Category: Women’s Health

Introduction

Clinical Teaching Associates (CTAs) are people, not necessarily medically trained, who provide their own bodies as teaching resources for medical education. CTAs can be exposed to physical or psychological examinations as part of the teaching process which are often extremely intimate. It is unclear how useful CTAs are in medical education and there is no region-wide policy on its implementation or efficacy. This review aims to look at different aspects of CTA programs as well as their benefits and difficulties.

Methodology

Data and studies were sourced using Medline via Ovid as it provided the easiest access to keyword searching. The following keywords were used in the search: Clinical Teaching Associate, effectiveness, ethics, gynecology, patient simulation, physical and simulation examination amongst others. Supplementary searching on google scholar and Pubmed were made whilst searching for particular titles.

Results and Discussion

It is widely acknowledged that medical and nursing students require access to clinical environments where they can practice and hone their examination and practical skills. Where access to appropriate patients or clinical areas is neither appropriate or adequate, simulation can be used as an educational tool. Simulation has been defined as an interactive method of teaching which imitates real scenarios in a guided manner (Gaba, 2004). This could be through the use of actors, mannequins, or CTAs. Mannequins were first introduced into medical education in the mid1950s to simulate airway and lung functionality (Okuda et al. 2009) but it was not until the 1980s that computerized, “realistic” mannequins that could respond to stimuli in a similar way to actual humans were introduced with the goal of improving patient outcomes (Cooper and Taqueti 2008).

Proficiency in pelvic examination is fundamental in women’s health but, due to its intimate nature, teaching medical and nursing students adequate technique is often difficult (Kleinman et al. 1996). Often, students learn these skills by practicing on mannequins and or on patients in operating theatres and clinics under supervision. While, anatomically, simple mannequins may provide a basis of physical examination, they have been criticized for not effectively teaching students adequate communication skills. Equally, performing examinations on patients under general anesthetic has similar issues. CTAs are trained specifically to teach students physical examination skills as well as communication and interpersonal skills which might not be available in other forms of simulation (Fairbank et al. 2014). Additionally, many CTA programs incorporate oral or written feedback from practitioners to students which has been shown to further improve student competence in pelvic examinations (Dilaveri et al. 2013).

CTA teaching usually involves two tutors: one simulating the patient and the other guiding and teaching before and during the practical aspect of the lesson. Afterward, both tutors provide constructive feedback to each student.

There are several difficulties with CTA programs both in terms of logistics and for individual women working as CTAs. A study from Melbourne Medical School(Fairbank et al. 2014) identified many of these problems. Spreading awareness of the program for recruitment purposes is difficult due to logistical reasons as recruitment options are often limited to “word of mouth” and posters on clinic walls. Additionally, the study identified public ignorance on the issue and, by extension, the concept that there are few people willing to subject themselves to such intimate procedures especially when the role is not understood or deemed worthy in society.

Many CTAs find that the role is very psychologically and physically demanding due to the invasive and personal nature of examinations performed upon them. Coupled with the relative inexperience of students performing these examinations, stress can mount rapidly if not monitored well. It is for this reason that most CTAs are limited to a specific number of examinations a week. In the case of Melbourne Medical School, that number is four pelvic examinations per week and much of their time is spent preparing student feedback(Fairbank et al. 2014). As it stands, there is little research into the psychological or physical effects of working as a CTA and this area is one which needs to be explored so as to ensure that this teaching resource is safe for the women undertaking it. It could be argued that this lack of research is symptomatic of a historical bias in the medical field away from women’s health until relatively recently because research, which was mostly carried out on men, was assumed to be true for women (Holdcroft 2007, Norton et al. 2016).

While most CTAs were found to come from health or teaching backgrounds, many find it difficult to talk about their work with colleagues and family members due to varying degrees of abuse or ignorance (Fairbank et al. 2014). Some of the worst examples of such abuse were people comparing the job to prostitution and not recognizing the relevance of the role within society.

The relative effectiveness of CTAs in improving student competence in women’s health conflicts in places. A randomized control study carried out amongst nursing students in the United States looked at the relative grade point average (GPA) of two cohorts of nurses; one using the CTA program and the other using traditional clinical teaching as a control. The study found that there was little difference between GPA scores between the two cohorts. In fact, the GPA was on average 1.6 points lower in the CTA group. Conversely, a similar randomised control study in Iran(Rahnavard et al. 2013) found that usage of CTAs did improve the clinical attainment of nursing students. There are, however, documented differences in the nursing student satisfaction in Iran, and other developing countries, with a wider “gap” between theoretical knowledge and clinical skills amongst nursing students (Rahnavard et al. 2013) with experienced and senior nurses being unwilling to teach students (Ghiasvandiyan 2004). Additionally, 63% of nursing students reported being treated poorly in the workplace(Ghiasvandiyan 2004). The increased performance in the CTA group in the study in Iran(Rahnavard et al. 2013) could be attributed to a more structured educational system with specific learning objectives relating to women’s health. With a lower baseline student satisfaction and attainment, introduction of a program with focused learning objectives within a safe environment, such as the CTA, would logically ameliorate scores and competence. More randomized control studies need to be conducted to ascertain the relative effectiveness of CTA programs as opposed to traditional clinical placements.

