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PubMed2005

Informed consent? How do primary care professionals prepare women for cervical smears: a qualitative study.

BACKGROUND: Cervical screening is a procedure that is mainly carried out in primary care, predominantly by general practitioners (GPs) and practice nurses (PNs). Much has been published about the effects on women of receiving an abnormal smear result but little has been done to investigate the preparation of women by primary care professionals for this. OBJECTIVE: To explore the self-reported behaviours of GPs and PNs in preparing a woman for a cervical smear test and possible abnormal result. METHODS: Letters inviting respondents to participate were sent to selected GPs and PNs at medical student teaching practices in Manchester, England. Twelve GPs and 15 PNs were interviewed. Interviews were audiotaped and covered aspects of the cervical screening programme, practice protocols and explored views about consenting a woman for a smear test and the information giving about the possibility of an abnormal test result. Interviews were analysed by constant comparison and the interview schedule modified. Recruitment for interviews ceased when category saturation was achieved. CONCLUSION: PNs and GPs differed widely in their descriptions of how they prepare a women for a smear. PNs reported following routines which they felt incorporated women's questions and anxieties; GPs reported that the discussion with the woman depended on the reason for doing the smear but also the amount of time available within the consultation. Few respondents reported raising issues of reliability or sensitivity of the test with women, neither did they report discussing with women the possibility of an abnormal smear result or what further investigation and treatment may be required. The degree of persuasion reported by practitioners used to encourage women to attend for smears varied and was related to their attitudes to the national cervical screening programme. PRACTICE IMPLICATIONS: The current system for recall being separate from practice activity, whilst ensuring accuracy of the data-base, may limit the opportunity for information-giving which is sensitive to the needs to the local population. There is a need to include consent issues in the training of PNs, rather than just practical aspects of smear-taking, and to formalise training updates for GPs. In addition, the taking of opportunistic smears and the constraints placed upon time and information-giving need addressing. The role of other primary care staff in encouraging women to attend for smears raises training needs for these staff which practices or primary care trusts must address.

Attitude of Health Personnel↗
PubMed2000

Understanding men's health and illness: a gender-relations approach to policy, research, and practice.

Men's health has emerged as an important public concern that may require new kinds of healthcare interventions and increased resources. Considerable uncertainty and confusion surround prevailing understandings of men's health, particularly those generated by media debate and public policy, and health research has often operated on oversimplified assumptions about men and masculinity. A more useful way of understanding men's health is to adopt a gender-relations approach. This means examining health concerns in the context of men's and women's interactions with each other, and their positions in the larger, multidimensional structure of gender relations. Such an approach raises the issue of differences among men, which is a key issue in recent research on masculinity and an important health issue. The gender-relations approach offers new ways of addressing practical issues of healthcare for men in college environments.

Gender Identity↗
PubMedDate not supplied

Socio-cultural dynamics of female genital cutting: research findings, gaps, and directions.

The goal of abolishing female genital cutting (FGC, or also FGM or 'female circumcision') requires that the socio-cultural dynamics of the practice be well understood if behavioural change is to be accomplished. This paper, based on the literature and the author's ethnographic research in Sudan, reports on the research issues of studying the variation in and complexity of cutting practices and their cultural correlates, arguing for multiple approaches and methods. It highlights directions for future research.

Circumcision, Female↗
PubMed2006

Treatment-seeking behaviour for malaria in children under five years of age: implication for home management in rural areas with high seasonal transmission in Sudan.

BACKGROUND: Effective management of malaria in children under the age of 5 requires mothers to seek, obtain, and use medication appropriately. This is linked to timely decision, accessibility, correct use of the drugs and follow-up. The aim of the study is to identify the basis on which fever was recognized and classified and exploring factors involved in selection of different treatment options. METHODS: Data was obtained by interviewing 96 mothers who had brought their febrile children to selected health facilities, conduction of 10 focus group discussions with mothers at village level as well as by observation. RESULTS: A high score of mothers' knowledge and recognition of fever/malaria was recorded. Mothers usually start care at home and, within an average of three days, they shift to health workers if there was no response. The main health-seeking behaviour is to consult the nearest health facility or health personnel together with using traditional medicine or herbs. There are also health workers who visit patients at home. The majority of mothers with febrile children reported taking drugs before visiting a health facility. The choice between the available options determined by the availability of health facilities, user fees, satisfaction with services, difficulty to reach the facilities and believe in traditional medicine. CONCLUSION: Mothers usually go through different treatment option before consulting health facilities ending with obvious delay in seeking care. As early effective treatment is the main theme of the control programme, implementation of malaria home management strategy is urgently needed to improve the ongoing practice.

Antimalarials↗
PubMedDate not supplied

Nurses' perceptions of continuing professional development.

