The potential impact of discrimination fears of older gays, lesbians, bisexuals and transgender individuals living in small- to moderate-sized cities on long-term health care

As an exploration of the potential impact of fears of discrimination against GLBTs in long-term health care settings, this study compared perceptions of GLBT persons and heterosexuals. A total of 132 GLBT persons and 187 heterosexuals living in Eastern Washington completed a survey that contained demographic questions and perceptions of discrimination in long-term care settings. Most respondents suspected that staff and residents of care facilities discriminate against GLBTs. GLBT respondents who believed that residents of care facilities are victims of discrimination were more likely to believe that they would have to hide their sexual orientation if admitted to a care facility. GLBT respondents were more likely than heterosexual respondents to believe that GLBTs do not have equal access to health care and social services, that GLBTs residents of care facilities are victims of discrimination, that GLBT sensitivity training programs would benefit staff and residents of care facilities, and that GLBT retirement facilities would be a positive development for older GLBTs. This study is offered as a preliminary investigation of concerns about GLBT discrimination in health care settings, how concerns are expressed, and the implications of those concerns for health care needs.     

Gay and lesbian perceptions of discrimination in retirement care facilities

Much research on older gay, lesbian, bisexual and transgender (GLBT) adults has focused on refuting the widely held misconceptions people have about GLBT lifestyles. To date, however, few studies on older GLBTs have examined their social and health care needs. Further, most studies have collected survey samples of older GLBT adults in large metropolitan areas and have not specifically addressed discrimination or bias in retirement care facilities. In the current exploratory study on perceptions of discrimination and bias in retirement care facilities, we surveyed a wide age range GLBT adults in a smaller metropolitan area of fewer than 400,000 people to discover the perceptions of both younger and older GLBTs. We surveyed perceptions of discrimination in retirement care facilities, sources of perceived discrimination, and suggestions for how discrimination might be reduced or eliminated in those settings. Respondents indicated that administration, care staff, and residents of retirement care facilities themselves were all potential sources of discrimination, and that education addressing awareness and acceptance of GLBTs is one potential remedy for discrimination against GLBTs in retirement care facilities. Respondents also indicated a strong desire for the development of GLBT-exclusive or GLBT-friendly retirement care facilities. Chi-square analyses of responses to the discrimination questions and respondents' demographic characteristics revealed significant differences with regard to age, income, gender, community size, and education level of the respondents.     

Disclosing a LGB Sexual Identity When Living in an Elderly Long-Term Care Facility: Common and Best Practices

ABSTRACT

This study aims at exploring staff perceptions of common and best practices toward a situation in which an older resident discloses their non-heterosexual sexual identity, differentiating between gay men, lesbians, and bisexuals. A total of 2,254 staff members from 96 Spanish long-term care facilities took part in the study. They were asked about what they think most of their workmates would do and what they think should be done in a situation in which an older resident discloses his/her non-heterosexual sexual orientation. The results indicate that, in general, staff’s attitudes to non-heterosexual older residents’ disclosure of their sexual identity are quite tolerant and open. However, differences in staff perceptions of common and best practices indicate that there is still potential for improvement. Results underline that factors such as residents’ sexual identity (and particularly, bisexuality), generation, professional position, and the prevailing model of care influence staff responses.     

Staff Member Reactions to Same-Gender,Resident-to-Resident Sexual Behavior Within Long-Term Care Facilities

The current study assesses ageism and heterosexism relating to older adult sexual activity within long-term care facilities. To assess caregiver reactions, 153 residential care facility staff members read one of three vignettes. Each vignette described a scenario in which a staff member walks in on two residents (male/female, male/male, or female/female) engaging in sexual activity. Although no main effects were discovered for vignette type, exploratory analyses revealed that the facility where participants were employed was significantly related to their ratings of approval. Furthermore, an interaction effect between vignette and facility types was also discovered for caregivers’ approval of sexual activity among residents. Additionally, a strong overall approval rating of older adult sexuality was reported by staff members. The results of this study warrant that further research is necessary regarding older adults’ perception of caregiver bias, as well as further investigation of caregivers’ perceptions of older adults’ sexual activity.     

