Heath promotion has become recognized as a vital component of health care delivery. It is well known that the traditional model of medical care delivery is limited by its focus on diagnosis of illness and treatment. The integration of public health concepts of prevention and health promotion offers depth and breadth of care that is associated with attaining optimal health status. This review offers a historical reflection on the early and continued integration of health promotion activities in midwifery care in the United States.
]]>This article describes the impact of health literacy on women's health and provides strategies for addressing this public health issue.
A comprehensive literature review was conducted of peer-reviewed journals. Multiple electronic databases were used, including CINAHL, MEDLINE, PubMed, and Google Scholar. Key words were used to identify articles and were combined to include health literacy, health behavior, women's health, patient education, and professional role. Additional articles were identified as a result of reviewing reference lists found during the electronic search.
Health literacy is a complex issue that affects many women and can adversely affect women's knowledge, ability to adhere to clinical plans of care, and health outcomes for women and their children. It is estimated that 36% of adults in the United States possess limited health literacy skills. Effective strategies can be used by health care providers to address this serious problem, including clear and effective communication, development of health education materials, professional education, and development of community partnerships.
Health literacy is a serious problem. Effective approaches can be employed to blunt the adverse effect on women's health. Health care providers are well positioned to demonstrate leadership within the health care system regarding health literacy.
Health education and counseling are important elements of the care provided by clinicians. Counseling efforts may involve helping women to understand their options for symptom management related to various reproductive life transitions. In light of this, the need for information during the menopausal transition is critical for assisting women with their health care decisions. Yet the Institute of Medicine estimates that approximately half the adult population in the United States has difficulty understanding and using health information. The US Food and Drug Administration (FDA) mandates the distribution of written information for estrogen-containing products; however, the readability of information for these pharmaceutical products has not been widely studied. To address this gap, this study examined the readability of written information for FDA-approved prescription menopausal hormone therapies (N = 31).
Readability of the written information about hormone therapies from 31 hormone therapy products was assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level formulas.
The reading level ranged from 6.70 to 12.30, with an average grade level of 9.33 (ninth-grade reading level). All but one of the hormone therapy products evaluated in this study exceeded the recommended sixth-grade reading level for written health information. In addition, only 48% of the written information instructions in the study sample (n = 15) included illustrations.
Assessment of written information about menopausal hormone therapies showed that the majority of the materials are written at a high reading level. These findings have implications for health literacy and counseling efforts when helping women to understand their options for menopausal symptom management. Midwives, nurses, and other health care providers may need to supplement written information with additional consumer-friendly written information, utilize illustrations, and use verbal instructions more frequently to help support women in evaluating their treatment options.
During pregnancy, women actively seek out health information that promotes the well-being of themselves and their fetuses. For those with health literacy challenges, access to understandable health information can be difficult. Written information, in particular, needs to be readable and usable by the women served. Plain language is an essential component of effective health education material. In an effort to create standardized prenatal education materials for a diverse population of childbearing women, Boston Medical Center's midwifery service led a multidisciplinary initiative to develop a comprehensive plain-language prenatal education book. Midwives, obstetricians, family physicians, nurses, and community doulas contributed to the content of the book; art students provided graphic design skills; and a literacy consultant assisted in the wording and layout. The Hey Mama! book provides women with woman-centered, readable, comprehensive information about pregnancy, labor, postpartum, and newborn care.
]]>Alcohol and drug use is a significant public health problem with particular implications for the health and safety of women. Women who abuse these substances are more likely to have untreated depression and anxiety and are at higher risk for intimate partner violence, homelessness, incarceration, infectious disease, and unplanned pregnancy. Substance abuse during pregnancy places both mother and fetus at risk for adverse perinatal outcomes. Data regarding the prevalence of substance abuse in women are conflicting and difficult to interpret. On the clinical level, strong arguments exist against routine urine drug testing and in favor of the use of validated instruments to screen women for drug and alcohol use both in primary women's health care and during pregnancy. A number of sex-specific screening tools are available for clinicians, some of which have also been validated for use during pregnancy. Given the risks associated with untreated substance abuse and dependence in women, the integration of drug and alcohol screening into daily clinical practice is imperative. This article reviews screening tools available to providers in both the prenatal and primary women's health care settings and addresses some of the challenges raised when women screen positive for drug and alcohol abuse.
]]>Pertussis has been on the rise worldwide for more than 20 years. Waning immunity may be the major cause for the resurgence of this disease. Adolescents and adults have become the vectors of pertussis, with newborns and infants less than 12 months of age at greatest risk for morbidity and mortality. Health care providers need to become aware of a vaccine strategy called cocooning that provides the needed vaccines to individuals who have contact with newborns and infants. Cocooning can protect our most vulnerable populations from pertussis and other vaccine -preventable diseases in the 21st Century.
