with the partner, social support and work/life balance. Therefore, to improve women health women should early discuss ways in which these issues can be incorporated as they pursue their academic or career goals. Hence, we emphasize the importance of supporting women to gain increased awareness about a healthy life balance and to have realistic goals in work as well as in their social life.

Experiences of health after dietary changes in endometriosis: a qualitative interview study.

OBJECTIVES: Endometriosis is a chronic disease with no known cure. Persons affected by this disease often use complementary therapies such as dietary changes to reduce their symptoms, and so it is important to investigate whether and how these therapies affect endometriosis symptoms. The aim of this study was to explore how persons with endometriosis experienced their health after dietary changes. DESIGN: Semi-structured qualitative interviews were conducted with 12 persons with endometriosis who had made individual dietary changes aimed at decreasing their endometriosis symptoms. The interviews were recorded and transcribed verbatim, and analysed using thematic analysis. SETTING: Region Västra Götaland and the estern part of Central Sweden, Sweden. PARTICIPANTS: Twelve persons with endometriosis aged 28 to 44 were recruited from two Swedish endometriosis support forums on the Internet. RESULTS: Participants experienced an increase in well-being and a decrease in symptoms following their dietary and lifestyle changes. They also felt that the dietary changes led to increased energy levels and a deeper understanding of how they could affect their health by listening to their body's reactions. The participants understood that they could influence their symptoms through lifestyle changes. Support from family and friends was important in implementing and sustaining the dietary changes. However, the participants stressed the lack of support from healthcare professionals. CONCLUSIONS: This study contributes to filling the knowledge gap about dietary strategies in endometriosis and lifestyle change as a method of alleviating suffering and increasing well-being. An important finding is that the participants experienced decreased symptoms and increased well-being after adopting an individually-adapted diet. Healthcare professionals should take their patients' knowledge and experience into consideration, and allow patients to participate in their own care. Further research is necessary to give evidenced-based dietary advices in endometriosis.

Fathers' reactions over their partner's diagnosis of peripartum cardiomyopathy: A qualitative interview study.

BACKGROUND: Fathers' experience of childbirth has been described as both distressing and wonderful, but little has been described in the literature about fathers´ reactions when their partners get life threatening diagnoses such as peripartum cardiomyopathy (PPCM) during the peripartum period. AIM: To learn more about fathers' reactions over their partner's diagnosis of peripartum cardiomyopathy. METHODS: Fourteen fathers, whose partner was diagnosed with PPCM before or after giving birth, were interviewed. Data were analysed using inductive content analysis technique. RESULTS: The first reaction in fathers was shock when they heard their partner had PPCM, which was sudden, terrible and overwhelming news. Their reactions to trauma are described in the main category: The appalling diagnosis gave a new perspective on life with emotional sub-categories: overwhelmed by fear, distressing uncertainty in the situation and for the future, feeling helpless but have to be strong, disappointment and frustration, and relief and acceptance. Although terrified, fathers expressed gratitude towards health care professionals for the diagnosis that made it possible to initiate adequate treatment. CONCLUSION: Exploring father's reactions will help peripartum and cardiology healthcare professionals to understand that emotional support for fathers is equally important as the support required for mothers during the peripartum period. Specifically they will help professionals to focus on future efforts in understanding and meeting the supportive care needs of fathers when their partner suffers from a life-threatening diagnosis like PPCM.

Mighty Mums - a lifestyle intervention at primary care level reduces gestational weight gain in women with obesity.

BACKGROUND: Obesity (BMI ≥30) during pregnancy is becoming an increasing public health issue and is associated with adverse maternal and perinatal outcomes. Excessive gestational weight gain (GWG) further increases the risks of adverse outcomes. However, lifestyle intervention can help pregnant women with obesity to limit their GWG. This study evaluated whether an antenatal lifestyle intervention programme for pregnant women with obesity, with emphasis on nutrition and physical activity, could influence GWG and maternal and perinatal outcomes. METHODS: The intervention was performed in a city in Sweden 2011-2013. The study population was women with BMI ≥30 in early pregnancy who received standard antenatal care and were followed until postpartum check-up. The intervention group (n = 459) was provided with additional support for a healthier lifestyle, including motivational talks with the midwife, food advice, prescriptions of physical activity, walking poles, pedometers, and dietician consultation. The control group was recruited from the same (n = 105) and from a nearby antenatal organisation (n = 790). RESULTS: In the per-protocol population, the intervention group had significantly lower GWG compared with the control group (8.9 ± 6.0 kg vs 11.2 ± 6.9 kg; p = 0.031). The women managed to achieve GWG < 7 kg to a greater extent (37.1% vs. 23.0%; p = 0.036) and also had a significantly lower weight retention at the postpartum check-up (- 0.3 ± 6.0 kg vs. 1.6 ± 6.5 kg; p = 0.019) compared to the first visit. The most commonly used components of the intervention, apart from the extra midwife time, were support from the dietician and retrieval of pedometers. Overall compliance with study procedures, actual numbers of visits with logbook activity, and dietician contact correlated significantly with GWG. There was no statistically significant difference in GWG (10.3 ± 6.1 kg vs. 11.2 ± 6.9 kg) between the intervention and control groups in the intention-to-treat population. CONCLUSION: Pregnant women with obesity who follow a lifestyle intervention programme in primary health care can limit their weight gain during pregnancy and show less weight retention after pregnancy. This modest intervention can easily be implemented in a primary care setting. TRIAL REGISTRATION: The study has been registered at ClinicalTrials.gov, Identifier: NCT03147079. May 10 2017, retrospectively registered.

