The prevalence of complementary medicine product (CMP) use by pregnant or breastfeeding Australian mothers is high, however, there is limited data on factors influencing women's decision-making to ...use CMPs. This study explored and described the factors influencing women's decisions take a CMP when pregnant or breastfeeding.
Qualitative in-depth interviews and focus group discussions were held with 25 pregnant and/or breastfeeding women who currently used CMPs. Participants' health literacy was assessed using a validated single-item health literacy screening question and the Newest Vital Sign. Interview and focus group discussions were audio-recorded, transcribed verbatim and thematically analysed.
Participants were a homogenous group. Most had higher education, medium to high incomes and high health literacy skills. They actively sought information from multiple sources and used a reiterative collation and assessment process. Their decision-making to take or not to take CMPs was informed by the need to establish the safety of the CMPs, as well as possible benefits or harms to their baby's or their own health that could result from taking a CMP. Their specific information needs included the desire to access comprehensive, consistent, clear, easy to understand, and evidence-based information. Women preferred to access information from reputable sources, namely, their trusted health care practitioners, and information linked to government or hospital websites and published research. A lack of comprehensive, clear, consistent, or evidence-based information often led to decisions not to take a CMP, as they felt unable to adequately establish its safety or benefits. Conversely, when the participants felt the CMPs information they collected was good quality and from reputable sources, it reassured them of the safety of the CMP in pregnancy and/or breastfeeding. If this confirmed a clear benefit to their baby or themselves, they were more likely to decide to take a CMP.
The participants' demographic profile confirms previous research concerning Australian women who use CMPs during pregnancy and lactation. Participants' high health literacy skills led them to engage in a reiterative, information-seeking and analysis process fuelled by the need to find clear information before making the decision to take, or not to take, a CMP.
The community's awareness of Tuberculosis (TB) and delays in health care seeking remain important issues in Indonesia despite the extensive efforts of community-based TB programs delivered by a ...non-government organisation (NGO). This study explored the knowledge and behaviours in relation to TB and early diagnosis before and after an asset-based intervention designed to improve these issues.
Six villages in Flores, Indonesia were purposively selected to participate in this study. Three villages served as intervention villages and the other three villages provided a comparison group. Data collection included interviews, group discussions, observations, field notes and audit of records.
In total, 50 participants across six villages were interviewed and three group discussions were conducted in the intervention villages supplemented by 1 - 5 h of observation during monthly visits. Overall, participants in all villages had limited knowledge regarding the cause and transmission of TB before the intervention. The delay in health seeking behaviour was mainly influenced by ignorance of TB symptoms. Health care providers also contributed to delayed diagnosis by ignoring the symptoms of TB suspects at the first visit and failing to examine TB suspects with sputum tests. Stigmatisation of TB patients by the community was reported, although this did not seem to be common. Early case detection was less than 50 % in four of the six villages before the asset-based intervention. Knowledge of TB improved after the intervention in the intervention villages alongside improved education activities. Early case detection also increased in the intervention villages following this intervention. The behaviour changes related to prevention of TB were also obvious in the intervention villages but not the comparison group.
This small project demonstrated that an asset-based intervention can result in positive changes in community's knowledge and behaviour in relation to TB and early case detection. A continuing education process is like to be required to maintain this outcome and to reach a wider community. Promoting community involvement and local initiatives and engaging health care providers were important elements in the community-based TB program implemented.
Issue addressed: This paper aims to report findings of a scoping review which mapped and summarised available literature regarding Aboriginal peoples' use of Dose Administration Aids (DAAs) for ...improved medication management. Aboriginal and Torres Strait Islander peoples have higher rates of chronic disease than other Australians. This leads to increased numbers of prescribed medications and complex medication taking regimens. The Australian Government and Pharmacy Bodies provide programs for Aboriginal peoples with chronic conditions, including programs supporting access to DAAs to improve medication adherence. Methods: The search strings used included three key concepts: Indigeneity; DAAs and outcomes. PubMed, Medline via Ovid and the grey literature were searched. Results: After removal of duplicates, 426 papers were screened by title and abstract for inclusion. A further 407 papers were then excluded leaving a total of nineteen papers included in the review. Only three of these papers included all three concepts in the search criteria, and none of these were empirical studies. Conclusion: The lack of studies found in this review support the requirement for empirical research regarding the effects of DAAs on medication taking behaviours of Aboriginal people, and the programs that provide them. So What?: The Australian Government funds programs that provides access to DAAs as a method of improving medication taking behaviours. But what do we really know about DAAs and if or how they assist in this goal? This review scopes out what is known, in order to direct studies that will answer this question.
