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United Kingdom (UK) health policy over the past thirty years has been predicated on a partnership model focusing on empowering service users to be fully involved in their care. Within maternity care partnership relationships have been conceptualised as empowering women to have continuity, choice and control (Department of Health (DoH), 1993), within a relationship of personal autonomy between the woman and her carers. In this study I sought to identify the extent to which the Government agenda for partnership working and choice is realised or desired by women during pregnancy and childbirth. In addition, I wanted to examine the level of alignment between the views of midwives with that of women accessing the maternity services. This study took a qualitative approach, drawing on the principles of grounded theory. In the first phase of the study a purposive sample of sixteen pregnant women were recruited and invited to complete a diary and to take part in two interviews. Women maintained diary entries following appointments with the midwife during pregnancy and childbirth. Semi–structured interviews were undertaken at 36 weeks of pregnancy and four weeks after the birth, based on the diary entries. In the second phase, four focus groups were undertaken with two groups of community midwives and birth centre midwives from two National Health Service (NHS) Trusts. Quotes from the diary-interviews from phase one were utilised to develop three vignettes which acted as a prompt during the focus group interviews. Following a thematic analysis of the data, I analysed women’s views on partnership working and choice. Most women in this study did not feel that they developed a partnership relationship with the midwife. This was associated with a lack of continuity of care and insufficient time to engage in meaningful discussion in an environment which was not conducive to shared decision making. Women described wide variations on the midwives role in supporting decision making. This ranged from decisions being dictated to midwives guiding choices and for some women, being facilitated to make informed choices. Many women described input of family and friends and widespread use of the internet as an information source. Women depicted their antenatal midwifery care as medicalised and felt that whilst their bio-medical needs were met their psycho-social and emotional needs were not. Women described the visits frequently as ‘in and out’ or ‘ticking the boxes’ to describe this approach to care. A small number of women (n=5) did experience a partnership relationship. Three of these women knew the midwife from a previous pregnancy; the remaining two women attended a midwifery led unit for all of their care. In relation to the choice agenda, most of the women who participated in this study were not aware that they had a choice about who provided their care or where they would have their care. The midwife focus groups concurred with the women’s findings and suggested that a lack of time was a significant factor hindering the formation of a partnership relationship. Midwives felt that this was exacerbated by the paperwork they were required to complete in order to audit care and meet the ‘payment by results’ agenda (DoH, 2003b). During the focus groups midwives identified strategies which could be implemented to enhance midwifery led care, including offering antenatal care to small groups of women and undertaking an antenatal home visit towards the end of pregnancy, to provide women with the time to discuss any issues that they wanted to explore in more depth. The findings from this study contribute to the current body of knowledge on midwifery led care particularly in providing the women’s perspective on partnership working. Women want to experience midwifery care that meets their psycho-social needs as well as bio-medical needs through a model of care that provides continuity. In contrast to previous research findings, the women in this study described community based care as mechanistic, clinically focused and time bound, more in line with an obstetric model of care than a midwifery model. However, midwifery led care offered within a birth centre was perceived by women as providing a more holistic, social model of care. Whilst continuity of care is not a new concept, what this study contributes is that despite successive administrations supporting partnership working and informed choice over the past twenty years, most of the women in this study did not experience this level of care. The findings from this study resulted in the development of a midwifery partnership model as a theoretical framework that could be utilised in future research studies to evaluate the extent to which a partnership relationship exists within a range of midwifery care settings.

The literature concerning what medical students learn from midwives during specialist obstetric rotations is scarce. In the UK, despite a long tradition of providing midwifery attachments for medical students, it is almost non-existent. Working with midwives is arguably the only opportunity medical students have to experience holistic or social models of maternity care, focusing on normality rather than on the medical concept of risk. This study sought to discover how medical students constructed their knowledge about childbirth during a six week specialist rotation in obstetrics in a Northern English teaching hospital (NETH), with particular emphasis on whether participants assimilated any concepts from midwifery knowledge (MK). A Delphi Study, done as the first phase of the research, focused on MK, utilizing an international sample of experienced midwives. Resulting themes were used to develop the data collection tool for the second phase of the research. The research employed a qualitative case study method with students from a single year cohort comprising the case. Data were collected using a tool consisting of three problem based learning (PBL) scenarios. These were presented to the students in consecutive interviews at the beginning, the middle and the end of their obstetric rotation. Following analysis, five main themes were identified which illuminated the medical students' construction of knowledge about maternity care. These were explored and discussed. The thesis concludes with recommendations for increasing opportunities for IPE in the medical and midwifery curricula.

This thesis focuses on the concept of informed choice in family planning and how numerical and systematic targeting aimed at raising the numbers of contraceptive acceptors fundamentally undermines this concept in highland Chiapas. The Government of Mexico’s policy aims within its Reproductive Health Programme (1995-2000) are to reduce the total fertility rate whilst promoting reproductive health services and family planning choices. Though Mexico has seen a decline in its total fertility rate attributed to increased contraceptive use in urban areas, in rural parts the rate remains high. Consequently, the rural poor, and in Chiapas overwhelmingly indigenous populations, have become a major target of the Reproductive Health Programme. Monthly targets are set for clinics and family planning services are offered systematically every time a woman attends a clinic for whatever reason. Amongst the factors which must be accounted for in assessing family planning provision in highland Chiapas are cultural differences between mestizo providers and the indigenous target groups as well as local economic and political conditions. Presently, the state of Chiapas is highly militarised and under the cloud of a low intensity war precipitated by the Zapatista uprising in 1994. The provision of any kind of health services is difficult under these situations, but more so what one considers the distrust sown between some indigenous communities and the government Who provide the health services. This thesis examines the practicalities of implementing a global policy at a local level and the constraints faced by both providers and intended recipients in the social context of Los Altos. Mindful of the care required in identification most people in this thesis (with the exception of a few well-known academics) appear under pseudonyms.