AIM: To investigate NHS and private sector nurses' perceptions of the value of continuing professional development (CPD), and to analyse the factors that influence these perceptions and any potential barriers to successful CPD. METHOD: Questionnaires were sent to 200 staff working in two NHS trusts and 13 nursing homes. Following analysis of the questionnaires, interviews took place with eight self-selecting respondents to explore certain issues further. Each interview was taped and lasted 30-45 minutes. The venue for the interview was arranged to suit the respondent, either in a private office in the work environment or at home. Written consent was sought before taping the interview. RESULTS: From the results of the postal questionnaires a largely positive perception of CPD was determined. However, it was shown that there were some barriers to professional development that have not previously been reported in the literature. Managers' leadership styles were found to influence nurses' perceptions of the value of CPD, as well as their ability to reflect, which affected the application of learning to practice. CONCLUSION: Influencing factors included managers' leadership styles and their responsiveness to change, as well as a reduced ability for nurses to reflect. A disassociation between post-registration education and practice (PREP) and CPD in terms of understanding the purpose of PREP was also discovered among nurses.

Attitude of Health Personnel↗
PubMed1999

Perceptions of cancer and its causes among "Industrial Corridor" residents: the LMRICS Planning Project. Lower Mississippi River Interagency Cancer Study.

The Industrial Corridor is composed of 11 parishes heavily concentrated with petrochemical facilities along the Mississippi River from Baton Rouge to the mouth of the river. There exists a generalized belief that the proximity of these waste-emitting industries to residential areas has adversely impacted the health of the residents including increasing the rates of cancer. At the same time, Louisiana Tumor Registry data do not support the widely held belief of excess cancer rates in the corridor. A community in the corridor was chosen to explore the issues of health beliefs, health-seeking behavior, and perceived quality of life. An extensive questionnaire was developed and administered to a sample of community residents. The results of the questionnaire suggest there may be multiple factors that influence the perceived well-being and preventive health practices of corridor residents.

Black or African American↗
PubMed2006

Nursing students' and faculty members' knowledge of, experience with, and attitudes toward complementary and alternative therapies.

This study was designed to describe and compare the knowledge, experience, and attitudes of nursing faculty and students (undergraduate and graduate) regarding complementary and alternative therapies (CAT). A cross-sectional survey (N = 153) of undergraduate (n = 41) and graduate (n = 57) students and faculty (n = 55) was conducted in one school of nursing. Most participants were White (87%) and female (78%). More than 70% of the students and faculty agreed that clinical care should integrate the use of CAT. More than 85% desired more education about CAT, especially in undergraduate nursing curricula. More than 65% agreed that the clinical nurse specialist or nurse practitioner role should include the use of CAT in their practice, and more than 50% agreed that they had some knowledge of CAT, but only approximately 30% had some experience with CAT. Faculty and students expressed positive attitudes toward integrating CAT into the undergraduate nursing curriculum and nursing practice. Faculty development and nursing research are needed to facilitate curriculum change and integrate CAT into nursing programs at all levels.

Adult↗
PubMed2006

Husbands' experiences before wives' hysterectomy.

After Caesarean section, hysterectomy ranks as the surgical procedure most frequently performed on women. To most women, the partner's support is vital. Currently, there is a lack of research on the experiences of husbands facing their wife's hysterectomy. The aim of this study was to understand husbands' experiences when their wives were to undergo a hysterectomy. The study used a phenomenological approach and purposive sampling; data were collected at three teaching hospitals in northern Taiwan. Twenty participants were interviewed and data were analyzed by Colaizzi's method. The findings demonstrated that, when their wives were to undergo a hysterectomy, six major themes emerged among the husbands, as follows: (1) limited knowledge about the surgical process; (2) considerations about and adjustments to changes in one's sex life; (3) support in making necessary decisions; (4) difficulty in acquiring information on uterine disorders; (5) ensuring the wife's safety during the operation; and (6) expecting full communication with medical personnel. The findings from this study should contribute significantly to advances in practice, education and research concerning Taiwanese males' experiences as they face their wife's hysterectomy. These findings highlight the significance of the husband's involvement in meeting his wife's needs as regards providing information and communicating. Implications for nursing practice and further research are discussed.

Adaptation, Psychological↗
PubMed1996

Developing a training programme in patient-centred consulting for evaluation in a randomised controlled trial; diabetes care from diagnosis in British primary care.

AIM: To develop a feasible/theoretically based training programme in patient-centred consulting, for evaluation in a randomised controlled trial of diabetes care from diagnosis. METHODS: The programme was developed with four primary care teams and their patients in an action research framework, with observation of diabetes review consultations before and after training, and evaluated by questionnaire after each training session, among 23 general practitioners and 32 practice nurses from 21 practices in the trial. RESULTS: The observation study identified opportunities and obstacles to introducing a patient-centred approach into daily practice, especially in relation to time management and skill needs. The modified training programme was rated highly by participating general practitioners and nurses. CONCLUSIONS: Developing training programmes with the help of participating primary care teams ensures relevance and feasibility. Patient-centred consulting demands a shift from habitual consulting patterns. Practitioners are implementing the approach in practice, and the impact on patients is now under evaluation in the randomised controlled trial.

