‘The best thing for the baby’: Mothers’ concepts and experiences related to promoting their infants’ health and development

Caregivers' perceptions on routine childhood vaccination: A qualitative study on vaccine hesitancy in a South Brazil state capital

Immunization programs worldwide have been facing challenges in keeping vaccination coverage high. Even though universally known for its robust National Immunization Program, Brazil has also faced significant challenges regarding vaccination coverage. One of the reasons for this is vaccine hesitancy, a complex, multi-causal, and context-specific phenomenon. This qualitative study aims to understand the factors associated with decision-making and the drivers of vaccine hesitancy in Florianopolis, Santa Catarina state capital, regarding caregivers' perceptions of routine childhood vaccination. In-depth interviews were conducted in the Capital city of Santa Catarina State. Families with children up to 6 years old were included. Data were analyzed based on thematic content analysis. Twenty-nine caregivers in 18 families were interviewed. These caregivers were mainly mothers and fathers. Three themes emerged: 1. Access to information and the decision-making process, where we discuss the role of social circles, healthcare workers, and the internet; 2. Individual-institutions power relationships: Perceptions about the State's role and the Health institutions: 3. Reasons and motivations: The senses and meanings behind non-vaccination, where we discuss the drivers of vaccine hesitancy related to risk perception, caregivers' opinions on the medical-pharmaceutical industry, vaccines' composition and their side effects, families' lifestyles and worldviews, and the childhood routine vaccination schedule. The results of this study reaffirm the complexity of the decision-making process in childhood vaccination and further enable a better contextual understanding of the complex and challenging phenomenon of vaccine hesitancy.

A mixed-methods study of women's birthplace preferences and decisions in England

PROBLEM

Choice has been a key aspect of maternity care policy in England since 1993, however a gap remains between the birthplaces women want and where they actually give birth.

BACKGROUND

The latest maternity care policy in England acknowledges that women are not being given 'real choice' in their care and often being told what to do. This is problematic since unfulfilled preferences have been linked to negative childbirth experiences.

AIM

To understand the factors affecting women's birthplace preferences and decisions, and why these might differ.

METHODS

A sequential mixed-methods study consisting of an online questionnaire (n=49) and follow-up interviews (n=14) with women who were either currently pregnant or had recently given birth in a metropolitan region in England.

FINDINGS

Most women in this study said that they would prefer to give birth in an alongside maternity unit because it offered a compromise between the risk of poor outcomes and risk of unnecessary medicalisation. However, the majority of women's preferences were medicalised at the point of decision-making as the minimisation of clinical risk was ultimately prioritised.

DISCUSSION

Women's preference for the alongside maternity unit demonstrates the growing popularity for this less medicalised, 'alternative' birthplace option. However pre-existing conditions, reproductive histories and experiential knowledge influence women's decision to give birth in the labour ward and suggests that minimising clinical risk is women's key priority.

CONCLUSION

Women navigate complex and competing discourses when forming childbirth preferences and making decisions, selectively considering different risks and knowledges to make the decisions right for them.

A two-item screening of maternal or infant perceived life threat during childbirth prospectively associated with childbirth-related posttraumatic stress symptoms up to six months postpartum: two observational longitudinal studies

Objective

This study investigated prospective relationships between the perception of threat to one's own life or to that of one's infant during childbirth and maternal childbirth-related posttraumatic stress symptoms (CB-PTSS) and probable childbirth-related posttraumatic stress disorder (CB-PTSD) in a community and a community and an emergency cesarean section (ECS) sample.

Methods

Study samples included 72 mothers from a community sample and 75 mothers after emergency cesarean section. Perceived maternal and infant life threat were assessed at ≤1 week postpartum. Maternal CB-PTSS and probable CB-PTSD were assessed with validated questionnaires up to 6 months postpartum. Covariates were extracted from hospital records. Secondary data analysis with logistic and linear regressions was performed.

Results

Globally, mothers were significantly more likely to perceive their infant's life to be threatened, rather than their own. Both types of perceived threat were prospectively but differentially associated with maternal CB-PTSS and probable CB-PTSD at 4-6 weeks and 6 months postpartum. Statistical significance was set at p<0.05.

Conclusion

The type of perceived threat differently influences maternal CB-PTSS and probable CB-PTSD up to 6 months postpartum. These results may be the basis for the development of a short screening instrument after traumatic childbirth in clinical settings. Future studies need to assess the psychometric properties and acceptability of such a brief screening tool.

A qualitative analysis of the breastfeeding experiences of mothers who are nurses and nutritionists

BACKGROUND

From a medical standpoint, breastmilk is the optimal option for feeding a baby, relegating the cultural, social, and material determinants to breastfeeding. Worldwide, breastfeeding rates are low, especially among working mothers. Healthcare providers have low breastfeeding rates due to several barriers to lactation, i.e. work schedule andlack of private places for pumping.

METHOD

A descriptive qualitative methodology was applied to examine the breastfeeding experiences of Ecuadorian mothers who are healthcare professionals. Twenty healthcare professionals who breastfed their babies took part in the research. Data gathering employed synchronous semi-structured interviews in Spanish. The data analysis followed the Phronetic Iterative Approach.

RESULTS

Women shifted the preconceived idea of the ideal breastfeeding scenario concerning duration, promotion, and support, ideals which are constructed in their training as healthcare professionals. Although these women believe that breast milk and breastfeeding is the best way to feed a baby, the internalized ideal of breastfeeding shifted with the experience of motherhood. Although they had that clash between the ideal and the external reality, they continued breastfeeding their babies, and those experiences resulted in them improving their professional practice.

CONCLUSIONS

This study demonstrated that breastfeeding for this group of women appears to be a unique relational and identity negotiation process. The findings emphasize that experiencing breastfeeding for this group of healthcare providers positively shifted how they communicate breastfeeding with their patients in the clinical encounter. Ensuring that healthcare professionals acquire a different approach for educating and communicating about lactation is an essential determinant in efforts to improve breastfeeding rates in Ecuador.

Conflicting and complementary notions of responsibility in caregiver's and health care workers' vaccination narratives in the Philippines

Background

Vaccine hesitancy (VH) continues to pose a public health threat globally. Understanding the attitudes and perceptions about vaccination of key stakeholders in vaccine decision-making (such as health care workers (HCWs) and caregivers) about vaccination can pave the way toward novel approaches to bolster vaccine confidence. In this study, we explored the role of notions of responsibilities among HCWs and caregivers in shaping vaccination interactions and decision-making in the Philippines.

Methods

We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with 44 vaccine-hesitant caregivers, seven HCWs, and 20 community health workers (barangay health workers) in the Philippines between August 2020 and March 2021. The interviews and focus groups were conducted online, transcribed verbatim, and analysed through the reflexive thematic analysis approach.

Results

Caregivers highlighted responsibility in terms of being a good caregiver, managing risk to one's own child, and seeking and validating information. Meanwhile, HCWs highlighted responsibility as: being a good HCW, managing risk to children and to the community, and providing and transforming information. Our findings suggest that responsibility manifests differently in HCWs' and caregivers' narratives, and that these notions can be both conflicting and complementary, shaping the interaction between stakeholders and, ultimately, their vaccine decision-making. We also found that fostering a good relationship between HCWs and caregivers through communication techniques such as motivational interviewing could help bridge the gap created by mistrust in vaccinations. HCWs sharing their own experiences as parents who vaccinate their own children also resonate with caregivers.

