Health Care Delivery For Women Research Articles

Optimizing the Equitable Deployment of Virtual Care for Women: Protocol for a Qualitative Evidence Synthesis Examining Patient and Provider Perspectives Supplemented with Primary Qualitative Data.

Women experience numerous barriers to patient-centered health care (e.g., lack of continuity). Such barriers are amplified for women from marginalized communities. Virtual care may improve equitable access. We are conducting a partner-engaged, qualitative evidence synthesis (QES) of patients' and providers' experiences with virtual health care delivery for women. We use a best-fit framework approach informed by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework and Public Health Critical Race Praxis. We will supplement published literature with qualitative interviews with women from underrepresented communities and their health care providers. We will engage patients and other contributors through multiple participatory methods. Our search identified 5525 articles published from 2010 to 2022. Sixty were eligible, of which 42 focused on women and 24 on provider experiences. Data abstraction and analysis are ongoing. This work offers four key innovations to advance health equity: (1) conceptual foundation rooted in an antiracist action-oriented praxis; (2) worked example of centering QES on marginalized communities; (3) supplementing QES with primary qualitative information with populations historically marginalized in the health care system; and (4) participatory approaches that foster longitudinal partnered engagement. Our approach to exploring virtual health care for women demonstrates an antiracist praxis to inform knowledge generation. In doing so, we aim to generate findings that can guide health care systems in the equitable deployment of comprehensive virtual care for women.

Midwives’ Experiences of Rural Maternal - Newborn Care in Ghana: A Phenomenological Inquiry

Midwives’ experiences of frontline healthcare delivery in rural maternal and newborn care have been minimally explored over the past two decades in low and middle-income countries but particularly in resource-limited settings, the situation is concerning. Understanding the dynamic influences that impact health care delivery in rural and remote settings is important for averting deaths, improving health outcomes and rural health care practice. Purpose: This study aimed to understand, unveil the meanings and articulate the experiences of midwives who practice in rural settings in rural Ghana. Sample: Thirteen (13) midwives who voluntarily participated in the study were purposively and conveniently sampled. Methods: Interpretive phenomenology that integrated African philosophy was used to explore and unveil the meanings embedded in the experiences of midwives practicing in South rural Ghana. Findings: The findings establish that midwives make sustained serial efforts to save maternal and newborn lives however, midwives’ ethnic background, age, gender and family situation influence their retention in rural health care settings where they work alone under stressful conditions as skilled care birth attendants. Community recognition and supportive community participation positively impact midwives’ practice in spite of unattractive living and working conditions. Future research needs to investigate the dynamic influences of chiefs, queen mothers and community leaders on emergency obstetric and newborn health care service delivery. Conclusion: The rural environment poses significant risks and barriers to safe and ethical health care delivery for women and newborns in Ghana. The intricate dynamics of midwives’ age and family life, limited support in skilled care delivery and community participation influences midwives’ intention to stay in rural practice. Keywords: Rural, Midwives, Pregnant Women, Labour, Newborns, Ghana DOI: https://doi.org/10.14574/ojrnhc.v21i2.654

Patterns of smoking and menopause-specific quality of life: smoking duration matters more

Evidence about the association of quantity of cigarettes smoked and duration of smoking with quality of life in menopause is sparse. The purpose of this study was to examine the association between smoking patterns and menopause-specific quality of life. This cross-sectional study included 513 consecutive midlife women at two primary health care centers in Belgrade, Serbia. Collection of data was carried out from February 2014 to January 2015, using three questionnaires: socio-epidemiologic questionnaire, Menopause-specific Quality of Life questionnaire (MENQOL) and Beck’s Depression Inventory (BDI). Women reported their smoking status (smoker, former smoker, non-smoker), the length of time spent smoking and quantity of cigarettes smoked per day. There was no difference in proportions of ever smokers compared to never smokers. However, there were more women who were current nonsmokers than current smokers. A linear regression model, adjusted for residency district, relationship status, educational level, employment, drinking alcohol, having exercise, age and BDI, showed that longer duration of smoking, but not number of cigarettes smoked per day, was associated with worse Physical domain and total MENQOL score. Receiver Operating Characteristic analysis showed that menopausal symptoms as measured by total MENQOL score were significantly less bothersome for women who smoked less than 10 years and significantly more intense in women who smoked 21 to 30 years. Midlife women should be encouraged to quit smoking as soon as possible, preferably before menopause. Strategies to prevent and quit smoking should be prioritized at all levels of health care delivery for women. Supplemental data for this article is available online at

