Common avoidable factors leading to maternal, perinatal and neonatal deaths include lack of birth planning (and delivery in an inappropriate place) and unmet need for contraception. Progress has been ...slow because routine antenatal care has focused only on women. Yet, in Uganda, many women first want the approval of their husbands. The World Health Organization recommends postpartum family planning (PPFP) as a critical component of health care. The aim of this trial is to test the feasibility of recruiting and retaining participants in a trial of a complex community-based intervention to provide counselling to antenatal couples in Uganda.
This is a two-group, non-blinded cluster-randomised controlled feasibility trial of a complex intervention. Primary health centres in Uganda will be randomised to receive the intervention or usual care provided by the Ministry of Health. The intervention consists of training village health teams to provide basic counselling to couples at home, encouraging men to accompany their wives to an antenatal clinic, and secondly of training health workers to provide information and counselling to couples at antenatal clinics, to facilitate shared decision-making on the most appropriate place of delivery, and postpartum contraception. We aim to recruit 2 health centres in each arm, each with 10 village health teams, each of whom will aim to recruit 35 pregnant women (a total of 700 women per arm). The village health teams will follow up and collect data on pregnant women in the community up to 12 months after delivery and will directly enter the data using the COSMOS software on a smartphone.
This intervention addresses two key avoidable factors in maternal, perinatal and neonatal deaths (lack of family planning and inappropriate place of delivery). Determining the acceptability and feasibility of antenatal couples' counselling in this study will inform the design of a fully randomised controlled clinical trial. If this trial demonstrates the feasibility of recruitment and delivery, we will seek funding to conduct a fully powered trial of the complex intervention for improving uptake of birth planning and postpartum family planning in Uganda.
Pan African Clinical Trials Registry PACTR202102794681952 . Approved on 10 February 2021. ISRCTN Registry ISRCTN97229911. Registered on 23 September 2021.
Pregnancy rates and the desire to conceive are increasing among women living with HIV in Africa. However, attempts to conceive may increase the risk of HIV transmission or reinfection. A better ...understanding of factors influencing fertility desires would significantly contribute to programmes to meet the reproductive needs of women living with HIV. Using a couples-based approach, this paper explored fertility desires among HIV-seroconcordant and -discordant couples in Lusaka, Zambia. Participants were 208 heterosexual couples recruited from community health clinics and their respective catchment areas. Couples completed assessments on demographics, condom use, relationship quality and communication. Desire for children was often shared among couple members, and the strongest predictor of participants' desire for children was having a partner who wanted children. Additionally, the number of children participants had, their own reports of positive communication, and their partner's HIV serostatus influenced reproductive desires. Results support the involvement of both couple members in pre-conception counselling and pregnancy planning interventions. The inclusion of both partners may be a more effective strategy to respond to the reproductive needs of couples affected by HIV, enabling them to safeguard the health of both partners and infants.
Macrogenre Muntigl, Peter
Linguistics and the human sciences (Online),
03/2008, Volume:
2, Issue:
2
Journal Article
Peer reviewed
Research on social activities that consist of multiple genres, also termed macrogenres, remains a relatively unexplored area in the linguistic sciences. Furthermore, representations of genres and ...macrogenres tend to be constituency based, highlighting ideational meanings as opposed to interpersonal and textual ones. In this paper, I illustrate how Halliday’s tripartite metafunctional (ideational, interpersonal, textual) model can be applied to a narrative counselling interview macrogenre. I argue that each metafunctional perspective can provide a different angle through which to observe, represent and explain counselling logogenesis. The data from this study were taken from audiorecordings of 2 cases of 6 conjoint narrative counselling sessions, involving 2 couples and a male counsellor. Using the methods of Genre & Register theory and Systemic Functional Linguistics, it was found that, for both cases of counselling, counsellor and couples drew from similar sets of linguistic resources to collaboratively construct the counselling process. Furthermore, these linguistic patterns were shown to cluster together, forming identifiable generic stages and genres in which couples problems were constructed and subsequently effaced. Finally, it was found that representing the counselling macrogenre from different metafunctional perspectives provided a more comprehensive picture of the purposeful and goal directed unfolding of the counselling process.
Family, network or couples-based therapies have been helping to support people with substance problems for decades. Their value in supporting a person to change their alcohol or drug use is clear. ...However, as links between substance use and domestic abuse are increasingly recognised, these approaches need to reflect on the potential safety risks they present to people taking part. The prevalence of domestic abuse among people receiving drug and alcohol services is considerably higher than general population estimates, yet this does not appear to have been adequately addressed in network therapies. This article suggests that this needs to change and that safety of service users needs to be at least as important as the intervention itself. It offers for debate a number of potential safety issues raised by network therapies where there is evidence of domestic abuse; it provides examples of three approaches used to marshal social and network support in substance interventions; and offers a number of suggestions for how network therapies can ensure their use remains safe and supportive where there is domestic abuse. Galvani SA. Safety in numbers? Tackling domestic abuse in couples and network therapies. Drug Alcohol Rev 2007;26:175 - 181
This book, written in plain language by an experienced, psychoanalytically-orientated therapist, is aimed at lay readers who wish to understand how couples consciously and unconsciously operate in ...successful and unsuccessful partnerships. It covers the central concepts involved, illustrated by (disguised) case material. The book will also be invaluable for trainers, trainees, and individual counsellors/psychotherapists wishing to extend their work into a fresh clinical area – namely couple therapy. The style is lively and accessible, covering a complete range of couple issues from early union till death.
By means of real people’s stories it clearly demonstrates how internal and external experiences throughout development from birth to adolescence shape the style, quality, and progress of a committed pair bond.
