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PubMed2005

The pervasive triad of food security, gender inequity and women's health: exploratory research from sub-Saharan Africa.

OBJECTIVES: This study was designed to explore the interactions between food securing activities, health and gender equity from the perspective of rural east African women. The specific objectives were to document the critical interaction among these three issues-food security, gender inequity, women's health within the context of sub-Saharan Africa; to describe the nature of this triad from the perspective of women farmers in Africa; and to propose a framework for linking available interventions to the vicious nature of this triad. SETTING: In-depth interviews and focus group discussions were conducted with rural women farmers in Kwale District, Kenya and Bagamoyo District, Tanzania. METHODS: A total of 12 in-depth interviews and 4 focus group discussions have been included in this analysis. Transcribed text from interviews and focus group discussions were coded and thematic conceptual matrices were developed to compare dimensions of common themes across interviews and settings. A thematic analysis was then performed and a framework developed to understand the nature of the triad and explore the potential for interventions within the interactions. FINDINGS: The vicious cycle of increasing work, lack of time, and lack of independent decision making for women who are responsible for food production and health of their families, has health and social consequences. Food securing activities have negative health consequences for women, which are further augmented by issues of gender inequity. CONCLUSION: The African development community must respond by thinking of creative solutions and appropriate interventions for the empowerment of women farmers in the region to ensure their health.

Agriculture↗
PubMed2000

[Study on unsupervised classification in marshland of endemic area of Schistosomiasis Japonica using satellite TM image data].

OBJECTIVE: To categorize the vegetation of marshland in the endemic areas of Schistosomiasis Japonica using satellite thematic mapper (TM)data in Liupo Village, Anhui Province. METHODS: Data of three satellite TM hands, namely TM3, TM4 and TM5, were selected to be used in classification with principal component analysis. Then, satellite TM images were applied to false color composite and unsupervised classification with computer software to manage the images. Finally, the resulting clusters were identified and reclassified by site visits to categorize the land coverage and vegetation. RESULTS: Five classifications of land coverage were generated, including poplar forest, bulrush and marshland, all with snail habitants. Based on the survey in the spring of 1998, the overall live snail density and infested snail density in the study areas were 0.510/0.11 m2 and 0.007/0.11 m2, respectively. CONCLUSION: Unsupervised classification, which is a technique for the interpretation of remotely sensed imagery, can contribute to the classification of environment with snail habitants and ecological diseases and become a new method in epidemiological studies.

Animals↗
PubMed2006

Adolescents with asthma: learning needs and internet use assessment.

OBJECTIVE: To identify particular learning needs among adolescents with asthma and explore the potential utility of the Internet in addressing adolescents' expressed learning needs. METHODS: In 2004 and 2005, 6 gender-specific and age-specific focus groups were conducted among adolescents, ages 12-18 years, with mild intermittent to severe persistent asthma. Thematic analysis of participants' statements from transcribed group sessions were conducted by the research team, who compared field notes, reviewed focus group transcripts, and validated emerging and final themes. RESULTS: The majority of participants denied previous experience with formal asthma education. Participants reported their limited knowledge of asthma and its management. Health-care providers were recognized as the most credible source of asthma information. Compared to the older adolescents, the younger adolescents expressed stronger motivation to learn about asthma. The participants identified asthma learning needs for others, including peers, teachers, and parents. The importance of socialization, support, and information-sharing with other adolescents with asthma was perceived by participants in all age and gender groups. Participants discussed their Internet use and articulated suggestions regarding potential uses of the Internet to assist in adolescent asthma management. CONCLUSIONS: This study underscores the necessity of an early intervention to take advantage of younger adolescents' greater interest in learning about asthma, and highlights the importance of incorporating peer dynamics in designing interventions for adolescents. Our findings also illustrate the variety of ways that the Internet may be useful in developing a technology-driven intervention for adolescents.

Adolescent↗
PubMed2004

Simulation-based training to improve acute care skills in medical undergraduates.

