This thesis presents perspectives and experiences of different stakeholders and their ways of reasoning around pregnancy and pregnancy care. Data were generated from individual interviews with 25 health care providers, 18 women and 6 traditional birth attendants (TBAs) as well as 11 focus groups discussions with women, men and TBAs. The challenges experienced by health care providers in their provision of antenatal care, while attempting to change antenatal care through routines proven to have medical value, are highlighted. Changing some long established routines, such as weighing and timing of visits, proved difficult mostly because of resistance from the users of care, whose reasoning and rationale for using care did not correspond with the professional perspectives of care. Women also combined biomedical and traditional care. The women used the clinic to receive professional care and assurance that the pregnancy was progressing well and used TBAs, who are believed to have supernatural powers, for cultural forms of assurance and protection. The health care staff did not appreciate these aspects and discouraged women using TBAs. Midwives had problems to change routines of care because of their stressful working situations and the expectations of the women. In addition, they described the paradoxes in providing antenatal care in the context of HIV and AIDS. The caregivers were aware of the magnitude of HIV and AIDS and yet did not have any information on the HIV status of the women they cared for. This also caused fear for occupational transmission. HIV/AIDS is highly stigmatised in this area and women used various strategies to avoid testing. The study emphasised the need to broaden the conceptualisation and practice of evidence-based care to incorporate different types of evidence and include realities, knowledge and perspectives of not only the beneficiaries but also those implementing change as well as local knowledge. The necessity of reorganising the health care systems to accommodate the new challenges of the HIV/AIDS epidemic is also emphasised.

Bakgrund: Tidigare forskning visar att det i flertal länder inom sjukvården finns bristande kunskap kring implementering och rekommendation av komplementär alternativ medicin (KAM), där yoga ingår. Samtidigt visar forskning att patienter önskar alternativa behandlingsmetoder ensamt i tillägg till traditionell medicinsk behandling. Syfte: Att undersöka patienters erfarenheter av yogans effekt som omvårdnadsåtgärd inom primärvården. Metod: En litteraturöversikt där resultatet baseras på 15 vetenskapliga artiklar ifrån sex olika länder. Cinahl, PubMed och PsycINFO är databaserna som användes. Efter analys har resultat från artiklarna delats upp i tre teman och sex subteman. Resultat: Patienters erfarenhet av yogans effekt är att yoga kan öka livskvalitet, minska stress, öka medvetenhet och öka acceptans av kroppen. Yoga visar sig kunna vara ett verktyg för patienterna att hantera negativa tankar och minska eller förebygga ångest. Resultatet visar att patienters erfarenheter av yoga är att det finns utmaningar att upprätthålla yogautövningarna och att hitta tid för yoga i vardagslivet bland konkurrerande prioriteringar. Sammanfattningsvis visar litteraturöversiktens resultat att yoga har minst en psykologisk god effekt oavsett vad som undersöktes. Slutsats: Resultatet visar god effekt på psykologiska och fysiologiska symtom och yoga skulle kunna vara en effektiv omvårdnadsåtgärd i primärvården där egenvård och hälsofrämjande ligger i fokus. / Background: Previous research’s shows that there is a lack of knowledge about the implementation and recommendation of complementary alternative medicine (CAM), which includes yoga. At the same time research shows that patients want alternative treatment methods in addition to traditional medical treatment. Aim: Patients’ experience of the effect of yoga as a nursing measure in primary care. Method: A literature review where the result is based on fifteen scientific articles from six different countries from the databases Cinahl, PubMed and PsycINFO. After analysis, results from the articles were divided into three themes and six subthemes. Results: Patient’s experience of the effect of yoga is that yoga can increase quality of life, reduce stress, increase awareness and increased acceptance of the body. Yoga proves to be a tool for patients to deal with negative thoughts and reduce or prevent anxiety. The result shows that patients’ experience of yoga is that there are challenges in maintaining yoga practice and finding time for yoga in everyday life among competing priorities. In summary the literature review results shows that yoga has at least one psychologically good effect, regardless of what they examined. Conclusion: The result shows good effect on psychological and physiological symptoms and yoga could be an effective nursing measure in primary care where self-care and health promotion are in focus.

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