Women's Studies

Research shows that women’s lives are disproportionately impacted by the effects of climate change. While the topic of women is largely absent from climate discourse overall, the representations of women that occur reveal underlying structures of power rooted in imperialism and colonial dominance. This thesis presents an analysis of the ways in which the category “woman ” is constructed in climate change discourse by utilizing data from the micro-blogging site Twitter.com in the 60 days surrounding the 17th UNFCCC Conference of the Parties (COP17) in 2011. The findings of this research are that women are represented through imageries of violence and victimization, while simultaneously constructed as mythical heroines/warriors who will defend and save humanity from this global threat. Using transnational and postcolonial feminist theory, I critique these representations and examine the function and consequences of the narrow representations of women in climate change discourse. Based...

This chapter from _Women's Lives Around the World: A Global Encyclopedia, Volume 2: The Americas_ discusses women's lives in Puerto Rico from a transnational feminist perspective.

This four-volume encyclopedia set provides an in-depth look at the lives of women and girls in approximately 150 countries, offering readers transnational feminist analysis of the many issues that are critical to the survival and success of women and girls. Coverage includes the key roles women play in their families, careers, religions, and cultures; how issues for women intersect with colonialism, transnationalism, feminism, and established norms of power and control.

Organized geographically, each volume presents detailed entries about the lives of women in particular countries. Additionally, each volume offers sidebars that spotlight topics related to women and girls in specific regions or focus on individual women's lives and contributions. The organization of the set enables readers to take an in-depth look at individual countries as well as to make comparisons across countries.

Microfinance has become standardized within global development policy, disproportionately impacting the lives of women of the global South and, increasingly, in the global North with the dismantling of the welfare state. Poverty finance policies employ an entrepreneurial model to facilitate women’s labor market participation whereby borrowers are extended microcredit, or small loans, to invest in their microbusinesses. Global poverty finance is, however, deeply gendered and racialized in ideology and practice. This paper explores the ways that entrepreneurialism, as a cultural formation, privatizes women’s labor into normative gendered, feminine, and domestic labor sectors alongside the expansion of markets and neoliberal restructuring of economies. This paper argues that entrepreneurialism, and its narrative and visual rhetoric galvanized by poverty finance brokers, uphold a gender- and racially segregated micro labor force based upon a false dichotomy of "noble" racialized mothers of the global South as respectable entrepreneurial subjects. As the neoliberal capitalist logics of global poverty finance rearticulate the burden of impoverishment onto the poor, this encumbers the microentrepreneur to ‘rise above’ her class and socioeconomic conditions. In the global North, however, mothers of color largely define the margins of entrepreneurialism, and are often decried as recipient subjects. Entrepreneurial policies and practices re-create the politics of austerity and anti-welfare sentiment that have long undervalued the kincare, social reproductive labor, and mother work of women. This paper, lastly, argues for focus to the creation of feminist economic policies addressing the structural conditions of racial capitalism and its colonial and imperial legacies.

Montes Ireland, Heather (2021). 'Noble Mothers' and their Others: Racialized Women Entrepreneurs and Poverty Finance. Journal of International Women's Studies, 22(7), 69-82.

Microfinance has become standardized within global development policy, disproportionately impacting the lives of women of the global South and, increasingly, in the global North with the dismantling of the welfare state. Poverty finance policies employ an entrepreneurial model to facilitate women’s labor market participation whereby borrowers are extended microcredit, or small loans, to invest in their microbusinesses. Global poverty finance is, however, deeply gendered and racialized in ideology and practice. This paper explores the ways that entrepreneurialism, as a cultural formation, privatizes women’s labor into normative gendered, feminine, and domestic labor sectors alongside the expansion of markets and neoliberal restructuring of economies. This paper argues that entrepreneurialism, and its narrative and visual rhetoric galvanized by poverty finance brokers, uphold a genderand racially segregated micro labor force based upon a false dichotomy of “noble” racialized mothers o...

