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.     

Do securely and insecurely attached children derive well‐being from different forms of gender identity?

We examined whether attachment security moderates influences of two gender identity variables—felt gender typicality and felt pressure for gender differentiation—on preadolescents' well‐being. We tested two hypotheses. The first was that attachment security protects children from the distress that can stem from feeling gender atypical or from feeling pressure for gender conformity. The second was that secure children derive well‐being from believing they are similar to same‐gender peers whereas insecure children derive well‐being from believing it important to be different from other‐gender peers. We assessed children's attachment security, gender identity, and well‐being (self‐esteem, internalizing problems) in two successive years (N = 211, M initial age = 10.1 years). Results supported the second hypothesis. Attachment security may govern children's contingencies of well‐being.     

Mothering after child removal: Living under the rule of Greek gods

Many women who experience mental illness are mothers. Evidence suggests that the role of mother is of great importance and value to these women, yet they are more likely than other women to have their children removed from their care. Little is known about the experiences of these mothers after their children are removed. This paper presents a phenomenological analysis of in‐depth interviews with 8 women to answer the following question: How do mothers living with severe mental illness experience mothering after removal of their children by child protection services? The analysis showed that mothering continued to be a major life role for these women, but the way they enacted this role was transformed. Their mothering was now constrained and prescribed by external agents, likened to Greek gods, which imposed both boundaries to what they could do and an obligation to prove themselves worthy. Like Greek gods, these external agents were seen as all powerful, unpredictable, and flawed. The study highlights the need for child protection services and support services to recognize and support noncustodial mothering activities.     

Sex Differences in Preadolescents’ Attachment Strategies: Products of Harsh Environments or of Gender Identity?

We evaluated two hypotheses proposed to account for sex differences in preadolescents’ insecure attachment strategies (more avoidant for boys, more preoccupied for girls). The first hypothesis, rooted in life history theory, is that the sex differences develop among children who experience adverse environmental conditions (e.g., harsh parenting). The second hypothesis, grounded in gender self‐socialization theory, is that the sex differences develop among children who identify confidently with their gender collective. Data from an ethnically/racially diverse sample (443 girls, 420 boys; M age = 11.1 years) supported the second hypothesis: Sex differences were evident mainly among children who felt gender‐typical, were content with their gender, or felt pressure to avoid cross‐sex behavior. Further, sex differences were generally smaller rather than larger among children experiencing adverse environments.     

Foundations and innovation in the nonprofit sector

Using a sample of 17 foundations that are at the forefront of encouraging innovation this study explored foundations' motivations behind funding innovation, their perceived ability to impact the levels of innovation in nonprofit organizations, and strategies that foundations are using or can use to encourage innovation in nonprofit organizations. The results showed that among the major motives behind funding innovation were leveraging the capital, honoring the foundations' core identity (mission and values), and desiring to encourage innovation in nonprofit organizations. Five strategies/mechanisms that foundations are using/can use to encourage innovation in nonprofit organizations were identified: (a) offering innovation awards/grants as catalysts for innovation, (b) providing risk capital and supporting early stage idea development, (c) educating other foundations on the value of innovation and serving in a convener role, (d) serving as thought leaders, and (e) increasing nonprofit organizations' capacity for innovation. Implications for practice are discussed along with recommendations for future research.     

The NODS–CLiP: A Rapid Screen for Adult Pathological and Problem Gambling

Objectives  

To describe and evaluate tests of the performance of the NODS–CLiP, an efficient standardized diagnostic interview instrument for adult pathological and problem gambling.     

Home Care Workers’ Skills in the Context of Task Shifting: Complexities in Care Work

