El presente estudio analiza cómo la gestión de la comunicación es aplicada por un centro de salud privado en Lima, Perú, para promocionar la salud sexual y reproductiva, y de esta manera, generar cambios más saludables en los conocimientos, actitudes y prácticas de las personas. Se identificarán los medios utilizados para la planeación, gestión y evaluación de la campaña, y los factores que influyeron en su elección. También se analizará el desarrollo de la estrategia de comunicación planeada y la valoración de esta. Para realizar esta investigación con un diseño fenomenológico, y desde un paradigma interpretativo, la técnica de recolección de datos será la entrevista semiestructurada, que mantiene un equilibrio entre la estructura de una conversación guiada y la flexibilidad de poder utilizar un acercamiento creativo para aprovechar la entrevista desde distintos ángulos y enfoques que nos permitan conseguir resultados más fiables y certeros. El análisis de los resultados será temático. Bajo esta perspectiva, se identificarán a mayor detalle los patrones y los temas de mayor importancia en base al análisis de las entrevistas, obteniendo así una mejor comprensión del fenómeno en cuestión. / The present study analyzes how communication management is applied by a private health center in Lima-Peru to promote sexual and reproductive health and, also, contribute to generate healthier changes on people's knowledge, attitudes and practices. The resources applied for the planning and evaluation of the campaign will be identified, along with a justification for their use. The development of the planned communication strategy and its evaluation will also be analyzed. To carry out this research with a phenomenological design, and from an interpretive model, the data collection technique will be the semi-structured interview, which maintains a balance between the structure of a guided conversation and the flexibility to use a creative approach to take advantages of variety of angles and perspectives which will allow us to achieve more reliable and accurate results. The analysis of the results will be thematic. Through this perspective, it will be able to identify in greater detail the most important patterns and themes based on the analysis of interviews, thus getting a better understanding of the phenomenon in question. / Trabajo de investigación

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<p><b>Background:</b> Shared decision-making (SDM) increases patients’ involvement in their healthcare, extending the goal of patient-centered care provision. However, SDM is underexplored in women’s reproductive health, where choices about contraception and pregnancy are frequently value and lifestyle-dependent. Furthermore, limited research exists on SDM outside of the patient-physician dyad, preventing insight into how non-physician community-based healthcare professionals (HCPs) engage women in practice. Finally, little research takes a social-ecological approach to SDM, despite interaction of multiple levels of influence in women’s reproductive healthcare decision-making. Therefore, the purpose of this study was to explore women’s and HCPs’ experiences with SDM, including the various factors associated with how women make their reproductive healthcare choices.</p><p> </p><p><b>Methods: </b>This study consisted of three distinct, but interconnected phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18-45 living in Indiana who sought community-based or private healthcare for women’s reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician HCPs (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women’s reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using an expanded grounded theory framework. Constant comparative analysis identified emergent themes in both phases. Phase 3 consisted of an online survey. Women (18-45 years) living in Indiana who sought reproductive healthcare completed the survey (N=432). Multiple linear regression, chi-square analyses, and structural equation modeling were utilized to identify ecological factors associated with pregnancy and contraceptive shared decision-making.</p><p> </p><p><b>Results:</b><i> Phase 1)</i> Participants (n=22) wanted to be invited into healthcare discussions. Additionally, they wanted conversations to proceed organically, where HCPs listened to their needs, and supported and validated their choices. Though these behaviors did not always occur, they provided recommendations to enhance these experiences. Additionally, participants described quality of time was more important than quantity of time during appointments. Prior negative healthcare experiences specifically tied to HCP-interactions decreased women’s healthcare engagement. Additionally, social support system experiences were influential on women’s choices. Race also emerged as impactful toward decision-making, including Black women feeling less respected in care and making choices about their reproductive healthcare to ensure their voices were heard, such as enlisting Black doulas. <i>Phase 2)</i> HCPs noted patient-centered care was important to community-based care. They also noted the importance of contextualized decision-making approaches to ensure they could meet women’s varied needs. Results identified that outcome-oriented SDM concepts, including patient buy-in and investigative listening, were important for increasing SDM. HCPs suggested SDM improved healthcare experience beyond one visit. <i>Phase 3) </i>Structural equation modeling revealed access, social support, and patient-HCP relationship had significant relationships with contraceptive and pregnancy SDM. These models demonstrated good global and component fit, suggesting the importance of context in women’s health choices. Further, regression results demonstrated SDM was associated with higher reproductive healthcare quality. Additionally, utilizing community-based healthcare for reproductive health was associated with decreased contraceptive SDM scores.</p><p> </p><p><b>Conclusion: </b>Findings from this study provide practical considerations for extending SDM work in women’s reproductive health. In particular, results supported shifting SDM beyond the patient-physician dyad to include non-physician HCPs and HCPs in community-based healthcare settings. Women frequently access these services when seeking reproductive healthcare; thus, findings improve our understanding of the practical considerations researchers, policy-makers, and HCPs must make when promoting SDM in these settings. Furthermore, results revealed SDM use across multiple touchpoints, including community-based services, is imperative for women to achieve partnership in their healthcare. Thus, SDM provides a broader opportunity to enhance patient involvement across the spectrum of women’s reproductive healthcare. Incorporating women’s contextual needs and preferences improves HCPs’ insight into women’s experiences to further personalize care. Findings emphasize the importance of decisional space that include the various factors, agents, healthcare settings, and options that exist in reproductive health decision-making as these can shape women’s choices, and, subsequently, their SDM experiences. This mixed methods study allowed thorough insight into multiple stakeholder groups engaged in healthcare decision-making; thus, the results offer guidance on the verbiage, resources, and strategies to engage in SDM and strengthen patient involvement reflective of women’s lifestyle needs and HCPs’ existing workflow. Findings drive SDM practice into community-based healthcare and position it as the standard of care across healthcare settings.</p><br>