Conclusions

Notions of responsibility can underpin collaborative and divisive interactions between HCWs and caregivers. Public health messaging and interventions related to vaccination must consider strategies that align with these notions to address VH.

COVID-19 vaccination in pregnancy: ambiguity in decision-making

Throughout the COVID-19 pandemic, pregnant women/people were identified as an at-risk group of severe COVID-19 disease. Consequently, vaccine uptake among this group became a public health priority. However, the relationship between pregnancy and vaccination decision-making is complex, and the heightened uncertainty and anxiety produced through the pandemic further exacerbated this immunization decision. This study explores COVID-19 vaccination decision-making during pregnancy in Aotearoa New Zealand by using an online story completion survey tool. Ninety-five responses were received and analysed using thematic analysis where ambiguity was a core facet within and across stories. Three ambiguities were identified, including who makes the decision (agential), what the risks are (risk) and how immunity to this threat can be best achieved (immunity). We discuss the implications of this ambiguity and how the strong desire to protect the baby persisted across accounts. The recognition of the rather persistent ambiguity in vaccination decision-making helps conceptualize influencing factors taken into account in a more nuanced manner for further research, public health campaigns and health professionals. Future public health campaigns can consider redistributing responsibility for vaccination decision-making in pregnancy, traverse an either/or perspective of 'natural' and 'artificial' immunity-boosting and consider how risk is perceived through anecdotes and viral immediacy.

A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy

OBJECTIVE

We aimed to explore the experiences and perspectives of pregnant women, antenatal healthcare professionals, and system leaders to understand the impact of the implementation of remote provision of antenatal care during the COVID-19 pandemic and beyond.

METHODS

We conducted a qualitative study involving semi-structured interviews with 93 participants, including 45 individuals who had been pregnant during the study period, 34 health care professionals, and 14 managers and system-level stakeholders. Analysis was based on the constant comparative method and used the theoretical framework of candidacy.

RESULTS

We found that remote antenatal care had far-reaching effects on access when understood through the lens of candidacy. It altered women's own identification of themselves and their babies as eligible for antenatal care. Navigating services became more challenging, often requiring considerable digital literacy and sociocultural capital. Services became less permeable, meaning that they were more difficult to use and demanding of the personal and social resources of users. Remote consultations were seen as more transactional in character and were limited by lack of face-to-face contact and safe spaces, making it more difficult for women to make their needs - both clinical and social - known, and for professionals to assess them. Operational and institutional challenges, including problems in sharing of antenatal records, were consequential. There were suggestions that a shift to remote provision of antenatal care might increase risks of inequities in access to care in relation to every feature of candidacy we characterised.

CONCLUSION

It is important to recognise the implications for access to antenatal care of a shift to remote delivery. It is not a simple swap: it restructures many aspects of candidacy for care in ways that pose risks of amplifying existing intersectional inequalities that lead to poorer outcomes. Addressing these challenges through policy and practice action is needed to tackle these risks.

Inter-embodied parental vigilance; the case of child food allergy

There is developing interest in issues of embodiment in studies of children, health and illness. We take our point of departure in the parent-child-health/illness triad to explore the embodied aspects of parental vigilance in parenting children who have a food allergy, utilizing the concept of inter-embodiment. Drawing on a focus group study with parents in Sweden the analysis reveals that this vigilance can be seen as the embodied manifestation of concern for children's bodies in perpetual liminality, when constantly exposed to allergens and the risk of becoming ill. We argue that the lens of inter-embodiment, with a focus on bodies in relation, captures how parents lived experience of managing food allergy intertwines with that of their children in the parent-child-health/illness triad. The analysis uncovers a form of embodied knowledge that is often not verbalized, offering potential for new understandings of parent-child relations that center on chronic child health conditions.

COVID-19 vaccination in pregnancy: How discrepant public health discourses shape responsibility for fetal health

Early in COVID-19 vaccine rollout, expert recommendations about vaccination while pregnant and breastfeeding changed rapidly. This paper addresses the (re)production of gendered power relations in these expert discourses and recommendations in Canada. We collected texts about COVID-19 vaccine use in pregnancy (N ​= ​52) that Canadian health organizations (e.g., professional societies, advisory groups, health authorities) and vaccine manufacturers made publicly available online. A discourse analysis was undertaken to investigate intertextuality (relations between texts), social construction (incorporation of assumptions about gender), and contradictions between and within texts. National expert recommendations varied in stating COVID-19 vaccines are recommended, should be offered, or may be offered, while manufacturer texts consistently stated there was no evidence. Provincial and territorial texts reproduced discrepancies between the Society of Obstetricians and Gynaecologists of Canada and National Advisory Committee on Immunization recommendations, including that COVID-19 vaccines should be versus may be offered in pregnancy. Our findings suggest gaps in data and discrepant COVID-19 vaccine recommendations, eligibility, and messaging limit guidance regarding vaccination in pregnancy. We argue that these discrepancies magnified the already common practice of deferring responsibility for the uncertainties of vaccination in pregnancy onto parents and healthcare providers. The deferral of responsibility could be reduced by harmonizing recommendations, regularly updating texts that describe evidence and recommendations, and prioritizing research into disease burden, vaccine safety, and efficacy before vaccine rollout.

The decision-making process of pregnant individuals offered termination of pregnancy for serious congenital abnormalities

OBJECTIVES

This study aimed to explore the decision-making process of patients with pregnancies affected by serious congenital abnormalities.

METHODS

The study design was an exploratory qualitative study. The sample for this study was pregnant individuals who had a prenatal diagnosis of a serious congenital abnormality and were offered termination of pregnancy. Semi-structured face-to-face interviews with closed and open-ended questions, recorded and transcribed verbatim, were used to collect the data; this was then analyzed using a thematic data analysis approach.

RESULTS

Five topics were developed: "Health care services", "Home", "Being a mother", "Finding meaning", and "The aftermath". The first four topics describe the decision-making process where the participants filtered through multiple factors to reach their final decision. Although the participants consulted with their families, partners, and community, they made the final decision themselves. The final topics describes activities which were necessary for closure and coping.

CONCLUSION

This study has provided valuable insight into the decision-making process, which can be used to improve services offered to patients.

PRACTICE IMPLICATIONS

Information should be communicated clearly with follow-up appointments to discuss further. Healthcare professional should show empathy and assure the participants that their decision is supported.

Be the mother, not the daughter: Immigrant Chinese women, postpartum care knowledge, and mothering autonomy

Scholars have documented the transformation of modern motherhood, as mothering practices have been a target of medical knowledge that comes to define correct modes of conduct for women caring for their pregnant bodies, undergoing childbirth and childrearing. Such accounts usually set scientific knowledge and medical authority in opposition to women's autonomy. Drawing on the interviews with immigrant Chinese mothers in Canada, we offer a different account of knowledge and agency in new motherhood. These women's often-intense experiences of intergenerational care-giving associated with the practice of zuo yuezi reveal a more fluid relationship between medical authority and mothering agency. We find that the central tension during the postpartum experience lies in intergenerational and family relationships. In this context, new mothers draw on alternative sources of knowledge-and medical professionals are one such key source-to demonstrate within the family their competence to make care decisions for themselves and their babies. These women's use of medical knowledge to counter a familial and intergenerational authority complicates dominant accounts about medicalisation, demonstrating that women's relationship to medical knowledge and authority maybe be far more fluid and complex than a standard account of medicalisation and loss of women's agency would predict.

