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Vamos CA, Foti TR, Reyes Martinez E, Pointer Z, Detman LA, Sappenfield WM. Identification of Clinician Training Techniques as an Implementation Strategy to Improve Maternal Health: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6003. [PMID: 37297607 PMCID: PMC10252379 DOI: 10.3390/ijerph20116003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Training is a key implementation strategy used in healthcare settings. This study aimed to identify a range of clinician training techniques that facilitate guideline implementation, promote clinician behavior change, optimize clinical outcomes, and address implicit biases to promote high-quality maternal and child health (MCH) care. A scoping review was conducted within PubMed, CINAHL, PsycInfo, and Cochrane databases using iterative searches related to (provider OR clinician) AND (education OR training). A total of 152 articles met the inclusion/exclusion criteria. The training involved multiple clinician types (e.g., physicians, nurses) and was predominantly implemented in hospitals (63%). Topics focused on maternal/fetal morbidity/mortality (26%), teamwork and communication (14%), and screening, assessment, and testing (12%). Common techniques included didactic (65%), simulation (39%), hands-on (e.g., scenario, role play) (28%), and discussion (27%). Under half (42%) of the reported training was based on guidelines or evidence-based practices. A minority of articles reported evaluating change in clinician knowledge (39%), confidence (37%), or clinical outcomes (31%). A secondary review identified 22 articles related to implicit bias training, which used other reflective approaches (e.g., implicit bias tests, role play, and patient observations). Although many training techniques were identified, future research is needed to ascertain the most effective training techniques, ultimately improving patient-centered care and outcomes.
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Affiliation(s)
- Cheryl A. Vamos
- USF’s Center of Excellence in Maternal and Child Health Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Tara R. Foti
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Estefanny Reyes Martinez
- College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA;
| | - Zoe Pointer
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Linda A. Detman
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
| | - William M. Sappenfield
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
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Lewis NV, Stone T, Feder GS, Horwood J. Barriers and facilitators to pharmacists' engagement in response to domestic violence: a qualitative interview study informed by the capability-opportunity-motivation-behaviour model. J Public Health (Oxf) 2023; 45:e104-e113. [PMID: 36921261 PMCID: PMC10017087 DOI: 10.1093/pubmed/fdab375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/03/2021] [Accepted: 10/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Domestic and sexual violence and abuse (DSVA) is a global public health problem resulting in health inequalities. Community pharmacies are uniquely placed to help people affected by DSVA. We examined factors that impact pharmacists' engagement in response to DSVA when providing public health services. METHODS Semi-structured qualitative interviews with community pharmacists (n = 20) were analyzed thematically, with inductive themes mapped to the Capability-Opportunity-Motivation Behaviour (COM-B) model. RESULTS Pharmacists were confident in providing public health services, but a lack of DSVA training meant there is a need to support their 'Capability' to respond to DSVA. Pharmacies were perceived as highly accessible healthcare providers on the high street, with sexual health consultations offering an ideal 'Opportunity' to enquire about DSVA in a private consultation room. Pharmacist's 'Motivation' to enquire about DSVA was driven by potential positive client outcomes and a desire to be more involved in public heath interventions, but organisation- and system-level support and remuneration is needed. CONCLUSIONS Community pharmacy offers opportunities for integrating DSVA work in existing public health services. Pharmacists need training on DSVA, ongoing support, allocated funding for DSVA work, and awareness raising campaign for the public on their extended public health role.