Both the above studies rely heavily on assessment of clinical knowledge as the main parameter for whether or not CTA is an effective model of clinical teaching. While this is useful information when it comes to analyzing attainment, this is not the sole factor of what constitutes clinical competence in the field of women’s health, and more specifically, pelvic examination. Clinical communication and technique are not specifically addressed by either study.

In some cultures around the world, the use of CTAs is considered controversial or even taboo. The idea of practicing examinations on a healthy person, i.e. not a patient, and or examining female genitalia outside of the clinical setting are not considered proper(Sarmasoglu et al. 2016). In Turkey, a pilot program was carried out(Sarmasoglu et al. 2016) which saw dramatic qualitative improvements in students’ confidence and proficiency in intimate examinations despite extra cultural hurdles not commonly seen in the west. It was hailed as successful as it managed to break away from cultural paradigms in order to improve student confidence and patient outcomes.

Historically, individuals within medicine, most notably surgery, have gained notoriety for cases of blasé attitudes to gaining consent for procedures under general anesthetic (Irabor 2006) and there have reportedly been numerous cases of surgeons allowing medical students to practice intimate examinations on unconsenting patients while in theatre(Adashi 2020) even when they are not relevant to surgery itself. Even if consent was gained, this would still present many ethical dilemmas(Hammoud et al. 2019) Providing a safe clinical environment for all medical students to practice these examinations in the form of CTA programs could mean that there is less of a need for students to resort to practicing on patients, not only in surgery but in general as well. This is especially relevant today when patients feel increasing like they are tools for students to practice on(Okuda et al. 2009).

In an increasingly overburdened and resource-starved health system, cost-effectiveness should be considered when assessing CTA necessity. A BMJ study(Janjua et al. 2018) carried out an economic evaluation of CTA program compared to mannequin as well as a randomized control study where two cohorts of medical students’ gynecological proficiencies were assessed where one group used a mannequin and the other used CTA teaching. The study concluded that CTA was more effective as a teaching tool but significantly more expensive than the cost of mannequin teaching. The average cost of CTA teaching per student was £45.06 as opposed to £7.40 for a mannequin with extra costs of up to £37.66 per student. The study did conclude that the cost is likely to be considered worthwhile as a degree of competency was seen with CTAs and there were fewer unanticipated costs.

Conclusion

CTA programs certainly give students a safe and focused environment to develop physical and communication skills and are unquestionably excellent teaching tools. Students are ensured access to a part of the medical field which is the cause of anxiety for many students without prior experience(Sarmasoglu et al. 2016). CTAs themselves have an admirable willingness to sacrifice their personal privacy in the name of medical education that is unseen elsewhere in the profession. This is not to neglect the significant but manageable stresses the role can put upon CTAs and their personal lives. Regulation and monitoring of CTAs must be robust to protect workers in this field. There are questions of whether CTAs are more effective than traditional clinical placement or mannequin training. Most studies, however, have limitations whether it be definitions of success or what factors constitute a more useful teaching method. Further, it has been postulated that most would view the CTA programs cost-effective despite the higher cost due to prioritization of higher standard of care. Studies in this review have mostly compared CTAs to other traditional teaching methods but none have explored the possibility of combining CTA programs with more traditional methods. The outcomes of such a program could be useful to study in future.

Women’s body magazine covers create social values with practically every issue they publish. To start, the cover gives the reader an insight into what’s written inside the magazine. Based on how appealing the cover is, readers chose particular magazines. As a result, magazine authors use every trick in the book to reel readers in.

When it comes to women’s body magazines, authors tend to follow a pattern. For certain words, they increase the size of the font so that they stand out from the words which have fonts at a fraction of the size. They even use different colored fonts, typically bright colored ones so that they stand out. For example, in Muscle and Fitness magazine, the ‘best body for 2015’ is displayed in red font. With most of the magazines in black font, the red font draws the attention of the reader. Though, the issue with the cover is that the model is a professional athlete, a profession where attaining such a figure is much easier than for the ordinary female. By saying ‘best body for 2015’, the cover idolizes a figure that only a small percentage of women can achieve.

A trend amongst the covers is an attractive, skinny female. Authors place the model in the center of the cover, having them take up ⅓ of the page. By simply magnifying certain elements of magazine covers, authors are capable of capturing the reader’s attention. Furthermore, the author emphasizes words such as ‘look better’ and ‘slim down’. These words make way for the interpretation that you can always become thinner. That you could lose a few more pounds and look ‘better’. Though, the downside is that women will always try to cut down so that they could look like these professional models. Lastly, the 2008 Women’s Health Issue was issued on January 1st, which was the day after New Year’s Eve. As part of their new year’s resolution, many women have hopes of becoming fitter. By issuing the magazine on such a day, the author hopes to satisfy those goals and in return, sell more copies.