Diabetes Mellitus, Type 2↗
PubMed2006

Listening to female sex workers in Vietnam: influences on safe-sex practices with clients and partners.

BACKGROUND: This qualitative study assessed HIV/AIDS knowledge and frequency of and influences on condom use with clients and regular, non-client partners among female sex workers (FSWs) in Khanh Hoa, a tourist-oriented province of central Vietnam where sex work is common. METHODS: Data were collected via semi-structured interviews with indirect (n = 16) and direct (n = 9) FSWs. RESULTS: Although the majority of respondents were well informed about HIV/AIDS transmission, about one-third had inaccurate beliefs about HIV-positive people as well as the mechanisms by which HIV is transmitted from mother to child. Condom use was inconsistent. More direct than indirect FSWs reported using condoms most of the time with clients but none used condoms all the time. With regular partners, most respondents reported that they never used condoms. Around one-third of women hid their sex work from their regular partners, who made the decision to use or not to use condoms. The most frequently reported reasons for not using condoms with clients were because clients offered a higher price, clients insisted on condom-free sex, and possession of condoms as evidence of sex worker status. For regular partners, the reasons were familiarity, condom use being dependent on partner's decision, and condom use as evidence of sex worker status. There was no apparent relationship between HIV knowledge, time in sex work, and safe sex practices. CONCLUSION: Recommendations are made to improve the rate of condom use among FSWs.

Adolescent↗
PubMed2004

Delivery of nutrition services in health systems in sub-Saharan Africa: opportunities in Burkina Faso, Mozambique and Niger.

BACKGROUND: In sub-Saharan Africa, underweight and micronutrient deficiencies account for an estimated 25% of the burden of disease. As the coverage of national health systems expands, increased opportunities exist to address the needs of children and women, the most vulnerable to these deficiencies, through high-quality nutrition services. OBJECTIVES: To assess health providers' knowledge and practice with regard to essential nutrition services for women and children in Burkina Faso, Mozambique and Niger, in order to assist the development of a standard guide and tools to assess and monitor the quality of the nutrition services delivered through national health systems. FINDINGS: The three surveys reveal the extent of missed opportunities to deliver nutrition services during routine prenatal, postnatal and child-care consultations for the prevention and treatment of highly prevalent nutritional deficiencies. CONCLUSION: A commitment to improving the quality of facility-based nutrition services is necessary to impact on the health outcomes of women and children 'covered' by national health systems. Rigorous assessment and monitoring of the quality of nutrition services should inform health programme and policy development. Building on the lessons learned in these three assessments, Helen Keller International has developed a standard Guide and Tools to assess the quality of the nutrition services delivered through national health systems. These tools can be adapted to assess ongoing nutrition services in health facilities, provide a framework for nutrition programming, inform the development of pre-service as well as in-service nutrition training curricula for providers, and evaluate the impact of nutrition training on providers' practices.

Adult↗
PubMed1992

Worry: a particular determinant of consultation illuminated.

In this study, exploring the worry experienced by patients in the GP waiting room and the reasons for being worried, 791 patients completed a structured questionnaire just before they consulted their GP, and afterwards. The perceptions of the patients concerning the complaint and the need for more information about the complaint played an important role in the degree of worry. Patients who wanted more information about the complaint were more worried than the patients who did not feel they needed more information. Not surprisingly, the more serious the patients perceived the complaint to be and the greater the perceived chance of serious disease, the more worried they were. General health status and frequency of consultations per year were related to the degree of general worry. According to the patient self-reports, worry was almost never due to information from the mass media or from other persons, or to a concern for the consultation itself. Patients generally evaluated the consultation as positive with respect to the way their worry was discussed. The decrease in worry after consulting the GP, in patients who were positive about the consultation was significantly higher than that in patients who were less positive. The theoretical and practical implications of this study are discussed.

Adult↗
PubMed2003

Creating healthy environments: household-based health behaviors of contemporary Mexican American women.

This article describes the household-based health behaviors of a sample of contemporary Mexican American women.1 Using the Household Production of Health (HHPH) as a conceptual framework and ethnographic methods of inquiry, 13 moderately to highly acculturated women of Mexican ancestry participated in multiple interviews about their health beliefs and household health behaviors. This article examines the findings related to the following research question: What are the health-producing and help-seeking behaviors (proximate determinants of health) used by Mexican American women to produce health? Themes focusing on creating healthy environments and treating illness are discussed. Awareness of the activities that women use to create and support household health can enhance the practice of nurses interested in supporting women's health work and improving health outcomes in the Mexican American community.

Acculturation↗
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↗