Perceived Social Influences on Women's Decisions to use Medications not Studied in Pregnancy. A Qualitative Ethical Analysis of Preexposure Prophylaxis Implementation Research in Kenya

Implementation research ethics can be particularly challenging when pregnant women have been excluded from earlier clinical stages of research given greater uncertainty about safety and efficacy in pregnancy. The evaluation of human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) during pregnancy offered an opportunity to understand important ethical considerations and social influences shaping women's decisions to participate in the evaluation of PrEP and investigational drugs during pregnancy. We conducted interviews with women ( n = 51), focus groups with male partners (five focus group discussions [FGDs]), interviews with health providers ( n = 45), four FGDs with pregnant/postpartum adolescents and four FGDs with young women. Data were analyzed using thematic content analysis, including ethical aspects of the data. Our study reveals that women navigate a complex network of social influences, expectations, support, and gender roles, not only with male partners, but also with clinicians, family, and friends when making decisions about PrEP or other drugs that lack complete safety data during pregnancy.

Download Full-text

Men perspectives on attending antenatal care visits together with their pregnant partners in Misungwi district, rural Tanzania: a qualitative study

10.21203/rs.3.rs-33575/v2 ◽

2020 ◽

Author(s):

Maendeleo Boniphace ◽

Dismas Matovelo ◽

Rose Laisser ◽

Hadija Swai ◽

Victoria Yohana ◽

...

Keyword(s):

Antenatal Care ◽

Health Workers ◽

Cultural Norms ◽

Health Providers ◽

Group Discussions ◽

Individual Interviews ◽

Men 2 ◽

Rural Tanzania ◽

Expectant Fathers ◽

And Gender

Abstract Background: Mens’attendance with their pregnant partners at facility-based antenatal care (ANC) visits is important for maternal and child health and gender equality yet remains uncommon in parts of rural Tanzania. This study examined men’s perspectives on attending ANC with their pregnant partners in Misungwi District, Tanzania.Methods: Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers, expectant fathers, and in-depth interviews were done to health providers, volunteer community health workers, and village leaders. Interviews were recorded and transcribed in Swahili and later translated to English. The research team conducted thematic analysis to identify common themes among interviews. Results: We identified two broad themes on the barriers to male attendance at facility-based ANC visits: (1) Perceived exclusion during ANC visits among men (2) Traditional gender norms resulting to low attendance among men.Conclusion: Attendance at health facility for ANC visits by men with their pregnant partners in the study areas were challenged by structural and local cultural norms. At the facility men were uncomfortable to sit with women due to lack of specific waiting area for men and that they perceived to be neglected. Local cultural norms demanded women to have secrecy in pregnancy while men perceived not to have a role of being with their partners during ANC visits.

Download Full-text

Men perspectives on attending antenatal care visits with their pregnant partners in Misungwi district, rural Tanzania: a qualitative study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03585-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maendeleo Boniphace ◽

Dismas Matovelo ◽

Rose Laisser ◽

Hadija Swai ◽

Victoria Yohani ◽

...

Keyword(s):

Antenatal Care ◽

Health Workers ◽

Cultural Norms ◽

Health Providers ◽

Group Discussions ◽

Individual Interviews ◽

Men 2 ◽

Rural Tanzania ◽

Expectant Fathers ◽

And Gender

Abstract Background Mens’attendance with their pregnant partners at facility-based antenatal care (ANC) visits is important for maternal and child health and gender equality yet remains uncommon in parts of rural Tanzania. This study examined men’s perspectives on attending ANC with their pregnant partners in Misungwi District, Tanzania. Methods Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers, expectant fathers, and in-depth interviews were done to health providers, volunteer community health workers, and village leaders. Interviews were recorded and transcribed in Swahili and later translated to English. The research team conducted thematic analysis to identify common themes among interviews. Results We identified two broad themes on the barriers to male attendance at facility-based ANC visits: (1) Perceived exclusion during ANC visits among men (2) Traditional gender norms resulting to low attendance among men. Conclusion Attendance at health facility for ANC visits by men with their pregnant partners in the study areas were challenged by structural and local cultural norms. At the facility men were uncomfortable to sit with women due to lack of specific waiting area for men and that they perceived to be neglected. Local cultural norms demanded women to have secrecy in pregnancy while men perceived not to have a role of being with their partners during ANC visits.