Another element in these magazine covers is the concept of happiness. Practically every cover has a model who’s smiling, implying that becoming lean will lead to happiness. By displaying the model in such a way, they link the ideas of happiness and physique. All three models have postures that open up their bodies which exude self-confidence. On top of that, in the Women’s Health South Africa magazine, Charlize Theron is displayed with a facial expression that shows confidence. By featuring confidence in their expressions and posture, the authors manage to associate a fit physique with self-confidence. In doing so, women are presented with the idea that becoming thinner will allow them to be more comfortable in their skin.

Another trend with these covers, especially the Muscle and Fitness magazine is that the models have curvy figures. Though, many leave out the fact that these women receive implants and even liposuctions to look good as they do. They emphasize the idea that women should have these massive curves to be attractive. Some women cannot attain such curves due to anatomy and genes. With all these models displaying such curves, women will feel ashamed of themselves and seek out various procedures to achieve such a figure. On top of that, there have been various cases where the models have been photoshopped so that they could have larger curves or look skinnier. This even furthers the idea that attaining such a figure is ridiculously difficult and even impossible without these modifications. Though, such false advertising can be detrimental to how women view themselves within society. Through these magazine issues, they’re sold this false idea that they could achieve such a figure. But, through all of their strategies, they’re able to sell more magazines. Especially by emphasizing the idea that anyone could achieve such a figure, even with ease. They even include fitness plans and various tips so that readers would purchase their magazines in hopes of obtaining their ‘dream’ bodies. Through all of these tactics, authors are capable of manipulating the emotions of their readers so that they could generate more revenue by selling more copies.

In all three magazine covers, authors offer enticing propositions that play into the emotions and aspirations of women. For example, the 2008 Women’s Health magazine emphasizes the words ‘lose fat fast, and the Muscle and Fitness magazine highlights the phrase ‘the easiest way to lose weight.’ Usually, the readers and customers of such magazine subscriptions have hopes of attaining a certain figure. This magazine covers promises results within a short time without emphasizing that a great amount of hard work and dedication would need to be applied. Muscle and Fitness magazine states that one would achieve ‘amazing arms in just 7 moves’. In today’s day and age, individuals have a strong desire for immediate results without putting in great amounts of dedication and the language in such magazines plays into those hopes and aspirations.

In the Women’s Health South Africa magazine, the usage of the phrase ‘hot body fast’ has a clear implication. After reading such a phrase, women would compare themselves to the models and in most cases, look down on themselves since they don’t have the qualities or features of the model on the front cover. On top of that, the author associates happiness with being skinny by emphasizing the phrase ‘get fit and stay happy’. It suggests that becoming fit will lead to long-term happiness, a desirable trait for almost every individual. Furthermore, authors manipulate women into purchasing magazines by stating that the magazine includes various fat loss tips. The Muscle and Fitness magazine would draw the attention of readers due to the emphasization of ‘237 can’t miss fitness tips.’ In conclusion, women’s health magazine covers include various tricks including strategic placement and magnifying elements to persuade readers to purchase their magazine.

1.0 Introduction

1.1 Overview

Pregnancy is one of the most important periods of a woman’s life where during this time, lots potentially worrying changes could occur in her body. Pregnant mothers need regular check-ups, regular supervision, and care once they find out they are pregnant. In Malaysia, the health ministry has created a health record book for pregnant women known as ‘Buku Pink’ or in medical terms, it is called antenatal red card, but because of its pink color, it is better known as a ‘Buku Pink’. This antenatal book is important as it contains a wealth of important information such as menstrual deadlines, delivery dates, and pregnancy history records, including prenatal screening appointments at the Maternal and Child Health Clinic (KKIA) and government or private hospitals. (Sayyed, n.d.)(“Buku pink dan keperluannya kepada ibu hamil – BabyCenter,” n.d.). These antenatal red cards are used to record the information about the medical history, physical examination and the test made (HIV, Hepatitis B, and others), and also the result. One important aspect of pregnancy that was found to be widely used was keeping daily records in a paper-based format. However, according to the authors’ observations, there is no longer any mobile app for pregnant women’s health records in Malaysia.

1.1.1 Pregnancy in Malaysia

According to Vital Statistic, Malaysia, in 2018, live births increased whilst the births rate declined in 2017. The number of live births was 508,685 in 2017, an increase of 0.1 percent as compared to 508,203 in 2016. The crude birth rate (CBR) declined from 16.1 (2016) to 15.9 (2017) per 1,000 population. More male babies were born than females. A total 262,575 (51.6%) male babies were born in 2017 as compared to 246,110 (48.4%) female babies. The CBR for both sexes declined from 16.1 per 1,000 population in 2016 to 15.9 in 2017. (“Department of Statistics Malaysia Official Portal,” n.d.) Generally, for pregnant women and especially for those who had their first experience of pregnancy will not be comfortable with the pregnancy symptoms such as morning sickness, tiredness, low backache, and /or pain and etc. Brown and Smith (2004) suggest that if women can have their own case notes, they will feeling safer under the doctor’s observation of their medical records. Moreover, if they can maintain their own health records during pregnancy, they will feel more “maternal control and satisfaction”. They also found other benefits for providing pregnant women with their own health records, including “increased availability of antenatal records”.