This study examines the accessibility and barriers that Polish immigrants face in public gynecological care in Sweden and explains their attitudes towards and frequency of gynecological visits. To understand attitudes of the research group, the study explores their knowledge about basic gynecological health topics such as Pap and HPV tests, HPV infections and vaccinations. Qualitative ethnographic methods were used in this research. Thirteen semi-structured interviews were conducted with 25 to 45-year old Polish women living in Stockholm, Sweden. Analysis was performed using descriptive and theoretical approaches. The results indicate several barriers to fully adapt to the Swedish healthcare system for Polish women. The barriers included the lack of understanding of how Swedish gynecological care works (division of specializations), problems in finding specialist care, an insufficient number of specialists, a lack of information in English or Polish, and a limited amount of knowledge among study participants about HPV tests and vaccinations. The adaptation of Polish immigrants to the Swedish system and their level of trust is influenced by their first experiences in Sweden, health literacy, experiences with the Polish private gynecological system, and the attitudes of partners and family with Swedish backgrounds or those who have long term experiences in Sweden.

Background: More than 13 million women worldwide have been forced to flee their home countries. Women with a refugee background have higher rates of ill health compared to the general population, with an increased risk for sexually transmitted diseases, sexual violence, and perinatal morbidity, contributing to a diminished sexual and reproductive health. Aim: To identify the self-experienced barriers that prevent sexual and reproductive health and wellbeing in women with a refugee background. Method: A general literature review using a qualitative content analysis on 17 original articles according to the 9 steps described by Polit and Beck. Results: Three main categories were found: Barriers to knowledge, Limited agency, and Barriers to care. Women experienced barriers due to shame, misconceptions, lack of knowledge regarding sexuality and reproduction, and limited sexual and reproducitve agency. Several factors contributed to barriers within a health care setting, and in access to health care. Conclusion: Barriers to sexual and reproductive health can cause suffering. Which barriers prevent women from acheiving sexual and reproductive health over times is highly individual. Nurses need to be knowledgeable about which barriers patients could be affected by in order to provide them with person-centered care, strengthen their empowerment, and improve their health. / Bakgrund: Över 13 miljoner kvinnor i världen är på flykt från sina hemländer. Kvinnor med flyktingbakgrund har sämre hälsa än övriga befolkningen. De löper ökad risk att drabbas av sexuellt överförbara sjukdomar, sexuellt våld samt ohälsa i samband med graviditet, vilka är bidragande faktorer till en försämrad sexuell och reproduktiv hälsa. Syfte: Syftet med studien var att identifiera självupplevda barriärer till en god sexuell och reproduktiv hälsa för kvinnor med flyktingbakgrund. Metod: Allmän litteraturöversikt där 17 originalartiklar analyserades med kvalitativ innehållsanalys. Studien följer Polit och Becks niostegsmodell. Resultat: Tre huvudkategorier framkom: Kunskapsbarriärer, Begränsat livsutrymme och Vårdbarriärer. Kvinnor upplevde olika barriärer som grundades i skam, missuppfattningar, bristande kunskaper om sex och reproduktion samt begränsat utrymme till sexuell och reproduktiv agens. Flera faktorer bidrog till hinder i vårdmöten och tillgången till vård. Slutsats: Barriärer till sexuell och reproduktiv hälsa kan orsaka lidande. Vilka barriärer som hindrar kvinnor med flyktingbakgrund att uppnå en god sexuell och reproduktiv hälsa över tid kommer vara högst individuellt. Sjuksköterskor behöver känna till vilka typer av barriärer de upplever för att på ett personcentrerat sätt stärka dem till ökad egenmakt och förbättrad hälsa.

