A feasibility trial of online Acceptance and Commitment Therapy for women with provoked vestibulodynia

OBJECTIVES

Acceptance and Commitment Therapy (ACT) is an established treatment for chronic pain. However, it is a form of treatment that have not yet been applied much in the treatment of persistent vulvar pain disorders. This study examines the feasibility and preliminary effects of online ACT for patients with provoked vestibulodynia.

METHODS

Women diagnosed with provoked vestibulodynia were assigned randomly either to online ACT or to a waitlist control group. Feasibility was assessed in terms of recruitment potential, treatment credibility, completions rates, retention in trial, and data quality. Participants completed measures of pain with sexual activity, sexual functioning, emotional and relational adjustment, and potential treatment processes before and after treatment.

RESULTS

Of the 111 women who were invited to participate in the study, 44 were included (39.6 % recruitment rate). Thirty seven participants (84.1 %) completed the pre-treatment assessment. Participants who received online ACT rated treatment credibility positively, and completed on average 4.31 (SD=1.60) of the six treatment modules. Of participants, 34 provided post treatment data, giving a trial retention rate of 77 %. Effects of online ACT, as compared to waitlist, were large for pain acceptance and quality of life, medium for anxiety and pain catastrophizing, and small for sexual satisfaction, pain with sexual activity, and relationship adjustment.

CONCLUSIONS

With some adjustments to recruitment procedures, a full scale randomized controlled trial of online ACT for provoked vestibulodynia appears feasible.

Perceptions of contraception, non-protection and induced abortion among a sample of urban Swedish teenage girls: Focus group discussions

OBJECTIVES

To explore the attitudes of teenage girls towards contraception and induced abortion in order to better understand underlying reasons for non-protection.

METHODS

Four focus group discussions with urban teenage girls aged 15-18 years (n = 16).

RESULTS

Attitudes towards abortion were generally positive despite some degree of misinformation and lack of knowledge about the subject. Knowledge about methods of birth control was accurate. The use of alcohol was often cited as a factor contributing to risk-taking behaviour. Sexual abuse was mentioned as a common phenomenon, and all participants knew someone who had been sexually abused. Participants agreed that sexual partners were reluctant to use condoms and that it was difficult to negotiate with them about this use. The increased rate of abortion was felt to be mainly due to initiation of sexual activity at a younger age. A need for easily available and inexpensive contraception was expressed along with improvement in the quality of sexual education in school.

CONCLUSION

Qualitative sexual education with single-sex sessions and gender related messages as a recurrent activity in the school curricula may help to empower young women and promote avoidance of risk-taking during sexual activity thus helping to reduce the incidence of unwanted pregnancies. In addition, access to cheap condoms could provide a stimulus to increased use of condoms.

Limited impact of an intervention regarding emergency contraceptive pills in Sweden—repeated surveys among abortion applicants

OBJECTIVE

To evaluate a community-based intervention consisting of an information campaign and advance provision of emergency contraceptive pills (ECP) to abortion applicants.

METHODS

Submission of repeated waiting room questionnaires to abortion applicants in two cities in mid-Sweden; one intervention city (IC) and one comparison city (CC) in 2002 (IC = 92, CC = 95) and 2003 (IC = 244, CC = 204).

RESULTS

The overall response rate was 90%. The percentage of women who had undergone an abortion within the previous year had decreased in the intervention group but not in the comparison group. Almost two-thirds (63%) of the targeted women had noticed the information campaign and one out of three (33%) who had visited a family planning clinic recalled being given information about ECP. There was a small decline in the use of combined oral contraceptives and intrauterine devices over time. After the intervention, women in the intervention city had better knowledge of ECP and had used it more than women in the comparison city did.

CONCLUSIONS

More than half of the targeted women had noticed the information campaign and it may have had a limited impact. Further investigations are needed to determine whether advance supply of ECP to abortion applicants can reduce repeat abortions.

Emergency contraceptive pills over-the-counter: practices and attitudes of pharmacy and nurse-midwife providers

Deregulation of emergency contraceptive pills (ECP) has led to pharmacy staff becoming a new provider group of ECP, together with nurse-midwives, who are already experienced in prescribing contraceptives. This postal questionnaire survey aimed to assess practices and attitudes towards ECP and the over-the-counter (OTC)-availability among pharmacy staff (n=237) and nurse-midwives (n=163). The overall response rate was 89%. Both study groups were positive to ECP and the OTC-availability and the vast majority agreed that sexually active women should be aware of ECP and that routine information about ECP should be included in contraceptive counseling. Verbal information on all aspects of ECP to clients was reported more often by nurse-midwives than by pharmacy staff. Both groups supported collaboration between providers. Our findings suggest that further collaboration between pharmacies and family planning clinics should be encouraged to ensure a competent and client-friendly provision of ECP.

