BMJ Sexual & Reproductive Health最新文献

Background: Abortion is a common pregnancy outcome; in the UK one in three women will have an abortion by age 45 years. Despite women making up 11.7% of the UK Armed Forces (UKAF), anecdotal voices from patient groups and clinicians highlight their gender-specific health needs not being addressed by the UKAF. There is a worldwide absence of literature and policy on abortion care in the AF, including rates and experiences. This survey addresses the paucity of data on abortion experiences in UK servicewomen to ensure the UKAF is providing the best possible care for them.

Methods: A REDCap survey was circulated among UK servicewomen via email and social media networks, and snowball distribution was utilised to widen participation. Quantitative data were used for descriptive statistics and qualitative data were analysed iteratively by the authors, with regular meetings to agree on themes.

Results: A total of 427 servicewomen responded: 124 (29%) declared they previously had an abortion, with 102 (23.9%) being in service. Twelve (11.8%) of these abortions were required when on deployment. Four key themes emerged: 'Trust in information holders', 'Influencers, barriers and access', 'Systemic lack of awareness' and 'Life in the military'.

Conclusions: This is the first study to collect data on UK servicewomen's experience around abortion care, and highlights a complex interplay of factors which may influence abortion care decisions. Stigma and judgement were pervasive threads running through all themes, negatively impacting UKAF women. Evidence-based policies and information on abortion are recommended for both servicepeople and healthcare professionals to facilitate access to abortion and begin to destigmatise it in the AF.

Background: The postpartum period is a high-risk time for unintended pregnancy. We developed a 2-minute audiovisual animation on postpartum contraception (PPC) including the return of fertility after birth for patients. The aim of our study was to determine the views of healthcare professionals (HCPs) involved in pregnancy care on the animation and to identify facilitators and barriers to its implementation into routine pregnancy care pathways.

Methods: An anonymous online questionnaire was circulated to 100 HCPs (midwives, doctors, health visitors) in Glasgow, Scotland, UK who provide antenatal and/or postnatal care. The aim was to collect 50 responses. The questionnaire contained 12 questions including fixed responses, categorical Likert rating scale questions and open-ended questions. Content analysis was used for the free-text responses.

Results: Forty-four responses were obtained. HCPs rated the animation positively for information and inclusivity (95%), accessibility for those with a disability (81.8%) and non-English speaking (59%), and usefulness for HCPs (88.6%) and pregnant individuals (97%). Some felt the animation should contain more information or could be displayed on digital screens in clinical waiting areas. Suggestions were made as to the optimal time to view the animation in pregnancy and the importance of choice of whether/how to view and considerations on trauma-informed care. Accessibly for HCPs was mentioned, with considerations on how the resource could alleviate perceived service and financial pressures.

Conclusions: The animation was felt to be an engaging, inclusive and informative knowledge tool for patients. Consideration needs to be given to allow choice to view, timing and the appropriate digital media for delivering it.

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.