Understandings and practices related to risk, immunity and vaccination during the Delta variant COVID-19 outbreak in Australia: An interview study

Background

The aim of this study was to use indepth social research to better understand the relationships and intersections between understandings and practices of COVID-19 risk, immunity and vaccination in lay people’s accounts.

Methods

This article reports findings from a qualitative research project involving semi-structured telephone interviews with a diverse group of 40 adults from around Australia about their experiences of the COVID crisis, conducted in late 2021 during the Delta variant outbreak. The participants’ responses to questions about COVID risk, COVID vaccines and how they thought they could best protect their health were analysed using an inductive thematic approach.

Results

A notion of ‘communal risk’ was expressed together with ‘individual risk’. Relatedly, people’s understandings of what might be characterised as ‘communal immunity’ as well as individual immunity also dominated in their accounts. Both communal risk and communal immunity are influenced by a range of constantly changing and interrelated factors. Locale was a strong factor in shaping people’s experiences and stances related to COVID risk. The participants referred to aspects such as their community’s geographical location; the number of COVID cases and the level of COVID vaccination by others living in their state or territory; adoption of preventive measures; vaccine availability, scheduling and take-up; viral testing and tracing reporting; and the extent and timing of viral spread in the population. These factors were continually related back to highly specific conditions and practices in their community or state of residence.

Conclusions

Understandings and practices related to COVID risk, immunity and vaccination were based both on individual experiences and broader ideas about the role of community. Spatial contexts are influential but there is also a strong temporality to these understandings and practices. There is a fine balance to be maintained between individual-level protection from COVID risk and community-level actions.

Internet-delivered psychological interventions for reducing depressive, anxiety symptoms and fear of childbirth in pregnant women: A meta-analysis and meta-regression

OBJECTIVE

The current review aims to (1) investigate the effectiveness of Internet-based psychological intervention in reducing depressive, anxiety, and stress symptoms and fear of childbirth among pregnant women at post-intervention and follow-up; (2) compare the effects of the intervention using different psychological principles; and (3) explore potential covariates on the intervention effect.

METHODS

A literature search of seven databases was carried out to identify published and unpublished randomized controlled trials (RCTs) in English without any time limitation up to February 2021. Meta-analysis and meta-regression were conducted using Comprehensive Meta-analysis software. This review protocol was registered on PROSPERO (CRD42021235565).

RESULTS

Sixteen RCTs involving 3894 pregnant women were included from more than 23 countries. Internet-delivered psychological interventions were found to significantly (p < 0.05) reduce depressive (g = -0.16 to -0.32) and anxiety (g = -0.22 to -0.33) symptoms with small effect sizes at post-intervention and follow-up during 6 to 8 weeks postpartum compared with those in the comparator group. However, there was insufficient evidence for fear of childbirth and stress symptoms. Our subgroup analyses found that psychological interventions adopting component of cognitive behavioral therapy (g = -0.29) or mindfulness therapy (g = -0.62) showed beneficial effects to improve depressive symptoms among pregnant women. Univariate random-effect regression analyses showed that the attrition rate was a significant covariate (Z = -2.33, p = 0.02) on depressive symptoms. The certainty of main outcomes was graded from low to very low in accordance with the GRADE criteria.

CONCLUSIONS

Our reviews suggested that Internet-delivered psychological intervention may complement usual antenatal care in the improvement of depressive and anxiety symptoms. Future trials involving a large-scale sample are needed to improve the methodological quality.

Mothering on the web: A feminist analysis of posts and interactions on a Chilean Instagram account on motherhood

This article is temporarily under embargo.

Ecological factors influencing parenting self-efficacy among working mothers with a child under 36 month old in South Korea: a cross-sectional and correlational study

BACKGROUND

Parenting self-efficacy is an essential component for parents to successfully perform their role and is important for mother and child well-being. To support parenting self-efficacy amongst working mothers, it is necessary to understand the factors influencing parenting self-efficacy amongst this group. However, the majority of previous studies regarding factors influencing parenting self-efficacy did not focus on working mothers. Therefore, this study aimed to identify the factors influencing parenting self-efficacy of working mothers using an ecological framework.

METHODS

The research design was a cross-sectional, correlational study. The participants were 298 working mothers with a child under 3 years of age, who were recruited from ten nurseries. Data were collected from August 8 to September 22, 2017 using structured questionnaires, including the Parenting Sense of Competency scale, a one-item Short Form Health Survey scale, the Maternal Role Satisfaction scale, the Parenting Stress Inventory, the Work and Parent Role Conflict scale, the Parenting Alliance Inventory, the Social Support scale, and the Childbirth and Parenting Friendly System scale. The study process of this study was approved by the Institutional Review Board. Collected data were analyzed by SPSS 23.0 Win program with descriptive statistics, t-test, one way ANOVA, Pearson correlation coefficient, and hierarchical multiple regression.

RESULTS

Working mothers who were the primary caregiver had higher parenting self-efficacy compared to those who were not the primary caregiver (β = .13, p = .022). At the individual level, the higher maternal role satisfaction, the higher parenting self-efficacy of working mothers (β = .27, p < .001). In the micro-system level, higher parenting support by a spouse was associated with higher parenting self-efficacy of working mothers (β = .19, p = .002).

CONCLUSIONS

Educational interventions for increasing the awareness and satisfaction of maternal role and various strategies for fathers' active participation in parenting should be developed. In addition, practical interventions that reduce the burden of parenting while supporting parenting self-efficacy of working mothers who are the primary caregiver should also be considered.

Vaccine hesitancy and emerging parental norms: A qualitative study in Taiwan

This article reports a qualitative study on vaccine hesitancy in Taiwan. Based on its findings, this research illuminates the close relationships between expanding vaccine hesitancy and current parental norms. It answers the following questions: how do parents understand their roles and responsibilities regarding childhood vaccination under new parental norms? How do new parental norms interweave with other social contexts to shape parental practices of childhood vaccination? This research collected data from March 2018 to July 2020. This research observed lectures and activities concerning childhood vaccination organised by parental groups and interviewed 24 parents and three CDC professionals. Results show that 'uniqueness of every child', 'informed decision-making' and 'intensive parenthood' are three essential elements in contemporary parental norms that significantly influence parents' experiences regarding childhood vaccination. Under the norms, parents perceive their responsibility to inform themselves and make decisions most suitable for their children. Results also highlight the tension when health authorities failed to recognise new parental roles in childhood vaccination. The current lack of communication on childhood vaccination causes parents' anxiety even among those who comply with vaccination policy. Health authorities and professionals should pay attention to new parental norms affecting people's childhood vaccination practices and develop suitable communication strategies.

