Women's experiences of trauma-informed care for forced migrants: A qualitative interview study.

Introduction: Forced migration affect the health and wellbeing of millions of women. The aim was to explore experiences of trauma-informed care among women who are forced migrants. Methods: This was an exploratory qualitative study. Eleven women who had concluded treatment at multidisciplinary trauma centers in Sweden were interviewed, recruited through consecutive sampling. Audio-recorded interviews were transcribed and analyzed with systematic text condensation. Results: Women dealt with mental and physical manifestations in a challenging psychosocial situation. Various structural and individual barriers were addressed that hindered access to adequate health services. Women appreciated various benefits of the treatment and recalled the care as supportive and compassionate. However, undergoing treatment was considered demanding, requiring significant determination and energy. Participants suggested that peer support could enhance the support. Conclusions: Migrant women experience a range of health-related burdens and encounter barriers to trauma-informed care. While demanding, treatment has the potential to alleviate symptoms. Health professionals and stakeholders providing trauma-informed care need to ensure that their services are accessible and culturally sensitive towards the unique needs of women. Peer support has the potential to enhance support further, which need further evaluation.

Trauma-informed care for women who are forced migrants: a qualitative study among service providers.

AIMS: The aim was to explore service providers' perspectives on trauma-informed care for women who are forced migrants. METHODS: Service providers (n=32) employed at one of six centres providing trauma-informed care for forced migrants were recruited by way of managers. Audio-recorded and transcribed semi-structured focus group discussions were analysed with systematic text condensation. RESULTS: The analysis revealed exposure to gender-based violence and abuse within patriarchal structures as the main challenges for women. Participants recognised remarkable strength and resilience among women. A range of structural, psychosocial and individual barriers to trauma-informed care were addressed. While trauma-informed care was considered to have the potential to improve the health for many women, participants articulated room for improvement in the competence of service providers and the conditions impacting women's opportunities to access support. CONCLUSIONS: Violence, abuse and oppression against forced migrant women severely impact their health and possibilities of accessing support. Services providing trauma-informed care for forced migrants need to empower women, and carefully consider gender-related aspects impacting women's opportunities to access and utilise trauma-informed care. To ensure that women who need support access it, trauma-informed services should work with outreach efforts, ensure competence development among providers, counteract practical barriers and coordinate with health and social services.

Mental health and societal challenges among forced migrants of diverse sexual orientations, gender identities and gender expressions: health professionals' descriptions and interpretations.

The aim of this study was to explore health professionals' descriptions and interpretations of post-migration mental health and societal challenges among forced migrants with diverse sexual orientations, gender identities and gender expressions. Participants representing seven professions were recruited by a combination of convenience, purposive and snowball sampling. Data were collected through focus groups and individual interviews, analysed with systematic text condensation in a collaborative process involving researchers, clinicians and migrants with lived experiences. Participants described a challenging trajectory for migrants, as migrants venture through an uncertain and demanding journey impacting their mental health. Needing to deal with legal requirements, stressful circumstances and normative expectations during the asylum process were highlighted as major challenges, along with exposure to discrimination, violence, abuse and lack of psychosocial safety. Participants described significant psychological distress among migrants, including loneliness and shame. Challenges were also recognised related to exploring, accepting and expressing sexuality and gender. Loneliness and shame are major challenges in need of further attention in research, which could be addressed through the development and evaluation of actions, programmes and interventions to provide peer support.

Support interventions to promote health and wellbeing among women with health-related consequences following traumatic experiences linked to armed conflicts and forced migration: a scoping review.