Sex, Grief, and Psychic Trauma: Considering History and Politics in the Psychosexual Treatment of Women with FGC

This paper stems from a presentation given at the “Second International Expert Meeting on Female Genital Mutilation/Cutting (FGM/C): Sharing data and experiences, improving collaboration,” which took place at Centre Hospitalier Universitaire Ste. Justine, Montreal, Canada, in May 2018. It aims to shed light on the psychosexual health of women with female genital cutting (FGC), drawing from both scientific research and clinical work. This paper also addresses the inherent challenges to healthcare delivery for “cut” women and seeks to illuminate the social and historical realities that form the backdrop to the clinical encounter. While there is a vast body of literature on the psychological determinants of sexual health, studies on “cut” women’s sexual health have yet to delve into its psychological correlates. In addition, healthcare delivery for women with FGC poses a number of challenges, which impinge upon patient experience and health-seeking behavior. Ethical considerations in care delivery for women with FGC must delve into the hegemonic nature of the patient-practitioner interactions and politics of Otherness. Interdisciplinary research and praxis on FGC will prevent biological reductionism and the pathologization of these women. It will afford more integrated, comprehensive, and ethical care for women with FGC.

Delivering Care to Women who are Homeless: A Narrative Inquiry into the Experience of Health Care Providers in an Obstetrical Unit

The purpose of the study was to explore the experiences and perceptions of health care providers in an acute care setting delivering care to pregnant women who are experiencing homelessness. In recent years, the number of women experiencing homelessness has significantly increased. In North America, the emerging homeless profile is that of a younger person and more often women. Living in precarious housing situations increases one’s risk for serious health conditions. Women who are homeless often experience complex health issues but many intersecting barriers exist between homeless women and health care providers, which impacts the care provided. A better understanding of the health care providers who provide care is urgently needed. A narrative inquiry design was implement. We recruited 10 health care providers from antenatal, postpartum, and labour and delivery units in a large, urban tertiary care hospital. Using narrative inquiry methodology, and a conversation guide we explored care providers’ personal and professional experiences over time, place, and within social contexts. Conversations with participant were held 2 or 3 times. From participants’ narrative accounts, we identified four threads that were evident across their experiences: shaping and being shaped by institutional mandates, the importance of conversational spaces, the lack of interprofessional interactions and living with conflicted views about practice. Care practices are shaped by complex personal, interpersonal, and institutional factors. Contextualized learning experiences within health care settings may serve to encourage narrative reflective practices and support communities of practice with the ultimate goal to improve health care delivery for women in precarious housing situations.

Strategies and methods to study female-specific cardiovascular health and disease: a guide for clinical scientists.

BackgroundIn 2001, the Institute of Medicine’s (IOM) report, “Exploring the Biological Contributions to Human Health: Does Sex Matter?” advocated for better understanding of the differences in human diseases between the sexes, with translation of these differences into clinical practice. Sex differences are well documented in the prevalence of cardiovascular (CV) risk factors, the clinical manifestation and incidence of cardiovascular disease (CVD), and the impact of risk factors on outcomes. There are also physiologic and psychosocial factors unique to women that may affect CVD risk, such as issues related to reproduction.MethodsThe Society for Women’s Health Research (SWHR) CV Network compiled an inventory of sex-specific strategies and methods for the study of women and CV health and disease across the lifespan. References for methods and strategy details are provided to gather and evaluate this information. Some items comprise robust measures; others are in development.ResultsTo address female-specific CV health and disease in population, physiology, and clinical trial research, data should be collected on reproductive history, psychosocial variables, and other factors that disproportionately affect CVD in women. Variables related to reproductive health include the following: age of menarche, menstrual cycle regularity, hormone levels, oral contraceptive use, pregnancy history/complications, polycystic ovary syndrome (PCOS) components, menopause age, and use and type of menopausal hormone therapy. Other factors that differentially affect women’s CV risk include diabetes mellitus, autoimmune inflammatory disease, and autonomic vasomotor control. Sex differences in aging as well as psychosocial variables such as depression and stress should also be considered. Women are frequently not included/enrolled in mixed-sex CVD studies; when they are included, information on these variables is generally not collected. These omissions limit the ability to determine the role of sex-specific contributors to CV health and disease. Lack of sex-specific knowledge contributes to the CVD health disparities that women face.ConclusionsThe purpose of this review is to encourage investigators to consider ways to increase the usefulness of physiological and psychosocial data obtained from clinical populations, in an effort to improve the understanding of sex differences in clinical CVD research and health-care delivery for women and men.

