CONTEXT: The influences of gender and geography are increasingly being acknowledged as central to a comprehensive understanding of health. Since little research on rural women's health has been conducted, an in-depth qualitative approach is necessary to gain a better initial understanding of this population.
PURPOSE: To explore the determinants of health and their influence on rural women's health.
METHODS: From November 2004 to September 2005, 9 focus groups and 3 individual interviews were conducted in 7 rural southwestern Ontario communities. Sixty-five rural residents aged 26 years and older participated in the study. Semi-structured interview questions were used to elicit participants' perceptions regarding determinants of rural women's health.
FINDINGS: Four Health Canada determinants (employment, gender, health services, and social environments) and 3 new determinants (rural change, rural culture, and rural pride) emerged as key to rural women's health.
CONCLUSIONS: Although health determinants affect both urban and rural people, this qualitative study revealed that rural women experience health determinants in unique ways and that rural residents may indeed have determinants of their health that are particular to them. More research is needed to explore the nature and effects of determinants of health for rural residents in general, and rural women in particular.
Ovarian cancer patients experience high levels of anxiety and depression, yet there is little research regarding coping and support of this population. In this study we examined the experiences of women during diagnosis and treatment via 30 semistructured interviews. The interviews were analyzed qualitatively, and five main themes were evident: (1) extreme blunting; (2) having a "forgotten cancer"; (3) traumatic surprise of diagnosis; (4) highs and lows of health care; and (5) support gap experienced postdiagnosis. Currently, there is no readily accessible psychosocial/educational information source for these patients. It is likely that a telephone intervention would be the most effective solution.
Dating violence is a significant public health problem in the lives of young women. Their age, in conjunction with perceived pressures to engage in intimate relationships, makes these women particularly vulnerable to dating violence. The pressures to be in relationships can be intense and therefore may add to young women's willingness to overlook, forgive, or excuse the violence that is occurring. The authors' purposes in this feminist study were to examine the experience of dating violence from young women's perspectives; investigate how contextual factors shape their experiences; examine how health is shaped by these experiences; and explore ways that dating violence is perpetuated and normalized in young women's lives. Findings revealed that family environment and gender are critical in shaping young women's experiences. The participants described a range of physical and emotional health problems and perceived few sources of support. Their efforts to obtain support were often met with skeptical and dismissive attitudes on the part of health care providers and other trusted adults. Recommendations for health care practice, education, and research are presented.
Journal»Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en diététique : une publication des Diététistes du Canada
PURPOSE: Vietnamese women's breastfeeding experience and challenges were explored, as were their families' needs for prenatal and postpartum health professional programs and services.
METHODS: A qualitative study was conducted in Middlesex-London, Ontario, using in-depth, semi-structured interviews in a heterogeneous sample of 11 Vietnamese mothers of children younger than two years. Diverse subject characteristics were sought in terms of parity, maternal age, infant age, marital status, education, employment, and breastfeeding initiation and duration. The 45- to 60-minute interviews were audiotaped and transcribed verbatim. Research team members independently reviewed interview transcripts at several stages during data collection. Qualitative analysis was sequential, and involved a combination of editing and template organizing styles.
RESULTS: Lack of knowledge and misinformation were major barriers to breastfeeding. Inability to communicate in English and a lack of effective transportation were key obstacles to the women's ability to access mainstream prenatal and postpartum health programs and services. Standard nursing prenatal and postpartum services appear not to have reached this group of mothers effectively.
CONCLUSIONS: Culturally and linguistically sensitive breastfeeding promotion and postpartum support services are needed for this Vietnamese community.
Rural living poses special challenges (and opportunities) for the significant health information intermediary role that women enact. The authors describe interviews with 40 women living in a rural, medically underserved county in south-western Ontario, Canada, who discussed their information-seeking experiences and the strategies used to find information about a chronic health concern or an acute medical problem. The women's stories reveal that they define health very broadly and that their information seeking is influenced by contextual factors, such as rural living and gender roles, that interplay with their self-reliance, health literacy, and the availability and willingness of others in professional and non-professional roles to give support within relationships of care. The authors discuss themes emerging from the interviews in connection with the apparent mismatch between women's lived realities and the policy assumptions supporting the development of e-health strategies for providing health information to people living in rural and remote communities.
Clients living at home with chronic disabling conditions together with their caregivers, service providers, and policymakers face major challenges in optimizing health care. In this critical feminist interpretive study we examined the experiences of women receiving home care for chronic disabling conditions. Five themes emerged: struggling with the embodied limitations of disabling chronic conditions; actively seeking health; struggling with service limitations; seeking ways to manage; and living with isolation and marginalization. Having done this study, we learned that home care services do not always contribute sufficiently to the overall health and well-being of women living with chronic disabling conditions and, in fact, may negatively impact upon their health.
OBJECTIVE: To describe the decision support needs of immigrant and refugee women from HIV endemic countries regarding decision-making about voluntary counseling and testing for HIV (VCT) in Canada; and the needs of practitioners who support these women in making this decision, in a culturally appropriate manner.
METHODS: Adapted, semi-structured questionnaires, based on the Ottawa Decision Support Framework (ODSF), were used to interview practitioners and patients. Practitioners from diverse backgrounds were purposefully selected from centers providing VCT in Ottawa. Adult, English-speaking immigrant and refugee women from HIV endemic countries were recruited from a clinic specializing in immigrant health services. Responses were tabulated using descriptive statistics, and emerging themes coded to identify unique factors affecting decision-making.
