Expressions of Concern and Social Support about Reproductive Care for Young Women on an Online Message Board

The experience of a pelvic exam or Pap smear is something that, while necessary to maintain reproductive health, can be fraught with difficulty for women. Ouj, Igberase, Exe, and Ejikeme (2011) note that “[m]ost women feel a level of discomfort or pain and for some it is embarrassing, dehumanizing, degrading and associated with fear, anxiety and apprehension” (p. 637). However, little recent research has focused on the specific communication surrounding reproductive care for young women. The Internet is a common place for young people to seek health information, understand their own health risks, and seek social support from others. The current study utilizes information gleaned from the archives of an internet message board and sexual education website to examine the way that young women communicate about reproductive health care, risk, and social support with experts and peers in the online community. Results indicate that young women request, seek, and receive several different types of social support in the online community. Further, themes illuminate the complex nature of women’s concerns about potential risk and reproductive care

Changing the conversation about prostate cancer among African Americans: results of formative research

Objectives: To understand obstacles to and opportunities for improving prostate cancer communication to and within African American communities. Design: Researchers conducted interviews with 19 community leaders and five focus groups with healthy men and survivors. The team also conducted process evaluations of two outreach projects in which survivors spoke to African American men about prostate cancer and screening. Results: Three levels of obstacles to prostate cancer screening and treatment were identified. Individual-level obstacles included limited knowledge about the condition, about prevention and treatment, and fear of cancer. Socio-cultural barriers included distrust of the medical system, lack of a provider for routine and preventive care, reluctance to talk about cancer, and aversion to aspects of screening. Institutional deficits included the scarcity of educational efforts targeting prostate cancer. Outreach project evaluations suggested that survivors can be effective in building prostate cancer knowledge, promoting positive attitudes toward screening, and fostering conversations about prostate cancer. Educational efforts included little information about screening risks and decision-making however. Conclusions: The findings suggest that most potent interventions may combine survivor-led education with mass media and institution-based outreach. Such comprehensive programs could shift social norms that inhibit conversation and foster fear, leading in turn to more informed decisions and better treatment outcomes

Navigating mental health care access in Louisville : an ethnography of local resources and care assemblages.

This thesis examines barriers to care access present in Louisville, Kentucky\u27s community mental health care infrastructure, and how individuals who seek mental health care experience and navigate those barriers. This thesis expands research about the impacts of health care reform following the Affordable Care Act and adds to literature about the political economy of health-seeking behaviors. Drawing on assemblage theory and ethnographic research with both care-providers and care-recipients of Community Mental Health Care Organizations, I argue that both groups attempt to alleviate barriers to care access and facilitate mental health recovery through the development of formal and informal strategies. Examining the ways that these individuals find creative and agentive solutions to the challenges of structural and institutional precariousness and chronic mental illness can be useful findings for developing effective mental health interventions

Suicide and self-harm in Britain: researching risk and resilience using UK surveys

Aim The main aim of this study was to raise awareness of surveys that could be used to inform self-harm and suicide prevention work. We asked: What UK survey datasets are available for research? What aspects of people’s lives are associated with self-harm and attempted suicide? How do statistical findings resonate with people’s lived experience? What implications do they see? Findings Survey analyses revealed that risk factors for self-harm are wide ranging and include: Mental health Physical health and health behaviours Social relationships Stressful events Employment and financial circumstances Identity and demographics Many different factors are independently associated with self-harm. There is a dose relationship, with more exposure to a factor linked with increased risk. Risks are cumulative that is, exposure to multiple factors is associated with greater risk. Through facilitated consultation, men with lived experience, bereaved family members, and practitioners identified recommendations for responding to suicidal distress in men. These related to the following three main areas: 1. Recognising need: who is ‘ill enough’? Permission - men said that they often did not know they were entitled to help Ask - people who outwardly appear to be functioning may not be Persistence - ask and offer help more than once. 2. Facilitating access: right words, time and place What is available - support is needed with ongoing stress as well as for crises Find the words - men wanted examples of how to ask for help Allow time - employers expect recovery to be swift, some men felt rushed to come off medications or were discharged from services they still needed. 3. Adjusting delivery: equal engagement Power - some were uncomfortable with service dynamics, preferring peer support Every service contact counts - negative contacts had particular impact Safe spaces - may be different for men and women. Methods There were three strands of work: Secondary analysis of nine survey series, spanning more than twenty years Linkage of 144,000 survey participants to information on whether they were alive in 2013 and whether they had taken their own life Facilitated consultation, through depth interviews with people with lived experience

Social Determinants of Diabetes Self-Management, and Diabetes Health Care Utilization in African American and Latino Men with Type 2 Diabetes.

