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PubMed2006

Parenting, class and culture: exploring the context of childrearing.

This paper highlights the central role of social class in shaping experiences of childrearing. Drawing on material from qualitative interviews with a range of working class mothers it explores and contextualises day-to-day family practices. It examines the different ways in which parents cope with disadvantage and shows how their decisions and practices are grounded in a material and social reality. In contrast to evaluative and outcome-focused literature on parenting, it demonstrates how decisions and practices that make less sense from a middle class vantage point shift their meaning when viewed from a working class perspective. The paper illustrates how the promotion of parenting 'skills' as neutral technical tips obscures normative, culturally specific assumptions about what constitutes successful childrearing. The implications of this for health visitors' practice will be considered.

Adaptation, Psychological↗
PubMed2006

Knowing how to play the game: hospitalized substance abusers' strategies for obtaining pain relief.

This study explored hospitalized substance abusers' perspectives about getting their pain adequately addressed in the hospital setting and their interactions with nurses about pain-management issues. The aim of the study was to generate theory that can contribute to a greater understanding of the problem of pain management with this population. A grounded theory approach was used to interview participants with a substance abuse problem who were hospitalized with a medical/surgical problem. Interviews were conducted using an interview guide; interviews were audiotaped and transcribed. In addition, a focus group of nurses who worked with this population met twice, once midway through the study, and before the final participant interview. The nurses commented on the fit of the developing model according to their experiences of working with the population described. Eighteen participants were interviewed for a total of 20 interviews (two participants were interviewed twice). All participants were polysubstance abusers and had a painful medical/surgical problem for which they were hospitalized. The Model of "Knowing How to Play the Game" was developed on the basis of participants' descriptions of their experiences and consisted of two core action categories "Feeling Respected/Not Respected" and " Strategizing to Get Pain Relief." Participants had many suggestions about nursing actions that were helpful or not helpful in assisting them to obtain pain relief. Nursing practice, education, research, and policy implications were discussed.

Adaptation, Psychological↗
PubMed1991

Some factors affecting acceptance of family planning in Manus.

This paper examines selected factors affecting the acceptance and delivery of modern family planning from health centres in Manus. A survey was carried out of mothers attending Maternal and Child Health clinics and a written questionnaire was given to health workers. The survey of mothers demonstrated the importance of the husband's approval for contraceptive practice and showed that knowledge about traditional methods of family planning is widespread. The health workers' questionnaire demonstrated a high level of dissatisfaction with the current family planning program delivered by health clinics: 45% found the program ineffective; 68% wrote that health workers' attitudes discouraged mothers from attending for family planning. The perceived and actual benefits and costs of children and the role of men should be assessed locally before planning future family planning programs. Widespread retraining and motivating of health workers is essential if improved coverage is to be achieved through health services. The efficacy of alternative methods of delivery of family planning such as local community-based and social marketing programs should also be investigated.

Age Factors↗
PubMed1998

The versatile nature of physical activity--on the psychological, behavioural and contextual characteristics of health-related physical activity.

This paper presents a comprehensive characterisation of physical activity based on psychological, behavioural and contextual aspects. Based on the characterisation it suggests a promotional classification of physical activity into five categories. The categories are: 1, Occupational activity; 2, Lifestyle activity; 3, Recreation activity; 4, Fitness activity; and 5, Sport activity. Examples are given of activities in each category and of the related emotional aspects, outcome expectations, degree of personal choice and health benefits. The importance of the emotional component and the relevance of the outcome expectations are discussed and contextual considerations are presented on the basis of the promotional classification. The implications of the classification for the practice of health-enhancing physical activity promotion are discussed.

Adult↗
PubMed2005

Abstain or die: the development of HIV/AIDS policy in Botswana.

This paper traces the development of policies dealing with HIV/AIDS in Botswana from their beginning in the late 1980s to the current programme to provide population-wide anti-retroviral therapy (ARV). Using a variety of source material, including long-term ethnographic research, it seeks to account for the failure of Western-inspired approaches in dealing with the pandemic. It does this by looking at the cultural and institutional features that have created resistance to the message and inhibited effective implementation. The negative response to the first educational campaign stressing condom use is described and contextualized in terms of Tswana ideas of morality and illness. Nor, as was initially expected, did the introduction of free ARV therapy operate to break the silence and stigma that had developed around the disease. Take-up was very slow, and did not operate to encourage widespread testing. In 2003, key policymakers in Botswana began to argue for a break with the AIDS 'exceptionalism' position, with its emphasis on voluntarism, confidentiality and the human rights of patients. This resulted in routine testing being introduced in 2004. This links to a major argument running through the paper which is that the failure of policy cannot be attributed solely to the nature of local populations. Western cultural assumptions about 'good practice' also require critical examination.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Between "science" and "superstition": moral perceptions of induced abortion among young adults in Vietnam.

