Ann Oakley

Social support in pregnancy: Does it have long-term effects?

Abstract This paper describes the results of a 7-year follow-up survey of families who took part in a randomized controlled trial of research midwife-provided social support in pregnancy in 1986–88. Analysis of data 6 weeks and 1 year after delivery indicated that families offered the social support intervention had better health outcomes than those in the control group. A further wave of data collection using postal questionnaires was undertaken when the index children were aged between 6 and 8 years. The findings indicated that the initial advantage shown by the intervention group appeared to have been maintained. At 7 years, there were significant differences favouring the families in the intervention group in the health and development outcomes of the children, and the physical and psychosocial health of the mothers. The results confirm the health-promoting effect of social support, and the importance of providing supportive care within the routine maternity services, not only as a means to improve wo...

The effect of dislike of school on risk of teenage pregnancy: testing of hypotheses using longitudinal data from a randomised trial of sex education

Study objective: To examine whether attitude to school is associated with subsequent risk of teenage pregnancy. To test two hypotheses that attitude to school is linked to pregnancy via pathways involving young people having “alternative” expectations or deficits in sexual health knowledge and confidence. Design: Analysis of longitudinal data arising from a trial of sex education. Examination of associations between attitude to school and protected first sex, unprotected first sex, unprotected and protected last sex, and pregnancy, both crude and adjusting in turn for expectation of parenting by age 20, lack of expectation of education/training at age 20, and sexual health knowledge and confidence. Setting: Schools in central and southern England. Participants: Girls of median age 13.7 years at baseline, 14.7 years at follow up 1, and 16.0 years at follow up 2. Main results: In unadjusted analysis, attitude to school was significantly associated with protected and unprotected first sex by follow up 1, protected first sex between follow up 1 and 2, unprotected last sex, and pregnancy. Dislike of school was more strongly associated with increased risk of these outcomes than was ambivalence to school. These associations remained after adjusting for socioeconomic status and for expectation of parenting, lack of expectation of education/training, and various indicators of knowledge and confidence about sexual health. Conclusions: Dislike of school is associated with subsequent increased risk of teenage pregnancy but the mechanism underlying any possible causal link is unlikely to involve “alternative” expectations or deficits in sexual health knowledge or confidence.

No pills for heartache: The importance of social support for women who suffer pregnancy loss

Abstract This paper uses part of the data from a randomized controlled trial of social support in pregnancy in order to investigate whether the provision of social support in a subsequent pregnancy for women who have previously undergone pregnancy loss makes an appreciable difference to their physical and emotional health in that subsequent pregnancy. Significant differences in emotional well-being, at 6 weeks and 1 year after delivery, were found between the supported and unsupported groups. Physical health was not affected by the intervention. Qualitative data on the womens experiences of pregnancy loss highlight their need for the recognition of the dead baby as a person and thus for the legitimation of mourning. Isolation after pregnancy loss is exacerbated by negative social attitudes to death, the disappearance of traditional mourning rituals, low levels of intimacy, and gender differences in grieving. By providing non-directive social support, tailored to the individuals needs, the research midwi...

Using random allocation to evaluate social interventions: Three recent UK examples

Although widely accepted in medicine and health services research, randomized controlled trials (RCTs) are often viewed with hostility by social scientists, who cite a variety of reasons as to why this approach to evaluation cannot be used to research social interventions. This article discusses the three central themes in these debates, which are those of science, ethics, and feasibility. The article uses three recent U.K. trials of social interventions (day care for preschool children, social support for disadvantaged families, and peer-led sex education for young people) to consider issues relating to the use of random allocation for social intervention evaluation and to suggest some practical strategies for the successful implementation of “social” RCTs. The article argues that the criteria of science, ethics, and feasibility can and should apply to social intervention trials in just the same way as they do to clinical trials.

Effect of social exclusion on the risk of teenage pregnancy: development of hypotheses using baseline data from a randomised trial of sex education

