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Item Open Access Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model(Elsevier, 2002-05) Austin, LT; Ahmad, F; McNally, MJ; Stewart, Donna EileenThe aim of this study was to review published studies that examined factors influencing breast and cervical cancer screening behavior in Hispanic women, using the Health Belief Model (HBM). MEDLINE and PsycINFO databases and manual search were used to identify articles. Cancer screening barriers common among Hispanic women include fear of cancer, fatalistic views on cancer, linguistic barriers, and culturally based embarrassment. In addition, Hispanic women commonly feel less susceptible to cancer, which is an important reason for their lack of screening. Positive cues to undergo screening include physician recommendation, community outreach programs with the use of Hispanic lay health leaders, Spanish print material, and use of culturally specific media. Critical review of the literature using the theoretical framework of the Health Belief Model identified several culturally specific factors influencing cancer screening uptake and compliance among Hispanic women. Future interventions need to be culturally sensitive and competent.Item Open Access Computer-assisted screening for intimate partner violence and control: a randomized trial(American College of Physicians, 2009-07) Ahmad, F; Hogg-Johnson, Sheilah; Stewart, Donna Eileen; Skinner, HA; Glazier, Richard; Levinson, WBackground: Intimate partner violence and control (IPVC) is prevalent and can be a serious health risk to women. Objective: To assess whether computer-assisted screening can improve detection of women at risk for IPVC in a family practice setting. Design: Randomized trial. Randomization was computer-generated. Allocation was concealed by using opaque envelopes that recruiters opened after patient consent. Patients and providers, but not outcome assessors, were blinded to the study intervention. Setting: An urban, academic, hospital-affiliated family practice clinic in Toronto, Ontario, Canada. Participants: Adult women in a current or recent relationship. Intervention: Computer-based multirisk assessment report attached to the medical chart. The report was generated from information provided by participants before the physician visit (n = 144). Control participants received standard medical care (n = 149). Measurements: Initiation of discussion about risk for IPVC (discussion opportunity) and detection of women at risk based on review of audiotaped medical visits. Results: The overall prevalence of any type of violence or control was 22% (95% CI, 17% to 27%). In adjusted analyses based on complete cases (n = 282), the intervention increased opportunities to discuss IPVC (adjusted relative risk, 1.4 [CI, 1.1 to 1.9]) and increased detection of IPVC (adjusted relative risk, 2.0 [CI, 0.9 to 4.1]). Participants recognized the benefits of computer screening but had some concerns about privacy and interference with physician interactions. Limitation: The study was done at 1 clinic, and no measures of women's use of services or health outcomes were used. Conclusion: Computer screening effectively detected IPVC in a busy family medicine practice, and it was acceptable to patients. Primary Funding Source: Canadian Institutes of Health Research and Ontario Women's Health Council.Item Open Access Cross-cultural perspectives on research participation and informed consent(Elsevier, 2006-01) Barata, PC; Gucciardi, Enza; Ahmad, F; Stewart, Donna EileenThis study examined Portuguese Canadian and Caribbean Canadian immigrants' perceptions of health research and informed consent procedures. Six focus groups (three in each cultural group) involving 42 participants and two individual interviews were conducted. The focus groups began with a general question about health research. This was followed by three short role-plays between the moderator and the assistant. The role-plays involved a fictional health research study in which a patient is approached for recruitment, is read a consent form, and is asked to sign. The role-plays stopped at key moments at which time focus group participants were asked questions about their understanding and their perceptions. Focus group transcripts were coded in QSR NUDIST software using open coding and then compared across cultural groups. Six overriding themes emerged: two were common in both the Portuguese and Caribbean transcripts, one emphasized the importance of trust and mistrust, and the other highlighted the need and desire for more information about health research. However, these themes were expressed somewhat differently in the two groups. In addition, there were four overriding themes that were specific to only one cultural group. In the Portuguese groups, there was an overwhelming positive regard for the research process and an emphasis on verbal as opposed to written information. The Caribbean participants qualified their participation in