Lucia Guerra-Reyes

Postpartum Health Information Seeking Using Mobile Phones: Experiences of Low-Income Mothers.

Objectives To assess low-income mothers’ perceptions of their postpartum information needs; describe their information seeking behavior; explore their use of mobile technology to address those needs; and to contribute to the sparse literature on postpartum health and wellness. Methods Exploratory community-based qualitative approach. Interviewees were recruited among clients of community partners and had children aged 48 months and under. A survey assessing demographics was used to identify low-income mothers. 10 low-income mothers were recruited from survey participants to complete in-depth interviews regarding postpartum information needs, information seeking, and technology use. Interviews were transcribed verbatim and coded by three researchers independently. Narratives were analyzed along predetermined (etic) and emergent (emic) categories. Results Establishing breastfeeding and solving breastfeeding problems were central postpartum concerns leading to information seeking. Interviewees reported almost exclusive use of mobile phones to access the Internet. Mobile applications were widely used during pregnancy, but were not valuable postpartum. Face-to-face information from medical professionals was found to be repetitive. Online information seeking was mediated by default mobile phone search engines, and occurred over short, fragmented time periods. College graduates reported searching for authoritative knowledge sources; non-graduates preferred forums. Conclusions for Practice Low-income postpartum women rely on their smartphones to find online infant care and self-care health information. Websites replace pregnancy-related mobile applications and complement face-to-face information. Changes in searching behavior and multitasking mean information must be easily accessible and readily understood. Knowledge of page-rank systems and use of current and emergent social media will allow health-related organizations to better engage with low-income mothers online and promote evidence-based information.

Sexual diversity in the United States: Results from a nationally representative probability sample of adult women and men

In 2015, we conducted a cross-sectional, Internet-based, U.S. nationally representative probability survey of 2,021 adults (975 men, 1,046 women) focused on a broad range of sexual behaviors. Individuals invited to participate were from the GfK KnowledgePanel®. The survey was titled the 2015 Sexual Exploration in America Study and survey completion took about 12 to 15 minutes. The survey was confidential and the researchers never had access to respondents’ identifiers. Respondents reported on demographic items, lifetime and recent sexual behaviors, and the appeal of 50+ sexual behaviors. Most (>80%) reported lifetime masturbation, vaginal sex, and oral sex. Lifetime anal sex was reported by 43% of men (insertive) and 37% of women (receptive). Common lifetime sexual behaviors included wearing sexy lingerie/underwear (75% women, 26% men), sending/receiving digital nude/semi-nude photos (54% women, 65% men), reading erotic stories (57% of participants), public sex (≥43%), role-playing (≥22%), tying/being tied up (≥20%), spanking (≥30%), and watching sexually explicit videos/DVDs (60% women, 82% men). Having engaged in threesomes (10% women, 18% men) and playful whipping (≥13%) were less common. Lifetime group sex, sex parties, taking a sexuality class/workshop, and going to BDSM parties were uncommon (each <8%). More Americans identified behaviors as “appealing” than had engaged in them. Romantic/affectionate behaviors were among those most commonly identified as appealing for both men and women. The appeal of particular behaviors was associated with greater odds that the individual had ever engaged in the behavior. This study contributes to our understanding of more diverse adult sexual behaviors than has previously been captured in U.S. nationally representative probability surveys. Implications for sexuality educators, clinicians, and individuals in the general population are discussed.

Investigating the Suitability of the Asynchronous, Remote, Community-based Method for Pregnant and New Mothers

Traditional qualitative research methods, such as, interviews and focus groups, may not be feasible for certain populations- who face time, mobility, and availability constraints. We adapted the Asynchronous, Remote, Community-based (ARC) method that used closed Facebook groups to study people with rare diseases, to study a different population - pregnant and new mothers. During the course of eight weeks, we engaged 48 participants in 19 study activities using three closed Facebook groups. We added new activities to the original ARC method, informed by past HCI research, to triangulate participant input. We carefully analyzed participation patterns and activity engagement, to assess the suitability of the ARC method for engaging pregnant and new mothers in remote, group-based, qualitative research. We provide an in-depth analysis of the ARC method, noting participation characteristics, activity preferences, and the suitability of the ARC method as an online focus group.

Performing purity: reproductive decision-making and implications for a community under threat of zika in iquitos, Peru

Abstract The long-term management and prevention of Zika virus requires understanding of reproductive and sexual health behaviours, including mechanisms of partnered decision-making. In this article, we report on a qualitative study conducted before the arrival of Zika in Iquitos, Peru. We assessed existing patterns of reproductive decision-making among partnered men and women in a community under threat of Zika and discuss how these may impact Zika prevention in the long-term. We used a rapid qualitative assessment methodology, including in-depth semi-structured interviews with partnered women (28) and men (21). Deeply unequal gender role expectations limit discussion of reproductive decisions until after a first child is born. Women needed to perform a domestic ‘of-the-house’ role to be considered suitable partners, leading them to hide their knowledge of sexual and reproductive health. Condoms symbolise risk and are unused with partners in committed relationships. A shared perception that men must take care of female partner’s sexual health, translates into male sexual and reproductive preferences overcoming female desires. Existing decision-making patterns lead to an increased risk of Zika exposure. Long-term response should expand Zika virus information and preventive messages to men and young people, in addition to engaging with broader societal challenges to gender inequity.

let me know if you need anything: support realities of new mothers

This paper presents findings from a study conducted with 48 pregnant and new mothers to understand their support needs and support sources. We engaged 10 first-time pregnant women, 20 pregnant mothers, and 18 new mothers in eight weeks of research activities using closed Facebook groups. The activities included surveys, open ended questions, creative tasks, and discussions. Our findings indicate that mothers most value instrumental support: physical help in tasks, such as laundry and cooking. Our findings also show that support needs and support sources of women evolve as they go through pregnancy, childbirth, and stages of motherhood. Informed by these findings, we propose a design framework - the Evolving Ecology of Support (EES) - and provide examples on how the Pervasive Health community can develop empowering and support enabling solutions.