Not all couples require therapy, of course. A careful reading of this book could be sufficient to start off a change in a couple’s way of thinking, such that impending problems are prevented or better managed. A summary of who might and might not need help is presented in the concluding section of the book.
The author provides no easy solutions to conflict or impending break-up, but she does offer a clear model for understanding the complexity and depth of couple disharmony. Such insight may create opportunities for change.
The couple relationship is at the centre of this book. The complex nature of the couple attachment is emphasised, drawing both on psychoanalytic concepts and on attachment theory. The chapters aim to ...integrate theory with practice and can be seen, both separately and together, as offering new insights into the intricate web of psychic fantasies, shared unconscious anxieties and external realities that shape the attachment between the couple.
The World Health Organization (WHO) recommends couple human immunodeficiency virus (HIV) counselling and testing (CHCT) as one of the beneficial and cost-effective means for the prevention of ...mother-to-child transmission (PMTCT) of HIV within couple’s relationships. However, CHCT within the PMTCT of HIV settings in Zimbabwe remains low. This study explored adult men and women’s views from a rural district of Zimbabwe regarding the possible factors that facilitate or inhibit the uptake of CHCT for the PMTCT of HIV. The study utilised qualitative methods. Data were collected by conducting eight focus group discussions among adult men and women, as well as eight in-depth interviews with pregnant women admitted in antenatal wards in local hospitals. Thematic analysis was used for analysing the data with the aid of NVivo software. The study revealed that CHCT initiatives were hampered by certain patriarchal behaviours and beliefs that make it acceptable for men to have multiple sexual partners, thereby exposing their marriages and relationships to HIV. Social constructions around gender roles tend to prescribe women as the sole custodians of children’s health, and this led to stigmatisation against men who participated in PMTCT programmes. In addition, certain religious practices do not allow the use of medicine, which makes CHCT a nonevent. However, engaging men on platforms that advocate for progressive masculinities and raising awareness of this practice through information dissemination were identified as enablers in increasing CHCT.Contribution: The significant contribution of this study is that it demonstrated the importance of acknowledging the societal, cultural and religious practices inherent in a community, as they are central to their responses to HIV prevention interventions.
Objective: This longitudinal study aims to evaluate the effect of psychological counselling on quality of life, marital satisfaction and need for parenthood in couples undergoing fertility treatments ...(ART).
Background: Recent guidelines on the ART suggest that psychological counselling should target both members of the infertile couple in order to improve their conjoint management of the infertility-related stress. However, studies on the dyadic outcome of couples are scarce.
Methods: 262 patients were originally considered in the study and completed questionnaires on quality of life, need for parenthood and marital satisfaction, before treatment (T1) and at the day of intrauterine insemination/embryo transfer (T2). For the purposes of this study, 34 counselled couples were then matched to 34 non-counselled couples by propensity scores. The Common Fate Model (CFM) was used to examine dyadic changes.
Results: Couples receiving counselling had higher dyadic quality of life and lower dyadic stress due to the need for parenthood at T2 compared to non-counselled couples. No differences were found on marital satisfaction.
Conclusion: The findings provide support for the effectiveness of counselling on interpersonal outcome. The CFM allows researchers to examine how the dyad as a whole responds to counselling, highlighting the change in the couple's relational dynamics.
Knowledge of HIV status is crucial for HIV prevention and management in marital relationships. Yet some marital partners of people living with HIV decline HIV testing despite knowing the HIV-positive ...status of their partners. To date, little research has explored the reasons for this.
An exploratory qualitative study was undertaken in Lusaka, Zambia, between March 2010 and September 2011, nested within a larger ethnographic study. In-depth interviews were held with individuals who knew the HIV-positive status of their marital partners but never sought HIV testing (n = 30) and HIV service providers of a public sector clinic (n = 10). A focus group discussion was also conducted with eight (8) lay HIV counsellors. Data was transcribed, coded and managed using ATLAS.ti and analysed using latent content analysis.
The overarching barrier to uptake of HIV testing was study participants' perception of their physical health, reinforced by uptake of herbal remedies and conventional non-HIV medication to mitigate perceived HIV-related symptoms. They indicated willingness to test for HIV if they noticed a decline in physical health and other alternative forms of care became ineffective. Also, some study participants viewed themselves as already infected with HIV on account of the HIV-positive status of their marital partners, with some opting for faith healing to get 'cured'. Other barriers were the perceived psychological burden of living with HIV, modulated by lay belief that knowledge of HIV-positive status led to rapid physical deterioration of health. Perceived inability to sustain uptake of life-long treatment - influenced by a negative attitude towards treatment - further undermined uptake of HIV testing. Self-stigma, which manifested itself through fear of blame and a need to maintain moral credibility in marital relationships, also undermined uptake of HIV testing.
Improving uptake of HIV testing requires a multi-pronged approach that addresses self-stigma, lay risk perceptions, negative treatment and health beliefs and the perceived psychological burden of living with HIV. Strengthening couple HIV testing services, including addressing conflict and addressing gendered power relationships are also warranted to facilitate joint knowledge, acceptance and management of HIV status in marital relationships.
SEFT: A Critical Review and Call to Action Peters, Harvey Charles; Das, Bagmi
Journal of professional counseling, practice, theory, & research,
01/02/2021, Volume:
48, Issue:
1
Journal Article
Peer reviewed
This article seeks to galvanize experiential-humanistic marriage and family counselors toward the advancement of Symbolic-Experiential Family Therapy (SEFT). Despite being a fundamental and ...influential experiential-humanistic family theory, SEFT receives little scholarly attention. Accordingly, this article serves as a theoretical review and call to action for the future research, training, and praxis of SEFT.
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