Objective: The aim of the study was to describe pregnant women's expectations of being able to access their electronic health records from antenatal care. Methods: Nine pregnant women passing 25 full gestational weeks were interviewed individually. Collected data were analysed with an inductive approach using content analysis. The study was performed in antenatal care units in southern Sweden. Results: The following five categories emerged from the analysis: Being able to achieve increased participation, being able to have more control, being more knowledgeable about the pregnancy, identification of possible risks, and perceptions of one's own well-being can predict usage. The five categories led to one main category: 'Shift in power from passive passenger to participating co-pilot'. Conclusion: The pregnant women expected that having access to electronic health records would give them more control, make them more knowledgeable and increase their participation. Access to electronic health records may empower pregnant women and contribute to a more person-centred approach. This could provide greater knowledge for the woman and her partner about her health, thus, allowing them to make evidence-based choices in relation to the newborn baby and the woman's health.

Objectives: The purpose of this study was to explore Arabic-speaking women´s experiences of communication at antenatal care in Sweden when using a tablet application (app).

Design: The study is a part of a major research project, where a Swedish-Arabic app was developed to improve and facilitate communication between Arabic-speaking women and midwives. The first prototype was developed in 2017 and tested at six antenatal clinics in southeast of Sweden. Ten Arabic-speaking women were purposively recruited, and individual interviews were performed. Content analysis was used.

Findings: Four main categories emerged: "Adapting the content to the patient group", "language and communication", "user-friendly" and "improvement proposal". The women reported that the content was educational, reliable and understandable. The information gave the women a sense of security. It was time effective and allowed opportunity for dialogue. Depending on language skills, there were different opinions as to whether the App should be a complement to having an interpreter or used separately.

Key conclusion: Arabic-speaking women perceived the App as being a communication tool despite their language skills in Swedish. There is a need for digital support for communication in maternity care

INTRODUCTION Providing good communication is at the core of recent international guidelines for improving women's outcomes at birth. Communication barriers are identified as major obstacles to providing effective and equal care among foreign-born women. There is a need for accurate communication tools in antenatal care. The aim of this study was to describe challenges met by researchers when developing culturally sensitive content in a Swedish-Arabic application for communication support at antenatal care in Sweden. METHODS A co-design methodology was used for the development of the application, entailing collaboration between users and researchers in five different phases: users' needs and preferences, development, field testing I, refinement, and field testing II. RESULTS Five challenges emerged: evidence-based information, time frame, realistic photographs, norm-critical perspective, and cultural issues. One challenge was to meet the needs of the users and combine it with information following evidence-based obstetric welfare guidelines. It was also challenging to produce short informational videos that could be adjusted for the duration of the visit with the midwife without omitting important information and to produce photographs which can become outdated. It was also a challenge to portray a less clinical environment and to maintain parents' integrity. It was also challenging to produce norm-critical content from the women's perspective. CONCLUSIONS When developing content of an application for antenatal care, converting content proposals into a finished product is challenging. Collaboration between a cross-disciplinary research team, midwives and target-language women is essential to ensure that the content is usable and reliable.

Objective

The Internet plays a major role for pregnant women in seeking knowledge and for getting in touch with like-minded women. The information is available at all hours and can be accessed anywhere. The information provides the women with a sense of control and confidence but the large amount of information available can also be overwhelming. The aim of this study was to identify how women use the Internet as a source of information during their pregnancy and how it affects them.

Design and setting

A descriptive cross-sectional study was conducted.Data were collected through a questionnaire at antenatal clinics in the southern Sweden. The data were analyzed descriptively

Participants

A total of 193 Swedish women, pregnant at least 34 weeks, participated in the study. The response rate was 94%.

Findings

Almost all (95%) of the women in the study used the Internet as a source of information. The main reason was to find information and read about people in the same situation. Reading pregnancy-related information on the Internet was seen as positive. However, a majority of the woman experienced feelings of worry due to something they read online. These feelings were most commonly coped with by talking to a partner, relatives, and friends or by asking the midwife at their next appointment. Eleven per cent of the women contacted the general healthcare services because of their feelings of worry.

Conclusion

Almost all women in this study searched the Internet to find pregnancy-related information, despite being satisfied with the information they received from the ANC. Using the Internet was seen as complementary to the information from professionals. It also caused feelings of worry, which could lead to the woman contacting healthcare services for support. ANC could help to reduce these feelings for some women by informing about the advantages and disadvantages with online information and recommending suitable web pages.

Introduction

Prolonged progress can occur in the first and second stages of labour and may contribute to a negative birth experience. However, previous studies have mainly focused on quantitative aspects or overall birth experience, and little is known about women’s experiences of a prolonged passive second stage. 

