Clients' returning for cervical screening results : a focus group study exploring the reasons why women spontaneously return for their results at the Khayelitsha Cervical Cancer Screening Project

Bibliography: leaves 112-123.Cervical cancer is integrally associated with the problems of poverty in the developing world. It is the most common cancer cause of death among women in these regions. In South Africa, the lifetime risk for black African women developing this cancer is 1 in 26. Rates for white women are 1 in 80. Cervical cancer is largely preventable by screening for its precursor stages. However, cervical cancer screening in low-resource settings has only rarely been initiated and sustained. There are many barriers to the establishment of mass, organised screening programmes. This study focuses on one aspect of the screening process: the clients' receiving of their screening results. For the most part, health providers in resource-poor settings rely on the clients themselves to return to the health service to receive their results and consequent arrangements for further care. Understanding those factors that impact upon clients' returning is therefore crucial to the success of the screening. The Khayelitsha Cervical Cancer Screening Project (KCCSP) was established in 1996 to evaluate alternative screening tests to cytology. In addition, the Project has evaluated alternative screening algorithms to the traditional approach of cytology, colposcopy, biopsy and treatment, specifically, a "screen and treat" approach. This approach is expected to overcome some of the many barriers to women participating in screening programmes. This study aims to investigate the phenomenon of the high spontaneous return rate in the setting of the KCCSP. Motivating and deterring factors are sought, both logistical and psychological, in the clients' personal contexts, as well as those related to their experiences of the Project. Exploratory study in the interpretive research paradigm located in a peri-urban informal settlement outside Cape Town, South Africa. Volunteer sample of women enrolled in the KCCSP returning for their first set of screening results. Four focus groups were conducted in Xhosa, facilitated by a Xhosa-speaking social worker from Khayelitsha who has experience in focus group work. Discussion guidelines were followed. The discussions were tape recorded and later transcribed before being translated into English by the facilitator. Analysis of the data draws on elements of both the grounded theory and the systems theory paradigms. The findings reveal that, for the most part, women present to the KCCSP in order to have general gynaecological problems addressed. Returning for results represents an extension of this need. Obstacles to returning include problems with access to the clinic, the need to care for dependents at home and the competing priorities of housework and generating income. Factors that promote the returning for results are the imperative to understand the cause of, and have treatment for pre-existing gynaecological symptoms which cause high levels of anxiety. Related to this, women are motivated to have confirmed or refuted the diagnosis of a fatal disease, including cancer and HIV. Certain qualities and design features of the KCCSP facilitate women returning fOr their results. These include the perceived superior quality of interpersonal communication between Project staff and clients and the efficient manner in which results are made available to clients. Other promotive or obstructive factors that playa role in cervical screening service utilisation include; client attitudes towards traditional healers, a prevalent fear of hysterectomy, concern about privacy and gossip and a suspicious attitude toward caring health workers. Women enrolled in the KCCSP have a personal health agenda with a different focus to that of the Project. Chronic gynaecological problems are frequently experienced and give rise to levels of anxiety about their being signs of serious pathology. Women have not had these fears or the symptoms adequately addressed at other health services. The need to have these issues properly managed represents a large enough motivating force to overcome many of the practical and psychological obstacles to utilisation of the KCCSP. The Project represents for women a general women's health service

Image data processing system requirements study. Volume 2: Appendixes

Supporting information for the ERS loading study contains computer simulation loading output including printout description, and similar output representing data that include night station contacts

Image data processing system requirements study. Volume 1: Analysis

Digital image processing, image recorders, high-density digital data recorders, and data system element processing for use in an Earth Resources Survey image data processing system are studied. Loading to various ERS systems is also estimated by simulation

EOS image data processing system definition study

The Image Processing System (IPS) requirements and configuration are defined for NASA-sponsored advanced technology Earth Observatory System (EOS). The scope included investigation and definition of IPS operational, functional, and product requirements considering overall system constraints and interfaces (sensor, etc.) The scope also included investigation of the technical feasibility and definition of a point design reflecting system requirements. The design phase required a survey of present and projected technology related to general and special-purpose processors, high-density digital tape recorders, and image recorders