The impact of COVID-19 on the provision of respectful maternity care: Findings from a global survey of health workers

BackgroundSignificant adjustments to maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care.AimTo explore how the COVID-19 pandemic negatively affected frontline health workers’ ability to provide respectful maternity care globally.MethodsWe conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected qualitative data between July and December 2020 among a subset of respondents and conducted a qualitative content analysis to explore open-ended responses.FindingsHealth workers (n = 1127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers’ fear of getting infected and measures taken to minimise COVID-19 transmission.DiscussionMultidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term.ConclusionsThe measures taken during the COVID-19 pandemic had the capacity to disrupt the provision of respectful maternity care and therefore the quality of maternity care.     

‘I really needed help’: What mothers say about their post-birth care in Queensland,Australia

BackgroundAustralian mothers consistently rate postnatal care as the poorest aspect of their maternity care, and researchers and policymakers have widely acknowledged the need for improvement in how postnatal care is provided.AimTo identify and analyse mothers’ comments about postnatal care in their free text responses to an open ended question in the Having a Baby in Queensland Survey, 2010, and reflect on their implications for midwifery practice and maternity service policies.MethodsThe survey assessed mothers’ experiences of maternity care four months after birth. We analysed free-text data from an open-ended question inviting respondents to write ‘anything else you would like to tell us’. Of the final survey sample (N = 7193), 60% (N = 4310) provided comments, 26% (N = 1100) of which pertained to postnatal care. Analysis included the coding and enumeration of issues to identify the most common problems commented on by mothers. Comments were categorised according to whether they related to in-hospital or post-discharge care, and whether they were reported by women birthing in public or private birthing facilities.ResultsThe analysis revealed important differences in maternal experiences according to birthing sector: mothers birthing in public facilities were more likely to raise concerns about the quality and/or duration of their in-hospital stay than those in private facilities. Conversely, mothers who gave birth in private facilities were more likely to raise concerns about inadequate post-discharge care. Regardless of birthing sector, however, a substantial proportion of all mothers spontaneously raised concerns about their experiences of inadequate and/or inconsistent breastfeeding support.ConclusionWomen who birth in private facilities were more likely to spontaneously report concerns about their level of post-discharge care than women from public facilities in Queensland, and publically provided community based care is not sufficient to meet women's needs. Inadequate or inconsistent professional breastfeeding support remains a major issue for early parenting women regardless of birthing sector.     

Common Factors That Enhance the Quality of Life for Women Living in Their Own Homes or in Aged Care Facilities

A qualitative study of older women living in their own homes and older women living in aged care facilities found that the concerns of the women living in their own homes were the realities of life for the residents in the aged care facilities. Twenty-five female residents across two facilities and 11 older women living in their own homes were interviewed. The positive outcomes of aging at home are relevant and desirable for residents of aged care facilities. A smooth transition from community living to residential aged care involves retaining some of these positive aspects of their lives.     

Midwife-led continuity of care increases women’s satisfaction with antenatal,intrapartum, and postpartum care: North Shoa,Amhara regional state,Ethiopia: A quasi-experimental study