Download Full-text

Men perspectives on attending antenatal care visits together with their pregnant partners in Misungwi district, rural Tanzania: a qualitative study

10.21203/rs.3.rs-33575/v3 ◽

2021 ◽

Author(s):

Maendeleo Boniphace ◽

Dismas Matovelo ◽

Rose Laisser ◽

Hadija Swai ◽

Victoria Yohana ◽

...

Keyword(s):

Antenatal Care ◽

Health Workers ◽

Cultural Norms ◽

Health Providers ◽

Group Discussions ◽

Individual Interviews ◽

Men 2 ◽

Rural Tanzania ◽

Expectant Fathers ◽

And Gender

Download Full-text

Uveitis and Gender: The Course of Uveitis in Pregnancy

Journal of Ophthalmology ◽

10.1155/2014/401915 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Nathalie P. Y. Chiam ◽

Lyndell L. P. Lim

Keyword(s):

Systemic Treatment ◽

Safety Data ◽

Cell Phenotype ◽

Third Trimester ◽

Changes In Pregnancy ◽

And Gender ◽

Maternal Tolerance ◽

Special Time ◽

Immunosuppressive Cytokines ◽

In Pregnancy

The hormonal and immunological changes in pregnancy have a key role in maintaining maternal tolerance of the semiallogeneic foetus. These pregnancy-associated changes may also influence the course of maternal autoimmune diseases. Noninfectious uveitis tends to improve during pregnancy. Specifically, uveitis activity tends to ameliorate from the second trimester onwards, with the third trimester being associated with the lowest disease activity. The mechanism behind this phenomenon is likely to be multifactorial and complex. Possible mechanisms include Th1/Th2 immunomodulation, regulatory T-cell phenotype plasticity, and immunosuppressive cytokines. This clearly has management implications for patients with chronic sight threatening disease requiring systemic treatment, as most medications are not recommended during pregnancy due to lack of safety data or proven teratogenicity. Given that uveitis activity is expected to decrease in pregnancy, systemic immunosuppressants could be tapered during pregnancy in these patients, with flare-ups being managed with local corticosteroids till delivery. In the postpartum period, as uveitis activity is expected to rebound, patients should be reviewed closely and systemic medications recommenced, depending on uveitis activity and the patient’s breastfeeding status. This review highlights the current understanding of the course of uveitis in pregnancy and its management to help guide clinicians in managing their uveitis patients during this special time in life.

Download Full-text

Provider self-efficacy in delivering evidence-based psychosocial interventions: A scoping review

Implementation Research and Practice ◽

10.1177/2633489520988258 ◽

2021 ◽

Vol 2 ◽

pp. 263348952098825

Author(s):

Cheri J Shapiro ◽

Kathleen Watson MacDonell ◽

Mariah Moran

Keyword(s):

Mental Health ◽

Scoping Review ◽

Implementation Research ◽

Self Efficacy ◽

Psychosocial Interventions ◽

Health Interventions ◽

Evidence Based ◽

Health Providers ◽

Plain Language ◽

Mental Health Interventions

Background: Among the many variables that affect implementation of evidence-based interventions in real-world settings, self-efficacy is one of the most important factors at the provider level of the social ecology. Yet, research on the construct of provider self-efficacy remains limited. Objectives: This scoping review was conducted to enhance understanding of the construct of provider self-efficacy and to examine how the construct is defined and measured in the context of implementation of evidence-based mental health interventions. Design: Online databases were used to identify 190 papers published from 1999 to June of 2018 that included search terms for providers, evidence-based, and self-efficacy. To be eligible for the scoping review, papers needed to focus on the self-efficacy of mental health providers to deliver evidence-based psychosocial interventions. A total of 15 publications were included in the review. Results: The construct of provider self-efficacy is not clearly defined but is typically described as confidence to deliver a specific intervention or practice. A range of measures are used to assess provider self-efficacy across both provider and intervention types. Conclusions: Standardized definition and measurement of provider self-efficacy is needed to advance practice and implementation research. Plain language abstract: Provider self-efficacy is known to influence implementation of evidence-based mental health interventions. However, the ways in which provider self-efficacy is defined and measured in implementation research literature is not well understood; furthermore, it is not clear what types of providers and interventions are represented in this literature. This scoping review adds to current research by revealing that there is no agreed upon definition or measure of provider self-efficacy in the context of implementation of evidence-based interventions, and that the research includes multiple types of providers (e.g., social workers, counselors, psychologists) and interventions. Self-efficacy appears to change as a function of training and support. To further research in this area, a common definition and agreed upon measures of this construct are needed.

