The Influence of the Built Environment and Other Factors on the Physical Activity of Older Women from Different Ethnic Communities

ABSTRACT

Inactivity has been identified as a major contributor to the burden of disease in older women. Study aims were: (a) to assess the personal, social, and environmental facilitators and impediments to physical activity in older women from ethnic communities; and (b) to determine the factors associated with physical activity participation. Older women (aged 60–84 years) were recruited from the local Italian (n = 20), Vietnamese (n = 26) and Anglo-Celtic (n = 26) communities. A survey questionnaire was administered in the participants' preferred language. The most common barriers were: “I am not in good health,” “I am self-conscious about my looks,” “I am too tired,” “I don't have time,” and “The weather is bad.” When comparing the ethnic groups, the Vietnamese women reported fewer barriers than the Italian women (2.6 vs. 5.9). While the Vietnamese women were much more likely to report being “self-conscious about my looks,” the Italian women more commonly reported poor health, being too tired, and not liking exercise as barriers. Overall, those living alone were more likely to be active and those who reported fear of injury, less active. Recognizing ethnospecific differences in the prevalence of barriers may be important when devising strategies to increase activity levels of older women.     

Indicators of ‘good’ feeding,breastfeeding latch,and feeding experiences among healthy women with healthy infants: A qualitative pathway analysis using Grounded Theory

BackgroundBreastfeeding behaviour remains a public health priority worldwide. Despite evidence-based guidelines, healthy women who give birth to healthy, term infants continue to face barriers to breastfeeding. Understanding women’s experiences of feeding in the early postnatal period is crucial to identify how support may be better tailored to improve breastfeeding outcomes, including women’s experiences.QuestionTo understand women’s experiences of infant feeding amongst healthy women who give birth to healthy, average-weight, term infants.MethodsGrounded Theory methodology was used to analyse data from a nested qualitative interview study. Twelve women between four and twelve months postpartum were recruited from a longitudinal cohort study and public advertisements. Semi-structured face-to-face interviews were audio-recorded and transcribed for analysis.FindingsThree distinct themes were found, subsuming identified super-categories: Perceived indicators of ‘good’ feeding (infant ‘output’; infant crying; weight gain; feeding frequency and duration); Women’s experiences of breastfeeding latch (‘good’ latch; ‘bad’ latch with pain and discomfort); and Overall breastfeeding experience (positive; negative; and uncertain). Data suggest women give precedence to their latch experiences over indicators of ‘good’ feeding, highlighting breastfeeding latch as a possible mediating factor to the overall breastfeeding experience. Feeding experience can be achieved through four distinct pathways.DiscussionThe physical and psychological impacts of latch pain were pronounced. Even amongst healthy women with healthy infants, a positive breastfeeding experience overall was uncommon, highlighting the difficulties women continue to encounter. Understanding women’s perceptions of ‘good’ feeding, and ensuring a pain-free latch, may better support women to have a positive breastfeeding experience.     

“It Makes My Skin Crawl”: Women’s experience of breastfeeding aversion response (BAR)

ProblemSome women who intend to breastfeed experience a breastfeeding aversion response (BAR) while breastfeeding.BackgroundLittle is known about the experience of those who have feelings of aversion while breastfeeding.AimThis study aimed to investigate the experiences of women who have an aversion response to breastfeeding while their infant is latched at the breast. This is the first study that aims to understand this breastfeeding aversion response (BAR) as described by women who experience this phenomenon.MethodsInterpretative phenomenological analysis (IPA) was used to conduct and analyse ten semi-structured in-depth interviews with women who self-identified as experiencing BAR.FindingsFour overarching themes were identified: (1) Involuntary, strong sensations of aversion in response to the act of breastfeeding, (2) Internal conflict and effects on maternal identity, (3) The connection between BAR and relationships with others, and (4) Reflections on coping with BAR and building resilience.DiscussionSome women who intend to breastfeed can experience BAR, and this negative sensation conflicts with their desire to breastfeed. BAR can impact on maternal wellbeing. Those who experience BAR may benefit from person-centred support that directly addresses the challenges associated with BAR to achieve their personal breastfeeding goals.ConclusionThe experience of BAR is unexpected and difficult for mothers. If support is not available, BAR can have detrimental effects on maternal identity, mother–child bonds, and intimate family relationships.     

