Recent media coverage and case reports have highlighted women's attempts to end their pregnancies by self-inducing abortions in the United States. This study explored women's motivations for attempting self-induction of abortion. We surveyed women in clinic waiting rooms in Boston, San Francisco, New York, and a city in Texas to identify women who had attempted self-induction. We conducted 30 in-depth interviews and inductively analyzed the data. Median age at time of self-induction attempt was 19 years. Between 1979 and 2008, the women used a variety of methods, including medications, malta beverage, herbs, physical manipulation and, increasingly, misoprostol. Reasons to self-induce included a desire to avoid abortion clinics, obstacles to accessing clinical services, especially due to young age and financial barriers, and a preference for self-induction. The methods used were generally readily accessible but mostly ineffective and occasionally unsafe. Of the 23 with confirmed pregnancies, three reported a successful abortion not requiring clinical care. Only one reported medical complications in the United States. Most would not self-induce again and recommended clinic-based services. Efforts should be made to inform women about and improve access to clinic-based abortion services, particularly for medical abortion, which may appeal to women who are drawn to self-induction because it is natural, non-invasive and private.
Local health departments (LHDs) have a key role to play in developing built environment policies and programs to encourage physical activity and combat obesity and related chronic diseases. However, information to guide LHDs’ effective engagement in this arena is lacking. During 2011–2012, the New York City Department of Health and Mental Hygiene (DOHMH) facilitated a built environment peer mentoring program for 14 LHDs nationwide. Program objectives included supporting LHDs in their efforts to achieve built environment goals, offering examples from DOHMH’s built environment work to guide LHDs, and building a healthy built environment learning network. We share lessons learned that can guide LHDs in developing successful healthy built environment agendas.
Aims and methodTo share evaluation findings of a new decentralised mental healthcare system addressing Axis I disorders, developed in four subdistricts of Aceh Besar in Indonesia following the 2004 Asian tsunami. Two complementary methodologies were employed: an adequacy survey that assessed whether agreed programme implementation tasks were completed, and an outcome study that utilised patient, caregiver and staff assessment of the programme to determine what changes, if any, resulted from participation in the programme.ResultsThe system is functional in 3 of 4 subdistricts, and 47 of 53 subdistrict clinics (puskesmas) have trained mental healthcare nurses. Both patients and caregivers reported statistically significant differences when ranking patient wellbeing and were able to qualitatively describe specific changes in patient symptomatology and social functioning.Clinical implicationsResults indicate that (a) the creation of a decentralised system with outreach at multiple levels, (b) emphasis on staff capacity building within a wider household-to-hospital continuum of care, and (c) incorporation of community volunteers working with trained medical personnel led to effective treatment options for people with Axis I disorders in a resource-poor setting.
IntroductionInstitutional mentoring may be a useful capacity-building model to support local health departments facing public health challenges. The New York City Department of Health and Mental Hygiene conducted a qualitative evaluation of an institutional mentoring program designed to increase capacity of health departments seeking to address chronic disease prevention. The mentoring program included 2 program models, a one-to-one model and a collaborative model, developed and implemented for 24 Communities Putting Prevention to Work grantee communities nationwide.MethodsWe conducted semi-structured telephone interviews to assess grantees’ perspectives on the effectiveness of the mentoring program in supporting their work. Two interviews were conducted with key informants from each participating community. Three evaluators coded and analyzed data using ATLAS.ti software and using grounded theory to identify emerging themes.ResultsWe completed 90 interviews with 44 mentees. We identified 7 key program strengths: learning from the New York City health department’s experience, adapting resources to local needs, incorporating new approaches and sharing strategies, developing the mentor–mentee relationship, creating momentum for action, establishing regular communication, and encouraging peer interaction.ConclusionParticipants overwhelmingly indicated that the mentoring program’s key strengths improved their capacity to address chronic disease prevention in their communities. We recommend dissemination of the results achieved, emphasizing the need to adapt the institutional mentoring model to local needs to achieve successful outcomes. We also recommend future research to consider whether a hybrid programmatic model that includes regular one-on-one communication and in-person conferences could be used as a standard framework for institutional mentoring.
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