Download Full-text

Exploring the potential for introducing home monitoring of blood pressure during pregnancy into maternity care: current views and experiences of staff—a qualitative study

BMJ Open ◽

10.1136/bmjopen-2020-037874 ◽

2020 ◽

Vol 10 (12) ◽

pp. e037874

Author(s):

Lisa Hinton ◽

James Hodgkinson ◽

Katherine L Tucker ◽

Linda Rozmovits ◽

Lucy Chappell ◽

...

Keyword(s):

Blood Pressure ◽

Maternity Care ◽

Healthcare Providers ◽

Home Monitoring ◽

Structured Interviews ◽

Group Discussions ◽

Self Monitoring ◽

Team Members ◽

Registration Number ◽

In Pregnancy

ObjectiveOne in 20 women are affected by pre-eclampsia, a major cause of maternal and perinatal morbidity, death and premature birth worldwide. Diagnosis is made from monitoring blood pressure (BP) and urine and symptoms at antenatal visits after 20 weeks of pregnancy. There are no randomised data from contemporary trials to guide the efficacy of self-monitoring of BP (SMBP) in pregnancy. We explored the perspectives of maternity staff to understand the context and health system challenges to introducing and implementing SMBP in maternity care, ahead of undertaking a trial.DesignExploratory study using a qualitative approach.SettingEight hospitals, English National Health Service.ParticipantsObstetricians, community and hospital midwives, pharmacists, trainee doctors (n=147).MethodsSemi-structured interviews with site research team members and clinicians, interviews and focus group discussions. Rapid content and thematic analysis undertaken.ResultsThe main themes to emerge around SMBP include (1) different BP changes in pregnancy, (2) reliability and accuracy of BP monitoring, (3) anticipated impact of SMBP on women, (4) anticipated impact of SMBP on the antenatal care system, (5) caution, uncertainty and evidence, (6) concerns over action/inaction and patient safety.ConclusionsThe potential impact of SMBP on maternity services is profound although nuanced. While introducing SMBP does not reduce the responsibility clinicians have for women’s health, it may enhance the responsibilities and agency of pregnant women, and introduces a new set of relationships into maternity care. This is a new space for reconfiguration of roles, mutual expectations and the relationships between and responsibilities of healthcare providers and women.Trial registration numberNCT03334149.

Download Full-text

Utilizing perspectives from HIV-infected women, male partners and healthcare providers to design family planning SMS in Kenya: a qualitative study

BMC Health Services Research ◽

10.1186/s12913-019-4708-7 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Karren Lewis ◽

Elizabeth K. Harrington ◽

Daniel Matemo ◽

Alison L. Drake ◽

Keshet Ronen ◽

...

Keyword(s):

Family Planning ◽

Controlled Trial ◽

Healthcare Providers ◽

Short Message ◽

Male Partners ◽

Group Discussions ◽

Sensitive Topics ◽

Care Workers ◽

Message Service ◽

Education Support

Abstract Background Short message service (SMS) presents an opportunity to expand the reach of care and improve reproductive health outcomes. SMS could increase family planning (FP) use through education, support and demand generation. The purpose of this analysis is to determine the perspectives of potential FP users to inform design of SMS. Methods We conducted focus group discussions (FGD) with HIV-infected women and in-depth interviews (IDI) with male partners and health care workers (HCW) at urban and rural clinics in Kenya to design SMS content for a randomized controlled trial. Results Women and men indicated SMS could be used as a tool to discuss FP with their partners, and help decrease misconceptions about FP. Women stated SMS could make them more comfortable discussing sensitive topics with HCWs compared to in-person discussions. However, some women expressed concerns about FP SMS particularly if they used FP covertly or feared partner disapproval of FP use. These findings were common among women who had not disclosed their status. Providers viewed SMS as an important tool for tracking patients and clinical triage in conjunction with routine clinical visits. Conclusion Our findings suggest that SMS has the potential to facilitate FP education, counselling, and interaction with HCWs around FP.

