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In sub-Saharan Africa, traditional medical practitioners also referred to as herbalists, offer diagnostics and therapeutics for diverse medical conditions irrespective of the cause. Given their traditional role as healers and repository of knowledge about medicinal plants, spirituality, customs and religion, people use their services regardless of their location, education, or socio-economic backgrounds. The aim of the study is to explore herbalists´ views and explanations on infertility and women with infertility. Using an exploratory qualitative design, semi-structured interviews were conducted with 10 herbalists, 5 from the North-East region, 2 from Ashanti region and 3 from the Greater Accra region. Following thematic analysis, findings show that infertility has multiple causes - medical, natural, spiritual and lifestyle. Some herbalists stated that everyone was created to bear children while others refuted this notion. They shared the common consensus that not everyone can have children even though they may be medically and spiritually fit. The public should be advised on the need for periodic reproductive health checks. Also, there should be a conscious, concerted efforts to gradually dissociate unhealthy explanations of infertility from the actual empirically proven realities. This would empower society to rise above those entrenched beliefs, thereby reducing the stigma associated with infertility and women with infertility.

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Infertility has debilitating effects on couples, especially for women and in pronatalist cultures. This study explored ways of reducing stigma from infertility in Ghana. Thirty infertile married women were interviewed: 15 each from the North-East and Ashanti regions. Ten herbalists were interviewed: five from the North-East, two from the Ashanti, and three from the Greater Accra, regions. A semi-structured protocol was used. A phenomenological study design was employed to explore experiences and views and thematic analysis was used: coding and analysing all this data, to identify themes. Ways of reducing stigma were suggested at different levels: society, community members, herbalists, and infertile women. The women and herbalists suggested that public education was necessary to avoid certain misconceptions about childlessness such as wombs being removed spiritually by others due to jealousy or envy. They stated that the community can be sensitized to the effects of stigma such as perceiving victims as cursed and useless. Women in the North-East region suggested they should be empowered and assisted financially to establish their own businesses. All the herbalists pledged their unflinching support for comprehensive public education and expressed their readiness to partake in the campaign to curb the stigma. Most Ghanaians have limited knowledge of the causes of infertility, resulting in stigmatization. Most people do not know that infertility has some unexplained or natural causes and, therefore, attribute all causes to spirits, abortions, or both. It is essential that communities are educated on the causes and treatment of infertility as well as on how they can support such women and help improve their well-being.

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Infertility is a troubling condition for couples, especially for women, in pronatalist cultures. The ways in which infertility is explained have important effects on the stigma associated with childlessness and thus on the suffering it causes. This article explored the explanations for infertility among involuntarily childless women in the North-East and Ashanti regions of Ghana. Thirty infertile married women were interviewed, 15 from each region, by using a semi-structured interview protocol. A phenomenological study design and thematic analysis were used to explore the aetiological explanations of their infertility. The data from the Ashanti region was transcribed verbatim from Twi to English, coded, and analysed into themes unlike the data from the North-East which was already in English. Most of these infertile women attributed their condition to supernatural factors irrespective of their settings, level of education, and religion. They proffered such explanations for conditions for which they could not readily pinpoint causes or when these were for them beyond comprehension. Other explanations of infertility were medical, such as fluid in the ovaries and hormonal imbalance. Moreover, lifestyle factors such as the use of contraceptives or having had an abortion were mentioned. Some women mentioned that the cause of their infertility had not been found. Health professionals should educate women on reproductive health issues. Counsellors and therapists should educate would-be couples on the possible challenges in marriages, especially concerning childlessness and infertility. Moreover, to reduce stigma, it is essential that the communities are educated on the documented causes of infertility.

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BACKGROUND: Infertility is detrimental to the health of married couples, especially women. Despite the consequences associated with the condition, little is done to reduce the repercussions. This study throws more light on the lived experiences of infertile women and on how they can be helped to improve their own condition. METHODOLOGY: We interviewed 30 infertile married women in the Northern and Ashanti regions of Ghana, 15 from each region. A qualitative method, phenomenological study design and thematic analysis was employed to explore their lived experiences. RESULTS: Due the huge stigma, some women reported that their loved ones encouraged them to try to conceive. Others revealed that, they were considering relocating from their current communities to reduce the insults, intense pressure, stress, and stigma. Though some revealed maltreatment from their husbands and in-laws, others stated their husbands disclosed their fertility status to their own family members to avoid these families pressuring these women. CONCLUSIONS: To reduce the stigma, pronatalist societies urgently need education and sensitization. Would-be couples should be counselled to have a plan to deal with such occurrences should they experience them.

