Kath Ryan

Asthma during Pregnancy: The Experiences, Concerns and Views of Pregnant Women with Asthma

Objective. To investigate how pregnant women manage their asthma during pregnancy and factors influencing their behavior. Methods. In-depth interviews (telephone or face-to-face) with a purposive sample of 23 asthmatic women at various stages of pregnancy and with varying severity of asthma. Results. Five major themes were discerned relating to health behavior of pregnant women with asthma. Many of the participants decreased or discontinued their asthma medications themselves and refrained from taking doses when necessary during pregnancy without consulting their doctors. Reasons behind their decisions revolved around lack of support and information about what to do, concerns about the safety of the medications, past experiences, and desire for an “all natural” pregnancy. Asthma monitoring during pregnancy was seen as a low priority for some women and their doctors. Communication between pregnant women and health professionals regarding asthma management was poor. The health behavior of pregnant women with asthma could be explained using the Health Beliefs Model. Conclusions. Pregnant women are not well supported in managing asthma during pregnancy, despite being concerned about outcomes. Interventions, education, and more support are warranted and wanted by pregnant women with asthma to optimize pregnancy and neonatal outcomes.

Expressionists of the Twenty-First Century: The Commodification and Commercialization of Expressed Breast Milk

Breast milk expression has been promoted as liberating for women and as offering them more choices, but there has been little research on womens experiences of it and even less critical commentary on the consequences of its incorporation into mainstream behavior. Drawing on narratives of women in the United Kingdom about breastfeeding, we explore the increasingly popular practice of expressing and feeding expressed breast milk. We argue that breast milk has become commodified, breastfeeding commercialized and technologized, and the mother–infant relationship disrupted. We suggest that breastfeeding as a process is being undermined by vested interests that portray it as unreliable and reconstruct it in artificial feeding terms, so playing on womens insecurities. The major beneficiaries of expression are fathers who want increased involvement in infant care and commercial enterprises that aim to maximize profits for shareholders.

Infant feeding attitudes of women in the United Kingdom during pregnancy and after birth.

Background: To address the recognized low rates of breastfeeding in the United Kingdom (UK), a change in fundamental attitudes toward infant feeding might be required. This paper reports an exploration of women’s attitudes toward breastfeeding at different time points in the perinatal period, undertaken as part of a larger breastfeeding evaluation study. Objectives: To measure women’s infant feeding attitudes at 3 stages during the perinatal period to see whether, on average, they differed over time. Methods: Using the 17-item Iowa Infant Feeding Attitudes Scale (IIFAS), this cross-sectional study measured the infant feeding attitudes of 866 UK women at 3 perinatal stages (20 and 35 weeks antenatally and 6 weeks postpartum). Results: Mean IIFAS scores were very similar, which shows that discrete groups of women at different time points in pregnancy and postpartum appear to have the same attitudes toward infant feeding. The predominance of scores lay in the mid-range at each of the time points, which may indicate women’s indecision or ambivalent feelings about infant feeding during pregnancy and the postpartum period. Conclusions: Action must be undertaken to target the majority of women with mid-range scores whose ambivalence may respond positively to intervention programs. The challenge is to understand what would be appropriate and acceptable to this vulnerable group of women.

Teaching social sciences to undergraduate pharmacy students: an international survey

Objectives: To describe how characteristics of newly graduated pharmacy students may influence their perceptions of, and satisfactions with, an undergraduate pharmacy course.Methods: In 2007, a piloted postal questionnaire based on the National Student Survey (NSS), which is administered to final year undergraduate students in all universities in England and Northern Ireland and in some in Scotland and Wales, was sent to all 98 pharmacy pre-registration students who had newly graduated from a UK university.Results: A response rate of 52% was achieved; 84% of the respondents were satisfied with the quality of the course. Characteristics, such as reasons for choosing to study pharmacy and selecting the university, country of origin and language background influenced satisfaction.Conclusion: Characteristics may influence students’satisfaction with an undergraduate pharmacy course; further research is required into how the expectations of students may be managed and courses enhanced.

Narratives about illness and medication: a neglected theme/new methodology within pharmacy practice research. Part I: Conceptual Framework

This paper sets out a conceptual and theoretical framework relevant to developing research in the area of narratives about medication. Drawing on an understanding and critique of the psychological, sociological and anthropological literature in the area of patients’ narratives about health and illness, we argue that pharmacy practice researchers need to acknowledge and appreciate the insights that can come from engaging with narrative. We provide a critique of the current limitations of pharmacy practice research as applied to patient’s use of medication and suggest that an appreciation of narrative might provide another window on the world of patients’ experiences.

Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital

To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies.