AIM: Acquisition of clinical skills by medical undergraduates can be problematic, especially in the context of medical emergencies. Simulation using computerised manikins may be an effective and ethical solution. We assessed the ability of undergraduates to manage medical emergencies, and evaluated simulation as an educational and assessment tool. METHOD: Medical undergraduates were assessed in standardised, highly contextualised simulations of medical emergencies using both checklists and global ratings, and were reassessed following a simulation-based educational intervention to measure learning effect. The scores for groups at different levels of training were compared to test construct validity of global ratings of simulator performance. We explored student perspectives of simulation through thematic analysis of questionnaire responses. RESULTS: Seventy-one students were studied. Final year students performed significantly better than fourth year students, but the ability to initiate management of medical emergencies was unsatisfactory in both groups. Performance improved significantly over the course of the simulation workshop. The learning processes in simulation-based education were perceived as more effective than traditional methods, and consistent with known principles of effective learning. Students felt the simulations were a reasonable measure of their abilities and 91% felt that such simulations should be included in their end-of-year assessment. CONCLUSION: Current medical undergraduate training does not ensure new graduates can intervene effectively in an emergency. Simulation-based workshops are effective and should be incorporated into the undergraduate curriculum both for education and assessment of competence in emergency management.

Clinical Competence↗
PubMed2005

What is needed to assist patients with advance directives from the perspective of emergency nurses.

INTRODUCTION: Nurses, by the nature of their practice, are in a unique position to help patients complete advance directives (ADs). This article focuses on an open-ended question that was part of a larger quantitative survey, "What do emergency nurses need to increase their ability to assist patients with ADs?" METHODS: A random sample of emergency nurses in four states was surveyed. Of the 663 nurses who responded to the survey, 506 (76%) wrote responses to the open-ended question. Thematic analysis was used to establish and saturate themes. RESULTS: The major themes discussed most often by the nurses were the need for more education and more time to discuss ADs with patients. Other themes discussed by nurses were the need for: a supportive work environment, other health care professionals' participation conducive to assisting patients, patient/public education related to ADs, communication, and particular nursing characteristics needed to successfully assist patients with ADs. Not all the nurses in the study felt that assisting patients with ADs was the role of emergency nurses. CONCLUSIONS: Those nurses who saw assisting patients with ADs as their role were very clear about what they needed to be able to carry out the role (more time to spend with patients and more education related to ADs) and that they could not fulfill that role without the support of their institution's administration.

Adult↗
PubMed2026

The psychosocial supports and interventions accessed by family members of patients with developmental and epileptic encephalopathies: A systematic review.

AIM: Family members of patients with developmental and epileptic encephalopathies (DEEs) face profound emotional, social and practical challenges, yet little is known about how they access psychosocial support. We synthesised the literature on the psychosocial support accessed by family members of patients with DEEs, including evidence-based interventions. METHOD: Four databases were searched. Two reviewers independently screened and extracted data, appraised study quality (QualSyst Tool), and determined certainty of evidence (GRADE-CERQual Framework). Data were synthesised using inductive thematic analysis. RESULTS: 28 papers comprising 27 unique studies were included and methodological quality was high overall (median = 0.91, IQR = 0.85-1.00). Most studies focused on parent experiences; only two included siblings' perspectives. Families reported high psychological needs which were rarely met by psychological support. Clinicians rarely provided adequate information, quality communication or addressed mental health. Families valued respite care, but experienced barriers to access. Peer support was the most common and valued resource. Three studies tested interventions and appeared feasible and acceptable for parents. However, evidence for intervention effectiveness is preliminary and limited to small, uncontrolled pilot studies. INTERPRETATION: Gaps exist in psychosocial support provision for families of patients with DEEs, including insufficient research on siblings' and grandparents' needs, and lack of evidence-based interventions. We propose evidence-informed research and implementation strategies to address these gaps.

Humans↗
PubMed2000

Increasing uptake rates of cervical cancer screening amongst Hong Kong Chinese women: the role of the practitioner.

Women's attendance for regular cervical screening has been identified as a significant factor in the prevention of cervical cancer. Evidence suggests, however, that both extrinsic and intrinsic factors influence women's attendance patterns for screening. Extrinsic factors, in particular the practitioner undertaking the screening procedure, have been shown to influence women's return rates for further screening. In Hong Kong, where uptake rates amongst Chinese women remain comparatively low, a study was undertaken to examine Chinese women's experiences and perceptions of cervical screening undertaken by either a female doctor or nurse. A multiple case study design using both qualitative and quantitative methods of data collection was employed. This paper reports the findings from the qualitative data obtained from 52 women participating in 12 focus group interviews held in the two case studies. Thematic analysis of the data demonstrated the importance of the caring nature, communication skills, experience and expertise of the practitioner to women's attendance pattern for screening. The experience and expertise of the practitioner, described by women as teaching, minimizing pain and discomfort and being considerate, were considered more influential to uptake rates than the professional discipline of the practitioner. Findings such as these indicate the importance of the influence of the practitioner in determining uptake rates for cervical screening amongst this population group.