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OBJECTIVES: To explore the possible reasons for concealing type 1 diabetes (T1D) at work. METHODS: The main set of data came from a cross-sectional survey (response rate 49.3%), the participants of which were 688 wage earners with T1D. Concealment of T1D was measured by asking respondents have they ever during their working career hidden their diabetes from their (A) colleagues and (B) line manager. Furthermore, semistructured interviews (n=20) were conducted to obtain deeper understanding. Questionnaire data were analysed using logistic regression analyses and qualitative interviews with inductive thematic analysis. RESULTS: About 30% of wage earners with T1D had concealed their condition during their working career from their colleagues and almost 20% from their line manager. Individuals aged 18-44 years age were more likely to conceal their T1D from their colleagues than older workers during their working career. Not disclosing T1D to the extended family (OR 5.24 (95% CI 2.06 to 13.35)), feeling an outsider at work (OR 2.47 (95% CI 1.58 to 3.84)), being embarrassed by receiving special attention at work (OR 1.99 (95% CI 1.33 to 2.96)) and neglecting treatment at work (OR 1.59 (95% CI 1.01 to 2.48)) were all associated with concealment of T1D from colleagues. The youngest age group of 18-24 years were more likely to conceal their T1D from their line managers than the older age groups during their working career. Not disclosing T1D to the extended family (OR 4.41 (95% CI 1.72 to 11.32)), feeling like an outsider at work (OR 2.51 (1.52 to 4.14)) and being embarrassed by receiving special attention at work (OR 1.81 (95% CI 1.13 to 2.91)) were associated with concealment of T1D from line managers. From the interviews, five main themes related to concealment emerged, expressing fears related to the consequences of telling: (1) being perceived as weak, (2) job discrimination, (3) unwanted attention, (4) being seen as a person who uses their T1D for seeking advantages and (5) losing privacy. CONCLUSIONS: A considerable proportion of wage earners with T1D are concealing their diagnosis often because of feelings associated with stigma. Both overemphasis and underestimation of T1D at work by the colleagues or line manager may lead to concealing T1D and may thus be harmful to self-management of T1D. The obstacles in disclosing T1D might be diminished by giving adequate information at the workplace about the condition and its significance.

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BACKGROUND: The incidence of type 1 diabetes is increasing worldwide. Since so little is known about work life of individuals with type 1 diabetes, we examined incidence and prevalence trends of type 1 diabetes among working-aged Finns. We also investigated the employment rate and how workers with type 1 diabetes perceive their health and work ability, and their intended retirement age. METHODS: We analyzed changes in the incidence, prevalence, and employment rate using nationwide multi-register-based FinDM data, and estimated a Self-Rated Health, Work Ability Score, and inquired about retirement intentions of 767 working individuals with type 1 diabetes in a cross-sectional survey. All estimates were compared to the corresponding data of the Finnish general population. RESULTS: The average annual age-standardized incidence rate of type 1 diabetes among men aged 18-39 was 29 per 100,000/year; the incidence rate has increased by 33% from 1992 to 2007. Among women, the incidence remained at 16 per 100,000/year. Among working-aged (18-64) people, the age-standardized prevalence of type 1 diabetes increased by 39% among women and 33% among men. Two out of every three working aged individuals with type 1 diabetes were in the labor force; this is about 10% lower than in the Finnish population. The average age-standardized employment rate among those individuals with type 1 diabetes belonging to the labor force was 82%, compared to 84% in the general population. Working individuals with type 1 diabetes rated their health and work ability as being slightly lower than the general working population, but nonetheless, there were no significant differences in retirement intentions. CONCLUSIONS: Between 1992 and 2007, the number of working-aged people and workers with type 1 diabetes increased by 35%. Most workers with type 1 diabetes manage as well at work as the general population. Special attention should be paid to workers with type 1 diabetes when they are diagnosed and/or report moderate or poor work ability.

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BACKGROUND: Diabetes distress is common among people with type 1 diabetes, but knowledge is scarce regarding the perceived burden of reconciling work with this disease. This cross-sectional study investigated work-related diabetes distress among Finnish workers with type 1 diabetes. METHODS: A questionnaire was mailed to 2500 randomly sampled 18- to 65-year-old Finns with type 1 diabetes; 49.3 % responded. Work-related diabetes distress was measured by combining worry and exhaustion in reconciling work with diabetes. Self-perceived work-related diabetes distress was evaluated in the context of physical and psychosocial work conditions, job demands, work ability, general stress, diabetes acceptance, glycosylated hemoglobin (HbA1c) level, high blood glucose maintenance at work, and depressive symptoms. The data were analyzed with the use of cross-tabulation, chi-square tests, ANOVA analysis, Spearman correlation coefficients, and structural equation modeling. RESULTS: Of the respondents, 70 % experienced work-related diabetes distress. Problems with physical work conditions (ß = 0.27), work ability (ß = -0.21), difficulty in accepting diabetes (ß = 0.18), and job demands (ß = 0.14) were found to be associated with work-related diabetes distress. This distress was strongly associated with the maintenance of a high blood glucose level at work (ß = 0.34). In turn, a high blood glucose level at work was associated with a high HbA1c level (ß = 0.29). Work-related diabetes distress and depressive symptoms had a bi-directional association (ß = 0.06 and ß = 0.14). Difficulty accepting diabetes had three-dimensional associations: work-related diabetes distress (ß = 0.18), depressive symptoms (ß = 0.13), and high HbA1c level (ß = 0.12). There was no notable association between work-related diabetes distress and general stress. CONCLUSIONS: Work-related diabetes distress is common among workers with type 1 diabetes, and it may influence metabolic control. This stress could be prevented by adapting physical work conditions. People with type 1 diabetes should also be encouraged to pursue their full educational potential, and psychological support should be provided for those with difficulty accepting their diabetes.

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Psychotherapy is widely held to be an effective means to decrease depression. It seems, however, that not everyone benefits from every kind of therapy, and the relevant outcomes vary from person to person. In this article, the pre-therapy views and post-therapy experiences of 14 users of either long-term psychodynamic psychotherapy or short-term solution-focused therapy are analyzed. The interviewees' personal views about their depression and therapy are approached with the concept of inner narrative. Three "basic stories" or orientations were found: life historical, situational and moral. These offered people different contexts from which to evaluate the outcomes of their therapy. The findings suggest that a person's expectations, hopes and values are worth taking into account to ensure positive therapy outcomes.

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