Risk factors of severity of abuse against older women in the home setting: A multinational European study

ABSTRACT

This article examines the ecological risk factors of abuse against older women. Data from 2,880 older women were randomly collected in five European countries (Austria, Belgium, Finland, Lithuania, and Portugal) using a standardized questionnaire. Results indicate that overall 30.1 % older women had at least one experience of abuse in the past year. The findings demonstrate that a single emphasis on personal risk factors (e.g., health, coping) is important but too simple: Abuse is multifaceted and is embedded in environmental (e.g., loneliness, household income) as well as macrocultural contexts (e.g., old age dependency ratio).     

Barriers to and facilitators for addressing overweight and obesity before conception: A qualitative study

BackgroundObesity is a significant global health issue, especially for reproductive-aged women. Women who enter pregnancy overweight or obese are at increased risk of a range of adverse reproductive, maternal, and child health outcomes. The preconception period has been recognised as a critical time to intervene to improve health outcomes for women and their children. Despite this recognition, adequate information is significantly lacking in relation to women’s health experiences, behaviours, and information preferences to inform the development of high-quality preconception intervention strategies.AimThis study aimed to examine women’s perspectives of barriers, enablers, and strategies for addressing overweight and obesity before conception.MethodUsing a qualitative research design, twelve multiparous women, aged between 32 and 43 years, who considered themselves to be overweight or obese were interviewed. Data were analysed using thematic analysis.FindingsThree themes were identified in relation to barriers: lack of information and knowledge, time constraints, and affordability. The following four themes emerged with respect to enablers and strategies: knowledge provision, accountability and motivation, regular contact, and habit formation.ConclusionKey factors to incorporate in women-centred interventions for preconception weight loss include multi-faceted knowledge provision and practical affordable methods for supporting healthy behaviours. Interventions should integrate techniques for ensuring regular contact with support networks, to enhance accountability, motivation, and facilitate habit formation. Further research is now being conducted by our team to co-design interventions and strategies informed by these findings.     

Self-Management of a Chronic Illness: An Exploratory Study on the Role of Spirituality Among Older African American Women

ABSTRACT

Living with a chronic illness is an experience characterized by changes in self-management behavior. Few studies have addressed the role of spirituality in the self-management of a chronic illness among older African American women. The purpose of this exploratory study was to understand the role of spirituality in the self-management of chronic illness. Data from a sample of 10 African American women were collected from semi-structured interviews and analyzed for common themes through narrative analysis. Four themes emerge from the linkage of spirituality and self-management. Understanding this experience will assist public health providers in creating culturally appropriate health education interventions.     

The Psychosocial Context of Bereavement for Older Women Who Were Caregivers for a Spouse With Advanced Cancer

The psychosocial context of bereavement for older women who were caregivers for a spouse with advanced cancer was explored qualitatively with 13 older women. Interviews and diaries were analyzed using constant comparison. The psychosocial context emerged as the intrapersonal : exhaustion, loneliness, pain, and recovering physical health; the interpersonal: finding a new way through both supportive and difficult relationships; and the community/societal: a loss of identity, pressure to move on, financial concerns, and relying on formal supports. The psychosocial context of bereavement for older women who were caregivers is uniquely challenging and must be considered when providing care and programs of support.     

Women and waterbirth: A systematic meta-synthesis of qualitative studies

BackgroundThe practice of waterbirth is increasing worldwide and has been a feature of maternity services in the United Kingdom for over twenty years. The body of literature surrounding the practice focusses on maternal and neonatal outcomes comparing birth in and out of water.AimTo undertake a review of qualitative studies exploring women’s experiences of waterbirth. This understanding is pertinent when supporting women who birth in water.MethodsA literature search was conducted in databases British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Maternity and Infant Care, Medline, Applied Social Sciences Index and Abstracts and Web of Science, using search terms waterbirth, labour/labor, childbirth, women, mothers, experience, perception and maternity care. Five primary research articles published between 2003 and 2018 which explored the views of women who had birthed in water were selected for inclusion. Using meta-ethnography, qualitative research studies were analysed and synthesised using the method of ‘reciprocal translational analysis’ identifying themes relating to women’s experiences of birthing in water.FindingsFour themes were identified: women’s knowledge of waterbirth; women’s perception of physiological birth; water, autonomy and control; and waterbirth: easing the transition.Discussion and conclusionDespite the paucity of qualitative studies exploring women’s experiences of waterbirth, meta-synthesis of those that do exist suggested women identify positively with the choice. The experience of birthing in water appears to enhance a woman’s sense of autonomy and control during childbirth suggesting waterbirth can be an empowering experience for women who choose it.     