Despite the increasing use of reproductive technologies the world over, anthropological studies have paid remarkably limited attention to the ethical dilemmas involved in people's choices of such technologies. Against this background, the author analyzes moral perceptions of induced abortion among unmarried young adults in urban North Vietnam. While the ethical aspects of abortion are shrouded in silence in public life in Vietnam, the young people participating in the study expressed strong moral scepticism towards the practice of abortion, even while undergoing it themselves. Through the analysis of young people's experiences and perceptions, the paper demonstrates how moral ideas are tied to particular social situations and structured by larger socio-political circumstances. It is argued that moral notions which are dominant in a society's public sphere may not be representative of the moral sentiments that are lived in practice and felt in private.

Abortion, Induced↗
PubMedDate not supplied

The need for sexual health information: perceptions and desires of young adults.

PURPOSE: To ascertain young adults perceptions of previously received sexual health information and describe what types of information they would like to receive. STUDY DESIGN AND METHODS: In individual interviews, 55 young adults were asked questions regarding their perceptions of previously received sexual health information as well as their interests in receiving future information. Content analysis was used to categorize responses and identify categories. RESULTS: The majority of participants remember receiving information about sexually transmitted infections (STIs) primarily from classes in middle and high school. Less than half remembered receiving information about contraception or how to prevent STIs. The majority of participants did not feel that (or were uncertain about whether) past information influenced their current sexual practices. Of those who felt past education influenced them in changing sexual practices, an increase in awareness of their risk was the category most often cited. One-third of the participants responded that a culture of abstinence in the US explained why current educational programs failed. When asked to describe an ideal sexual health program, the most common answers were wanting a comfortable, "not scared" person to teach them more "nitty-gritty" information about STIs with "more details," what they could do to protect themselves, "how to get birth control," and "how the reproductive system works." CLINICAL IMPLICATIONS: Young adults have specific needs and interests when it comes to sexual health information. Research is necessary to see if development of specific interventions requested by young adults would result in higher levels of recall and ability to avoid dangerous sexual practices.

Adolescent↗
PubMed2005

Use of moisturizers in dermatologic disease: the role of healthcare providers in optimizing treatment outcomes.

Although atopic dermatitis is a common cutaneous disorder, patients often are frustrated in their attempts to understand the disease and its treatment. Studies have shown that the patient-provider relationship is key to patient compliance with a skin care regimen and that most patients with atopic dermatitis are eager to be well informed. However, many patients fail to receive an adequate explanation of the causes of atopic dermatitis or to be taught how to apply topical treatments, even though instruction and practical demonstrations are associated with a dramatic improvement in the treatment outcome. Efforts to educate patients regarding the use of moisturizers are correlated with clinical improvement and a reduction in the use of topical medications such as corticosteroids and calcineurin inhibitors. In addition to topical moisturizers, medications, wet wraps, and hydration therapy has become a frequently used practice in the management of atopic dermatitis.

Administration, Topical↗
PubMed2004

Kidney transplantation: determination of the problems encountered by Turkish patients and their knowledge and practices on healthy living.

BACKGROUND: Although renal transplantations remove many limitations, dialysis can improve quality life in patients with end-stage renal disease, once transplantation has been performed and the patient has been discharged with a functioning graft, life with a chronic illness continues. AIMS AND OBJECTIVES: This study was carried out to define problems encountered by patients undergoing kidney transplantation and their knowledge and practices on healthy living. DESIGN: This study was designed as a retrospective and descriptive survey. METHODS: This study was performed on 125 patients who were followed at Social Insurance Institute's Ankara Specialty Hospital Transplantation Clinic between March and August 2001. A convenience sample was drawn from the population of renal transplant patients. A questionnaire was prepared based on the literature, which included patients' socio-demographic information, physiological problems, diseases and repeated hospitalizations; side-effects and usage of immunosuppressive drugs, knowledge and practices of patients regarding healthy living and their knowledge needs. Data were collected through interviews. Percentage and chi-square test were used in evaluation of the data. RESULTS: Physiological problems and diseases after renal transplantations were seen such as 38.4% had infections in urinary and respiratory tract. Some had hypertension (22.4%) hypercholesterolaemia (26.5%) and 5.6% had malignancy. Most (67.2%) developed antirejection drugs side-effects. About 55.2% were admitted to hospital after renal transplantation and 68.8% had not received any training after transplantation from a health professional. Only 35.2% knew the signs and symptoms of rejection entirely or partly. It was determined that 55.2% stated that they avoid sunlight and 56% stated that they exercise regularly. Only 26.8% of female patients do regular breast self-examination. While 52.8% listed the forbidden foods correctly, only 27.2% could list the forbidden beverages accurately. CONCLUSIONS: According to the results, patients undergoing renal transplantation experience various problems that may influence their quality of life adversely and their knowledge and practice is not adequate for them to continue to lead healthy lives. RELEVANCE TO CLINICAL PRACTICE: In accordance with the results of the study, offering continuing education and counselling services, preparing training guides, brochures, video cassettes and CDs for patient education, improving the national web sites to inform the public and creation of a home care system were suggested.

