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- Asplin, Nina, et al.
(author)
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Pregnancy termination due to fetal anomaly : women's reactions, satisfaction and experiences of care
- 2014
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In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 30:6, s. 620-627
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Journal article (peer-reviewed)abstract
- OBJECTIVE:to explore what women who have had a pregnancy terminated due to a detected fetal malformation perceived as having been important in their encounters with caregivers for promoting their healthy adjustment and well-being.METHOD:an exploratory descriptive design was used. Semi-structured interviews were audiotaped, and the information pathway described. The text was processed through qualitative content analysis in six steps.SETTING:four fetal care referral centres in Stockholm, Sweden.PARTICIPANTS:11 women opting for pregnancy termination due to fetal malformation.FINDINGS:in-depth understanding and compassion are important factors in providing the feeling of support people need so they are able to adapt to crisis. The women emphasised that the caregivers have to communicate a sense of responsibility, hope and respect and provide on-going care for them to feel assured of receiving good medical care and treatment. Aside from existing psychological conditions, the women identified as having emotional distress directly after termination and for at least the following three months. Most women experienced a range of negative emotions after pregnancy termination, including sadness, meaninglessness, loneliness, tiredness, grief, anger and frustration. Still some of this group had positive reactions because they experienced empathy and well-organised care.CONCLUSION AND IMPLICATIONS FOR PRACTICE:The most important factors associated with satisfaction regarding pregnancy termination due to a fetal malformation are the human aspects of care, namely state-dependent communication and in-depth understanding and compassion. The changes in care most often asked for were improvements in the level of standards and provision of adequate support through state-dependent communication, in-depth understanding and compassion, and complete follow-up routines and increased resources. Targeted education for the caregivers may be suited to ensuring that they properly meet needs of their patients.
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- Asplin, Nina, et al.
(author)
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Pregnant women's experiences, needs, and preferences regarding information about malformations detected by ultrasound scan
- 2012
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In: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives. - : Elsevier BV. - 1877-5764 .- 1877-5756. ; 3:2, s. 73-8
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Journal article (peer-reviewed)abstract
- OBJECTIVES: The aim of the study was to explore pregnant women's experiences of received information in relation to fetal malformation detected on ultrasound.METHOD: An exploratory descriptive design was used. Semi-structured interviews with women who continued their pregnancy and women who chose to terminate were audiotaped, the information pathway described, and the text subjected to qualitative content analysis.RESULTS: Most of the women who expected a baby with an abnormality experienced the information given as insufficient, often misleading, conflicting, or incoherent, and sometimes negative. Important factors for interaction between women and caregivers were timing, duration, and manner of the initial dialog and ongoing support. Positive interactions improved the women's ability to understand the information, fostered feelings of trust and safety which reduced their anxiety.CONCLUSION: Women expressed dissatisfaction both regarding the care-givers' methods of giving information and apply for information from different specialists and continuity. The study highlights important factors which may be helpful to the professionals for improving the information to this vulnerable group of women.
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- Asplin, Nina, et al.
(author)
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Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination
- 2013
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In: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 4:2, s. 79-84
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Journal article (peer-reviewed)abstract
- ObjectivesThe aims of the study were to explore factors influencing the decision to continue or terminate pregnancy due to detection of fetal malformation following ultrasound examination, to elucidate the need for more information or other routines to facilitate the decision-making process and to assess satisfaction with the decision made.DesignDescriptive study.SettingFour fetal care referral centres in Stockholm, Sweden.PopulationPregnant women with a detected fetal malformation.MethodsData was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed.ResultsBoth women who continued and those who terminated pregnancy based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were aspects including socioeconomic considerations. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (p⩽ 0.004) of previous abortions than those in the continuing group (23.2%).ConclusionThe decision to continue or terminate the pregnancy was to a great extent based on the severity of the malformation. Religious aspects did not seem to influence the decision. Many women expressed a need for additional occasion of information. The vast majority of women were satisfied with their decision.