BackgroundThe provision of midwife-led continuity of care (MLCC) is effective in high-resource settings in improving maternal satisfaction. This study aimed to evaluate the effect of MLCC on women’s satisfaction with care in a low-income/resource setting.MethodA study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals in the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low-risk women were allocated to one of two groups; the MLCC (intervention group) that received all antenatal, intrapartum, and immediate postnatal care from a primary midwife or backup midwife) (n = 589) and the shared model of care (SMC) group that received care following established practice in Ethiopia, care from different staff members at different times) (n = 589). Data for this paper were collected using face-to-face interviews at the women’s home at the end of the postpartum period. The study’s outcome was the mean sum-score of satisfaction with care through the antenatal, intrapartum, and postnatal period continuum, where mean sum-scores range from 1 (lowest) to 5 (highest).FindingsCompared with SMC, MLCC was associated with statistically significantly higher satisfaction with all continuity of care (4.07 vs. 2.79 adjusted mean difference 1.27, 95% CI 1.18–1.35; p < 0.001), during antenatal care (4.14 vs. 2.81 adjusted mean difference 1.33 (95% CI 1.22–1.52), intrapartum care (3.83 vs. 2.71 adjusted mean difference 1.06 (95% CI 0.88–1.23) and postnatal care (5.46 vs. 3.71 adjusted mean difference 1.75 (95% CI 1.54–1.94)).ConclusionMLCC increased women's satisfaction with maternity care for women at low risk of medical complications. These findings confirm that the MLCC model will be applicable in the Ethiopian health care system with similar settings.     

Is it possible to incorporate evidence-based professional midwifery practices into public health services in Mexico?

Problem and backgroundDuring the past two decades, Mexico has launched innovative maternal health initiatives to improve maternal and neonatal outcomes, placing emphasis on the incorporation of professional midwifery practices into the healthcare system. This study explored the perceptions of healthcare providers and women using public birth care services regarding professional midwifery practices and how can the inclusion of evidence-based midwifery techniques improve the quality of service.MethodologyWe conducted a qualitative, cross-sectional study of three healthcare networks in Mexico. A content analysis was performed of data collected through 109 semi-structured interviews: 72 with healthcare providers and 37 with women.ResultsHealthcare providers and women had minimal knowledge of the competencies and skills of professional midwives. Medical personnel accepted the incorporation of some evidence-based midwifery practices. Women had experienced fear and anguish during childbirth so they considered that incorporating professional midwifery practices into maternal health services would be favourable in that it would render birth care more respectful.Discussion and conclusionsHealthcare providers are willing to consider the inclusion of some evidence-based midwifery practices in health services and regard assistance from professional midwives. They believe that structural conditions will complicate their incorporation. Although the women interviewed had experienced fear, anxiety and loneliness during childbirth, most of them admitted to feeling “safer” in a hospital (secondary-care health centre) setting where possible complications could be resolved. This perception of safety served to justify the delivery of healthcare in a manner that is inattentive to women’s needs, which go beyond biomedical issues and include emotions and the positive experience of childbirth.     

Sexual Orientation and Sexual Health Care Needs: A Comparison of Women Beneficiaries in Outpatient Military Health Care Settings

ABSTRACT

The objectives of this study are to compare the sexual concerns, interest and experiences in discussing these concerns with their doctor for women of “Only Men” and “Some to Only Women” sexual orientation. A survey was mailed to women patients from two military outpatient settings, with 1,196 women responding. Of eligible respondents (N = 1,170), 90% reported “Only Men” and 10% reported “Some to Only Women” sexual orientation. Sexual concerns varied by sexual orientation, while interest and experience in discussing sexual concerns and desire for physicians to initiate the topic differed minimally. Women with “Some to Only Women” sexual orientation have both similar and differing sexual concerns compared to “male-only” oriented women. Larger primary care patient-based studies of sexual health care needs of sexual minorities are needed.     

The future in their hands: Graduating student midwives’ plans,job satisfaction and the desire to work in midwifery continuity of care