1.1.2 Mobile technology

Mobile technology is a form of technology that is mostly used in cellular communication and other related aspects. Moreover, mobile technology is rapidly changing, and we are seeing new products, services, and innovations every day. As everyone knows, when mobile technology was introduced for the first time, basically it just have function of calls, messages, and games. Over the years, mobile technology has also taken steps to improve and adding more functions and has now transformed into a digital world and made life and business easier. Smartphone has rapidly become the preference device for most Malaysian to remain connected as it use the current mobile technology. Chief Statistitian Datuk Seri Dr. Uzir Mahidin said smartphone usage for internet access also increased to 97.7 percent compared to 97.5 percent in 2015. On mainstream internet activity, among the popular activities are social networking sites with 86.3 percent and downloading images, movies, videos or music and playing or downloading video games at 81.2 percent. (Alias, 2018) . From the statistic that have been mentioned, we can say that, people in our country like to use mobile technology in doing any work or anything including pregnant women because it is become more easier when the technology have been grows up.

1.1.3 Mobile technology trends in healthcare

Health telematics had becoming a great topic in terms of medical informatics and healthcare. Currently, most hospitals and clinics rely heavily on systems based on information technology and communications (IT) to improve the quality, safety, and productivity of healthcare services. Healthcare takes benefits from the revolution of smartphones, such as smart watches, or other sensors that control the health status of consumers. A survey showed that in Malaysia with 86.9% of users relying on the Internet to look for information, majority of them (77.2%) did look for health information online. The most common health-related information that users were seeking were on ‘symptoms and diseases’ (91.4%), followed by ‘health care tips’ (89.8%) and ‘treatment method’ (83.5%). Over half of them were looking for ‘medications/drugs information’ (73.7%), as well as a ‘place to get treatment’. (Unknown, 2012)

1.1.4 Mobile apps for pregnant women’s healthcare records

The application developed and described in this paper is intended for use by the doctors and pregnant women and it assists maternal healthcare by automating the following: data collection, integration, and correlation, the regular checkup must be continue follow its schedule to check on the baby’s condition and contextual advisory. This application will replace the antenatal book or ‘antenatal red card’ where all information in the book will be convert into a system and will be develop into the application. Other than that, this application also will synchronized with web-based system created by the hospitals to make sure the doctors also will get the data about pregnant women’s health care records. This study will address system acceptance by measuring perceived usefulness and perceived ease of use by user testing, based on the following hypotheses: Pregnant women are more likely to adopt a pregnancy-specific PHR module when they find it useful. Pregnant women are more likely to adopt a pregnancy-specific PHR module when they find it easy to use. (Sayyed, n.d.)

1.2 Problem statement

Pregnancy is a period in life in which women must get used to a new state and begin to deal with new uncertainties and anxieties. During this period, pregnant women like to use the internet to find information on pregnancy care, prenatal education, and other than that. In addition to seeking information from the Internet, they also need to register at any nearest clinic, whether government or private in the early stages of pregnancy. This is because they need to sign up for a regular checkups on infants at a nearby clinic. After they have registered at a nearby clinic, they will be given a pink book or called an antenatal book or antenatal red card where the function of the book is to record their health as well as their infants during pregnancy.

Health Ministry have develop the antenatal red card for pregnant women to keep all the record and status of pregnancy and their current health. The used of the antenatal red card is the manual way used by the current clinics to record the data about the pregnant women. The major problem of using this manual way is, the card could be lost or misplaced. Forgetting or neglecting is part of one’s life. As human beings, we will never miss the attitude of always forgetting where things are or where things are wrong. This can be due to being overly busy, under stress, fatigue or possibly experiencing health problems such as depression, hypothyroidism or worse, dementia. However, this neglect or neglect is a normal occurrence in one’s life regardless of age limit. A survey showed that the number of personal belongings that we lose each day has no official figure, but one company that produces gadgets to track personal items claims that we spend at least 10 minutes per day looking for lost or misplaced items — or about 2.5 days per year. Moreover, forgetfulness can also be genetic, in which case organic searching may not be enough. A German study also found that some people are more likely to be forgetful, thanks to carrying a D2 receptor gene (DRD2) in their DNA — 75% of 500 people surveyed. (“Virtual Lost and Found – Computer Science Zone,” n.d.)