Trust, affect, and choice in parents' vaccination decision-making and health-care provider selection in Switzerland

This article examines the relationships between biomedicine, complementary and alternative medicine (CAM) and parents' vaccination decision-making in Switzerland. Our empirical evidence sheds light on an understudied phenomenon-parents switching from one doctor to another provider (often one offering CAM services) around issues that arise during vaccination consultations. This is important to understand since CAM is used by 25%-50% of the Swiss population and is integrated into the Swiss health-care system when offered by biomedically trained medical doctors with additional CAM training. Qualitative data gathered from in-depth semi-structured interviews with parents (N = 30) and ethnographic observations of vaccination consultations (N = 16 biomedical consultations, N = 18 CAM consultations) demonstrate how there was not always a clear-cut, direct relationship between (non)vaccination and parents' use of CAM and/or biomedicine. Borrowing from Hirschman (Exit, voice, and loyalty: Responses to decline in firms, organizations, and states, Harvard Univ. Press, 1970), we frame our analysis by using the concepts of exit, voice and loyalty to describe parents' provider selection and vaccination decision-making process, although only four families in the sample described switching solely because of vaccination-related issues. Findings add to vaccine decision-making literature by describing and analysing the underdiscussed provider-switching phenomenon and by demonstrating the importance of parents' experiences of trust, affect and choice in vaccination consultations as they pursue the best health outcomes for their children.

New Motherhood Concepts, Implications for Healthcare. A Qualitative Study

The aim of this study was to explore the experience of women who take care of their children in postpartum and who desire to be understood by society, with no judgements. For this purpose, a qualitative methodology was followed. In-depth interviews, discussion groups, and an online forum were used for data collection. The participants were Spanish women that had given birth in the past 6 months, and their partners. Healthcare specialists with experience in the topic were also included. Results showed three main categories: lack of priority, self-demand, and self-esteem changes. As a conclusion, the concept of motherhood needs to be redefined, as women feel that they are living under the pressure of being a “perfect mother”. It is important that mothers allow themselves to fail in reaching the imposed requirements. Simple acceptance of motherhood boundaries could help in this transition.

Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis

BACKGROUND

Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. However, worldwide, many children do not receive all recommended vaccinations, for several potential reasons. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services. Our understanding of what influences parents' views and practices around childhood vaccination, and why some parents may not accept vaccines for their children, is still limited. This synthesis links to Cochrane Reviews of the effectiveness of interventions to improve coverage or uptake of childhood vaccination.

OBJECTIVES

- Explore parents' and informal caregivers' views and practices regarding routine childhood vaccination, and the factors influencing acceptance, hesitancy, or nonacceptance of routine childhood vaccination. - Develop a conceptual understanding of what and how different factors reduce parental acceptance of routine childhood vaccination. - Explore how the findings of this review can enhance our understanding of the related Cochrane Reviews of intervention effectiveness.

SEARCH METHODS

We searched MEDLINE, Embase, CINAHL, and three other databases for eligible studies from 1974 to June 2020.

SELECTION CRITERIA

We included studies that: utilised qualitative methods for data collection and analysis; focused on parents' or caregivers' views, practices, acceptance, hesitancy, or refusal of routine vaccination for children aged up to six years; and were from any setting globally where childhood vaccination is provided.

DATA COLLECTION AND ANALYSIS

We used a pre-specified sampling frame to sample from eligible studies, aiming to capture studies that were conceptually rich, relevant to the review's phenomenon of interest, from diverse geographical settings, and from a range of income-level settings. We extracted contextual and methodological data from each sampled study. We used a meta-ethnographic approach to analyse and synthesise the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane Reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We integrated the findings of this review with those from relevant Cochrane Reviews of intervention effectiveness. We did this by mapping whether the underlying theories or components of trial interventions included in those reviews related to or targeted the overarching factors influencing parental views and practices regarding routine childhood vaccination identified by this review.

MAIN RESULTS

We included 145 studies in the review and sampled 27 of these for our analysis. Six studies were conducted in Africa, seven in the Americas, four in South-East Asia, nine in Europe, and one in the Western Pacific. Studies included urban and rural settings, and high-, middle-, and low-income settings. Many complex factors were found to influence parents' vaccination views and practices, which we divided into four themes. Firstly, parents' vaccination ideas and practices may be influenced by their broader ideas and practices surrounding health and illness generally, and specifically with regards to their children, and their perceptions of the role of vaccination within this context. Secondly, many parents' vaccination ideas and practices were influenced by the vaccination ideas and practices of the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turn strengthened their views and practices around vaccination. Thirdly, parents' vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes. Finally, parents' vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers. We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination. The first concept, 'neoliberal logic', suggests that many parents, particularly from high-income countries, understood health and healthcare decisions as matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children. The second concept, 'social exclusion', suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates. Many of the overarching factors our review identified as influencing parents' vaccination views and practices were underrepresented in the interventions tested in the four related Cochrane Reviews of intervention effectiveness.

AUTHORS' CONCLUSIONS

Our review has revealed that parents' views and practices regarding childhood vaccination are complex and dynamic social processes that reflect multiple webs of influence, meaning, and logic. We have provided a theorised understanding of the social processes contributing to vaccination acceptance (or not), thereby complementing but also extending more individualistic models of vaccination acceptance. Successful development of interventions to promote acceptance and uptake of childhood vaccination will require an understanding of, and then tailoring to, the specific factors influencing vaccination views and practices of the group(s) in the target setting. The themes and concepts developed through our review could serve as a basis for gaining this understanding, and subsequent development of interventions that are potentially more aligned with the norms, expectations, and concerns of target users.

Women's informal surveillance of alcohol consumption in intimate heterosexual relationships during the early parenting period

Alcohol consumption may play an important part in intimate heterosexual relationships, including regulating partners' emotional well-being and sustaining relational bonds. Quantitative studies consistently indicate that women play a prominent role in the informal surveillance of their partners' drinking. This paper aims to contribute to the evidence-base by examining possible meanings and reasons underpinning the surveillance of drinking in the early parenting period. In doing so, we draw from the results of a study conducted in Yorkshire (UK), exploring accounts of alcohol drinking practices in women up to three years after giving birth. This is a phase of family readjustment, in which childcare is at its most time- and labour-intensive. Free Association Narrative Interviews (FANI) were conducted between 2017 and 2018 with 21 working mothers from different backgrounds, each interviewed twice about daily routines and drinking practices. Narrative and thematic content analysis cast light on the gendered aspects of surveillance of alcohol consumption. Participants described seeking to exert informal surveillance over their partners' drinking and to set boundaries around what was considered an acceptable level of consumption. Their accounts reflected how traditional gender performances and expectations were relationally constructed through drinking practices. Women's attempts at surveillance were generally articulated in non-confrontational language. However, in the interviews, women expressed disappointment and unhappiness that partners' drinking activities were associated with an unequal distribution of domestic responsibilities. Through informal surveillance of drinking, we argue, women performed actions of health-risk management within the family. Most importantly, informal surveillance appeared to be a strategy which sought to negotiate a fairer allocation of household labour, and greater equity between the partners. Findings demonstrates how inequalities in power play out and permeate intimate relationships, re-affirming women's traditional role in the regulation of drinking. Drinking practices, we conclude, provide valuable insights into how gender operates in the sphere of intimacy.

Stigma Attached to Smoking Pregnant Women: A Qualitative Insight in the General French Population

INTRODUCTION

Cigarette consumption during pregnancy has major health consequences for women and unborn children. The stigma of smoking during pregnancy might hinder mothers-to-be's access to adequate healthcare and smoking cessation, especially in disadvantaged groups. This qualitative study was designed to describe extensively the public stigma associated with smoking during pregnancy.

METHOD

Participants were French adults recruited from the general population through social networks (N=100). They were asked to answer three pairs of open-ended questions regarding cognitions, emotions and behaviours elicited in the general population by pregnant smoking women. An inductive thematic analysis was performed and inter-judge agreement was computed on 30% of the corpus analysed deductively. Finally, independence (chi-square) between themes and gender, education, parenthood and smoking status was tested.