research studies and repeatedly raised images of invasive research.Item Open Access Eating Disorders(BioMed Central, 2004-08-25) Gucciardi, Enza; Celasun, N; Ahmad, F; Stewart, Donna EileenHealth Issue: Eating disorders are an increasing public health problem among young women. Anorexia and bulimia may give rise to serious physical conditions such as hypothermia, hypotension, electrolyte imbalance, endocrine disorders, and kidney failure. Key Issues: Eating disorders are primarily a problem among women. In Ontario in 1995, over 90% of reported hospitalized cases of anorexia and bulimia were women. In addition to eating disorders, preoccupation with weight, body image and self-concept disturbances, are more prevalent among women than men. Women with eating disorders are also at risk for long-term psychological and social problems, including depression, anxiety, substance abuse and suicide. For instance, in 2000, the prevalence of depression among women who were hospitalized with a diagnosis of anorexia (11.5%) or bulimia (15.4 %) was more than twice the rate of depression (5.7 %) among the general population of Canadian women. The highest incidence of depression was found in women aged 25 to 39 years for both anorexia and bulimia. Data Gaps and Recommendations: Hospitalization data are the most recent and accessible information available. However, this data captures only the more severe cases. It does not include the individuals with eating disorders who may visit clinics or family doctors, or use hospital outpatient services or no services at all. Currently, there is no process for collecting this information systematically across Canada; consequently, the number of cases obtained from hospitalization data is underestimated. Other limitations noted during the literature review include the overuse of clinical samples, lack of longitudinal data, appropriate comparison groups, large samples, and ethnic group analysis.Item Open Access Knowledge about human papillomavirus among adolescents(Wolters Kluwer, 2000-11) Dell, DL; Chen, H; Ahmad, F; Stewart, Donna EileenObjective: To assess knowledge of human papillomavirus (HPV) among high school–aged adolescents. Methods: We administered written surveys to 523 innercity high school students in Toronto, Canada, that asked about HPV, other sexually transmitted diseases (STDs), and Papanicolaou testing. We also asked them to report doctor or clinic visits and whether they received sexual health information at those visits. The predictor variables used in analysis were gender and sexual experience. Results: Eighty-seven percent of our population [95% confidence interval (CI) 84%, 89%) had not heard of HPV. Although adolescent women were more knowledgeable about Papanicolaou testing than adolescent men, only 39% of sexually experienced adolescent women knew who should get a Papanicolaou test. Sexually experienced and inexperienced adolescents failed to identify correctly their STD risk. Both genders showed greater knowledge about human immunodeficiency virus (HIV) than other diseases. Among adolescent women, 85% had visited a doctor or clinic within the past year, but only 29% had talked about sexual health. Conclusion: Knowledge of HPV infection and cervical cancer screening was low in this urban adolescent population. Improved efforts are needed for prevention of HPV infection and HPV-related cervical changes. Programs modeled after HIV-education programs might be effective. Doctors’ offices and clinics providing health care to adolescents should take greater responsibility in sexual health education.Item Open Access Patriarchal beliefs and perceptions of abuse among South Asian immigrant women(SAGE, 2004-03) Ahmad, F; Riaz, S; Barata, P; Stewart, Donna EileenThis study investigates the relationship between South Asian immigrant women’s patriarchal beliefs and their perceptions of spousal abuse. Twenty-minute telephone surveys were conducted with 47 women. The survey collected information about demographic characteristics, patriarchal beliefs, ethnic identity, and abuse status. Participants were read a vignette that depicted an abusive situation and were asked whether they felt that the woman in the vignette was a victim of spousal abuse. As hypothesized, higher agreement with patriarchal social norms predicted a decreased likelihood of identifying the woman in the vignette as a victim of spousal abuse. This finding is discussed in terms of its application to violence against women educational programs in the South Asian immigrant community.Item Open Access Perspectives of family physicians on computer-assisted health-risk assessments(Journal of Medical Internet Research, 2010-05-07) Ahmad, F; Skinner, HA; Stewart, Donna Eileen; Levinson, WBackground: The firsthand experience of physicians using computer-assisted health-risk assessment is salient for designing practical eHealth solutions. Objective: The aim of this study was to enhance understanding about computer-assisted health-risk assessments from