Medical students’ knowledge, attitudes, and perceptions on contraceptive use and counselling : a cross-sectional survey in Maharashtra, India

Objectives. This study aimed to investigate the knowledge, attitudes and perceptionstowards contraceptive use and counselling among medical students in Maharashtra, India. Setting. Considerable global maternal mortality and morbidity could be avoided through theuse of effective contraception. In India, contraception services are frequently unavailable or there are obstacles to obtaining modern, reversible contraceptives. Participants. A cross-sectional descriptive study using a self-administered questionnaire was conducted among 1996 medical students in their fifth year of study at 27 medical colleges in the state of Maharashtra, India. Descriptive and analytical statistics interpreted the survey instrument and significant results were presented with 95% CI. Results. Respondents expressed a desire to provide contraceptive services. A few studentshad experienced training in abortion care. There were misconceptions about moderncontraceptive methods and the impact of sex education. Attitudes towards contraceptionwere mainly positive, premarital counselling was supported and the influence of traditional values and negative provider attitudes on services was recognised. Gender, area of upbringing and type of medical college did not change the results. Conclusions. Despite mostly positive attitudes towards modern contraceptives, sex education and family planning counselling, medical students in Maharashtra have misconceptions about modern methods of contraception. Preservice and in-service training in contraceptive counselling should be implemented in order to increase women's access to evidence-based maternal healthcare services.

Knowledge translation in Uganda : a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. RESULTS: The sub-elements of organizational context in the PARIHS framework--i.e., receptive context, culture, leadership, and evaluation--also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings--resources, community involvement, and commitment and informal payment--should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.

Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam

BACKGROUND: In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members. METHODS: Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis. RESULTS: Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators' lack of health knowledge was regarded as a deficit for assisting the groups' assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups. CONCLUSIONS: This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and survival in Vietnam : a qualitative study

Background In the Neonatal health – Knowledge into Practice (NeoKIP) trial in Vietnam, local stakeholder groups, supported by trained laywomen acting as facilitators, promoted knowledge translation (KT) resulting in decreased neonatal mortality. In general, as well as in the community-based NeoKIP trial, there is a need to further understand how context influences KT interventions in low- and middle-income countries (LMICs). Thus, the objective of this study was to explore the influence of context on the facilitation process in the NeoKIP intervention. Methods A secondary content analysis was performed on 16 Focus Group Discussions with facilitators and participants of the stakeholder groups, applying an inductive approach to the content on context through naïve understanding and structured analysis. Results The three main-categories of context found to influence the facilitation process in the NeoKIP intervention were: (1) Support and collaboration of local authorities and other communal stakeholders; (2) Incentives to, and motivation of, participants; and (3) Low health care coverage and utilization. In particular, the role of local authorities in a KT intervention was recognized as important. Also, while project participants expected financial incentives, non-financial benefits such as individual learning were considered to balance the lack of reimbursement in the NeoKIP intervention. Further, project participants recognized the need to acknowledge the needs of disadvantaged groups. Conclusions This study provides insight for further understanding of the influence of contextual aspects to improve effects of a KT intervention in Vietnam. We suggest that future KT interventions should apply strategies to improve local authorities’ engagement, to identify and communicate non-financial incentives, and to make disadvantaged groups a priority. Further studies to evaluate the contextual aspects in KT interventions in LMICs are also needed.

Leva som man lär? : En studie av spänningsfältet mellan genusvetande och genusgörande

Practice as you preach? Gender scholars’ reflections on practising gender theory Being a gender scholar – to what extent is it possible to practice as you preach? This study investigates how gender scholars relate to using and practicing theoretical knowledge on gender.Ten in-depth interviews are conducted with gender scholars at Swedish universities. A semi-structured interview guide, based on ambitions, possibilities and obstacles regarding using theoretical knowledge in practice, is used. The results indicate that being a gender scholar is a highly reflective project, since it involves turning your gender theoretical gaze towards yourself. Practicing as you preach seems to be interpreted as undoing gender. Attempts to undo gender are said to be hindered by gender normative structures rendering gender scholar women and gender scholar men different possibilities to practice the undoing of gender. The analysis show that gender scholars perform a balancing act by adding some expressions for the opposite gender to their everyday doings and their physical appearance, thus combining a doing with an undoing of gender. The pace and force of change in these doings and undoings are rather small. Nevertheless, small as they may be, these steps are interpreted as part of a strategy to change gender normative structures, making possible yet other and freer gender performances.