RESULTS

Themes (n=25) were defined regarding cognitions (n=9, e.g., irresponsible, thoughtless and unmindful, etc.), emotions (n=8, e.g., anger, disgust, etc.) and behaviours (n=8, e.g., inform and persuade, moralise and blame, etc.). Global inter-judge agreement was strong (κ=0.8). No difference was observed in themes according to gender, parental status or education, indicating a heterogenous awareness of stigma. However, some differences were observed according to smoking status (χ2 = 69.59, p = 0.02) (e.g., non-smokers more frequently stressed immorality).

CONCLUSION

The stigma associated with smoking during pregnancy includes various components that might be measured and targeted in interventions to improve access to adequate healthcare and smoking cessation in this specific population.

IMPLICATIONS

This qualitative study explores the stigma that the general French population attaches to pregnant women who smoke. Themes regarding cognitions (e.g., irresponsible, thoughtless and unmindful, etc.), emotions (e.g., anger, disgust, etc.) and behaviours (e.g., inform and persuade, moralise and blame, etc.) were identified. These themes could guide further research regarding scale development and anti-stigma interventions to support smoking cessation.

Negotiating identities of 'responsible drinking': Exploring accounts of alcohol consumption of working mothers in their early parenting period

Mothers' alcohol consumption has often been portrayed as problematic: firstly, because of the effects of alcohol on the foetus, and secondly, because of the association between motherhood and morality. Refracted through the disciplinary lens of public health, mothers' alcohol consumption has been the target of numerous messages and discourses designed to monitor and regulate women's bodies and reproductive health. This study explores how mothers negotiated this dilemmatic terrain, drawing on accounts of drinking practices of women in paid work in the early parenting period living in Northern England in 2017-2018. Almost all of the participants reported alcohol abstention during pregnancy and the postpartum period and referred to low-risk drinking practices. A feature of their accounts was appearing knowledgeable and familiar with public health messages, with participants often deploying 'othering', and linguistic expressions seen in public health advice. Here, we conceptualise these as Assumed Shared Alcohol Narratives (ASANs). ASANs, we argue, allowed participants to present themselves as morally legitimate parents and drinkers, with a strong awareness of risk discourses which protected the self from potential attacks of irresponsible behaviour. As such, these narratives can be viewed as neoliberal narratives, contributing to the shaping of highly responsible and self-regulating subjectivities.

First 1000 days: New Zealand Mothers' perceptions of early life nutrition resources

Research into associations between early life nutritional exposures and vulnerability to adult non-communicable disease (NCD) highlights the importance of maternal diet. A booklet outlining evidence-based dietary guidelines for the first 1000 days of life was first published in 2016 by early life nutrition experts for distribution to pregnant women in Australia and New Zealand. First-time New Zealand mothers' (n=9) perceptions of the booklet and its relevance for the future health of their child were explored via semi-structured focus groups and interviews. Recruitment took place via social media channels and antenatal classes around Auckland. Three major themes were identified using thematic analysis: 1. A difference in the ways mothers related to the booklet depending on their apparent level of health literacy and communication preferences; 2. A tendency for women to outsource decision-making to nutrition 'rules', rather than interpreting information to suit personal circumstances; 3. Intense pressure to comply, resulting in feelings of shame or guilt when the 'rules' were not followed. In this study, first-time mums expressed feeling under pressure to 'get it right' and identified a desire for more support from healthcare providers and society. Nutrition education is essential; however, a booklet should provide a starting point for conversation rather than a stand-alone list of recommendations. Further exploration is needed to develop a resource that can be used by health professionals working alongside women and their partners to support healthy child development.

Neurobiological limits and the somatic significance of love: Caregivers' engagements with neuroscience in Scottish parenting programmes

While parents have long received guidance on how to raise children, a relatively new element of this involves explicit references to infant brain development, drawing on brain scans and neuroscientific knowledge. Sometimes called 'brain-based parenting', this has been criticised from within sociological and policy circles alike. However, the engagement of parents themselves with neuroscientific concepts is far less researched. Drawing on 22 interviews with parents/carers of children (mostly aged 0-7) living in Scotland, this article examines how they account for their (non-)use of concepts and understandings relating to neuroscience. Three normative tropes were salient: information about children's processing speed, evidence about deprived Romanian orphans in the 1990s, and ideas relating to whether or not children should 'self-settle' when falling asleep. We interrogate how parents reflexively weigh and judge such understandings and ideas. In some cases, neuroscientific knowledge was enrolled by parents in ways that supported biologically reductionist models of childhood agency. This reductionism commonly had generative effects, enjoining new care practices and producing particular parent and infant subjectivities. Notably, parents do not uncritically adopt or accept (sometimes reductionist) neurobiological and/or psychological knowledge; rather, they reflect on whether and when it is applicable to and relevant for raising their children. Thus, our respondents draw on everyday epistemologies of parenting to negotiate brain-based understandings of infant development and behaviour, and invest meaning in these in ways that cannot be fully anticipated (or appreciated) within straightforward celebrations or critiques of the content of parenting programmes drawing on neuropsychological ideas.

Producing bodies at risk in sexual health - an ethnographic comparative analysis between the combined oral contraceptive pill and pre-exposure prophylaxis in Switzerland

This article demonstrates that 'bodies at risk' in sexual health are socially constructed. It does so via a heuristic comparison between two molecular technologies that are central to the promotion of sexual health: the combined oral contraceptive pill (COCP) and pre-exposure prophylaxis (PrEP). Drawing on ethnographic research conducted in two sexual health institutions in the western part of Switzerland, the article presents two main findings. First, it argues that bodies are constructed as being at low or high risk by sexual health professionals (based on health and lifestyle criteria). Second, it shows that access to either the COCP or PrEP is largely based on this former classification. The article also demonstrates that there are ambivalent situations in which sexual health professionals seek compromises between different risks, and pragmatically adapt their medical protocols.

The effectiveness of smoking cessation, alcohol reduction, diet and physical activity interventions in changing behaviours during pregnancy: A systematic review of systematic reviews

BACKGROUND

Pregnancy is a teachable moment for behaviour change. Multiple guidelines target pregnant women for behavioural intervention. This systematic review of systematic reviews reports the effectiveness of interventions delivered during pregnancy on changing women's behaviour across multiple behavioural domains.

METHODS

Fourteen databases were searched for systematic reviews published from 2008, reporting interventions delivered during pregnancy targeting smoking, alcohol, diet or physical activity as outcomes. Data on behaviour change related to these behaviours are reported here. Quality was assessed using the JBI critical appraisal tool for umbrella reviews. Consistency in intervention effectiveness and gaps in the evidence-base are described.

RESULTS

Searches identified 24,388 results; 109 were systematic reviews of behaviour change interventions delivered in pregnancy, and 36 reported behavioural outcomes. All smoking and alcohol reviews identified reported maternal behaviours as outcomes (n = 16 and 4 respectively), whereas only 16 out of 89 diet and/or physical activity reviews reported these behaviours. Most reviews were high quality (67%) and interventions were predominantly set in high-income countries. Overall, there was consistent evidence for improving healthy diet behaviours related to increasing fruit and vegetable consumption and decreasing carbohydrate intake, and fairly consistent evidence for increase in some measures of physical activity (METs and VO2 max) and for reductions in fat intake and smoking during pregnancy. There was a lack of consistent evidence across reviews reporting energy, protein, fibre, or micronutrient intakes; smoking cessation, abstinence or relapse; any alcohol behaviours.