Perinatal suicidal ideation and behaviour: psychiatry and adversity

Pregnant women are at increased risk for suicidal ideation and behaviours (SIB) compared to the general population. To date, studies have focused on the psychiatric correlates of SIB with lesser attention given to the associated contextual risk factors, particularly in low- and middle-income countries. We investigated the prevalence and associated psychiatric and socio-economic contextual factors for SIB among pregnant women living in low resource communities in South Africa. Three hundred seventy-six pregnant women were evaluated using a range of tools to collect data on socio-economic and demographic factors, social support, life events, interpersonal violence and mental health diagnoses. We examined the significant risk factors for SIB using univariate, bivariate and logistic regression analyses (p ≤ 0.05). The 1-month prevalence of SIB was 18%. SIB was associated with psychiatric illness, notably major depressive episode (MDE) and any anxiety disorder. However, 67% of pregnant women with SIB had no MDE diagnosis, and 65% had no anxiety disorder, while 54% had neither MDE nor anxiety disorder diagnoses. Factors associated with SIB included lower socio-economic status, food insecurity, interpersonal violence, multiparousity, and lifetime suicide attempt. These findings focus attention on the importance of socio-economic and contextual factors in the aetiology of SIB and lend support to the idea that suicide risk should be assessed independently of depression and anxiety among pregnant women

Maternal mental health and the first 1 000 days

Even though maternal mental health receives low priority in healthcare, it is a vital component for the developing fetus and the raising of healthy children who are able to contribute meaningfully to society. This article explores risk factors for common mental illnesses and treatment options available in under-resourced settings

Abuse in South African maternity settings is a disgrace: Potential solutions to the problem

Abuse of mothers in maternity settings is widespread globally. In South Africa, this human rights violation has been documented by many sources. Particular factors relating to health workers’ professional and personal contexts contribute to the problem and need to be addressed if it is to be solved. Several local and international initiatives are discussed as possible solutions

Group problem solving therapy for perinatal depression in primary health care settings in rural Uganda:an intervention cohort study

Background: Perinatal depression is of substantial public health importance in low and middle income countries. The study aimed to evaluate the impact of a mental health intervention delivered by non-specialist health workers on symptom severity and disability in women with perinatal depression in Uganda. Methods: Pregnant women in the second and third trimester were consecutively screened using the Luganda version of the 9-item Patient Health Questionnaire (PHQ-9). Women who scored ≥5 on the PHQ-9 and who were confirmed to have depression by a midwife were recruited into a treatment cohort and offered a psychological intervention in a stepped care fashion. Women were assessed with PHQ-9 and WHODAS-2.0 at baseline and again at 3 and 6 months after the intervention. Negative regression analysis was done to examine change in PHQ-9 and WHODAS-2.0 scores from baseline to end line. Data were analysed using STATA version 14. Results: A total of 2652 pregnant women (98.3%) consented to participate in the study and 153 (5.8%) were diagnosed as depressed. Over a quarter (28.8%) reported having experienced physical interpersonal violence (IPV) while (25.5%) reported sexual IPV in the past year. A third (34.7%) of women diagnosed with depression received 4 or more group PST sessions. There was a mean reduction in PHQ-9 score of 5.13 (95%CI − 6.79 to − 3.47, p &lt; 0.001) and 7.13 (95%CI − 8.68 to − 5.59, p &lt; 0.001) at midline and endline, respectively. WHODAS scores reduced significantly by − 11.78 points (CI 17.64 to − 5.92, p &lt; 0.001) at midline and − 22.92 points (CI 17.64 to − 5.92, p &lt; 0.001) at endline. Clinical response was noted among 69.1% (95%CI 60.4–76.6%) and 93.7% (95%CI 87.8–96.8%) of respondents at midline and endline, respectively. Conclusion: An evidence based psychological intervention implemented in primary antenatal care by trained and supervised midwives in a real-world setting may lead to improved outcomes for women with perinatal depression. Future randomised studies are needed to confirm the efficacy of this intervention and possibility for scale up.</p

Smoothie or Fruit Salad? Learners’ Descriptions of Accents as Windows to Concept Formation

This paper explores the linguistically naive descriptions which one set of EFL learners provided when identifying and describing accents. First and second-year English majors at a French university were asked to do two tasks. First, they listened to two extracts to determine whether the speaker’s accent sounded more British or American, and to explain which features helped them to decide. Later they answered two questions: a) What do you do when you want to sound more like an American? and b) more like a British person? The analysis of their answers highlights learners’ underlying representations of accents as well as concept formation in relation to English pronunciation. I argue that this cognitive aspect of L2 learning should be addressed explicitly in instruction