Postpartum women’s experiences of social and healthcare professional support during the COVID-19 pandemic: A recurrent cross-sectional thematic analysis

ProblemDisrupted access to social and healthcare professional support during the COVID-19 pandemic have had an adverse effect on maternal mental health.BackgroundMotherhood is a key life transition which increases vulnerability to experience negative affect.AimExplore UK women’s postnatal experiences of social and healthcare professional support during the COVID-19 pandemic.MethodsSemi-structured interviews were conducted with 12 women, approximately 30 days after initial social distancing guidelines were imposed (T1), and a separate 12 women were interviewed approximately 30 days after the initial easing of social distancing restrictions (T2). Recurrent cross-sectional thematic analysis was conducted in NVivo 12.FindingsT1 themes were, ‘Motherhood has been an isolating experience’ (exacerbated loneliness due to diminished support accessibility) and ‘Everything is under lock and key’ (confusion, alienation, and anxiety regarding disrupted face-to-face healthcare checks). T2 themes were, ‘Disrupted healthcare professional support’ (feeling burdensome, abandoned, and frustrated by virtual healthcare) and ‘Easing restrictions are bittersweet’ (conflict between enhanced emotional wellbeing, and sadness regarding lost postnatal time).DiscussionRespondents at both timepoints were adversely affected by restricted access to informal (family and friends) and formal (healthcare professional) support, which were not sufficiently bridged virtually. Additionally, the prospect of attending face-to-face appointments was anxiety-provoking and perceived as being contradictory to social distancing guidance. Prohibition of family from maternity wards was also salient and distressing for T2, but not T1 respondents.ConclusionHealthcare professionals should encourage maternal help-seeking and provide timely access to mental health services. Improving access to informal and formal face-to-face support are essential in protecting maternal and infant wellbeing.     

Aging Happens: Experiences of Swiss Women Living Alone

ABSTRACT

The purpose of this study was to give beginning insights into how aging is experienced by women living alone in Switzerland. A feminist methodology was used to gather and interpret 17 interviews conducted with a selected group of 9 older women living alone. Interviews were taped and transcribed for hermeneutic analysis; major themes were developed. Aging happens, Independence, Being vulnerable, Memory and aging, and If I had been a boy were the themes discovered. These experiences represent how aging is shaped by individual life courses, sociocultural conditions along with gender and class.     

Pregnant in prison: An integrative literature review

BackgroundPregnant women in prisons are recognised as a marginalised group. However, there is a limited understanding of the women’s unique maternity needs and how correctional institutions and maternity service providers respond to these needs.AimThe aims of the review are threefold.

• 1.Identify pregnant women’s needs during the antenatal, birthing and postnatal periods in prison.
• 2.Examine how the pregnant incarcerated women’s needs are met by the correctional institutions.
• 3.Explore what maternity services are available and how these services are provided.

MethodAn integrative literature review was undertaken. A comprehensive search strategy using seven electronic databases resulted in the retrieval of 363 articles. Of them, 32 peer-reviewed studies met the final selection criteria and were included in this review which utilised the Critical Appraisal Skills Program tools and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. Thematic analysis identified universal themes.FindingsThree dominant themes emerged related to the experience of pregnant women in prison: (1) risks and vulnerability factors; (2) prison enablers and supports; and (3) prison barriers. Extant research on risks and vulnerability factors is disproportionate to research examining how prisons can enable or obstruct responding to the women’s perinatal needs. Limited research on the midwifery support available to the women in prison is available. Significantly, only two out of 32 reviewed papers include research directly conducted with the pregnant women in prison.ConclusionPregnant women in prisons have complex needs. More research is required to understand how prisons can enhance the pregnancy experience by engaging pregnant women in prisons as research participants.     

