PhD Graduates – Alexander

Ivy Marie Alexander, PhD
Spring 2001

“Hearing Women’s Voices: Primary Care Interactions.”

The purpose of this study was to identify characteristics of health care interactions with a Primary Care Nurse Practitioner as defined by women and any emancipatory interests that surfaced when women examined these interactions. Primary care for women is being redefined to encompass more than the traditional obstetrical and gynecological focus. Despite extensive discourse on this topic, and the fact that client-provider interactions form the basis for every health care encounter, reliable information describing women’s needs and expectations for these interactions is missing.
Feminism and Critical Theory provided the framework for this participatory action study. Five successive group meetings with eight ethnically diverse women were held to discuss primary care interactions with nurse practitioners. Field notes, seating charts, participant interaction notations, session transcripts, and audiotapes were repeatedly reviewed to identify significant statements. These were grouped into common categories to identify essential themes. Results were validated with participants.
Characteristics of primary care interactions included the process of making an appointment, access to the clinic, comfort of the waiting area and clinic rooms, and interactions with staff and clinicians. Problems were identified with interactions (problematization). The overarching issue was a lack of caring; a pervasive attitude
demonstrated when clinicians failed to show concern, did not listen, were not trustworthy or treated the women with disrespect or prejudice. The women discussed and tried several ways they might alter this experience (testing untested feasibilities). Participants wanted to learn how to “stand-up” for themselves. They believed that this could be accomplished by developing a positive sense of self-esteem. Ultimately, they identified the right way to “talk-back” to clinicians and created a method for regaining control of their own health and changing the situation (emancipatory actions).
The women strongly valued caring clinicians. Caring, according to these women, is demonstrated by treating women with some degree of equality and with respect for their individual knowledge and life experiences. These findings have commonalties with other literature that calls for egalitarian interactions and underscores the need for extensive changes in primary care interactions with women. A framework for creating caring interactions in primary care for women is proposed.