Midwives’ self-reported knowledge and skills to assess and promote maternal health literacy: A national cross-sectional survey

BackgroundLittle is known about midwives’ knowledge and skills to assess and promote maternal health literacy.AimsTo test the reliability and validity of a new tool to assess midwives’ health literacy knowledge, skills and attitudes.MethodsUsing a cross-sectional design, midwives were recruited through professional and social media networks. The online survey included demographic and professional questions and a new measure on midwives’ health literacy knowledge, skills and attitudes. Convergent validity was assessed using ten items from the Caring Assessment Scale. Perceived barriers to promoting maternal health literacy were sought.FindingsThree hundred and seven participants completed the survey. A two-factor solution accounted for 41% of variance and resulted in 14 items, including all attitude items, being removed. Cronbach’s alpha reliability was acceptable (Skills = .76; Knowledge = .66). Convergent validity was established. Most midwives (77.1%, n = 221) reported giving limited attention to formally assessing women’s health literacy. Between 30 to 60% of midwives never or only sometimes used specific techniques to promote maternal health literacy. Most (75%, n = 201) had not received education about health literacy.Discussion and ConclusionsThe new Transforming Maternity Care Collaborative Health Literacy tool was valid and reliable. Few midwives formally assessed or promoted women’s health literacy. Midwives require education about maternal health literacy assessment and promotion to ensure women understand information being conveyed. A large national survey of midwives using the new tool is recommended.     

Prediction of Human Development from Environmental Indicators

The Sustainable Development Goals (SDG) list the objectives and targets that should be addressed to solve the global issues regarding sustainable development. They encompass the social, economic and environmental dimensions and search for solutions that are able not only to monitor but also to control the operational indicators attributed to each objective. It is expected that many of these indicators are associated to each other and the accurate understanding of these correlations allows to build predictive statistical models that can improve the monitoring and controlling of variables. It would increase the rate of success in achieving the SDG. This study tested a linear multivariate model able to predict the human development index based on environmental variables which are related to SDG 3 (health), 4 (education), 8 (sustainable economic growth and decent work) and 15 (protect, restore and promote sustainable use of terrestrial ecosystems). We fitted the models using the Linear Discriminant Analysis and Best Subset Selection applied to a Linear Multivariate Regression. The model predictive ability was assessed by R² and cross-validation (CV). The results showed that exposure to unsafe sanitation, access to drinking water, tree cover loss, unsafe water quality, wastewater treatment level, and household air pollution are excellent predictors of human development index of a population, with R² = 0.94 and 10-fold CV Mean Squared Error equal to 0.0014. This tool can help stakeholders to monitor and control indicators attributed to good health and well-being, quality education, clean water and sanitation, decent work and economic growth, sustainable cities and communities and life on land sustainable development goals.     

The Effect of Antenatal Care on Professional Assistance at Delivery in Rural India

Delivering births in a medical institution or at home with professional medical assistance has been shown to promote safe motherhood and child survival. Yet three-quarters of births in rural India continue to take place at home, most of them without the assistance of any trained health worker. This study examines the role of antenatal care (ANC) in promoting professional assistance at delivery, using data from India’s 1992–93 and 1998–99 National Family Health Surveys (NFHS-1 and NFHS-2). We estimate the effect of number of antenatal care visits (0, 1–2, 3+) on professional assistance at delivery (no assistance, professional assistance at home, delivery in a medical institution), using multinomial logistic regression, controlling for demographic, geographic, and socioeconomic factors, pregnancy complications, and two measures of access to health facilities. The results indicate that, after controlling for other variables (including ANC), pregnancy complications and access to health facilities do not have much effect on assistance at delivery. By contrast, ANC has a large effect, even after all other variables are controlled. The effect of ANC on professional assistance at delivery is larger in South India than in North India, and predicted percentages receiving professional assistance are higher in South India than in North India. A policy implication is that increased antenatal care coverage can be an effective means of increasing professional assistance at delivery, especially delivery in a medical institution.