Objective

To describe the lived experiences of a prolonged passive second stage of labour in nulliparous women.MethodsA qualitative study was conducted with 15 nulliparous women with a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. 

Results

The analysis resulted in four themes: “An unknown phase” that entailed remaining in a phase that the women lacked an awareness of. “Trust and mistrust in the body’s ability” represents the mindset for vaginal birth as well as feelings of powerlessness and self-guilt. The theme “Loss of control” included experiences of frustration, fatigue, and having to deny bodily instincts. “Support through presence and involvement” signifies support through the midwife’s presence in the birthing room, although there were also descriptions of emotional or physical absence.

Conclusions

The findings contribute to the understanding of prolonged labour based on women’s lived experiences and add to the body of knowledge about the prolonged passive second stage. This study highlights that women need support through information, presence, and encouragement to remain in control. It can be beneficial during birth preparation to include knowledge about the passive second stage together with unexpected or complicated situations during birth, such as prolonged labour.

Objective: To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women.

Methods and findings: A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to <2 h), 120–239 min (2- <4h) and ≥240 min (≥4h). Differences between the groups were examined using t-test and Chi2-tests and regression analyses were used to analyse adjusted odds ratio with 95% confidence intervals. The primary outcome was mode of delivery in relation to the duration of the passive second stage and the secondary outcomes covered a series of adverse maternal and neonatal birth outcomes. The rates of instrumental and caesarean deliveries increased as the duration of the passive second stage increased. A ≥4-hour duration of the passive second stage was associated with a nine-times increased risk of caesarean section, and a four-times risk of instrumental delivery compared to a duration of <2 hours in the adjusted analyses. No differences were found in the maternal birth outcomes. The risk of a 5-minute Apgar score <7 was increased in the 2-<4h group. A longer passive second stage was not associated with an increased risk of negative birth experience.

Conclusions: Our study demonstrates an increased risk of operative delivery for a longer duration (>2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged.

Introduction This study examined the prevalence of and risk factors for a prolonged passive second stage of labor in nulliparous women. Material and Methods This was a historical cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. Duration of the passive second stage was measured as time from retracted cervix to start of pushing. Prolonged passive second stage was defined as >= 2 h. Prevalence was calculated and associations between prolonged passive second stage and maternal, obstetric and neonatal characteristics and potential risk factors were assessed using logistic regression models. Results The prevalence of prolonged passive second stage was 37.6%. Factors associated with an increased risk of prolonged passive second stage were epidural analgesia (adjusted odds ratio [aOR] 3.93; 95% confidence interval [CI] 2.90-5.34), malpresentation (aOR 2.26; 95% CI 1.27-4.05), maternal age >= 30 years (aOR 2.00; 95% CI 1.50-2.65) and birth weight >= 4 kg (aOR 1.50; 95% CI 1.05-2.15). Maternal body mass index >= 30 (aOR 0.52; 95% CI 0.34-0.79) and noncohabiting (aOR 0.51; 95% CI 0.30-0.89) reduced the odds of prolonged passive second stage. Conclusions A prolonged passive second stage of labor in nulliparous women is common (n = 425 [38%]). We found epidural analgesia, malpresentation, maternal age >= 30 years and birthweight >= 4 kg to be major risk factors associated with an increased risk of a prolonged passive second stage. Birth outcomes for prolonged passive second stage need to be investigated to strengthen evidence for the management of the second stage of labor.

Målet har varit att göra ett effektivt, integrerande och interaktivt dialogstöd (https://sadima.lnu.se/). Stödet är avsett att användas i mödravårdssam­tal mellan kvinnor med begränsade kunskaper i svenska och svensktalande barnmorskor och är ett komplement till tolk. Samtalsstödet finns på arabiska, engelska, svenska och är fritt tillgängligt på internet.  Vi vill uppnå förbättrad och effek­­tiviserad kommu­ni­ka­tion mellan barnmorskor och kvinnor. Samtalsstödet ska leda till ökad patientsäkerhet med färre komplika­tioner och minskad sjuklighet och dödlighet bland kvinnorna och deras barn, och därigenom öka vårdkvaliteten och effektivisera bru­ket av sam­hälleliga resurser. Avsikten är att sprida och nyttiggöra sam­talsstödet till ansvariga i Sveriges Kom­muner och Regioner (SKR) och samordnings­barn­morskor i Sverige. Stödet består av en del där information kan inhämtas och en del där information kan ges om gravidi­tet, förloss­ning och preventiv­medel. Genom webbsidan ska mödra­hälso­­­vården göras mer jämlik och kom­munikativ, med ökad patientsäkerhet och egenmakt för kvinnor i mödravården.

