Promoting health in lesbian and bisexual women: it is not just about behaviour change.

AIMS AND OBJECTIVES: To highlight different ways that healthcare professionals can promote health and reduce health inequalities of lesbian and bisexual women using a health promotion framework that focusses on the wider healthcare context. BACKGROUND: Lesbian and bisexual women experience numerous health disparities that place them at high risk of poor health outcomes. The Frieden health impact pyramid (American Journal for Public Health, 100, 2010 and 590) identifies five tiers of public health interventions. This pyramid could be used to promote health in lesbian and bisexual women in healthcare settings. DESIGN: A discursive paper. METHODS: Literature was searched from 2008-2015 using PubMed, ScienceDirect and published grey literature. Individual key words were used to locate articles that focused on lesbian and bisexual women's health inequalities and to identify the interventions to address these. RESULTS: Examples are presented across the tiers of the health impact pyramid in the context of healthcare settings that healthcare practitioners could action to promote health in lesbian and bisexual women. CONCLUSIONS: The use of the Frieden triangle offers an alternative way to promote health by conceptualising health promotion interventions that promote lesbian and bisexual women without just focusing on behaviour change. The importance of changing areas of practice in healthcare organisations to be more supportive of lesbian and bisexual women and their healthcare needs is highlighted. RELEVANCE TO CLINICAL PRACTICE: This study highlights the ways that healthcare professionals can promote health of lesbian and bisexual women within their healthcare practice to help reduce health disparities.

Stroke among African-Caribbean women: lay beliefs of risks and causes.

AIMS AND OBJECTIVES: To investigate African Caribbean women's subjective accounts of stroke and how this impacted on their lives and identify beliefs attributed to the causes of stroke in this post stroke. BACKGROUND: In the UK, those from African or African Caribbean ethnicity are at an increased risk of stroke, and stroke risks are double that of the UK White population. This is because diabetes and hypertension are more common in those of African and African Caribbean ethnic groups. The main risk factors for stroke are high blood pressure, alongside obesity and overweight, poor diet and lack of physical activity. DESIGN: A qualitative study using interpretative phenomenological analysis. METHODS: Data were collected via semi-structured indepth interviews for six African Caribbean women. Interviews were audio recorded and transcribed verbatim. Interpretative Phenomenological Analysis was used to deconstruct the data and facilitate developing themes. RESULTS: Six semi-structured interviews were completed with women aged 47-85 years. Two themes emerged (1) the role of lifestyle and biological risk factors linked to the causes of stroke and (2) the role of spirituality, in identifying the lay beliefs and causes of stroke. CONCLUSION: Alternative explanations of the causes of stroke that include witchcraft, or wishing someone wrong suggests a lack of perceived control over stroke. This may suggest a focus on less visible risk factors such as hypertension, familial history or diabetes and will need inclusion in health promotion materials. Lay beliefs such as witchcraft can co-exist amicably alongside modern medicine, as long as they do not hinder access to medication, treatment or risk factor management of stroke. RELEVANCE TO CLINICAL PRACTICE: The results demonstrated that nursing care and health promotion materials should emphasise on obesity, overweight and management of these through diet and physical activity to prevent stroke occurring.

The readability and suitability of sexual health promotion leaflets.

OBJECTIVE: To investigate the readability and suitability of sexual health promotion leaflets. METHOD: Application of SMOG, FRY and SAM tests to assess the readability and suitability of a selection of sexual health leaflets. RESULTS: SMOG and FRY scores illustrate an average reading level of grade 9. SAM scores indicate that 59% of leaflets are superior in design and 41% are average in design. Leaflets generally perform well in the categories of content, literacy demand, typography and layout. They perform poorly in use of graphics, learning stimulation/motivation and cultural appropriateness. CONCLUSION: Sexual health leaflets have a reading level that is too high. Leaflets perform well on the suitability scores indicating they are reasonably suitable. There are a number of areas where sexual health leaflets could improve their design. PRACTICE IMPLICATIONS: Numerous practical techniques are suggested for improving the readability and suitability of sexual health leaflets.

Life after Stroke: Coping mechanisms among African Caribbean Women.

In the UK, stroke is the third most common cause of death for women and the incidence in African Caribbean women is higher than that in the general population. Stroke burden has major consequences for the physical, mental and social health of African Caribbean women. In order to adjust to life after stroke, individuals affected employ a range of strategies which may include personal, religious (church) or spiritual support (i.e. prayer), individual motivation or resignation to life with a disability. This study explored these areas through the coping mechanisms that African Caribbean women utilised post stroke in the context of stroke recovery and lifestyle modification efforts needed to promote healthy living post stroke. A qualitative approach using interpretative phenomenological analysis was adopted. Seven women were recruited into the study. Semi-structured, in-depth interviews were audio recorded and were transcribed verbatim. Data were analysed using a four-stage framework: familiarisation, sense making, developing themes, and data refinement and analysis. Three main themes on coping emerged: the need to follow medical rules to manage stroke, strength and determination, and the use of religion and faith to cope with life after stroke. These findings illustrate both a tension between religious beliefs and the medical approach to stroke and highlight the potential benefits that religion and the church can play in stroke recovery. Implications for practice include acknowledgement and inclusion of religion- and church-based health promotion in post-stroke recovery.