Healthcare delivery for women in prison: a medical record review.

When women come into prison, many have unmet health needs. In this study we examine the health care provided to women in prison and their identified health needs, and discuss opportunities for improved healthcare delivery. We undertook a medical record review of women released from a minimum 6-week period of incarceration in New South Wales correctional centres between May 2013 and January 2014. Records from 231 periods of incarceration were reviewed. At reception, 52% of women were identified as having anxiety or depression. Hearing health was not documented despite 30% of records being of women from an Aboriginal and Torres Strait Islander background, a high-risk group for whom hearing screening is recommended. Most women had multiple in-prison clinical contacts, including interactions with general and specialised nurses (97%), general practitioners (65%) and psychiatrists (35%). At release, 49% were on psychotropic medication and most required ongoing management for: mental health (71%), substance misuse (65%) and physical health (61%) problems. External specialist appointments were pending in 7% at release. Health management plans generated in prison were not always completed before release for reasons including custodial factors and waits for hospital-based appointments. Provision of effective health care in prison requires improved integration with community health services, including timely access to a wide range of health services while women are in prison, and continuity of care at release.

Considerations about retirement from clinical practice by obstetrician-gynecologists

Retirement of obstetrician-gynecologists is becoming a matter of increasing concern in light of an expected shortage of practicing physicians. Determining a retirement age is often complex. We address what constitutes a usual retirement age range from general clinical practice for an obstetrician-gynecologist, compare this with practitioners in other specialties, and suggest factors of importance to obstetrician-gynecologists before retirement. Although the proportion of obstetrician-gynecologists ≥55 years old is similar to other specialists, obstetrician-gynecologists retire at younger ages than male or female physicians in other specialties. A customary age range of retirement from obstetrician-gynecologist practice would be 59-69 years (median, 64 years). Women, who constitute a growing proportion of obstetrician-gynecologists in practice, retire earlier than men. The large cohort of "baby boomer" physicians who are approaching retirement (approximately 15,000 obstetrician-gynecologists) deserves tracking while an investigation of integrated women's health care delivery models is conducted. Relevant considerations would include strategies to extend the work longevity of those who are considering early retirement or desiring part-time employment. Likewise volunteer work in underserved community clinics or teaching medical students and residents offers continuing personal satisfaction for many retirees and preservation of self-esteem and medical knowledge.

Women’s perception of quality of maternity services: a longitudinal survey in Nepal

BackgroundIn the context of maternity service, the mother’s assessment of quality is central because emotional, cultural and respectful supports are vital during labour and the delivery process. This study compared client-perceived quality of maternity services between birth centres, public and private hospitals in a central hills district of Nepal.MethodsA cohort of 701 pregnant women of 5 months or more gestational age were recruited and interviewed, followed by another interview within 45 days of delivery. Perception of quality was measured by a 20-item scale with three sub-scales: health facility, health care delivery, and interpersonal aspects. Perceived quality scores were analysed by ANOVA with post-hoc comparisons and multiple linear regression.ResultsWithin the health facility sub-scale, birth centre was rated lowest on items ‘adequacy of medical equipment’, ‘health staff suited to women’s health’ and ‘adequacy of health staff’, whereas public hospital was rated the lowest with respect to ‘adequacy of room’, ‘adequacy of water’, ‘environment clean’, ‘privacy’ and ‘adequacy of information’. Mean scores of total quality and sub-scales health facility and health care delivery for women attending private hospital were higher (p < 0.001) than those using birth centre or public hospital. Mean score of the sub-scale interpersonal aspects for public hospital users was lower (p < 0.001) than those delivered at private hospital and birth centre. However, perception on interpersonal aspects by women using public hospital improved significantly after delivery (p < 0.001).ConclusionsOverall, perception of quality differed significantly by types of health facility used for delivery. They rated lowest the supplies and equipment in birth centres and the amenities and interpersonal aspects in the public hospital. Accordingly, attention to these aspects is needed to improve the quality.