Background: In Jordan, practices in maternity wards are not based on the best evidence. Women are still largely confined to bed during the first stage of labor. Objective: This study examined the ...effect of ambulation during the first stage of labor on maternal and neonatal outcomes. Methods: A blinded randomized controlled trial was conducted in a labor ward of one large hospital in Southern Jordan. Primiparous women (n = 290) were randomly assigned to an intervention group (n = 140) and a control group (n = 150). The intervention group was encouraged to ambulate, and the control group received the usual care. Descriptive statistics, independent t-tests, and analysis of variance were used for data analysis. Results: Compared to the control group, women in the intervention group experienced a shorter duration of the first stage of labor (P < 0.001), reported less intensity of labor pain (P < 0.001), and used less analgesics (P < 0.001). They experienced less augmentation of labor (P = 0.030), were more likely to give birth by normal vaginal birth (P = 0.015) and were more satisfied with the birth experience (P = 0.001). No statistically significant differences were found between groups concerning perineal status, postpartum complications, and neonatal outcomes. Conclusion: Although the intervention has had a positive impact on maternal outcomes, no negative effects on neonatal outcomes were found. Encouraging women to ambulate and assume the upright position during the first stage of labor, is likely to produce better physical, social and economic outcomes in maternity services.
The prevalence of complementary medicine use in pregnancy and lactation has been increasingly noted internationally. This systematic review aimed to determine the complementary medicine products ...(CMPs) used in pregnancy and/or lactation for the benefit of the mother, the pregnancy, child and/or the breastfeeding process. Additionally, it aimed to explore the resources women used, and to examine the role of maternal health literacy in this process.
Seven databases were comprehensively searched to identify studies published in peer-reviewed journals (1995-2017). Relevant data were extracted and thematic analysis undertaken to identify key themes related to the review objectives.
A total of 4574 articles were identified; 28 qualitative studies met the inclusion criteria. Quantitative studies were removed for a separate, concurrent review. Herbal medicines were the main CMPs identified (n = 21 papers) in the qualitative studies, with a smaller number examining vitamin and mineral supplements together with herbal medicines (n = 3), and micronutrient supplements (n = 3). Shared cultural knowledge and traditions, followed by women elders and health care professionals were the information sources most accessed by women when choosing to use CMPs. Women used CMPs for perceived physical, mental-emotional, spiritual and cultural benefits for their pregnancies, their own health, the health of their unborn or breastfeeding babies, and/or the breastfeeding process. Two over-arching motives were identified: 1) to protect themselves or their babies from adverse events; 2) to facilitate the normal physiological processes of pregnancy, birth and lactation. Decisions to use CMPs were made within the context of their own cultures, reflected in the locus of control regarding decision-making in pregnancy and lactation, and in the health literacy environment. Medical pluralism was very common and women navigated through and between different health care services and systems throughout their pregnancies and breastfeeding journeys.
Pregnant and breastfeeding women use herbal medicines and micronutrient supplements for a variety of perceived benefits to their babies' and their own holistic health. Women access a range of CMP-related information sources with shared cultural knowledge and women elders the most frequently accessed sources, followed by HCPs. Culture influences maternal health literacy and thus women's health care choices including CMP use.
This article reports on a study that explored what it means to be a mature-age Aboriginal and Torres Strait Islander university graduate in the context of age, life-stage, history, culture, ...socioeconomic status, race and place. Using narrative interview data and fieldwork observation, we focus on the graduates' workplace experiences and take a case study approach to amplify their voices. We argue that the data challenges the ideological construct of Australia as a 'postracial' society and illustrates how interrelated variants of structural racism function to sanction, silence and control educated Aboriginal and Torres Strait Islander people, divide communities into quasi-hierarchies, and sustain white power and privilege. We show how these variants are expressed as low expectations, shadeism, culturism and privilege protectionism, and argue that their enactment can erect an invisible barrier to Aboriginal and Torres Strait Islander professional progression: a 'white ceiling' above which many graduates struggle to ascend.
To examine the impact of maternity waiting homes on the use of facility-based birthing services for women in two remote districts of Timor-Leste.