BACKGROUND: Women exposed to armed conflicts and forced migration face significant health-related risks and consequences. Consequently, there is a need to identify and develop effective interventions that provide tailored support for them. The aim of this scoping review was to examine research evaluating support interventions promoting the health and well-being among women with traumatic experiences linked to armed conflict and/or forced migration. METHODS: A scoping review of empirical studies evaluating non-pharmacologic/non-surgical interventions promoting health and well-being among adult women with traumatic experiences linked to armed, torture, and/or forced migration, identified through systematic searches in February 2022 within five databases (AMED, CINAHL, Cochrane Library, PsycINFO, and PubMed). Methodological characteristics and results were extracted and analyzed with narrative analysis using tabulations, descriptive statistics, text-based summaries, and thematization. RESULTS: Assessment of 16 748 records resulted in 13 included reports. The methodological approaches were quantitative (n = 9), qualitative (n = 2), and mixed methods (n = 2), with most reports being feasibility/pilot studies (n = 5) and/or randomized controlled trials (n = 4). The most common recruitment strategy was non-probability sampling (n = 8). Most interventions were conducted in North America (n = 4), Asia (n = 3) or Middle East (n = 3). Thirteen intra-intervention techniques and five categories of components utilized within the interventions were identified, the most common being skill building (n = 12). Ten developed the interventions through theoretical frameworks or manuals/therapy, while five developed interventions through public or stakeholder involvement. Eleven studies evaluated outcomes related to psychological health, disorders, or distress. A large proportion of the investigated outcomes showed post-exposure improvements and improvements when compared with controls. Qualitative findings highlighted improved mental and physical health, empowerment and stigma reduction, and enhanced knowledge. CONCLUSION: Few studies have developed and evaluated tailored support interventions for this population, containing a range of components and intra-intervention techniques. No clear focus was identified regarding outcome measures, and most studies used non-probability sampling. Few developed interventions through public contribution in collaboration with women. While limited studies show promising effects on women's mental health, more empirical intervention research that closely corresponds to women's needs are needed.

Nurse education about forced migrants with diverse sexual orientations, gender identities, and gender expressions: An exploratory focus group study.

BACKGROUND: In many countries, forced migrants can seek asylum based on persecution and danger related to self-identifying as having diverse sexual orientations, gender identities, and gender expressions; herein defined as lesbian, gay, bisexual, transgender, queer, or other non-heterosexual orientations, non-cisgender identities, gender expressions and/or reproductive development considered beyond cultural, societal or physiological norms. Nurse education has a significant role in promoting cultural competence among future health professionals. OBJECTIVES: To explore the experiences and views regarding education about forced migrants with diverse sexual orientations, gender identities, and gender expressions, among students and lecturers in nurse education. DESIGN: Explorative qualitative study with focus group discussions. SETTINGS: Swedish nursing programs. PARTICIPANTS: Final-year nursing students and lecturers (n = 25 participants) at nursing programs were recruited with convenience and snowball sampling. METHODS: Semi-structured digital focus group discussions (n = 9) were audio recorded and transcribed verbatim. Data were analyzed with inductive qualitative content analysis. RESULTS: Promoting a broader understanding regarding societal structures and preparing students to provide culturally sensitive care were considered as essential components in nurse education. Challenges and problems involved a need for increased awareness, the associated topics and target populations seldom being addressed, and a need for improvements within clinical placements. Participants suggested the utilization of external resources, presented a range of different specific learning activities that would promote in-depth understanding, and articulated a need for overarching decisions and guidelines regarding mandatory inclusion in nurse education. CONCLUSIONS: Students and lecturers describe several challenges and problems that need to be addressed in regard to forced migration, sexual health, and inclusion health. There seems to be a need for utilization of external competence in learning activities as well as establishing clearer guidelines, which may increase the quality of education and better prepare future nurses to support patients with diverse backgrounds and identities.

Post-migration psychosocial experiences and challenges amongst LGBTQ+ forced migrants: A meta-synthesis of qualitative reports.

AIMS: Synthesize qualitative research to illuminate the post-migration psychosocial experiences amongst LGBTQ+ forced migrants. DESIGN: Meta-synthesis of qualitative reports. DATA SOURCES: Systematic searches in seven databases and manual screenings were performed in July 2021 (21,049 entries screened in total). The final sample included 29 English-language reports containing empirical qualitative findings about post-migration experiences and published 10 years prior to the searches, based on migrants as the primary source. REVIEW METHODS: Methodological quality was appraised using the CASP and JBI checklists. Through a collaborative process involving nurse-midwife researchers and experienced clinical professionals, reports were analysed with a two-stage qualitative meta-synthesis including an inductive qualitative content analysis. RESULTS: The methodological quality was high and the reports included 636 participants in total. Two themes were identified through the meta-synthesis. The first theme illustrates the psychological distress and numerous challenges and stressors forced migrants face after arrival, including challenges encountered as an LGBTQ+ forced migrant, psychological reactions and manifestations, and practical issues related to resettlement and living conditions. The second theme highlights the resilience and strength they find through various internal processes and external resources, including resilience and strengthening resources, identity formation and establishing and maintaining social relationships. CONCLUSION: After arrival in the host country, forced migrants identifying as LGBTQ+ face numerous societal and personal challenges whilst being at risk of experiencing significant psychological distress. These migrants utilize a wide range of resources that may strengthen their resilience. Peer support stands out as a highly appreciated and promising resource that needs further attention in experimental research. IMPACT: Forced migrants identifying as LGBTQ+ need access to adequate and sufficient support. The findings emphasize several strength-building resources that may inform nurses, midwives, researchers and other professionals when providing psychosocial support for these persons. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Experiences of armed conflicts and forced migration among women from countries in the Middle East, Balkans, and Africa: a systematic review of qualitative studies.