RESULTS: Analysis revealed differences between practitioner and patient perceptions of the decision-making needs of women from HIV endemic countries regarding VCT. Practitioners identified women's lack of knowledge about HIV transmission and prevention as a primary need, while patients identified inadequate awareness of HIV screening and treatment services, and their benefits and harms. Patients also perceived that women would not be aware of the various VCT options, while few practitioners highlighted this concern. Both groups held similar viewpoints about counseling strategies that could improve decision-making.
CONCLUSION: Women were unaware of the options available to them for VCT. Both practitioners and patients highlighted the issue of stigma and negative outcomes associated with testing that created barriers or contributed to delays in women receiving testing. Women preferred anonymous testing, and recommended that information and decision support regarding HIV testing be provided via non-targeted strategies, and integrated within general health services or public education.
PRACTICE IMPLICATIONS: Decision support in the context of VCT can improve decision quality, empowering patients to make informed decisions based on personal values. Study findings can inform the development of clinical guidelines for the routine offering of VCT.
In many Western welfare jurisdictions, publicly provided home care is being eroded and its provision increasingly individualized. These shifts are of a particular significance for older women, a group for whom supportive home care has been an important buttress against the social and physical jeopardies of old age. A longitudinal, qualitative study of such women in Ontario, Canada, spanned the implementation of managed competition in home care and a period of rapid privatization and service rationing. Study participants experienced cuts and, stemming from increasingly precarious employment conditions in the home care workforce, inconsistent care providers. These changes generated distress, insecurity, and isolation in participants' lives. This article explores how their complaints about insufficient care were silenced: by fear, hopelessness, and the cultural injunction to put a stoic and selfless face on the limitations of old age. Their accounts reveal how large material and discursive shifts and state restructuring come to penetrate identity, feeling, and speech. This examination of the silencing of complaint at home care's front lines reveals the cumulative effects of rationing; it also illuminates how, if heard, service users' voices can inform collective struggles to resist the degradation of home care and reposition older people in relation to the state.
AIM: The aim of this paper is to describe the experiences of mothers with serious mental illness from their perspectives and how they attempted to manage their mothering circumstances.
BACKGROUND: The desire to mother in women with serious mental illness is increasingly acknowledged by healthcare professionals. For these women, mothering is often framed as a pathological problem needing professional intervention. Yet little is known about mothering and illness from the perspectives of the mothers themselves.
METHOD: Using Glaser's grounded theory approach and both purposive and theoretical sampling, interviews were conducted with 20 mothers who were receiving treatment for mental health problems. The data were collected in 2002.
FINDINGS: We found the core category of Keeping close described mothers' efforts to have meaningful relationships with their children in the context of illness and suffering. To this end, mothers chose strategies that would hide illness for the sake of protecting their roles and their children. These strategies--masking, censoring speech, doing motherwork and seeking help--served to imitate ideal perceptions of mothering while making illness invisible to their children. Mothering in illness, however, became a vortex of contradictions, resulting in mothers 'hitting bottom', a point in time when they realized they could not keep close via pretences. To return to the valued place of mother, they sought treatment, hoping to learn how to be with their children authentically.
CONCLUSION: To assist mothers with serious mental illness, healthcare professionals must be sensitive to the social and cultural context in which they mother in order to create healthier possibilities for nurturing their children.
BACKGROUND: Home visiting by public health nurses and family visitors is promoted as an important intervention for enhancing parent and child development. Mothers of children at-risk for developmental delays tend to be the most difficult to access and engage, and commonly drop out of home visiting programmes prematurely.
PURPOSE: This paper reports a study developing a theory that describes the process by which mothers of children at-risk engage with public health nurses and family visitors in a blended home visiting programme.
METHODS: Grounded theory was used to guide the collection, recording, organization and analysis of the data. A purposeful sample of 20 mothers receiving public health nurse and family visitor home visits were recruited from a public health unit in Canada. Data were collected through client record reviews and 29 in-depth interviews that explored participants' experiences, beliefs and expectations about engagement. Data collection and analysis continued until all categories were saturated.
FINDINGS: Mothers felt vulnerable and frequently powerless when they allowed the service providers into their home. Mothers with children at-risk engage with public health nurses and family visitors through a basic social process of limiting family vulnerability, which has three phases: (1) overcoming fear; (2) building trust; and (3) seeking mutuality. The personal characteristics, values, experiences and actions of the public health nurse, family visitor and mother influence the speed at which each phase is successfully negotiated and the ability to develop a connected relationship.
CONCLUSION: Public health nurses working with families at risk need to identify client fears and perceptions related to home visiting, and to explain the role of public health nurses and family visitors to all family members. Given the importance that mothers place on the development of an interpersonal relationship, it is important for home visitors continually to assess the quality of their relationships with clients.
The influences of gender and geography are increasingly being acknowledged as central to a comprehensive understanding of health. Since little research on rural women's health has been conducted, an in-depth qualitative approach is necessary to gain a better initial understanding of this population.
PURPOSE:
To explore the determinants of health and their influence on rural women's health.
METHODS:
From November 2004 to September 2005, 9 focus groups and 3 individual interviews were conducted in 7 rural southwestern Ontario communities. Sixty-five rural residents aged 26 years and older participated in the study. Semi-structured interview questions were used to elicit participants' perceptions regarding determinants of rural women's health.
FINDINGS:
Four Health Canada determinants (employment, gender, health services, and social environments) and 3 new determinants (rural change, rural culture, and rural pride) emerged as key to rural women's health.
CONCLUSIONS:
Although health determinants affect both urban and rural people, this qualitative study revealed that rural women experience health determinants in unique ways and that rural residents may indeed have determinants of their health that are particular to them. More research is needed to explore the nature and effects of determinants of health for rural residents in general, and rural women in particular.
