BMJ Sexual & Reproductive Health最新文献

Background: Pain with gynaecological clinic-based procedures is common and undertreated. Prior research has focused on interventions for reducing pain and anxiety with analgesics, yet there remain gaps in understanding the myriad of facilitators and barriers to a person's positive experience. We aimed to start to address these gaps by exploring factors that influence a person's experience during gynaecological procedures beyond quantitative measures of pain.

Methods: A qualitative thematic analysis approach was used for this exploratory study. Through convenience sampling, we recruited 15 participants with gynaecological procedural experience with intrauterine device (IUD) insertions, surgical abortions, colposcopies and/or endometrial biopsies. We conducted in-depth, semi-structured 1:1 interviews that explored participants' experience of the procedure. We then used a mixed inductive and deductive approach for development of a codebook and thematic analysis based on the Person-Centered Care Framework for Reproductive Health Equity (PCFRHE).

Results: Four themes fundamental to understanding how patients process procedural experiences were identified: (1) Balancing preparation and anxiety, (2) Variable rapport with clinicians, (3) Self-advocacy and autonomy and (4) Clinician responsiveness to pain.

Conclusions: Person-centred care in an inclusive, trauma-responsive environment is essential for improving gynaecological procedural experience. Ensuring patient access to pre- and post-visit information and offering multiple options to increase comfort are tangible actions clinicians can take to improve patient experience. This study underscores the importance of person-centred care in gynaecological procedures, emphasising better preprocedural education and support.

Background: Contraception has revolutionised women's health, enabling planned pregnancies and improved outcomes for mothers and babies. However, disparities exist in rates of unintended pregnancies and contraceptive uptake among ethnic groups. The reasons for this are poorly understood.

Objective: To understand women from ethnic minorities' perspectives about contraception.

Methods: Our qualitative study used a participatory action research approach, utilising community research link workers. Public engagement was embedded in the study's conception. We used focus groups and interviews to elicit perspectives, then analysed the data using thematic analysis. The study participants were women who self-identified as being from an ethnic minority group in Sheffield, UK.

Results: Thirty-six women participated in four focus groups and five interviews. Thematic analysis revealed four themes: (1) The role of contraception in a woman's life, (2) External influencers, (3) Cultural and religious considerations and (4) Everyone is different (individuality). Contraceptive needs should be considered holistically, rather than with a siloed, targeted approach. 'External influencers', such as partners, family and communities, determine how contraception is accessed and experienced. 'Cultural considerations', such as personal, sociocultural and religious factors specific to women from ethnic minorities, influence contraceptive choice.

Conclusions: This study provides a transcultural perspective of the issues at play when a woman from an ethnic minority makes a decision about contraception. Practitioners and health providers must be culturally competent and tailor consultations and services to the individual.

Background: Clinical diagnosis of heavy menstrual bleeding (HMB) is dependent on patient report of menstrual product usage of pads and tampons, but it is unknown if newer reusable menstrual products (cup and underwear) are similarly diagnostic.

Methods: We enrolled 20 regularly menstruating individuals with HMB for two menstrual cycles. Participants completed a retrospective baseline Pictorial Blood loss Assessment Chart (PBAC) at the time of enrolment (eligibility PBAC score ≥100) as well as several different measures with each study cycle. In cycle 1, participants used study-provided disposable pads and tampons. For cycle 2, participants were randomised to menstrual cup or underwear and collected their menstrual fluid on their heaviest 2 days. We compared the two cycles with respect to the weight of menstrual fluid collected and the frequency of product changes and leaks during the heaviest days in cycles 1 and 2, as well as questionnaire responses.

Results: Overall, the mean rate of product changes per heaviest day were 5.5 disposable product changes (range 1.5-11), 3.6 cup changes (range 1.3-6.2), and 3.5 underwear changes (range 2.7-6.9). Both groups (cup users and underwear users) reported a median 3.5 leaks (range 1-5) per heaviest day in cycle 2, while using the menstrual cup or underwear.