BACKGROUND: A significant proportion of the global population is displaced, many being women. Qualitative studies can generate in-depth findings that will contribute to an understanding of their experiences, but there is a need for further synthetization efforts. The aim was to provide a comprehensive perspective about adult women's experiences of armed conflicts and forced migration, focusing on women in or from countries in the Middle East, Balkans, or Africa. METHODS: Systematic review of English reports presenting empirical qualitative studies published in scientific journals 1980 or later, utilizing searches performed in September 2021 within three databases combined with manual screening. Of the 3 800 records screened in total, 26 were included. Methodological details and quality were appraised using pre-specified extraction and appraisal tools. The findings within the included reports were analyzed with thematic analysis. RESULTS: Most reports utilized interviews, including in total 494 participants, and were appraised as having insignificant methodological limitations. The first theme concerns changed living conditions, involving reduced safety, insufficient access to resources meeting basic needs, forced migration as a last resort, and some positive effects. The second theme concerns the experienced health-related consequences, involving psychological distress, risks during pregnancy and childbirth, exposure to violence and discrimination as a woman, as well as a lack of adequate healthcare services and social support. The third theme concerns the resources and strategies that enhance resilience, involving social support and family life, as well as utilization of internal resources and strategies. CONCLUSION: When experiencing armed conflicts and forced migration, women face significant challenges related to changed living conditions and are exposed to health-related consequences. Consistently, women are targets of severe structural and personal violence, while lacking access to even the most basic healthcare services. Despite facing considerable hardships, these women display extraordinary resilience and endurance by finding strength through social support and internal resources. Synthesized qualitative research illustrates that women value social support, including peer support, which is a promising intervention that needs to be evaluated in future experimental studies.

Quality of web-based information about the coronavirus disease 2019: a rapid systematic review of infodemiology studies published during the first year of the pandemic.

BACKGROUND: Following the outbreak of the coronavirus disease 2019, adequate public information was of outmost importance. The public used the Web extensively to read information about the pandemic, which placed significant responsibility in, for many, an unfamiliar situation as the disease spread across the globe. The aim of this review was to synthesize the quality of web-based information concerning the coronavirus disease 2019 published during the first year of the pandemic. MATERIALS AND METHODS: A rapid systematic review was undertaken by searching five electronic databases (CINAHL, Communication & Mass Media Complete, PsycINFO, PubMed, Scopus). Empirical infodemiology reports assessing quality of information were included (n = 22). Methodological quality and risk of bias was appraised with tools modified from previous research, while quality assessment scores were synthesized with descriptive statistics. Topics illustrating comprehensiveness were categorized with content analysis. RESULTS: The included reports assessed text-based content (n = 13) and videos (n = 9). Most were rated good overall methodological quality (n = 17). In total, the reports evaluated 2,654 websites or videos and utilized 46 assessors. The majority of the reports concluded that websites and videos had poor quality (n = 20). Collectively, readability levels exceeded the recommended sixth grade level. There were large variations in ranges of the reported mean or median quality scores, with 13 of 15 total sample scores being classified as poor or moderate quality. Four studies reported that ≥ 28% of websites contained inaccurate statements. There were large variations in prevalence for the six categories illustrating comprehensiveness. CONCLUSION: The results highlight quality deficits of web-based information about COVID-19 published during the first year of the pandemic, suggesting a high probability that this hindered the general population from being adequately informed when faced with the new and unfamiliar situation. Future research should address the highlighted quality deficits, identify methods that aid citizens in their information retrieval, and identify interventions that aim to improve the quality of information in the online landscape.