Vi har analyserat material med språkliga, normkritiska och vård­vetenskapliga metoder. I projektet har appen Sadima utvecklats i två versioner, en första testversion och sedan en andra version som ut­for­mats som en webbsida. För ut­veck­lan­det av den första versionen av appen fick vi medel av Vinnova (2016–2019). Vi arbetade med barnmorskor och skapade en testapp som sedan revide­ra­des och förbättrades suc­ces­sivt genom forskning om kvinnornas och barnmorskornas er­faren­het av att använda samtalsstödet. Det befintliga stödets innehåll är patientsäkrat av läkare och barnmorskor i Region Kalmar. 

Vi har mätt funktiona­liteten i samtalsstödet genom iterativa tester, en­käter och fokusgrupper med barnmorskor och arabisktalande kvinnor, där stödets information har pro­ble­ma­tiserats; det har gällt etnicitet (språk och kultur), klass (utbildning) och jämlikhet mellan kvinnor. Mät­ningarna har granskats och utvärde­rats av referensgruppen för bedömning av funktiona­liteten hos samtalsstödet. Grup­pen har bedömt att samtalsstödet bidragit till bättre förståelse, ökad patient­säkerhet och effektivare vård. 

Aims: To follow up on exchange students' alcohol use, drug use, mental health, self-rated health, and risky sexual behaviour after a semester abroad and to compare them with students who remained on campus. Methods: The study design was a follow-up study based on a previous baseline survey of 114 prospective exchange students and 451 campus students. Of the original 565 students, 48 (42.1%) prospective exchange students and 209 (43.3%) campus students responded to the follow-up. Both the baseline survey and the follow-up survey included the General Health Questionnaire 12, one single item from Self-Rated Health, and nine items from Knowledge, Attitudes and Sexual Behaviour in Young People in Sweden. Results: We found a statistically significant increase in the weekly consumption of alcohol among exchange students after their semester abroad. A larger proportion of exchange students had sex with a new partner and sex with more than three partners during their semester abroad compared to follow-up campus students. Conclusions: Our findings indicate that exchange students consume alcohol more frequently during their semester abroad and indulge in sexually risky behaviour. Exchange students' use of alcohol and sexually risky behaviour could be associated with even greater risks due to them being in an unknown environment, unfamiliar culture, and with limited support from family and friends. This highlights the need for further research on exchange students' experiences, especially concerning alcohol use and sex while abroad.

Aim: Our aim was to investigate potential differences in mental health, self-rated health, risky sexual behaviour, alcohol use, and drug use between (1) Prospective exchange students and campus students separated by sex, and (2) male and female students as a group. Method: Comparative cross-sectional design using an online survey containing the following instruments: Knowledge, Attitudes, and Sexual Behaviour in Young People in Sweden; Self-Rated Health Questionnaire; and General Health Questionnaire 12. One-hundred and fourteen prospective exchange students and 451 campus students participated in the study. Results: Male prospective exchange students rated their mental health as being better and had used cannabis more often compared with female prospective exchange students. Male prospective exchange students also rated their mental health as being better than male campus students. Female students, in general, rated their mental health as worse than male students. A larger proportion of male prospective exchange students had sex together with alcohol compared with male campus students, and a larger proportion of female prospective exchange students had sex with a new partner and drank more alcohol compared to female campus students. Conclusion: The result shows that risky alcohol use and sexually risky behaviour is prominent amongst prospective exchange students. It is possible that they will continue, and even increase their risky behaviour whilst abroad as they find themselves in a new social context, and free from influence of the rules and restrictions that they might have at home. With limited knowledge of the local culture, native language, and in an unfamiliar environment, it is possible that the risks will be enhanced and possibly decrease their health. This highlights the need for proactive interventions, conceivably with some variations in content between sexes.

Sömnen påverkas under en graviditet med bland annat fler uppvaknanden och mindre djupsömn. Sömnproblem under graviditeten ökar risken för psykiska problem och medicinska komplikationer hos den gravida och fostret. Det saknas svenska studier om sömnproblem och graviditet.

Syftet var att kartlägga sömnproblem och sömnkvalitet bland gravida och jämföra de tre trimestrarna, samt undersöka samband mellan sömnproblem och självskattad hälsa.

Studien genomfördes som en tvärsnittsstudie med en webbaserad enkät som besvarades av 836 gravida kvinnor.

