Fears and uncertainties of expectant mothers during the COVID-19 pandemic: trying to reclaim control.

PURPOSE: The novel coronavirus disease (COVID-19) outbreak has exponentially spread across the globe and formed one of the greatest health threats in history. Pregnant women are vulnerable, and their vulnerability is amplified by the associated containment measures of the pandemic. In this study, we aim to explore and describe expectant mothers' experiences during the lockdown of COVID-19. METHOD: A qualitative descriptive design was used. Eighteen pregnant and postpartum women were recruited through purposive and snowball sampling. Semi-structured phone call interviews were conducted by a female researcher. Braun and Clarke's thematic data analysis was followed. RESULTS: Three main themes are developed: (1) Living with fears and uncertainties amid the COVID-19 pandemic, (2) Lockdown disrupting the normalcy of pregnancy, (3) Trying to control the chaos of life. Five subthemes underlined the three themes. CONCLUSION: Findings portrayed expectant mothers' uncertainties, fears, and the fragility of the healthcare systems in responding to mothers' needs during the COVID-19 pandemic. Although the pandemic has resulted in disruption of the normalcy of pregnancy, mothers sought adaptive means to protect themselves and maintain control. Governmental authorities and healthcare providers are directly responsible to maintain considerate perinatal care services for expectant mothers during lockdown and crises.

Understanding attitudes and norms related to sexual and gender-based violence among youth in Jordan: an egocentric social network study protocol.

INTRODUCTION: Sexual and gender-based violence (SGBV) is a major public health concern in Jordan, especially among youth. Social acceptance of SGBV is alarmingly high, including among youth. Refugee populations may be at particular risk given limited social support and access to health services combined with increased social and economic pressure and vulnerability. Further research is needed to understand how norms are embodied and reproduced at individual, interpersonal and community levels through relationships between partners, families, peers and community leaders. This study seeks to provide data on attitudes and norms in communities and across youth social networks in order to support gender transformative approaches that seek to change harmful social norms that perpetuate acceptance of SGBV. METHODS AND ANALYSIS: This study will collect egocentric data from 960 youth in Jordan (480 men and 480 women) aged between 18 years and 24 years. Individuals will be asked about their perceptions of norms relating to SGBV in their community as well as their perceptions of the attitudes held by up to 15 individuals within their social network. Data will also be collected on the social, economic and demographic variables, refugee status, experience of depression and anxiety, and social support. We will use multilevel analysis to examine individual and group-level associations. We will also assess other network attributes, such as homophily, the role of social engagement, social learning and social support in the transmission of norms and attitudes. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Institutional Review Boards of the Harvard T.H. Chan School of Public Health and the University of Jordan. Rigorous ethical protections will be followed with regard to confidentiality and respondent safety. We intend to publish peer-reviewed papers of our findings in addition to a variety of tools and resources targeting diverse audiences, including policy and technical briefs.

Beliefs About Illness and Treatment Decision Modelling During Ill-Health in Arabic Families.

BACKGROUND: The use of self-prescribed antibiotics and other unproven herbal remedies is common in the Arab world. Understanding how family members decide to manage illness is an important priority for health care providers. PURPOSE: This paper presents a new model that can be viewed as an extension to the Health Belief Model and help clarifies the cognitive processes families use to manage illness in an Arab family in Jordan. It aims to generate an understanding of family beliefs about the causes of illness and appraisal of how best to manage illness in an Arab family. METHODS: A qualitative approach using a family interview method was used to collect data. Twenty-five families participated in semi-structured interviews designed to elicit representational models of illness and treatment-decisions. RESULTS: Thematic analysis revealed two forms of intertwined beliefs: core beliefs (fatalistic) and secondary beliefs (biomedical, supernatural and situational beliefs). Four key elements were identified as underpinning the involvement of family in treatment decision: perceived threat of illness, efficacy of treatment option, cost or availability and family prior experience. CONCLUSION: An understanding of the health belief model and related cognitive appraisal processes used by families may assist health care providers to engage with and overcome some of the social, cultural, and structural variables that could influence how family members decide to manage illness in Jordan.

Health care professionals' attitudes towards youth-friendly sexual and reproductive health services in Jordan: a cross-sectional study of physicians, midwives and nurses.