Readability, understandability and language accessibility of Swedish websites about the coronavirus disease 2019: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic has caused significant morbidity and mortality. To mitigate its spread, members in the general population were prompted to apply significant behavioral changes. This required an effective dissemination of understandable information accessible for people with a wide range of literacy backgrounds. The aim of this study was to investigate the readability, understandability and language accessibility of Swedish consumer-oriented websites containing information about COVID-19. METHODS: Websites were identified through systematic searches in Google.se (n = 76), and were collected in May 2020 when the pandemic spread started in Sweden. Readability and understandability were assessed with the Readability Index, the Ensuring Quality Information for Patients (EQIP) tool, and the Patient Education Materials Assessment Tool Understandability subscale (PEMAT-PU). RESULTS: The median total sample score for Readability Index was 42.0, with the majority of scores being classified as moderate (n = 30, 39%) or difficult (n = 43, 57%). Median total sample scores were for EQIP 54.0% (IQR = 17.0, Range = 8-75) and for PEMAT-PU 60.0% (IQR = 14.75, Range = 12-87). The majority of the websites did not have any texts or links containing information in an alternative language (n = 58, 76%). CONCLUSIONS: Swedish websites contained information of difficult readability and understandability at the beginning of the coronavirus disease 2019 pandemic, with few providing information available in alternative languages. It is possible that these deficits contributed to the spread and impact of the virus. There is a need for studies investigating methods aiming to enhance the readability, understandability and language accessibility of web-based information at the beginning of an epidemic or pandemic.

Peer Support Experienced by Mothers of Children With Congenital Heart Defects in Sweden.

The aim of this study was to describe experiences of peer support among mothers of children with congenital heart defects. Ten mothers were interviewed through a semi-structured approach and interviews were analyzed with systematic text condensation. The respondents established various channels used for peer support and navigated between the channels depending on what type of information or support they needed. Through the channels, they found peers they developed strong friendships with and who they relied on for emotional support. Communicating with peers involved the reciprocal exchange of unique emotional support between peers who understand each other as well as the exchange of information derived from their collective knowledge, and thus, difficult to find without the help of peers. The findings illustrate the potential strengths of establishing reliable collaboration and liaisons between clinical units and peer support networks.

Contraceptive counseling about adverse reactions of intrauterine contraception: Exploration of narratives found in web-based discussion boards.

OBJECTIVE: the possibility of experiencing adverse reactions is an important aspect of contraceptive decision-making and information about this topic is highlighted as an essential aspect of contraceptive counseling. The aim of this study was to explore experiences of contraceptive counseling about potential adverse reactions of intrauterine contraception. DESIGN: exploratory qualitative study of messages in discussion boards, analyzed with inductive qualitative content analysis. SETTING: two large public Swedish web-based discussion boards about sexual and reproductive health. PARTICIPANTS: threads related to the aim were identified through searches in the discussion boards during 2019 and 2020, resulting in in 43 included posters who had written 140 messages in total. FINDINGS: the themes 'difficulties making an informed decision due to insufficient and untrustworthy information about adverse reactions' and 'feeling dismissed when communicating about experienced adverse reactions' illustrate the results. Posters emphasized the importance of sufficient information about adverse reactions. However, professionals were perceived as overly optimistic regarding intrauterine contraception and focusing on mild or common reactions. The importance of feeling that their adverse reactions were acknowledged was articulated, but posters felt that some professionals dismissed the reactions when being told about it, resulting in frustration and dissatisfaction with care. The discussion boards contained narratives describing a resistance among professionals to send in a formal report about the adverse reaction. KEY CONCLUSIONS: according to statements made by posters who have experience of adverse reactions of intrauterine contraception, contraceptive counseling have room for improvement in regard to inclusion of comprehensive information about adverse reactions. The findings illustrate the importance that clients who experience adverse reactions of intrauterine contraception feel they are acknowledged and offered adequate support. IMPLICATIONS FOR PRACTICE: echoing guidelines for high-quality contraceptive counseling, the narratives provide further weight that professionals need to have adequate training and resources to offer comprehensive information about adverse reactions of intrauterine contraception. The findings call attention to the importance of follow-up services for clients who experience adverse reactions.

Belonging to a community of care: Mothers' experiences of online peer support groups for parents having lost a child with congenital heart defects.