Resultatet analyserades med en deskriptiv och analytisk statistik. Resultatet visar att majoriteten av de gravida (69,5 %) rapporterade sömnproblem och 84,2 % rapporterade dålig sömnkvalitet. Inga signifikanta skillnader fanns mellan de olika trimestrarna. Av de gravida skattade 79,5 % sin hälsa som god. Bland gravida med god självskattad hälsa hade 65,3 % sömnproblem, bland gravida med dålig självskattad hälsa hade 86 % sömnproblem (p <0,001). Av de gravida med god självskattad hälsa hade 81,4 % dålig sömnkvalitet och bland gravida med dålig självskattad hälsa hade 95,3 % dålig sömnkvalitet (p <0,001). Kvinnorna rapporterade många graviditetssymtom störde de gravidas sömn. En majoritet (62,9 %) besvärades av illamående i första trimestern. Påverkan av sura uppstötningar/reflux, ryggont och obekväma ställningar ökade med varje trimester. Livliga drömmar och oro för förlossningen upplevdes störst i första trimestern. Över 80 % av alla gravida kvinnor i alla tre trimestrarna fick störd nattsömn av frekvent urinering.

Majoriteten av de gravida hade sömnproblem och dålig sömnkvalitet. Trots detta skattade de flesta sin hälsa som god.

Aim: To explore why parents refused to allow their ten to 12-year-old daughters to

receive the human papillomavirus (HPV) vaccination from the Swedish schoolbased

vaccination programme.

Methods: Individual interviews with 25 parents who had been offered, but not

consented to, their daughters receiving the HPV vaccination.

Results: Five themes emerged through the interviews: 1) she is just a little girl, 2)

inadequate information, 3) not compatible with our way of life, 4) scepticism about

the vaccination and 5) who can you trust? The parents made their decisions with

their child’s best interests in mind. This was not considered the right time and the

vaccine was perceived as unnecessary and different from other vaccines. Mistrust in

Government recommendations and a lack of evidence or information were other

reasons to decline.

Conclusion: The decision-making process was complex. These parents preferred

to wait until their daughter was older and believed the information they received from

the school health system was insufficient. The results indicate that a more flexible

HPV vaccination schedule may improve vaccine uptake. This includes more

transparent information about the virus and the vaccine and information about who

to contact to get the daughter vaccinated at a later date.

Objective: To improve primary prevention of human papillomavirus (HPV) infection by promoting vaccination and increased condom use among upper secondary school students. Design: Cluster randomised controlled trial. Setting: 18 upper secondary schools in Sweden. Participants: Schools were first randomised to the intervention or the control group, after which individual classes were randomised so as to be included or not. Of the 832 students aged 16 years invited to participate during the regular individual health interview with the school nurse, 751 (90.2%) agreed to participate and 741 (89.1%) students completed the study. Interventions: The intervention was based on the Health Belief Model (HBM). According to HBM, a person’s health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 min face-to-face structured information about HPV, including cancer risks and HPV prevention, by propagating condom use and HPV vaccination. Students in the intervention and the control groups completed questionnaires at baseline and after 3 months. Main outcome measures: Intention to use condom with a new partner and beliefs about primary prevention of HPV, and also specifically vaccinationstatus and increased condom use. Results: All statistical analyses were performed at the individual level. The intervention had a significant effect on the intention to use condom (p=0.004). There was also a significant effect on HBM total score ( p=0.003), with a 2.559 points higher score for the intervention group compared to the controls. The influence on the HBM parameters susceptibility and severity was also significant (p<0.001 for both variables). The intervention also influenced behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls ( p=0.02). No harms were reported. Conclusions: The school-based intervention had favourable effects on the beliefs about primary prevention of HPV, and increased the HPV vaccination rates in a diverse population of adolescents.

Background: Vaccination against human papillomavirus (HPV) is one important factor for preconception health and care. In Sweden a national vaccination programme for girls was implemented in 2012.

Aim: To improve primary prevention of HPV infection by promoting vaccination and increased condom use among upper secondary school students at time for the general health interview with the school nurse.

Methods: Randomised controlled trial among upper secondary schools (n=18). Participant schools were first randomised to the intervention or the control group, after which individual classes were randomised to be included or not. 832 students, both boys and girls aged 16 were invited to participate and in the end, 741 (89.1%) students completed the study. The intervention was based on the Health Belief Model (HBM). According to HBM a person’s health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 minute face-to-face structured information about HPV, including cancer risks and HPV prevention, i.e. condom use and HPV vaccination. Students in both groups completed questionnaires at baseline and after three months.

Results: The intervention had positive effect on behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls (p=0.02). There was also a significant effect on HBM total score (p=0.003), students in the intervention group had more favourable beliefs compared to the controls. The influence on the HBM parameters susceptibility and severity were also significant (p<0.001 for both variables). In addition, the intervention had significant effect on the intention to use condom (p=0.004).

Conclusion: The school-based intervention increased HPV vaccination rates and had favourable effects on beliefs towards primary prevention of HPV in a diverse population of adolescents. These resultss provide the scientific support for the implication of nation-wide educational interventions with the potential to improve preconception health.