Racial capitalist, neoliberal ideologies restructure and privatize the very social ecologies that support Black and Brown life. Crossing temporal registers to excavate the story of Eula Mae Love (d. 1979) along with contemporary media case studies of Shanesha Taylor, Debra Lynn Harrell, and Eva Hernández, this paper suggests a framework of economic violence to critically encompass the systemic injuries that low-income mothers of color confront, and to create conditions and possibilities for countering this violence. I argue that this commonplace violence against low-income Black and Brown women is disregarded; as a product of a racial-capitalist system, economic violence is assuaged and proliferated by racialized narratives of meritocracy and other cultural discourses that naturalize these injuries. Indeed, as economic violence serves a purpose for the low-wage, cheap labor needs of capital, low-income mothers of color are recurrently criminalized for attempting to create the conditions of survival for themselves and their families. Critical feminist policy analysis must, I urge, address the material and social conditions that produce economic violence in the lives of low-income mothers of color to re-imagine and renew calls for intersectional, redistributive economic justice.

Intellectual and political border crossings have shaped the intersectional insights foundational to Chicana feminist thought from its inception, as Aída Hurtado illuminates in Intersectional Chicana Feminisms: Sitios y Lenguas. The book highlights how Chicana feminism has developed from “the interstices of multiple social, economic, and cultural systems” rooted in the experiences of Mexican and Mexican American women (10). Critical features, distinct from and yet connected to other feminist and anti-racist traditions, comprise Chicana feminism, and Chicana feminists have theorized gender and sexual marginalization in ways that make the “complexities of cross-border existence . . . fully legible” (62). Hurtado capably explains how, as a vibrant and intersectional “living theory” (Trujillo) in pursuit of collective liberation, Chicana feminism continues to evolve in its analyses of the intricate webs of power embedded in the lives of gender and sexual minorities of color. [...]

Background: As the use of patient-owned devices, including smartphones and tablets, to manage day-today activities grows, so does healthcare industry's interest to better leverage technology to engage patients. For surgical care, a unique opportunity exists to capture patient-generated health data (PGHD) including photographs. As part of a broader initiative to evaluate PGHD for surgical site infection (SSI) surveillance, we sought evidence regarding patient involvement and experience with PGHD for SSI monitoring and surveillance. Methods: Through a scoping review of the literature and semi-structured stakeholder interviews we gathered evidence on what is currently known about patient perspectives of and experiences with mobile health (mHealth) interventions for post-operative recovery. We presented findings to and discussed with the ASSIST PGHD Stakeholder Advisory Group (PSAG) to generate priorities for further examination. Results: Our scoping review yielded 34 studies that addressed post-discharge use of PGHD for monitoring and surveillance of SSI. Of these, 16 studies addressed at least one outcome regarding patient experience; the most commonly measured outcome was patient satisfaction. Only three studies reported on patient involvement in the development of PGHD tools and interventions. We conducted interviews (n = 24) representing a range of stakeholder perspectives. Interviewees stressed the importance of patient involvement in tool and program design, noting patient involvement ensures the ''work'' that patients do in their daily lives to manage their health and healthcare is recognized. Discussion of evidence with the ASSIST PSAG resulted in formal recommendations for direct involvement of patients and caregivers for future work. Conclusions: While mHealth initiatives to advance post-operative management offer the ability to improve patient engagement, work is needed to ensure the patient voice is reflected. Active engagement with patients and caregivers in the development of new technology, the design of new workflows, and the conduct of research and evaluation ensures that the patient experiences and values are incorporated.

IN BRIEF Cost-effective innovations to improve health and health care in patients with complex chronic diseases are urgently needed. Mobile health (mHealth) remote monitoring applications (apps) are a promising technology to meet this need. This article reports on a study evaluating patients' use of a tablet device with an mHealth app and a cellular-enabled glucose meter that automatically uploaded blood glucose values to the app. Improvements were observed across all three components of the Patient Protection and Affordable Care Act's "triple aim." Self-rated wellness and numerous quality-of-care metrics improved, billed charges and paid claims decreased, but no changes in clinical endpoints were observed.