Condoms and Healthcare professionals : Risk-behavior and attitudes towards condom use

Alarming S.T.I’s percentages and low condom use motivated this research. Healthcare professional’s risk-behavior and attitudes towards risk-behavior were reviewed. Three hypotheses, aimed to test whether healthcare professionals working with S.T.I’s should have a different attitude, knowledge and behavior to condom use compared to healthcare professionals that did not work with S.T.I’s. Ninety-five participants working at a hospital in middle-Sweden answered a questionnaire, based on the Swedish UNGKAB09 research. Mann-Whitney analyses showed no significant difference between the two groups on knowledge, attitude and behavior. A high percentage of steady relationships, high homogeneity between groups as well the same attitudes and intentions could have been a reliability problem. The collected data was however interesting as a base for further research

Skicklig läs- och skrivundervisning i åk 1-3 : Om lärares möjligheter och hinder

This study focuses on teachers’ opportunities and obstacles to perform skillful reading and writing instruction. It’s about the ability to accurately identify where students are in their reading and writing process and to help them develop good reading skills. It is also about the ability to recognize signs of difficulties that students may have in their written language development and to know what efforts are needed to help them advance their reading and writing skills. The research is based on teachers’ own statements and survey responses on the external conditions for teaching and on their approach, attitudes and knowledge in reading and writing. The empirical material consists of interviews, surveys and test data. The interview study was conducted with eight teachers. The questionnaire was answered by 249 teachers, while the knowledge test was conducted of 269 teachers and 31 special education teachers. Many of the teachers in this study have lack knowledge in the structure of language and common Swedish spelling rules. Furthermore, it appears that a large part of them are unaccustomed to explaining, in detail, students’ reading development and find it difficult to systematically describe the aspects of daily literacy instruction. The overall picture is that many teachers teach without having tools to reflect on how their education really affects students’ reading and writing. These shortcomings make it difficult to conduct effective literacy instruction. Once students have learned to decode or if they have reading difficulties, many teachers seem to one-sidedly focus on getting students to read more. The consequence could be that those who would need to practice more on the technical basic of reading or comprehension strategies are left without support. Lack of variety and individuality in fluency and comprehension training can challenge the students’ reading and writing development. The teachers in the study, who have the old junior school teacher and elementary teacher education, have the highest amount of knowledge of reading and writing (the test). Good education can provide student teachers with professional skills that they may develop further in their careers. Knowledge of the meaning of phonological and phonemic awareness as well as knowledge of how to count phonemes seem to be important for knowledge of reading and writing (the test). Knowledge of basic reading processes can be obtained by systematic and structured work with students’ linguistic development, and through continuous dialogues with experienced colleagues on how and why questions. This is one important way to work also in teacher training. When essential professional skills are established in the teacher education, in practice students will obtain the school’s learning goals.

Attitudes towards the minority variety Caló in the south of Spain : a sociolinguistic study

Caló is a variety spoken by the Spanish Calé (i.e. the Roma). It belongs to a group of languages referred to as “Para-Romani”, characterized by Romani vocabulary, but largely non-Romani morphology, phonology and syntax, in the case of Caló deriving from Spanish. According to previous research carried out – with focus on the vocabulary and the grammar of this variety – Caló is on its way to extinction. However, there is an expressed interest in reintroducing a form called “Romanó-Caló”. Attitudes play an important role in minority language maintenance as well as in order for a revitalization project to be successful. The aim of this study is to measure the attitudes that both Calé and non-Calé have towards Caló and Caló speakers, a type of study never carried out in the past. The methods applied are both direct and indirect. In total, 231 informants listened to different recordings of voices acting as either a “Spanish speaking person” or a “Caló speaking person”, a technique referred to as ‘matched guise’, answering questions related to the voices on attitude scales. Furthermore, 182 of the informants rated their agreement or disagreement to positive and negative items towards Caló and its speakers on a Likert scale. The results of the analysis indicate that the attitudes differ towards Caló and Caló speakers, depending on the informant’s (a) ethnicity (b) contact with Caló as well as with Caló speakers, and (c) gender. It is those who – in their own opinion – belong to the ethnic group Calé, as well as those who claim that they have some contact with the variety and its speakers, who show positive attitudes in both parts of the study. The women also show more positive attitudes than the men. It is also possible to note positive attitudes towards the variety and its speakers among the subjects with a high level of knowledge of Caló words, as well as among those with the highest willingness to use Caló. These observations suggest that a revitalization project of the variety Caló has a clear chance of being successful.

