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  • 1.
    Carlsson, Tommy
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Sophiahemmet University College / Uppsala University.
    Ulfsdottir, Hanna
    Sophiahemmet University College / Karolinska University Hospital.
    Waterbirth in low-risk pregnancy: an exploration of women's experiences2020In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    AIMS: To explore retrospective descriptions about benefits, negative experiences and preparatory information related to waterbirths.

    DESIGN: A qualitative study.

    METHODS: Women who gave birth in water with healthy pregnancies and low-risk births were consecutively recruited between December 2015 - October 2018 from two birthing units in Sweden. All who gave birth in water during the recruitment period were included (N=155) and 111 responded to the survey. Women were emailed a web-based survey six weeks postpartum. Open-ended questions were analyzed with qualitative content analysis.

    RESULTS: Two themes were identified related to benefits: (1) physical benefits: the water eases labor progression while offering buoyancy and pain relief; and (2) psychological benefits: improved relaxation and control in a demedicalized and safe setting. Two themes were identified related to negative experiences: (1) equipment-related issues due to the construction of the tub and issues related to being immersed in water; and (2) fears and worries related to waterbirth. In regard to preparatory information, respondents reported a lack of general and specific information related to waterbirths, even after they contacted birthing units to ask questions. Supplemental web-based information was sought, but the trustworthiness of these sources was questioned and a need for trustworthy web-based information was articulated.

    CONCLUSION: Women who give birth in water experience physical and psychological benefits, but need better equipment and sufficient information. There is room for improvement with regard to prenatal and intrapartum care of women who give birth in water.

    IMPACT: Judging from women's recounts, midwives and nurses should continue advocating waterbirth in low-risk pregnancies. The lack of adequate equipment in Swedish birthing units articulated by women challenge current routines and resources. The findings illustrate unfulfilled needs for preparatory information about waterbirth, further strengthening that midwives should discuss the possibility of waterbirth when meeting expectant parents in the antenatal setting.

  • 2.
    Eriksson, Catrin
    et al.
    Sophiahemmet University.
    Skinstad, Matilda
    Sophiahemmet University.
    Georgsson, Susanne
    The Swedish Red Cross University College. Karolinska Institutet.
    Carlsson, Tommy
    The Swedish Red Cross University College, Department of Health Sciences. Sophiahemmet University / Uppsala University.
    Quality of websites about long-acting reversible contraception: a descriptive cross-sectional study2019In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 16, no 1, article id 172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Today, there are various short- and long-acting contraceptive alternatives available for those who wish to prevent unintended pregnancy. Long-acting reversible contraception are considered effective methods with a high user satisfaction. High-quality information about contraception is essential in order to empower individuals to reach informed decisions based on sufficient knowledge. Use of the Web for information about contraception is widespread, and there is a risk that those who use it for this purpose could come in contact with sources of low quality.

    OBJECTIVE: The overarching aim was to investigate the quality of websites about long-acting reversible contraception.

    METHODS: Swedish client-oriented websites were identified through searches in Google (n = 46 included websites). Reliability and information about long-acting reversible contraceptive choices were assessed by two assessors with the DISCERN instrument, transparency was analyzed with the Journal of the American Medical Association benchmarks, completeness was assessed with inductive content analysis and readability was analyzed with Readability Index.

    RESULTS: The mean DISCERN was 44.1/80 (SD 7.7) for total score, 19.7/40 (SD 3.7) for reliability, 22.1/35 (SD 4.1) for information about long-acting reversible contraceptive choices, and 2.3/5 (SD 1.1) for overall quality. A majority of the included websites had low quality with regard to what sources were used to compile the information (n = 41/46, 89%), when the information was produced (n = 40/46, 87%), and if it provided additional sources of support and information (n = 30/46, 65%). Less than half of the websites adhered to any of the JAMA benchmarks. We identified 23 categories of comprehensiveness. The most frequent was contraceptive mechanism (n = 39/46, 85%) and the least frequent was when contraception may be initiated following an abortion (n = 3/46, 7%). The mean Readability Index was 42.5 (SD 6.3, Range 29-55) indicating moderate to difficult readability levels, corresponding to a grade level of 9.

    CONCLUSIONS: The quality of client-oriented websites about long-acting reversible contraception is poor. There is an undeniable need to support and guide laypersons that intend to use web-based sources about contraceptive alternatives, so that they may reach informed decisions based on sufficient knowledge.

  • 3.
    Georgsson, Susanne
    et al.
    The Swedish Red Cross University College. Karolinska Institutet.
    Carlsson, Tommy
    Sophiahemmet University / Uppsala University.
    Pain and pain management during induced abortions: a web-based exploratory study of recollections from previous patients2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 11, p. 3006-3017Article in journal (Refereed)
    Abstract [en]

    AIMS: To explore recollections of pain and pain management during induced abortions.