Diabetes is among one of the leading causes of death in the United States. This dissertation seeks to identify psychosocial and structural factors that influence self-care and health care utilization in Latino and African American men with diabetes on regional and national levels. My dissertation also explores how gender identity is conceptualized among Latino and African American men with diabetes, and examines how conceptualizations of masculinity influence self-care and health care utilization behaviors. Three empirical chapters examined different aspects of these topics. Chapter two identified differences in predictors of diabetes self-management and health care use in Latinos and African Americans with type 2 diabetes participating in a Detroit-based diabetes lifestyle intervention. Regression model results showed that older age increased diabetes self-management, while low levels of diabetes knowledge significantly decreased it, but these associations did not exist for health care utilization. Chapter three used data collected from three focus groups with African American and Latino men with type 2 diabetes to explore structural and psychosocial factors that influence health care use and self-management. Three themes emerged that characterize gender identity and its relationship to health behavior in men: 1) men’s beliefs about being men; 2) manhood’s influence on health behavior; and 3) men’s role in diabetes education. Results suggest that the way men define gender roles may have implications for how they engage in their care. Chapter four explored whether social support and social integration mediate or buffer the relationship between race and health care utilization among U.S. men, using cross-sectional data from the 2001 National Health Interview Survey. My findings showed that non-Hispanic black men with high levels of social integration were less likely to forego care than their non-Hispanic white counterparts with high social integration. Also, non-Hispanic black men who did not attend church had higher odds of foregoing care compared to men Hispanic and non-Hispanic white men who did attend church services. The implications of my work highlight a need for more research on the direct impact of masculine roles, social integration and heterogeneity in predictors of diabetes self-management versus health care use on diabetes care for men.PhDSocial Work and SociologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/111356/1/jachawk_1.pd

Progress and opportunities in lesbian, gay, bisexual and transgender health communications

This article describes elements of effective health communication and highlights strategies that may best be adopted or adapted in relation to lesbian, gay, bisexual, and transgender (LGBT) populations. Studies have documented the utility of multidimensional approaches to health communication from the macro level of interventions targeting entire populations to the micro level of communication between health care provider and consumer. Although evidence of health disparities in LGBT communities underscores the importance of population-specific interventions, health promotion campaigns rarely target these populations and health communication activities seldom account for the diversity of LGBT communities. Advances in health communication suggest promising direction for LGBT-specific risk prevention and health promotion strategies on community, group, and provider/consumer levels. Opportunities for future health communication efforts include involving LGBT communities in the development of appropriate health communication campaigns and materials, enhancing media literacy among LGBT individuals, supporting LGBT-focused research and evaluation of health communication activities, and ensuring that health care providers possess the knowledge, skills, and competency to communicate effectively with LGBT consumers

Information Practices of Administrators for Controlling Information in an Online Community of New Mothers in Rural America

Rarely does any empirical investigation show how administrators routinely control information in online communities and alleviate misinformation, hate speech, and information overload supported by profit-driven algorithms. Thematic analysis of in-depth phone interviews with members and administrators of a “Vaginal Birth After Cesarean” (VBAC) group with over 500 new mothers on Facebook shows that the administrators make 19 choices for recurring, authoritative but evolving 19 information-related activities when (a) forming the VBAC group over Facebook for local new mothers, (b) actively recruiting women who had a VBAC or have related competencies, (c) removing doctors and solicitors from the group, (d) setting up and revising guidelines for interactions in the group, (e) maintaining the focus of the group, (f) initiating distinct threads of conversations on the group, (g) tagging experts during conversations in the group, and (h) correcting misinformation. Thirty-eight information practices of the administrators indicate their nine gatekeeping roles, seven of these roles help administrators alleviate misinformation, hate speech, and information overload. Findings also show that the management of members and their interactions is a prerequisite to controlling information in online communities. Prescriptions to social networking companies and guidelines for administrators of online communities are discussed at the end

The role of shared medical appointments in the management of chronic disease: utilising international experiences to design an intervention for peripheral arterial disease in the NHS

With over 15 million people living with chronic disease in England alone, patients and healthcare systems face significant burden, in terms of symptoms, quality-of-life and resource costs. One such chronic disease is peripheral arterial disease (PAD), with an estimated UK prevalence of 7%. Patients with PAD often have co-morbidities and require risk factor modification, having increased risk of cardiovascular morbidity and mortality. They utilise primary care, community and hospital resources, requiring multi-disciplinary team input, to provide lifestyle, medical and surgical management. With increasing prevalence of chronic disease and in the current economic climate, there is a need to empower patients to take an active role in their care and improve utilisation of existing healthcare resources. Interventions that streamline patient pathways, integrate the multi-disciplinary team and facilitate self-care are likely to benefit patients and the NHS. Shared medical appointments (SMAs) can improve patient education, self-management and clinical outcomes in those with chronic disease, whilst delivering care more efficiently. Whilst their use has increased in countries such as USA across a variety of settings, research or use within the NHS has mainly been within primary care. To date, SMAs have not been used within vascular surgery, in the UK or abroad. Using the example of PAD, this thesis seeks to investigate the role for SMAs in the NHS. Firstly, it identifies scope for improvement within current care. Through international collaboration, it then examines barriers and facilitators to implementing SMAs and the patient experience of this model of care. It details a co-design process, whereby UK patients and healthcare professionals were brought together to work with qualitative data from the preceding chapters. The final data chapters describe a pilot SMA and discuss experiences of staff and patients involved. Finally, the thesis reflects on implications of this work for clinical practice and healthcare policy.Open Acces