Women from migrant and refugee backgrounds’ perceptions and experiences of the continuum of maternity care in Australia: A qualitative evidence synthesis

BackgroundWomen who were born overseas represent an increasing proportion of women giving birth in the Australian healthcare system.ProblemWomen from migrant and refugee backgrounds have an increased risk of poor pregnancy and birth outcomes, including experiences of care.AimTo understand how women from migrant and refugee backgrounds perceive and experience the continuum of maternity care (pregnancy, birth, postnatal) in Australia.MethodologyWe conducted a qualitative evidence synthesis, searching MEDLINE, CIHAHL, and PsycInfo for studies published from inception to 23/05/2020. We included studies that used qualitative methods for data collection and analysis, that explored migrant/refugee women’s experiences or perceptions of maternity care in Australia. We used a thematic synthesis approach, assessed the methodological limitations of included studies, and used GRADE-CERQual to assess confidence in qualitative review findings.Results27 studies met the inclusion criteria, representing women in Australia from 42 countries. Key themes were developed into 24 findings, including access to interpreters, structural barriers to service utilisation, experiences with health workers, trust in healthcare, experiences of discrimination, preferences for care, and conflicts between traditional cultural expectations and the Australian medical system.ConclusionThis review can help policy makers and organisations who provide care to women from migrant and refugee backgrounds to improve their experiences with maternity care. It highlights factors linked to negative experiences of care as well as factors associated with more positive experiences to identify potential changes to practices and policies that would be well received by this population.     

Smoking cessation care during pregnancy: A qualitative exploration of midwives’ challenging role

ProblemThe majority of South Australian pregnant women who smoke do not quit during pregnancy. Additionally, the prevalence of smoking is higher among pregnant women living in socially disadvantaged areas.BackgroundUnderstanding challenges in midwives’ provision of smoking cessation care can elucidate opportunities to facilitate women’s smoking cessation.AimWe aimed to understand midwives’ perspectives on current practices, perceived barriers and facilitators to delivery of smoking cessation care, and potential improvements to models of smoking cessation care.MethodsAn exploratory qualitative research methodology and thematic analysis was used to understand the perspectives of midwives in five focus groups.FindingsFour themes were generated from the data on how midwives perceived their ability to provide smoking cessation care: Tensions between providing smoking cessation care and maternal care; Organisational barriers in the delivery of smoking cessation care; Scepticism and doubt in the provision of smoking cessation care; and Opportunities to enable midwives’ ability to provide smoking cessation care.DiscussionA combination of interpersonal, organisational and individual barriers impeded on midwives’ capacities to approach, follow-up and prioritise smoking cessation care. Working with women living with disadvantage and high rates of smoking, the midwife’s role was challenging as it balanced delivering smoking cessation care without jeopardising antenatal care.ConclusionProviding midwives with resources and skills may alleviate the sense of futility that surrounds smoking cessation care. Provision of routine training and education could also improve understandings of the current practice guidelines.     

Cougars or kittens? The representation of celebrity cougars and their toyboys in gossip media

Abstract

Relationships involving a woman who is much older than her male partner have become increasingly visible in popular culture. These women are referred to as “cougars” and their partners as “toyboys.” This type of relationship has the potential to undermine elements of heteronormativity and intersectional gender/age performances, as women who are past their forties are not expected to engage in sexual relationships with (younger) men. The present study discusses the discourse found in Dutch gossip media (n = 138) on the relationships of preselected celebrity “cougars:” Demi Moore, Madonna, Patricia Paay, and Heleen van Royen. A qualitative content analysis reveals that certain aspects of heteronormativity are challenged: these women are depicted as financially and sexually empowered, whereas their partners are seen as interchangeable male suitors who are dependent on the female partner’s (financial/career) achievements. Yet, traditional understandings of intersectional performances (i.e., gender/age) are also found: a wise, caring mother, and a handsome, boyish, adventurous partner. Overall, these women are seen as both maintaining and challenging traditional roles that are typically associated with older women.     