Sexual and reproductive rights, like other human rights, are to be respected, protected and fulfilled by the state. Public authorities and welfare organizations thus have an obligation to conduct a work practice accordingly. Social services' supportive and promotive mission for individuals' living conditions should include SRHR in general, not least in the work with children and youths. Yet previous research points out many obstacles that obstruct a practice grounded in sexual and reproductive rights within different social work environments. This in turn makes it difficult to achieve better sexual and reproductive health. The aim of this study is to obtain a deeper understanding of how professional​​s at residential care centers within Malmö Stad experience the work related to youths sexual and reproductive health. Additionally the aim is to highlight the challenges involved in incorporating sexual and reproductive rights of placed youths. In order to achieve the purpose, a qualitative method was applied. Semi structured interviews have been conducted with six employees within said organizations. These objects of study all had professional experience in working close to the clients on behalf of social service's assignments. The empirics has been analyzed and interpreted based on theoretical concepts such as street-level bureaucracy and discretion. The findings are also related to previous research and state of knowledge presented in the study. The result indicates that all of the informants experience difficulties in executing a social work practice grounded in SRHR. These difficulties are experienced at different levels such as in relation to clients, colleagues, management and the mission itself. Unclear or lacking of priorities, different normative attitudes among staff, deficient or various knowledge and ambiguity seem to be prevalent factors. These results suggest that discretion plays a substantial role in regards to the SRHR grounded practice within residential care.

Aim: The aim of this study was to broaden the understanding of the role of communitygroups in the prevention of intimate partner violence (IPV) in Bolivia. Therefore, this work assessed the connection between community group membership and the justification ofphysical IPV among women in Bolivia. IPV justification was chosen as an outcome, as it is strongly correlated to IPV experience. Methods: Data from a quantitative survey by the World Values Survey involving 988 womenin Bolivia was used for the analysis. To assess possible confounders, bivariate analysis was conducted. Logistic regression analysis between women’s community group membership andtheir justification of physical IPV has been performed. Results: The results indicate that 19.6% of women in Bolivia partly or always justify IPV.There has not been a significant association between community group membership and IPVjustification. The factors that were significantly associated to IPV justification in the final model were age and educational level of the women. Women aged 50 + had lower odds ofjustifying physical IPV than women aged 18-29 (OR 0.59, 95% CI: 0.35-0.97, p= &lt;0.05). Similarly, women in the highest educational group had lower odds of justifying IPVcompared to women in the lowest educational group (OR 0.63, 95% CI: 0.41-0.98, p= &lt;0.05). Conclusion: The association between community group membership and IPV justification inthis study was insignificant. This could be due to limitations in the study design. Futureresearch in the area should conduct studies with focus on different types of community groups singularly.