Background: The expert panel that conducted the Assessing Surgical Site Infection Surveillance Technologies (ASSIST) project elaborates on the key findings of the health technologies assessment (HTA) report in a series of articles addressing topics from workflow challenges to implementation strategies to new big data analytics tailored to incorporate serial patient-generated health data (PGHD). Conclusion: By reporting on the methodology, with an emphasis on stakeholder engagement, the ASSIST investigators provide the basis for a future deep dive into the next phase of PGHD integration into surgical site infection (SSI) surveillance.

Objective The growing prevalence of chronic conditions requiring changes in lifestyle and at-home self-management has increased interest in and need for supplementing clinic visits with data generated by patients outside the clinic. Patient-generated health data (PGHD) support the ability to diagnose and manage chronic conditions, to improve health outcomes, and have the potential to facilitate more “connected health” between patients and their care teams; however, health systems have been slow to adopt PGHD use in clinical care. Materials and Methods We surveyed current and potential users of PGHD to catalog how PGHD is integrated into clinical care at an academic health center. The survey included questions about data type, method of collection, and clinical uses of PGHD. Current users were asked to provide detailed case studies of PGHD use in research and care delivery. Results Thirty-one respondents completed the survey. Seventeen individuals contributed detailed case studies of...

Background: Wearable devices, mobile health apps, and geolocation technologies place the ability to track, monitor and report data in the individuals' hands-or on their bodies. These innovations create an opportunity for "connected health," where individuals collect data outside of the healthcare encounter and report it to care providers. Collection of such patient-generated health data (PGHD) has the potential to impact the delivery of healthcare through remote monitoring, and by allowing patients and healthcare teams to provide targeted and efficient care that aligns with the health status of individual patients. Methods: To understand the value and barriers associated with clinical integration of PGHD we engaged a range of stakeholders, examining their perspectives and experiences of PGHD use. We conducted open-ended interviews with healthcare consumers (patients and care partners), healthcare providers, and healthcare administrators. Open recruitment and purposive sampling were utilized to identify participants that represented the breadth of PGHD use in research and clinical care. Interview guides focused on the value and barriers of PGHD use. Interviews were recorded, transcribed, and analyzed for emergent themes. Results: Themes emerged around the value of PGHD to support care decisions and improve patientprovider communication and engagement, and the promise of applying PGHD to formal care pathways and measurement-based care. Significant barriers included data validity and actionability, and the burden of integrating PGHD into existing care processes. Interviews highlighted areas for future research to better understand how PGHD can advance care transformation. Conclusions: These findings provide rich context for understanding the experiences and needs of the individuals who interface with PGHD. Translating advances in technology and data tracking into successful clinical implementation requires understanding how stakeholders conceptualize and make use of PGHD, the potential value that PGHD can add to care, and the challenges that may limit PGHD's promise. Our results illustrate the value and challenges associated with health-system implementation of PGHD. Efforts to increase the scale and spread of PGHD will benefit from an approach that addresses the value and challenges PGHD brings to clinical care.

Objective With the unprecedented rise of patient access to clinical documentation through electronic health records, there is a need for health systems to understand best practices for redesigning clinical documentation to support patient needs. This study used an experience-based co-design approach to inform the redesign of cancer pathology reports to improve their patient-centeredness and impact on patient engagement. Materials and methods Multiple methods for data collection and stakeholder engagement were used, including Delphi prioritisation with breast and colorectal cancer experts (n=78) and focus groups with patients with cancer (n=23) in the Seattle area. Iterative rounds of consensus generation and reflection were used to elicit themes and design recommendations for the development of patient-centred pathology reports on cancer care. Results Although each cancer type had nuanced elements to consider, common design requirements emerged around two key themes: (1) clinical do...