Using Research to Transform Care for Women Veterans: Advancing the Research Agenda and Enhancing Research–Clinical Partnerships

The purpose of this paper is to report on the outcomes of the 2010 VA Women's Health Services Research Conference, which brought together investigators interested in pursuing research on women veterans and women in the military with leaders in women's health care delivery and policy within and outside the VA, to significantly advance the state and future direction of VA women's health research and its potential impacts on practice and policy. Building on priorities assembled in the previous VA research agenda (2004) and the research conducted in the intervening six years, we used an array of approaches to foster research-clinical partnerships that integrated the state-of-the-science with the informational and strategic needs of senior policy and practice leaders. With demonstrated leadership commitment and support, broad field-based participation, strong interagency collaboration and a push to accelerate the move from observational to interventional and implementation research, the Conference provided a vital venue for establishing the foundation for a new research agenda. In this paper, we provide the historical evolution of the emergence of women veterans' health services research and an overview of the research in the intervening years since the first VA women's health research agenda. We then present the resulting VA Women's Health Research Agenda priorities and supporting activities designed to transform care for women veterans in six broad areas of study, including access to care and rural health; primary care and prevention; mental health; post deployment health; complex chronic conditions, aging and long-term care; and reproductive health.

Still Piecing It Together: Women's Primary Care

The 20-year anniversary of Women’s Health Issues is an opportune time to consider whether the past two decades have seen substantial progress in improving primary care for American women. At least as early as 1992, when Clancy and Massion (1992) described women’s health care as ‘‘a patchwork quilt with gaps,’’ health services researchers and health care providers have been aware of the unique challenges to providing coordinated, comprehensive, high-quality primary care services to women. One of the major issues is how to integrate and coordinate routine reproductive health services with other components of women’s primary care in a seamless delivery system. This is not a trivial question, because reproductive caredincluding, for example, contraceptive services, pregnancy-related care, infertility services, gynecological care, and gender-specific cancer screeningdis needed by all women at some point in their lives. Despite the fact that women are the majority of health care consumers, this issue has not beenwidely recognized by those promoting ideal conceptions of ‘‘primary care’’ or the newer concept of a ‘‘patient-centered medical home.’’ Have we made any progress at all? Historical patterns of care delivery based on the specialty areas of physicians, as well as on the ways in which health services are funded or reimbursed, have resulted in fragmented primary care for women. Most women have directly experienced fragmentation. Any womanwho has visited her family physician for a regular checkup and then had tomake a separate visit (with another copay) for a routine Pap smear understands that her convenience and needs are not foremost in the design of basic health services. Anywomanwhose obstetrician-gynecologist has told her that she has to go elsewhere for a cholesterol test knows that a reproductive health specialist does not provide comprehensive care. Any womanwho reports symptoms of postpartum depression or consequences of intimate partner violence to her

Outcomes Evaluation of St. Petersburg Russia Women's Wellness Center

Researchers demonstrate that investing in women's health yields great social and economic dividends, yet the health of women often receives little attention throughout the world. Women's wellness centers (WWCs) were established in the former Soviet Union beginning in 1992 under the sponsorship of the American International Health Alliance (AIHA) in conjunction with the United States Association for International Development (USAID) to provide a women-centered approach to primary care, providing access to a wide range of clinical services and educational outreach programs. Because the St. Petersburg Womens Wellness Center (WWC) is considered one of the more advanced centers and represents a microcosm of opportunities and challenges in women's health care delivery in the Russian Federation, a descriptive qualitative outcomes evaluation of the clinic was conducted. In the spirit of continuous quality improvement, interviews were conducted with childbearing women. Findings are categorized into the dimensions of access, privacy and comfort, communication with providers, comprehensiveness of care, and follow-up care. Strengths of the clinic include the “woman friendly” environment and educational offerings. Suggestions also were made by study participants for improvement of clinic services. Qualitative research can be translated into clinical practice guidelines for WWCs in Eastern Europe.

