Background and Aims: Mental health difficulties during the perinatal period (pregnancy to 1 year postnatal) are commonplace and are associated with significant impacts for mothers and infants. There is an acknowledgement that more needs to be understood about perinatal mental health, particularly during pregnancy, and that service and treatment options need to be improved. Women's lived experience of difficulties during pregnancy, particularly when experiencing moderate to severe mental health difficulties, is a little researched area. A need for wider treatment options than medication alone has been highlighted and Peer Support Interventions (PSIs) are often considered within this area. Despite this, there is yet to be a review of their effectiveness to date that also considers women's views of such interventions. Therefore, this thesis aimed to systematically review literature focused on women's views of PSIs and their effectiveness. In addition, it also aimed to explore the lived experience of women with moderate to severe difficulties with their mental health during pregnancy, with a focus on trying to establish any psychological needs/needs they may have. Methods: A mixed methods systematic review was conducted to meet the aims on PSI interventions. This involved searching electronic databases, quality assessment of included papers and summarising results, including a meta-synthesis for qualitative findings. The empirical project, on women's lived experiences, utilised an Interpretative Phenomenological Analysis approach to explore the lived experience of women experiencing moderate to severe mental health difficulties during pregnancy. Semi-structured interviews were conducted with 11 women recruited via a specialist perinatal mental health service. Results Thirteen studies were included in the review. Results highlighted the heterogeneity of types of PSIs and methodologies employed to evaluate these. Most studies focused on PSIs for the postnatal period and were often aimed at depression. There was a lack of research on PSIs targeted antenatally, or for other types of mental health difficulties. There was tentative evidence for the use of telephone based PSIs in reducing depressive symptomatology postnatally, but less evidence for the use of other types of PSI, or for interventions during pregnancy. The qualitative evidence highlighted the acceptability of PSIs to women and a meta-synthesis of qualitative research identified a number of themes representing women's views of PSIs. From the empirical project, several Superordinate themes were identified: Need for acceptance, Need for awareness, Search for explanations, What helped, Emotional intensity, Societal influences and Service provision. Within these a range of emergent themes were also found. These themes highlighted possible psychological needs and other needs during this time, as well as providing a greater understanding of women's lived experience. Conclusions: There is a need for more research to establish effectiveness of PSIs during pregnancy and of other modes of delivery and to build on existing findings on the effectiveness of telephone based PSIs. Women viewing PSIs as highly acceptable for perinatal mental health difficulties, should cause services to consider their use, or other opportunities for sharing of peer advice/information. Themes identified from the empirical project highlight the need for greater awareness and acceptance of mental health difficulties during pregnancy, as well as the impact of societal influences on women during this time, and the role clinicians and services could play in achieving greater awareness. Small changes within services could help raise awareness levels and help women feel less isolated.

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Six women participated in a qualitative study to understand women's experiences with abortion. The women ranged in age from 52 to 26, and were at least five years post-abortion. A questionnaire was developed using a stress and coping model as a guide to answer the following: relevant primary and reappraisal processes; problem-focused and emotion-focused coping strategies; resources; and personal and environmental constraints. The results give the women's individual experiences as well as the themes that were consistent for the participants. The women all appraised the situation of an unplanned pregnancy as stressful. All of the participants viewed having the child as a threat to their education, career, or relationship with family. Although all of the women thought some part of the procedure was more stressful than they had anticipated, all found ways to cope with differing levels of stress. The women saw their friends, family, ob-gyn physicians, priest, and clinic staff as resources during the experience. The women most often reported that religious beliefs constrained their abilities to cope. They also reported a lack of information about the abortion procedure and possible physical and emotional effects as environmental constraints. Overall, all but one participant would make the same decision, and all viewed themselves as coping well with a stressful life event. / Master of Science

Evidence suggests that few women disclose, seek help or report their experiences of rape or sexual assault (RSA) to police, which may leave them vulnerable to Post-Traumatic Stress Disorder (PTSD). However, some women may disclose and seek help or support anonymously online. Through conducting a thematic analysis of 212 messages posted by women in an online RSA support forum, I identified two key themes relating to women’s possible motivation for using the forum: to seek validation as a victim of RSA and for others to bear witness to her story. Themes relating to the possible functions of the forum were serving as a jury, assigning blame, encouraging disclosure or help-seeking, and providing emotional support. These findings suggest that women whose experiences of RSA do not match stereotypical depictions may use online forums to anonymously seek out validation that their experiences qualify as RSA. Moreover, the findings suggest that online platforms may provide women with a safe and supportive environment in which to develop a coherent narrative of their experiences of RSA, which in turn may assist some women’s recovery from the trauma of RSA. Future research might explore if NHS online support or psychological interventions are therapeutic for this population.

