Homebound Women Research Articles

Sex-related differences in homebound advanced Parkinson's disease patients.

BackgroundWomen with Parkinson’s disease (PD) are more likely to be older, have greater disease severity and comorbidities, and yet are less likely to receive care from a neurologist, as compared with men with PD. Within the PD population, homebound individuals are a particularly vulnerable group facing significant barriers to care, yet within this understudied population, sex-related differences have not been reported.PurposeTo identify and describe differences in homebound men and women with advanced PD and related disorders, participating in an interdisciplinary home visit program.Patients and methodsThis was an exploratory analysis of homebound patients seen between February 2014 and July 2016 using data collected via in-person interviews and chart review.ResultsWe enrolled 85 patients, of whom 52% were women. PD was the most common diagnosis (79%), followed by dementia with Lewy bodies (5%), and other atypical parkinsonism (16%). Men were more likely to have a PD dementia diagnosis than women (17.1% vs 2.3%, p=0.03). Women were more likely to live alone (18.1% of women had no caregiver vs 2.4% of men, p=0.05).ConclusionThe role of the caregiver in facilitating safe aging-in-place is crucial. Among homebound individuals with advanced PD, women were far more likely to live alone. The absence of a spouse or care partner may be due in part to variable sex-based life expectancies. Our findings suggest that homebound women with advanced PD may face greater barriers to accessing support.

Health Seeking Behaviour of Women towards Reproductive Tract Infection : A Cross-Sectional Study at a Primary Health Level in Khashm Al'an , Saudi Arabia

Background: Reproductive tract infections (RTIs) are global burden and major public health concern, particularly in developing countries. If untreated, RTI's can lead to serious consequences such as ectopic pregnancy, cervical cancer and infertility and increase vulnerability to STIs. However, detection of disease and clinical diagnosis is largely dependent on patient’s awareness of RTI symptoms and attitude. There is limited publication on the subject in Gulf Arab states. Objectives: To describe the beliefs and health seeking behavior regarding RTIs among women of the reproductive age, and factors associated with poor knowledge and care seeking behavior for RTIs among Saudi women. Method: A cross-sectional study was conducted on total of 250 women who attended a primary health care clinic at Khashm Al’an in east of Riyadh, Saudi Arabia. Through a structured interview, participants gave data about demographics, knowledge of RTI's and care seeking behavior. Data were described in terms of frequencies and percentages. Relationships between nominal variables were explored by using Chi-square test. Statistical significance was set to 5% or less. Result: There were 62.8% of women who had heard of RTIs. Women, who were younger, educated, and employed or studying had higher awareness and knowledge on RTIs and sought medical care more than others. Women who were more aware, had experience, were younger, literate and not homebound were more likely to seek medical care if needed for RTIs. Television and Internet were significant sources of information for RTIs. Conclusion: Reproductive health awareness programs should focus on homebound, less educated and elder women. Television and internet are reliable resources for delivering reproductive health messages to the target population.

Incidents When Older Homebound Women Tried to Reach Help Quickly

During a longitudinal study of the experience of reaching help quickly, 34 homebound women (ages 85 to 97) who lived alone reported 106 reach-help-quickly incidents (RHQIs). The purpose of this study was to expand knowledge about RHQIs and intentions relative to them and to compare those facets of experience for subscribers to a personal emergency response system (PERS) and non-subscribers. We used a descriptive phenomenological method to analyze interview data, discerning six types of RHQIs, including finding myself down right here, realizing that I might not be alright after falling and getting up on my own, and realizing that something I cannot explain is or could be wrong with me. Intentions were focused on self-help before help seeking. The overall phenomenon was Handling a Situation When I Am Alone at Home and Probably Need Help Quickly. Practitioners should explore intentions about handling specific types of RHQIs and offer appropriate anticipatory guidance.