BACKGROUND: Youth-friendly sexual and reproductive health (SRH) services are thought to make such services for adolescents more accessible and acceptable; however, provider attitudes may still present an important barrier. Improving youth SRH service utilization has been recognized as a national priority in Jordan; however, existing services remain underutilized. Previous studies found that youth perceive SRH services to be inadequate and that providers are not supportive of their needs. The purpose of this study is measure provider attitudes towards youth-friendly SRH services and explore their variation according to individual characteristics among health care professionals in Jordan. METHODS: We measured provider attitudes towards youth-friendly SRH services using a scale that was developed and validated in Jordan. The scale consists of three subscales: (1) Attitudes towards SRH information and services offered to youth, (2) Norms and personal beliefs, and (3) Attitudes towards the policy and clinical environment. Possible scores range between 1 and 4, with higher scores reflecting more youth-friendly attitudes. Physicians, midwives and nurses working at either primary health centers, comprehensive care centers, or women's and children's health centers where services to adolescents are or should be offered were recruited from four governorates in Jordan using a two-stage, cluster sampling scheme. Differences in attitudes were assessed using simple and multivariable linear regression analysis. RESULTS: The sample consisted of 510 providers from four governorates in Jordan. The mean provider score on the full scale was 2.7, with a range of 2.0 to 3.8. On Subscales 1 and 2, physicians exhibited significantly more youth-friendly attitudes than nurses by scoring 0.17 points higher than nurses on Subscale 1 (95% CI: 0.02-0.32; p < 0.05) in adjusted analyses. Providers who had been previously trained in SRH issues scored 0.10 points higher (95% CI: 0.00-0.20; p < 0.05) than those who had not on Subscale 3. No differences were found according to provider characteristics on Subscale 2. Providers exhibited the lowest scores related to items referencing youth sexual behavior. CONCLUSIONS: Provider attitudes towards youth-friendly SRH service delivery highlight context-specific, cultural concerns. The limited variation in attitudes related to norms and personal beliefs may be a reflection that such beliefs are deeply held across Jordanian society. Last, as past training on SRH was significantly associated with higher scores, our results suggest opportunity for intervention to improve providers' confidence and knowledge.

Making sexual and reproductive (SRH) services easier for youth to access, organizing service delivery in a way that meets youth's needs, and supporting health care professionals to interact with youth in a friendly manner can make SRH services more youth-friendly. If SRH services are more youth-friendly, more youth may use them. In Jordan, steps have been taken to make SRH services more youth-friendly, but youth still do not believe that providers are supportive of their needs. This study aims to measure physician's, nurse's, and midwives' attitudes towards youth-friendly SRH services in Jordan. We also look at whether certain individual characteristics, such as age, type of service provider, etc. are related to provider attitudes We used a scale that tested in Jordan to measure provider attitudes. The scale focuses on three domains: (1) Attitudes towards SRH information and services offered to youth, (2) Norms and personal beliefs, and (3) Attitudes towards the policy and clinical environment. Possible scores range between 1 and 4, with higher scores reflecting more youth-friendly attitudes. Our sample includes 510 health care providers from four regions in Jordan. We used descriptive statistics and regression analysis to conduct our analysis. Our results show that physicians had more supportive attitudes than nurses or midwives on Subscales 1 and 3. Providers who reported having been trained in SRH issues in the past had higher scores on Subscale 3. No individual characteristics were related to Subscale 2. We find that in Jordan, provider attitudes may reflect deeply rooted cultural norms.

Sleeping with the enemy: sleep and quality of life in patients with lung cancer.

BACKGROUND: Patients with lung cancer have the poorest sleep quality compared with other patients with cancer and noncancer control subjects. However, few studies have examined sleep longitudinally. OBJECTIVE: The objective of this study was to characterize and correlate sleep quality, daytime sleepiness, sleep-wake actigraphy, and quality of life (QOL) before, during, and after chemotherapy for non-small cell lung cancer (NSCLC). METHODS: Using a prospective repeated-measures 1-group design, patients scheduled to receive chemotherapy for NSCLC were recruited. Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Functional Assessment of Cancer Treatment-Lung (FACT-L), and Motionlogger Actigraph were used for data collection. RESULTS: Poor nocturnal sleep and QOL were evident among 29 patients with NSCLC before treatment. The FACT-L subscale scores worsened and then improved significantly from baseline through 2 rounds of chemotherapy. Objective sleep duration and sleep efficiency were positively associated with FACT-L scores, whereas objective sleep latency and wake after sleep onset were negatively associated with FACT-L scores. Sleepy patients had significantly worse FACT-L scores than did nonsleepy patients. The FACT-L subscale items that demonstrated significant worsening and then improvement over time were shortness of breath, weight loss, coughing, and chest tightness. Lung cancer patients experience early and middle insomnia before and during treatment. CONCLUSION: Poor sleep quality is common in patients receiving treatment for NSCLC and is related to poorer QOL and respiratory symptoms. IMPLICATION FOR PRACTICE: Patients with NSCLC require routine screening for sleep disturbances. A positive screen for sleep disturbance warrants a thorough sleep assessment using practice guidelines and, if necessary, referral to a sleep specialist for diagnosis and treatment.