Debbie Smith

A qualitative study of women's experiences of communication in antenatal care: Identifying areas for action

To identify key features of communication across antenatal (prenatal) care that are evaluated positively or negatively by service users. Focus groups and semi-structured interviews were used to explore communication experiences of thirty pregnant women from diverse social and ethnic backgrounds affiliated to a large London hospital. Data were analysed using thematic analysis. Women reported a wide diversity of experiences. From the users’ perspective, constructive communication on the part of health care providers was characterised by an empathic conversational style, openness to questions, allowing sufficient time to talk through any concerns, and pro-active contact by providers (e.g. text message appointment reminders). These features created reassurance, facilitated information exchange, improved appointment attendance and fostered tolerance in stressful situations. Salient features of poor communication were a lack of information provision, especially about the overall arrangement and the purpose of antenatal care, insufficient discussion about possible problems with the pregnancy and discourteous styles of interaction. Poor communication led some women to become assertive to address their needs; others became reluctant to actively engage with providers. General Practitioners need to be better integrated into antenatal care, more information should be provided about the pattern and purpose of the care women receive during pregnancy, and new technologies should be used to facilitate interactions between women and their healthcare providers. Providers require communications training to encourage empathic interactions that promote constructive provider–user relationships and encourage women to engage effectively and access the care they need.

Participation in sex work: students' views

Increasing evidence points to student involvement in the sex industry. The current study comprised a cross-sectional sample of 315 undergraduates at a London university. Using a semi-structured questionnaire, data were gathered on students financial and employment circumstances and their views on participation in sex work. Results suggested awareness of student sex work was widespread, and considered understandable by the majority. Students principally attributed participation in the sex industry to their financial situation. A relatively high proportion (16.5%) indicated that they would be willing to engage in sex work to pay for their education, with 11% indicating they would work as escorts. A model of willingness to undertake sex work was able to explain over one-quarter of the variance. These findings are explained in relation to the mainstreaming of sexual consumption, the supply routes of sexual labour from privileged socio-economic positions and the effects of student debt.

The design of a community lifestyle programme to improve the physical and psychological well-being of pregnant women with a BMI of 30 kg/m2 or more.

BackgroundObesity is a global public health issue. Having a BMI of 30 kg/m2 or more (classifying a person as obese) at the start of pregnancy is a significant risk factor for maternal and fetal morbidity. There is a dearth of evidence to inform suitable inteventions to support pregnant women with a BMI of 30 kg/m2 or more. Here we describe a study protocol to test the feasibility of a variety of potential healthy lifestyle interventions for pregnant women with a BMI of 30 kg/m2 or more in a community based programme.Methods/DesignFour hundred women will be approached to attend a 10-week community lifestyle programme. The programme will be provided as a supplement to standard antenatal care. The programme is multi-faceted, aimed at equipping participants with the skills and knowledge needed to adopt healthy behaviours. The social (cognitive) learning theory will be used as a tool to encourage behaviour change, the behaviour change techniques are underpinned by five theoretical components; self-efficacy, outcome expectancies, goal setting, feedback and positive reinforcement.The main outcomes are pregnancy weight gain and caesarean section rate. Other important outcomes include clinical outcomes (e.g., birth weight) and psychological outcomes (e.g., well-being). Secondary outcomes include womens experience of pregnancy and health care services, amount of physical activity, food intake and the suitability of the intervention components.A prospective study using quantitative and qualitative methods will inform the feasibility of implementing the community lifestyle programme with pregnant women with a BMI of 30 kg/m2 or more. Mixed methods of data collection will be used, including diaries, focus groups/interviews, pedometers, validated and specifically designed questionnaires, a programme register, weight gain during pregnancy and perinatal outcome data.DiscussionFindings from this current feasibility study will inform future interventions and NHS services and add to the evidence-base by providing information about the experiences of pregnant women with a BMI of 30 kg/m2 or more undertaking a community lifestyle programme. The study will lead on to a randomised control trial of a suitable intervention to improve the pregnancy outcomes of this target group.Trail RegistrationISRCTN29860479.

Social Acceptance; A Possible Mediator in the Association between Socio-Economic Deprivation and Under-18 Pregnancy Rates?.

This study examines the social acceptance of young (under-18) pregnancy by assessing peoples acceptance of young pregnancy and abortion in relation to deprivation. A cross-sectional survey design was conducted in two relatively affluent and two relatively deprived local authorities in London (n=570). Contrary to previous findings, participants were significantly more accepting of young pregnancy in the more affluent areas and if they were young parents. When controlling for other personal characteristics, only age remained significantly related to acceptance, and there was evidence of an interaction between level of area deprivation and age. The work supported previous findings, with people in more affluent areas being the most accepting of abortion. Age and ethnicity were significantly associated with acceptance of abortion after adjusting for level of area deprivation. An interaction effect between ethnicity and area deprivation was found. The importance of the psychosocial processes behind acceptance of young pregnancy was highlighted. Area deprivation does not have a uniform influence over people who vary in their personal characteristics. Young pregnancy prevention programmes and support groups for young parents must address the influence of social deprivation, age and ethnicity and how this affects the fabric of young peoples lives.