The next problem is if the card or book is lost, the doctors will face the difficulties to analyze or to go through on the healthcare record and the pregnancy status of the cardholder. As we know, this antenatal book is very important for pregnant women and doctors who examine the baby in their womb. The pink book has two copies of which one will be kept by the patient himself and the other will be held by a clinic or doctor who examines the pregnant woman. Because of this, it’s easy for both pregnant women and doctors to see and check their health as well as the unborn baby. But if the both of copies are missing, it will be difficult for a doctor to analyze healthcare records of the pregnant women. In addition to the loss of the book, issues such as stolen patient data can also occur again in a manual way where if the clinic does not store the data in the computer, it will make it easier for the third party to steal the antenatal book which has all the data on female patients pregnant. Meanwhile, there are some clinics are turning paper patient records into digital files. But hospitals and physicians typically don’t take the extra step to protect those files — making them easier than ever for a hacker to quietly steal the important file. A study that showed Recent numbers shows 90% of health care organizations have exposed their patients’ data — or had it stolen — in 2012 and 2013, according to privacy researchers at the Ponemon Institute. (“90% of hospitals and clinics lose their patients’ data,” n.d.) Furthermore, the manual records maintenance requires more hours and effort to ensure patient privacy is protected and shared files are not accessed by unauthorized people. (O’Connor Stephen, 2015)

Next, we acknowledge the fact that the health Ministry are currently preparing the paper-based antenatal red cards. Paper-Based records are not as secure as digital files that are protected with encryption. Hospitals or clinics often have a single repository of patient data in paper form. Here we can conclude that using paper-based systems will take up a lot of space to keep patient records and data. This patient’s data and health records are important for their reference and cannot be simply dismissed. Paper records also naturally deteriorate over time in storage, regardless of how well their environment is controlled, and they tend to decay upon excessive handling. Also, not all doctors have good written results when using paper to write patient health records will make it difficult for us to read and refer back to them. For paper records, if any other person is interested in obtaining a record of pregnant women’s health for reference, the hospital or clinic must first convert the paper format to electronic format either by scanning or emailing before they can access the record. In terms of securities, paper records are not very secure because we do not know that someone may physically break into the repository of all the records and health data of pregnant women or any patient. Paper records also can be susceptible to natural disasters such as fires and floods. (“Paper vs. Electronic Medical Records | Chron.com,” n.d.)

1.3 Research question

The aim of this study was to design and implement a mobile application that replaces the pink book or antenatal books that are still used in any Malaysian clinic or hospital to keep a record of pregnant women’s health care. More specifically, this study aims to answer these research questions: 1) what are the key features and content for this mobile application? 2) Do the functions of this mobile application help pregnant women and facilitate the work of the clinical administration in maintaining their health care records? And (3) explore their concerns about data privacy and security when using this mobile application.

1.4 Research objective

This paper is focused on determining how mobile applications can be used to improve the antenatal book that stores all data about pregnant women’s healthcare records. This research conducted for the issue that faced by pregnant women and the healthcare workers who serve them. This review provides an overview of current literature on pregnancy apps and aims at describing 1) to determine the key features and content of the mobile application of pregnant women’s healthcare records, 2) to find out whether this mobile applications are useful for the doctors and also for the pregnant women and 3) to investigate their concerns about the data privacy and security when using the mobile application.

1.5 Scope

The aim for this paper is to focus on the scope of antenatal book use by pregnant women or doctors in clinics and hospitals in Malaysia. In all cases, some countries have developed a mobile application for pregnant women, but in Malaysia still uses the antenatal book or pink book to keep their health care records. Health Ministry have developed the antenatal red card for pregnant women to keep all the record and status of pregnancy and their current health. The antenatal book is one of the systems that use paper-based and this research paper will describe about the mobile application that will replace the antenatal book.

This study will be conducted on clinics in Malaysia that are manage the pregnancy matter. Usually, pregnant women will register at the clinic nearby to get the antenatal book for their healthcare records and checkup schedule. Other than that, this study also will be conducted on pregnant women and the doctors or the healthcare workers who serve them because they are the user of the antenatal book and will be a user for this mobile application.