CONCLUSIONS

The most consistent review evidence is for interventions improving dietary behaviours during pregnancy compared with other behaviours, although the majority of diet reviews prioritised reporting health-related outcomes over behavioural outcomes. Heterogeneity between reported behaviour outcomes limits ability to pool data in meta-analysis and more consistent reporting is needed. Limited data are available for alcohol interventions in pregnancy or interventions in low- or middle-income-countries, which are priority areas for future research.

L’enfant à naître : dispositifs de contrôle dès que la vie paraît

Cadre de la recherche : L’article met en lumière l’influence des technologies et de la médicalisation, dès la vie utérine, sur les femmes ayant une grossesse dite normale.

Objectifs : L’objectif est de démontrer comment le politique, les institutions et la société mettent en place des dispositifs permettant d’assurer un contrôle sur le fœtus à travers le corps de la mère et comment ceux-ci modifient le rapport à la grossesse et le développement de la relation anténatale.

Méthodologie : Une recherche qualitative avec une approche phénoménologique contextualisée a permis de recueillir les propos de vingt-cinq primipares québécoises sur leur expérience lors de la grossesse et après la naissance de l’enfant. L’analyse a été conduite dans une perspective socio-anthropologique.

Résultats : Les témoignages convergent inévitablement vers les dispositifs de contrôle mis en place autour de la procréation et de l’enfant à naître. La femme enceinte est ainsi invitée à se conformer à de nouvelles normes sociales et médicales par le biais de programmes gouvernementaux et d’un suivi de grossesse standardisé. Le pouvoir s’exerce de manière diffuse en faisant appel à sa responsabilisation face à la prise de bonnes décisions pour produire un enfant en santé. L’anticipation du risque et la technologie occupent une place prégnante sur le vécu des parents et il est difficile pour eux de s’y soustraire.

Conclusions : Les dispositifs de surveillance et de contrôle sur la vie anténatale ne cessent de croître et le développement de la technologie, avec la gamme de nouveaux dépistages génétiques, laisse entrevoir des conséquences importantes sur la signification de la  « normalité » et l’acceptabilité des naissances hors standards.

Contribution : Cet article contribue à montrer les effets des nouvelles technologies sur l’anticipation de l’enfant et les débuts de la grossesse ainsi qu’à constater la progression de la temporalité anténatale induite par la précocité des tests de grossesse.

Do previously held vaccine attitudes dictate the extent and influence of vaccine information-seeking behavior during pregnancy?

Pregnancy represents a high information need state, where uncertainty around medical intervention is common. As such, the pertussis vaccination given during pregnancy presents a unique opportunity to study the interaction between vaccine attitudes and vaccine information-seeking behavior.

We surveyed a sample of pregnant women (N = 182) during early pregnancy and again during late pregnancy. The variables of vaccine confidence and risk perception of vaccination during pregnancy were measured across two questionnaires. Additional variables of decision conflict and intention to vaccinate were recorded during early pregnancy, while vaccine information-seeking behavior and vaccine uptake were recorded during late pregnancy.

88.8% of participants reported seeking additional information about the pertussis vaccine during pregnancy. Women that had a lower confidence in vaccination (p = .004) and those that saw the risk of pertussis disease as high compared to the risk of side effects from the pertussis vaccination during pregnancy (p = .004) spent significantly more time seeking information about the pertussis vaccination.

Women’s perception of risk related to vaccination during pregnancy significantly changed throughout the pregnancy (t(182) = 4.685 p< .001), with women perceiving the risk of pertussis disease higher as compared to the risk of side effects from the vaccine as the pregnancy progresses.

The strength and influence of information found through seeking was predicted by intention to vaccinate (p = .011). As such, we suggest that intention to vaccinate during early pregnancy plays a role in whether the information found through seeking influences women towards or away from vaccination.

Mothers' Understanding of Infant Feeding Guidelines and Their Associated Practices: A Qualitative Analysis

There is limited evidence to describe Australian mothers’ understanding of the Australian Infant Feeding Guidelines (AIFG). A qualitative inductive methodological approach was used in this study to explore experiences with the introduction of solid food. Seven focus groups with 42 mothers of children aged 4–18 months were conducted in disadvantaged areas in Perth, Australia. The mean age of infants was 9.6 months and mean age of introduction of solid food was 4.3 months (range 1.2 to 7.5 months). Almost half of the mothers in this study were aware of the AIFG however, only half again could correctly identify the recommended age for introducing solid food. Four themes and nine subthemes emerged from the analysis. Themes were (1) Every child is different (judging signs of readiness); (2) Everyone gives you advice (juggling conflicting advice); (3) Go with your gut—(being a “good” mother); and (4) It’s not a sin to start them too early or too late (—guidelines are advice and not requirements). The findings indicated that in spite of continued promotion of the AIFG over the past ten years achieving the around six months guideline is challenging. Professionals must address barriers and support enablers to achieving infant feeding recommendations in the design education materials and programs.

Engaging with motherhood and parenthood: A commentary on the social science drugs literature

The majority of qualitative social scientific research on the topic of parenthood and substance use focuses on mothers who use illicit drugs and their experiences of social marginalization and stigmatization. This commentary argues that new and important insights might be gained about parenting in the context of substance use by engaging more closely with everyday experiences of mothering and with contemporary theorising around motherhood and parenthood. Drawing on recent sociological studies of family life influenced by late-modern individualism and by new expert attention on the quality of parent-child relationships, the commentary proposes directions for future social research on the identities and experiences of mothers and fathers who use alcohol and other drugs.

Women's decision making about antidepressant use during pregnancy: A narrative review

BACKGROUND

Depression is common, particularly among women of childbearing age, and can have far-reaching negative consequences if untreated. Efficacious treatments are available, but little is known about how women make depression treatment decisions during pregnancy. The purpose of this narrative review is to interpretively synthesize literature on women's decision making (DM) regarding antidepressant use during pregnancy.

METHODS

The databases PubMed, CINAHL, and PsycINFO were searched between May 2015 and August 2017 for peer-reviewed, English-language papers using terms such as "depression," "pregnancy," and "DM." The literature matrix abstraction method was used to systematically abstract data from full articles that met criteria for inclusion.

RESULTS

Of the articles abstracted (N = 10), half did not cite a DM theory on which the work was based. Key aspects of DM for this population were need for information and decision support, desire for active participation in DM, reflection on beliefs and values, evaluation of treatment option sequelae, and societal expectations. Treatment DM for depression during pregnancy is particularly impacted by the stigma associated with depression and societal expectations of pregnant women related to medication use during pregnancy. These findings, however, were based on studies of predominantly Caucasian and well-educated women.

CONCLUSIONS

Women require a nonjudgmental environment, in which shared DM feels safe, to foster positive DM experiences and outcomes. Future research is needed to define how to best support women to make depression treatment decisions in pregnancy, with particular attention to DM in the second and third trimesters of pregnancy.