physicians’ perspectives after completion of a trial at a Canadian, urban, multi-doctor, hospital-affiliated family practice clinic. Methods: A qualitative approach of face-to-face, in-depth, semi-structured interviews was used. All interviews were audio recorded and field notes taken. Analytic induction and constant comparative techniques were used for coding and analyses. Interpretation was facilitated by peer audit and insights gained from the social exchange theoretical perspective. Results: Ten physicians (seven female and three male) participated in the interviews. Three overarching themes emerged in relation to computer-assisted health-risk assessments: (1) perceived benefits, (2) perceived concerns or challenges, and (3) feasibility. Physicians unanimously acknowledged the potential of computer-assisted health-risk assessments to open dialogue on psychosocial health risks. They also appreciated the general facilitative roles of the tool, such as improving time-efficiency by asking questions on health risks prior to the consultation and triggering patients’ self-reflections on the risks. However, in the context of ongoing physician-patient relationships, physicians expressed concerns about the impact of the computer-assisted health-risk assessment tool on visit time, patient readiness to talk about psychosocial issues when the purpose of the visit was different, and the suitability of such risk assessment for all visits to detect new risk information. In terms of feasibility, physicians displayed general acceptance of the risk assessment tool but considered it most feasible for periodic health exams and follow-up visits based on their perceived concerns or challenges and the resources needed to implement such programs. These included clinic level (staff training, space, confidentiality) and organizational level (time, commitment and finances) support. Conclusions: Participants perceived computer-assisted health-risk assessment as a useful tool in family practice, particularly for identifying psychosocial issues. Physicians displayed a general acceptance of the computer tool and indicated its greater feasibility for periodic health exams and follow-up visits than all visits. Future physician training on psychosocial issues should address physicians’ concerns by emphasizing the varying forms of “clinical success” for the management of chronic psychosocial issues. Future research is needed to examine the best ways to implement this program in diverse clinical settings and patient populations.Item Open Access Physician health, stress and gender at a university hospital(Wolters Kluwer, 2003-02) Bergman, B; Ahmad, F; Stewart, Donna EileenObjective: To determine personal and work related factors contributing to physician health and stress in men and women physicians in a university hospital. Method: Mail survey of 161 hospital-based Canadian academic physicians (51 women, 110 men). Results: Women compared to men, physicians were younger (M= 43 years, S.D. = 7.4 vs. M= 48 years, S.D. = 8.64; P=.001) and fewer had spouses (76% vs. 90%; P= .01) and children (76% vs. 91%; P=.02). A five-item scale measured somatic symptoms, the dependent variable. Among physicians of both gender, the somatic symptoms scale was significantly correlated with satisfaction with amount of time spent working and scales of mental health (five items), work satisfaction (five items), workload (five items), healthy lifestyle (five items), coping abilities (three items) and support-in-stress (two items). On stepwise regression analysis, for women physicians, 70% of the variance in somatic symptoms was explained by support from colleagues when stressed, and workload. For men, 42% of the variance was explained by healthy lifestyle, mental health, support from colleagues when stressed, and workload. Regardless of gender, the majority of physicians reported an excessive workload but the sources of support when stressed varied by gender. Conclusion: Different strategies are needed for women and men physicians to reduce their stress levels.Item Open Access Popular health promotion strategies among Chinese and East Indian immigrant women(Taylor & Francis, 2004) Ahmad, F; Shik, A; Vanza, R; Cheung, Angela M.; George, U; Stewart, Donna EileenPurpose: To advance understanding about the popular health promotion strategies and factors associated with the successful transfer and uptake of health messages among Chinese and Indian immigrant women. Methods: Eight focus groups were conducted with 46 immigrant women, 22 from Mainland China and 24 from India, who had lived less than 5 years in Canada. Audiotaped data were transcribed, translated and analyzed by identification of themes and subcategories within and between groups. Results: In both ethnic groups, discussions on promoting health messages had five major themes, i.e., sources, barriers, facilitators, credibility and ways to improve access along with group specific sub-themes. Despite identification of several diverse sources