References

1. 90% of hospitals and clinics lose their patients’ data. (n.d.). Retrieved October 20, 2019, from https://money.cnn.com/2014/08/20/technology/security/hospitals-data/
2. Alias, A. (2018). Malaysia’s Internet penetration is now 85.7 per cent | New Straits Times | Malaysia General Business Sports and Lifestyle News. Retrieved October 19, 2019, from New Straits Times website: https://www.nst.com.my/business/2018/03/346978/malaysias-internet-penetration-now-857-cent
3. Buku pink dan keperluannya kepada ibu hamil – BabyCenter. (n.d.). Retrieved October 19, 2019, from https://www.babycenter.com.my/a25019647/buku-pink-dan-keperluannya-kepada-ibu-hamil
4. Department of Statistics Malaysia Official Portal. (n.d.). Retrieved October 19, 2019, from https://www.statistics.gov.my/index.php?r=column/cone&menu_id=dDM2enNvM09oTGtQemZPVzRTWENmZz09
5. O’Connor Stephen. (2015). Why Your Paper-Based System is Slowing Your Practice Down. Retrieved October 1, 2019, from Why Your Paper-based System is Slowing You Down website: https://www.adsc.com/blog/why-your-paper-based-system-is-slowing-your-practice-down
6. Paper vs. Electronic Medical Records | Chron.com. (n.d.). Retrieved October 20, 2019, from https://smallbusiness.chron.com/paper-vs-electronic-medical-records-40354.html
7. Sayyedi, K. (n.d.). A PERSONAL HEALTH RECORD MODULE FOR PREGNANT WOMEN: SYSTEM DEVELOPMENT AND USER ADOPTION STUDY.
8. Virtual Lost and Found – Computer Science Zone. (n.d.). Retrieved October 20, 2019, from https://www.computersciencezone.org/virtual-lost-found/

Introduction

Today health of a person is not only taken in the context of merely not only the absence of any pathology, instead, there can be multiple reasons. the relationship between two individuals can influence their behaviour as well as health. A healthy relationship can also be a reason of good health, ofcourse, if a person is satisfied internally, he would take less stress, sleep well and quit smoking.

This is according to the latest research that the main cause of unhealthy behaviour mostly refers to the sedentary lifestyle of the person. However, it is stated that healthy behaviours are essential in leading a healthy life. The objectives of the research paper are concerned with the determining or to investigate the influence of the partner’s behaviour on women’s health. This is the motivating study as this may spread awareness about the influence of partner’s behaviour on women’s health along with the approach of the influence of the health behaviour changes on the health of the partner.

In order to progress study in exploring the influence of the partner’s behaviour on women’s health the concept formation method is adopted; this is the systematic process to analyse the research as the qualitative exploration. For the mentioned research investigation, the data that has been collected is mainly obtained from the married couples, as it is the objective of the study to know the impact of the healthy behaviour choices of an individual in the betterment of the health of the partner as well.

Research Questions

Following are the research questions for this research work;

1. Does one partner’s behaviour change have an impact on the other partner regarding making positive health behaviour changes.
2. Does positive behavioral change helps in maintaining a healthy relationship between the couples?
3. How’s your relationship with your spouse or partner effect on your health?

Literature Review

As health is the biggest asset of a person. Healthy behaviour is the term that mainly used for the principles and activities of the person in attaining or maintaining their basic health or well-being. These health behaviours are imperative in the component of the practice, mostly known as the disease prevention method, as stated by Monden (2007). In order to adopt a healthy lifestyle, it is fundamental to take initiative towards the prevention of the disease although it is attained by implementing healthy behaviour. For this, the present literature has encouraged couples as the highly agreeable method of maintaining healthy behaviour along with avoiding unhealthy behaviours among the partners (Reynolds, Barlow and Pedersen, 2006). Holahan et al. (2012) proclaimed in his examination that the alterations in the health behaviour of the one partner are frequently observed to be linked with the changes in the health behaviour of another partner. According to Cobb et al. (2014), a positive behavioural change like for the individuals who have adopted a sedentary lifestyle has been reported a significant difference in their way of living when being associated with the consistent partner who is physically active. As this according to Jackson, Steptoe and Wardle (2015) will help them in sustaining a healthy relationship among the couple as well. As these changes are also described in the image given below.

According to Jong et.al. (1995), the health behaviour of individuals vary on their merital status. It can be observed that the married people have better health conditions when compared to the single. They also abstain from negative activities like smoking and drinking. The men who are involved in a relationship take more time for their health and exercise to stay fit which indicates a positive pattern.

In contrary to this Holahan et al. (2012) also described in his study those in overweight individuals when they accompanied by the partner who is of normal BMI constantly augments the inspiration by the partner in losing the weight. The researcher further reports the weight loss among the patterns as it has been linked with 3 folds higher weight loss statistics among the partners who are overweight (Reynolds, Barlow and Pedersen, 2006). The modifiable factor like smoking is also affected as this is also described in the above image, as smoking causes numerous health-related problems; globally it is the foremost cause of diseases combined with mortality. A study by Monden, (2007), reflects that there are many cases evident in which the smoking pattern of the partner has been influenced in cases of healthy choices by partners. The study revealed that most of the partners have quit smoking, though some have minimized the rate of smoking (Homish, and Leonard 2008). Other modifiable factors like poor diet, alcohol consumption or a sedentary lifestyle can also be impacted by the role of the partner in making healthy behaviour choices, as asserted by Centres for Disease Control and Prevention (CDC), (2011). Hence, it can be affirmed that health events have a direct impact on the behavioural changes in both the partners. The homogeneity of education can cause a change in the health behaviours where education is always the major factor in healthy decision-making.