Bakgrund: Varje år drabbas 1,3 miljoner kvinnor i världen av gynekologisk cancer. Gynekologisk cancer innefattar corpus-, cervix- och ovarialcancer. Prognosen och överlevnaden är god vid behandling av cancern. Behandlingsformer som används vid gynekologisk cancer kan innefatta kirurgi, strålning och cytostatika. De flesta kvinnor är sexuellt aktiva under sina liv och en konsekvens av behandling för gynekologisk cancer är att sexualiteten förändras, både ur ett fysiskt och psykiskt perspektiv. Syfte: Att beskriva kvinnors upplevelser av sexualitet efter gynekologisk cancer. Metod: Metaetnografi användes som analysmetod i denna kvalitativa metasyntes. PubMed och CINAHL användes till datainsamlingen. Artiklarna kvalitetsgranskades enligt Joanna Briggs granskningsmall. Resultatet i metasyntesen har baserats på 12 vetenskapliga artiklar. Resultat: Tre huvudteman fastställdes: Förändrad sexualitet, Kunskapsbrist hämmar sexualitet och Att vara kvinna, en upplevelse av skuld och tvång. Huvudtema Förändrad sexualitet följdes av tre underteman; komplikationer efter cancerbehandlingen påverkar sexualitet, Rädsla för negativ förändring och Lust och njutning, en tudelad upplevelse. Slutsats: Kvinnor upplevde negativa förändringar i sin sexualitet som följd av cancerbehandlingen. Vaginalsmärta som följd av behandlingen var den vanligaste komplikationen. Rädslan hade både fysiska- och psykiska orsaker till exempel att cancern skulle leda till återfall, spridning av cancern samt att bli lämnad av sin partner. Kvinnor upplevde en avsaknad av lust och njutning i samband med sexuell aktivitet. Att tillfredsställa sin partner var något som kvinnorna strävade efter trots minskad eller avsaknad av sexuell lust. Information från hälso- och sjukvården om sexualitet var något som kvinnorna saknade. Klinisktillämpbarhet: Examensarbetes resultat kan användas för att öka barnmorskor och övrig hälso- och sjukvårdspersonals förståelse för kvinnors sexualitet efter gynekologisk cancer och efterföljande behandling. Examensarbetet kan inspirera vårdgivarna att våga diskutera och informera om sexualitet för kvinnor som drabbats av gynekologisk cancer för att undvika att kvinnor ska uppleva skam och skuld eller leva sitt sexuella liv i ovisshet. / Background: Every year, 1.3 million women in the world are diagnosed with gynecological cancer. Gynecological cancer includes corpus-, cervix- and ovarian cancer. The prognosis and survival rates are good when treating the cancer. Treatments used for gynecological cancer may include surgery, radiation, and chemotherapy. Most women are sexually active throughout their lives, and the sexuality can be experienced and expressed both physically and psychologically. Aim: The purpose of the thesis was to explore women's experiences of sexuality after going through treatment for gynecological cancer. Method: Meta ethnography was used as the method of analysis in this qualitative meta synthesis. PubMed and CINAHL were the databases used for data collection. The articles were quality assessed according to the Joanna Briggs checklist. The result of the meta synthesis is a result of 12 scientific articles. Results: Three main themes were identified: Changes in sexuality, Lack of knowledge impede sexuality and being a woman, an experience of guilt and coercion. Main theme Changed Sexuality was followed by three sub-themes: complications after cancer treatment affect sexuality, Fear of negative change and Lust and Pleasure, an ambiguous experience. Conclusion: Women experienced negative changes in sexuality because of cancer treatment. Vaginal pain because of treatment was the most extensive change. The fear unfolded from different physical and psychological perspectives. The fear could express itself through the cancer's recurrence, spread and being left by their partner. The women´s experienced a lack of desire and pleasure in connection with the sexual activity. Satisfying their partner was something that the women´s strived for despite reduced or absent sexual desire. Information from the healthcare system about sexuality was something that the women were missing. Clinical applicability: The results of the thesis can be used to increase midwives' and other healthcare personnel's understanding of women's sexuality after going through gynecological cancer treatment. The thesis can inspire the midwives to dare to discuss and inform about sexuality for the women affected by gynecological cancer, to avoid the women experiencing shame and guilt or living their sexual life in uncertainty.

