Diss. (sammanfattning) Linköping : Linköpings universitet, 2010. / Härtill 4 uppsatser.

Magister Curationis - MCur / Depo-Provera, an injectable contraceptive, is utilized by about 30% of married women in Malawi. Most women have reported their preference to use Depo-Provera due to its effectiveness in preventing pregnancy, reversibility and easy to use since it is given once at 12-weeks intervals. Despite the method having such advantages, it has menstrual effects, and one of the major concerns for women, particularly in Africa, is amenorrhea. In Malawi, 40% of Depo-Provera users report experiencing amenorrhea after one year of use. Despite the concern for amenorrhea, some women have continued using the method. Literature shows that there is limited information on women's experiences of amenorrhea following use of Depo-Provera. A descriptive phenomenological research design was used to explore and describe women’s experiences of amenorrhea following use of Depo-Provera in order to understand how women experience amenorrhea and give meaning to the experience. Data were collected through in-depth unstructured interviews with six women, who were selected using purposive sampling. The interviews were conducted in Tumbuka language. Data analysis was done using Colaizzi’s method of analyzing descriptive phenomenological data. Five themes and some sub-themes emerged from data analysis. The themes were: "Lack of knowledge on cause of amenorrhea", "Fear of pregnancy", "Misconceptions associated with Depo-Provera Induced Amenorrhea", "Lack of proper counseling on amenorrhea resulting from Depo-Provera use" and "Amenorrhea not perceived as a problem when midwives provide adequate information". The themes showed that women accessing family planning services from Chitipa district hospital were not provided with information on amenorrhea resulting from using Depo- Provera. Hence, they expressed fear when they experienced the side effect. Participants stated that they were afraid of becoming infertile after using the family planning method, getting pregnant as well as amenorrhea itself. Their intention to discontinue using the method was largely associated with negative rumors, beliefs and misconceptions. The conclusion of the study is that there is need for midwives to provide information on amenorrhea resulting from Depo-Provera use. This will assist clients to understand that amenorrhea could occur as a side effect, and hence improve continued utilization of the method.

Background: To date, little information exists about contraception counselling, unplanned pregnancy counselling, and abortion services curricula in Ontario medical schools. Identifying existing curricula, including influences on whether and how curricula are delivered, is an essential starting point for evaluative processes. Purpose and Objectives: The purpose of this study was to explore contraception counselling, unplanned pregnancy counselling, and abortion services curricula in Ontario medical schools. The objectives were to 1) identify the existence of such curricula in undergraduate (preclinical, obstetrics and gynecology clerkship, and family medicine clerkship) and post-graduate (obstetrics and gynecology and family medicine) programs; and 2) explore factors influencing the existence and form of these curricula from the perspective of program directors. Design: An exploratory qualitative approach was used for this study whereby, Ontario program directors responsible for contraception counselling, unplanned pregnancy counselling, and abortion services curricula were interviewed. Results: Overall, the inclusion of routine curricula in contraception counselling, unplanned pregnancy counselling, and abortion services was limited and variable between schools, as well as within clerkship and post-graduate programs. Program directors were often uncertain about iii whether such routine curricula were present in their programs. Four factors were found to influence whether these curricula were included in a program: 1) program structure, 2) program resources, 3) the interests of residents/students, and 4) personal philosophy of the program director. A typology was developed to understand how program directors resolved uncertainty when asked about the existence of these curricula in their programs. The emergent sensemaking typology revealed strategies used by directors to either justify the current system of medical teaching (i.e., defending the status quo) or support change (i.e., responsive). Program directors were consistent across programs in terms of the factors they identified as influencing the curriculum offered. The perceived impact of these factors varied according to the sensemaking processes employed by each director. Conclusions: This study provides an outline of curriculum variability within and between medical school programs. Further, if offers a typology of the ways program directors explain their uncertainty regarding the inclusion of these curricula in their programs. In so doing, program director sensemaking as a key influence on the curriculum is revealed.

Background: To date, little information exists about contraception counselling, unplanned pregnancy counselling, and abortion services curricula in Ontario medical schools. Identifying existing curricula, including influences on whether and how curricula are delivered, is an essential starting point for evaluative processes. Purpose and Objectives: The purpose of this study was to explore contraception counselling, unplanned pregnancy counselling, and abortion services curricula in Ontario medical schools. The objectives were to 1) identify the existence of such curricula in undergraduate (preclinical, obstetrics and gynecology clerkship, and family medicine clerkship) and post-graduate (obstetrics and gynecology and family medicine) programs; and 2) explore factors influencing the existence and form of these curricula from the perspective of program directors. Design: An exploratory qualitative approach was used for this study whereby, Ontario program directors responsible for contraception counselling, unplanned pregnancy counselling, and abortion services curricula were interviewed. Results: Overall, the inclusion of routine curricula in contraception counselling, unplanned pregnancy counselling, and abortion services was limited and variable between schools, as well as within clerkship and post-graduate programs. Program directors were often uncertain about iii whether such routine curricula were present in their programs. Four factors were found to influence whether these curricula were included in a program: 1) program structure, 2) program resources, 3) the interests of residents/students, and 4) personal philosophy of the program director. A typology was developed to understand how program directors resolved uncertainty when asked about the existence of these curricula in their programs. The emergent sensemaking typology revealed strategies used by directors to either justify the current system of medical teaching (i.e., defending the status quo) or support change (i.e., responsive). Program directors were consistent across programs in terms of the factors they identified as influencing the curriculum offered. The perceived impact of these factors varied according to the sensemaking processes employed by each director. Conclusions: This study provides an outline of curriculum variability within and between medical school programs. Further, if offers a typology of the ways program directors explain their uncertainty regarding the inclusion of these curricula in their programs. In so doing, program director sensemaking as a key influence on the curriculum is revealed.