Gender and social geography: Impact on Lady Health Workers Mobility in Pakistan

BackgroundIn Pakistan, where gendered norms restrict women's mobility, female community health workers (CHWs) provide doorstep primary health services to home-bound women. The program has not achieved optimal functioning. One reason, I argue, may be that the CHWs are unable to make home visits because they have to operate within the same gender system that necessitated their appointment in the first place. Ethnographic research shows that women’s mobility in Pakistan is determined not so much by physical geography as by social geography (the analysis of social phenomena in space). Irrespective of physical location, the presence of biradaria members (extended family) creates a socially acceptable ‘inside space’ to which women are limited. The presence of a non-biradari person, especially a man, transforms any space into an ‘outside space’, forbidden space. This study aims to understand how these cultural norms affect CHWs’ home-visit rates and the quality of services delivered.DesignData will be collected in district Attock, Punjab. Twenty randomly selected CHWs will first be interviewed to explore their experiences of delivering doorstep services in the context of gendered norms that promote women's seclusion. Each CHW will be requested to draw a map of her catchment area using social mapping techniques. These maps will be used to survey women of reproductive age to assess variations in the CHW's home visitation rates and quality of family planning services provided. A sample size of 760 households (38 per CHW) is estimated to have the power to detect, with 95% confidence, households the CHWs do not visit. To explore the role of the larger community in shaping the CHWs mobility experiences, 25 community members will be interviewed and five CHWs observed as they conduct their home visits. The survey data will be merged with the maps to demonstrate if any disjunctures exist between CHWs’ social geography and physical geography. Furthermore, the impacts these geographies have on home visitation rates and quality of services delivered will be explored.DiscussionThe study will provide generic and theoretical insights into how the CHW program policies and operations can improve working conditions to facilitate the work of female staff in order to ultimately provide high-quality services.

Older homebound women's perceived risk of being unable to reach help quickly: Influence of situations involving age‐peers

The purpose of this facet of a longitudinal descriptive phenomenological study of the experience of reaching help quickly for older homebound women was to explore the personal-social context (life-world) of situations when age-peers had needed to reach help quickly (RHQ). Twenty-five women aged 85-95 (13 subscribers to a personal emergency response system and 12 non-subscribers) reported 80 peer situations. Life-world was characterized by sharing with peers the risk of being unable to RHQ. Knowledge of peer situations had varying degrees of influence on participants' decisions to adopt and use RHQ devices. Findings support the need for healthcare professionals to explore the influences of age-peer RHQ situations upon adoption and use of devices to RHQ by older homebound women.

Relationship Between Expanded Health Belief Model Variables and Mammography Screening Adherence in Women with Multiple Sclerosis

People with disabilities often find it more difficult to access health-care services than the general population, further jeopardizing their health and well-being. The purpose of this descriptive pilot study was to explore the relationship between variables of the Expanded Health Belief Model (EHBM) and adherence to mammography screening in a sample of homebound women with MS after completion of a National Multiple Sclerosis Society (NMSS) intervention, known as the "Home-Based Health Maintenance Program for Women with MS," that was conducted in Allegheny County, Pennsylvania. The intervention was conducted in the patients' homes and included education of the women and their partners on risk factors for breast cancer and instruction in breast examination techniques. The patients were also helped to make appointments for mammograms. This study derived its sample from the intervention program and used data on adherence recorded by the NMSS. After completion of the intervention, telephone interviews were conducted with women who met the inclusion criteria (N = 11). Descriptive statistics indicate that adherence can be successfully described using variables of the EHBM, including perceived susceptibility, perceived severity, perceived benefits, and self-efficacy. The instruments chosen for the research were well tolerated, useful, and efficient to administer and allowed for immediate assessment.

Intentions of Older Homebound Women With Regard to Reaching Help Quickly

The purposes of this longitudinal phenomenological study were to describe intentions of older women relative to reaching help quickly (RHQ), to place those intentions in personal-social context, and to compare intentions of subscribers to a personal emergency response system (PERS) and nonsubscribers. The 40 participants were aged 85 or older, resided alone, and needed help to leave home. Two contextual features ("recognizing my risk of being unable to RHQ" and "recognizing my need for a RHQ device to sustain myself") were basic to two phenomena ("negotiating reliance on people to reach quickly if I need help" and "reducing my risk of being unable to RHQ"). There was greater variation in intentions and context within each of the two naturally occurring groups (subscribers and nonsubscribers) than between them. Practitioners cannot assume that women intend to use available RHQ devices in specific situations; preventive nursing involves proactive exploration of intentions relative to RHQ.