The aim was to study mothers' experiences of online peer support groups after the death of a child. Participants (N = 8) were recruited through a newsletter for the Swedish association for families/children with heart defects, and two closed support groups on Facebook (900 and 100 members) and interviewed by telephone. Transcripts were analyzed with qualitative content analysis. The groups were available around the clock, regardless of support need, and mothers joined both to receive and provide support. Participation in online peer support groups may provide a sense of belonging to a caring community and serve as a valuable complement to healthcare.

Quality of web-based information at the beginning of a global pandemic: a cross-sectional infodemiology study investigating preventive measures and self care methods of the coronavirus disease 2019.

BACKGROUND: reducing the spread and impact epidemics and pandemics requires that members of the general population change their behaviors according to the recommendations, restrictions and laws provided by leading authorities. When a new epidemic or pandemic emerges, people are faced with the challenge of sorting through a great volume of varied information. Therefore, the dissemination of high-quality web-based information is essential during this time period. The overarching aim was to investigate the quality of web-based information about preventive measures and self care methods at the beginning of the COVID-19 pandemic. METHODS: in May 2020, consumer-oriented websites written in Swedish were identified via systematic searches in Google (n = 76). Websites were assessed with inductive content analysis, the JAMA benchmarks, the QUEST tool and the DISCERN instrument. RESULTS: seven categories and 33 subcategories were identified concerning preventive measures (md = 6.0 subcategories), with few specifying a method for washing hands (n = 4), when to sanitize the hands (n = 4), and a method for sanitizing the hands (n = 1). Eight categories and 30 subcategories were identified concerning self care methods (md = 3.0 subcategories), with few referring to the national number for telephone-based counseling (n = 20) and an online symptom assessment tool (n = 16). Overall, the median total quality scores were low (JAMA = 0/4, QUEST =13/28, DISCERN = 29/80). CONCLUSIONS: at the beginning of the pandemic, substantial quality deficits of websites about COVID-19 may have counteracted the public recommendations for preventive measures. This illustrates a critical need for standardized and systematic routines on how to achieve dissemination of high-quality web-based information when new epidemics and pandemics emerge.

Peer support among parents of children with congenital heart defects: A qualitative analysis of written responses submitted via an online survey.

AIM: To explore experiences of peer support among parents of children with congenital heart defects. DESIGN: A study analysing written responses to open-ended questions about peer support, collected via an online survey distributed in Sweden. METHODS: Respondents were recruited during 3 months in 2018 by means of convenience sampling, through ads via the Swedish foundation for families with children who have heart defects and two closed Facebook groups for peer support. An online survey containing open-ended questions was distributed and responses were analysed with systematic text condensation. RESULTS: Peer support was grounded in a mutual understanding among parents and involved highly appreciated emotional support. Listening to the stories of peers meant an opportunity to gain useful insights about what life is like for parents of children with heart defects. Receiving and providing peer support was described as rewarding on a personal level. Negative aspects of peer support were also described, which sometimes led to psychological distress and withdrawal from peer support activities. CONCLUSION: Peer support is emotionally relieving and appreciated among parents of children with congenital heart defects, who consider providing the support a rewarding responsibility. While peer support activities may have considerable benefits for individuals, it may also lead to psychological distress for some. IMPACT: This study addressed peer support among parents of children with congenital heart defects. The main findings illustrate the potential impact peer support can have on individuals and calls attention to the experienced benefits related to peer support activities, while also providing some insights regarding potential negative aspects. The findings have relevance for nurses, midwives, and other health professionals working in settings providing care for these families.

Readability of web-based sources about induced abortion: a cross-sectional study.

BACKGROUND: High-quality information is essential if clients who request an abortion are to reach informed decisions and feel prepared for the procedure, but little is known concerning the readability of web-based sources containing such material. The aim was to investigate the readability of web-based information about induced abortion. METHODS: The search engine Google was used to identify web pages about induced abortion, written in the English language. A total of 240 hits were screened and 236 web pages fulfilled the inclusion criteria. After correcting for duplicate hits, 185 web pages were included. The readability of the text-based content of each web page was determined with Flesch Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook, and Flesch Reading Ease. Data were analyzed with descriptive statistics, Pearson's correlation coefficient and Kruskal-Wallis with Dunn's test as post hoc analysis. RESULTS: Across all grade level measures, a small minority of the web pages had a readability corresponding to elementary school (n < 3, 1%), while the majority had readability corresponding to senior high school or above (n > 153, 65%). The means of the grade level measures ranged between 10.5 and 13.1, and the mean Flesch Reading Ease score was 45.3 (SD 13.6). Only weak correlations (rho < 0.2) were found between the readability measures and search rank in the hit lists. Consistently, web pages affiliated with health care had the least difficult readability and those affiliated with scientific sources had the most difficult readability. CONCLUSIONS: Overall, web-based information about induced abortions has difficult readability. Incentives are needed to improve the readability of these texts and ensure that clients encounter understandable information so that they may reach informed decisions and feel adequately prepared when requesting an abortion.

