Lynn M. Meadows

Balancing Culture, Ethics, and Methods in Qualitative Health Research with Aboriginal Peoples:

Including Aboriginal women in qualitative health research expands our understanding of factors that contribute to their health and well-being. As part of the larger WHEALTH study, we gathered qualitative health data on midlife Aboriginal women living both on and off reserves. Despite careful planning and a commitment to methodological congruence and purposiveness we encountered a number of challenges that raised ethical questions. We present how we addressed these issues as we attempted to produce ethical, culturally sensitive, and sound research in a timely fashion. This article provides important considerations for other researchers and funding bodies while illustrating the benefits of working with Aboriginal women as an under researched population.

Inuit women’s health in Nunavut, Canada: a review of the literature

Objectives. Inuit women face challenging health and wellness issues in Northern communities. Literature examining these contexts and the processes through which health is affected is virtually non-existent. The objective [corrected] of this review is to examine and consolidate the available literature on Inuit women`s health issues from the last decade in order to identify priorities for future research. Study Design. This study is a review of literature from the last decade. Inuit women`s health issues that have been raised in the literature and in various reports are examined within a health-determinants framework. Methods. Government reports and statistics, publications by Inuit organizations and publications available on MEDLINE were examined for this review. Results. Inuit women`s health is a crucial part of the health of their communities. Inuit women face serious health issues related to reproductive and sexual health, such as high rates of sexually transmitted infections and challenging circumstances surrounding childbirth. Wellness, suicide and stress are more significant issues for Inuit women compared with non-Inuit women. Food security and accessibility is an issue for all Northerners. Alcohol and substance abuse and exposure to violent situations endanger both the health and safety of Inuit women in many Northern communities. Conclusions. There exists an urgent need to better understand the mechanisms through which determinants of health affect Inuit women. As well as adding to the body of knowledge on health determinants in Canada, further examining these issues will provide valuable information for health policy decision-makers and program development in the North and facilitate the direction of resources to the necessary areas of health services provision in Nunavut.

Irritable bowel syndrome. An exploration of the patient perspective.

Although research into the etiology of irritable bowel syndrome (IBS) is extensive, this is not true for the patient experience of IBS. International population studies indicate that 15-20% of persons suffer from BS. IBS is one of the eight most common somatic symptom complexes that account for 23% of visits to primary care physicians. This article details the journey of IBS sufferers in their attempt to understand and manage their illness through documenting patient perceptions of the origin of the illness, their search for treatment, their present management strategies, and their need for information and control. A grounded theory approach is used Clinical practice protocols reflect the state of knowledge surrounding IBS: The variables are many and diagnosis and outcomes are uncertain. Farther, our data suggest there is a desperate need for support groups and opportunities for patients, physicians, and supportive others to share experiences and concerns.

After the Fall: Women's Views of Fractures in Relation to Bone Health at Midlife

ABSTRACT Past research has established the link between low energy fractures and the risk for future fractures. These fractures are potential markers for investigation of bone health, and may be precursors for osteoporosis. In spite of its significant public health burden, including burden of illness and economic costs, many individuals are not aware of the risk factors for and consequences of osteoporosis. This is a study of women aged 40 and older who experienced low energy fractures (e.g., from non-trauma sources and falls from no higher than standing height). We gathered data, using focus group interviews, about their experiences and understanding of the fractures in relation to bone health. Women often attributed the fractures to particular situations and external events (e.g., slipping on ice, tripping on uneven ground), and viewed the fractures as accidents. Women often felt that others are at risk for poor bone health, but believed that they themselves are different from those really at risk. Although the fractures are potential triggers for preventive efforts, few women connected their fracture to future risk. What is perceived by women (and others) as random and an accident is often a predictable event if underlying risk factors are identified. Only when there is more awareness of poor bone health as a disease process and fractures as markers for bone fragility will women, men and health care providers take action to prevent future fractures and established bone disease.

Health Promotion and Preventive Measures: Interpreting Messages at Midlife

In this article, the authors provide important insight into the cultural messages that midlife women receive about preventive health care. Data were collected from 24 rural women as part of an ongoing project on midlife women’s health. Kleinman’s model of the popular and professional health care sectors was used to examine the data. There is clear evidence of clashes between the orientations and expectations of these sectors. Women’s experiences reveal some consistent themes that contextualize their preventive health pursuits: time constraints, claims for expert knowledge, salience of family history, and the inclusion of nonallopathic resources as part of the professional realm. At the macrolevel, messages regarding women’s responsibility for their health are ubiquitous. At the microlevel, women must negotiate among competing messages and resources and a health care system that often confounds their efforts. These contradictions must be addressed before there are long-term effects on the health of midlife women.