Assessing the Use of the Family Affluence Scale as Socioeconomic Indicators for Researching Health Inequalities in Taiwan Adolescents

This study examined the reliability and validity of the Family Affluence Scale (FAS) and explored the relationship between FAS and health in a general adolescent population of Taiwan. Our data was obtained from a 2009 school-based survey. In total, 3,368 students (1,741 boys, 1,627 girls) in grades 6–10 in Kinmen County, Taiwan completed a modified WHO Health Behaviour in School-Aged Children (HBSC) questionnaire. Indicators of the family’s social position were their parents’ occupation and education. Indicators of material affluence were number of cars, number of holiday travel, whether the participant had his or her own room and number of computers (FAS items). A higher proportion of the participants completed the four family affluence items than their parents’ occupation and education items (≧98% vs. 90% and 88%; respectively). Analysis of the FAS showed a moderate internal reliability (Cronbach’s alpha = 0.35). The associations between the FAS scores and parental occupation and education were moderate (P < .001). Consistent gradients were found for the association between FAS and positive health and health promoting behaviours. In conclusion, the Taiwan version of the FAS had a high completion rate and moderate internal reliability and external validity. The clear associations between the FAS and health indicators confirm the findings of previous studies and suggest that the FAS can be used as an additional measure of socioeconomic status among Taiwan adolescents.     

Academic Buildings and Their Influence on Students’ Wellbeing in Higher Education Institutions

The purpose of this study is to explore the perception of students about aspects of academic building that affect their wellbeing. The study adopts focus group discussion using semi structured interview guide to elicit their responses. Six different groups of students participated in the study. Interviews were recorded using digital audio recorder and were later transcribed to text. The qualitative data obtained was analysed through content analysis. Six key themes that emerged from the analysis are: comfort; health and safety; access and quality of facilities; space provision and adequacy; participation and inclusiveness; interaction. These six items are considered as parameters that are important to students’ wellbeing in relation to academic buildings. The most emphasised aspects of academic building that are essential to meeting students need include thermal conditions, internet access, furniture, duration of access, availability of refreshment facilities, availability of discussion room and availability of personal workstation. This implies that facilities managers in higher education institutions should give adequate attention to these identified aspects of academic buildings as they can potentially affect students output.     

Education,Human Development and Quality of Life: Measurement Issues and Implications for India

This paper analyses and compares the measurement of indicators and variables in the construction of education index in Human Development Index (HDI) at the global, national and 18 sub-national human development reports in India since 1990. The results show non-comparability of measurement of the education indicators and variables. This implies that vertical and horizontal comparability of HDI may not be plausible for India. Implications of these analyses are highlighted for measurement of quality of life indices with special reference to physical quality of life index. Policy lessons are derived for future measurement of education index for India in particular, and other developing countries in general.

Midwives’ job satisfaction and intention to leave their current position in developing regions of Ethiopia

BackgroundThe aim of this research was to analyze midwives’ job satisfaction and intention to leave in developing regions of Ethiopia.MethodsA facility-based cross-sectional study was conducted amongst 107 midwives in four developing regions of Ethiopia. All midwives who were working in 26 health facilities participated in the study. A structured self-administered questionnaire, and in depth key informant interview guides, were used to collect data. Job satisfaction was measured by nine dimensions and intention to leave their current position was measured using three questions.ResultsMore than two-thirds (67%) of the midwives were female, with a mean age of 26.1 (sd ± 4.2) years old. Less than half (45%) of the midwives were satisfied with their job, less than half (42%) were satisfied with ‘work environment’ and less than half (45%) were satisfied with ‘relationship with management’ and ‘job requirements’. Relatively better satisfaction rates were reported regarding ‘professional status’, of which more than half (56%) of midwives were satisfied, followed by more than half (54%) of midwives being satisfied with ‘staff interaction’. Almost two-fifths (39%) of midwives intended to leave their current position.ConclusionJob dissatisfaction and intention to leave rates amongst midwives in developing regions in Ethiopia are a source of concern. The majority of midwives were most dissatisfied with their working environment and issues related to payment. Their intention to leave their current position was inversely influenced by job satisfaction. The introduction of both financial and nonfinancial mechanisms could improve midwives’ job satisfaction, and improve retention rates within the profession.     

Catastrophic household expenditure on caesarean deliveries in India

The objectives of our study were to examine the (1) trends and patterns of caesarean deliveries in India and; (2) differentials in catestrophic household expenditure on caesarean deliveries. The paper used data from 71st round of the National Sample Survey, India. The analysis included 14,310 women, hospitalised for delivery during the last 365 days preceding the survey. The proportion of caesarean sections among institutional deliveries in India was 2.5% in 1992–1993, which increased to 23.9% in 2014. In private facilities, 47.8% deliveries were conducted through caesarean section, while in public facilities, this proportion was 8%. OOPE per delivery was US$157 which was 64.9% of the total cost of maternal health care. OOPE varied by type of delivery; US$283 for caesarean and US$77 for non-caesarean delivery. About 60% of households incurred the expenditure on caesarean section exceeding 40% of their capacity to pay. The incidence of catastrophic delivery expenditure declined with increased education and per-capita expenditure. Caesarean delivery in private facilities and a hospital stay of more than 48 h increased the chances of catastrophic expenditure. Interventions and regulations are necessary for both public and private sector to check unwarranted caesarean deliveries and hospital stays to reduce catastrophic expenditure.