of health information in the adopted country, Indian and Chinese immigrant women perceived most strategies as not very effective. The reasons of perceived ineffectiveness were barriers to accessing and comprehending the health messages; and limited prior exposure to institution based or formal health promotion initiatives. These women were more familiar with informal means of obtaining health information such as social networks, mass media and written materials in their mother tongue. Conclusion: Existing health communication and health promotion models need to be re-orientated from a one-way information flow to a two-way dialogue model to bridge the gap between program efficacy and effectiveness to reach underserved immigrant women. An “outside the box” approach of non-institutional informal health promotion strategies needs to be tested for the studied groups.Item Open Access Predictors of clinical breast examination among South Asian immigrant women(Journal of Immigrant Health, 2004-07) Ahmad, F; Stewart, Donna EileenTo determine predictors of clinical breast examination (CBE) among South Asian immigrant women residing in Toronto, Canada. A cross-sectional self-administered survey with women patients visiting family physician group practices. Fifty-four women participated in the study (response rate 77%). Twenty women (38.5%) “ever had” CBE. Compared to women who never had CBE, women who had CBE were statistically older, had lived more years in Canada, had better knowledge of breast cancer, had lower perceived barriers to CBE, and were more likely to have ever had a periodic health exam. No significant differences were found between the two groups for education, employment, English language abilities, perceived health, and perceived benefits of CBE. A direct logistic regression with five predictor variables, significant at a univariate level, was statistically reliable, X2 (5, n=51) = 34.7, p < 0.001 and explained 67% of the variance in the CBE status. Age and perceived barriers to CBE remained significant over and above other predictor variables. The odds of 'ever had' CBE increased with age and decreased with more perceived barriers. The study highlights the need for education interventions on breast cancer and screening among SA recent immigrant women.Item Open Access Preferences for gender of family physician among Canadian European-descent and South-Asian immigrant women(Oxford University Press, 2002-04) Ahmad, F; Gupta, H; Rawlins, J; Stewart, Donna EileenObjective. The aim of this study was to investigate expressed preferences for family physician (FP) gender among Canadian European-descent (CED) and Canadian South-Asian (CSA) immigrant women. Method. An ‘on-site’ survey was conducted in community-based institutions in Toronto in order to determine preferences for the gender of FP under various health care scenarios: overall health care; gender-sensitive examinations; emotional problems; general ailments; and life-threatening conditions. Results. Ninety-four women responded to this survey (CED = 50, CSA = 44), response rate 77.3%. For all health care scenarios, CED and CSA women similarly expressed either a preference for a female FP or no preference. More than two-thirds of women preferred a female FP for gynaecological examinations (CED, 72.9%; CSA, 83.7%) or examinations with private body part exposure (CED, 72%; CSA, 81.8%). For ‘emotional problems', half of the women preferred a female FP and the other half had no preference. A similar pattern was observed for ‘overall health care', with some shift to female physician preference among CSA women (60.5%) compared with CED women (53.2%). For the ‘overall health care' scenario, CED and CSA women who preferred a female FP had a higher frequency of seeing female physicians within the last 5 years (CED, P ≤ 0.01; CSA, P ≤ 0.05), and attributed ‘positive' social skills more to female physicians (CED, P ≤ 0.01; CSA, P ≤ 0.01) compared with women with no preference for the gender of the FP. Yet, CED women with a female FP preference were more likely to have a concurrent female FP (P ≤ 0.01), and to rate past experiences with female physicians as high (P ≤ 0.01) and with male physicians as low (P ≤ 0.05) compared with CED women with no preference. In the CSA group, women with a preference for a female FP were more likely to be unemployed (P ≤ 0.01) and have low social support (P ≤ 0.01). Conclusions. Despite similar physician gender preference patterns, factors associated with these preferences show some differences between CED and CSA women.Item Open Access Primary prevention of violence against women(Elsevier, 2000-11) Hyman, I; Guruge, S; Stewart, Donna Eileen; Ahmad, FThe best mechanisms to prevent violence against women were reviewed in a critical appraisal conducted by the University Health Network Women’s Health Program. Several promising primary interventions were identified. These included: educational and policy-related interventions to change social norms, early