"I Felt Powerful and Confident": Women's Use of What They Learned in Feminist Sexual Assault Resistance Education.

Research on women's response and resistance to sexual assault risk has informed the development of interventions to improve women's ability to effectively resist sexual assault. However, little is known about how women anticipate, navigate, and respond to risk following participation in sexual assault risk reduction/resistance education programs. In this study, we examined the information and skills used by university women who had recently completed the effective Enhanced Assess, Acknowledge, Act (EAAA) sexual assault resistance program. We analyzed responses from 445 women using descriptive statistics and content and thematic analysis. Just under half (42%) of women used at least one EAAA strategy in the following 2 years. Most women reported that their efforts were successful in stopping an attack. Women's responses included strategies both to preempt sexual assault threat (e.g., avoiding men who display danger cues, communicating assertively about wanted and unwanted sex) and to interrupt or avoid an imminent threat (e.g., yelling, hitting, and kicking). Women's use of resistance strategies worked to subvert gendered social norms and socialization. The results suggest that counter to criticisms that risk reduction/resistance programs blame women or make them responsible for stopping men's violence, women who took EAAA typically positioned themselves as agentic and empowered in their resistance.

A Master Class in Family Doctor Leadership: Evaluating an Innovative Program.

BACKGROUND AND OBJECTIVES: In family medicine, leadership is critical for health care delivery, advancing curricula, research, and quality improvement. Systematic reviews of leadership development programs in health care identify limitations, calling for innovative designs and rigorous assessment. Our objective was to evaluate the impact of applying master class principles to leadership development in academic family medicine. METHODS: We used mixed methods to assess the impact of an innovative master class program on 15 emerging leaders in a large academic department of family medicine. The program consisted of five sessions where family physician masters shared their wisdom, techniques, and feedback with promising leaders. Quantitative evaluation involved participants' ratings of each session's content and delivery using a 5-point Likert scale. We assessed postcourse semistructured interviews with participants qualitatively using descriptive thematic content analysis. RESULTS: Individual sessions were highly evaluated, with a combined mean of 4.82/5. Qualitative thematic analysis identified self-perceived increased effectiveness in leadership activities; increased confidence as a leader; increased motivation to be a leader; and perceptions of value from the program, contributing to what participants described as unexpected potential change within themselves. Themes related to effectiveness of the program were practical advice; networking; diverse topics; accessible speakers sharing personal stories; and small-group, informal, early-evening format. CONCLUSIONS: Master class concepts can be adapted to leadership development in academic family medicine, with evidence of early positive impact on participants' self-perception of leadership skills and confidence. Further research is warranted to assess organizational impact and applicability to other settings.

Deliberation on Childhood Vaccination in Canada: Public Input on Ethical Trade-Offs in Vaccination Policy.

BACKGROUND: Policy decisions about childhood vaccination require consideration of multiple, sometimes conflicting, public health and ethical imperatives. Examples of these decisions are whether vaccination should be mandatory and, if so, whether to allow for non-medical exemptions. In this article we argue that these policy decisions go beyond typical public health mandates and therefore require democratic input. METHODS: We report on the design, implementation, and results of a deliberative public forum convened over four days in Ontario, Canada, on the topic of childhood vaccination. RESULTS: 25 participants completed all four days of deliberation and collectively developed 20 policy recommendations on issues relating to mandatory vaccinations and exemptions, communication about vaccines and vaccination, and AEFI (adverse events following immunization) compensation and reporting. Notable recommendations include unanimous support for mandatory childhood vaccination in Ontario, the need for broad educational communication about vaccination, and the development of a no-fault compensation scheme for AEFIs. There was persistent disagreement among deliberants about the form of exemptions from vaccination (conscience, religious beliefs) that should be permissible, as well as appropriate consequences if parents do not vaccinate their children. CONCLUSIONS: We conclude that conducting deliberative democratic processes on topics that are polarizing and controversial is viable and should be further developed and implemented to support democratically legitimate and trustworthy policy about childhood vaccination.

"We Can Be Oppressed but That Does Not Mean We Cannot Fight Oppression": Narratives of Resilience and Advocacy From Survivors of Intimate Partner Violence.