     

Maternal Health Care Seeking Behavior in a Post-Conflict HIPC: The Case of Rwanda

Rwanda is one of nine post-conflict heavily indebted poor countries (HIPC) of the world. There was a worsening of health indicators since the early nineties on account of conflict. In light of this, we examine factors affecting maternal health care seeking behavior in Rwanda using three rounds of Rwanda Demographic and Health Survey (RDHS) data (1992, 2000, and 2005). We find that progress towards increasing the share of assisted deliveries has been slow. There has been no significant increase in the proportion of women seeking antenatal care. This could partially explain why a large proportion of women continue to deliver at home without professional assistance. Further, women who gave birth in the 5 years preceding the 2000 RDHS are less likely to deliver in a health facility than those who gave birth in the 5 years preceding the 1992 RDHS. We do not find such a result for the year 2005. We also find that women are more likely to deliver at home with professional assistance in 2000 and 2005 compared to 1992.     

Women's access needs in maternity care in rural Tasmania,Australia: A mixed methods study

ObjectivesThis study investigates (i) maternity care access issues in rural Tasmania, (ii) rural women's challenges in accessing maternity services and (iii) rural women's access needs in maternity services.MethodsA mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored women's views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care.FindingsThe survey was completed by n = 210 women, with a response rate of 35%, with n = 22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural women's access needs.ConclusionThe study suggested that women's access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families.     

Trends in the association between educational attainment and class destinations in West Germany: Looking inside the service class

The paper investigates long-term trends in the association between educational attainment and class destinations in Germany. Most recent evidence for several European countries reveals a downward effect of education on social class. To test changes in the association in Germany I use the 1976–2007 waves of the German Microcensus (GMC), which is a nationally representative, repeated cross-sectional survey. For Germany, log-linear models indicate that the relationship between education and class destinations remains rather constant for both sexes. I also find that returns to higher education in access to service class positions do not consistently decline either. Only university graduates’ relative access chances slightly decreased in comparison to Abitur-holders from the 1980s to the 1990s. In order to consider compositional changes in the service class in more detail, I further disaggregate the service class into three types of employment: administrative/managerial positions, professional experts and professional positions in the social services. In fact, I find that access to administrative and managerial positions is less dependent on education than access to the professions. While professional positions in the social services become less stratified by education over time, it is compensated by a reverse development for professional experts. As substantially more employees work in administrative and managerial jobs since the 1970s, the slight reduction in university returns can indeed be attributed to a compositional effect. In spite of these qualitative and quantitative changes, the strong impact of education on access to the service class does not become blurred. The paper concludes that the persistent institutional framework in Germany does not lead to a decline in the overall association between educational attainment and class destinations.     

Rating Health and Social Indicators for Use with Indigenous Communities: A Tool for Balancing Cultural and Scientific Utility

This study reports on the development and evaluation of a rating tool to assess the scientific utility and cultural appropriateness of community-level indicators for application with Indigenous populations. Indicator criteria proposed by the U.S. Institute of Medicine were culturally adapted through reviewing the literature and consultations with academic and Indigenous stakeholders. Pre-testing and collaborator feedback drove the iterative development of the tool with stakeholder groups in Canada, Aotearoa/New Zealand, and Australia. Pilot testing with 17 raters across countries involved rating the same selection of six health and social indicators using a six-point ordinal scale. The final version of the rating tool includes 16 questions within three criterion domains: importance, soundness, and viability. Academic and community stakeholder review established face and content validity. The indicator rating tool demonstrated good internal consistency and excellent inter-rater reliability for two of three pilot testing groups. Use of this instrument can strengthen collaborative research planning and evaluation with Indigenous communities through selection of relevant and culturally appropriate indicators for application to public health research, prevention programmes, and health and social policy.     