Collaborating For Change: Creating a Women's Health Network

The definition of women’s health has broadened and the women’s health movement has gained significant momentum over the past 2 decades. Over that period of time, many women’s health organizations and advocacy groups have lobbied successfully for increased funding for women’s health research, and heightened awareness of gendered health issues such as breast cancer, osteoporosis, and reproductive health (Greenberger, 1999; Mosca et al., 2001; Norinsky, 1979), At the local level, however, women’s health services and resources are often fragmented, scarce, and poorly coordinated. As a result of these deficiencies, many women are underserved and their health needs go unmet. The 18 National Centers of Excellence in Women’s Health, established through funding from the Department of Health and Human Services (DHHS) Office on Women’s Health (OWH), have demonstrated successful models of integrated health care delivery for women (Weisman & Squires, 2000). However, these clinical care centers are susceptible to changes in federal funding and singular institutional support (Collins, 2002). Recent published reports emphasize a greater need for interdisciplinary collaboration to strengthen the overarching women’s health agenda at the local and state levels, where policy relevant to

Federally Funded Comprehensive Women's Health Centers: Leading Innovation in Women's Healthcare Delivery

Women's healthcare has historically been fragmented, given the artificial separation of reproductive care from general medical care. Aiming to advance new care models for delivery of comprehensive, integrated clinical care for women, two federal agencies-the U.S. Department of Health and Human Services (DHHS) and Department of Veterans Affairs (VA)-launched specialized women's health centers (WHCs). Exemplars of comprehensive service delivery, these originally federally funded centers have served as foundations for innovations in delivering comprehensive care to women in diverse practice settings. Little is known, however, about details of their organization, staffing, practice arrangements, and service availability that might inform adoption of similar models in the community. Using comparable key informant surveys, we collected organizational data from the DHHS National Centers of Excellence (CoE) (n = 13) and the original VA comprehensive WHC's (n = 8). We abstracted supplemental data (e.g., academic affiliation) from the 2001 American Hospital Association (AHA) survey. All DHHS and VA women's health programs served urban areas, and nearly all had academic partnerships. DHHS centers had three times the average caseload as did VA centers. Preventive cancer screening and general reproductive services were uniformly available at all centers, although DHHS centers offered extensive reproductive services on-site more frequently, and VA centers more often had on-site mental healthcare. The DHHS and VA comprehensive WHCs share similar missions and comparable organization, education, and clinical services, demonstrating their commitment to reducing fragmented service delivery. Their common structural components present opportunities for further advancing women's quality of care across other systems of care.

Knowledge as power

As we launch this first issue of African Journal of Midwifery and Women's Health (AJM), we must think critically about our mission and the tools that can enhance fulfillment of this mission. The complexity of midwifery and women's health in Africa will be reflected in the journal, which will provide a forum for topical debates on clinical and professional issues. Research and education will be integral to each issue, encouraging advanced skills, knowledge transfer and academic discussions. Dissemination of information and utilization of knowledge will provide powerful tools in midwifery and women's health, to promote our professional image as well as improving health care delivery for women, children and their families.

Perception of Health Care Delivery in Israel: Women's Voices

In this article, we describe the results of nine focus groups in which women were asked to discuss their perception of the women's health care delivery system in Israel. The focus groups, held in Israel in 2001, included nearly 150 women with diverse demographic characteristics. This project solicited focused input from women of different ages from the periphery as well as highly populated areas. The responses were categorized into designated themes and are presented here to demonstrate the range of women's feelings toward health care. The qualitative findings of this research show that place of residence affects the women's sense of responsibility for their health and their use of private care. Age was found to affect knowledge and use of health information, the frequency of visits to the doctor, and the general level of satisfaction with the system. These findings are important to improve health care delivery and can serve as a basis for forging policy changes in Israel.

