Sociality and transnational social space in the making of medical tourism: local actors and Indonesian patients in Malaysia

ABSTRACT

We investigate international medical travel between Indonesia and Malaysia through the conceptual lens of sociality, transnational social space and therapeutic mobilities. Drawing upon narratives of local persons, medical traveller-patients, accompanying family members, hospital staff and medical travel facilitators, we illustrate how multifaceted linkages and processes generate and sustain the flow of patients across the border. In these narratives, we see multiple mobilities articulate and cross-cut in the building of transnational connections. This paper stretches the concept of transnational social space to apply to medical travel and contributes to the literature framing of international medical travel as a complex and multifaceted arena.     

Experience of hope: An exploratory research with bereaved mothers following perinatal death

ProblemThe negative implications of perinatal death on mothers’ mental health are documented, however little is known about their experience of hope.BackgroundWithin the broader literature, hope has contributed to better mental health and bereavement adjustment and often bereaved mothers report the importance of hope for the grieving process.AimThis study aims to explore bereaved mothers’ experience of hope following perinatal death.MethodsIndividual interviews were conducted with 33 mothers having experienced the death of an infant in the perinatal period. Data from the interviews were analysed using thematic analysis.FindingsThe mothers’ experience of hope following perinatal loss is organized into three themes: Hope disrupted by perinatal loss; Transformed hope: a new pregnancy challenged by the sense of foreboding of another loss; and Ways to restore and foster hope in life.DiscussionAlthough hope has been a motivating force for mothers to reconnect with their life plan and move on after a loss, it is also negatively affected by the experience of perinatal bereavement, social support, and health professionals’ clinical practice.ConclusionBereaved mothers have reported a disruption in their experience of hope. While some experience a loss of hope or a sense of hopelessness, others experience a transformation and restoration of hope, which is reinvested in the grieving process. Mothers’ experience of hope highlights the need for the support of a healthcare professional and may contribute to enhanced clinical practice through the promotion of bereavement care, considering the aspects that instil, maintain, and interfere with hope.     

Older Women and the Health Care System: A Time for Change

SUMMARY

In spite of women's active involvement in a woman's health care movement, the mainline health care system continues to hold tight to its androcentric focus. If women are to be subjected to a health care system that employs sexist and ageist practices, the quality of life in their later years will continue to be jeopardized. The purpose of this paper is to first, recognize the existing health care practices which limit the health care opportunities and choices of older women; and secondly, to discuss how such basic feminist principles as education, egalitarianism, empowerment, and inclusion can be used to improve an older woman's experience.     

Intertwined therapeutic mobilities: knowledge,plants, healers on the move between Laos and the U.S.

ABSTRACT

We investigate the notion of therapeutic mobilities through the case study of transnational health care practices and medicinal flows within the Hmong diaspora between Laos and the U.S. Drawing upon narratives of traditional healers, pickers, and plant sellers, as well as a collection of postal registers, we highlight how therapeutic mobilities follow the routes of migration and organize the practices of healing among Hmong in receiving countries, particularly in the U.S. Through the different and multidirectional aspects of therapeutic mobilities, we illustrate how transnational healing touches upon questions of cultural identity within the Hmong diaspora. Therapeutic mobilities not only involve border-crossing, they also strengthen existing bonds within the Hmong diaspora. Similarly, herbal treatments not only achieve a therapeutic function, they also represent a range of meanings and values for patients. We explore the fabric of therapeutic mobilities through the prism of translocality and medical pluralism.     

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.     

LGBTQ College Students’ Experiences With University Health Services: An Exploratory Study

ABSTRACT

Access to inclusive, equitable health care is central to the wellbeing of all college students yet little is known about LGBTQ students’ experiences with university health services. In this article, individual interviews with a convenience sample of 14 LGBTQ students at a large public university were analyzed to explore their perceptions of and experiences with the university’s health center and its services. Our findings demonstrate that the university is not adequately meeting their health care needs. Participants’ narratives offer insights into how to improve campus-based health services for LGBTQ students.     