BackgroundMidwife-led continuity of care models benefit women and the midwives who work in them. Australian graduate midwives are familiar with, and educated to provide, continuity of care to women although the opportunity to work exclusively in positions providing continuity of care on graduation is uncommon.AimTo explore the immediate and aspirational employment plans and workforce choices, reasons for staying in midwifery and perceptions around factors likely to influence job satisfaction of midwives about to graduate from one Australian university during the years 2012–2016.MethodsThis longitudinal study draws on survey responses from five cohorts of midwifery students in their final year of study.FindingsNinety five out of 137 midwifery students responded to the survey. Almost nine out of ten respondents either aspired to work in a continuity of care model or recognised that they would gain job satisfaction by providing continuity of care to women. Factors leading to job satisfaction identified included making a difference to the women for whom they care, working in models of care which enabled them to provide women with ‘the care I want to give’, and having the ability to make autonomous midwifery decisions.ConclusionAligning early graduate work experiences with continuity of care models may have a positive impact on the confidence and professional development of graduate midwives, which in turn may lead to greater satisfaction and retention among a workforce already committed to supporting the maternity healthcare reform agenda.     

Midwife-led continuity of care improved maternal and neonatal health outcomes in north Shoa zone,Amhara regional state,Ethiopia: A quasi-experimental study

BackgroundIn a low-resource setting, information on the effect of midwife-led continuity of care (MLCC) is limited. Therefore, this study aimed to determine the effect of MLCC on maternal and neonatal health outcomes in the Ethiopian context.MethodA study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals of the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low risk women were allocated to one of two groups; the midwife-led continuity of care (MLCC or intervention group) (received all antenatal, labour, birth, and immediate postnatal care from a single midwife or backup midwife) (n = 589) and the Shared model of care (SMC or comparison group) (received care from different staff members at different times) (n = 589). The two outcomes studied were Spontaneous vaginal birth and preterm birth. Outcome variables were compared using multivariate generalized linear models (GLMs) and reported using adjusted risk ratios (aRR) with 95% confidence intervals.FindingsWomen in MLCC were, in comparison with women in the SMC group more likely to have spontaneous vaginal birth (aRR of 1.198 (95% CI 1.101–1.303)). Neonates of women in MLCC were in comparison with those in SMC less likely to be preterm (aRR of 0.394; 95% CI (0.227–0.683)).ConclusionIn this study, use of the MLCC model improved maternal and neonatal health outcomes. To scale up and further investigate the effect and feasibility of this model in a low resource setting could be of considerable importance in Ethiopia and other Sub-Saharan Africa countries.     

Exploring factors influencing adverse birth outcomes in a regional hospital setting in Ghana: A configuration theoretical perspective

BackgroundUnderstanding the complexity of factors that influence adverse childbirth outcomes at health facilities can be enhanced by the theoretical articulation of the interplay between external socio-structural and internal technical dynamics of the birthplace in context. Guided by configuration theory, this study explored the factors that influence adverse birth outcomes at a regional hospital setting in Ghana.MethodsQualitative data were collected from the Upper West regional hospital in Ghana. In-depth interviews were administered to 30 purposively selected respondents comprising 20 postpartum mothers and 10 midwives. The data was electronically audio-recorded, transcribed and analysed using thematic analysis.FindingsThe study revealed three key dimensions of socio-technical configurations shaping adverse birth outcomes within the hospital setting. These are mother-midwife personality and behavioral dynamics including personality clashes and poor communication; birth process dynamics consisting of diverse paradigms of safe birthing process and socio-technical conflicts on caesarean section; and birthplace context, comprising nature of the birthing environment, confidence in the safety of the birthplace and national health policy implementation challenges. These socio-technical interactions result in late reporting at facilities by mothers and delay in care delivery by midwives, contributing to adverse birth outcomes.ConclusionIn line with configuration theory, our study positions the influences of adverse birth outcomes in hospital settings in alignment with a subtle and iterative interplay of socio-technical factors. To comprehensively address adverse birth outcomes in hospital settings, health policymakers and practitioners need to understand and contextualise the socio-technical interactions that shape notable outcomes at specific hospital settings.     

