Tackling health inequalities through developing evidence-based policy and practice with childbearing women in prison: a consultation

A collaborative partnership between the Hallam Centre for Community Justice and the Mother and Infant Research Unit (MIRU) at the University of York was successful in securing funding to conduct this consultation project. This collaboration brought together the knowledge and expertise of researchers working in maternal and infant health and those with knowledge of the prison sector. This consultation scopes and maps the health needs and health care of childbearing women in prison, using the Yorkshire and Humberside region as a case study

Valuing Breastfeeding: Health Care Professionals’ Experiences of Delivering a Conditional Cash Transfer Scheme for Breastfeeding in Areas With Low Breastfeeding Rates

Alongside a randomized controlled trial testing the effectiveness of offering a cash transfer scheme (shopping vouchers) to mothers in areas with low breastfeeding rates, qualitative interviews were conducted with health care professionals delivering the scheme to explore their experiences. Health care professionals (n = 34; mainly midwives and health visitors) were interviewed in depth. Transcripts from recorded interviews were analyzed using a Framework Analysis approach. There was widespread acceptance of the scheme by health care professionals, with prior concerns regarding bribery and coercion being quickly allayed. Health care professionals reported that the scheme fitted in well with their routine ways of promoting and endorsing breastfeeding. They described their experiences of women’s positive reaction toward the scheme and how the scheme encouraged breastfeeding and gave breastfeeding higher value. Health care professionals reported that the incentives helped them engage women and promote and support breastfeeding in areas with low breastfeeding rates

Exploring the ‘I’ in musician: investigating musical identities of professional orchestral musicians

The lived experiences of professional orchestral musicians are under-­‐researched by scholars in both music and psychology, who are interested in the world of the professional orchestra and the careers of classical musicians. Framed within a Social Constructionist paradigm, the research in this thesis is concerned with investigating the subjective meanings and individual experiences of a group of ten classical orchestral musicians. Interpretative Phenomenological Analysis was the methodological framework chosen to design and analyse a set of open-­‐ ended interviews with the musicians, which allowed reflexivity and flexibility throughout the research process. Three superordinate themes were identified from a close reading and IPA analysis of the interview data: ‘Musical Foundations’, ‘Struggle: “The Never Ending Quest”’ and ‘Thank You For The Music’. ‘Musical Foundations’ examines the process of musical identity construction for the ten participants, from its early beginnings in childhood, through adolescence and their time in the professional orchestra. Different facets of musical identity construction are outlined and becoming an orchestral musician is viewed as essentially a social process shaped by social interactions, building on a sense of possessing certain ‘innate’ characteristics. ‘Struggle: ‘The Never Ending Quest”’ illustrates the challenges the musicians encountered within the profession and the impact that being a professional orchestral musician had on other aspects of their lives (e.g. personal and social). The fear and conflict the ten musicians experienced is outlined and how the musicians coped and ‘survived’ within the professional orchestra is demonstrated. In addition, the central importance of the identity of ‘orchestral musician’ within the participants’ lives is illustrated. The last theme, ‘Thank You For The Music’ outlines why the musicians continued within the profession despite the struggles summarised by the previous theme. This chapter highlights the autonomy and control the musicians felt they gained within their orchestras and the physiological and emotional connections they experienced with both the profession and classic music itself. Common to all three superordinate themes is their reported power struggle between the musicians and the orchestra, and between the individual and the collective. Another common issue was how central the identity of ‘orchestral musician’ was for all participants, impacting all aspects of their lives. The professional musicians constructed, negotiated and maintained their musical identities in accordance with both their own expectations and those of the classical music genre itself. The research in this thesis raises awareness of the importance of the orchestral musician identity in the musicians’ lives and how an understanding of this can help gain an insight into other aspects of the participants’ lives. Recommendations are made for further research regarding: the lived experiences of classical music students, investigation of current teaching practices in conservatoires and further exploration of the professional structures within an orchestra

Interventions for promoting the initiation of breastfeeding

BACKGROUND: Despite the widely documented health advantages of breastfeeding over formula feeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups. OBJECTIVE : To evaluate the effectiveness of interventions which aim to encourage women to breastfeed in terms of changes in the number of women who start to breastfeed. METHODS : Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2007), handsearched the Journal of Human Lactation, Health Promotion International and Health Education Quarterly from inception to 15 August 2007, and scanned reference lists of all articles obtained. Selection criteria: Randomized controlled trials, with or without blinding, of any breastfeeding promotion intervention in any population group except women and infants with a specific health problem. Data collection and analysis: One review author independently extracted data and assessed trial quality, checked by a second author. We contacted investigators to obtain missing information. MAIN RESULTS: Main results: Eleven trials were included. Statistical analyses were conducted on data from eight trials (1553 women). Five studies (582 women) on low incomes in the USA with typically low breastfeeding rates showed breastfeeding education had a significant effect on increasing initiation rates compared to standard care (risk ratio (RR) 1.57, 95% confidence interval (CI) 1.15 to 2.15, P = 0.005). Subgroup analyses showed that one-to-one, needs-based, informal repeat education sessions and generic, formal antenatal education sessions are effective in terms of an increase in breastfeeding rates among women on low incomes regardless of ethnicity and feeding intention. Needs-based, informal peer support in the antenatal and postnatal periods was also shown to be effective in one study conducted among Latina women who were considering breastfeeding in the USA (RR 4.02, 95% CI 2.63 to 6.14, P < 0.00001). AUTHORS' CONCLUSIONS: This review showed that health education and peer support interventions can result in some improvements in the number of women beginning to breastfeed. Findings from these studies suggest that larger increases are likely to result from needs-based, informal repeat education sessions than more generic, formal antenatal sessions. These findings are based only on studies conducted in the USA, among women on low incomes with varied ethnicity and feeding intention, and this raises some questions regarding generalisability to other settings

Predicting breastfeeding in women living in areas of economic hardship : explanatory role of the theory of planned behaviour

This study employed the theory of planned behaviour (TPB) and additional variables (descriptive norm, moral norm, self-identity) to investigate the factors underlying breastfeeding intention and subsequent breastfeeding at four time points (during hospital stay, at hospital discharge, 10 days postpartum and 6 weeks postpartum) in a sample of women selected from defined areas of economic hardship (N = 248). A model containing the TPB, additional variables and demographic factors provided a good prediction of both intention (R-2 = 0.72; attitude, perceived behavioural control, moral norm and self-identity significant predictors) and behaviour - breastfeeding at birth (88.6% correctly classified; household deprivation, intention, attitude significant), at discharge from hospital (87.3% correctly classified; intention, attitude significant), 10 days after discharge (83.1% correctly classified; education, intention, attitude, descriptive norm significant) and 6 weeks after discharge (78.0% correctly classified; age, household deprivation, ethnicity, moral norm significant). Implications for interventions are discussed, such as the potential usefulness of targeting descriptive norms, moral norms and perceived behavioural control (PBC) when attempting to increase breastfeeding uptake