Download Full-text

Developing a complex intervention to support pregnant women with mild to moderate anxiety: application of the Medical Research Council framework

10.21203/rs.3.rs-39833/v2 ◽

2020 ◽

Author(s):

Kerry Evans ◽

Helen Spiby ◽

Jane C Morrell

Keyword(s):

Pregnant Women ◽

Maternity Care ◽

Public Involvement ◽

Complex Interventions ◽

Psychological Theory ◽

Intervention Component ◽

Group Discussions ◽

Mrc Framework ◽

Care Systems ◽

In Pregnancy

Abstract Aim: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators. Discussion: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care. Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.

Download Full-text

A Qualitative Exploration in Causes of Water Insecurity Experiences, and Gender and Nutritional Consequences in South-Punjab, Pakistan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312534 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12534

Author(s):

Farooq Ahmed ◽

Muhammad Shahid ◽

Yang Cao ◽

Madeeha Gohar Qureshi ◽

Sidra Zia ◽

...

Keyword(s):

Physical And Mental Health ◽

Group Discussions ◽

Water Insecurity ◽

Health And Nutrition ◽

Punjab Province ◽

Household Water ◽

Optimal Health ◽

Victims Of Violence ◽

And Gender ◽

Qualitative Exploration

Although water insecurity has been discussed in general, its impacts on mothers’ physical and mental health, and infants’ and young children’s feeding (IYCF), has largely been ignored. This study explores household water insecurity experiences and their association with optimal health and nutrition of women and children in the Rajanpur district of Punjab Province. Using focus group discussions (FGDs) and key informants (KIIs) interviews from an area with high maternal-child malnutrition prevalence, a qualitative study was conducted to describe local experiences of water acquirement and arrangement, and of the consequences of water insecurity. The findings highlight that rural Western marginalized populations of the Rajanpur district rely on brackish, canal, or flood surface water as the water supply is absent, which intensifies mothers’ work burden and stress, and often makes them victims of violence, stigma, and sickness. Water fetching impacts women in unforeseen ways, impacting the psychosocial and physical health of mothers engaged in maternal breastfeeding. Water insecurity, originally rooted in regional disparities, compounds with gender inequities, which leads to maternal stress and child sickness. Justice in water resources is imperative and urgent in the deprived South of Punjab province for improving public health nutrition.

Download Full-text

Lipid disorders in pregnancy

Current Pharmaceutical Design ◽

10.2174/1381612827666210421103245 ◽

2021 ◽

Vol 27 ◽

Author(s):

Anastasios Liberis ◽

Stamatis Petousis ◽

Panagiotis Tsikouras

Keyword(s):

Pregnant Women ◽

Low Density Lipoprotein ◽

Safety Data ◽

Density Lipoprotein ◽

Lipid Lowering ◽

Lipid Disorders ◽

Severe Hypertriglyceridemia ◽

History Of ◽

Lipid Lowering Agents ◽

In Pregnancy

: Dyslipidemia represents a major risk factor for cardiovascular disease. In addition, severe hypertriglyceridemia is an important cause of acute pancreatitis. Accordingly, the increase in serum lipid levels that are observed during pregnancy have potentially important implications. The management of dyslipidemia in pregnancy is further complicated by the lack of safety data during this period for most of the lipid-lowering agents. In the present review, we discuss the most important lipid disorders in pregnant women and their management. Pregnancy is characterized by increases in both low-density lipoprotein cholesterol (LDL-C) and triglyceride levels, which might result in severe complications both for the mother and the fetus. Accordingly, LDL-C and triglyceride levels should be monitored during pregnancy, particularly in women with a history of dyslipidemia. Diet is the mainstay of management of dyslipidemia in pregnant women and apheresis can also be considered in patients with homozygous familial hypercholesterolemia or severe hypertriglyceridemia. However, there is a pressing need for studies that with evaluate the safety of lipid-lowering agents during pregnancy.

Download Full-text