The work of Michel Foucault: relevance to pharmacy practice

Michel Foucault remains a controversial figure in social theory, his ideas giving rise to both loathing and adoration in equal measure. Writing from the 1960s to the 1980s, his work spans the disciplines of history, sociology and philosophy, and defies easy categorisation and elucidation. In this paper we attempt to situate Foucaults approach within the broad sweep of sociological thought in the late 20th century. We describe some of his central ideas, before moving on to critique his work and the contribution he and his adherents have made to medical sociology. Finally, we suggest how scholars might draw on his ideas to guide their research in pharmacy practice and social pharmacy.

Narratives about illness and medication: a neglected theme/new methodology within pharmacy practice research. Part II: medication narratives in practice.

AimPart 2 of this paper aims to provide a methodological framework for the study of medication narratives, including a semi-structured interview guide and suggested method of analysis, in an attempt to aid the development of narrative scholarship within pharmacy practice research. Examples of medication narratives are provided to illustrate their diversity and usefulness.MethodsThe framework is derived from the work of other researchers and adapted for our specific purpose. It comes from social psychology, narrative psychology, narrative anthropology, sociology and critical theory and fits within the social constructionist paradigm. The suggested methods of analysis could broadly be described as narrative analysis and discourse analysis. Examples of medication narratives are chosen from a variety of sources and brief interpretations are presented by way of illustration.ConclusionNarrative analysis, a neglected area of research in pharmacy practice, has the potential to provide new understanding about how people relate to their medicines, how pharmacists are engaged in producing narratives and the importance of narrative in the education of students.Impact of the articleThis article aims to have the following impact on pharmacy practice research:Innovative approach to researching and conceptualising the use of medicinesIntroduction of a new theoretical perspective and methodologyIncorporation of social science research methods into pharmacy practice researchDevelopment of narrative scholarship within pharmacy

Protocol for ACCESS: a qualitative study exploring barriers and facilitators to accessing the emergency contraceptive pill from community pharmacies in Australia

Introduction The rate of unplanned pregnancy in Australia remains high, which has contributed to Australia having one of the highest abortion rates of developed countries with an estimated 1 in 5 women having an abortion. The emergency contraceptive pill (ECP) offers a safe way of preventing unintended pregnancy after unprotected sex has occurred. While the ECP has been available over-the-counter in Australian pharmacies for over a decade, its use has not significantly increased. This paper presents a protocol for a qualitative study that aims to identify the barriers and facilitators to accessing the ECP from community pharmacies in Australia. Methods and analysis Data will be collected through one-on-one interviews that are semistructured and in-depth. Partnerships have been established with 2 pharmacy groups and 2 womens health organisations to aid with the recruitment of women and pharmacists for data collection purposes. Interview questions explore domains from the Theoretical Domains Framework in order to assess the factors aiding and/or hindering access to ECP from community pharmacies. Data collected will be analysed using deductive content analysis. The expected benefits of this study are that it will help develop evidence-based workforce interventions to strengthen the capacity and performance of community pharmacists as key ECP providers. Ethics and dissemination The findings will be disseminated to the research team and study partners, who will brainstorm ideas for interventions that would address barriers and facilitators to access identified from the interviews. Dissemination will also occur through presentations and peer-reviewed publications and the study participants will receive an executive summary of the findings. The study has been evaluated and approved by the Monash Human Research Ethics Committee.

A qualitative study exploring first time mothers’ experiences of breastfeeding in Singapore

Background: The exclusive breastfeeding rate (for the first 6 months of a baby’s life) remained low in Singapore despite active promotion of breastfeeding by government bodies and hospitals. The aim of this study was to explore the breastfeeding experiences of first time mothers and the difficulties they faced during their breastfeeding period. Methods: A qualitative descriptive study design was adopted. Participants were chosen from a purposive sampling technique and data were collected from 10 semi-structured in-depth interviews. All interviews conducted were audio-taped and transcribed verbatim. Interview transcriptions were analysed using the qualitative content analysis approach. Results: The breastfeeding period of the 10 first time mothers in this study ranged from 3 days to 10 months, and four participants were still breastfeeding at the time of interview (4–12 months after delivery). The interview transcriptions generated 54 nodes, 12 sub-themes and four key themes. The four key themes identified were: (a) challenges and support for breastfeeding in the initial period after birth; (b) low degree of support for breastfeeding in the workplace; (c) unease at breastfeeding in front of others; and (d) emotional and psychological aspects of breastfeeding. Conclusion: This study provided a better understanding of the breastfeeding experiences of first time mothers in Singapore. Initiating and sustaining breastfeeding is still challenging for first time mothers. Greater public awareness, laws that support breastfeeding in public and the workplace, as well as support of family members could be fundamental to successful breastfeeding.