This is a study about Hindu women's experiences of arranged marriages. The study is based on previous research on women’s experiences. The purpose of this paper was to analyze the underlying factors that contribute to Hindu women experiencing that their mental health is affected by arranged marriages. The purpose was also to investigate how the women felt that the new legislation regulating of the dowry system has affected them regarding their relationship with the new family. The main purpose was to identify themes in women's experiences of arranged marriages and investigate connections between these themes.   The result showed that women who live in arranged marriages are more frequently exposed to both physical and mental violence, and as a result outcome they often suffer from different kinds of mental illness. The papers result also showed that these women’s opinions about arranged marriages differ slightly depending on their life situation. For instance, whether they live in a city or on the countryside, or how conscious they are about people who have other opinions and perceptions than their own. This study also shows the importance of these women having a job outside their home, as it offers contact with people beyond their family, enables the women contribute financially to the family and in other ways affects the women’s situation positively.

Background: Endometriosis is a prolonged gynecological disease that causes a lot of pain during menstruation and affects many aspects of the person’s life. The disease occurs in approximately 10 percent of the fertile women worldwide, making it a public health problem. Despite that, it takes a long time to get the right diagnosis and treatment. Nurses meet women with endometriosis in various contexts and thus have an important role in supporting and advocating for women’s health and rights. Aim: To illustrate how women with endometriosis experience healthcare encounter. Method: 11 scientific articles with a qualitative approach have been synthesized using thematic analysis. Results: Two main themes were identified: Feeling of powerlessness and alienation and Feeling of hope. Women with endometriosis had mainly negative experiences of the treatment due to the healthcare professional’s lack of knowledge and understanding of the disease. The results also showed that care meetings that were characterized by respect, knowledge and compassion led to positive experiences for the women. Conclusion: Women with endometriosis need greater attention both in healthcare but also in the general public. Knowledge, adequate treatment, understandable communication and patient participation are a basic prerequisite for more holistic and equal care. / Bakgrund: Endometrios är en långvarig gynekologisk sjukdom som orsakar mycket smärta i samband med menstruation och påverkar många aspekter av den enskilda individens liv. Sjukdomen drabbar ungefär 10 procent av de fertila kvinnorna världen över, vilket gör den till ett folkhälsoproblem. Trots detta tar det lång tid att få rätt diagnos och behandling. Sjuksköterskor träffar kvinnor med endometrios i olika sammanhang och har därmed en viktig roll i att stödja och förespråka kvinnans hälsa och rättigheter. Syfte: Att belysa hur kvinnor med endometrios upplever bemötandet inom hälso- och sjukvården. Metod: 11 vetenskapliga artiklar med kvalitativ ansats har syntetiserats med hjälp av tematisk analys. Resultat: Två huvudteman identifierades: Känsla av maktlöshet och utanförskap och känsla av hopp. Kvinnor med endometrios har huvudsakligen negativa upplevelser av bemötandet till följd av vårdpersonalens brist på kunskap och förståelse för sjukdomen. Resultatet visar även att vårdmöten som präglades av respekt, kunskap och medkänsla ledde till positiva upplevelser hos kvinnorna. Slutsats: Kvinnor med endometrios behöver uppmärksammas i större omfång både inom hälso-och sjukvården men även allmänheten. Kunskap, gott bemötande, tydlig kommunikation och patientdelaktighet är en grundläggande förutsättning för en mer holistisk och jämställd vård.