Background / Objectives

Background: In Sweden HPV vaccination is offered to girls aged 10-12 years within the school-based vaccination program, while older girls (13-26 years) are offered the vaccine through the primary care. The vaccination rates are substantially lower (59%) among the catch-up group compared to the younger age group (82%). Adolescents have low awareness and knowledge about HPV, especially regarding cancer risks. The providers - school nurses - play a key role in providing such information. Upper secondary school students, aged 16 years, are by the school nurse offered a health interview, which includes a dialogue regarding their health, including sexual health. The health interview does however not include systematic information about HPV.

Objectives: To improve adolescents’ knowledge and awareness about primary prevention of high risk HPV infection.

Methods

Methods: A cluster-randomised controlled trial among upper secondary schools (n=18) was performed. Schools were first randomised to an intervention or control group, after which individual classes were randomised. In total, 832 students, boys and girls aged 16 years attending theoretical or vocational programs were invited to participate. In the end, 741 (89.1%) students completed the256study. The intervention was based on the Health Belief Model (HBM). School nurses delivered 30 minutes of face-to-face structured information about HPV, including cancer risks and HPV prevention (i.e. condom use and HPV vaccination) to the intervention group. Students in both groups completed questionnaires at baseline and at follow-up after three months. The control group received standard treatment, i.e. the regular health interview with the school nurse. Generalized estimating equation analyses were used for examining the results of the intervention.

Results

Results: The intervention had positive effects on the adolescents’ knowledge (p<0.001), with a 0.582 higher score for the intervention group compared to the control group. There were no differences in knowledge due to sex (p=0.093) or immigrant background (p=0.592). The intervention also increased awareness (p<0.001), with a 0.590 higher score for the intervention compared to the control. Again, there were no differences in awareness due to sex (p=0.183) or immigrant background (p=0.319).

Conclusion

Conclusions: The school-based intervention delivered by school nurses, had favourable effects on knowledge and awareness about primary prevention of HPV among adolescents aged 16 years.

Background

Many Western countries have cervical cancer screening programmes and have implemented nation-wide human papillomavirus (HPV) vaccination programmes for preventing cervical cancer.

Objective

To explore immigrant women’s experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use.

Design

An exploratory qualitative study. The Health Belief Model (HBM) was used as a theoretical framework.

Setting and participants

Eight focus group interviews, 5–8 women in each group (average number 6,5), were conducted with 50 women aged 18–54, who studied Swedish for immigrants. Data were analysed by latent content analysis.

Results

Four themes emerged: (i) deprioritization of women’s health in home countries, (ii) positive attitude towards the availability of women’s health care in Sweden, (iii) positive and negative attitudes towards HPV vaccination, and (iv) communication barriers limit health care access. Even though the women were positive to the prevention of cervical cancer, several barriers were identified: difficulties in contacting health care due to language problems, limited knowledge regarding the relation between sexual transmission of HPV and cervical cancer, culturally determined gender roles and the fact that many of the women were not used to regular health check-ups.

Conclusion

The women wanted to participate in cervical cancer prevention programmes and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from health-care providers. Therefore, information needs to be in different languages and provided through different sources. Health-care professionals should also consider immigrant women’s difficulties concerning cultural norms and pay attention to their experiences.

BackgroundSweden is a multicultural country, nearly 20% of the population has an immigrant background. Certain ethnic groups have lower attendance rates in cervical cancer prevention programs.Recently a school-based HPV vaccination program free of charge was introduced for girls age 11-12.  The HPV vaccination raises questions and concerns about whether it will be accepted among all ethnic groups

Aim.To explore immigrant women’s experiences and views on the prevention of cervical cancer.

Methods. An exploratory qualitative study. Eight focus group interviews were conducted with 50 women aged 18-54, who studied Swedish for immigrants. Years in Sweden; 0-2 years N=17, 3-5  years N=30, > 6 years N=3. The women represented many countries from different geographic areas; Middle east N=24,  Africa N=16, Asia N=6 and East Europe N=4. Data were analysed by latent content analysis. The Health Belief Model (HBM) was used as a theoretical model; the results are discussed according to HBM.

Results The women were positive to the prevention of cervical cancer. However, several barriers were identified: difficulties in contacting healthcare, limited knowledge of the relation between sexually transmitted infections (STI) and human papillomavirus virus (HPV), cultural aspects and not being used to regular health check-ups in home countries.

’When I came to Sweden I received a paper and I didn’t understand anything, after 4 month, I read it, and I understood that it was a cancer test, but I can’t call and make an appointment’  

The women would accept HPV vaccine for their daughters but wanted adequate information before consent. The women spoke openly about sexual transmitted infections and emphasized both genders responsibility for prevention.