Motherhood and highly sensitive children in an online discussion forum

Discourse on the highly sensitive child as a mode of individual coming-into-being is transforming notions of good motherhood. Mothering a child is weighted with practical challenges, normative expectations, and moral implications, all of which can be accentuated when parenting a child that appears to differ from the average. How mothers address themselves to a highly sensitive child can reveal much about contemporary currents in family life. Through analysis of the online discussions in a Swedish forum, I examine mothers' discourse regarding categorization of highly sensitive children, elaboration on the behaviors that constitute this category of protean individuality, and the negotiation of motherhood norms. Three themes are identified: the way in which participants established entitlement to the application of the highly sensitive child label through a process of "enlightenment" based on observing their children and scrutinizing their own childrearing practices; discourse on the "allure" of the highly sensitive child since it depicts the children as super-normal and themselves as mothers called to the custodianship of a "different child"; and finally, how the highly sensitive child label deflects the guilt and frustration linked with handling challenging behaviors, in tension with permitting the sensitive child's self-determined development. The article suggests that the mothers' discourse reflects the intensive mothering norms of child-centered parenting that prevail in Western countries such as Sweden. Through the lens of the highly sensitive child, however, motherhood acquires new anticipatory, considerate and susceptible norms, and strategies that constitute a highly sensitive parenting style.

Anxiety and defensiveness as predictors of maternal child-centrism

Maternal child-centrism is widely regarded in Western societies as the ideal of being a good mother. However, it has recently been criticized for the toll it takes on mothers. This study examines the widespread maternal practice of child-centrism. It is the first, to our knowledge, to examine predictors of the tendency towards child-centrism. Nowadays, with the social unwritten imperative to prioritize children's needs regardless of maternal standpoint, this study aims to focus and shed light on mothers and to explore which maternal characteristics predict maternal child-centrism. Self-reported questionnaires were completed by 320 Jewish-Israeli mothers, dealing with maternal child-centrism, maternal characteristics (i.e. attachment style, anxiety, defensiveness, and negative and positive affect), and socio-demographic context. The results of the Hierarchical Regression analysis revealed that stress-related maternal characteristics of anxiety and defensiveness predicted maternal child-centrism. These findings may imply that child-centrism serves as a mechanism for overcoming distress faced by mothers struggling with current Western societal norms. Its relationship to the feminist conceptualization of the Myth of Motherhood is discussed.

Examining the social construction of surveillance: A critical issue for health visitors and public health nurses working with mothers and children

AIMS AND OBJECTIVES

To critically examine surveillance practices of health visitors (HV) in the UK and public health nurses (PHNs) in Canada.

BACKGROUND

The practice and meaning of surveillance shifts and changes depending on the context and intent of relationships between mothers and HVs or PHNs.

DESIGN

We present the context and practice of HVs in the UK and PHNs in Canada and provide a comprehensive literature review regarding surveillance of mothers within public health systems. We then present our critique of the meaning and practice of surveillance across different settings.

METHODS

Concepts from Foucault and discourse analysis are used to critically examine and discuss the meaning of surveillance.

RESULTS

Surveillance is a complex concept that shifts meaning and is socially and institutionally constructed through relations of power.

CONCLUSIONS

Healthcare providers need to understand the different meanings and practices associated with surveillance to effectively inform practice.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should be aware of how their positions of expert and privilege within healthcare systems affect relationships with mothers. A more comprehensive understanding of personal, social and institutional aspects of surveillance will provide opportunities to reflect upon and change practices that are supportive of mothers and their families.

The happiness imperative: Exploring how women narrate depression and anxiety during pregnancy

This article explores how women account for their experiences of pregnancy distress in light of cultural imperatives to be the perfect, happy mother. Our analysis is based on the accounts of 18 Australian women, interviewed during pregnancy on the basis of their reports of experiencing depression and/or anxiety. Working within a feminist discursive framework, we focus on the discourses that informed (and threatened) women’s positions as a good mother. In particular, we focus on the discourses women relied on to explain their distress and the discursive strategies they used in the construction of their (“distressed”) maternal identity(ies). We ask how women articulate and label distress, and with what rhetorical effects. Our analysis explores how women’s experiences of negative moods and distress were in direct opposition to cultural imperatives for mothers to stay happy and positive during pregnancy and beyond, posing rhetorical challenges to women’s accounts and hence their capacity to make meaning of their (negative) experiences. Three discursive strategies are explored: distancing from the depressed self, speaking between/around/without words, and in search of a balance. We close by considering the implications of the complex ways in which women account for idealised motherhood and how this serves to oppress vulnerable women.

Understanding the perceived logic of care by vaccine-hesitant and vaccine-refusing parents: A qualitative study in Australia

In terms of public health, childhood vaccination programs have benefits that far outweigh risks. However, some parents decide not to vaccinate their children. This paper explores the ways in which such parents talked about the perceived risks and benefits incurred by vaccinating (or not vaccinating) their children. Between 2013–2016 we undertook 29 in-depth interviews with non-vaccinating and/or ‘vaccine hesitant’ parents in Australia. Interviews were conducted in an open and non-judgmental manner, akin to empathic neutrality. Interviews focused on parents talking about the factors that shaped their decisions not to (or partially) vaccinate their children. All interviews were transcribed and analysed using both inductive and deductive processes. The main themes focus on parental perceptions of: 1. their capacity to reason; 2. their rejection of Western medical epistemology; and 3. their participation in labour intensive parenting practices (which we term salutogenic parenting). Parents engaged in an ongoing search for information about how best to parent their children (capacity to reason), which for many led to questioning/distrust of traditional scientific knowledge (rejection of Western medical epistemology). Salutogenic parenting spontaneously arose in interviews, whereby parents practised health promoting activities which they saw as boosting the natural immunity of their children and protecting them from illness (reducing or negating the perceived need for vaccinations). Salutogenic parenting practices included breastfeeding, eating organic and/or home-grown food, cooking from scratch to reduce preservative consumption and reducing exposure to toxins. We interpret our data as a ‘logic of care’, which is seen by parents as internally consistent, logically inter-related and inter-dependent. Whilst not necessarily sharing the parents’ reasoning, we argue that an understanding of their attitudes towards health and well-being is imperative for any efforts to engage with their vaccine refusal at a policy level.

Parental Experiences of Raising a Child With Medium Chain Acyl-CoA Dehydrogenase Deficiency

Newborn screening enabling early diagnosis of medium chain acyl-CoA dehydrogenase deficiency (MCADD) has dramatically improved health outcomes in children with MCADD. Achieving those outcomes depends on effective management by parents. Understanding parental management strategies and associated anxieties and concerns is needed to inform provision of appropriate care and support. Semistructured interviews were conducted with a purposive sample of parents of children aged 2 to 12 years. Thematic analysis identified two main themes. Managing dietary intake examined how parents managed day-to-day dietary intake to ensure adequate intake and protection of safe fasting intervals. Managing and preventing illness events explored parental experiences of managing illness events and their approach to preventing these events. Management strategies were characterized by caution and vigilance and influenced by a lack of confidence in others to manage the condition. The study identifies the need for increased awareness of the condition, particularly in relation to emergency treatment.

Parents' and informal caregivers' views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence

BACKGROUND

Childhood vaccination is an effective way to prevent serious childhood illnesses, but many children do not receive all the recommended vaccines. There are various reasons for this; some parents lack access because of poor quality health services, long distances or lack of money. Other parents may not trust vaccines or the healthcare workers who provide them, or they may not see the need for vaccination due to a lack of information or misinformation about how vaccinations work and the diseases they can prevent.Communication with parents about childhood vaccinations is one way of addressing these issues. Communication can take place at healthcare facilities, at home or in the community. Communication can be two-way, for example face-to-face discussions between parents and healthcare providers, or one-way, for instance via text messages, posters or radio programmes. Some types of communication enable parents to actively discuss vaccines and their benefits and harms, as well as diseases they can prevent. Other communication types simply give information about vaccination issues or when and where vaccines are available. People involved in vaccine programmes need to understand how parents experience different types of communication about vaccination and how this influences their decision to vaccinate.