Background: Intimate partner violence (IPV) is the most common form of men's violence against women. It is a public health and societal problem that threatens women's lives and well-being. Victims of IPV often seek care at the emergency department (ED) first hand. Nurses need knowledge about this subject and have a responsibility to screen for IPV. Aim: The aim of this study was to describe how women exposed to IPV experience the meeting with healthcare staff when seeking care at the emergency department. Method: A literature study was conducted with ten articles that had a qualitative approach. The collected data was analysed with manifest content analysis. Results: Two categories and four subcategories were generated from the analyse. The first category was :the women’s emotional process within with subcategories: barriers for disclosing intimate partner violence and the care environments impact. The second category was: the health care staff's attitude affects the care with subcategories: the need for empathic behaviour to enable trust and to be ‘seen and heard’.  Conclusion: Women who are victims of IPV experience fear and a loss of their autonomy and control when seeking care at an ED. It was crucial that these women were treated with empathy to overcome the fear of disclosing the IPV and to be able to continue to seek care. / Bakgrund: Våld i nära relationer är den vanligaste formen av mäns våld mot kvinnor. Det är ett samhälls- och folkhälsoproblem som hotar kvinnors liv och hälsa. Våldsutsatta kvinnor söker ofta vård på akutmottagningen i första hand. Sjuksköterskan behöver kunskap inom ämnet och har ett ansvar att fråga om våld i nära relationer. Syfte: Syftet var att beskriva hur kvinnor som har utsatts för våld i nära relationer erfar mötet med vårdpersonal på akutmottagning. Metod: En litteraturstudie genomfördes med tio vetenskapliga artiklar med kvalitativ ansats. Insamlade data analyserades med manifest innehållsanalys. Resultat: Två kategorier och fyra subkategorier framkom utifrån analysen. Den första kategorin var: kvinnornas emotionella inre process med subkategorierna: barriärer kring att berätta om våldet och vårdmiljöns påverkan. Andra kategorin var: vårdpersonalens attityd påverkar vårdmötet med subkategorierna: Förtroendeingivande bemötande och att inte bli ‘sedd och hörd’.  Slutsats: Kvinnor som utsatts för våld i nära relation upplevde rädsla och förlust av kontroll och autonomi när de sökt vård. Att bli bemött med empati var avgörande för att kvinnorna ska våga berätta om våldet de utsätts för och för att fortsätta söka vård.

<p>The experience of childbirth is an important life event for women, which may follow them throughout life. The overall aim of this thesis has been to describe and analyse these experiences from the women's perspective as well as the encounter between the woman and the midwife, and the possibility that a birth plan might improve women's experience of childbirth. The setting has been the ABC-centre (Alternative Birth Care), antenatal clinics and Sahlgrenska University hospital in Göteborg, and Karolinska hospital in Stockholm, Sweden. The studies have used both qualitative (phenomenological and hermeneutic) and quantitative approaches. The essential structure of the experiences of pregnancy and childbirth may be conceptualised under the heading ‘releasing and relieving encounters’, which for the woman constitutes an encounter with herself as well as with the midwife, and includes stillness as well as change. Stillness is expressed as being in the moment; exemplified as presence and being one's body. Change is expressed as transition; to the unknown and to motherhood. In the releasing and relieving encounter, for the midwife stillness and change equals being both anchored and a companion. To be a companion is to be an available person that listens to and follows the woman through the process of childbirth. To be anchored is to be the person that in the transition process respects the limits of the woman's ability as well as her own professional limits. The releasing and relieving encounter is not improved for women by a birth plan. Instead, in some aspects the relationship between the woman and her midwife during childbirth is reported as less satisfactory if preceded by a birth plan although some experiences of fear, pain and concerns for the child might be improved. </p>

The experience of childbirth is an important life event for women, which may follow them throughout life. The overall aim of this thesis has been to describe and analyse these experiences from the women's perspective as well as the encounter between the woman and the midwife, and the possibility that a birth plan might improve women's experience of childbirth. The setting has been the ABC-centre (Alternative Birth Care), antenatal clinics and Sahlgrenska University hospital in Göteborg, and Karolinska hospital in Stockholm, Sweden. The studies have used both qualitative (phenomenological and hermeneutic) and quantitative approaches. The essential structure of the experiences of pregnancy and childbirth may be conceptualised under the heading ‘releasing and relieving encounters’, which for the woman constitutes an encounter with herself as well as with the midwife, and includes stillness as well as change. Stillness is expressed as being in the moment; exemplified as presence and being one's body. Change is expressed as transition; to the unknown and to motherhood. In the releasing and relieving encounter, for the midwife stillness and change equals being both anchored and a companion. To be a companion is to be an available person that listens to and follows the woman through the process of childbirth. To be anchored is to be the person that in the transition process respects the limits of the woman's ability as well as her own professional limits. The releasing and relieving encounter is not improved for women by a birth plan. Instead, in some aspects the relationship between the woman and her midwife during childbirth is reported as less satisfactory if preceded by a birth plan although some experiences of fear, pain and concerns for the child might be improved.