identification of abuse by health and other professionals, programs and strategies to empower women, safety and supportive resources for victims of abuse, and improved laws and access to the criminal justice system. The policy recommendations emerging from this analysis are presented.Item Open Access Resilience and resources among South Asian immigrant women as survivors of partner violence(Springer, 2013-12) Ahmad, F; Rai, N; Petrovic, B; Erickson, PE; Stewart, Donna EileenThis study explored resilience among South Asian (SA) immigrant women who were survivors of intimate partner violence (IPV). Eleven women participated in in-depth interviews. Thematic analysis was conducted using constant comparison. We identified five cross-cutting themes: resources before and after the turning-point (i.e. decision to confront violence), transformations in self, modification of social networks, and being an immigrant. Women drew upon their individual cognitive abilities, social support, and professional assistance to move beyond victimization. All women modified their social networks purposefully. The changes in individual-self included an increased sense of autonomy, positive outlook, and keeping busy. The changes in collective-self occurred as women developed a stronger feeling of belonging to their adopted country. This hybrid identity created a loop of reciprocity and a desire to contribute to their community. Women were cognizant of their surmountable challenges as immigrants. SA immigrant women IPV survivors sought multiple resources at micro, meso and macro levels, signifying the need for socio-ecological approaches in programs and policies along with inter-sectoral coordination to foster resilience.Item Open Access Rural physicians’ perspectives on cervical and breast cancer screening: A gender-based analysis(Mary Ann Liebert, 2001-03) Ahmad, F; Stewart, Donna Eileen; Cameron, Jill; Hyman, ISeveral studies highlight the role of physicians in determining cervical and breast cancer screening rates, and some urban studies report higher screening rates by female physicians. Rural women in North America remain underscreened for breast and cervical cancers. This survey was conducted to determine if there were significant gender differences in practices and perceptions of barriers to breast and cervical cancer screening among rural family physicians in Ontario, Canada. One hundred ninety-one family physicians (response rate 53.1%) who practiced in rural areas, small towns, or small cities completed a mail questionnaire. The physicians’ mean age was 44.4 years (SD 9.9), and mean number of years in practice was 16.6 years (SD 10.3). Over 90% of physicians reported that they were very likely to conduct a Pap test and clinical breast examination (CBE) during a periodic health examination, and they had high levels of confidence and comfort in performing these procedures. Male (68%) and female (32%) physicians were similar in their likelihood to conduct screening, levels of confidence and comfort, and knowledge of breast and cervical cancer screening guidelines. However, the self-reported screening rates for Pap tests and CBE performed during last year were higher for female than male physicians (p < 0.01). Male physicians reported they were asked more frequently by patients for a referral to another physician to perform Pap tests and CBE (p < 0.001). Also, male physicians perceived patients’ embarrassment as a stronger barrier to performing Pap tests (p < 0.05) and CBE (p < 0.01) than female physicians. No gender differences were observed in screening rates or related barriers to mammography referrals. These findings suggest that physicians’ gender plays a role in sex-sensitive examination, such as Pap tests and CBE. There is a need to facilitate physician-patient interactions for sex-sensitive cancer screening examinations by health education initiatives targeting male physicians and women themselves. The feasibility of providing sex-sensitive cancer screening examinations by a same-sex health provider should also be explored.Item Open Access Single item measures of self-rated mental health: a scoping review(BioMed Central, 2014-09-17) Ahmad, F; Jhajj, AK; Stewart, Donna Eileen; Burghardt, M; Bierman, ASBackground: A single-item measure of self-rated mental health (SRMH) is being used increasingly in health research and population health surveys. The item asks respondents to rate their mental health on a five-point scale from excellent to poor. This scoping study presents the first known review of the SRMH literature. Methods: Electronic databases of Medline, CINAHL, PsycINFO, EMBASE and Cochrane Reviews were searched using keywords. The databases were also searched using the titles of surveys known to include the SRMH single item. The search was supplemented by manually searching the bibliographic sections of the included studies. Two independent reviewers coded articles for inclusion or exclusion based on whether articles included SRMH. Each study was coded