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Affiliation(s)
| | - Tracey Stone
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK
| | - Gene S Feder
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Jeremy Horwood
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK
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Day S, Kellett C, Jones S. Domestic abuse and violence reporting by service users of an online sexually transmitted infection testing service, during the Coronavirus-19 pandemic. Int J STD AIDS 2023; 34:328-331. [PMID: 36627226 PMCID: PMC9836836 DOI: 10.1177/09564624221150961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Following increased rates of domestic abuse/violence (DAV) reporting during the pandemic, London's online sexually transmitted infection (STI) testing service (Sexual Health London, SHL) introduced routine DAV enquiry and directed survivors to supportive online information. SHL evaluated this adaptation. METHOD SHL's database identified the first individuals that ordered a test-kit between 17.8.21-28.2.22 and triggered questions disclosing DAV. SHL clinicians only contacted these individuals if positive/abnormal STI results required communicating. Within these interactions DAV was opportunistically discussed and further counselling/support offered. RESULTS 3846/231460 (1.7%) service users triggered DAV question(s). The first 202 individuals were: median age 28 yrs (18-73 yrs); 66% (134/202) female; 72% (145/202) heterosexual; 75% (152/202) UK born. 27% (55/202) reported physical/emotional abuse, 81% (164/202) coercive control, and 22% (45/202) sexual abuse. 26% (52/202) had never visited a clinic. Telephonic discussion occurred with 10% (20/202) individuals: 10/20 accepted counselling/signposting; 2/20 referred to independent DAV advocate, 6/20 stated historic abuse, 2/20 mistakenly triggered, 2/10 declined support or disengaged. Of 29% (58/202) individuals that ordered another e-kit, 38% disclosed ongoing DAV and 9% sexual assault. CONCLUSION 1.7% e-service users reported DAV. Telephonic DAV discussion was accepted by 80% individuals contacted. Despite providing online support 38% experienced ongoing/escalating abuse. Further engagement and support for DAV survivors using e-services is required.
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Affiliation(s)
- Sara Day
- Sexual Health and HIV Department, St Stephens Centre, Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK,Sara Day, Sexual Health and HIV Department, St Stephens Centre, Chelsea and Westminster Hospitals NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
| | | | - Sophie Jones
- Sexual Health and HIV Department, St Stephens Centre, Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
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Dowrick A, Feder G, Kelly M. Boundary-Work and the Distribution of Care for Survivors of Domestic Violence and Abuse in Primary Care Settings: Perspectives From U.K. Clinicians. QUALITATIVE HEALTH RESEARCH 2021; 31:1697-1709. [PMID: 33749389 PMCID: PMC8438775 DOI: 10.1177/1049732321998299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health care encounters are opportunities for primary care practitioners to identify women experiencing domestic violence and abuse (DVA). Increasing DVA support in primary care is a global policy priority but discussion about DVA during consultations remains rare. This article explores how primary care teams in the United Kingdom negotiate the boundaries of their responsibilities for providing DVA support. In-depth interviews were undertaken with 13 general practitioners (GPs) in two urban areas of the United Kingdom. Interviews were analyzed thematically. Analysis focused on the boundary practices participants undertook to establish their professional remit regarding abuse. GPs maintained permeable boundaries with specialist DVA support services. This enabled ongoing negotiation of the role played by clinicians in identifying DVA. This permeability was achieved by limiting the boundaries of the GP role in the care of patients with DVA to identification, with the work of providing support distributed to local specialist DVA agencies.
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Affiliation(s)
- Anna Dowrick
- Queen Mary University of London, London, United Kingdom
| | - Gene Feder
- University of Bristol, Bristol, United Kingdom
| | - Moira Kelly
- Queen Mary University of London, London, United Kingdom
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Panovska-Griffiths J, Sohal AH, Martin P, Capelas EB, Johnson M, Howell A, Lewis NV, Feder G, Griffiths C, Eldridge S. Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation. BMC Health Serv Res 2020; 20:569. [PMID: 32571378 PMCID: PMC7309975 DOI: 10.1186/s12913-020-05397-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 06/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background Domestic violence and abuse (DVA) is experienced by about 1/3 of women globally and remains a major health concern worldwide. IRIS (Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial in England, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted temporarily. This study evaluates the impact of that service disruption. Methods We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013–April 2017) in borough B and 42 months (October 2013–April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression with sensitivity analyses exploring different regression models. Incidence Rate Ratio (IRR), 95% confidence intervals and p-values associated with the disruption were reported for each borough. Results A mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, lasted for about six months, reducing the referral rate significantly (p = 0.006) by about 70% (95%CI = (23,87%)). In borough C, the three-month service disruption, also significantly (p = 0.005), reduced the referral rate by about 49% (95% CI = (18,68%)). Conclusions Disrupting the IRIS service substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding and staffing of IRIS as a system level programme.