Adult↗
PubMed2001

Patients' and relatives' experiences and perspectives of 'Good' and 'Not so Good' quality care.

AIMS: To explore patients' and relatives' perceptions of care and identify key criteria used to evaluate quality care, via descriptions of actual care experiences. METHOD: A qualitative approach using Grounded Theory was adopted; data collected by semistructured interviews, from a purposive sample of 34 acute medical patients and 7 relatives, was subjected to question and thematic analysis. FINDINGS: The nature of the care provided and interpersonal aspects of caring emerged as key quality issues for patients. Good Quality Care was characterized as individualized, patient focused and related to need; it was provided humanistically, through the presence of a caring relationship by staff who demonstrated involvement, commitment and concern. Care described as 'Not so Good' was routine, unrelated to need and delivered in an impersonal manner, by distant staff who did not know or involve patients. CONCLUSIONS: Empirical evidence was found which support these findings, which are in opposition of the received view that patients place greater emphasis on the technical aspects of care tasks. The quality issues identified as important by patients and relatives in this study are not always evaluated in care audits. Those responsible for evaluating health care quality might consider combining traditional (professional/technical) audit criteria with those used by health care users to achieve a more comprehensive evaluation.

Adult↗
PubMed2002

Neighbors, friends, and other nonkin caregivers of community-living dependent elders.

OBJECTIVES: To describe naturally occurring care relationships between unpaid, nonprofessional, nonkin (unrelated) caregivers and frail community-living older adults. METHODS: Face-to-face, semistructured interviews were conducted with a convenience sample of 114 caregivers and care recipients recruited from the community through a variety of organizations. Standard techniques for thematic analysis of qualitative data were used along with descriptive and other statistics as appropriate for numerate data. RESULTS: Nonkin caregiving proved to be heterogeneous in initiation of relationship, form, duration, tasks performed, and association with family caregivers. Partnerships ranged from 0.1 to 57 years in duration, with just over half (58%) starting with the provision of care. Many caregivers (47%) were themselves older adults, aged 65 or older. There was little variation in what motivated or rewarded caregivers, many of whom felt morally obligated to help. More than half the sample used kin terms to characterize their relationship. Four distinct styles of relationship were discerned, varying by degree of emotional intimacy and types of assistance given. All relationships, however, involved socializing and help with at least two instrumental tasks of daily life. DISCUSSION: This kind of caregiving is important for sustaining community living for about 10% of frail elderly persons. A greater understanding is needed, from both theoretical and practical perspectives, of when and how nonkin relationships are beneficial and why they in many ways successfully mirror the actions and sentiments of family caregivers.

Adult↗
PubMed2006

A phenomenological study of fatigue in patients with primary biliary cirrhosis.

AIM: This paper reports the findings of research on the lived experience of fatigue in patients with primary biliary cirrhosis - a type of chronic liver disease. BACKGROUND: Fatigue is a universal phenomenon, commonly associated with both acute and chronic illness, but also seen in healthy individuals. However, it is not often addressed in healthcare encounters despite its disabling nature, perhaps because of the multitude of contributing factors and the lack of effective treatments. It is a common and debilitating symptom in patients with primary biliary cirrhosis. Despite the prevalence of fatigue in this condition, patients' experiences of this symptom have not been researched. METHOD: An interpretive-phenomenological approach developed by van Manen was chosen and this combines features of descriptive and interpretive phenomenology. Eight participants were interviewed during 2005 about their fatigue experience. Thematic analysis was conducted. FINDINGS: Five themes were identified: an unreliable body, fatigue as always present yet insidious, planning a life to conserve energy, struggling to maintain normality and emotional consequences. These themes reflected the unrelenting, intrusive nature of fatigue into the lives of those affected. CONCLUSION: This research will provide empathic insight into the fatigue experience in this condition and generate communication about coping strategies. It will add to the body of research on fatigue in chronic conditions and may generate ideas for intervention research.

Activities of Daily Living↗
PubMed2005

Is Post-Traumatic Stress Disorder a helpful concept for adults with intellectual disability?