A qualitative study of innovations implemented to improve transition of care from maternity to child and family health (CFH) services in Australia

BackgroundThe transition of care (ToC) from maternity services, particularly from midwifery care to child and family health (CFH) nursing services, is a critical time in the support of women as they transition into early parenting. However significant issues in service provision exist, particularly meeting the needs of women with social and emotional health risk factors. These include insufficient resources, poor communication and information transfer, limited interface between private and public health systems and tension around role boundaries. In response some services are implementing strategies to improve the transition of care from maternity to CFH services.AimThis paper describes a range of innovations developed to improve transition of care between maternity and child and family health services and identifies the characteristics common to all innovations.MethodsData reported were collected in phase three of a mixed methods study investigating the feasibility of implementing a national approach to child and family health services in Australia (CHoRUS study). Data were collected from 33 professionals including midwives, child and family health nurses, allied health staff and managers, at seven sites across four Australian states. Data were analysed thematically, guided by Braun and Clarke's six-step process of thematic analysis.FindingsThe range of innovations implemented included those which addressed; information sharing, the efficient use of funding and resources, development of new roles to improve co-ordination of care, the co-location of services and working together. Four of the seven sites implemented innovations that specifically targeted families with additional needs. Successful implementation was dependent on the preliminary work undertaken which required professionals and/or organisations to work collaboratively.ConclusionImproving the transition of care requires co-ordination and collaboration to ensure families are adequately supported. Collaboration between professionals and services facilitated innovative practice and was core to successful change.     

The perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women: An ethnographic study

BackgroundAcross the globe, many women including economic and humanitarian migrants receive inadequate antenatal care. Understanding the difficulties that migrant women encounter when accessing maternity care, including the approach of health professionals, is necessary because inadequate care is associated with increasing rates of morbidity and mortality. There are very few studies of migrant women’s access to and experience of maternity services when they have migrated from a low- to a middle-income country.AimTo examine the perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women, and to describe women’s experiences of their encounters with health professionals providing maternity care in Ranong Province in southern Thailand.MethodsEthnography informed the study design. Individual interviews were conducted with 13 healthcare professionals and 10 Burmese women before and after birth. Observations of interactions (130 h) between health care providers and Burmese women were also conducted. Data were analysed using thematic analysis.FindingsThe healthcare professionals’ practices differed between the antenatal clinics and the postnatal ward. Numerous barriers to accessing culturally appropriate antenatal care were evident. In contrast, the care provided in the postnatal ward was woman and family centered and culturally sensitive. One overarching theme, “The system is in control’ was identified, and comprised three sub-themes (1) ‘Being processed’ (2) ‘Insensitivity to cultural practices’ and, (3) ‘The space to care’.Discussion and conclusionsThe health system and healthcare professionals controlled the way antenatal care was provided to Burmese migrant women. This bureaucratic and culturally insensitive approach to antenatal care impacted on some women’s decision to engage in antenatal care. Conversely, the more positive examples of woman-centered care evident after birth in the postnatal ward, can inform service delivery.     

Hungarian Medical Students’ Knowledge About and Attitude Toward Homosexual,Bisexual, and Transsexual Individuals

ABSTRACT

Discrimination that LGBTQ individuals experience in health care settings might affect their health and intention of using health care services. However, health needs of LGBTQ patients are still inappropriately addressed in the medical curriculum. First-, third-, and fourth-year medical students (N = 569) from the four Hungarian medical universities participated in a study in 2017 to assess knowledge about homosexuality, homonegativity, and their attitude as health care professionals toward sexual minorities. We found that higher levels of knowledge about homosexuality were associated with lower levels of homonegativity, upper-grade level in university, not being religious, and having close LGBTQ acquaintances. Our results suggest that it may be necessary to introduce LGBTQ themes in the medical curricula (not only in Hungary, but also in other countries) in order to improve the knowledge and attitude of medical students and thereby improve the health care of LGBTQ individuals.     

Towards a conceptualisation of woman centred care — A global review of professional standards

BackgroundWoman centred care is purported to underpin Midwifery philosophy. However, the evidence and focus of this concept within midwifery professional standards has yet to be verified. Further to this, woman centred care is, at this time, mostly depicted as a way of assisting, supporting and interacting with a woman and her family. It is however, without a substantive universally accepted definition.ObjectiveThis study aimed to review midwifery standards documents. An organised and targeted methodology was conducted to identify the approaches to woman centred care that currently underpin midwifery governance.MethodsA comprehensive and specific search for ‘woman centred care’ was conducted across a global collection of midwifery standards. A professional document was included if it represented either or all of the underpinnings of midwifery education, contained statements related to standards of practice, overall governance or any equivalence. Individual documents were initially searched for the words ‘woman centred care’, followed by ‘women centred care’, ‘patient/person centred care’ and ‘client centred care’.FindingsAn extensive review of 142 documents was undertaken. These included: thirty independent nations, thirty represented by the European Midwives Association and a further twenty-one identified through the International Confederation of Midwives (ICM). The World Health Organisation (WHO), yielded midwifery information from a further sixty-one nations. The phrase ‘woman centred care’ was located within 3.5% of the documents reviewed. Overall, five examples were found that directly referred to the actual phrase ‘woman centred care’ and one to the use of ‘person centred care’. Therefore, it was established, that at the time of this review, there was limited formal depiction of the concept of woman centred care.     