Being involved in research as a collaborator with experience of a prenatal diagnosis of congenital heart defect in the fetus: a qualitative study.

BACKGROUND: An increasing number of research projects are now collaborating with persons who have lived experience of a specific health-related situation, such as a prenatal diagnosis of congenital heart defect. Such collaboration has the potential to provide valuable insights how to plan future studies, but little is known how these persons experience such involvement. The aim was to explore how persons with lived experience of a prenatal diagnosis perceived collaborating in a research project utilizing patient and public involvement to identify relevant research questions and develop suitable interventions. METHODS: Persons with experience of a prenatal diagnosis of congenital heart defect in the fetus were interviewed after their participation in a yearlong collaborative research project (n = 9) aiming to explore relevant research questions and develop interventions for expectant parents with a recent prenatal diagnosis. Interviews were analyzed with qualitative content analysis. RESULTS: Respondents acknowledged altruistic and personal value related to the collaboration. They valued the opportunity to contribute to future research so that the care of persons experiencing a prenatal diagnosis may be improved. Mixed feelings were described related to sharing and reliving experiences. While it had been emotionally difficult to relive a traumatic event, it also served as an opportunity to process experiences and psychologically adapt. Respondents with terminated pregnancies appreciated the possibility to meet peers, since it was difficult to find peers in everyday life and talk about their experiences with others. CONCLUSIONS: Researchers who plan to collaborate with persons who have experience of a prenatal diagnosis should be mindful of the potential associated emotional experiences. The appreciation related to meeting peers calls attention to the need for studies that explore peer support.

Quality of consumer-oriented websites containing information about the second trimester ultrasound examination during pregnancy.

BACKGROUND: Providing information about prenatal tests is a clinical challenge and the public frequently accesses the Web to read pregnancy-related information. The overarching aim of this study was to investigate the quality of consumer-oriented websites addressing obstetric ultrasound examination in the second trimester of pregnancy. METHODS: Swedish websites were identified with Google, using 20 search strings and screening 400 hits (n = 71 included websites). Reliability and information about the examination were assessed with the DISCERN instrument, completeness was assessed according to national guidelines, and readability analyzed with the Readability Index. Popularity was determined with the ALEXA tool and search rank was determined according to Google hit lists. RESULTS: The mean total DISCERN score was 29.7/80 (SD 11.4), with > 50% having low quality for 15 of the 16 questions. The mean completeness score was 6.8/24 (SD 4.5). The Readability Index ranged between 22 and 63, with a mean of 42.7 (SD 6.8), indicating difficult readability. Weak and non-significant correlations were observed between ALEXA/search rank and the investigated quality variables, except for search rank and reliability. CONCLUSIONS: The quality of consumer-oriented websites addressing the second trimester ultrasound examination is low. Health professionals need to discuss this with expectant parents considering undergoing the examination. There is a need for efforts that aim to improve the poor quality of online sources in the field of prenatal examinations.

Waterbirth in low-risk pregnancy: An exploration of women's experiences.