BACKGROUND: Research using the concept of Post-Traumatic Stress Disorder (PTSD) with adults with intellectual disability (ID)assumes they perceive and react to traumatic events in a similar way to non-disabled adults. Reactions to trauma displayed by children may be relevant to adults with ID as well. METHODS: Two focus groups were held with professionals and practitioners to explore the relevance of criteria from child as well as adult literature to adults with ID who experience trauma. Descriptive thematic analysis was carried out. RESULTS: Abuse, parental bereavement, and having children removed were considered common sources of trauma. Similarities identified between disabled and non-disabled adults were flashbacks and nightmares; distressed by reminders; avoidance; hypervigilance and increased arousal. Differences were the frequent occurrence of multiple rather than single events, which were considered significant in generating chronic problems similar to those described as PTSD; also the occurrence of physical health problems and behavioural re-enactments. DISCUSSION AND CONCLUSIONS: Experienced professionals and practitioners considered most of the ideas from PTSD research with non-disabled adults to be relevant to adults with ID who experience trauma, but that some behaviour reported in research with children was also relevant. Topics and questions for use in clinical and research practice with individuals who have experienced trauma were proposed.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2002

Children's perceptions of TV and health behavior effects.

PURPOSE: To understand and document children's stated experiences and beliefs about television and to elicit their suggestions for alternative activities. DESIGN AND METHODS: Eleven focus groups were conducted with 51 Anglo and Latino children, ages 7-10, in a large Northern California city. Philosophical underpinnings of developmental psychology were the basis for multiphase thematic analysis. Data were collected in 1998-1999. RESULTS: Themes were identified in five conceptual categories. Findings showed that children did not perceive many parental rules related to TV watching, rather daily routines are associated with TV viewing. Children revealed both covert and overt motivations for watching. Nearly all participants spoke of the deception of advertising, but they were unclear about the role of commercial sponsors in payment for TV shows. Children perceived both negative physical and behavioral health effects of TV and they had great difficulty imagining life without a TV. CONCLUSIONS: Children perceived television as providing educational and relational needs. Although they preferred alternatives to TV, they had difficulty articulating and getting those needs met. Clinicians and researchers can utilize these findings to design health interventions that attenuate the health-impairing effects of habitual sedentary activity in childhood.

Advertising↗
PubMed2003

Sex differences in the experience of testing positive for genital chlamydia infection: a qualitative study with implications for public health and for a national screening programme.

OBJECTIVES: To explore men's and women's accounts of chlamydia testing, with a view to understanding sex differences in attitudes and in behaviours of public health importance. METHODS: Semistructured interviews with 24 heterosexual patients (12 men; 12 women) diagnosed with genital chlamydia infection, at a large sexual health clinic in central London were transcribed and analysed using qualitative thematic analysis. RESULTS: Participants' expressions revealed important sex differences. Women felt anxious about their future reproductive health, feared stigmatisation, and blamed themselves for contracting chlamydia; whereas men generally reported less concern, were unwilling to disclose their condition to sexual partners, and some men projected attributions of blame onto their partners. Delays in seeking care appeared to be related to perceptions of chlamydia as a relatively minor infection, particularly in men. CONCLUSIONS: Health promotion needs to reflect sex and age differences, emphasising the negative consequences of delayed clinic attendance and exposure to repeat infections. For health professionals to respond appropriately and effectively to increasing numbers of chlamydia infections, there is a need to understand men's avoidant attitudes and behaviours in relation to sexual and reproductive health.

Adolescent↗
PubMed2006

Experiences of and attitudes toward mental health services among older youths in foster care.

OBJECTIVES: This study explored the experiences of youths in the Missouri foster care system who were receiving mental health services in order to identify characteristics that they valued in relationships with mental health professionals and in the services they received and to examine whether their attitudes toward services were associated with their experiences with services. METHODS: As part of a larger study, 389 youths aged 17 years were asked open-ended questions about their experiences with mental health providers. The qualitative responses were classified through thematic analysis, and the frequencies of themes were assessed. Service use was measured, and the confidence subscale of the Attitude Toward Seeking Professional Psychological Help scale was used to measure attitudes. RESULTS: Youths' comments generally centered on three aspects of their mental health care: their relationship with their mental health provider, the level of professionalism of their provider, and the effects of the treatment, including medication management. Youths who reported only negative experiences had less positive attitudes toward services than other youths, but they were not any more likely to have experienced changes in service use or medication six months later. CONCLUSIONS: Soliciting feedback from youths about mental health services is important to the provision of high-quality care. In addition to themes identified in similar studies, this study suggests that medication management plays an important role in the acceptability of the treatment that youths receive.