Experience,perceptions and attitudes of parents who planned home birth in Spain: A qualitative study

BackgroundA woman’s home birth and postpartum experience can have a major impact on her baby’s, partner’s and family’s well being. It is a life-altering event that can help improve or worsen women’s self-esteem and self-confidence.AimThe aim of this study was to describe and understand the experiences, perceptions and attitudes of parents who planned a home birth in Spain.MethodsA qualitative study was conducted based on Gadamer’s hermeneutic phenomenology. Two main methods were used for data collection; narratives and individual in-depth interviews with 14 mothers and 8 fathers who had planned a home birth in the last year. Inductive analysis was used to find themes based on the data obtained.FindingsSix main themes emerged from the data analysis: (1) in search of a natural and personalised birth, (2) breaking with social pressures, (3) experience of home birth for the mother, (4) role of the father in home birth, (5) how does the father experience home birth?, (6) home birth is not available to all mothers and fathers.ConclusionFor the mothers and fathers in this study the home birth experience fulfilled their previous expectations of an intimate and natural moment, making it a highly satisfying experience for both. However, parents expressed experiencing negative feelings such as fear and worry about complications and labor pain. According to our research society in general and public health professionals in particular issue numerous criticisms and value judgments towards mothers and fathers who opt for a home birth in our country. In addition, the study shows the economic and cultural inequalities in access to home birth in Spain.     

The views and attitudes of health professionals providing antenatal care to women with a high BMI: A qualitative research study

BackgroundThe prevalence of overweight and obesity is increasing amongst women of child bearing age. The objective of this study was to investigate the views and attitudes of providers of antenatal care for women who have a body mass index (BMI) of 30 kg/m² and over.MethodsA qualitative study using focus groups was undertaken within the department of obstetrics and gynaecology at a large teaching hospital in south-eastern Australia. Three focus group discussions were held. One with hospital midwives (n = 10), one with continuity of care midwives (n = 18) and one with obstetricians (n = 5). Data were analysed using Interpretative Phenomenological Analysis (IPA).FindingsSix dominant themes emerged: (1) obesity puts the health of mothers, babies and health professionals at risk; (2) overweight and obesity has become the norm; (3) weighing women and advising about weight gain is out of fashion; (4) weight is a sensitive topic to discuss; (5) there are significant barriers to weight control in pregnancy; and (6) health professionals and women need to deal with maternal obesity. These themes are drawn together to form a model representing current health care issues for these women.ConclusionHealth professionals, who have a high BMI, can find it difficult to discuss obesity during antenatal visits with obese women. Specialist dietary interventions and evidence based guidelines for working with child-bearing women is seen as a public health priority by health care professionals.     

“If you don’t ask … you don’t tell”: Refugee women’s perspectives on perinatal mental health screening

ProblemNational guidelines recommending mental health screening in pregnancy have not been implemented well in routine maternity care. Women of refugee background are likely to have experienced traumatic events and resettlement stressors, yet are not often identified with mental health issues in the perinatal period.BackgroundGlobally, perinatal mental health conditions affect up to 20% of women. Many difficulties in accessing mental health care in pregnancy exist for women of refugee background including stigma, and cultural and language barriers. Technology can provide an efficient and effective method to overcome some of these barriers.AimTo determine if a digital perinatal mental health screening program is feasible and acceptable for women of refugee background.MethodsThis qualitative evaluation study used focus group and semi-structured telephone interviews with refugee and migrant women from four communities. Interpreters were used with women who spoke little or no English. Data were analysed using both an inductive and deductive approach to thematic analysis.FindingsUnder the three key themes: ‘Women’s experiences of perinatal mental health screening in pregnancy’; ‘Barriers and enablers to accessing ongoing mental health care’ and ‘Improvements to the program: the development of audio versions’, women found the program feasible and acceptable.DiscussionScreening using a mobile device offered women more privacy and opened up discussions with midwives on emotional health. Improvements in service coordination and access to further mental health management for women is required.ConclusionPerinatal mental health screening is an acceptable and feasible option for women of refugee background. Integrated models of care, case management, and patient navigators are options for improvements in uptake of referral and treatment services.