Pregnant adolescent women’s perceptions of depression and psychiatric services in the United States

Problem

Adolescent mothers and their children are at high-risk for depression and the associated negative educational, social, health, and economic outcomes.

Beyond resistance: exploring health managers' propensity for participatory evaluation in a developing country

The evaluation of interventions is becoming increasing common and now often seeks to involve managers in the process. Such practical participatory evaluation (PPE) aims to increase the use of evaluation results through the participation of stakeholders. This study focuses on the propensity of health managers for PPE, as measured through the components of learning, working in groups, use of judgment and use of systematic methods. We interviewed 16 health managers to determine the meaning they ascribe to these four components in their practice in a developing country, Haïti. We found that learning was often informal and that all managers attached a negative meaning to the use of judgment. Working in groups was favored by all managers, while the health managers viewed the use of systematic methods differently than do evaluators. The administrative health managers generally ranked lower in propensity for PPE than did their clinical colleagues. Implications for the practice of evaluation are discussed in relation to the work styles exhibited by managers in everyday practice, the proactive repetition of actions, the control exercised by formal procedures, and the collective versus “solitary” image of one's environment of action.     

Midwifery care of non-vaccinating families — Insights from the Byron Shire

ProblemMidwives may feel ill-equipped to manage clinical encounters with non-vaccinating parents.BackgroundPregnancy is a peak time in the formation of parents’ vaccination views and intention. Midwives are central to maternity care in Australia. While most midwives will have infrequent contact with families who intend not to vaccinate, when they do, they must feel equipped to communicate with them in a manner which fulfils their professional responsibilities, acknowledges parental autonomy and facilitates continued engagement.AimTo understand how midwives can most effectively communicate with non-vaccinating parents.MethodsWe conducted in-depth interviews with 32 non-vaccinating parents and six key informant health professionals, and a focus group of six midwives. Data collection occurred in the Byron Shire of New South Wales, where childhood vaccination rates are persistently lower than national averages.FindingsThis study explores four central codes. The first, ‘hold on…I’m not sure about this’ providing insights into moments of doubt preceding parents’ decisions not to vaccinate. The second ‘Pregnancy: a decision-making focal point’ reinforces the importance of effective vaccination recommendations in the antenatal period. ‘Manipulation and ambivalence’ examines why overzealous or unclear recommendations about vaccination are unhelpful, and the fourth central code ‘engage, inform and encourage’ summarise recommendations from health professionals who are experienced in communicating, apparently effectively, with non-vaccinating families.DiscussionInsights from this study are used to recommend practical strategies which may be employed by midwives and maternity units to successfully and professionally manage clinical encounters with non-vaccinating parents.ConclusionMidwives are well positioned to provide clear recommendations to parents regarding childhood vaccination whilst maintaining engagement and meeting the goals of woman-centred care.     

Director tenure and contribution to board task performance: A time and contingency perspective

Director tenure is a topic of great interest in the corporate governance debate. Researchers try to assess the effects of tenure on director contribution, board effectiveness and firm performance. Regulators, corporations, and institutional investors advocate for term limits for outside directors to reduce the risks of impaired governance. Despite the burgeoning interest, there is lack of consensus on the mechanisms shaping directors' contributions over time. We argue that next to the ‘loss of independence’ and ‘knowledge acquisition’ hypotheses, respectively predicting a negative and positive effect of tenure on task performance, socio-cognitive and behavioral approaches elucidate the way in which directors' contributions rise and decline with time. Using a multiple case study approach, we document wide variability in directors' contributions at similar levels of tenure. We find this is due to a series of contingencies including whether directors are novice or experienced, the frequency and nature of board interactions, and the relative power of a director. This variability is particularly clear in longer serving directors for whom we find polarizing results: while some grow stale in the saddle, others sustain high levels of contribution despite extreme tenures. The latter finding is at odds with agency-based assumptions and general predictions from the literature. Overall, our study offers a tentative explanation as to why setting an ‘ideal’ tenure for outside directors has proven so difficult and encourages boards and policy makers to consider the influence of director-level features as well as board dynamics in shaping directors' contributions.     