Racial disparities in birth care: Exploring the perceived role of African-American women providing midwifery care and birth support in the United States

BACKGROUND Midwifery care has been linked to positive birth outcomes. Despite the broad racial disparities in maternal and infant outcomes in the United States (US), little is known about the role of minority women in either providing or receiving this type of care. A vibrant community of minority women, who self-identify as providing these services, exists online. In this exploratory study we ask how they describe their role; view their practice; and position themselves in the broader discussions of racial health disparities in the US. METHODS Using an internet mediated qualitative design we analyse online narratives from self-described African-American nurse-midwives, lay midwives and birth assistants; we found 28 unique websites. We collected and analysed narrative material from each site. We used a thematic analysis approach to identify recurrent and emergent themes in relation to the study question. RESULTS Narratives identified a strong link to the past, as providers viewed their practice in a historical perspective linking African roots, to the diaspora, and to current African-American struggles. Providers engaged both in direct clinical work, and in activist roles. Advocacy efforts sought to expand numbers of minority birth care workers and to extend the benefits of woman-centred birth care to underserved communities. CONCLUSION Results demonstrate the continued existence and important role of diverse types of African-American birth care providers in minority communities in the US. Recognition, support, and increasing the number of midwives of colour is important in tackling racial inequalities in health. Further research should explore minority access to woman-centred care.

Implementing a culturally appropriate birthing policy: Ethnographic analysis of the experiences of skilled birth attendants in Peru

Policies about skilled birth attendants (SBA) need to account for cultural acceptability of care rendered by SBAs. Few studies have assessed these policies from the perspective of SBAs. I identify challenges and analyze the experiences of SBAs implementing a culturally appropriate birth care policy in Peru. I collected data during 15 months of ethnographic research: conducting semi-structured interviews and informal conversations with 5 SBAs in 2 villages and with health officials. I compared interview results with my observations of consultations and of labor and delivery. Weak institutional support, lack of training, negative perceptions of the policy inhibited implementation, as did detrimental effects on future personal and professional opportunities. SBAs in Peru face many challenges when trying to establish intercultural birth care. My recommendations include provision of focused training, promoting a more diverse workforce, and increasing community engagement.

Perceived health concerns among sexual minority women in Mumbai India: an exploratory qualitative study.

Abstract The experiences of sexual minority women (i.e., women who do not identify as ‘heterosexual’) in India have largely been absent in scientific literature. In partnership with India’s oldest and largest sexual and gender minority-advocacy organisation, the Humsafar Trust, our study used community-based participatory research principles to explore the lived experiences and health concerns of sexual minority women in Mumbai. Study methodologies included interviews with key informants, a focus group comprised of six women, and an additional 12 in-person interviews with sexual minority women to identify important physical, mental, social and other health priorities from these women’s perspectives. Thematic data are organised within the framework offered by the social ecological model, including individual, interpersonal, micro and macro levels. Findings from this study are important in providing the groundwork for future research and intervention involving sexual minority women in India, a dramatically underserved population.

Social support relationships for sexual minority women in Mumbai, India: a photo elicitation interview study

Abstract Little research exists on women who do not identify as heterosexual in India. Social support for sexual minority women may protect against the effects of discrimination. An examination of significant social relationships may point to both strengths and weaknesses in this support. We aimed to understand relationship prioritisation and communication patterns associated with the social support of sexual minority women in Mumbai. In partnership with the Humsafar Trust, India’s oldest and largest sexual and gender minority-advocacy organisation, we conducted photo-elicitation interviews with 18 sexual minority women, using participants’ photographs to prompt dialogue about their social support. Intimate partners were a source of dependable support and many of those without relationships were seeking them. Participants’ extended networks included friends and family as well as less formal relationships of social support. Participants mediated their communication with particular social network members, which involved filtering information sexual identity, romantic interests, and personal aspirations, among others. The diverse relationships that sexual minority women have in their social support networks may be used to guide programmes to improve health outcomes.

Exploring Provider Perspectives as Barriers and Facilitators to Implementation of Quality Family Planning Recommendations at Title X Clinics: A Qualitative Study

BACKGROUND In 2014, the Centers for Disease Control and Prevention and the Office of Population Affairs released a document entitled Providing Quality Family Planning Services (QFP), which outlined recommendations for delivery of family planning services using a client-centered approach. These aimed to standardize service provision and address numerous reproductive health challenges. To date, little is known about QFP implementation or the factors influencing its adoption by clinicians. STUDY DESIGN Semistructured interviews were conducted with 16 family planning providers at Title X-funded clinics in Indiana and Missouri to measure provider attitudes toward the QFP, their influence on adoption of the recommendations, and other barriers to QFP implementation. Interviews were transcribed verbatim and analyzed in Nvivo. Using the diffusion of innovation theory as a framework, we identify themes related to innovation adoption. RESULTS Findings suggest that a providers values related to client-centered counseling and views regarding the relative advantage of the QFP are key factors influencing adoption. Participants identified a number of structural and interpersonal barriers to implementation including misinterpretation of the QFP and billing issues. CONCLUSIONS Although participants expressed that QFP was an improvement over previous guidelines, misalignment of the recommendations with professional values and experiences, lack of clarity of the guidelines, and logistical issues serve as major barriers to adoption and implementation. These findings inform our understanding of policy adoption. Increased training and precise messaging is necessary to improve adoption of QFP at Title X clinics.