Healthcare providers balancing norms and practice : challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study

BACKGROUND: Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. OBJECTIVE: This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. DESIGN: We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. RESULTS: The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. CONCLUSIONS: Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.

Socialisation and the work-related norms of marketing practitioners

This paper empirically describes the influences of professional and organisational socialisation on the norms of marketers. Based on a survey of 5,000 practitioners, it finds that the socialisation of marketers into their profession and organisations positively influences their marketing-related norms. This research appears to be the first investigation in the marketing ethics literature of the relationships among these constructs. The paper explains how the learning of professional and organisational rules, guidelines, and values influence the work-related norms of marketers. The findings have important implications for marketing managers and managers of professional associations.

Discordance between lung function of Chinese university students of 20-year-old established norms

Objective: We examined the validity of the 20-year-old established Asian norms for pulmonary function in a contemporary cohort of Hong Kong Chinese university students. Design and participants: Pulmonary function testing was conducted in university students (n = 805). Setting: A university campus in Hong Kong. Measurements and results: Parameters recorded included gender, age, height, weight, standard lung function variables (ie, FEV1, FVC, and peak expiratory flow rate [PEFR]), and exhaled carbon monoxide (CO) level. Subjects completed a questionnaire on pulmonary health, smoking history, and their dietary and exercise habits within 3 months of the study. Data were compared with the established norms for lung function for Chinese persons from Hong Kong. On average, subjects were taller than those reported in the original cohort, on whom the established norms are based; however, FEV1, FVC, and PEFR were lower. As predicted, the exhaled CO level was higher in smokers. Those who exercised regularly had a higher FEV1 and FVC, and reported fewer respiratory complaints. Conclusions: Our findings support the idea that lung function norms not only differ across ethnic groups, but that they may be susceptible to change over a single generation within an ethnic group living in the same geographic region. Assuming the equivalence of our testing methods and those on which established norms are based, our findings shed further insight into the dynamic nature of lung function, and have implications regarding the definition of normal pulmonary function and its variance over the short term.

Fitting triangular norms to empirical data

This chapter discusses some specific tools that can be used to build triangular norms based on a finite number of (possibly noisy) observations. Such problem arises in applications, when observed data (e.g., decision patterns of experts) need to be modelled with a special class of functions, such as triangular norms. We show how this problem can be transformed into a constrained regression problem, and then efficiently solved. We also discuss related operators: uninorms, nullnorms and associative copulas.

The SF36 Version 2: critical analyses of population weights, scoring algorithms and population norms

Background: The SF36 Version 2 (SF36V2) is a revision of the SF36 Version 1, and is a widely used health status measure. It is important that guidelines for interpreting scores are available.

Method: A population sample of Australians (n = 3015) weighted to achieve representativeness was administered the SF36V2. Comparisons between published US weights and sample derived weights were made, and Australian population norms computed and presented.

Major findings: Significant differences were observed on 7/8 scales and on the mental health summary scale. Possible causes of these findings may include different sampling and data collection procedures, demographic characteristics, differences in data collection time (1998 vs. 2004), differences in health status or differences in cultural perception of the meaning of health. Australian population norms by age cohort, gender and health status are reported by T-score as recommended by the instrument developers. Additionally, the proportions of cases within T-score deciles are presented and show there are important data distribution issues.

Principal conclusions: The procedures reported here may be used by other researchers where local effects are suspected. The population norms presented may be of interest. There are statistical artefacts associated with T-scores that have implications for how SF36V2 data are analysed and interpreted.