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Affiliation(s)
- Jasmina Panovska-Griffiths
- Department of Applied Health, Institute of Epidemiology and Health Care, University College London, London, UK. .,Institute for Global Health, University College London, London, UK. .,The Queen's College, Oxford University, Oxford, UK.
| | - Alex Hardip Sohal
- Institute of Population Sciences, Queen Mary University London, London, UK
| | - Peter Martin
- Department of Applied Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Estela Barbosa Capelas
- IRISi, Bristol, UK.,Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Natalia V Lewis
- Institute of Population Sciences, Queen Mary University London, London, UK.,Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Griffiths
- Institute of Population Sciences, Queen Mary University London, London, UK
| | - Sandra Eldridge
- Institute of Population Sciences, Queen Mary University London, London, UK
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Miltz AR, Lampe FC, Bacchus LJ, McCormack S, Dunn D, White E, Rodger A, Phillips AN, Sherr L, Clarke A, McOwan A, Sullivan A, Gafos M. Intimate partner violence, depression, and sexual behaviour among gay, bisexual and other men who have sex with men in the PROUD trial. BMC Public Health 2019; 19:431. [PMID: 31023281 PMCID: PMC6482482 DOI: 10.1186/s12889-019-6757-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about the prevalence and correlates of intimate partner violence (IPV) among gay, bisexual and other men who have sex with men (GBMSM) in the UK. The aim of this study was to investigate the prevalence of IPV, associations of socio-economic and psychosocial factors with IPV, and the association of IPV with depression and sexual behaviour, among GBMSM in the PROUD trial of pre-exposure prophylaxis (PrEP). Methods PROUD enrolled 544 HIV-negative participants in England from 2012 to 2014; participants were randomised to immediate or deferred PrEP. This analysis included 436 GBMSM who had IPV data at month-12 and/or 24. Prevalence of IPV victimization and perpetration (lifetime, and in the past year) was assessed at these time-points. Generalized estimating equations were used to investigate associations with IPV, using pooled data from both time-points. Results At month-12 (N = 410), 44.9% of men reported ever being a victim of IPV, 15.6% in the last year, and 19.5% reported ever perpetrating IPV, 7.8% in the last year. At month-24 (N = 333), the corresponding prevalence was 40.2 and 14.7% for lifetime and past year IPV victimization and 18.0 and 6.9% for lifetime and past year IPV perpetration. IPV prevalence did not differ by randomised arm. Men reporting internalized homophobia and sexualized drug use were more likely to report IPV. Lifetime and last year experience of IPV victimization and perpetration were strongly associated with depressive symptoms (PHQ-9 ≥ 10) (adjusted for socio-demographics: lifetime IPV victimization PR 2.57 [95% CI: 1.71, 3.86]; past year IPV victimization PR 2.93 [95% CI: 1.96, 4.40]; lifetime IPV perpetration PR 2.87 [95% CI: 1.91, 4.32]; past year IPV perpetration PR 3.47 [95% CI: 2.13, 5.64], p < 0.001 for all); IPV was not consistently associated with measures of condomless anal sex or high partner numbers. Conclusions GBMSM at high-risk of HIV who are seeking/taking PrEP may experience a high burden of IPV, which may be linked to depression. Training on awareness of and enquiry for IPV among GBMSM in sexual health clinics is recommended. Trial registration ClinicalTrials.gov identifier: NCT02065986. Registered 19 February 2014 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12889-019-6757-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ada R Miltz
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK.