A before-and-after study design was used to compare ...the number of facility-based births in women who lived at different distances (0-5, 6-25, 26-50 and > 50 km) from the health centre before and after implementation of maternity waiting homes. Routine data were collected from health centre records at the end of 2007; they included 249 births in Same, Manufahi district, and 1986 births in Lospalos, Lautem district. Population data were used to estimate the percentage of women in each distance category who were accessing facility-based care.
Most facility-based births in Same (80%) and Lospalos (62%) were among women who lived within 5 km of the health centre. There was no significant increase in the number of facility-based births among women in more remote areas following implementation of the maternity waiting homes. The percentage of births in the population that occurred in a health facility was low for both Manufahi district (9%) and Lautem district (17%), and use decreased markedly as distance between a woman's residence and the health facilities increased.
The maternity waiting homes in Timor-Leste did not improve access to facility-based delivery for women in remote areas. The methods for distance analysis presented in this paper provide a framework that could be used by other countries seeking to evaluate maternity waiting homes.
Birth models that work Davis-Floyd, Robbie; Barclay, Lesley; Tritten, Jan ...
2009., 20090307, 2009, 2009-04-06
eBook
This groundbreaking book takes us around the world in search of birth models that work in order to improve the standard of care for mothers and families everywhere. The contributors describe examples ...of maternity services from both developing countries and wealthy industrialized societies that apply the latest scientific evidence to support and facilitate normal physiological birth; deal appropriately with complications; and generate excellent birth outcomes—including psychological satisfaction for the mother. The book concludes with a description of the ideology that underlies all these working models—known internationally as the midwifery model of care.
Issue addressed: This article reports the qualitative evaluation of "Artspace," an innovative clinical program combining creative arts with physical and mental health care for young women. The ...program, provided since 2004, comprises weekly visual arts sessions alongside a youth health clinic offering drop-in appointments with a nurse, GP and counsellor.
Methods: A qualitative evaluation of Artspace was conducted between 2016 and 2017.
Results: The evaluation showed that Artspace was particularly beneficial for those clients who had considerable exposure to social adversity and trauma, and were experiencing related serious health impacts. Artspace facilitated their recovery by enabling equitable access facilitation, social inclusion, creating a "holding" environment, and through the directly therapeutic benefits of artist-led arts processes.
Conclusions: Our study highlights the positive impact of artist-led programs such as Artspace. It also attests to the importance of long-term sustainability of services, to allow the time needed for young people to experience genuine and sustained recovery, and to reduce the otherwise likely disadvantages associated with mental and physical health problems, as they move into their adult lives.
So what?: Youth health researchers have been recommending arts programs at health services as a means of engaging young people in health care for over 15 years, however, it remains an underutilised approach in primary care settings. Our evaluation affirms the effectiveness of art programs for this, and also demonstrates that art programs can be a key contributor to recovery from the serious health impacts of adversity and trauma.
Background
Pregnant and breastfeeding women's use of complementary medicine products (CMPs) is common, and possibly associated with autonomous health care behaviours. However, the health literacy ...levels and health locus of control (HLOC) beliefs of women who use CMPs in pregnancy and lactation have not been previously assessed in a large Australian sample.
Aim
The aim of this study is to determine the health literacy levels and HLOC beliefs of women who use CMPs in pregnancy and lactation and determine the types of CMPs used.
Methods
A cross‐sectional, national, online survey of Australian pregnant or breastfeeding women aged 18 years and older, and currently using CMPs was conducted.
Results
A total of 810 completed surveys (354 pregnant and 456 breastfeeding women) were analysed. Most had adequate functional health literacy levels (93.3%). Health care practitioners (HCPs) HLOC mean scores were the highest for the sample, followed by Internal HLOC beliefs mean scores. Almost all (n = 809) took at least one dietary supplement, the most popular being pregnancy and breastfeeding multivitamins, iron supplements and probiotics. Use was generally in line with clinical recommendations, except for low rates of iodine supplementation. Herbal medicine use was lower for the total sample (57.3%, n = 464), but significantly higher (p < .0001) for the breastfeeding cohort, with consumers taking one to four herbal medicines each. The most popular herbs were raspberry leaf, ginger, peppermint and chamomile (pregnant respondents) and chamomile, ginger and fenugreek (breastfeeding respondents).
Conclusions
Respondents were health literate, with high scores for Internal and HCP HLOC scales, suggesting that they are likely to demonstrate self‐efficacy, positive health behaviours and work well in partnership with HCPs. HCPs can facilitate discussions with pregnant and breastfeeding women using CMPs, while considering women's health literacy levels, health beliefs and goals.
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