The effects of attitudes and personality traits on mode choice

We hypothesise that differences in people's attitudes and personality traits lead them to attribute varying importance to environmental considerations, safety, comfort, convenience and flexibility. Differences in personality traits call be revealed not only in the individuals' choice of transport, but also in other actions of their everyday lives-such as how much they recycle, whether they take precautions or avoid dangerous pursuits. Conditioning on a set of exogenous individual characteristics, we use indicators of attitudes and personality traits to form latent variables for inclusion in an, otherwise standard, discrete mode choice model. With a sample of Swedish commuters, we find that both attitudes towards flexibility and comfort, as well as being pro-environmentally inclined, influence the individual's choice of mode. Although modal time and cost still are important, it follows that there are other ways, apart from economic incentives, to attract individuals to the, from society's perspective, desirable public modes of transport. Our results should provide useful information to policy-makers and transportation planners developing sustainable transportation systems.

Children’s Literature and English Teaching – Swedish Teachers’ Methods and Attitudes

This study investigates how primary school teachers of grades F-3 pupils in a number of sample schools in Sweden use children’s literature and other methods to enhance their teaching of English. The study explores the attitudes of these teachers’ to using English children’s literature as a teaching tool to promote language development in their pupils, focusing on vocabulary. An empirical questionnaire study was carried out including a total of twenty-three respondents from seven schools in a Stockholm suburb. The respondents are all working teachers with experience of teaching English to young learners, particularly in grades F-3. This study contributes with new knowledge about the often-recommended use of children’s literature as a method for teaching English to young learners, connecting international research with empirical data from the Swedish context. While the results suggest that the majority of the respondents are positive to using children’s literature in their teaching and regularly do so, many of them feel that it is somewhat difficult to find relevant materials to plan, implement and evaluate lessons within the allocated time-frame. Based on these results, further research about how to create more effective ways of using children’s literature as a method for English vocabulary teaching in Swedish schools is recommended.

Design and use of mobile technology in distance language education : Matching learning practices with technologies-in-practice

This thesis focuses on the adaptation of formal education to people’s technology- use patterns, theirtechnology-in-practice, where the ubiquitous use of mobile technologies is central. The research question is: How can language learning practices occuring in informal learning environments be effectively integrated with formal education through the use of mobile technology? The study investigates the technical, pedagogical, social and cultural challenges involved in a design science approach. The thesis consists of four studies. The first study systematises MALL (mobile-assisted language learning) research. The second investigates Swedish and Chinese students’ attitudes towards the use of mobile technology in education. The third examines students’ use of technology in an online language course, with a specific focus on their learning practices in informal learning contexts and their understanding of how this use guides their learning. Based on the findings, a specifically designed MALL application was built and used in two courses. Study four analyses the app use in terms of students’ perceived level of self-regulation and structuration. The studies show that technology itself plays a very important role in reshaping peoples’ attitudes and that new learning methods are coconstructed in a sociotechnical system. Technology’s influence on student practices is equally strong across borders. Students’ established technologies-in-practice guide the ways they approach learning. Hence, designing effective online distance education involves three interrelated elements: technology, information, and social arrangements. This thesis contributes to mobile learning research by offering empirically and theoretically grounded insights that shift the focus from technology design to design of information systems.

Learning Grammar : A study of upper secondary level students’ attitudes and beliefs concerning the learning of grammar

The communicative approach to language learning is widely taught in Western education, and yet its predecessor, the grammar-translation method, is still commonly employed in other parts of the world. In Sweden, the increasing popularity of the communicative approach is often justified by the high level of students’ communicative skills (Öhman, 2013). At the same time, students’ written texts and speech contain many grammatical errors (Öhman, 2013). Consequently, being aware of their tendency to produce grammatical errors, some students express beliefs regarding both the explicit and implicit learning of grammar (Sawir, 2005; Boroujeni, 2012). The objective of this thesis is to gain more knowledge regarding students’ beliefs concerning the learning of English grammar at the upper secondary level, in Sweden. With this purpose a survey was conducted in two schools in Sweden, where 49 upper-secondary English students participated. Qualitative and quantitative methods were applied to process the collected data. Despite some difference in the participants’ ages, there were many similarities in their attitudes towards the teaching and learning of grammar. The results show that the participants in both schools believe that only by applying both, explicit and implicit methods, can they obtain a high level of language proficiency. The results of this study can help teachers in planning different activities that enhance the students’ knowledge of grammar.

Medical students are afraid to include abortion in their future practices : in-depth interviews in Maharastra, India

BACKGROUND: Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education. METHOD: We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach. RESULTS: The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future. CONCLUSIONS: To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.