As the COVID-19 pandemic continues to unfold and states experience the impacts of reopened economies, it is critical to efficiently manage new outbreaks through widespread testing and monitoring of both new and possible cases. Existing labor-intensive public health workflows may benefit from information collection directly from individuals through patient-reported outcomes (PROs) systems. Our objective was to develop a reusable, mobile-friendly application for collecting PROs and experiences to support COVID-19 symptom self-monitoring and data sharing with appropriate public health agencies, using Fast Healthcare Interoperability Resources (FHIR) for interoperability. We conducted a needs assessment and designed and developed StayHome, a mobile PRO administration tool. FHIR serves as the primary data model and driver of business logic. Keycloak, AWS, Docker, and other technologies were used for deployment. Several FHIR modules were used to create a novel "FHIR-native" appl...

Background One in five people with gallstones develop symptoms (~ 13 million in the US), yet only a fraction undergo cholecystectomy. The frequency of and factors associated with patients choosing medical management for gallbladder disease are not well understood. The goal of this study was to assess patient decision-making regarding cholecystectomy, experiences with medical management, and interest in a clinical trial comparing cholecystectomy with medical management. Methods We conducted a cross-sectional survey from January 2020 through May 2020 using Amazon's crowdsourcing platform, MTurk. After a brief screening survey to determine gallbladder disease history and cholecystectomy status, eligible users without prior cholecystectomy were invited to complete the full survey for US $2.50. Results There were 148 responses included in analysis (93.7% of attempted). Participants were 54% female with a mean age of 36.2 (SD 11.3) years. 36% of participants had used medications or supplements to manage their symptoms with 17% using lecithin and 22% using ursodeoxycholic acid (Ursodiol®). 85% attempted lifestyle modifications to manage symptoms. Surgery was recommended for 60% of which 43% reported planning cholecystectomy. Among those recommended operation, most common reasons for pursuing were symptoms (50%) and symptoms interfering with care of family (42%), while most common reasons for not pursuing were risks of surgery/anesthesia (56%), ongoing medical management (50%), and symptom tolerance (38%). 67% reported willingness to participate in a clinical trial comparing medical management to cholecystectomy. Conclusion A significant portion of patients with symptomatic gallbladder disease choose not to undergo cholecystectomy. One of the most common reasons for avoiding surgery was the use of alternative therapies, despite limited evidence to support their use. The lack of prospective comparison of cholecystectomy to medical therapies for the management of gallbladder disease, along with patient interest, support the need for a clinical trial.

The prevalence of patients with multimorbidity (ie, multiple chronic conditions) is increasing. Clinical decisionmaking guided by patients' values, health priorities and goals, and treatment preferences is particularly important in the context of interacting diseases and psychosocial needs. Physicians face challenges incorporating patient perspectives into care plans. We examined primary care physician (PCP) views on the influence of patients' values, health priorities and goals, and preferences on clinical decisions for patients with multimorbidity and increased psychosocial complexity. Methods: We conducted semi-structured telephone interviews with 23 PCPs within patient-centered medical home teams in a nationally integrated health system in the United States between May and July 2020. Data were analyzed via thematic analysis with deductive and inductive coding. Results: Three major themes emerged: 1. Patient personal values were rarely explicitly discussed in routine clinical encounters but informed more commonly discussed concepts of patient priorities, goals, and preferences; 2. Patient values, health priorities and goals, and preferences were sources of divergent views about care plans between healthcare teams, patients, and families; 3. Physicians used explicit strategies to communicate and negotiate about patient values, health priorities and goals, and preferences when developing care plans, including trust-building; devoting extra effort to individualizing care; connecting patient values to healthcare recommendations; deliberate elicitation and acknowledgement of patient concerns; providing "space" for patient perspectives; incorporating family into care planning; pairing physician to patient priorities; and collaborative teamwork. Conclusion: Primary care physicians perceive patient values, health priorities and goals, and preferences as influential during clinical decision-making for complex patients with multimorbidity. Participants used concrete strategies to negotiate alignment of these aspects when physician-patient divergence occurred. While rarely discussed directly in clinical encounters, personal values affected patient health priorities, goals, and preferences during care planning, suggesting a clinical role for more deliberate elicitation and discussion of patient values for this population.