Delaying factors for maternal health service utilization in eastern Ethiopia: A qualitative exploratory study

BackgroundIn Ethiopia, maternal health service utilization is still unacceptably low. The societal and cultural factors that constrain women from attending these services have not yet been sufficiently explored. Using qualitative methods, we aimed to explore the factors that delay maternal health service utilization in eastern Ethiopia.MethodA total of 13 audio-recorded focus group discussions were conducted comprising 88 participants. We conducted separate group discussions with reproductive aged women, mothers-in-law, traditional birth attendants, husbands, and Health Extension Workers to capture their knowledge, practices, feelings, thoughts and attitudes towards maternal health service utilization. The recorded sessions were transcribed into the local language and then translated into English for analysis.ResultThe study identified a number of factors that may delay maternal health service utilization. Factors were grouped using the Three Delays model as a framework. Low level of awareness regarding need, poor involvement of husband, perceived absence of health problems, social power, community misperceptions and cultural restrictions, negative attitudes towards male midwives, acceptance of traditional birth attendants and poor social networking were Delay One factors. Lack of physical accessibility and high transportation costs were categorised as Delay Two factors for skilled birth care attendance. Perceived or experienced poor quality of care were categorised as Delay Three factors for both skilled birth and postnatal care utilization.ConclusionDespite the ongoing government measures to improve maternal health service utilization in Ethiopia, numerous factors continue to contribute to delays in service use, which in turn contribute to high maternal mortality.     

Affective practices,care and bioscience: a study of two laboratories

Scientific knowledge‐making is not just a matter of experiments, modelling and fieldwork. It also involves affective, embodied and material practices (Wetherell, 2012) which can be understood together as ‘matters of care’ (Puig de la Bellacasa, 2011). In this paper we explore how affect spans and connects material, subjective and organizational practices, focusing in particular on the patterns of care we encountered in an observational study of two bioscience laboratories. We explore the preferred emotional subjectivities of each lab and their relation to material practice. We go on to consider flows and clots in the circulation of affect and their relation to care through an exploration of belonging and humour in the labs. We show how being a successful scientist or group of researchers involves a careful choreography of affect in relation to materials, colleagues and others to produce scientific results, subjects and workplaces. We end by considering how thinking with care troubles dominant constructions of scientific practice, successful scientific selves and collectives.     

When children’s testimonies are used as evidence: how children’s accounts may impact child custodial decisions

Abstract

In child custody cases, children oftentimes provide allegations of experienced trauma against one of their parents. Such allegations can happen before any investigative interviews (e.g., by the police or child protective services) have taken place. A central theme here concerns how to appraise such allegations and make certain that children’s accounts are taken seriously. In the current special issue, the focus is on new work on the functioning of children’s memory and its relation to trauma or work on children’s suggestibility and memory when they are traumatized. Specifically, key experts in the field of children’s memory provided contributions on: (1) the impact of interviewer support and rapport building on children’s testimonies, (2) the role of parental alienation in children’s testimonial accuracy, and (3) different types of false memories in children’s memory reports.     

Perceptions of transition-related health and mental health services among transgender adults

The opportunity to live authentically is critical for the well-being of transgender individuals. For many this requires accessing transition-related services. Current knowledge of transition-related care is limited. This study aims to elucidate experiences and needs of transgender individuals (N = 65) related to (a) therapeutic support, (b) medical care, and (c) aspects of living authentically in order to inform the development and delivery of trans-affirmative services. Findings reveal challenges accessing health care providers with trans-specific competency; gaps between critical aspects of transition-related care and receipt of services; and heterogeneity of experiences and needs. Recommendations for improving transgender-affirmative services are provided.     

Overcoming the ‘tyranny of the urgent’: integrating gender into disease outbreak preparedness and response

ABSTRACT

This article contributes to discussions on the gender dimensions of disease outbreaks, and preparedness policies and responses, by providing a multi-level analysis of gender-related gaps, particularly illustrating how the failure to challenge gender assumptions and incorporate gender as a priority at the global level has national and local impacts. The implications of neglecting gender dynamics, as well as the potential of equity-based approaches to disease outbreak responses, is illustrated through a case study of the Social Enterprise Network for Development (SEND) Sierra Leone, a non-government organisation (NGO) based in Kailahun, during the Ebola outbreak.     

Hypothesis Testing of CNA Perceptions of Organizational Culture in Long Term Care

This commentary for the special issue on research that went wrong describes a study that explored factors that contribute to variability within Certified Nursing Assistants (CNAs) on organizational safety culture. We know from previous research that CNAs provide most direct care in nursing homes and that direct care workers often experience agency culture differently from agency management (Wolf et al., 2014). We were looking for factors that nursing homes could alter to improve the culture for CNAs, and thus, residents. We conducted a secondary analysis of data collected via a multi-component paper survey of CNAs employed in long term care. We used results from the Nursing Home Survey on Patient Safety Culture and primary shift, type of unit, and years as a CNA to identify modifiable characteristics that would explain variability in the perceptions of patient safety culture. The final sample included n = 106 from three nursing homes. Dimension scores were compared using bivariate tests appropriate to the scale and ordinal logistic regression. Despite support in the literature for the hypothesis, we found few significant differences on the total scale within groups. Differences in perceptions have implications for quality of care and the experiences of residents within nursing homes.     

Early socialization of hostile attribution bias: The roles of parental attributions,parental discipline,and child attributes

The goal of this study was to examine child and parent predictors of children's hostile attribution bias (HAB) with a particular focus on exploring the associations between parents’ early attribution of child misbehavior and children's HAB in the transition to school age. Participants were 241 children (118 girls) of middle‐income families who were at risk for school‐age conduct problems. Multi‐method, multi‐informant data were collected on maternal attributions of child misbehavior, parental use of corporal punishment, and child attributes (i.e., verbal IQ, effortful control, theory of mind, and emotional understanding) at 3 years, and child HAB in ambiguous situations at 6 years. Results indicated that mothers’ internal explanations for children's misconduct may either reduce or increase children's later HAB depending on the specific content of attributions, such that mothers’ belief that children misbehave because of their internal state (i.e., emotional state or temperament) was associated with lower levels of child HAB, whereas attributing power‐based motives (i.e., manipulative, controlling intentions) in children was associated with higher levels of HAB. The findings are discussed with respect to appreciating the complexity of parents’ explanations for children's behavior, and considering parental cognition as a potential target for early identification and prevention of child HAB and related problems.     

The turn to optional familialism through the market: Long‐term care,cash‐for‐care,and caregiving policies in Europe

Cash‐for‐care (CfC) schemes are monetary transfers to people in need of care who can use them to organize their own care arrangements. Mostly introduced in the 1990s, these schemes combine different policy objectives, as they can aim at (implicitly or explicitly) supporting informal caregivers as well as increasing user choice in long‐term care or even foster the formalization of care relations and the creation of care markets. This article explores from a comparative perspective, how CfC schemes, within broader long‐term care policies, envision, frame, and aim to condition informal care, if different models of relationships between CfC and informal care exist and how these have persisted or changed over time and into which directions. Building on the scholarly debate on familialization vs. defamilialization policies, the paper proposes an analytical framework to investigate the trajectories of seven European countries over a period of 20 years. The results show that, far from being simply instruments of supported familialism, CfC schemes have contributed to a turn towards “optional familialism through the market,” according to which families are encouraged to provide family care and are (directly or indirectly) given alternatives through the provision of market care.