Unconscious collusion: An interpretative phenomenological analysis of the maternity care experiences of women with obesity (BMI≥30kg/m²).

BACKGROUND: obstetric and midwifery literature continually emphasise incidence and consequence of obesity in pregnancy. However, they offer less consensus on how best to support women who are obese. Therefore, this study explores in depth the lived experience of women who have a Body Mass Index (BMI) ≥30kg/m². This exploration provides a bio-psycho-social understanding of the lived experience of women to identify how best to support them throughout their childbirth experience. METHODS: an Interpretative Phenomenological Analysis (IPA) design was adopted for this qualitative study. Purposive sampling of participants was conducted on the postnatal wards of a maternity hospital in the Republic of Ireland. In total, 15 participants volunteered to take part in semi-structured interviews conducted at six to ten weeks postnatally. Data were analysed utilising the IPA framework. FINDINGS: the results indicate that participants were conscious of the problematics of communicating obesity in pregnancy. The narrative data revealed an unconscious collusion between healthcare professionals and women as they navigate obesity related conversations. The behaviours related to unconscious collusion are incorporated in the sub-ordinate themes; 'just recorded and that's all', 'but what's eating healthy? 'pussy footing around' and 'I hate that word obesity. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the findings highlight a lack of information received by participants from healthcare professionals regarding increased BMI or weight management. The data suggests that healthcare professionals appeared to collude with women to avoid challenging discussions regarding obesity. This may be related to avoidance on participants' part and/or may be linked with healthcare professionals' reluctance to communicate issues relating to increased BMI. Although participants were generally unhappy with the communication skills of health professionals, they readily acknowledged the sensitive nature of obesity related communications. The findings provide healthcare professionals with an important insight into issues of effective communication and obesity related healthcare promotion from the woman's perspective in order to enhance provision of appropriate health information and maternity care to women who have an increased BMI.

Psychological distress and lifestyle of students: implications for health promotion.

Poor diet, physical inactivity, tobacco smoking and alcohol consumption are major risk factors for chronic disease and premature mortality. These behaviours are of concern among higher education students and may be linked to psychological distress which is problematic particularly for students on programmes with practicum components such as nursing and teaching. Understanding how risk behaviours aggregate and relate to psychological distress and coping among this population is important for health promotion. This research examined, via a comprehensive survey undergraduate nursing/midwifery and teacher education students' (n = 1557) lifestyle behaviour (Lifestyle Behaviour Questionnaire), self-reported psychological distress (General Health Questionnaire) and coping processes (Ways of Coping Questionnaire). The results showed that health- risk behaviours were common, including alcohol consumption (93.2%), unhealthy diet (26.3%), physical inactivity (26%), tobacco smoking (17%), cannabis use (11.6%) and high levels of stress (41.9%). Students tended to cluster into two groups: those with risk behaviours (n = 733) and those with positive health behaviours (n = 379). The group with risk behaviours had high psychological distress and used mostly passive coping strategies such as escape avoidance. The potential impact on student health and academic achievement is of concern and suggests the need for comprehensive health promotion programmes to tackle multiple behaviours. As these students are the nurses and teachers of the future, their risk behaviours, elevated psychological distress and poor coping also raise concerns regarding their roles as future health educators/promoters. Attention to promotion of health and well-being among this population is essential.

Public health nurse perceptions of empowerment and advocacy in child health surveillance in West Ireland.

OBJECTIVE: The objective of this study was to analyze public health nurses' perceptions of empowerment and advocacy within a child health screening and surveillance program in West Ireland. DESIGN AND SAMPLE: This study combined both qualitative and quantitative research methods. A purposive sample of 9 public health nurses (PHNs) (phase 1) participated in 2 focus groups and a purposive sample of 43 clients attending the child health screening service completed a questionnaire (phase 2). MEASURES: Focus groups and Questionnaires were used. RESULTS: Thematic content analysis revealed that PHNs in the study did not perceive themselves to be empowered in their work. They attributed this to workload, lack of professional advocacy, and restricted access to power and opportunity, while also identifying the need for continued managerial support and feedback. CONCLUSIONS: The results suggest that PHNs need to be empowered in order to facilitate client empowerment. PHNs struggled with empowerment and client advocacy. There is a need for professional development for PHNs in order to support them to more critically engage with empowerment and self-efficacy in their work. This needs to be done within organizational structures that support PHNs to critically analyze the role of advocacy and empowerment in their practice.

Gender implications of the teaching of relationships and sexuality education for health-promoting schools.

Relationships and sexuality education (RSE) was introduced in Irish schools in 1995 to address pressures on young people specific to relationships and sexuality. RSE is part of a whole school health promotion project. Emphasis is put on personal and social development of students, cross-curricular dimensions, school ethos, school climate and partnership with families and community. However, RSE has become the preserve of female teachers with fewer male teachers attending in-service. This research explored the attitudes, beliefs and needs of male post-primary teachers with regard to RSE in their school. A qualitative design was employed utilizing focus groups. A total of 25 male post-primary teachers took part in five focus groups. Two of the groups consisted of men who had participated in RSE training; the other three groups were with men who had not. The analysis of the data suggested that there was reluctance on the part of male teachers to teach RSE, and that they feel under threat about their personal and professional identity. They felt under threat both from internal personal forces, in the form of mental models assimilated through personal history and upbringing, and from external organisational forces, communicated through the local school and wider social culture. The data indicate the need for professional development and support that is tailored specifically for male teachers. In order to support male teachers to become more involved in school health promotion and in the teaching of health curricula, pre-service education needs to prioritize key issues such as gender roles and identity.