Pregnancy after loss during the COVID19 pandemic

BackgroundRapid changes to how maternity health care is delivered has occurred in many countries across the globe in response to the COVID-19 pandemic. Maternity care provisions have been challenged attempting to balance the needs and safety of pregnant women and their care providers. Women experiencing a pregnancy after loss (PAL) during these times face particularly difficult circumstances.AimIn this paper we highlight the situation in three high income countries (Australia, Ireland and USA) and point to the need to remember the unique and challenging circumstances of these PAL families. We suggest new practices may be deviating from established evidence-based guidelines and outline the potential ramifications of these changes.FindingsRecommendations for health care providers are suggested to bridge the gap between the necessary safety requirements due to the pandemic, the role of the health care provider, and the needs of families experiencing a pregnancy after loss.DiscussionChanges to practices i.e. limiting the number of antenatal appointments and access to a support person may have detrimental effects on both mother, baby, and their family. However, new guidelines in maternity care practices developed to account for the pandemic have not necessarily considered women experiencing pregnancy after loss.ConclusionBereaved mothers and their families experiencing a pregnancy after loss should continue to be supported during the COVID-19 pandemic to limit unintended consequences.     

Factors affecting rural women's utilisation of continuum of care services in remote or isolated villages or Pakistan – A mixed-methods study

IntroductionAn effective continuum of care for pregnancy and childbirth connects women and girls with essential reproductive and maternity care services. This study aimed to estimate the continuum of care utilisation rate of women who lived in remote and isolated regions of Pakistan and explored factors that influence women's utilisation of reproductive and maternity care services.MethodsA mixed-methods study was conducted in five rural villages of Sindh, Pakistan. A cross-sectional survey with 669 women who gave birth between July 2010 and September 2014 investigated women's maternity-care service utilisation during pregnancy, childbirth, and in the postpartum period. In-depth interviews with 15 women explored their maternity-care experiences with health providers.ResultsOnly 6.4% of 669 women participants reported to have completed the continuum of care for their last pregnancy. Skilled birth attendants, including health professionals, were used by 56.1% for antenatal care, 40.8% for both antenatal and childbirth, 22.3% for antenatal, childbirth and postnatal, and only 6.4% reported using all pregnancy-related and postpartum services. Limited knowledge about affordable health services, poor health literacy, and access to health services was associated with women's fragmented utilisation of maternity care. A lack of respectful maternity-care was also identified as a major barrier to women's utilisation of primary health care facilities, especially for childbirth.ConclusionThe existing primary health structure in Pakistan provides a good foundation to deliver continuity of care services; however, health services utilisation for reproductive and maternity care remains suboptimal in women who live in geographically remote regions of Pakistan.     

Working in caseload midwifery care: The experience of midwives working in a birth centre in North Queensland

BackgroundPregnancy, birth and child rearing are significant life events for women and their families. The demand for services that are family friendly, women focused, safe and accessible is increasing. These demands and rights of women have led to increased government and consumer interest in continuity of care and the establishment in Australia of birth centres, and the introduction of caseload midwifery models of care.AimThe aim of this research project was to uncover how birth centre midwives working within a caseload model care constructed their midwifery role in order to maintain a positive work–life balance.MethodsA Grounded Theory study using semi-structured individual interviews was undertaken with seven midwives who work at a regional hospital birth centre to ascertain their views as to how they construct their midwifery role while working in a caseload model of care.FindingsThe results showed that caseload midwifery care enabled the midwives to practice autonomously within hospital policies and guidelines for birth centre midwifery practice and that they did not feel too restricted in regards to the eligibility of women who could give birth at the centre. Work relationships were found to be a key component in being able to construct their birth centre midwifery role. The midwives valued the flexibility that came with working in supportive partnerships with many feeling this enabled them to achieve a good work–life balance.ConclusionThe research contributes to the current body of knowledge surrounding working in a caseload model of care as it shows how the birth centre midwives construct their midwifery role. It provides information for development and improvement of these models of care to ensure that sustainability and quality of care is provided to women and their families.     