Data and Method

The study investigation is done on mostly the middle-aged couple. The data has been collected from both married couples as well as cohabiting couples have; the age of the couple was over 50 years old. The logistic Regression strategy is been used for the methodology of the study. The English Longitudinal Study of Ageing (ELSA) is the source from which the data is obtained. Research is designed in a way to elaborate outcome variable & measures in a comprehensive manner. The factors that are meant to analyse in the research are the physical activities along with weight status that how much weight has been a loss or gained. The modifiable changes like prohibiting smoking and sedentary lifestyle etc. are also the influencing factors of the partner’s behaviour that have an impact on women’s health. Outcome variable measures include women health. Physical activities, weight loss, quit smoking.

Ethical Concern

All the work conducted for this research has been bounded by ethical boundaries. The personal information of data providers have been kept confidential. The safety of their personal information will be a huge responsibility but its protection will be ensured. On the parallel, all the unethical means that were possible to attempt in this research work have been avoided. The ethical approval for ELSA has been received from various ethics committees in which the London Multi-Centre Research Ethics Committee is also included.

Limitations

However, the estimated barriers of the study are difficulties in obtaining the secondary data that is associated with the attitude of the partner in the context of the health of women. Number of participants for data collection are also a limitation to this research study because this vast topic needs a very large sample size to produce accurate results. The availability of only small number of studies conducted on this topic is also a main limitation. However, this research work is conducted by overcoming these limitations as much as possible.

References

1. Centres for Disease Control and Prevention (CDC, 2011. Quitting smoking among adults-United States, 2001-2010. MMWR. Morbidity and mortality weekly report, 60(44), p.1513.
2. Cobb, L.K., McAdams-DeMarco, M.A., Huxley, R.R., Woodward, M., Koton, S., Coresh, J. and Anderson, C.A., 2014. The association of spousal smoking status with the ability to quit smoking: The Atherosclerosis Risk in Communities Study. American journal of epidemiology, 179(10), pp.1182-1187.
3. Holahan, C.J., North, R.J., Holahan, C.K., Hayes, R.B., Powers, D.A. and Ockene, J.K., 2012. Social influences on smoking in middle-aged and older women. Psychology of Addictive Behaviors, 26(3), p.519.
4. Homish, G.G. and Leonard, K.E., 2008. Spousal influence on general health behaviours in a community sample. American journal of health behaviour, 32(6), pp.754-763.
5. Jackson, S.E., Steptoe, A. and Wardle, J., 2015. The influence of the partner’s behaviour on health behaviour change: the English Longitudinal Study of Ageing. JAMA internal medicine, 175(3), pp.385-392.
6. Joung, I.M., Stronks, K., Van de Mheen, H. and Mackenbach, J.P., 1995. Health behaviours explain part of the differences in self reported health associated with partner/marital status in The Netherlands. Journal of Epidemiology & Community Health, 49(5), pp.482-488.
7. Monden, C., 2007. Partners in health? Exploring resemblance in health between partners in married and cohabiting couples. Sociology of Health & Illness, 29(3), pp.391-411.
8. Reynolds, C.A., Barlow, T. and Pedersen, N.L., 2006. Alcohol, tobacco and caffeine use: spouse similarity processes. Behaviour Genetics, 36(2), p.201.

1. Describe globalization and international patterns of health and disease.

Globalization is the word used to portray the developing association of the world’s economies, societies, and populaces, achieved by cross-outskirt exchange of products and ventures, innovation, and streams of speculation, individuals, and data. Nations have constructed monetary organizations to encourage these developments over numerous hundreds of years. The wide-going impacts of globalization are mind-boggling and politically charged. Likewise, with major mechanical advances, globalization benefits society in general, while hurting certain gatherings. Understanding the relative expenses and advantages can prepare for lightning issues while continuing the more extensive adjustments (Kolb, M., 2018).

About 33% of the world’s demises can be credited to few hazard factors. The five driving worldwide dangers for mortality on the planet are hypertension, tobacco use, high blood glucose, physical idleness, and overweight and corpulence. They are in charge of raising the danger of unending illnesses, for example, coronary illness and cancers. They influence the nation’s overall pay gatherings: high, center, and low. The main worldwide dangers for weight of illness on the planet are underweight and risky sex, trailed by liquor use and dangerous water, sanitation, and cleanliness (Global patterns of risks to health, 2015).

2. Identify international health care organizations and how they collaborate to improve global nursing and health care.

The Global Alliance for Improved Nutrition is a coalition driven by the vision of a world without lack of healthy sustenance. Made in 2002 at a Special Session of the UN General Assembly on Children, GAIN bolsters open private associations to build access to the missing supplements in eating regimens fundamental for individuals, networks, and economies to be more grounded and more beneficial. In under 10 years, GAIN has had the capacity to scale its activities by working in association with governments and global offices, and through tasks including in excess of 600 organizations and common society associations in excess of 30 nations, contacting an expected 667 million individuals with healthfully improved sustenance items. About portion of the recipients are ladies and youngsters. The increase will likely contact 1 billion individuals by 2015 with nutritious nourishments that have maintainable wholesome effect (Trahant, G., & Wish, G., 2019).