My quitting stories: A qualitative study exploring Aboriginal women’s experiences of smoking cessation and preventing relapse in the context of pregnancy

BackgroundMost women who give up smoking during pregnancy relapse to smoking postnatally. Evidence on strategies that are helpful in maintaining smoking cessation during and beyond pregnancy is limited.AimThis paper aims to explore Aboriginal women’s experiences of quitting smoking, relapsing, and preventing relapse, focusing on the strategies they applied for attaining and maintaining abstinence and the support they received.MethodsQualitative interviews were conducted between October 2020 and June 2021, in urban New South Wales, Australia, with 12 Aboriginal women who either smoked tobacco or quit smoking and had been pregnant in the last five years. Aboriginal Research Assistants recruited participants, participated in data collection and data analysis. Data were thematically analysed.ResultsMajor themes that emerged from the data include: a) aspiration to be abstinent; b) strong mindset; c) strategies to stay smoke-free; d) supports received; and e) service and policy recommendations. Protecting children from second-hand smoke had salience for the maintenance of abstinence. Having a strong mindset was perceived as a prerequisite to staying smoke-free. Use of multiple coping strategies in combination was frequently expressed. Knowledge about tobacco-related harms, the way nicotine dependence works, and the available support options was empowering and enabled informed decision making and actions around smoking cessation.ConclusionThis qualitative study conducted with 12 Aboriginal women revealed that Aboriginal women employ multiple strategies (cognitive, behavioural and social) to quit smoking and stay smoke-free. The strategies warrant further exploration with different Aboriginal communities across Australia and consideration of inclusion in smoking cessation care.     

Navigating uncertainty alone: A grounded theory analysis of women’s psycho-social experiences of pregnancy and childbirth during the COVID-19 pandemic in London

ProblemMaternity care underwent substantial reconfiguration in the United Kingdom during the COVID-19 pandemic.BackgroundCOVID-19 posed an unprecedented public health crisis, risking population health and causing a significant health system shock.AimTo explore the psycho-social experiences of women who received maternity care and gave birth in South London during the first ‘lockdown’.MethodsWe recruited women (N = 23) to semi-structured interviews, conducted virtually. Data were recorded, transcribed, and analysed by hand. A Classical Grounded Theory Analysis was followed including line-by-line coding, focused coding, development of super-categories followed by themes, and finally the generation of a theory.FindingsIterative and inductive analysis generated six emergent themes, sorted into three dyadic pairs: 1 & 2: Lack of relational care vs. Good practice persisting during the pandemic; 3 & 4: Denying the embodied experience of pregnancy and birth vs. Trying to keep everyone safe; and 5 & 6: Removed from support network vs. Importance of being at home as a family. Together, these themes interact to form the theory: ‘Navigating uncertainty alone’.DiscussionWomen’s pregnancy and childbirth journeys during the pandemic were reported as having positive and negative experiences which would counteract one-another. Lack of relational care, denial of embodied experiences, and removal from support networks were counterbalanced by good practice which persisted, understanding staff were trying to keep everyone safe, and renewed importance in the family unit.ConclusionPregnancy can be an uncertain time for women. This was compounded by having to navigate their maternity journey alone during the COVID-19 pandemic.     

Uncertainty in interorganizational collaboration and the dynamics of trust: A qualitative study

The field study presented in the article illustrates how trust is operationalized in business practices. It shows that deciding to engage and remain in collaborative relations characterized by high uncertainty is influenced by reciprocal interactions among (i) transactional and relational attributes, (ii) organizational and environmental characteristics, (iii) governance structures and processes, and (iv) acts of suspension. Our framework demonstrates that exchange partners sometimes need to suspend (i.e., accept and embrace) risks in a non-calculative manner. Thus, building on a qualitative study of collaborative software development projects, this paper calls for the dynamic treatment of governance mechanisms in interorganizational relationships.