Recent changes in legislation and access to information, through sources such as the media, may have influenced peoples' expectations for information about their prescribed medication. As a result, health care professionals may perceive an increased pressure to provide information. A case study approach was employed to examine the sources and scope of information patients draw upon when they are prescribed oral steroids for asthma. The aim was to examine the extent to which patients can be said to exercise an `informed choice' when they take prescribed medication. The role and importance of GPs (general practitioners) in informing the choices patients make was also examined. Both qualitative and quantitative methods were employed. Interviews conducted with both patients and GPs indicated `gaps' in understanding. Although the GP was the preferred source of information, patients reported that the choices they made were based on information from a range of sources. General practitioners justified not providing information to patients so as to `protect' patients from knowledge of side effects. However, there was some awareness of the range of sources of information used by patients. A vignette technique was employed to further investigate GPs' recognition and understanding of the range of sources of information patients' use to inform the choices they make. Approximately half of the GPs who responded to the vignette recognised the influences presented. General practitioners who had been practising for a shorter period of time were significantly more likely to recognise these influences. The conclusions draw on the literature of the sociology of the professions. In spite of the way in which the Government has sought to encourage patients to act as consumers, the state has also continued to endorse GPs right to make decisions concerning the level of information to provide. If GPs do not believe it is in the interests of patients to be provided with information to make choices about their medications then the information available to patients may be limited. This will have an impact on the ease with which patients may make `medically' informed choices about their prescribed medication. Only when the communication between patients and GPs improves, will it be possible for a relationship to develop where patients may be assured of gaining information from their GP at the level they feel is appropriate to enable them to make informed choices about their medication.

Wage theft and worksite injury is a significant issue for day workers in Texas and across the nation. In Texas, where a majority of day laborers are undocumented and therefore more vulnerable, the most urgent issue that needs to be addressed is exploitation, which is often compounded by laborers’ lack of access to information about worker rights and employers’ reputations. In 2014 alone, 524 workers were documented to have been killed on their job site in Texas, while many deaths went unreported. And between 2010 and 2014, more than 40,000 Texan workers were victims of wage theft amounting to a total of more than $70 million. Operating in the field of ICT (Information and Communication Technology), I hypothesize that access to both English- and Spanish-language information about worker rights and potential employers’ labor violation-related records can empower workers to make informed employment decisions that will increase their safety and prosperity. At a time when the field of design and advanced digital technologies can skew toward serving the privileged and elite of the society, I am using technology to help members of marginalized/disadvantaged communities use information to improve their economic condition and quality of life: in short, to effect social justice from the bottom up. In my thesis project, Su Voz, Su Decisión, meaning your voice, your decision, I use the methodology of user-centered design to design a mobile app that provides a system of information access for day laborers in Austin. In this report, I will discuss the process of user experience (UX) design that I followed to design the solution, which is a mobile app for Android and iOS, and how I used physical data visualization to represent the data that helped me create the app.

Background: Adequate knowledge is essential for making informed decisions. We attempted to determine the level of knowledge about mechanisms of action of birth control methods in five representative samples of European women. Study design: Randomly selected women, aged 18-49 years, completed an anonymous survey in Germany, France, the UK, Sweden and Romania (N=1137). Participants were asked about how contraceptive methods work and if providers should inform them about this issue. Multiple linear regression was used to evaluate women’s characteristics associated with their knowledge of mechanisms of action. Results: The majority of women identified the unequivocal mode of action of condoms, sterilization and abortion. Less than 2% identified all possible mechanisms of action of hormonal contraceptives and intrauterine devices. Highly-educated women correctly identified the mechanism or mechanisms of action of more methods than less educated women (β coef.=0.22, 95%CI=0.01-0.43). Regardless of their sociodemographic characteristics and their belief about when human life begins, most women (75%) stated that the provider should inform them about possible postfertilization effects. Conclusions: European women have low knowledge about mechanisms of action of several contraceptive methods. The majority want to be informed about possible postfertilization effects. Since adequate knowledge is essential for making informed decisions, providers are encouraged to inform women about all possible mechanisms of action of contraceptives.

Background: The choice of a birth control method is influenced by socio-cultural and personal factors. We explored the perceived influences in women’s choice of a birth control method in five European countries (Germany, France, the U.K., Romania and Sweden), where contraception is widely used. Study design: Cross-sectional study of 1137 randomly selected women, aged 18-49 years. An anonymous, 31-item questionnaire related to birth control methods was used. Logistic regression was used to identify variables associated with partner participation in choice of a contraceptive. Results: Oral contraceptives were mainly used in Germany (54.3%), France (50.5%) and Sweden (34.6%) and condoms in the UK (29.6%) and Romania (22.9%). Sweden showed the highest use of intrauterine devices (19%). Romania had the lowest use of contraception. Oral contraceptives and intrauterine devices use were frequently suggested by providers instead of by women. Choosing the method with the partner was associated with age (OR=0.97, 95%CI 0.94-0.99), university graduate (OR=1.59, 95%CI 1.01-2.29), married (OR=1.52, 95%CI 1.01-2.29) and with using a method that requires partner’s cooperation (OR=8.18, 95%CI 5.46-12.27). Conclusions: Hormonal contraceptives and intrauterine devices are commonly recommended by providers rather than requested by women. Partner preferences are taken into account when his cooperation in the use of the method is needed. As fertility care is a male and female issue, there is still more room for actively involving both women and men in choice of a birth control method.