Traditional birth attendants’ roles and homebirth choices in Ethiopia: A qualitative study

BackgroundIn Ethiopia, it is encouraged that labour and delivery care are performed under the observation of skilled/trained midwifery or medical professionals. However, 70% of all births occur outside the healthcare system under the care of unskilled birth attendants, family members, or without any assistance at all.ObjectiveThis study aimed to assess the reasons for choosing homebirth and the role of traditional birth attendants in Arba Minch Health and Demographic Surveillance Site.MethodA qualitative, exploratory study was carried out between May and June 2017. Twenty-nine semi-structured interviews were conducted with various respondent groups such as traditional birth attendants, pregnant women, skilled birth attendants, and health extension workers. Data were transcribed and for analysis, structured as per the participants’ responses, sorted and categorized as per the topic guide, and presented in narrative form.FindingsThe study revealed that traditional birth attendants are actively engaged in assisting homebirths in the selected area. It was also found that many women still prefer traditional birth attendants for childbirth assistance. Reasons for choosing homebirth included lack of transport to health care facilities, distance to health care facilities, lack of respectful care at health care facilities, and the friendliness of traditional birth attendants. Lack of formal partnerships between traditional birth attendants and the health system was also observed.ConclusionsThere is a need to incorporate traditional birth attendants as a link between healthcare facilities and pregnant women; thereby, improving respectful care at the healthcare facilities.     

“Whatsapping” the continuity of postpartum care in Switzerland: A socio-anthropological study

BackgroundDigital media such as Apps, Internet and social networks have become integral parts of the maternity experience for more than a decade. These media can support or undermine women’s experiences as has been shown in digital sociology research. Using Immediate Messaging Applications to provide information and support to women during the perinatal period is an emerging practice.AimThis article analyses how health and social care professionals – with a focus on community midwives – and women communicate between postpartum home visits through Immediate Message Applications in Switzerland.MethodsA socio-anthropological study that relied on qualitative methods including semi-directed interviews with midwives and health and social care professionals (n = 30) and immigrant women (n = 20).FindingsSince the introduction of Immediate Messaging Applications, women and their carer converse more regularly between post-partum home visits. Women send questions, pictures and videos to them, often allowing swift responses to their concerns. Midwives encounter difficulties answering women’s questions when they cannot be solved through quick communication (e.g. infant crying). To them, texting frequency forms a clinical clue to women’s mental health. Not all women contact their carer through digital messages; immigrant women are less likely to know and use this service.Discussion and conclusionImmediate Messaging Applications form a promising communication tool, complementary to home visits, and contribute to woman-centered care and continuity of care. As an emergent practice, it has not been framed by a guideline yet. Policy makers and practitioners should ensure that its use does not contribute to unequal access to care.     

Women’s experiences of their maternity care: A principle- based concept analysis

BackgroundDespite many countries employing the use of national and large scale regional surveys to explore women’s experiences of their maternity care, with the results informing national maternity policy and practice, the concept itself is ambiguous and ill-defined having not been subject of a structured concept development endeavour.AimThe aim of this review is to report on an in-depth analysis conducted on the concept of ‘women’s experiences of their maternity care’.MethodsUsing the principle-based method of concept analysis by Penrod and Hupcey (2005), the concept of ‘women’s experiences of their maternity care’ was analysed under the epistemological, pragmatic, linguistic and logical principles. The final dataset included 87 items of literature published between 1990 and 2017 retrieved from a systematic search of the MEDLINE, CINAHL, EMBASE and PSYCinfo databases.FindingsThe epistemological principle identified that a theoretical definition of the concept is elusive with a variety of implicit meanings. The pragmatic principle supports the utility of the concept in scientific literature, however the lack of a theoretical definition has led to inconsistent use of the concept, as highlighted by the linguistic principle. Furthermore, the logical principle highlighted that as the concept lacks definition blurring is identifiable when theoretically positioned with related concepts.ConclusionThe outcome of this concept analysis is a theoretical definition of a previously undefined concept. This definition highlights the subjective nature of the concept, its dependency upon a woman’s individual needs, expectations and circumstances and the influence of the organisation and delivery of maternity care.     

