Impact of no publicly accessible prenatal education programming on patients and their care providers: a descriptive qualitative study in Nova Scotia, Canada.

OBJECTIVE: Patients in Nova Scotia do not have access to public prenatal education programming. This study aimed to explore whether care providers find patients are uninformed or misinformed, and the impact of that on patients and their care providers with a focus on clinical outcomes, time, resources and informed decision-making. METHODS: Semistructured interviews were conducted with 13 care providers around Halifax and Cape Breton. An interview guide (supplemental) of open-ended questions was used for consistency. A descriptive qualitative approach was employed to describe the contents of the interviews. Each interview was audio-taped and transcribed verbatim by an interdependent transcriber. Transcripts were analysed using established techniques in qualitative descriptive research including coding, grouping, detailing and comparing the data using NVivo V.12 software. A co-coder (SS) independently coded two interviews for inter-rater reliability. RESULTS: The study revealed six themes: (1) concern for a significant population of Nova Scotians experiencing pregnancy, birth and postpartum uninformed and misinformed, (2) consequences for patients who are uninformed and misinformed, (3) more time and resources spent on care for patients who are uninformed or misinformed, (4) patients and their care providers need a publicly available education programme, particularly vulnerable populations, (5) emphasis on programme quality and disappointment with the programme previously been in place and (6) recommendations for an effective prenatal education programme for Nova Scotians. CONCLUSIONS: This study shows care providers believe a public prenatal education programme could improve health literacy in Nova Scotia. Patients are seeking health education, but it is not accessible to all and being uninformed or misinformed negatively impacts patients' experiences and outcomes. This study revealed excess time and resources are being spent on individualised prenatal education by care providers with high individual and system-wide cost and explored the complicated process of providing patient-centred care for people who are uninformed or misinformed.

A secondary mixed methods analysis examining midwives' responses regarding patient sexual orientation and gender identity (SOGI) disclosure.

OBJECTIVE: Recent research suggests that midwives generally have positive attitudes towards sexual and gender minority (SGM) clients; however, little research has examined whether and how these attitudes translate into specific clinical practices. In this study, we performed a secondary mixed methods analysis to examine midwives' beliefs and practices regarding the importance of asking and knowing their patients' sexual orientation and gender identity (SOGI). METHODS: A confidential, anonymous paper survey was mailed to all midwifery practice groups (n = 131) in Ontario, Canada. Participants were midwives who were members of the Association of Ontario Midwives who responded to the survey (n = 267). Sequential explanatory mixed methods analysis was employed: quantitative SOGI questions were analyzed first, followed by qualitative open response comments to explain and contextualize the quantitative findings. FINDINGS: Midwives' responses indicated that it was not important to know or ask about clients' SOGI because (1) it is not necessary to be able to provide the best care to everyone, and (2) the onus is on the client to disclose SOGI. Midwives indicated that they would like more training and knowledge to be able to confidently care for SGM. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Midwives' hesitancy to ask or know SOGI demonstrates that positive attitudes do not necessarily translate into current best practices for obtaining SOGI data in the context of SGM care provision. Midwifery education and training programs should address this gap.

Factors influencing ultra-endurance athletes food choices: an adapted food choice questionnaire.

Inadequate nutritional intake has been reported during ultra-endurance training and competition. While substandard nutritional knowledge may contribute to inappropriate nutritional choices, the relationship between these variables is often weak. As such, this study investigated the importance of a range of factors to the food choices of ultra-endurance athletes. An existing food choices questionnaire was extended to reflect the main factors proposed to influence the food choices of these athletes. The questionnaire was pilot tested with endurance athletes, during which, it was refined and reassessed for internal consistency and test-retest reliability. Subsequently, 101 experienced ultra-endurance athletes completed the amended questionnaire. Athletes also documented dietary restrictions or strategies employed in preparation for competition. The factors rated as important by the majority of the athletes were "provides me with energy", "do not cause me gastrointestinal discomfort" and, "are nutritious". Despite the high importance of the provision of energy, only 38.2% of participants reported following a high carbohydrate diet in preparation for competition. In addition, given that nutritious foods are typically high in fibre, it is likely that this factor may conflict with the avoidance of gastrointestinal discomfort. The potential incompatibility of these factors may help explain the observed suboptimal nutritional intake.