E. Van Teijlingen

Models of intrapartum care and women’s trade‐offs in remote and rural Scotland: a mixed‐methods study

Objectiveu2002 To explore women’s preferences for, and trade‐offs between, key attributes of intrapartum care models.

Getting women to hospital is not enough: a qualitative study of access to emergency obstetric care in Bangladesh

Objective: To explore what happened to poor women in Bangladesh once they reached a hospital providing comprehensive emergency obstetric care (EmOC) and to identify support mechanisms. Design: Mixed methods qualitative study. Setting: Large government medical college hospital in Bangladesh. Sample: Providers and users of EmOC. Methods: Ethnographic observation in obstetrics unit including interviews with staff and women using the unit and their carers. Results: Women had to mobilise significant financial and social resources to fund out of pocket expenses. Poorer women faced greater challenges in receiving treatment as relatives were less able to raise the necessary cash. The official financial support mechanism was bureaucratic and largely unsuitable in emergency situations. Doctors operated a less formal “poor fund” system to help the poorest women. There was no formal assessment of poverty; rather, doctors made “adjudications” of women’s need for support based on severity of condition and presence of friends and relatives. Limited resources led to a “wait and see” policy that meant women’s condition could deteriorate before help was provided. Conclusions: Greater consideration must be given to what happens at health facilities to ensure that (1) using EmOC does not further impoverish families; and (2) the ability to pay does not influence treatment. Developing alternative finance mechanisms to reduce the burden of out of pocket expenses is crucial but challenging. Increased investment in EmOC must be accompanied by an increased focus on equity.

Absence of conception after caesarean section: voluntary or involuntary?

Backgroundu2002 Women who deliver by caesarean section have been shown to be less likely to have a subsequent pregnancy. It is not clear whether this is due to a direct effect of the procedure on future fertility or due to deliberate avoidance of a future pregnancy.

Health demonstration projects: Evaluating a community-based health intervention programme to improve young people's sexual health

There has been criticism of systematic reviews and meta-analyses that have shown little evidence of effect of interventions to improve teenage sexual health. Moreover, there is considerable controversy surrounding the validity of outcomes and rigour of design in evaluation methods for community-based programmes. In this climate, Scotland launched Healthy Respect, one of four community-based national Demonstration Projects, to address teenage sexual health. Healthy Respect is a complex and multi-stranded intervention in Lothian Region that includes education and health-promotion activities and alternative ways to provide sexual health services for young people. A multidisciplinary research team at the University of Aberdeen was appointed to undertake an independent evaluation of this demonstration project. Challenging some aspects of theory-based evaluation, it is argued that adopting both quantitative and qualitative methods will provide an understanding of both the context and process of this Health Demonstration Project, as well as tracking outcomes, including behavioural change, in the target population. The authors’ evaluation includes: examining the process of implementation; comparative regional mapping of the service context including inter-agency partnership working; and assessing effectiveness using a quasi-experimental design and adjusted, population-based, behavioural and sexual health outcomes. Evaluation from these key perspectives contributes to a balanced appraisal of a complex, community-based health promotion and service delivery intervention.

The Grampian Mobile Information Bus: An overview of the early implementation and process evaluation of a mobile, community-based health information service

Abstract The Grampian Mobile Information Bus (MIB) is a community-based intervention that provides health and related information for young people aged 1218 years living in rural areas in the north-east of Scotland. The MIB is a partnership project involving health and local authorities and voluntary organisations, and operates as a mobile outreach service for this group of young people. This paper provides an overview of the early implementation and evaluation of the MIB initiative. The strengths and limitations of the project and its evaluation are discussed. Findings suggest that this initiative proved very popular with the intended target group, with users reporting high levels of satisfaction. In addition, it suggests that an initiative of this nature has the potential to mobilise local agencies in addressing their health and local needs. However, at this early stage in the projects lifetime, it is impossible to determine if changes made to the provision of services with local communities, attributed to the work of the MIB project, can be sustained in the longer term. This will require further research.