Helping others has been identified as an important component in recovery and resilience for women following intimate partner violence (IPV). However, little is known about the experiences of women who are IPV survivors and who also engage in formal and informal violence against women (VAW) advocacy work, such as supporting IPV survivors in a social work role or volunteering on VAW advocacy committees. Using in-depth semistructured interviews with nine "survivor-advocates" who were part of a larger study on IPV and resilience, this study extends the existing literature to examine the multidirectional relationship between IPV, advocacy work, and resilience using narrative analysis. Three distinct narratives were identified in survivor-advocates' accounts of their experiences of abuse and advocacy work. The working through the abuse narrative focused on using the knowledge and experience from advocacy work that began prior to IPV to critically reflect on the abuse and its meaning for women. The second narrative, helping others, focused on using personal experiences of abuse to help other IPV survivors. The third narrative, personal strength, focused on a personal identity as a lifelong advocate and inner strength and determination as central to resilience. The findings of this study demonstrate the multitude of ways that engaging in advocacy work interacts with abuse experiences and women's recovery and resilience processes. The findings of this study can inform approaches for promoting resilience and recovery for IPV survivors and highlight the importance of cultivating a critical understanding of abuse to support resilience and recovery following IPV.

The state-of-play in physician health systems leadership research.

PURPOSE: This paper aims to review a decade of evidence on physician participation in health system leadership with the view to better understand the current state of scholarship on physician leadership activity in health systems. This includes examining the available evidence on both physicians' experiences of health systems leadership (HSL) and the impact of physician leadership on health system reform. DESIGN/METHODOLOGY/APPROACH: A state-of-the-art review of studies (between 2007 and 2017); 51 papers were identified, analyzed thematically and synthesized narratively. FINDINGS: Six main themes were identified in the literature as follows: (De)motivation for leadership, leadership readiness and career development, work demands and rewards, identity matters: acceptance of self (and other) as leader, leadership processes and relationships across health systems and leadership in relation to health system outcomes. There were seemingly contradictory findings across some studies, pointing to the influence of regional and cultural contextual variation on leadership practices as well entrenched paradoxical tensions in health system organizations. RESEARCH LIMITATIONS/IMPLICATIONS: Future research should examine the influence of varying structural and psychological empowerment on physician leadership practices. Empirical attention to paradoxical tensions (e.g. between empowerment and control) in HSL is needed, with specific attention to questions on how such tensions influence leaders' decision-making about system reform. ORIGINALITY/VALUE: This review provides a broad synthesis of diverse papers about physician participation in health system leadership. Thus, it offers a comprehensive empirical synthesis of contemporary concerns and identifies important avenues for future research.

Is postgraduate leadership education a match for the wicked problems of health systems leadership? A critical systematic review.

PURPOSE: There have been a growing number of leadership education programs for physicians. However, debates about the value and efficacy of leadership education in medicine persist, and there are calls for systematic and critical perspectives on medical leadership development. Here, we review evidence on postgraduate leadership education and discuss findings in relation to contemporary evidence on leadership education and practice. METHOD: We searched multiple databases for papers on postgraduate leadership development programs, published in English between 2007 and 2017. We identified 4,691 papers; 31 papers met the full inclusion criteria. Data regarding curricular content and design, learner demographics, instructional methods, and learning outcomes were abstracted and synthesized. RESULTS: There was modest evidence for effectiveness of programs in influencing knowledge and skills gains in select domains. However, the conceptual underpinnings of the 'leadership' training delivered were often unclear. Contemporary theory and evidence on leadership practice was not widely incorporated in program design. Programs were almost exclusively uni-professional, focused on discrete skill development, and did not address systems-level leadership issues. Broader leadership capacity building strategies were underutilized. A new wave of longitudinal, integrated clinical and leadership programming is observed. CONCLUSIONS: Our findings raise questions about persistent preparation-practice gaps in leadership education in medicine. Leadership education needs to evolve to incorporate broader collective capacity building, as well as evidence-informed strategies for leadership development. Barriers to educational reform need to be identified and addressed as educators work to re-orientate education programs to better prepare budding physician leaders for the challenges of health system leadership.

Notes on the development of health psychology and behavioral medicine in the United States.

