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Contraceptive use dynamics of Asian women in Britain.

In-depth interviews were conducted with married Asian women from Indian, Pakistani and Bangladeshi backgrounds, to investigate patterns of contraceptive use and influences on contraceptive decision making. The results show two distinctively different contraceptive 'lifecycles'. Non-professional women typically have little knowledge about contraception until after their marriage or first birth. Their patterns of contraceptive behaviour show low levels of contraceptive use until after their first birth, when condom use is most prevalent. Non-professional women are influenced by their extended family, religion and cultural expectations on their fertility and family planning decisions. Professional women show an entirely different pattern of contraceptive behaviour. They are more likely to have knowledge about contraception before marriage, use some method of contraception throughout their childbearing years (typically the pill) and cite personal, practical or economic considerations in their fertility decisions rather than religious, cultural or extended family influences.

Adult↗

The relational determinants of condom use with commercial sex partners in Thailand.

OBJECTIVE: To analyze the extent and determinants of condom use with commercial sex partners among lower socioeconomic status groups in the Thai population. DESIGN: Respondents were sampled in Udon Thani, Saraburi and Bangkok in 1992. Completed sample size was 678 women in brothels, 330 male truck drivers and 1,075 men aged 17-45 years. Behavioral data and local sexual network information were collected using structured questionnaires (face-to-face interviews), focus groups and in-depth unstructured interviews. METHODS: Data were analyzed using univariate and multivariate logistic regression. RESULTS: Condom use with commercial partners remains inconsistent. Consistent use was reported by 61% of women in brothels, 25% of truck drivers, and 29% of men in the low-income population. The single strongest predictor of consistent condom use for all groups is type of partnership. Consistent use drops significantly with regular (multivisit) commercial sex partners compared with casual (single visit) commercial partners; adjusted odds of consistent use are 0.22 for women and 0.25 for men. Brothel women report that one in five of their commercial partners is a 'regular', and 20% of the young men who report a commercial partner report a 'regular'. DISCUSSION: The strongest determinant of consistent condom use is the nature of the relational bond between the partners, rather than their individual characteristics, knowledge or attitudes. To raise condom use further, programs will have to move beyond the standard knowledge-attitudes-practices paradigm focus on individual attributes to address the contextual determinants of behavior.

Adolescent↗

Becoming clear.

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Administrative Personnel↗

[Organisational issues in implementing clinical trials in primary care].

OBJECTIVE: To identify health professionals concerns on the organisational issues of a randomised clinical trial. DESIGN: A qualitative cross-sectional, descriptive study. SETTING: Primary Care Area 11, Madrid, Spain. PARTICIPANTS: Twenty-four doctors and nurses from 4 primary care teams. METHOD: Three planning meetings with researchers. Design of an anonymous self-administered questionnaire to collect researchers' perceptions on design, method, and organisation during the implementation of a clinical trial. RESULTS: The prestige of being involved in a multi-centre nationwide project, the training sessions offered, a primary care research topic, a working team model of doctor and nurse, and the support provided by team from the 11th Area, were the main organisational incentives. Lack of time, increased clinic workload, and methodological difficulties are discouraging issues. 79.2% (19/24) of the researchers returned the questionnaire. 94.7% (18/19) considered themselves highly motivated. 84.2% (16/19) of researchers, the time required to complete recruitment was reasonable. The 57.9% (13/19) spent 20-25 minutes collecting data at the interview. Cooperation between doctors and nurses had been effective for 68.4% (13/19) of researchers. 89.4% (17/18) considered that support from the Area 11 organisers was useful. CONCLUSIONS: Organisational barriers for implementation are: complexity of data collection at the recruitment interview, design and methodological issues too unrealistic for a primary care setting, and lack of time and extra workload at consultations. The factors that make organisation easier are: having a high level of motivation, sharing workload with other professionals, and support provided by organisers of the trial.

Cross-Sectional Studies↗

Beliefs, practices, and experiences of Korean women in relation to childbirth.

Korean women's health beliefs and childbirth experiences in the United States were examined. A convenience sampling procedure was used, and face-to-face interviews were conducted in Korean. Interviews were audiotaped, typed, and translated from Korean to English. These women had a holistic concept of health. Some practices were influence by ancient Chinese medicine. Childbirth experiences indicated that language is a barrier requiring specific interventions. Recommendations include (a) development of an assessment tool with which health-care professionals can identify individual health beliefs early in pregnancy; (b) development of a bilingual pamphlet about medical terms and the U.S. health-care system; (c) development of a short bilingual dictionary of common foods for use in menu selection during hospitalization; and (d) provision of English practice periods based on anticipatory guidance principles to prepare women to ask for specific assistance.

Adult↗

Researching sensitive issues and ethnicity: lessons from sexual health.