An exploration of Australian midwives’ knowledge of intimate partner violence against women during pregnancy

BackgroundIntimate partner violence is recognised as a global public health issue. Living with intimate partner violence results in poorer health status with reduced quality of life and higher utilisation of health services. Increased awareness, education and training, and an understanding of multi-agency collaboration are vital in order for health practitioners to respond to women experiencing partner violence and abuse. Midwives are well placed to identify, provide immediate support, and refer women onto appropriate support agencies but may lack appropriate education, training or support.AimTo investigate midwives’ knowledge of intimate partner violence against women during pregnancy.MethodsAn online survey link was distributed through the Australian College of Midwives. The survey included personal, professional and practice details, and 25 questions that tested knowledge about intimate partner violence.Findings152 midwives completed the online questionnaire. Knowledge scores ranged from 27 to 48 (out of a possible 50), with the mean total score of 42.8 (SD = 3.3). Although 60% of participants scored 48, two-thirds did not know about the risks and signs of intimate partner violence. One-third of the midwives did not know about age risks associated with intimate partner violence. Around 25% incorrectly believed that perpetrators are violent because of alcohol or drug use. Nearly 90% (88%) of participants had some education or training about intimate partner violence. Those with some training achieved higher knowledge scores than those with no formal training (Mann–Whitney U = 1272, p = 0.003).ConclusionParticipating midwives generally reported a high level of knowledge about intimate partner violence but held misconceptions about risks and characteristics of perpetrators of violence. These knowledge gaps may adversely affect their ability to identify women at risk of violence. Education about intimate partner violence was associated with improved knowledge. Future training and education on intimate partner violence should target identified knowledge gaps.     

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.     

The Evolution of Well-Being in Spain (1980–2001): A Regional Analysis

Evaluations of regional welfare conventionally rely on Gross Value Added (GVA) per capita as an indicator of well-being. This paper attempts to re-address the regional welfare issue using alternative indicators to per capita income. With this aim, a database for the Spanish regions (NUTS II) has been constructed for the period 1980–2001 and an augmented version of the United Nations Development Programme (UNDP) Human Development Index (HDI) has been estimated incorporating indicators of health, education and per capita income. The results show that, whereas regional income per capita disparities have remained constant, regional convergence in the Augmented Human Development Index (AHDI) was achieved between 1980 and 2001. None the less, there is no evidence of intra-distributional mobility (leap-frogging) across regions in the AHDI     

Burnout and Wellbeing: Testing the Copenhagen Burnout Inventory in New Zealand Teachers

The Copenhagen Burnout Inventory (CBI) is a public domain questionnaire measuring the degree of physical and psychological fatigue experienced in three sub-dimensions of burnout: personal, work-related, and client-related burnout. This study first examines the reliability and validity of the CBI in measuring burnout in New Zealand secondary school teachers, and then the relationship between burnout and wellbeing among this population. The CBI had acceptable reliability (internal consistency and homogeneity) as well as factorial and criterion-related validity. As expected, burnout was negatively related to wellbeing measures (wellbeing index, school connection, and perceived general health). The findings indicate that this burnout questionnaire is a valid instrument to use with New Zealand secondary teachers, and also highlight the potential impact of burnout on the health and wellbeing of teachers.

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.     

The Performance of the World Health Organization’s WHOQOL-BREF in Assessing the Quality of Life of Thai College Students

The purpose of this study was to examine the performance of the Thai-version of WHOQOL-BREF in assessing the quality of life (QoL) among Thai college students. The psychometric properties of WHOQOL-BREF were assessed in this study. The self-administered WHOQOL-BREF questionnaire was applied. A total of 407 Thai college students (male age = 20.5 ± 1.2; female age = 20.5 ± 1.2) participated in this study. Item-response distributions, internal consistency reliability, discriminant validity, criterion-related validity and construct validity through confirmatory analysis were analyzed. The findings indicate that the WHOQOL-BREF had acceptable internal consistency (α = 0.73–0.83 across four domains), all items highly correlated with corresponding domain scores (r = 0.53–0.80), the indices of a two-order confirmatory factor analysis (CFA) demonstrate that the data fit the model well with allowing covary of error variances of some items, all items had good property of criterion-related validity and item discrimination and, all three domain scores except the social relationship domain had significant associations with overall QoL or general health. The results suggest that the WHOQOL-BREF was reliable and valid to health professionals in the assessment of the QoL of college-based Thai youth, but some unsuitable items may be deleted in future studies.