by theme and data were extracted about study design, sample, variables, and results. Results: Fifty-seven studies included SRMH. SRMH correlated moderately with the following mental health scales: Kessler Psychological Distress Scale, Patient Health Questionnaire, mental health subscales of the Short-Form Health Status Survey, Behaviour and Symptom Identification Scale, and World Mental Health Clinical Diagnostic Interview Schedule. However, responses to this item may differ across racial and ethnic groups. Poor SRMH was associated with poor self-rated health, physical health problems, increased health service utilization and less likelihood of being satisfied with mental health services. Poor or fair SRMH was also associated with social determinants of health, such as low socioeconomic position, weak social connections and neighbourhood stressors. Synthesis of this literature provides important information about the relationships SRMH has with other variables. Conclusions: SRMH is associated with multi-item measures of mental health, self-rated health, health problems, service utilization, and service satisfaction. Given these relationships and its use in epidemiologic surveys, SRMH should continue to be assessed as a population health measure. More studies need to examine relationships between SRMH and clinical mental illnesses. Longitudinal analyses should look at whether SRMH is predictive of future mental health problems.Item Open Access Spousal-abuse among Canadian immigrant women(Springer, 2005-10) Ahmad, F; Ali, M; Stewart, Donna EileenThe study aimed to investigate the rates of self-reported physical and emotional spousal abuse among recent Canadian-immigrant (CI) women compared to Canadian-born (CB) women. The study conducted secondary data analyses on the General Social Survey, 1999. A sample of CB (n = 3548) and CI (n = 313) women was drawn that included women 25 to 49 years of age who were currently married or in a common-law relationship. Person weights and bootstrapping estimates were used to estimate the 95% confidence intervals. The proportion of emotional spousal abuse was higher in CI (14.7%, 95% CI: 10.7–18.8%) compared to CB women (8.7%, 95% CI: 7.8–9.6%). However, the proportion of physical spousal abuse was not statistically different between two groups. Possible explanations are discussed setting direction for future research and services for immigrant women.Item Open Access A tailored intervention to promote breast cancer screening among South Asian immigrant women(Social Science and Medicine, 2005-02) Ahmad, F; Cameron, Jill; Stewart, Donna EileenThis study developed and evaluated a socioculturally tailored intervention to improve knowledge, beliefs and clinical breast examination (CBE) among South Asian (SA) immigrant women. The intervention comprised a series of socioculturally tailored breast-health articles published in Urdu and Hindi community newspapers. A pre- and post-intervention design evaluated the impact of the mailed articles among 74 participants. The mean age of participants was 37 years (SD 9.7) and they had lived 6 years (SD 6.6) in Canada. After the intervention, there was a significant increase in self-reporting 'ever had' routine physical checkup (46.4-70.8%; p < 0.01) and CBE (33.3-59.7%; p < 0.001). Also, the total summed scores of accurate answers to 12 knowledge items increased (3.3-7.0; p < 0.001). For constructs of health belief model, participants rated their level of agreement for a number of items on a scale of 1-4 (disagree to agree). After the intervention the following decreased: misperception of low susceptibility to breast cancer among SA immigrant women (3.0-2.4; p < 0.001); misperception of short survival after diagnosis (2.7-1.8; p < 0.001); and perceived barriers to CBE (2.5-2.1; p < 0.001). Self-efficacy to have CBE increased (3.1-3.6; p < 0.001). The change scores of five predictor variables were entered in a direct logistic regression to predict the uptake of CBE among participants who never had it prior to the intervention. The model, as a set, was statistically reliable [x2(5, n = 48) = 14.2 , p < 0.01] and explained 35% of variance in the outcome; perceived barriers remained an independently significant predictor. The results support the effectiveness of written socioculturally tailored language-specific health education materials in promoting breast cancer screening within the targeted population. Future research should test the intervention in other vulnerable populations.Item Open Access Voices of South Asian women: immigration and mental health(Taylor & Francis, 2004) Ahmad, F; Shik, A; Vanza, R; Cheung, Angela M.; George, U; Stewart, Donna EileenPurpose: This qualitative research aimed to elicit experiences and beliefs of recent South Asian immigrant women about their major health concerns after immigration. Methods: Four focus groups were conducted with 24 Hindi-speaking women who had lived less than five years in Canada. The audiotaped data were