Researchers are generally familiar with the need to adapt their research methods in order to minimise the impact of sensitivity. However, are different considerations required for studies of ethnicity or with ethnic minority respondents? This paper provides insight into strategies used by the authors to tackle sensitivity in qualitative and quantitative research studies of sexual health and ethnicity. Drawing on examples from these studies, the paper demonstrates the relevance of Lee's model of sensitivity, and examines ways in which ethnicity may add further dimensions to our ability to understand, identify and limit sensitivity in the research process. The paper identifies techniques available to researchers for handling sensitivity in general, as well as those that may be useful for researching sensitive topics among ethnic minority populations. The paper concludes that, given the transitional and contextual nature of ethnicity and sensitivity, formulaic approaches for tackling the latter are inappropriate. Instead, strategies are best developed in collaboration with the study communities.

Cultural Characteristics↗

Verbal autopsy as a tool for diagnosing HIV-related adult deaths in rural Uganda.

BACKGROUND: In general, information on the causes of adult deaths in developing countries is scarce. More specifically, relatively little is known about the effect of HIV-1 associated disease on adult mortality in general populations. In this study we have used a verbal autopsy technique to ascertain whether adult deaths were associated with HIV-1 in a rural population with a prevalence of HIV-1 infection of 8%, and used HIV-1 antibody status to validate the verbal autopsy findings. METHODS: All adult deaths in the population cohort that occurred between December 1990 and November 1993 were identified through a monthly death registration system. Approximately 2 months after death, a relative of the deceased was interviewed by a trained nurse, and questionnaires were assessed by at least two independent clinicians; all were unaware of the HIV serostatus of the deceased. RESULTS: A total of 155 adult deaths was assessed, i.e. 53% of all recorded adult deaths. Of those assessed half were HIV-1 positive. In all 47% of deaths were classified as HIV-related. The overall specificity and positive predictive value of the verbal autopsy tool were both 92%; in those aged 13-44 years (83 adults) the corresponding values were 85% and 95% respectively. The verbal autopsy estimated HIV-1 attributable mortality fraction was similar to the calculated fraction based on prospective data. CONCLUSIONS: The results of this study suggest that verbal autopsy studies may assist in providing data on HIV-associated mortality in general populations and may be useful as surveillance tools.

Adolescent↗

Assessment and treatment of symptoms among Italian medical oncologists.

OBJECTIVES: This work was conducted to evaluate symptoms assessment and use of patient-tailored protocols in clinical practice among Italian medical oncologists. METHODS: A questionnaire based on four topics (assessment of symptoms, assessment of a specific symptom, assessment of pain, use of patient-tailored protocols of treatment) was administered to 250 Italian medical oncologists. RESULTS: Of these oncologists, 43.7% used multiple symptoms tools and 37.9% used symptom specific tools; 58.9% used some instrument to assess pain. More than a third of the respondents (35.5%) used patient-tailored protocols. No statistical differences were found regarding region of residency, availability of consultants in pain therapy and/or palliative care, colleagues with main interest on palliative care, and beds dedicated to palliative care. Statistically significant differences were found regarding the position (staff/resident) in three out four topics. CONCLUSIONS: Among Italian medical oncologists, the instruments used for assessment of symptoms are poorly employed. Even when these instruments are used, patient-tailored protocols are rarely administered.

Clinical Protocols↗

Adolescent mothers four years later: narratives of the self and visions of the future.

This study examined patterns, variations, and existential turning points in young mothers' narratives of self and their visions of the future as part of a larger hermeneutic, longitudinal study. The study was philosophically based in the phenomenology of everyday practices as inherently meaningful, situated, and historically derived and drew on dialogical views of the self. The sample consisted of 13 (of the original 16) young mothers and family members who had been interviewed 4 years earlier. For the present study, data consisted of life history accounts of the intervening 4 years, stories of caregiving routines, and recent coping episodes of parenting elicited through in-depth interviews. Findings offer a situated understanding of young mothering and highlight meaningful distinctions in the ways young mothers experience the self and project themselves into the future. The discovery of patterns and variations in the young mother's sense of self and future have implications for guiding clinical practice and are preliminary to designing programs and interventions that are tailored to the practical understanding and situated possibilities of young mothers.

Adolescent↗

Illegal migration in Taiwan: a preliminary overview.

Since 1986, there have been indications that Taiwan (the Republic of China) has been experiencing an increase in illegal migration. Despite a lack of data describing the number, origins, and demographic characteristics of the illegal migrants, an open policy debate has been carried out by economic and social planners, entrepreneurs, and labor leaders. Interviews with representatives of these 3 groups suggest that, contrary to expectations, planners favor the legalization of foreign workers; individual entrepreneurs also consider legalization a wise option. Labor leaders, as expected, are opposed to the use of imported labor. In January 1990, the Executive Yuan (Assembly) adopted regulations permitting limited use of foreign labor. The increase in illegal migrants and the decision to regularize their status suggests the need to review carefully the implications of all planning initiatives as far in advance as possible, and preferably when development plans are being initially implemented.

Administrative Personnel↗