‘It [the vaccine] is really good, it is good for the future health.’

‘Yes, value not so good but the man is always first, second is woman. And think like this that diseases are not so important.’

‘Why must woman do everything? Doesn’t a man also infect?’

Conclusion.The women wanted to participate in cervical cancer prevention programs and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from healthcare.Information about preventive programs needs to be in different languages and provided through different sources. Healthcare professionals should consider immigrant women’s difficulties concerning cultural norms and pay attention to their experiences.

Objective: To investigate school nurses’ attitudes to, and experiences of the school-based HPV vaccination programme,one year after its implementation in Sweden.

Methods: Data were collected using a web-based questionnaire in spring 2013, and 83.1% (851/1024) of the nursesanswered the questionnaire.

Results: The majority (88.9%, n=756) agreed that HPV vaccinations should be the school nurses’ responsibility, and mostalso agreed (81.5%, n=693) that boys also should be offered the vaccine. Two thirds, 66.9% (n=570), stated that they hadexperienced difficulties with the vaccination and of these 59.1% (n=337) considered the task time-consuming. Three outof four nurses, 76.1% (n=648), had been contacted by parents who raised questions regarding the vaccine. The most commonquestions were related to side effects. There were strong associations between the nurses’ received education aboutthe HPV vaccine and perceived knowledge about the HPV vaccine and a favourable attitude towards vaccination (both p<0.001). A school nurse with a high level of received education was 9.8 times more likely to have a positive attitude to HPVvaccination compared to a nurse with a low level of received education (p<0.001). Nurses with high perceived knowledgewere 2.5 times more likely to have a positive attitude compared to those with a low level of perceived knowledge(p=0.006).

Conclusions: HPV vaccination is a complex and time-consuming task and the school nurses need adequate knowledge,education, skills and time in order to address questions and concerns from parents, as well as informing about HPV.

Background: Sweden introduced a school-based human papillomavirus (HPV) vaccination programme in 2012, and school nurses are responsible for managing the vaccinations. The aim of the present study was to investigate the attitudes and experiences of school nurses regarding the school-based HPV vaccination programme 1 year after its implementation. Methods: Data were collected using a web-based questionnaire in the spring of 2013, and 83.1% (851/1024) of nurses responded. Results: There were strong associations between the nurses' education about the HPV vaccine and their perceived knowledge about the vaccine and a favourable attitude towards vaccination (both p < 0.001). School nurses who received a high level of education were more likely to have a positive attitude to HPV vaccination compared with nurses with little education about HPV vaccination (adjusted odds ratio [OR] = 9.8; 95% confidence interval [CI]: 3.797-25.132). Nurses with high perceived knowledge were more likely to have a positive attitude compared with those with a low level of perceived knowledge (OR = 2.5; 95% CI: 1.299-4.955). If financial support from the government was used to fund an additional school nurse, nurses were more likely to have a positive attitude than if thefinancial support was not used to cover the extra expenses incurred by the HPV vaccination (OR = 2.1; 95% CI: 1.051-4.010). The majority, 648 (76.1%), had been contacted by parents with questions aboutthe vaccine, mostly related to adverse effects. In addition, 570 (66.9%) stated that they had experienced difficulties with the vaccinations, and 337 (59.1%) of these considered the task to be time-consuming. Conclusions: A high level of education and perceived good knowledge about HPV are associated with a positive attitude of school nurses to the HPV vaccination programme. Thus, nurses require adequate knowledge, education, skills and time to address the questions and concerns of parents, as well as providing information about HPV. Strategic financial support is required because HPV vaccination is a complex and time-consuming task.

BACKGROUND

Parents' beliefs about human papillomavirus (HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model.

METHODS

The sample consisted of 200 (55%) parents of children aged 11-12 years in the Swedish national vaccination program. Data were collected using a self-reported questionnaire. Most parents (N = 186) agreed to the vaccination. Pearson's chi-square, Fisher's exact test, and the Mann-Whitney U test were used to analyze data.

RESULTS

Declining parents saw more risks and fewer benefits of HPV vaccination but no differences in beliefs regarding the severity or young girls' susceptibility to HPV were found. There was an association between refusing the HPV vaccine and lower acceptance of previous childhood vaccinations, and their main source of information was the Internet. Parents who declined the vaccine believed it could adversely affect condom use, the age of their daughter's sexual debut, and the number of sexual partners.

CONCLUSION

Parents should have the possibility to discuss HPV and HPV vaccine with a school nurse or other health care professionals, and should have access to evidence-based information on the Internet.

Objective

The purpose was to examine mothers’ experiences and feelings related to breastfeeding initiation from a two-decade perspective.