Discussion: Participants reported fewer daily changes of reusable products compared with disposable ones, but more leaks, suggesting that 'rate of product change' with reusable products may result in missed diagnoses of HMB.

Background: Prevention and self-management of lifestyle risks can reduce non-communicable disease risks and improve the health of mothers and their children. We explored Australian women's preferences for lifestyle risk reduction engagement during the interconception period.

Methods: We conducted a qualitative descriptive interview study between February and May 2022. Women and people who have been pregnant and intended to have more children were recruited. We asked participants about their preferences for lifestyle risk reduction between pregnancies. Following reflexive thematic analysis, we conceptualised findings using the COM-B system.

Results: Among 17 participants, most had given birth to one child and intended to have another child in 1 to 2 years. Our analysis found that most described lifestyle risk reduction engagement through nutrition and exercise, informed by personal experiences and their health goals for a future pregnancy/child. Key attributes affecting engagement in lifestyle risk reduction activities included their feasibility and practicality, habits and routines, motivation, pregnancy planning, and the source and quality of information. Participants' capacity and capability to engage in lifestyles supportive of interconception health were varied and influenced by juggling the routines of work, finances, health and evolving caring responsibilities. Community-based influences, including the availability of recreational infrastructure, the level of support provided by partners/family/peers and culture, also influenced participants' engagement in lifestyle risk reduction activities.

Conclusions: For lifestyles that encourage interconception health, maximising participants' capability and opportunities required motivation and access to infrastructure supportive of healthy meal options and exercise, health services and community networks.

Background: Pregnancy within a year of childbirth has negative impacts on women and their children's health. We developed a digital health intervention (DHI) to empower women in contraceptive choices postpartum. Our pilot randomised controlled trial (RCT) aimed to establish the feasibility of a main RCT of the effects of the DHI compared with standard care on long-acting contraception use.

Methods: Our pilot RCT recruited 52, 20-24 weeks pregnant women in NHS Lothian, UK between October 2022 and April 2023. Participants were randomised 7:3 to receive either the DHI (n=37) in addition to standard care, or standard care alone (n=15). Telephone survey follow-up was at 24 weeks' gestation and 6 weeks postpartum. Semi-structured qualitative interviews (n=10) were conducted with participants receiving the DHI.

Results: All eligible women joined the study and completed follow-up. All intervention participants found the animation highly acceptable; one participant requested text message discontinuation. We completed followed up on 37/37 (100%) of participants. DHI participants reported they valued access to credible contraceptive information that supported decision making in a non-pressurised way.

Conclusions: Our DHI is highly acceptable and a trial is feasible. A larger trial is needed to establish if the DHI increases uptake of long-acting reversible contraception postpartum and reduces unintended pregnancies within 12 months of childbirth.

Trial registration number: (Trial registration ISRCTN48521918).

Background: Recent media attention has been given to an apparent shift away from hormonal methods of contraception. While an increase in fertility awareness-based or 'natural' family planning methods is reported in the grey literature, there are no robust data to determine any such trend in the UK.

Methods: We compared self-reported contraceptive use at conception among patients presenting for abortion at British Pregnancy Advisory Service from January to June 2018 (N=33 495) and January to June 2023 (N=55 055) using chi-square (χ²) tests of association.

Results: Reported use of fertility awareness-based methods of contraception around the time of conception increased from 0.4% in 2018 to 2.5% in 2023 (p<0.001). In contrast, use of hormonal methods of contraception decreased from 18.8% in 2018 to 11.3% in 2023 (p<0.001) and use of long-acting reversible contraception fell from 3% to 0.6% (p<0.001). Those reporting using no contraception at the time of conception significantly increased by 14% (p<0.001) when comparing data from 2018 (55.8%) with data from 2023 (69.6%).

Conclusions: Significantly fewer abortion patients report using effective methods of contraception around conception while also reporting an increased use of fertility awareness-based methods. Further research is needed to understand the reasons for this change.