Adaptation, Psychological↗
PubMed2004

The Boston Haitian HIV Prevention Coalition formative evaluation: a participatory approach to community self-assessment.

This article describes the application of participatory evaluation principles and methods to designing and conducting a community survey of the metropolitan Boston Haitian population. The findings of the evaluation baseline community survey of 2,719 Haitians are described, including an overview of the population characteristics and the prevailing HIV prevention knowledge, attitudes, and practices. The participatory evaluation approach was effective in building evaluation capacity, and provided a reliable data source with which to fine-tune the prevention intervention, and increase its efficacy in reducing HIV transmission.

Adult↗
PubMed2004

Promoting evidence-based practice: an organizational approach.

AIM: To examine factors influencing the achievement of evidence-based practice. BACKGROUND: This paper reports on the approach taken by a large teaching hospital in England to promote evidence-based practice. A summary of initiatives spanning a 5 year period is presented in order to set the scene for a recent survey of nurses to review progress made. Consideration is given to how the findings from the survey have been used to inform policy and practice. METHODS: A survey by self-completed questionnaire was undertaken with a sample of clinical nurses (n = 330). The questionnaire examined the extent to which nurses utilised different sources of knowledge to inform their practice; perceived barriers to accessing evidence-based information and effecting change in practice; and a self-assessment of core skills necessary to underpin evidence-based practice. FINDINGS: Nurses relied most heavily on experiential knowledge gained through their interactions with nursing colleagues, medical staff and patients to inform their practice. Organisational information in the form of policies and audit reports was drawn upon more frequently than research reports. Lack of time, resources and perceived authority to change practice influenced the extent to which nurses utilised formal sources of evidence. Whereas nurses were relatively well skilled at accessing and reviewing research evidence, they were less confident about their ability to change practice. CONCLUSION: Health care organisations need to consider multiple strategies to facilitate and promote evidence-based practice. Managerial support, facilitation, and a culture that is receptive to change are essential.

Attitude of Health Personnel↗
PubMedDate not supplied

Redesigning prenatal care through CenteringPregnancy.

CenteringPregnancy is a model of group prenatal care that provides more than 20 hours of contact time between the childbearing care provider and a cohort of pregnant women with similar due dates. During this time, each woman has the opportunity to build community with other pregnant women, learn self-care skills, get assurance about the progression of her pregnancy, and gain knowledge about pregnancy, birth, and parenting. Ten essential elements have been defined, which contribute to the success of this model of prenatal care delivery. These elements correspond with the Institute of Medicine's 2001 challenge to improve the quality of health care in the United States. Foundational perspectives provide potential explanations for the model's growing influence and success. Implications for clinical practice and further research to link it with perinatal health outcomes are suggested.

Anecdotes as Topic↗
PubMed2004

Linking active living and nutrition counselling: dietitians' perceptions.

Healthy eating and active living have become key concepts in health promotion, and, increasingly, the two messages are being combined. Dietitians are in an ideal position to promote physical activity as an adjunct to nutrition counselling. Focus group interviews were used to identify dietitians' perceptions and needs related to incorporating active living messages into their practices. Six focus groups, involving 42 participants (40 registered dietitians and two dietetic interns), were conducted in cities throughout Alberta. Issues explored during the interviews included the dietitian's role in promoting active living, barriers to promoting physical activity, opportunities for collaboration between dietitians and exercise professionals, and dietitians' perceived needs for integrating active living messages into their practices effectively. Findings indicate strong support for incorporating active living messages into nutrition counselling. However, lack of knowledge was identified as a barrier to dietitians' proactive role, and concerns were raised about public and professional perceptions if dietitians counselled on this issue. Participants felt that they required additional knowledge and training in physical activity in order to promote it effectively. Development and implementation of programs designed to meet these needs would help dietitians integrate active living messages into their practices.

Alberta↗
PubMed2005

Using action research in nursing practice with older people: democratizing knowledge.