Behind the veil

Subject area The case addresses issues related to value chains, sustainable businesses, business environment in emerging economies and cross-cultural issues. applicability/applicability This case would be best addressed by students in upper years of their undergraduate degree or at a Master's level. Case overview The case addresses a project conducted by MEDA in Pakistan which focused on developing a value chain in the embroidery sector with the end goal of improving the livelihood of homebound rural women. The case walks the students through the local cultural constraints, the project design the development of the various value chain actors and the most significant outcomes. The primary issue requires the students to evaluate the most appropriate exit strategy for MEDA which would not harm the existing networks and allow the whole value chain to continue sustainably. Expected learning outcomes To appreciate the complexity of value chain development while understanding the benefits and opportunities they offer. To understand the importance of sustainability and how this can be achieved using market tools. To grasp the concept of exit strategies in the context of development projects and explore various ways these can be structured. To identify the impact of culture on business environment. Integrating the poor into thriving markets. Business as a development tool. Supplementary materials Teaching notes

The Ball Mate/The S-911 Bracelet/Intentions of Older Homebound Women to Reduce the Risk of Falling Again/Simple LEASH®/PowerTel amplified telephones and accessories

The Ball Mate/The S-911 Bracelet/Intentions of Older Homebound Women to Reduce the Risk of Falling Again/Simple LEASH®/PowerTel amplified telephones and accessories

Reducing My Risk of Intrusion

In assessing home safety for older persons, nurses have checked home security or assessed fear of crime but neglected to explore intentions to reduce the risk of intrusion. To describe the intentions of old homebound women relative to reducing the risk of intrusion. A descriptive phenomenological method was used. The 40 participants (aged 85-98 years, M = 89.6) met criteria for age, living alone, and homebound status. Over 18 months, a series of tape-recorded interviews was completed, focusing on perceptions about changes in feeling safe at home and precautions to prevent the need to reaching help quickly. Data analyzed were drawn from interviews with the 32 women who reported intentions to reduce intrusion risk. Feeling safe in-place was contextual to recognizing intrusion risk and intentions to reduce the risk. Most women denied a recent change in feeling safe but reported intentions to reduce intrusion risk. The nine women who reported feeling less safe referred to various personal-social situations as explanatory. The five components of the phenomenon were keeping watch here, keeping out of harm's way here, preventing theft and vandalism here, discouraging people who might want to get in here, and keeping intruders out of here. Each component phenomenon was the umbrella for a variety of specific intentions to reduce intrusion risk. Each woman was intending to reduce intrusion risk in unique ways. When conducting home safety assessments, nurses should explore intentions to reduce intrusion risk and use that information as a basis for individualized interventions to promote safety, rather than relying on generic suggestions such as locking the door.

Contemplating What I Would Do If Someone Got in My House

There is little research guiding interventions to help old homebound women prepare to manage an intrusion event. During a phenomenological study of the experience of reaching help quickly, I compared intentions during a possible intrusion event for 9 women subscribing to a personal emergency response system and 5 nonsubscribers. The phenomenon of contemplating what I would do if an intruder got in my home had 4 components. Only 2 personal emergency response system subscribers voiced the definitive intention to use the personal emergency response system. Findings underpin a new empirical perspective of competence grounded in situations relevant to living alone at home rather than specific tasks of daily living.

From behind the veil: industry-level methodologies for disadvantaged communities in Pakistan

'Enterprise development' has evolved from the upgrading of individual businesses to the attempted advancement of entire industries using new approaches such as value chain development and making markets work for the poor. This change has resulted in an increased focus on macro-level issues such as enabling environments, trade agreements and national associations, and some policy makers question the relevance of programmes that target microenterprises. This paper presents the case of rural homebound women in Pakistan to illustrate that, although systemic analysis is essential to good programme design, projects that specifically target marginalized communities can produce significant results that would not be achievable through industry-level interventions alone. It provides an overview of MEDA's (Mennonite Economic Development Associates) work in Pakistan with sequestered women, a description of how the programme is attempting to integrate these homebound women into lucrative value chains, results of the programme to date, and conclusions relevant to the broader development industry.

Double Strain of Severe Obesity and Depression on Perception of Increased Diabetes Burden Among Homebound Older Women

Background: Obesity, depression, and diabetes, all of which are increasing in prevalence among older women, represent a growing public health problem. Objective: To determine the relationship of severe obesity and depressive symptomatology to perceived burden of diabetes. Design: Baseline data of 266 homebound older women were used to cross-sectionally examine the relationship of depression and severe obesity with an individual's perception of the burden of diabetes on daily activities. Results: The coexistence of depression and severe obesity was independently associated with increased burden of diabetes while depression or severe obesity individually was not. Discussion: Older adults who are severely obese with depressive symptoms may be at particularly high risk for adverse outcomes, and represent a growing public health concern with diabetes management or complications.