Adopting a healthy lifestyle when pregnant and obese - an interview study three years after childbirth.

BACKGROUND: Obesity during pregnancy is increasing and is related to life-threatening and ill-health conditions in both mother and child. Initiating and maintaining a healthy lifestyle when pregnant with body mass index (BMI) ≥ 30 kg/m(2) can improve health and decrease risks during pregnancy and of long-term illness for the mother and the child. To minimise gestational weight gain women with BMI ≥ 30 kg/m(2) in early pregnancy were invited to a lifestyle intervention including advice and support on diet and physical activity in Gothenburg, Sweden. The aim of this study was to explore the experiences of women with BMI ≥ 30 kg/m(2) regarding minimising their gestational weight gain, and to assess how health professionals' care approaches are reflected in the women's narratives. METHODS: Semi-structured interviews were conducted with 17 women who had participated in a lifestyle intervention for women with BMI ≥ 30 kg/m(2) during pregnancy 3 years earlier. The interviews were digitally recorded and transcribed in full. Thematic analysis was used. RESULTS: The meaning of changing lifestyle for minimising weight gain and of the professional's care approaches is described in four themes: the child as the main motivation for making healthy changes; a need to be seen and supported on own terms to establish healthy routines; being able to manage healthy activities and own weight; and need for additional support to maintain a healthy lifestyle. CONCLUSIONS: To support women with BMI ≥ 30 kg/m(2) to make healthy lifestyle changes and limit weight gain during pregnancy antenatal health care providers should 1) address women's weight in a non-judgmental way using BMI, and provide accurate and appropriate information about the benefits of limited gestational weight gain; 2) support the woman on her own terms in a collaborative relationship with the midwife; 3) work in partnership to give the woman the tools to self-manage healthy activities and 4) give continued personal support and monitoring to maintain healthy eating and regular physical activity habits after childbirth involving also the partner and family.

Mighty Mums - An antenatal health care intervention can reduce gestational weight gain in women with obesity.

BACKGROUND: overweight and obesity are growing public health problems and around 13% of women assigned to antenatal health care (AHC) in Sweden have obesity (Body Mass Index, BMI ≥30). The risk of complications during pregnancy and childbirth increase with increasing BMI. Excessive gestational weight gain (GWG) among obese women further increases the risks of adverse pregnancy outcomes. In this pilot-study from AHC in Gothenburg, a co-ordinated project with standardised care, given by midwives and supported by dietitian and aiming at reducing weight gain in obese pregnant women, is evaluated. OBJECTIVE: to evaluate the effects of a behavioural intervention programme for women with BMI ≥30, with emphasis on nutrition and physical activity, with regards to GWG and effect on weight at the post partum check-up. METHODS: in the pilot study, the intervention group consisted of the first 50 enrolled obese pregnant women in a large life style project within the AHC in Gothenburg. The control group consisted of 50 obese pregnant women in the same city. The intervention included 60 minutes extra time with the midwife and also offered food discussion group, walking poles and pedometers. The intervention group was prescribed physical activity and could choose from food advice with different content. If needed, the woman was offered referral to the dietitian for a personal meeting. A network was formed with the surrounding community. Outcome measures were GWG, weight change at the postnatal check-up compared with when signing in to antenatal health care, and change in BMI during the same period. FINDINGS: women in the intervention group had a significantly lower GWG (8.6 ± 4.9 kg versus 12.5 ± 5.1 kg; p=0.001) and a significantly lower weight at the postnatal check up versus the first contact with AHC (-0.2 ± 5.7 kg versus +2.0 ± 4.5 kg; p=0.032), as well as a decrease in BMI (-0.04 ± 2.1 versus +0.77 ± 2.0; p=0.037). More women in the intervention than in the control group managed GWG <7 kg [18 (36%) versus 8 (16%); p=0.039]. CONCLUSION: obese pregnant women adhering to a standardised life style project in primary care using restricted resources can limit their weight gain during pregnancy, and show less weight retention after pregnancy compared to controls.