Mapping Discrimination Experienced by Indonesian Trans* FtM Persons

This work sought to document how Indonesian trans* FtM persons experienced discrimination across the interlinked domains of social networks, religious and educational institutions, employment and the workplace, and health care institutions. Objectives were (1) to map the discrimination experienced by trans* FtM individuals in Indonesia, and (2) to establish the specific priorities of the Indonesian trans* FtM community. In-depth interviews, focus groups, and participant observation was used involving 14 respondents. Findings revealed that respondents experienced othering through rejection, misidentification, harassment, “correction,” and bureaucratic discrimination across the five preestablished domains. Health care and a lack of information emerged as areas of particular concern for respondents. This work calls for health care that is sensitive to the needs of trans* FtM people coupled with high-quality information to alleviate the cycles through which discrimination is sustained.     

Sources of Discrimination and Their Associations With Health in Sexual Minority Adults

ABSTRACT

Health disparities exist between sexual minorities and heterosexuals. These health disparities may be due to stressful social situations and environments that are created by discrimination. The current study recruited 277 sexual minorities to complete an online survey to examine the effects of discrimination on health. Discrimination from family and friends, compared to non-family and friends, was found to be more strongly associated with poorer health. This effect was partially statistically mediated by perceived stress reactivity. Findings from this study highlight the importance of distinguishing between different sources of discrimination when examining the effect of discrimination on health in sexual minority adults.     

Primary Care Providers’ Attitudes,Practices, and Knowledge in Treating LGBTQ Communities

ABSTRACT

Cultural competency in lesbian, gay, bisexual, transgender, and queer (LGBTQ) health care has been found to be lacking within various medical specialties, but no studies have compared competency among primary care providers. The authors compared 127 primary care providers’ cultural competency regarding LGBTQ health using a survey that assessed providers’ attitudes, practices, and knowledge. Overall, 78.0% of respondents agreed that they were comfortable treating LGBTQ patients. Yet many providers did not feel well informed on specific LGBTQ health needs (70.1%), on clinical management of LGBTQ care (74.8%), nor on referring patients with LGBTQ issues (78.7%). Overall accuracy on LGBTQ knowledge questions was 51.0%. This study revealed a lack of cultural competency and much need for improvement as primary care providers endorsed negative attitudes, biases, inconsistencies in clinical practice, and deficiencies in medical knowledge in specialty-specific ways. There is a need for greater LGBTQ-specific education to increase providers’ comfortability and competency in the needs, management, and referrals within LGBTQ health care.     

Sexual risk-taking in the slums of Nairobi,Kenya, 1993-8

Relatively less attention has been paid to reproductive health problems facing deprived urban residents than to those facing rural residents in the sub-Saharan Africa. This is probably because the majority of Africans live in rural areas, where they are presumed to have poorer medical, educational, and other social services. Yet, the unprecedented rate of urbanization and the accompanying disproportionate growth in the proportion of poor city residents pose new challenges for health care in the region. This study examines differences in sexual behaviour between slum residents and non-slum residents in Nairobi city. The results show that slum residents start sexual intercourse at earlier ages, have more sexual partners, and are less likely than other city residents to know of or adopt preventive measures against contracting HIV/AIDS. The findings highlight the need to treat slum residents as a sub-population uniquely vulnerable to reproductive health problems and to expend more resources in slum settings.     

Sexual risk-taking in the slums of Nairobi,Kenya, 1993-98

Relatively less attention has been paid to reproductive health problems facing deprived urban residents than to those facing rural residents in sub-Saharan Africa. This is probably because the majority of Africans live in rural areas, where they are presumed to have poorer medical, educational, and other social services. Yet, the unprecedented rate of urbanization and the accompanying disproportionate growth in the proportion of poor city residents pose new challenges for health care in the region. This study examines differences in sexual behaviour between slum residents and non-slum residents in Nairobi city. The results show that slum residents start sexual intercourse at earlier ages, have more sexual partners, and are less likely than other city residents to know of or adopt preventive measures against contracting HIV/AIDS. The findings highlight the need to treat slum residents as a subpopulation uniquely vulnerable to reproductive health problems, and to expend more resources in slum settings.