Study objective: The UK government argues that “social exclusion” increases risk of teenage pregnancy and that educational factors may be dimensions of such exclusion. The evidence cited by the government is limited to reporting that socioeconomic disadvantage and educational attainment influence risk. Evidence regarding young people’s attitude to school is not cited, and there is a lack of research concerning the UK. This paper develops hypotheses on the relation between socioeconomic and educational dimensions of social exclusion, and risk of teenage pregnancy, by examining whether dislike of school and socioeconomic disadvantage are associated with cognitive/behavioural risk measures among 13/14 year olds in English schools. Design: Analysis of data from the baseline survey of a study of sex education. Setting and participants: 13/14 year old school students from south east England. Main results: The results indicate that socioeconomic disadvantage and dislike of school are associated with various risk factors, each with a different pattern. Those disliking school, despite having comparable knowledge to those liking school, were more likely to have sexual intercourse, expect sexual intercourse by age 16, and expect to be parents by the age of 20. For most associations, the crude odds ratios (ORs) and the ORs adjusted for the other exposure were similar, suggesting that inter-confounding between exposures was limited. Conclusions: It is hypothesised that in determining risk of teenage pregnancy, the two exposures are independent. Those disliking school might be at greater risk of teenage pregnancy because they are more likely to see teenage pregnancy as inevitable or positive.

School-based cognitive-behavioural interventions: A systematic review of effects and inequalities

Abstract Little is known about the impact of preventive interventions on inequalities in young people’s mental health. We conducted a systematic review of mental health promotion interventions based on cognitive behavioural therapy (CBT) delivered in schools to young people aged 11–19. Meta-analysis of 17 high quality randomised controlled trials (RCTs) showed a reduction in symptoms of depression, which was generally short term. Interventions for people with clinical risk factors or existing symptoms were more effective, with benefits lasting up to six months. We also found that CBT may be more effective for young people from families with middle to high socioeconomic status (SES) than for those from low SES backgrounds. However, this finding was based on a metaregression with only six studies. A lack of long-term follow-up data and a failure to report subgroup analyses prevented further conclusions being drawn about the effect of these types of interventions on mental health inequalities.

Science, gender, and women's liberation: an argument against postmodernism

Abstract In much contemporary feminist discourse, the concepts of “science” and “gender” are discredited as tools for analysing womens situation. Postmodernist debates criticise the whole positivist enterprise that underlies “the scientific method” and is reflected in “quantitative” and “experimental” ways of knowing. Gender as a social construction conceptually distinct from a “biological” division into female and male has also been called into question by postmodernist theories. This paper argues the desirability of rehabilitating both the concepts of science and gender within a feminist discourse committed to the practical liberation of women. Two current problems in womens health care—cervical cancer screening and hormone replacement therapy—are examined as a case study.

Evaluating Processes A Case Study of a Randomized Controlled Trial of Sex Education

This article explores the rationales offered in the evaluation literature for studying the processes involved in programme implementation, and their relationship with current arguments about the use of experimental designs to evaluate social interventions. It describes, as a case study, a process evaluation carried out as an integral part of a randomized controlled trial of peer-led sex education. The process evaluation was designed to answer important questions about the implementation of the intervention, the social context of the trial, and the experiences of trial participants. The article describes the methods used to collect process data, and some of the challenges involved. It concludes by arguing that process evaluation is necessarily complex, but essential to the task of understanding why and how interventions and outcomes may be related.

Public policy experimentation: Lessons from America

Abstract The years from the early 1960s to the late 1980s in the United States represent a unique era in the history of public policy experimentation. During these years a number of social programmes were implemented and evaluated using the ‘medical’ model of the randomised controlled trial design. The reasons for the widespread acceptance among policy‐makers of this approach to evaluation included recognition of the chaos and inefficiency in existing welfare services, and the consequent need to adopt a more rational means of solving policy issues; a government mandate specifying that a proportion of social programme budgets be devoted to evaluation; a long‐standing tradition of social experimentation among behavioural scientists; and the conceptual and methodological tools for applying experimental models of evaluation to the social domain. The paper examines nine public policy experiments carried out during this period in the fields of income maintenance, employment‐support and penal policy. These exper...

Discrepancies in findings from effectiveness reviews: the case of health promotion for older people in accident and injury prevention

The present study introduces some of the key methodological issues in conducting and using effectiveness reviews, taking reviews of accident and injury prevention in older people as an example. A comparative analysis of six effectiveness reviews was undertaken. These reviews all related to the impact of exercise on falls in older people but offered apparently conflicting conclusions. The reviews were compared in terms of their scope, search strategies, methodological quality criteria, methods for data extraction and synthesising findings and review conclusions. The reviews were found to differ in terms of: whether they addressed a narrow or broad scope; the number of studies they included; and the quality criteria used to assess the included studies such that the same studies were treated differently in different reviews. Although the implications for research and practice from the reviews were found to conflict across different reviews, the authors of the reviews exercised caution when drawing final conclusions which served to minimise these conflicts. These results are discussed in terms of the implications for effectiveness reviews and their methodology within health promotion.