A controlled clinical trial of home care management versus hospital care management for preterm labour

Prenatal hospitalisation has not been shown to reduce perinatal morbidity and mortality, yet it is still the treatment of choice for women who experience preterm labour. Home care management may be an alternative means of delivering safe, efficacious and care for these women. The objectives of this controlled clinical trial were to examine differences in neonate's gestational age and birthweight, and antenatal stress, social support satisfaction, and family functioning among pregnant women receiving home care and those receiving hospital care management. Pregnant women experiencing preterm labour ( N=250) were randomly assigned to home care management (the experimental group [EG]) or hospital care management (the control group [CG]). A Perinatal Information Form was used to collect data on sociodemographic and pregnancy variables. The High-Risk Pregnancy Stress Scale, Brown's Social Behaviors Inventory, and the Family Assessment Measure III Dyadic Relationships Scale were administered to the women at randomisation (T1) and at 1-week (T2) and 2-weeks (T3) after randomisation. Gestational age and birthweight were similar in the two groups of neonates. Women in the EG reported that antenatal stress was significantly lower at T3 than at T1 and T2, while for those in the CG, antenatal stress was significantly lower at T3 than at T1, and significantly lower at T2 than at T1. Women in the EG were more satisfied with support from the male partner at T3 than women in the CG. There was no significant difference between the two groups in family functioning at T1, T2 and T3. These findings indicate that home care management is a safe and efficacious mode of health care delivery for women experiencing preterm labour.

What We Know and How We Know It: Contributions from Nursing to Women’s Health Research and Scholarship

In this first chapter, we trace the historical roots of nursing research and scholarship focused on protecting and promoting women's health. Beginning with Florence Nightingale, modern nursing's first researcher, who focused on the health impact of women's daily lives through her detailed observations of human behavior. More recently, nursing's contributions to women's health over the past 30 years have redefined women's health, proposed new frameworks for understanding women's health; provided reviews of the women's health literature across disciplines; developed communities of nurse scholars and researchers focused on new areas of women's health research; generated and expanded the knowledge base for women's health practice and education; promoted a global view of women's health; and proposed new models for women's health care delivery. Clearly, a community of nursing scholars, developed over the past 25 years, has contributed to advancing women's health knowledge and improving the health and well-being of women. Without the benefit of a crystal ball, we suggest that nursing will continue to provide leadership in the conduct and the application of research to improve women's health and women's lives.

The trends in health care delivery for women: challenges for medical education.

The author discusses four key trends in the U.S. health care delivery system that affect how women's health care is delivered: the restructuring of primary care, particularly in the context of managed care organizations; initiatives in quality assessment; changes in patterns of health insurance coverage; and threats to the health care safety net. She concludes that medical educators need to link training to these changes in the health care delivery system to prepare physicians to work effectively for women's health in the changing system and to help bring about appropriate, needed transformations of the institutions in which women's health care is provided. Specific recommendations for medical educators are given after the discussion of each trend.

Women's health and managed care: Promises and challenges

T his is an appropriate time to examine women’s health and managed care. With the rapid growth of managed care in today’s health care delivery system, managed care organizations are playing an increasingly important role in the health of women. As managed care quickly becomes the dominant source of health care delivery for women in both the public and private sectors, understanding its impact on the health of women is crucial. It is increasingly difficult to define what the term managed care means. According to the Congressional Budget Office, managed care encompasses a broad range of health care organizational arrangements that are intended to eliminate unnecessary and inappropriate care and to reduce costs.’ The spectrum of managed care includes tightly structured group and staff model health maintenance organizations (HMOs), more loosely structured network and preferred provider organization (PPO) models, and various hybrid products such as point of service (POS) arrangements. Although comparisons of the different models are limited, it is likely that each model will vary with respect to patient care, satisfaction, and costs. Managed care plans now finance care for more than half of privately insured individuals, 9% of Medicare beneficiaries, and 23% of Medicaid beneficiaries.2A The most rapid enrollment growth, particularly among the privately insured population, is occurring among the less-structured managed care arrangements. The number of enrollees in network and independent practice association (IPA) arrangements increased from 19 million in 1988 to 35 million in 1994, whereas group/staff HMO enrollment grew from 14 million to 16 million over the same period.’ The managed care industry also is characterized increasingly by for-profit health plans. More than half of managed care enrollees (58%) were in for-profit plans in 1994, compared with one-quarter in 1985.6 Given this changing managed care environment, there are many unknowns with respect to changes in access to and quality of patient care as well as health care costs.7 Studies are just beginning to provide information on how these different plans perform. This paper examines the impact that managed care is having on privately o 1996 by x-he Jacobs Institute insured women and on low-income women with Medicaid coverage. To unof Women’s Health derstand managed care’s effect on women with private insurance, an analysis Published by Elsevier Science Inc