| | - Fiona C Lampe
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Loraine J Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - David Dunn
- MRC Clinical Trials Unit, University College London, London, UK
| | - Ellen White
- MRC Clinical Trials Unit, University College London, London, UK
| | - Alison Rodger
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Andrew N Phillips
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | | | | | - Ann Sullivan
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset. Br J Gen Pract 2018; 69:e199-e207. [PMID: 30510095 PMCID: PMC6400602 DOI: 10.3399/bjgp18x700277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/20/2018] [Indexed: 01/24/2023] Open
Abstract
Background Evidence of an association between exposure to domestic violence and abuse (DVA) and use of emergency contraception (EC) is lacking in the UK. Aim To quantify the association between exposure to DVA and consultations for EC in general practice. Design and setting Nested case-control study in UK general practice. Method Using the Clinical Practice Research Datalink, the authors identified all women all women aged 15–49 years registered with a GP between 1 January 2011 and 31 December 2016. Cases with consultations for EC (n = 43 570) were each matched on age and GP against four controls with no consultations for EC (n = 174 280). The authors calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between exposure to DVA in the previous year and consultations for EC. Covariates included age, ethnicity, socioeconomic status, pregnancy, children, alcohol misuse, and depression. Results Women exposed to DVA were 2.06 times more likely to have a consultation for EC than unexposed women (95% CI = 1.64 to 2.61). Women aged 25–39 years with exposure to DVA were 2.8 times more likely to have a consultation for EC, compared with unexposed women (95% CI = 2.08 to 3.75). The authors found some evidence of an independent effect of exposure to DVA on the number of consultations for EC (OR 1.48, 95% CI = 0.99 to 2.21). Conclusion A request for EC in general practice can indicate possible exposure to DVA. Primary care consultation for EC is a relevant context for identifying and responding to DVA as recommended by the World Health Organization and National Institute for Health and Care Excellence guidelines. DVA training for providers of EC should include this new evidence.
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Cassell JA. Highlights from this issue. Br J Vener Dis 2018. [DOI: 10.1136/sextrans-2018-053564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lyus L, Masters T. Routine enquiry for domestic violence and abuse in sexual health settings. Sex Transm Infect 2018; 94:81-82. [PMID: 29362214 DOI: 10.1136/sextrans-2017-053411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 12/22/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
- Lucy Lyus
- Freelance healthcare communications consultant, London, UK
| | - Tracey Masters
- Homerton University Hospital NHS Foundation Trust, London, UK
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Horwood J, Morden A, Bailey JE, Pathak N, Feder G. Assessing for domestic violence in sexual health environments: a qualitative study. Sex Transm Infect 2017; 94:88-92. [PMID: 28778979 PMCID: PMC5870459 DOI: 10.1136/sextrans-2017-053322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/09/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Domestic violence and abuse (DVA) is a major clinical challenge and public health issue. Sexual health services are an important potential site of DVA intervention. The Assessing for Domestic Violence in Sexual Health Environments (ADViSE) intervention aimed to improve identification and management of DVA in sexual healthcare settings and is a modified version of the Identification and Referral to Improve Safety (IRIS) general practice programme. Our qualitative evaluation aimed to explore the experiences of staff participating in an IRIS ADViSE pilot. METHODS Interviews were conducted with 17 sexual health clinic staff and DVA advocate workers. Interviews were audio recorded, transcribed, anonymised and analysed thematically. RESULTS Staff prioritised enquiring about DVA and tailored their style of enquiry to the perceived characteristics of patients, current workload and individual clinical judgements. Responding to disclosures of abuse was divided between perceived low-risk cases (with quick onwards referral) and high-risk cases (requiring deployment of institution safeguarding procedures), which were viewed as time consuming and could create tensions with patients. Ongoing training and feedback, commissioner recognition, adequate service-level agreements and reimbursements are required to ensure sustainability and wider implementation of IRIS ADViSE. CONCLUSIONS Challenges of delivering and sustaining IRIS ADViSE included the varied styles of enquiry, as well as tensions and additional time pressure arising from disclosure of abuse. These can be overcome by modifying initial training, providing regular updates and stronger recognition (and resources) at policy and commissioning levels.
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Affiliation(s)
- Jeremy Horwood
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,School of Social and Community Medicine,University of Bristol, Bristol, UK
| | - Andrew Morden
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,School of Social and Community Medicine,University of Bristol, Bristol, UK
| | - Jayne E Bailey
- School of Social and Community Medicine,University of Bristol, Bristol, UK
| | - Neha Pathak
- School of Social and Community Medicine,University of Bristol, Bristol, UK.,Women's Health Research Unit,Queen Mary University of London, London, UK
| | - Gene Feder
- School of Social and Community Medicine,University of Bristol, Bristol, UK
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