]]>Obesity and diabetes have become pandemic in the United States, with more than one-third of the US population obese and 8.3% of the population affected by diabetes. Efforts to prevent type 2 diabetes focus primarily on healthy eating and physical activity. In particular, women from at-risk racial and ethnic groups and those who have experienced gestational diabetes are at high risk for developing type 2 diabetes. Achieving a healthy weight prior to conception, staying within weight gain guidelines during pregnancy, and losing accumulated pregnancy weight postpartum are key prevention factors. Maintaining a healthy weight in the long-term is a challenge. Behavioral psychology and coaching techniques are presented in this article that can be useful in sustaining behaviors that promote a healthy weight.
]]>The diagnosis of gestational diabetes mellitus (GDM) signals greater pregnancy risk but also increased lifelong risk of developing diabetes and cardiovascular disease. In women with GDM, insulin resistance exceeds that observed in normal pregnancy and to varying degrees may persist or worsen after birth. Therefore, during postpartum and interconception periods, women with a history of GDM must be monitored for manifestations of increasing insulin resistance, hyperglycemia, dyslipidemia, hypertension, and increased adiposity. Care of women with prior GDM in the postpartum and interconception periods affords clinicians a unique opportunity for targeted screening and health promotion. The objective of this review was to synthesize evidence related to interconception care for women following a pregnancy complicated by GDM and to suggest principles of care: 1) case finding and multiple patient/clinician reminders for women with prior GDM are necessary so that screening occurs in the postpartum through interconception periods; 2) monitoring of metabolic (glucose) and cardiovascular risk (lipids, blood pressure, adiposity) should occur at regular intervals and more often in women with additional risk factors such as insulin use during pregnancy, early diagnosis of GDM, obesity, prediabetes, and dyslipidemia; 3) breastfeeding and use of long-term contraception should be encouraged; and 4) lifestyle modifications that are effective in preventing and delaying disease should be encouraged.
]]>The purpose of this study was to invite girls who participated in a gender-specific sexual risk-reduction intervention to describe their experiences and identify program characteristics most or least beneficial to their involvement.
Semistructured interviews were completed with 26 African American, low-income girls aged 15 to 19 years who had participated in a sexual risk-reduction intervention as part of a randomized controlled trial. The girls were interviewed after completing a 12-month postintervention survey. Interviews were recorded, transcribed, and analyzed for categories.
Analyses of the interview data identified 6 categories: 1) reasons for participating, 2) strategies for maintaining behavior changes, 3) interacting with others, 4) communicating with mothers, 5) disseminating information to friends and family, and 6) disseminating information to the males in the community.
Many of the girls participating in the theory-based behavior change intervention reported selecting from a menu of strategies learned through the intervention to reduce their sexual risk. Having the opportunity to discuss sexual health with peers and trained facilitators, particularly in an all-female environment, was cited as a positive benefit. Community health organizations and clinicians who care for adolescent girls can adapt many aspects of this intervention to help reduce their sexual risk.
Sexual health problems are common in women and have the potential to affect all aspects of their lives. These issues can include diminished or lack of desire for sex, difficulty with arousal and sexual pleasure, inability to orgasm, and pain with sex. Causes of sexual health issues can be complex and multifaceted; therefore, a holistic perspective, in which all potential factors are considered, is warranted. Despite the prevalence of women's sexual health issues, discussion by providers is often absent or limited to avoidance of sexually transmitted infections or unwanted pregnancies. Health care providers may feel they do not have the time or resources to address sexual health problems. This article provides a sexual health assessment approach using a model of sexual health whereby sociocultural factors are given priority, followed by factors related to partner and relationships, psychological factors, and finally medical factors.
]]>As women enter midlife, health issues and chronic health problems can emerge. The University of Utah Health Science Center's Midlife Women's Health Assessment Clinic was developed to provide a personalized approach to healthy aging by individual assessment, group education, motivational interviewing, and wellness coaching to women. This article describes the model of care and an initial evaluation of this model.
Four pilot clinics were conducted to determine if the model would be successful. Data analyzed included patient history questionnaires, laboratory and diagnostic test results, new diagnoses, and follow-up recommendations; telephone surveys of patients 2 to 4 weeks after clinic visits; and verbal queries of clinicians about their experiences and recommendations for improving the clinics.
Among the 62 women attending the clinics, the most frequent concern was healthy aging. Two-thirds of the women had new diagnoses during the clinics. Both the women and clinicians participating positively evaluated the pilot clinics.
This model of care could be replicated to provide comprehensive and efficient health care to aging women in a variety of settings.