AIM: This paper reports on an action research study which raised some questions about the processes of developing a sense of shared ownership in action research in a research environment which does not always have the appropriate mechanisms to support and sustain action research. BACKGROUND: Action research has gained popularity in nursing and healthcare research, offering a way of developing practice-based knowledge, which can assist in changing practice and democratizing inquiry. METHODS: There are other organizational constraints on action research which arise at different levels, and which also require discussion. These can be issues about communication and ownership at a practice level and issues of funding and project management procedures. This paper reports on a study in which these issues came to the fore, and offers some thoughts on how they can affect the processes of action research. CONCLUSION: While the principles of action research appear to offer much towards the development of a practice-rooted body of knowledge for nursing, unless some of the issues of ownership are resolved, it is unlikely to move beyond academic rhetoric. RELEVANCE TO CLINICAL PRACTICE: If nursing is to engage in action research, this must be done critically and reflectively and careful attention paid to developing an inclusive and collaborative approach to knowledge and practice development. Furthermore, to develop in nursing and health care research, it must find ways to meet the requirements of funding bodies.

Activities of Daily Living↗
PubMed2000

Acute-care nurses' attitudes towards older patients: a literature review.

With increases in life expectancy and increasing numbers of older patients utilising the acute setting, attitudes of registered nurses caring for older people may affect the quality of care provided. This paper reviews recent research on positive and negative attitudes of acute-care nurses towards older people. Many negative attitudes reflect ageist streotypes and knowledge deficits that significantly influence registered nurses' practice and older patients' quality of care. In the acute setting, older patients experience reduced independence, limited decision-making opportunities, increased probability of developing complications, little consideration of their ageing-related needs, limited health education and social isolation. Available instruments to measure attitudes towards and knowledge about older people, although reliable and valid, are outdated, country-specific and do not include either a patient-focus or a caring perspective. This paper argues for the development and utilisation of a research instrument that includes both a patient focus and a caring dimension.

Aged↗
PubMed2006

Knowledge and attitudes towards attention deficit hyperactivity disorder among elementary school teachers.

OBJECTIVE: Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in child and adolescent psychiatry. ADHD children are at risk for academic and psychological difficulties. Lack of cooperation between schools, parents and therapeutic institutions inhibits a multimodal treatment program. This study surveys teachers' knowledge and attitudes towards attention deficit hyperactivity disorder. METHOD: One hundred and ninety six elementary school teachers in Shiraz, Iran, anonymously completed a self-report questionnaire on ADHD. RESULTS: Knowledge about ADHD was relatively low. 46.9% of respondents agreed that ADHD is due to biological and genetic vulnerabilities and causation. 53.1%of all the teachers considered ADHD to be the result of parental spoiling. The attitude score towards ADHD children was also low. 64.8% agree that the same disciplinary rules used for all students should also be applied to ADHD children. 77.6% believe that ADHD students experience difficulties in their relations with their classmates. There was a significant correlation between teachers' knowledge of ADHD and their attitude. The main sources of knowledge about ADHD were: Television and radio; friends and relatives; periodical, newspapers and magazines. CONCLUSION: Knowledge about ADHD was sound to be very low. PRACTICE IMPLICATIONS: Health and/or Educational Ministry should promote a special course on ADHD for teachers and education should be part of the curriculum in faculty training. Providing these educational programs on television and radio may be highly effective as they were the most common source of information.

Adult↗
PubMed2006

Health workers' support for breastfeeding in Ibadan, Nigeria.

Breastfeeding in Nigeria is universal, and exclusive breastfeeding was introduced in 1992, yet no study has assessed health workers' support for breastfeeding at the grassroots level. This study assessed health workers' tangible support for breastfeeding at primary care facilities in Ibadan and factors affecting it, including knowledge of and attitudes toward breastfeeding. Among the 386 workers, there was moderate support for breastfeeding (median score = 15.0, maximum = 20). Following multivariate analysis, young age of worker (20-29 years; odds ratio [OR] = 2.9, 95% confidence interval [CI]: 1.2-6.8), more than 5 years of post-training experience (OR = 2.3, 95% CI: 1.2-4.4), senior profession (OR = 2.1, 95% CI: 1.0-4.4), high breastfeeding knowledge scores (OR = 2.5, 95% CI: 1.4-4.5), and sufficient opportunities to practice tangible breastfeeding support (OR = 4.3, 95% CI: 2.4-7.7) were found to predict tangible breastfeeding support. Deliberate efforts should be made to incorporate continuing education workshops to better prepare health professionals for their role in providing tangible breastfeeding support at the primary care level.

Adult↗