    DESIGN: Mixed-methods exploratory study in Sweden.

    METHODS: A web-based survey was distributed between October 2017 - July 2018 via Swedish discussion boards and social media. Open-ended questions were asked about recollection of pain and pain management, followed by self-report ratings. The survey was answered by 185 participants, responses analyzed with qualitative content analysis.

    FINDINGS: Recollections of pain intensity illustrated considerable pain and a traumatic event, described in temporal aspects and likened to other painful conditions such as dysmenorrhea and childbirth. Recollections of pain management illustrated experiences of insufficient treatment of pain and dissatisfaction with pain management, including inefficient treatment and lack of professional attendance. Psychological aspects and consequences illustrated that participants related psychological distress to physical pain, felt unprepared for the physical pain and emphasized the importance of psychological support. Those who experienced intense pain described long-term psychological consequences, including fear of childbirth.

    CONCLUSION: Physical pain and psychological distress can manifest as considerable challenges during induced abortion. Abortion-related pain is a multidimensional phenomenon involving physical and psychological components that needs to be rigorously treated. When physical pain is unsuccessfully treated, women may experience long-term psychological consequences after an abortion.

    IMPACT: The results illustrate the importance of holistic abortion care where the multidimensional components of abortion-related pain are considered. Patients need to be offered sufficient preparatory information about potential physical pain and psychological distress. This study indicates that there is room for improvement in pain management. Larger studies are needed.

  • 4.
    Georgsson, Susanne
    et al.
    The Swedish Red Cross University College. Karolinska Institutet.
    Krautmeyer, Stina
    Sophiahemmet University.
    Sundqvist, Emilia
    Sophiahemmet University.
    Carlsson, Tommy
    Sophiahemmet University / Uppsala University.
    Abortion-related worries, fears and preparedness: a Swedish Web-based exploratory and retrospective qualitative study2019In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 24, no 5, p. 380-389Article in journal (Refereed)
    Abstract [en]

    Objective: A survey was conducted to explore worries, fears and preparedness relating to the recollected experience of having an induced abortion. Methods: The Web-based survey was carried out in Sweden among 185 women. Respondents answered open-ended questions and gave retrospective self-reported ratings about their abortion-related worries, fears, preparedness and satisfaction with information obtained from health professionals and the Web. Data were analysed using qualitative content analysis and descriptive statistics. Results: Worries and fears included the abortion process, physical reactions and psychosocial aspects. The abortion was associated with unexpected events, including the abortion process, poor health professional treatment and support, and side effects and complications. Respondents described a lack of preparatory information, leading to uncertainties due to insufficient information. Many searched for Web-based information, but respondents experienced difficulties finding high-quality sources. Respondents also recounted that the preparatory information received did not reflect the actual abortion experience. Conclusion: There is room for improvement with regard to informing, preparing and supporting women who seek an abortion. The results emphasise the importance of health professionals' giving sufficient preparatory information to enable preparedness and lessen the impact of possible unexpected events. There is a need for the development of a trustworthy Web-based service that contains honest and high-quality information.

  • 5.
    Georgsson, Susanne
    et al.
    The Swedish Red Cross University College. Karolinska Institutet.
    van der Spoel, Linde
    Uppsala University.
    Ferm, Johanna
    Uppsala University.
    Carlsson, Tommy
    Uppsala University / Sophiahemmet University.
    Quality of web pages about second-trimester medical abortion: A cross-sectional study of readability, comprehensiveness, and transparency2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 11, p. 2683-2691Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate the readability, comprehensiveness and transparency of web pages about medical abortion in the second trimester of pregnancy.

    DESIGN: A cross-sectional descriptive study of Swedish web pages.

    METHODS: Six systematic searches were performed in Google during January 2017. The first 10 hits of each search were screened, resulting in 46 included Swedish web pages. The web pages were analyzed with readability index (LIX) to investigate readability, inductive manifest content analysis to investigate comprehensiveness, and Journal of the Medical Association benchmarks to investigate transparency.

    RESULTS: Median LIX was 29.0 and the largest proportion had LIX 31-40 (N = 17), indicating moderate readability. Visual components were observed in 13 websites. Content analysis resulted in 12 categories illustrating comprehensiveness, but eight of these were only included in ≤50% web pages. With regard to transparency, 29 (63%) adhered to no benchmark, 15 (33%) adhered to one benchmark, and 2 (4%) adhered to two benchmarks. Most web pages were written or reviewed by laypersons (N = 25) and health professionals (N = 11).

    CONCLUSION: The results indicate that web pages about medical abortion have moderate readability, varied comprehensiveness and poor transparency.

    IMPACT: Health professionals need to acknowledge the risk of contact with web-based information about poor quality. There is a need for research that aims to increase the chances that patients encounter high-quality web-based information about medical abortion in the second trimester of pregnancy.

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