<p>This dissertation, broadly, examines how power dynamics manifest during clinical interactions related to vague and gendered medical symptoms, such as pelvic pain. To examine this issue, I approach my research questions through multiple methods including a critical discourse analysis of the medical discourse on pelvic pain, a survey experiment administered to healthcare workers in the US, and a narrative analysis of pelvic pain patient experiences. While the focus of this research is on pelvic pain, the analyses presented here reach far beyond ideas of power dynamics and pelvic pain. Rather, the findings from this research speak to theoretical discussions medical sociologists have been having for decades. Specifically, findings provide new insight on: 1) the limits of evidence-based medicine as a biomedical paradigm, 2) how fundamental causes of health inequality intersect with each other as well as other factors, such as gender, important in predicting health outcomes and 3) how discussions of metamechanisms in fundamental cause theory can inform our understanding of the accumulation of cultural health capital. In providing such insight, this dissertation uses the case of pelvic pain to integrate multiple perspectives and theories in medical sociology to drive the field forward in a way that acknowledges the many ways power is simultaneously constituted in the clinical interaction. From the role of gender, race, and class in power relations, to the ways medical knowledge, discourse, and authority dictate the clinical interaction, this research covers a wide range of sociological theories and concepts. In doing so, this dissertation sheds new light on current understandings of power in the clinical interaction and its relationship to inequitable health outcomes in the US.</p>

Although the world has experienced great progress in the area of Sexual and Reproductive Health and Rights (SRHR), the contemporary transnational turn towards nationalist, right-wing and populist politics has generated a backlash, primarily affecting women and members of the LGBTQ-community (lesbian, gay, bisexual, transgender and queer/questioning). Yet, opposition to gender and sexual equality, particularly in the European context, is undertheorized. Hence, this thesis sets out to explore and understand the dynamics of political homophobia as a conscious political strategy in Poland and how the homophobic rhetoric pursued by the governing party PiS and their allies has achieved resonance. That is, how anti-LGBTQ ideas have gained support as they echo the ideas, beliefs and values central to potential adherents. The advancements of political homophobia in today’s Poland is rather puzzling since there has not been an upswing in homophobic values among the population. Although the Polish society is not intrinsically homophobic, the dominating values, norms, rules and practices are generally patriarchal and heteronormative. Due to the heteropatriarchal bias of the institutional context, this thesis suggests that both informal and formal institutions may enhance the resonance of the ideas embedded in the anti-LGBTQ ideas framing. Drawing on framing theory and new institutionalism, this thesis develops a framework to analyze this dynamic and reciprocal relationship between framing strategies and the institutional context. The first section of the two-stepped analysis describes how LGBTQ has been framed by identifying the core framing tasks and various framing strategies while the second part outlines various formal rules and informal norms that have facilitated the campaign and identifies how these institutions are heteronormative. The main findings suggest that conservative elites have managed to enhance resonance for their anti-LGBTQ ideas by framing the issue in congruence with heteronormative informal norms, which are perceived to be fundamental for Polish national identity and by exploiting pre-existing formal regulations, which are seemingly neutral but produce heteronormative effects.

Background: One in ten people in the U.S. are affected by a substance use disorder (SUD), roughly one third of whom are women. Rates of unintended pregnancy are higher in this population than in the general public. Little is understood about how women with SUD use prescription contraception and think about pregnancy. Methods: By analyzing Medicaid claims data and conducting qualitative interviews with women with SUD, this doctoral thesis seeks to: 1) compare any use of and consistent, continued coverage by prescription contraceptives between women with and without SUD; 2) determine the extent to which SUD is associated with pregnancy, abortion, and adverse feto-maternal outcomes in women who use prescription contraception; and 3) explore facilitators of and barriers to contraceptive utilization by women with SUD, using qualitative interviews. Results: Compared to women without SUD, women with SUD are less likely to use any prescription contraceptive, particularly long-acting reversible methods. Among women who do use long-acting methods, SUD is associated with less continued, consistent coverage by a prescription contraceptive. Among women who use contraception, SUD is also associated with increased odds of abortion. When interviewed, women with SUD report fatalistic attitudes towards pregnancy planning, and have difficulty conceptualizing how susceptibility to pregnancy may change over time. Women with SUD also report that pregnancy has substantial impact on their drug treatment prospects. Conclusions: This study is the first to examine contraceptive utilization by women with SUD who are enrolled in Medicaid or state-subsidized insurance. Our study may help to inform clinical practice and policy development to improve the reproductive health and wellbeing of women with SUD.