Methodological congruence in complex and collaborative mixed method studies

Abstract The concept of methodological congruence has gained more attention due to the need for careful planning of coherence and purpose among parts of research studies. The complexity of the study, the goals of the study, and the research questions that focus the study must all be taken into consideration. Maintaining methodological congruence, therefore, is an important aspect of employing multiple methods and ensuring study validity. In this study we sought to understand the impacts of social context on processes of adaptation, integration, and maintenance of a new program within a health system. This article clarifies the terms used in mixed method and mixed strategy studies and offers a case example of how methodological strategies can be integrated and used to foster triangulation and validity in the data by giving attention to methodological congruence at all stages of research.

Women’s Perceptions of Future Risk After Low-Energy Fractures at Midlife

PURPOSE Low-energy fractures experienced by women at midlife and beyond place them at increased risk of future fractures and may be early indicators of low bone density. We report here on women’s postfracture narratives to provide insight into how family physicians might tailor their messages to patients in communicating risk. METHODS An interview guide was used in face-to-face interviews with women aged 40 years and older. Patients were asked to describe their fracture experience and recovery during the subsequent year. Interviews were audiorecorded and transcribed verbatim. Analysis was done initially using an immersion-crystallization approach. RESULTS Twenty-two women participated in this research. The analysis showed women’s reactions to information about their risk fell into 3 groups. The first took a laissez faire approach, preferring to wait and see what the future held. The second group recognized some of the things they should be doing but were inconsistent in maintaining changes or seeking relevant information. The third group saw information about future risk as salient and important to their daily lives. They actively sought out information, including discussions with their family physicians. CONCLUSIONS Discovering whether patients have had an injury and, if so, how they perceive future risk is important because the invisibility of this health hazard calls for vigilance early on in women’s lives. Family physicians can help patients move from perceiving the fractures as isolated accidents to understanding them as indicators of future risk by discussing the importance of bone health in the short and long term.

Public Participation for Women's Health: Strange Bedfellows or Partners in a Cause?

A major focus of health system reform in Canada has been the regionalization of health services administration. With a goal of bringing decision-making closer to the community, there has been a commitment to public participation in planning by some health authorities. Women, however, often feel that their participation is minimal or their needs are not addressed. During regionalization of the Alberta health system, the Calgary Health Region (CHR) negotiated an agreement with the Salvation Army to provide womens health services through the Grace Womens Health Centre, a major part of the regions womens health program. We present a case study exploring the process and final agreement and the impact of this agreement on womens participation in health policy development. The historical context and the nature and impact of the agreement are described and several participation strategies that occurred within the partnership are discussed. The development of a formal partnership agreement, a governance model, was a success for public participation in this case; however, the greatest success for women was maintenance of a political space in which womens health as a priority could be discussed in a context where the forces against gender equity talk are strong.

Using Mixed Methods to Facilitate Complex, Multiphased Health Research

From conceptualization to application and evaluation, research is conducted in a context of increasing complexity of disciplines, goals, communities, and partnerships. Researchers often are challenged to demonstrate the rigor of their methods and results to audiences with diverse backgrounds and disciplinary expertise. This article illustrates the benefits of using mixed methods approaches in research designed to address issues in complex research projects. It outlines the implementation of a private, public, and academic partnership, where scientific merit of methods and results was a critical foundation to the development of public policy. The overall goal of the Public Health Leadership Competencies Project (the Project) was to identify public health leadership competencies that could apply to public health practice across the country. This research demonstrates how mixed methods research in public health might be of perceived benefit to complex projects. The Project included challenges and opportunities through multiple phases of data collection and participation of members from each of the seven disciplines in public health (i.e., public health dentists, physicians, dietitians, and nurses, as well as epidemiologists, health promoters, and environmental health inspectors). The discussion addresses challenges of a national project, the complex organizational framework within which we were directed to work, and the lessons associated with using multiple sources of data.

Women's health resources: facilitating a community of care for midlife women.

Since 1981 research has explored the role of womens health centres in providing health information and education to women in a non-traditional setting. These settings have been designed to provide more appropriate, and often more comprehensive, care by responding to the specific health issues and needs of women across the age continuum. The type of care and resources provided by these centres make a significant contribution to womens capacity for participation in decisions and action around their own health. This article examines the service delivery and perceived roles of one such centre, the Womens Health Resources (WHR) centre in Calgary, Canada. Data for this paper were extracted from WHR evaluation forms for 199 midlife women seeking individual consultation, as well as personal interviews that were conducted with four female staff members. Clients of the WHR cited numerous reasons for seeking service at the centre, the most common being for emotional health care, nutritional consultation or more comprehensive information on a specific illness. Three major components of service provision at the centre were identified: information, psychological care and complementarity of services. Women used the information they gained from WHR services to aid in health decision-making and as a resource for empowerment in being partners in their own health. Clients noted that the WHR was a valuable source of additional information beyond what their own family physician and/or specialist were able to provide. The feminist and woman-centred care at WHR, in conjunction with the emphasis on education, offers an invaluable source of information and services for women. Through the shared experiences of both the clients and staff of this centre, this article provides an outline of how such services are perceived and utilized.