TransfOrming Transnational intErcultural sensitivity for Midwifery students through an inclusive mobility model: A mixed-method evaluation of the TOTEMM project.

BACKGROUND: Contemporary midwifery curricula require that student midwives have insight and understanding of global health practice and intercultural sensitivity. The current mobility model excludes large numbers of students from engaging in transnational learning. OBJECTIVES: 1) to evaluate midwifery students' experiences of blended mobility; 2) to investigate if the combination of virtual and physical mobility activities supported development of intercultural sensitivity and soft skills. DESIGN: Multi-centre mixed-methods study. SETTINGS: Four European Higher Education Institutions located in England, Italy, Estonia and The Netherlands. PARTICIPANTS: Sixty-four midwifery students studying in one of the four partner institutions selected as study sites and who participated in the TOTEMM blended mobility scheme took part in the evaluation. METHODS: Data were collected through two online surveys, face-to-face focus groups and learning analytics. Descriptive summary statistical analysis of survey data was undertaken. Focus group discussions were subjected to thematic analysis. Findings from the quantitative survey and qualitative focus groups were merged using a convergent mixed methods approach. Learning Analytics were interpreted as complementary to the above components, to further triangulate the findings. RESULTS: Both virtual and physical components were evaluated positively by students, with high engagement confirmed by learning analytics. A statistically significant increase in the mean of the Total Intercultural Sensitivity Scale score was seen between the pre- and post-mobility surveys, indicating participation in the TOTEMM mobility model was associated with enhanced intercultural sensitivity. Positive effects on confidence, open-mindedness, empathy, interaction and non-judgment were shared by participants. CONCLUSIONS: TOTEMM is an innovative inclusive approach to enable a diverse student group to benefit from transnational learning, including the development of intercultural sensitivity. The TOTEMM blended mobility model has potential for integration into future midwifery curricula and programmes in the four partner settings involved in TOTEMM and utility for the wider European context.

Existing Health Practices in Shaping the Decision to Participate During Breast Cancer Screening Among 50-69 Years Old Women in Estonia.

Introduction: Breast cancer is easily detectable by mammography and many countries run national screening programs for women as a target group. Yet, the majority of these countries have screening participation rates below the recommended level of 70%. Objective: The aim of the present article was to examine a connection between existing health practices and a decision to participate during breast cancer screening. Methods: Methodologically, this research was a web panel and quantitative telephone survey. The survey was conducted among 1200 Estonian women in the age group 50-69 years. Statistical data analysis was performed with SPSS using a descriptive and logistic regression model. Results: The findings revealed that among different background variables, age and existing health practices significantly influenced the decision-making for participating in the screening. Results also highlighted that the possibility to participate in the screening increased with existing supportive health practices and with the increasing age. Other sociodemographic factors did not have a significant influence on the decision-making of participation. Conclusions: There is a need to educate people from an early age about the developments in health practices that could support a healthy lifestyle in terms of individual responsibility. Thus, public health campaigns should not only call for action but also focus on health education in terms of the role of preventive medicine and health practices.

Practice theoretical approach on the reasons why target group women refrain from taking breast cancer screening.

OBJECTIVE: Breast cancer is the most common cancer in women. Despite the availability of effective breast cancer screening programmes, there are only six countries in the European Union reaching the recommended target rate of 70% screened. In addition to the individual reasons for refraining from breast cancer screening, this research aims to follow earlier suggestions to use a practice theoretical approach. METHODS: The study sites were Estonia and Latvia, where 9 and 12 semi-structured interviews were conducted, respectively. Convenience and snowball sampling methods were used. The research was approved by ethics committees in both countries. The interviews passed textual analysis and coding. RESULTS: The findings revealed that there are three major types of reasons - habitual, practical, and emotional - that influence the formation of the final decision to participate in breast cancer screening. CONCLUSION: The implementation of an individualistic approach is not sufficient to bring along desired health behaviour. All groups of reasons, individual and societal context are involved in the decision formation. Thus, structurally provided approaches and messages should be re-conceptualised and re-designed accordingly. PRACTICE IMPLICATIONS: Future screening related campaigns and public health education should address the concerns derived from different types of reasons for refraining from screening.

The rising impact of civic activism on health policy: The analysis of the closure of smaller obstetric units in Estonia.

In 2017, the Estonian government performed an administrative reform with the promise to keep vital services available for people. In March 2018, the closure of two smaller obstetrics units (OU) was announced, thereby raising resistance by community members. The aim of the research is to identify public perceptions and information needs during the closure process of smaller maternity units, and examine it in the context of recently performed administrative reform. Data was collected from 226 respondents via a web-based questionnaire. To evaluate the level of information seeking activity for pregnancy- and birth-giving-related information, new aggregated index variables were constructed. For authorities and lay-people "near home" and "safety" had different meanings in the context of childbirth. Findings revealed strong correlations between perceived information availability and sufficiency (for pregnancy, birth-giving and transfer to the hospital). The subjective lack of information appeared in recognition of the start of the labour and how, when, and where to go. Respondents considered both the medical capability and personal aspects to be equally important. Considering the lack of knowledge and hesitancy among Estonians, the arguments of civic activists presented in the debate were well-grounded. To conclude, public communication must be consistent and people need clearer instructions for activities related to labour-period and security that necessary features of medical help and personal approach to be both available.