AIMS: To explore retrospective descriptions about benefits, negative experiences and preparatory information related to waterbirths. DESIGN: A qualitative study. METHODS: Women who gave birth in water with healthy pregnancies and low-risk births were consecutively recruited between December 2015-October 2018 from two birthing units in Sweden. All who gave birth in water during the recruitment period were included (N = 155) and 111 responded to the survey. Women were emailed a web-based survey six weeks postpartum. Open-ended questions were analysed with qualitative content analysis. RESULTS: Two themes were identified related to benefits: (a) physical benefits: the water eases labour progression while offering buoyancy and pain relief; and (b) psychological benefits: improved relaxation and control in a demedicalized and safe setting. Two themes were identified related to negative experiences: (a) equipment-related issues due to the construction of the tub and issues related to being immersed in water; and (b) fears and worries related to waterbirth. In regard to preparatory information, respondents reported a lack of general and specific information related to waterbirths, even after they contacted birthing units to ask questions. Supplemental web-based information was sought, but the trustworthiness of these sources was questioned and a need for trustworthy web-based information was articulated. CONCLUSION: Women who give birth in water experience physical and psychological benefits, but need better equipment and sufficient information. There is room for improvement with regard to prenatal and intrapartum care of women who give birth in water. IMPACT: Judging from women's recounts, midwives and nurses should continue advocating waterbirth in low-risk pregnancies. The lack of adequate equipment in Swedish birthing units articulated by women challenge current routines and resources. The findings illustrate unfulfilled needs for preparatory information about waterbirth, further strengthening that midwives should discuss the possibility of waterbirth when meeting expectant parents in the antenatal setting.

Quality of websites about long-acting reversible contraception: a descriptive cross-sectional study.

BACKGROUND: Today, there are various short- and long-acting contraceptive alternatives available for those who wish to prevent unintended pregnancy. Long-acting reversible contraception are considered effective methods with a high user satisfaction. High-quality information about contraception is essential in order to empower individuals to reach informed decisions based on sufficient knowledge. Use of the Web for information about contraception is widespread, and there is a risk that those who use it for this purpose could come in contact with sources of low quality. OBJECTIVE: The overarching aim was to investigate the quality of websites about long-acting reversible contraception. METHODS: Swedish client-oriented websites were identified through searches in Google (n = 46 included websites). Reliability and information about long-acting reversible contraceptive choices were assessed by two assessors with the DISCERN instrument, transparency was analyzed with the Journal of the American Medical Association benchmarks, completeness was assessed with inductive content analysis and readability was analyzed with Readability Index. RESULTS: The mean DISCERN was 44.1/80 (SD 7.7) for total score, 19.7/40 (SD 3.7) for reliability, 22.1/35 (SD 4.1) for information about long-acting reversible contraceptive choices, and 2.3/5 (SD 1.1) for overall quality. A majority of the included websites had low quality with regard to what sources were used to compile the information (n = 41/46, 89%), when the information was produced (n = 40/46, 87%), and if it provided additional sources of support and information (n = 30/46, 65%). Less than half of the websites adhered to any of the JAMA benchmarks. We identified 23 categories of comprehensiveness. The most frequent was contraceptive mechanism (n = 39/46, 85%) and the least frequent was when contraception may be initiated following an abortion (n = 3/46, 7%). The mean Readability Index was 42.5 (SD 6.3, Range 29-55) indicating moderate to difficult readability levels, corresponding to a grade level of 9. CONCLUSIONS: The quality of client-oriented websites about long-acting reversible contraception is poor. There is an undeniable need to support and guide laypersons that intend to use web-based sources about contraceptive alternatives, so that they may reach informed decisions based on sufficient knowledge.

Feeling excluded and not having anyone to talk to: Qualitative study of interpersonal relationships following a cancer diagnosis in a sibling.

PURPOSE: To explore experiences related to interpersonal relationships following a cancer diagnosis in a sibling. METHODS: Respondents (n = 7 females) were recruited by means of convenience sampling during a camp for children affected by childhood cancer and their siblings. Data from children and adolescents with a sibling diagnosed with cancer was collected through individual face-to-face interviews and analyzed using systematic text condensation. RESULTS: Two categories portrayed the experiences related to interpersonal relationships following a cancer diagnosis in a sibling. Feeling excluded while wanting to maintain a relationship with their ill sibling and be involved in the care portrayed that trying to be involved in the care of their ill sibling was a stressful and difficult experience, since they were simultaneously expected to also manage household chores and attend school. Feeling stigmatized and exposed in social contexts while needing an allowing space to talk about their experiences portrayed the emotional difficulties evoked by social situations and behaviors of others, which left respondents feeling exposed and mistreated. Having the possibility to talk about their experiences and receiving social support was described as essential in order to cope with the situation. CONCLUSIONS: Health professionals need to take into consideration the emotional difficulties and vulnerable situation that children and adolescents who have a sibling diagnosed with cancer are at risk of experiencing. Stigmatization and social exposure present a risk of psychological distress. Having an allowing space to communicate feelings and experiences is desired. Interventions may be necessary to help these individuals psychologically cope.