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- Asplin, Nina
(author)
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Women's experiences and reactions when a fetal malformation is detected by ultrasound examination
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Background: Second trimester ultrasound examination among pregnant women in Sweden is almost universal. The detection of a fetal malformation on ultrasound puts health care providers and pregnant women in a difficult and precarious situation. What information and how it is communicated is crucial to women’s decision-making about continuing or terminating at pregnancy. The main aim of this thesis was to describe and analyze women’s experiences and reactions following the detection of a fetal malformation on an ultrasound scan. Methods: Two semi-structured in-depth interviews were performed, with women informed of a fetal malformation following an ultrasound scan. A total of 27 women took part in the first round of interviews: women continuing their pregnancy were interviewed, either in gestational week 30 or three weeks after the diagnosis; those terminating their pregnancy were interviewed two to four weeks after termination (Paper I). A second interview with 11 women who terminated their pregnancy was conducted six months after termination (Paper III). Two questionnaires were also administered. The first, answered by 99 women (Paper II) and comprising 22 study- specific questions along with emotional well-being and socio-demographics variables and medical and obstetric history, was conducted at the same time as the first stage of interviews. The other questionnaire, answered by 56 women incorporated common self- report instruments and was performed three times: first in gestational week 30, and then two respectively six months postpartum (Paper IV). Qualitative data were analyzed through content analysis, and quantitative data were analyzed through descriptive statistics. Results: The timing, duration, and manner of women’s initial counseling and ongoing support were shown to be important in the interaction between women and caregivers. Positive interactions improved the women’s ability to understand the information and fostered feelings of trust and safety, which in turn reduced their anxiety. Most of the women who expected a baby with an abnormality expressed their need for information on several occasions to help them make this difficult decision. They also wished for information from different specialists and continuity of care. These needs were even stronger in women who chose to terminate their pregnancy. We found women continuing their pregnancy to be at high risk of depressive symptoms, major worries, and high anxiety levels, both in mid-pregnancy, and at two months and one year postpartum. Despite these findings, the results of the maternal-fetal attachment scale for women who continued their pregnancy with a fetus diagnosed with a malformation indicated a high level of attachment. Conclusions and Clinical Implications: Effective communication, empathy and compassion, and consistent follow-up routines are important to ensure good treatment and care of this group of women. Taking these results into account may improve caregivers’ ability to counsel these vulnerable patients and to ensure that their needs are properly met.
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- Blom, Helena, 1970-
(author)
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Violence exposure among Swedish youth
- 2015
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Doctoral thesis (other academic/artistic)abstract
- BackgroundViolence is a global public health problem and violence among youth is a matter of high priority. Adolescence and young adulthood are important periods for the foundation of future health. Youth victimization may have serious health consequences, making it important to address the occurrence and socio-medical context for possible interventions against violence.AimsTo analyze prevalence, risk patterns and gender differences in emotional, physical, sexual, and multiple-violence victimizations and the associations between violence victimization and sexual ill health, sexual risk behaviors and mental health in Swedish youth.MethodsA cross sectional study using two samples, a national sample from nine youth health centers in Sweden and a population-based sample from a middle-sized Swedish city. The questionnaire included standardized instruments addressing violence exposure (NorAQ), socio-demographics, mental and sexual ill-health and sexual risk behaviors, alcohol and substance use. Proportions and crude and adjusted odds ratios with a 95% CI were calculated.ResultsA total of 2,250 young women and 920 men, aged 15-23, answered the questionnaire at the youth health centers. In upper secondary school, 1,658 women and 1,589 men, aged 15-22, answered the questionnaire.High prevalence rates with gendered differences both in rates and in co-occurrence of different types of violence were found. Women were more often exposed to emotional violence and sexual violence than men, while men were more often physically victimized. For both women and men, violence victimization before the age of 15 was strongly associated with all types of violence victimizations during the past year.Strong associations were found between multiple-violence victimization and poor mental health in both genders. Among the sexually experienced students, consistent associations between lifetime multiple-violence victimization and various sexual ill-health and sexual risk behaviors were found in both genders, except for non-contraceptive use.ConclusionsHigh prevalence of violence victimization in youth and strong associations between victimization, especially multiple victimization, and poor mental and sexual health were found. This needs to be recognized and addressed in social and medical settings.