Gender Differences in Physical Performance, Body Composition, and Dietary Intake in Homebound Elders

ABSTRACT Considering that the most vulnerable subgroup of elders for poor nutritional status and functional decline is the increasing number of home-bound women, we examined gender differences in physical performance, body composition, and dietary intake in a randomly recruited sample of 345 home-bound elders (81% women, 48% black > 65% income < $750/month). After controlling for demographic and health-related factors, the results from multivariate analyses indicated that women were more likely than men to report the lowest nutrient intake and were 2.9 times more likely to be at the worst level of overall physical performance. These results suggest a heightened vulnerability of homebound older women to poor physical performance, low dietary intake, and increased Body Mass Index (BMI). Prospective research is now needed to examine the interrelationships between physical performance, dietary intake, and body composition among the growing homebound older population.

Telephone Group Work: Challenges for Practice

ABSTRACT The telephone conference call group is growing in popularity. The convenience, the anonymity, and the increased accessibility offered by this type of group enlarges the scope of group work practice. Along with its advantages, the telephone conference call group can present the worker and the members with challenges not encountered in a face-to-face situation. This paper looks at a telephone conference call group with four homebound elderly women and discusses five areas of difficulty identified during that experience. Illustrations depicting these difficulties are provided. Anticipating and preparing for the challenges can help the social worker to maximize the benefits of a telephone conference call group and to facilitate a rewarding experience for all of the participants.

Catharine Beecher and Charlotte Perkins Gilman: Architects of Female Power

When we first compare the writings of Charlotte Perkins Gilman with those of her great-aunt, Catharine Beecher, we are likely to conclude that the two could not have had more disparate notions about the kind of lives American women should lead. Beecher, who by the age of thirty-five had founded and supervised two female academies (the Hartford Female Seminary and the Western Female Institute), achieved recognition when her book, A Treatise on Domestic Economy, appeared in 1841. She became known as the proponent of a domestic ideology in which men and women by definition occupy spheres, the men's sphere being the public realm of commerce and politics, and women's the contained environment of the home. Giving free rein to the appetite for systematization and homology that had led her, years earlier, to impose Butler's Analogy of Religion on her students, Beecher developed a vision of gendered propriety in which a woman's arrangement of rolling parlor screens was subtly but undeniably linked to social and divine order. Powerfully reinforcing the boundary between private and public space, Beecher codified femininity in the spatial and material layout of the home, creating, thereby, a rhetoric of containment for women that passed itself off as a recognition of influence. The formulation of American womanhood as a pious blend of self-denial and influence exerted within the four walls of the home went over well with Beecher's audience. The Treatise was reissued fifteen times within fifteen years of its publication, and was given a second life when Beecher and her younger sister, Harriet Beecher Stowe, revised it as American Woman's Home in 1869. Gilman, by contrast, expended much of her intellectual energy trying to undo the domestic ideology to which her great-aunt so ambitiously contributed. In print and in public lectures, Charlotte Perkins Gilman attacked the nineteenth century's configuration of private space as woman's domain and its attendant generalizations about femininity. Whether speaking before a crowd at Cooper Union in New York, or addressing the readers of her own monthly magazine, the Forerunner, Gilman unflaggingly urged her audience to consider their logic in assigning women to the home. Hadn't the composition of home life altered radically between the beginning and final decades of the nineteenth century? Americans had witnessed the decided shift of productivity from the home to the factory. Who was to say that women, too, shouldn't resituate themselves outside of discrete homes (a question Gilman asked with characteristic inattention to the migration of working-class women into factories, and a habitual conflation-the legacy of her great auntof womanhood and middle-class interests)? With industrial capitalism having effected so many changes in American society, Gilman sought to remind people that the status quo of women as the overseers of the home was itself open to-in fact, in need of-change. As she queries in 1898, in her book Women and Economics: Is our present home life, based on the economic dependence of woman in the sex-relation, the best calculated to maintain the individual in health and happiness, and develop in him the higher social faculties? The individual is not maintained in health and happiness,-that is visible to all; and how little he is developed in social relation is shown in the jarring irregularity and wastefulness of our present economic system. (210) Like Catharine Beecher, Gilman links the role of women to the general health of the social system; the dependent and isolated situation of women in their separate homes generates irregularity and wastefulness within the larger economic system. Unlike Beecher, however, Gilman does not struggle to proclaim the influence of homebound women on society while maintaining that the two spheres are fundamentally separate. Rather, Gilman seeks to blur the distinction between private and public life. In her novel, Moving the Mountain, for example, Gilman proposes a community in which central housekeeping services and communal eating halls displace the labor of individual households, thus concentrating in the hands of a few the duties of the conventional housewife, while freeing the majority of women for a new range of unorthodox pursuits. …