Methods

A repeated cross-sectional survey was conducted at a maternity ward before and after introduction of Baby Friendly Hospital Initiative (BFHI) and in a follow-up survey. Women participated in 1992 (n = 83), 1993 (n = 74) and 2011 (n = 94).

Results

The duration of time at the first suckling differed; in 2011, the baby sucked 24.4 minutes compared to 12.7 minutes in 1992 (p < .001) and 13.6 minutes in 1993 (p < .001). In 1992, 34.6% of the women reported using supplementary formula compared with 5.9% in 1993 and 9.3% in 2011 (p < .001). The mothers’ contacts with the child or the father as well as their moods did not vary during the years. Mothers rated their feelings towards breastfeeding as being lower in 2011 than in 1992 and 1993 (p = .008). In 2011, mothers experienced breastfeeding as being more difficult and reported a higher degree of tension, insecurity and anxiety.

Conclusions

Supplementation was given to healthy newborn infants, which does not conform to BFHIs intentions. Routines and support in relation to breastfeeding initiation need to be continuously evaluated in order to strengthen and sustain the BFHI.

Objective: To explore midwives’ experiences and views of amniotomy.

Design: A qualitative inductive design was used. Data were collected using interviews and analysed with content analysis carried out with NVivo 12.

Setting and participants: Sixteen midwives working at delivery wards at three hospitals in the south of Sweden.

Findings: Three categories emerged: “Promote, protect and support the physiological process of labour”, “To make the decision -to do or not to do” and “Unpredictable response”. The overall theme linking the three categories was “We become our decisions”, portraying how midwives carry the responsibility in the decision-making and represent themselves in their handling of amniotomy.

Conclusions: Amniotomy was experienced and viewed as both simple and complex, safe and risky, and deciding on it sometimes implied balancing contradicting perspectives. By using midwifery skills in the decision-making for an amniotomy, the midwives tried to predict the response, purposing to support physiological labour and promote health for women and babies.

Background

In Sweden, simulation- and skills training are implemented in midwifery education in order to prepare students for clinical practice. Research regarding the use of both low to high levels of fidelity in simulation in midwifery programme is limited.

Aim

The aim of this study was to explore midwifery students' experiences of simulation- and skills training.

Methods

Midwifery students (n = 61), at advanced level, were interviewed in 13 group interviews from 2011 to 2105. A semi-structured interview guide was used, and data were analysed by content analysis.

Results

The results are presented in four main categories: develops hands on skills and communication, power of collaborative learning, highly valued learning environment and facilitates clinical practice. The majority of students felt that the simulation- and skills training were necessary to become familiar with hands on skills. Having repetitive practices in a safe and secure environment was viewed as important, and students highly valued that mistakes could be made without fear of comprising patient safety. Student's collaboration, reflections and critical thinking increased learning ability. Simulation- and skills training created links between theory and practice, and the lecturer had an important role in providing instructions and feedback. Students felt prepared and confident before their clinical practice, and simulation- and skills training increased safety for all involved, resulting in students being more confident, as patients in clinical practice became less exposed. Furthermore, mentors were satisfied with students' basic skills.

Conclusion

Simulation- and skills training support the development of midwifery skills. It creates links between theory and practice, which facilitates students' learning ability. Training needs to include reflections and critical thinking in order to develop their learning. The lecturer has an important role in encouraging time for reflections and creating safe environment during the skills and simulation training.

Human papillomavirus (HPV) is one of the world´s most common sexually transmitted infections. HPV can cause cell changes and cervical cancer in women, but the virus is also one of the causes of anal, head and neck cancer. Several problem areas have been identified in connection with the introduc­tion of the HPV vaccination in the childhood immunisation programme. One problem is the difficulty to obtain informed consent for HPV vaccination. From a gender perspective, it is a problem that only girls are offered the HPV vac­cination in the childhood vaccination programme. By only vaccinating girls, the image of girls being carriers is stigmatised. Boys do not have access to free vaccinations, although they are carriers of HPV and may get cancer. By excluding boys from the general vaccination programme, vulnerable groups are discriminated against, for example, men who have sex with men.

Since the widespread introduction of cervical cancer screening programs the incidence and mortality of cervical cancer has declined. In general, cervical cancer screening programs are viewed as a valuable component of preventive health services, but are also associated with negative effects for participants. The side effects of cervical cancer screening include anxiety, false reassurance and overdiagnosis. The purpose of the present review was to study the research literature on psychological adjustment among women undergoing cervical cancer screening. The review revealed two main areas with barriers to cervical cancer screening, the pelvic examination and Pap smear results. Women felt anxiety and embarrassment during the pelvic examination and highlighted the importance of a suitable examiner. Fear of negative results played a major role in women's decisions to participate. Fearing results of the Pap smear could be a source of distress.