transcribed, translated, and analyzed by identification of themes and subcategories. Results: Mental health (MH) emerged as an overarching health concern with three major themes, i.e., appraisal of the mental burden (extent and general susceptibility), stress-inducing factors, and coping strategies. Many participants agreed that MH did not become a concern to them until after immigration. Women discussed their compromised MH using verbal and symptomatic expressions. The stress-inducing factors identified by participants included loss of social support, economic uncertainties, downward social mobility, mechanistic lifestyle, barriers in accessing health services, and climatic and food changes. Women's major coping strategies included increased efforts to socialize, use of preventative health practices and self-awareness. Conclusion: Although participant women discussed a number of ways to deal with post-immigration stressors, the women's perceived compromised mental health reflects the inadequacy of their coping strategies and the available resources. Despite access to healthcare providers, women failed to identify healthcare encounters as opportunities to seek help and discuss their mental health concerns. Health and social care programs need to actively address the compromised mental health perceived by the studied group.Item Open Access "Why doesn't she seek help for partner abuse?" An exploratory study with South Asian immigrant women(Elsevier, 2009-08) Ahmad, F; Driver, N; McNally, MJ; Stewart, Donna EileenThis study explores why South Asian immigrant women with experiences of partner abuse delay seeking help from professionals. Three focus groups were conducted in Hindi language with South Asian immigrant women in Toronto. Twenty-two women participated with a mean age of 46 years (range 29-68 years). Thematic analysis was conducted on the transcribed data using constant comparison techniques within and across the groups. We found that three major themes emerged from the discussions: reasons for delayed help-seeking, turning points and talking to professionals. Women expressed delaying help-seeking to the point when "Pani sar se guzar jata he" (water crosses over your head). Their dominant reasons for delayed help-seeking were social stigma, rigid gender roles, marriage obligations, expected silence, loss of social support after migration and limited knowledge about available resources and myths about partner abuse. Women usually turned for help only after experiencing pronounced mental and physical health problems. The findings are interpreted in light of participants' immigration context and the socio-cultural norms of patriarchy, collectivism and familism. Prevention approaches to address partner abuse and delayed help-seeking among South Asian immigrant women should include tailored community education, social services to reduce vulnerability, and cultural competency of professionals. Further research and program evaluation is needed to advance the field.Item Open Access Women physicians and stress(Mary Ann Liebert, 2000-03) Stewart, Donna Eileen; Ahmad, F; Cheung, Angela M.; Bergman, B; Dell, DLMost women physicians enjoy better than average physical health and lead satisfying and productive lives. However, higher than average rates of depression, anxiety, marital problems, and substance abuse have been reported by some, but not all, authors. This quantitative survey of 196 women physicians and qualitative focus groups with 48 other women physicians was conducted to determine perceptions of their health, stress, satisfaction, knowledge, and abuse rates in medical practice. Eight specialties plus family practice physicians participated. The average age was 44.1 years (SD 8.8, range 23–77). Seventy-four percent of women physicians were married, with children. Specialists and family physicians were similar in all demographic characteristics except that family physicians were more significantly likely to be divorced, separated, or widowed (p ≤ 0.01). Specialists perceived their personal physical health to be better than that of family doctors (p ≤ 0.05), and family physicians rated their medical knowledge better than that of specialists (p ≤ 0.0001). Women physicians over age 50 or with children over age 19 reported the best mental health (p ≤ 0.0001 and 0.003, respectively). Overall, 49% of women physicians reported usually having high levels of stress, 44% felt mentally tired, and 17% took antidepressant drugs. Seventy-three percent reported verbal abuse at work (71% in the last year), and 33% reported physical assault at work (11% in the last year). Focus groups identified three major sources of stress: high expectations, multiple roles, and work environment. These results are discussed and compared with the literature. Both personal and systemic strategies are required to solve the problems identified. Women physicians can facilitate the adoption of some of these strategies by sharing information about successes, challenges, and solutions.