Adolescent↗
PubMed2004

GPs' perceptions of the gender-related barriers to discussing sexual health in consultations--a qualitative study.

OBJECTIVE: This paper explores the barriers related to gender that general practitioners (GPs) face when discussing sexual health matters in primary care consultations. METHOD: Qualitative study. In-depth interviews were conducted with 22 GPs recruited from different practice types and locations across Sheffield, UK. Transcripts were analysed thematically, assisted by NUD*IST qualitative data analysis programme. RESULTS: GPs were virtually unanimous in believing that patients preferred to see same-sex GPs regarding sexual health, and some felt that as a consequence they became "de-skilled" in dealing with sexual matters of opposite sex patients. Discussion of sexual issues was also perceived to be hindered if the patient was male; for women, reproductive health issues provided an appropriate context to asking about sexual health. CONCLUSION: Barriers that prevent discussion of sexual matters in consultations can not only impinge upon potential treatment for the patient, but also have an indirect affect on the patient's life, health and intimate relationships. Solutions to overcoming such barriers relate largely to the provision of training for medical students and qualified GPs.

Adult↗
PubMed2005

Physician responses to ambiguous patient symptoms.

OBJECTIVE: To examine how primary care physicians respond to ambiguous patient symptom presentations. DESIGN: Observational study, using thematic analysis within a larger cross-sectional study employing standardized patients (SPs), to describe physician responses to ambiguous patient symptoms and patterns of physician-patient interaction. SETTING: Community-based primary care offices within a metropolitan area. PARTICIPANTS: Twenty-three primary care physicians (internists and family physicians). METHOD: Participating physicians had 2 unannounced SP visits randomly inserted into their daily practice schedules and the visits were audiotaped and transcribed. A coding system focusing on physician responses to concerned patients presenting with ambiguous symptoms was developed through an inductive process. Thematic analyses were then applied to coded data. RESULTS: Physicians' responses to ambiguous symptoms were categorized into 2 primary patterns: high partnering (HP) and usual care (UC). HP was characterized by greater responsiveness to patients' expression of concern, positivity, sensitivity to patients' clues about life circumstances, greater acknowledgment of symptom ambiguity, and solicitation of patients' perspectives on their problems. UC was characterized by denial of ambiguity and less inclusion of patients' perspectives on their symptoms. Neither HP physicians nor UC physicians actively included patients in treatment planning. CONCLUSIONS: Primary care physicians respond to ambiguity by either ignoring the ambiguity and becoming more directive (UC) or, less often, by acknowledging the ambiguity and attempting to explore symptoms and patient concerns in more detail (HP). Future areas of study could address whether physicians can learn HP behaviors and whether HP behaviors positively affect health outcomes.

Attitude of Health Personnel↗
PubMed2002

A thematic analysis of the AIDS literature.

Faced with the need for human comprehension of any large collection of objects, a time honored approach has been to cluster the objects into groups of closely related objects. Individual groups are then summarized in some convenient manner to provide a more manageable view of the data. Such methods have been applied to document collections with mixed results. If a hard clustering of the data into mutually exclusive clusters is performed then documents are frequently forced into one cluster when they may contain important information that would also appropriately make them candidates for other clusters. If a soft clustering is used there still remains the problem of how to provide a useful summary of the data in a cluster. Here we introduce a new algorithm to produce a soft clustering of document collections that is based on the concept of a theme. A theme is conceptually a subject area that is discussed by multiple documents in the database. A theme has two potential representations that may be viewed as dual to each other. First it is represented by the set of documents that discuss the subject or theme and second it is also represented by the set of key terms that are typically used to discuss the theme. Our algorithm is an EM algorithm in which the term representation and the document representation are explicit components and each is used to refine the other in an alternating fashion. Upon convergence the term representation provides a natural summary of the document representation (the cluster). We describe how to optimize the themes produced by this process and give the results of applying the method to a database of over fifty thousand PubMed documents dealing with the subject of AIDS. How themes may improve access to a document collection is also discussed.

Acquired Immunodeficiency Syndrome↗