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| 8. |
- Charandabi, Sakineh Mohammad-Alizadeh, et al.
(author)
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Effect of a peer-educational intervention on provider knowledge and reported performance in family planning services : a cluster randomized trial
- 2010
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In: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 10
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Journal article (peer-reviewed)abstract
- Background: Peer education is an interactive method of teaching or learning which is widely used for educating school and college students, in a variety of different forms. However, there are few studies on its effectiveness for in-service education. The aim of this study was to evaluate the effect of an educational programme including peer discussions, based on a needs assessment, on the providers' knowledge and reported performance in family planning services. Methods: An educational programme was designed and applied in a random selection of half of in-charges of the 74 family health units (intervention group) in Tabriz at a regular monthly meeting. The other half constituted the control group. The programme included eight pages of written material and a two-hour, face-to-face discussion session with emphasis on the weak areas identified through a needs assessment questionnaire. The educated incharges were requested to carry out a similar kind of programme with all peers at their health facilities within one month. All in-charges received one self-administered questionnaire containing knowledge questions one month after the in-charge education (follow-up I: 61 responses), and another one containing knowledge and self-reported performance questions 26 months later (follow-up II: 61 responses). Also, such tests were done for the peers facilitated by the in-charges one (105 responses) and 27 months (114 responses) after the peer discussions. Multiple linear regression was used for comparing mean total scores, and Chi square for comparing proportions between control and intervention groups, after defining facility as the unit of randomization. Results: The mean total percentage scores of knowledge (percent of maximal possible score) in the intervention group were significantly higher than in the control group, both at follow-up I (63%) and at follow-up II (57%); with a difference of 16 (95% CI: 11, 22) and 5 (95% CI: 0.4, 11) percentage units, respectively. Only two of the nine reported performance items were significantly different among the non in-charges in the intervention group at follow-up II. Conclusions: The educational programme including peer discussions using existing opportunities with no need for additional absence from the workplace might be a useful complement to formal large group education for the providers.
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| 10. |
- Falk, Gabriella, 1955-
(author)
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Teenagers´unintended pregnancies and contraception
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Teenage pregnancies are often not intended, and there is a high risk that unintended pregnancies will lead to abortion. The wide-spread availability of Youth Clinics, the subsidizing of contraceptives and the introduction of new and effective contraceptives have failed to lower the abortion rates. The aim of this thesis was to study possible risk groups and to highlight underlying reasons for contraceptive failure.Methods: Study I and II were quantitative studies with the aims of investigating whether teenagers who sought emergency contraception (Paper I) and teenage mothers (Paper II) were at risk for new unintended pregnancies during a 12-month follow-up period.Study III and IV were qualitative studies. The aim in study III was to see how contraceptive use was documented in medical records (MRs) concerning teenagers who had attended for induced abortion. In study IV the aim was to find out reasons for non- use or inconsistent use of contraceptives among teenagers attending for abortion.Results: In study I and II data were collected from medical and antenatal records. The results showed that both groups, despite contraceptive counselling, were at high risk for new unintended pregnancies leading to abortion. Attendance at the postpartum visit was low and 24% of the teenage mothers did not receive any recommendation about using a particular contraceptive method. Within 12 months 25% had a new pregnancy and of these one third led to legal abortion.In Study III two themes were generated from the analysis of the MRs; ‘Contraceptive methods previously used’ and ‘Plan for future contraceptive use’. All MRs did not contain information about contraceptive use. In study IV one theme was generated from the analysis of the interview text: ‘Struggling with feelings of uncertainty and patterns of behaviour’.Conclusion: Teenagers using emergency contraceptive pills and teenage mothers were at high risk for unintended pregnancies. Contraceptive failure in teenagers who have had an abortion may be due to in part to the absence of contraceptive counselling at abortion visits and in part to problems with contraceptive use due to insufficient knowledge and not knowing what do when side-effects occurs.
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