Exploring the experiences of people with urogynaecology conditions in the UK: a reflexive thematic analysis and conceptual model

Pelvic health in female military personnel: Broadening the conversation

Pelvic health is an understudied area for female military personnel. This study aimed to explore the pelvic health concerns, prevalence rates, and co-existence of a wide range of pelvic health issues in Australian servicewomen. An online questionnaire was offered to adult females (sex-assigned at birth) who had completed a minimum of 6-month active-duty service in the Australian Defence Force (ADF). Data analyses were focused on calculating prevalence for the included female pelvic health issues and identifying trends within the data (frequencies, 95% CI). Of the 987 survey responses, 496 were excluded, leaving 491 responses (49.7%) to inform this study. Over two-thirds of servicewomen reported pelvic health concerns (n = 350, 71%, 95% CI 67-75%), including sexual dysfunction (41%), gynecological surgery (34%), menstrual cycle manipulation (32%), frequent pelvic pain (20%), endometriosis (18%), irregular menstrual cycles (17%), pelvic organ prolapse (12%), pelvic injury (10%), and frequent episodes of fecal incontinence (2%). Coexistence of pelvic health issues were also reported by 24%. Pelvic health concerns, beyond lower urinary tract symptoms, are common and can co-exist in Australian servicewomen. Consideration of sex-responsive health services within military organizations may help to mitigate potential risks, enhancing wellbeing, operational readiness, and mission outcomes.

Community as Medicine: A Novel Approach to Improve Health Behaviors and Mental Well-Being for Vulnerable Populations

Purpose

Evaluate a group-based, trauma-informed health coaching model based on Lifestyle Medicine pillars, delivered by community health coaches, to improve health behaviors and mental well-being for vulnerable populations.

Methods

This program evaluation analyzed quantitative longitudinal data with linear mixed models and qualitative data with reflexive thematic analysis. Participants (n = 720) were low-income adults referred through Federally Qualified Health Centers (FQHCs), who participated in weekly 90-120 minute groups for 3 months. Data were collected via monthly surveys, including the PHQ-9, GAD-7, UCLA 3-item loneliness, exercise as a vital sign, a 2-item dietary screener, and 3 qualitative questions.

Results

Participants saw significant reductions in depression, anxiety, and isolation, and significant increases in daily servings of fruits and vegetables, and weekly minutes of exercise. The qualitative analysis identified 4 themes related to the drivers and reinforcers of positive behavior change and improved mental well-being.

Conclusions

Initial data suggest this model helps reduce depression, anxiety, and isolation, and promotes positive behavior change within populations most impacted by health inequity. Qualitative results identified drivers of positive change, such as creating a sense of belonging and mutual support. Future research should consider how to continue to scale this program to a variety of populations and across different settings.

Pelvic floor muscle training for female urinary incontinence: development of a programme theory from a longitudinal qualitative case study

BACKGROUND

Urinary incontinence (UI) negatively affects the well-being of women globally. Pelvic Floor Muscle Training (PFMT) is a complex intervention that aims to decrease UI symptoms. Information about how the multiple complex components involved in PFMT achieve and maintain the desired effect are rarely studied as a whole. The evidence base lacks data about how women experience PFMT over time and in the longer-term. This study explored women's experiences of biofeedback-assisted PFMT and PFMT alone, to identify and understand what influenced self-reported adherence to PFMT, and UI outcomes over time.

METHODS

This rigorous longitudinal qualitative case study, nested within a randomised controlled trial, recruited forty cases (women with stress or mixed UI; 20 in biofeedback-assisted and 20 in PFMT alone group). A case included up to four semi-structured interviews with each woman (prior to starting PFMT, end of treatment [6 months], 12 months, 24 months). Analysis followed case study analytic traditions, resulting in a Programme Theory about PFMT from the perspectives of women with UI.

FINDINGS

The theory demonstrates factors that motivated women to seek UI treatment, and how these influenced long-term adherence. Therapists who delivered PFMT played a crucial role in supporting women to know how to undertake PFMT (to have capability). Some, but not all, women developed self-efficacy for PFMT. Where women did not have PFMT self-efficacy, adherence tended to be poor. When women had PFMT self-efficacy, the conditions to support adherence were present, but contextual factors could still intercede to inhibit adherence. The intercession of contextual factors was individual to a woman and her life, meaning any particular contextual factor had inconsistent influences on PFMT adherence over time for individual women and exerted varying influences across different women.

CONCLUSION

Long term adherence to PFMT is a complex interaction between many different factors. Enquiring about an individual woman's motivation to seek treatment and understanding the contextual factors that affect an individual woman will enable a practitioner to support longer-term adherence.

A mixed methods systematic literature review of barriers and facilitators to help-seeking among women with stigmatised pelvic health symptoms

BACKGROUND

Women's pelvic health is a globally important subject, included in international and United Kingdom health policies, emphasising the importance of improving information and access to pelvic health services. Consequences of pelvic symptoms are intimate, personal, and varied, often causing embarrassment and shame, affecting women's quality of life and wellbeing.

AIM

To understand the experience of seeking healthcare for stigmatised pelvic health symptoms by synthesising all types of published primary research and mapping the results to behavioural theory, to identify potential targets for intervention.

METHODS

Systematic search of MEDLINE, CINAHL, PsycINFO, SocINDEX, PubMED databases, CDSR and CENTRAL registers, from inception to May 2023 for all types of research capturing women's views and experiences of seeking help with stigmatised urogenital and bowel symptoms. Studies only reporting prevalence, predictors of help-seeking, non-health related help-seeking, or written in languages other than English, German, French, Spanish and Swedish were excluded. Reference checking and forward citation searching for all included studies was performed. A results-based synthesis approach was used to integrate quantitative and qualitative data. Themes were mapped to the Common-Sense model and Candidacy framework. The Mixed Methods Appraisal Tool was used for critical appraisal. Grading of Recommendations Assessment, Development and Evaluation - Confidence in Evidence from Reviews of Qualitative research for assessing certainty of review findings.

RESULTS

86 studies representing over 20,000 women from 24 high income countries were included. Confidence was high that barriers to help-seeking were similar across all study types and pelvic symptoms: stigma, lack of knowledge, women's perception that clinicians dismissed their symptoms, and associated normalising and deprioritising of low bother symptoms. Supportive clinicians and increased knowledge were key facilitators.

CONCLUSIONS

Using the Common-Sense Model to explore women's help-seeking behaviour with stigmatised pelvic symptoms reveals problems with cognitive representation of symptom identity, emotional representations of embarrassment and shame, and a subjective norm that women believe their symptoms will be trivialised by clinicians. Together these barriers frustrate women's identification of their candidacy for healthcare. Addressing these issues through behavioural change interventions for women and clinicians, will help to achieve universal access to pelvic healthcare services (United Nations Sustainable Development Goal 3.7).

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021256956.