Father for the first time--development and validation of a questionnaire to assess fathers' experiences of first childbirth (FTFQ).

BACKGROUND: A father's experience of the birth of his first child is important not only for his birth-giving partner but also for the father himself, his relationship with the mother and the newborn. No validated questionnaire assessing first-time fathers' experiences during childbirth is currently available. Hence, the aim of this study was to develop and validate an instrument to assess first-time fathers' experiences of childbirth. METHOD: Domains and items were initially derived from interviews with first-time fathers, and supplemented by a literature search and a focus group interview with midwives. The comprehensibility, comprehension and relevance of the items were evaluated by four paternity research experts and a preliminary questionnaire was pilot tested in eight first-time fathers. A revised questionnaire was completed by 200 first-time fathers (response rate = 81%) Exploratory factor analysis using principal component analysis with varimax rotation was performed and multitrait scaling analysis was used to test scaling assumptions. External validity was assessed by means of known-groups analysis. RESULTS: Factor analysis yielded four factors comprising 22 items and accounting 48% of the variance. The domains found were Worry, Information, Emotional support and Acceptance. Multitrait analysis confirmed the convergent and discriminant validity of the domains; however, Cronbach's alpha did not meet conventional reliability standards in two domains. The questionnaire was sensitive to differences between groups of fathers hypothesized to differ on important socio demographic or clinical variables. CONCLUSIONS: The questionnaire adequately measures important dimensions of first-time fathers' childbirth experience and may be used to assess aspects of fathers' experiences during childbirth. To obtain the FTFQ and permission for its use, please contact the corresponding author.

First-time fathers' experiences of childbirth--a phenomenological study.

OBJECTIVE: To describe fathers' experiences during childbirth. DESIGN: Qualitative method with phenomenological lifeworld approach. A re-enactment interview method, with open-ended questions analysed with a phenomenological method, was used. PARTICIPANTS AND SETTING: 10 First-time fathers from two hospitals were interviewed four to six weeks after childbirth in Southwest Sweden during the autumn of 2008. FINDINGS: The essential meaning of first-time fathers' lived experience of childbirth was described as an interwoven process pendulating between euphoria and agony. The four themes constituting the essence was: 'a process into the unknown', 'a mutually shared experience', 'to guard and support the woman' and 'in an exposed position with hidden strong emotions'. KEY CONCLUSIONS: Childbirth was experienced as a mutually shared process for the couple. The fathers' high involvement in childbirth, in cooperation with the midwife, and being engaged in support and care for his partner in her suffering is fulfilling for both partners, although the experience of the woman's pain, fear of the unknown and the gendered preconceptions of masculine hegemony can be difficult to bear for the father-to-be. IMPLICATIONS FOR PRACTICE: In order to maintain and strengthen childbirth as a mutually shared experience for the couple, the father needs to be recognised and supported as a parent-to-be. Midwives have to acknowledge fathers as valued participants and support their significant position.

Experiences of the first year as father.

BACKGROUND AND AIMS: The importance of fathers' participation for development of the child and the well-being of the family is recognized from earlier research. In Sweden, legislation allows fathers to share the parental leave equally with the mother even so fathers only use a small of their paid leave. The aim of the study was to explore experiences of the first year as a father. METHOD: A phenomenological life world approach was used. Ethical approval was obtained. Ten men, recruited by a purposive sample, were interviewed 12-14 months after the delivery of their first child. The data collection was performed during June and August 2004 in the south-west area of Sweden. FINDINGS: The essence of the experiences of the first year as father was to place the baby in the centre without giving up one's own person. The child provided warmth and happiness in the family and men experienced a deeper relationship to their partner. The contact between father and child was facilitated by engagement and time spent alone with the child. The major constituents identified from the findings were 'To be overwhelmed', 'To master the new situation' and 'To get a new completeness in life'. DISCUSSION AND CONCLUSION: To master fatherhood maintenance of integrity and possibility to develop an independent relationship with the child is important. Fathers are invited to participate in postnatal childbirth education but the activities address women's needs and it is doubtful if the fathers benefit from participation. Though fathers entered the delivery room some decades ago, as a support to the woman, health personnel of today must be aware of fathers' own needs and the impact gender aspects have on their professional support.