A Decision Aid for midwifery continuity of care: Development and pilot acceptability testing

BackgroundMany maternity services in Australia offer women a variety of models of care including midwife led models. Childbearing women, however, need to understand the differences between these models if they are to make an informed decision about their choice of care. Decision Aids (DA) help people decide when there is not a single best option and the best decision will be based upon the values of the decision maker. There is no current tool that focuses on the choice of midwife led vs other models of maternity care.AimThis research aimed to develop, and pilot test a Decision Aid focusing on the choice between midwife led and standard models of maternity care.MethodsThe DA was developed using the International Patient Decision Aid Standards and pilot tested for acceptability with a group of clinicians who provide antenatal care in one jurisdiction in Australia. A posttest only study was conducted assessing knowledge, acceptability and decisional conflict, with a group of women of childbearing age living in the jurisdiction.FindingsA DA was developed and pilot acceptability testing with 14 women and 13 clinicians of Australian Capital Territory (ACT) health demonstrated its acceptability and highlighting areas for further development.DiscussionSome revisions may be needed to address issues of balance and bias toward midwife-led care identified by some recipients.ConclusionPilot acceptability testing with women and staff of ACT health provides a steppingstone to further research, development and evaluation of this DA.     

Salutogenic qualities of midwifery care: A best-fit framework synthesis

BackgroundAlthough midwifery care is wellness-based and promotes normal physiology, it exists within a medical model that focuses on risk aversion and disease prevention. Salutogenic theory could provide an alternative approach to midwifery care, supporting health-promoting factors, rather than solely avoiding adverse events.AimsThe aim of this study was to explore women’s experiences of their midwifery care and identify salutogenic aspects of midwifery care.MethodsBest-fit framework synthesis was used to analyse 349 quotes about women’s experiences of midwifery care from 31 qualitative studies in ten high-income countries. Key salutogenic concepts of comprehensibility, manageability and meaningfulness were used as the basis for coding, and thematic analysis was used to expand and clarify the framework to best fit the data.FindingsDefinitions for the salutogenic aspects of midwifery care were developed. Comprehensibility (cognitive aspects of health): ways that midwives help women increase predictability and preparation during childbearing through apredictable caregiver, a predictable system and preparation for an unpredictable experience. Manageability (behavioural aspects of health): ways that midwives enhance and support a woman’s internal resilience, adding extra support when needed, and strengthen women’s external resources through connections to family, community and specialist care. Meaningfulness (emotional/spiritual aspects of health): ways that midwives encourage the commitment and engagement of childbearing women by providing care through a personalised relationship, by cultivating a woman’s autonomy.ConclusionFindings of this study may be used to further research into ways that salutogenic theory can bring a health and wellness-focused agenda to midwifery policy and practice.     

Knowing your audience: Investigating stillbirth knowledge and perceptions in the general population to inform future public health campaigns

BackgroundThe prevalence of stillbirth in many high income countries like Australia has remained unchanged for over 30 years. The 2018 Australian government Senate Select Committee on Stillbirth Research and Education highlighted the need for a public health campaign to encourage public conversations and increase awareness. However, there is little evidence about the community’s knowledge and perceptions towards pregnancy and stillbirth, nor their aspirations for a public health campaign.AimsTo assess the general knowledge, perceptions, myths and attitudes towards stillbirth to inform future public health campaigns.MethodsAustralian participants (n = 344; predominately women n = 294 (85.5%)) were recruited via Facebook.com. They completed a cross-sectional online survey designed to assess their knowledge of pregnancy and stillbirth, with additional questions on socio-demographic characteristics.ResultsStillbirth knowledge and awareness of incidence was low in this sample. Prominent myths, such as baby runs out of room in the uterus (n = 112, 33%) and baby slows down when preparing for labour (n = 24, 27%) were endorsed. Only 25% (n = 85) knew the prevalence of stillbirth in Australia (six per day). Almost two-thirds (n = 205; 62%) agreed that there needs to be a public health campaign, however one in five (n = 65; 20%) were concerned that talking about stillbirth with pregnant women may cause them to worry.Discussion and conclusionOur findings reinforce the need for a targeted campaign, which educates the general population about the definition and prevalence of stillbirth, stillbirth risks and modifiable health behaviours. Appropriate messaging should target pregnant women during antenatal care as well as their support and care systems (family, friends, and care providers).