Task shifting, which involves the transfer of care work from regulated health‐care professionals to home care workers (HCWs), is a strategy to ensure the efficient delivery of home care services in Canada and internationally. Using a feminist political economy approach, this paper explores the effects of task shifting on HCWs’ skills. Task shifting may be understood as a form of downward substitution—and an effort to increase control over workers while minimizing costs—as some of health‐care professionals’ responsibilities are divided into simpler tasks and transferred to HCWs. Our interviews with 46 home health‐care providers in Ontario, which focused explicitly on HCWs’ role in care provision, problematize the belief that “low skilled” care workers have little control over their work. HCWs’ skills become more complex when they do transferred tasks, and HCWs sometimes gain greater control over their work. This results in increased autonomy and mastery for many HCWs. In turn, this serves to reinforce the intrinsic rewards of care work, despite the fact that it is low paid and undervalued work. Le transfert des tâches consiste à transférer certaines activités des professionnels de la santé aux travailleurs de soutien à domicile, et s'avère être une stratégie visant à assurer la prestation efficace des services de soutien à domicile au Canada et à l'étranger. En utilisant la théorie de l'économie politique féministe, cet article explore l'impact du transfert des tâches sur les compétences des travailleurs de soutien à domicile. Le transfert des tâches peut être interprété comme une forme de substitution à la baisse avec un contrôle accru des travailleurs et une minimisation des coûts des services. Ceci se produit lorsque certaines des responsabilités des professionnels de la santé sont fragmentées en tâches plus simples pour être ensuite transférées aux travailleurs de soutien à domicile. Pourtant, le contenu de 46 entrevues avec des travailleurs de soutien à domicile et professionnels de la santé vient ébranler l'hypothèse selon laquelle les travailleurs de soutien à domicile «peu qualifiés» auraient peu de contrôle sur leurs tâches de travail. Les résultats de cette étude suggèrent que les compétences des travailleurs de soutien à domicile se complexifient lorsqu'il s'agit de tâches transférées, et que ces travailleurs obtiennent parfois plus d'autonomie à l'emploi. Donc, les travailleurs de soutien à domicile acquièrent une plus grande autonomie et un contrôle plus significatif à l'emploi. Par conséquent, le transfert des tâches renforce les gratifications intrinsèques du travail en relation d'aide et ce, en dépit d'une piètre rémunération et de la sous‐valorisation du métier.     

Making Critical Minds: Nurturing ‘Not‐Knowing’ in Students of Health and Social Care

The two authors have been involved in developing teaching and learning resources that can be used with students undertaking a whole range of health and social care courses. The aims of this development work included the fostering of critical thinking skills and of inter professional learning. In this Ideas in Action paper we share both some of the thinking behind our work and several of the learning activities that we have utilized with our students.     

Provision of Auricular Acupuncture and Acupressure in a University Setting

Abstract

Auricular acupuncture using the National Acupuncture Detoxification Association (NADA) protocol ¹ National Acupuncture Detoxification Association. “About NADA”. Available at: http://acudetox.net/about-nada/12-faqs. Accessed May 2, 2013 [Google Scholar] stimulates 5 points in each ear—the Shen Men, sympathetic nervous system, liver, kidney, and lung. This protocol is also known as Acu Detox, and has been used for recovery in community-based settings and drug use treatment programs. It has also been proven to be effective in alleviating stress and enhancing a general sense of well-being. This article describes the auricular acupuncture and acupressure program developed for a university setting and its use as a tool to enhance harm reduction and mental health services.     

Perceptions of teen motherhood in Australian adolescent females: Life-line or lifederailment

PurposeThe findings presented in this paper describe the beliefs and attitudes of three different groups of adolescent females about teen motherhood. These were elicited from a larger analysis that explored and theorized contraceptive pathways in a sample of young Australian women.MethodsA purposive sample of females aged 14 to 19 years was recruited from three distinct populations in the city of Perth, Western Australia: (1) never-pregnant; (2) pregnant-terminated; and (3) pregnant-continued. Grounded theory principles were used to analyze data generated from 69 semi-structured interviews conducted over a 21 month period (2006–2008).ResultsTwo categories that described teenagers’ attitudes to pregnancy and motherhood were elicited from the analysis. These explained the level of priority that teenagers placed on using contraception and postponing the transition to parenthood. The category labeled ‘life derailment’ represented how those who had never had a pregnancy or had terminated a pregnancy constructed teen motherhood as potentially restricting their personal, career and social transition to adulthood. The alternative category, ‘life-line’, reflected how those who continued with their pregnancy perceived teen motherhood as a positive and transformative experience that fostered personal growth.ConclusionsThe findings from this study contribute further insight into the complex nature of adolescent contraceptive use and pregnancy risk. The analysis has strengthened evidence of the critical role of self-perceptions of pregnancy and childbearing on teenagers’ fertility outcomes. It has also emphasized the broader life circumstances that shape these attitudes, intentions and related behavior. Strategies directed toward academic support and vocational skill development may broaden teenage girls’ perceived future options and achievement capacity, thus influencing key reproductive health outcomes.