Health Leads trusts that an alternate sort of medicinal services framework is workable for America – one that tends to all patients’ essential asset needs as a standard piece of value care. We trust that one day, all social insurance suppliers will probably endorse arrangements that improve wellbeing, not simply oversee infection. We try to adjust the powers vital for this change, utilizing Health Leads’ work in our accomplice emergency clinics and wellbeing focuses to put forth a more extensive defense for incorporating fundamental assets into social insurance conveyance (Trahant, G., & Wish, G., 2019). In the meantime, America is balanced for a medicinal services change because of market-driven goals concentrated on improving patient wellbeing and decreasing expenses.

A great many individuals bite the dust superfluously every year because of absence of human services. A large number of these are youngsters living in destitution who bite the dust from jungle fever, pneumonia, and diarrheal malady since they couldn’t get viable medicinal treatment. Grown-ups with interminable illnesses, for example, diabetes and coronary illness can’t get the constant consideration expected to carry on with a solid life. A noteworthy explanation behind these pointless passing is the deficiency of specialists and medical caretakers in poor nations, particularly in rustic zones where the most unfortunate individuals live. However, a large portion of these issues can be effectively treated by different kinds of well-being laborers in the event that they are given the devices they have to adequately analyze and treat these patients (Trahant, G., & Wish, G., 2019). We intend to bring exact and successful determination and treatment to the world’s poor through the acquaintance of simple with use programming fusing electronic conventions that direct the well-being laborer well-ordered to the right finding and treatment for every patient. This utilization of clinical guidelines of consideration has been appeared to be a powerful method to improve the nature of the consideration gave to patients.

3. Identify and discuss the major indicators of women’s health.

Over the globe, ladies are foundations of the nuclear family, essentially in charge of child care, sustenance, and in general family prosperity. Amid their childbearing years, ladies face numerous wellbeing dangers explicit to pregnancy and labor. Any trade-off in ladies’ wellbeing amid this time of their lives, or presentation to sexual orientation based savagery or separation, has, in this manner, negative ramifications for individual ladies, their families, networks, and the bigger society (Women’s Health, 2017).

Some of the indicators of women’s health are: osteoporosis, Alzheimer’s disease, arthritis, cardiovascular diseases, hypertension, etc. Around 30 percent of non-Hispanic White and Hispanic ladies 65 and over uncovered that they had been determined to have osteoporosis, appeared differently in relation to 11.1 percent of non-Hispanic Black ladies of a comparative age. Driving reasons for death in ladies credit to coronary illness and dangerous neoplasms (Women’s Health USA, 2011). Two other driving reasons for death are stroke and COPD. Suicide speaks to more than 30,000 passing in the United States each year and is the third driving purpose behind death for ladies over the periods of 18–35 years.

4. Identify and discuss the barriers to adequate health care for women.

While numerous individuals in low-and center pay nations face these difficulties, ladies lopsidedly bear the weight of wellbeing disparities over the globe and are given novel boundaries to getting to therapeutic consideration. For instance, ladies and kids are lopsidedly influenced by transportation boundaries, which may emerge as geological segregation, absence of open transportation, or absence of assets to buy their own method of transportation.

Boundaries to mind add to financial, racial and ethnic, and geographic contrasts in social insurance usage and well-being status. Ladies were likewise somewhat almost certain than men to have sworn off required social insurance because of expense. For the two ladies and men, the extent who postponed required consideration because of cost fluctuated by destitution level. Among ladies, around one-fifth of those living in family units with earnings under 200 percent of destitution encountered a neglected requirement for social insurance because of expense, contrasted with 13.5 percent of those with family unit wages of 200– 399 percent of neediness and 6.5 percent of those with family unit livelihoods of 400 percent or a greater amount of destitution (Women’s Health USA 2012, 2012).

References

1. Global patterns of risks to health. (2015, November 02). Retrieved March 16, 2019, from https://www.who.int/whr/2002/chapter4/en/index10.html
2. Kolb, M. (2018, October 29). What Is Globalization? Retrieved March 16, 2019, from https://piie.com/microsites/globalization/what-is-globalization.html
3. Mary A. Nies, Mary A., McEwen, Melanie (2015). Community/Public Health Nursing.
4. Promoting the Health of the Populations. (6th ed).
5. Trahant, G., & Wish, G. (2019, February 21). 15 Organizations Changing The World Through Healthcare. Retrieved March 16, 2019, from https://www.causeartist.com/10-organizations-changing-world-health/
6. Women’s Health. (2018, January 17). Retrieved March 16, 2019, from https://www.measureevaluation.org/prh/rh_indicators/womens-health
7. Women’s Health USA 2012. (n.d.). Retrieved March 16, 2019, from https://mchb.hrsa.gov/whusa12/hsu/pages/bcunc.html