A "standard" historiographical overview of the development of health psychology in the United States, alongside behavioral medicine, first summarizes previous disciplinary and professional histories. A "historicist" approach follows, focussing on a collective biographical summary of accumulated contributions of one cohort (1967-1971) at State University of New York at Stony Brook. Foundational developments of the two areas are highlighted, contextualized within their socio-political context, as are innovative cross-boundary collaboration on "precursor" studies from the 1960s and 1970s, before the official disciplines emerged. Research pathways are traced from social psychology to health psychology and from clinical psychology to behavioral medicine.

Vaginal health and hygiene practices and product use in Canada: a national cross-sectional survey.

BACKGROUND: The vaginal microbiome influences quality of life and health. The composition of vaginal microbiota can be affected by various health behaviors, such as vaginal douching. The purpose of this study was to examine the types and prevalence of diverse vaginal/genital health and hygiene behaviors among participants living in Canada and to examine associations between behavioral practices and adverse gynecological health conditions. METHOD: An anonymous online survey, available in English and French, was distributed across Canada. The sample consisted of 1435 respondents, 18 years or older, living in Canada. RESULTS: Respondents reported engaging in diverse vaginal/genital health and hygiene behavioral practices, including the use of commercially manufactured products and homemade and naturopathic products and practices. Over 95% of respondents reported using at least one product in or around the vaginal area. Common products and practices included vaginal/genital moisturizers, anti-itch creams, feminine wipes, washes, suppositories, sprays, powders, and waxing and shaving pubic hair. The majority of the sample (80%) reported experiencing one or more adverse vaginal/genital symptom in their lifetime. Participants who had used any vaginal/genital product(s) had approximately three times higher odds of reporting an adverse health condition. Several notable associations between specific vaginal/genital health and hygiene products and adverse health conditions were identified. CONCLUSIONS: This study is the first of its kind to identify the range and prevalence of vaginal/genital health and hygiene behaviors in Canada. Despite a lack of credible information about the impact of these behaviors on women's health, the use of commercially manufactured and homemade products for vaginal/genital health and hygiene is common. Future research can extend the current exploratory study by identifying causal relationships between vaginal/genital health and hygiene behaviors and changes to the vaginal microbiome.

Healthcare providers' perspectives on the acceptability and uptake of HPV vaccines in Zimbabwe.

BACKGROUND: Human papillomavirus (HPV) vaccines are a critical strategy in the prevention of cervical cancer, especially in countries like Zimbabwe where cervical cancer screening rates are low. In Zimbabwe, cervical cancer is the leading cause of cancer-related deaths in women but the HPV vaccine is not yet widely available. This study examined healthcare providers': (1) perceptions of current hospital practices and issues in cervical cancer prevention and treatment in Zimbabwe; (2) knowledge of HPV and HPV vaccines; and (3) perspectives on introducing HPV vaccination programs in Zimbabwe, including potential facilitators and barriers to successful implementation. METHOD: In-depth semi-structured interviews were conducted at a rural hospital with 15 healthcare providers in Zimbabwe. Interviews included eight main questions and a number of additional probes that reflected the study's purpose. Data were analyzed using thematic analysis. RESULTS: Participants reported that women are not consistently being screened for cervical cancer. There were generally low levels of knowledge about HPV and HPV vaccines, but participants asked many questions indicating a desire to learn more. Although they were highly supportive of implementing HPV vaccination programs in Zimbabwe, they also identified a number of likely psychosocial, cultural, and logistical barriers to successful implementation, including cost, vaccine schedule, and hospital infrastructure. However, participants also provided a number of culturally relevant solutions, including education and community engagement. CONCLUSION: This study provides insight from healthcare providers about barriers to implementation and possible solutions that can be used by policy makers, practitioners, and other stakeholders to facilitate the successful implementation of forthcoming HPV immunization programs in Zimbabwe.

The Experience of Resilience for Adult Female Survivors of Intimate Partner Violence: A Phenomenological Inquiry.

While resilience research in the context of intimate partner violence (IPV) is increasing, there remains little known about women's lived experience of resilience. Using a phenomenological approach, this study examined the experience of resilience for adult female survivors of IPV. Sixteen women who were currently experiencing or had previously experienced abuse by an intimate partner participated in semi-structured interviews. Resilience was experienced as multiple cognitive, emotional, and behavioral shifts across three theme areas: toward resistance, in the experience of control, and toward positivity. The results of this study suggest a number of applications for clinical practice and intervention.