Objective: To explore youth clinic midwives role in cervical cancer prevention and their attitude to HPV vaccination.

Study design:Individual interviews with 13 midwives working at youth clinics in Sweden. The interviews were recorded, transcribed, and analysed by qualitative content analysis.

Results: Three themes were identified in the qualitative content analysis: “Cervical cancer prevention not a prioritised area”, “Ambivalence to the HPV vaccine”, and “Gender and socioeconomic controversies”. Few midwives talked spontaneously about cervical cancer prevention. The responsibility for providing information about HPV vaccination was considered as primarily that of school health nurses and parents. Midwives were positive about the HPV vaccination, but recognised certain risks, such as its potential negative impact on cervical cancer screening and increased sexual risk taking. The midwives expressed concerns with medical risks, such as side effects and unknown long-term effects of the HPV vaccine. The midwives in the study had ethical concerns that boys were not included in the program and not all families had the financial resources to vaccinate their children. Thus, weak socioeconomic groups might be excluded.

Conclusion: The midwives considered cervical cancer prevention as important, but did not integrate information on the HPV vaccine into their routine work, mainly because young people visiting youth clinics had had their sexual debut and they were concerned about the medical risks and that the vaccine was too expensive.

Detta är en etikbok med inriktning på barnmorskans huvudområden: reproduktiv, perinatal och sexuell hälsa. Boken är skriven med fokus på att ge läsaren goda förutsättningar att träna på att göra etiska reflektioner och argumentera kring dessa i komplexa situationer.

Inom alla de områden som en barnmorska verkar uppstår frågor och etiska dilemman som barnmorskan måste ha verktyg för att kunna hantera. Boken beskriver vanligt förekommande etiska utmaningar genom fallbeskrivningar. Etik för barnmorskor ger en gemensam värdegrund som utgår från den yrkesetiska koden och kan användas av barnmorskor när de reflekterar över sitt professionella förhållningssätt både i mötet med kvinnan och hennes närstående och i samarbetet med andra yrkesgrupper.

Bokens primära målgrupp är barnmorskestudenter men den kan också användas av barnmorskor, läkare, sjuksköterskor och andra som arbetar inom området. Boken utgör ett komplement till böcker inom reproduktiv och sexuell hälsa, obstetrik och gynekologi och förutsätter att läsaren har grundkunskaper inom de olika ämnesområdena.

Background: The information about fetal malformation findings during the ultrasound examination often comes unexpectedly, and the women and their partners may not necessarily receive any conclusive statement on the prognosis. A finding such as fetal hydronephrosis range from being a soft markers or mild anomaly, to a serious condition associated with neonatal morbidity and mortality. The aim of this study was to explore women’s reactions to the discovery of fetal hydronephrosis in the context of uncertainty regarding the prognosis.

Methods: Ten women were interviewed and the interviews were conducted six to twelve months after the women gave birth. They had experience of suspected fetal hydronephrosis in gestational week 18–20. The interviews were recorded, transcribed verbatim and analysed using constant comparative analysis.

Results: The core category, ‘Going through crisis by knowing that you are doing the right thing’ illustrates the meaning of women’s reactions and feelings. It illuminates the four categories: ‘When the unexpected happens’– on the one hand, women had positive views that the suspicious malformation could be discovered; however, on the other hand, women questioned the screening. ‘To live in suspense during pregnancy’ – the suspicious malformation caused anxiety and was a stressful situation. ‘Difficulties in understanding information’ – the women thought they had limited knowledge and had difficulties in understanding the information. ‘Suppress feelings and hope for the best’ – the women tried to postpone the problem and thought they should deal with it after delivery.

Conclusions: Women are worried irrespective of suspicious or severe malformations, and in need of information and counselling tailored to their individual needs. Other sources of support could be: written information, links to reliable sources on the Internet and possibilities for ongoing follow-ups.

Purpose: The aim was to explore young women’s decision-making process for HPV vaccination

Method: This study employed a qualitative design. Data were collected by tape-recorded interviews with 17 Swedish women aged 17-26 years. Data were analysed by latent content analysis.

Findings: In general, the young women had confidence in the vaccination and emphasised vaccination against cancer. Mother’s support and sponsor of costs initiated the HPV vaccination. Other trigger factors were advertisements and friends. Despite having been vaccinated, they were unaware of the association between sexual behaviour and HPV. They believed that HPV vaccination would not affect their future sexual behaviour.

Conclusion: Health care professionals at youth clinics and schools have to initiate discussion for clarifying the association between cervical cancer and a sexually transmitted virus.