OBJECTIVES

The specific objectives of the review were to identify, appraise and synthesise qualitative studies exploring: parents' and informal caregivers' views and experiences regarding communication about childhood vaccinations and the manner in which it is communicated; and the influence that vaccination communication has on parents' and informal caregivers' decisions regarding childhood vaccination.

SEARCH METHODS

We searched MEDLINE (OvidSP), MEDLINE In-process and Other Non-Index Citations (Ovid SP), Embase (Ovid), CINAHL (EbscoHOST), and Anthropology Plus (EbscoHost) databases for eligible studies from inception to 30 August 2016. We developed search strategies for each database, using guidelines developed by the Cochrane Qualitative Research Methods Group for searching for qualitative evidence as well as modified versions of the search developed for three related reviews of effectiveness. There were no date or geographic restrictions for the search.

SELECTION CRITERIA

We included studies that utilised qualitative methods for data collection and analysis; focused on the views and experiences of parents and informal caregivers regarding information about vaccination for children aged up to six years; and were from any setting globally where information about childhood vaccinations was communicated or distributed.

DATA COLLECTION AND ANALYSIS

We used maximum variation purposive sampling for data synthesis, using a three-step sampling frame. We conducted a thematic analysis using a constant comparison strategy for data extraction and synthesis. We assessed our confidence in the findings using the GRADE-CERQual approach. High confidence suggests that it is highly likely that the review finding is a reasonable representation of the phenomenon of interest, while very low confidence indicates that it is not clear whether the review finding is a reasonable representation of it. Using a matrix model, we then integrated our findings with those from other Cochrane reviews that assessed the effects of different communication strategies on parents' knowledge, attitudes and behaviour about childhood vaccination.

MAIN RESULTS

We included 38 studies, mostly from high-income countries, many of which explored mothers' perceptions of vaccine communication. Some focused on the MMR (measles, mumps, rubella) vaccine.In general, parents wanted more information than they were getting (high confidence in the evidence). Lack of information led to worry and regret about vaccination decisions among some parents (moderate confidence).Parents wanted balanced information about vaccination benefits and harms (high confidence), presented clearly and simply (moderate confidence) and tailored to their situation (low confidence in the evidence). Parents wanted vaccination information to be available at a wider variety of locations, including outside health services (low confidence) and in good time before each vaccination appointment (moderate confidence).Parents viewed health workers as an important source of information and had specific expectations of their interactions with them (high confidence). Poor communication and negative relationships with health workers sometimes impacted on vaccination decisions (moderate confidence).Parents generally found it difficult to know which vaccination information source to trust and challenging to find information they felt was unbiased and balanced (high confidence).The amount of information parents wanted and the sources they felt could be trusted appeared to be linked to acceptance of vaccination, with parents who were more hesitant wanting more information (low to moderate confidence).Our synthesis and comparison of the qualitative evidence shows that most of the trial interventions addressed at least one or two key aspects of communication, including the provision of information prior to the vaccination appointment and tailoring information to parents' needs. None of the interventions appeared to respond to negative media stories or address parental perceptions of health worker motives.

AUTHORS' CONCLUSIONS

We have high or moderate confidence in the evidence contributing to several review findings. Further research, especially in rural and low- to middle-income country settings, could strengthen evidence for the findings where we had low or very low confidence. Planners should consider the timing for making vaccination information available to parents, the settings where information is available, the provision of impartial and clear information tailored to parental needs, and parents' perceptions of health workers and the information provided.

The impact of a vaccine scare on parental views, trust and information needs: a qualitative study in Sydney, Australia

BACKGROUND

Vaccine safety scares can undermine public confidence in vaccines and decrease immunisation rates. Understanding and addressing parental concerns arising during such scares can assist in lessening their impact. In Australia in April 2010 there was a temporary suspension of influenza vaccine for children under 5 years of age after reports of an increase in the rate of adverse events following vaccination. This qualitative study aimed to explore the impact of the vaccine suspension on parental knowledge, attitudes, trust, information needs, and intent related to influenza vaccination and broader immunisation programs.

METHODS

Semi-structured interviews were conducted with 25 parents of children attending childcare centres in Sydney, Australia, between June 2010 and May 2011. Centres were selected to include parents from a range of socioeconomic backgrounds. Interview transcripts were coded and analysed using an approach informed by grounded theory.

RESULTS

Findings indicated that, for those who recalled the vaccine suspension, there was a lasting sense of uncertainty and confusion and a perceived lack of information. Parents had distinct information needs following the vaccine suspension, especially in regards to vaccine safety, testing and recommendations. For many, influenza vaccination intent was conditional on receipt of information from a trusted, authoritative source allaying safety concerns. Importantly, the impact of the scare was contained to influenza vaccines only, and not other vaccine programs.

CONCLUSIONS

Parental concerns and information gaps following a vaccine safety scare need to be actively addressed. We provide policy and practice suggestions for proactively managing such incidents, particularly in relation to communication of timely, targeted information to parents and immunisation providers.

"As soon as you've had the baby that's it…" a qualitative study of 24 postnatal women on their experience of maternal obesity care pathways

Background

Maternal obesity is associated with risks to mother and infant, and has implications for healthcare costs. United Kingdom (UK) levels of maternal obesity are rising, with higher prevalence in North East (NE) England, where this study was set. Pregnancy is often seen as an opportune time for intervention – a ‘teachable moment’ - which is ripe for promoting behaviour change. In response to rising obesity levels, a National Health Service (NHS) Foundation Trust in NE England implemented three maternal obesity care pathways contingent on Body Mass Index (BMI) at time of booking: pathway 1 for those with BMI ≥30 kg/m²; pathway 2 for BMI ≥35 kg/m²; and pathway 3 for BMI ≥40 kg/m². These incorporated relevant antenatal, intrapartum and postnatal clinical requirements, and included a focus on weight management intervention. This evaluation explored the accounts of postnatal women who had been through one of these pathways in pregnancy.

Methods

The study used a generic qualitative approach. Semi-structured interviews were carried out to explore the views and experiences of 24 recent mothers (aged 20–42), living in NE England, who had commenced on one of the pathways during pregnancy. Interviews explored experiences of weight management support during and after pregnancy, and perceived gaps in this support. Data were analysed using thematic content analysis.

Results

Three main themes emerged reflecting women’s views and experiences of the pathways: communication about the pathways; treating obese pregnant women with sensitivity and respect; and appropriate and accessible lifestyle services and information for women during and after pregnancy. An overarching theme: differences in care, support and advice, was evident when comparing the experiences of women on pathways 1 or 2 with those on pathway 3.

Conclusions

This study indicated that women were not averse to risk management and weight management intervention during and after pregnancy. However, in order to improve reach and effectiveness, such interventions need to be well communicated and offer constructive, individualised advice and support. The postnatal phase may also offer an opportune moment for intervention, suggesting that the simple notion of seeing pregnancy alone as a window of opportunity or a ‘teachable moment’ should be reconsidered.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3289-1) contains supplementary material, which is available to authorized users.