Bringing emergency contraception over the counter: experiences of nonprescription users in France, Norway, Sweden and Portugal

Emergency contraceptive pills are now available on a nonprescription basis in over 25 countries worldwide. In an effort to learn about women's experiences with this new means of emergency contraception (EC) service delivery, we conducted focus-group discussions with nonprescription EC users from France, Norway, Portugal and Sweden. Participants from these countries overwhelming supported pharmacy access to EC, explaining that pharmacy delivery facilitated rapid access to the method. Despite expressing mixed reviews of the counseling given by the providing pharmacists, participants reported that they knew how use the method safely and properly. Most indicated that the package insert was easy to understand and adequately answered the majority of their questions. Participants described the EC experience as a motivating factor that, in many cases, has led to more consistent use of regular contraceptive methods. These data are valuable to policy-makers and institutions interested in learning more about the safety and acceptability of nonprescription access to emergency contraceptive pills.

[No reduced number of abortions despite easily available emergency contraceptive pills. Studies of women's knowledge, attitudes and experience of the method]

Despite the fact that emergency contraceptive pills (ECP) have become easily available across the country during recent years, abortion numbers continue to rise in Sweden, especially in the young age groups (< 25). In a series of studies, we have investigated knowledge, attitudes and experience of ECP among young women. Our results show that, whereas most women are aware of the method, many lack knowledge about the mechanism of action and time frames for best use, which could explain why ECPs are not used by more than a fraction of women who might have had benefit from their use. Since half of the women requesting a termination of pregnancy stated that they would have used ECP if they had had them available at home at the time of the unprotected intercourse which led to an unintended pregnancy, it seems reasonable to encourage women to keep ECPs at home, in case the need should arise. It is important that ECPs are available without prescription, but beyond that, much more information about ECP is necessary in order for the method to be widely accepted and used as a back-up after failure with other contraceptives.

Women's voices about emergency contraceptive pills "over-the-counter": a Swedish perspective

This study aimed to describe women's experiences with the emergency contraceptive pill (ECP) as a prescription-free over-the-counter (OTC) product. Women (median age 24) who had bought ECP as an OTC product were interviewed in focus groups. Data were analyzed by content analysis. All participants appreciated the OTC availability. Timesaving aspects were seen as important benefits and pharmacies were seen as the right place to sell ECP. The media was the main source of information about OTC, probably due to the debates of the introduction of ECP as an OTC product in Sweden. All women discussed the mechanism of action. The women's experiences of interacting with the pharmacists were both positive and negative. Inconsistencies in routines with regard to providing ECP and different attitudes toward use of ECP among the pharmacists, were identified. The women expected up-to-date information about ECP and the OTC availability from gynecologists and other health professionals.

Knowledge, use and attitudes towards emergency contraceptive pills among Swedish women presenting for induced abortion

OBJECTIVE

To investigate the knowledge, experiences and attitudes towards emergency contraceptive pills (ECP) among women presenting for induced abortion.

DESIGN

Survey by self-administered waiting room questionnaires.

SETTING

Three large hospitals in the cities of Uppsala, Västerås and Orebro in Sweden.

POPULATION

591 Swedish-speaking women consecutively attending the clinics for an induced abortion during a four-month period in 2000.

RESULTS

The response rate was 88% (n = 518). As many as 43% had a history of one or more previous abortions and 43% were daily smokers. Four out of five women, 83%, were aware of ECP, but only 15 women used it to prevent this pregnancy. Fewer, 38%, knew the recommended timeframes for use and 54% had knowledge of the mode of action. The two most common sources of information about ECP were media and friends. One out of five, 22%, had previously used the method, and at the time of conception, 55% would have taken ECP if it had been available at home, and 52% were positive to having ECP available over the counter.

CONCLUSIONS

Emergency contraception is well known but is still underused. Lack of awareness of pregnancy risk may be one limiting factor for its use. Making ECP available over the counter may be an important measure towards better availability. Information strategies to the public are needed before ECP will be a widely used back-up method.

Reasons for pregnancy termination, contraceptive habits and contraceptive failure among Swedish women requesting an early pregnancy termination

BACKGROUND

More than 30 000 legal abortions are performed every year in Sweden despite sexual education in schools, widespread youth-clinics and family planning services that are free of charge. The aim of this study was to investigate reasons for induced abortion, contraceptive habits and reasons for contraceptive failure among women presenting for induced abortion.

METHODS

A questionnaire was administered to 591 Swedish-speaking women consecutively attending three different health care providers concerning an induced abortion during spring 2000.

RESULTS

The response rate was 88% (n = 518). As many as 43%, among daily smokers 53%, had experienced one or more previous legal abortions. The majority of the women (97%) had discussed the decision about abortion with someone. The most cited reasons contributing to their decision were financial concerns, worries about the relationship and bad timing of the pregnancy. Though 85% had used contraception during the previous year, 36% of the women had not used any contraceptive method at the time of conception. The main reason given for not using contraception was the belief that they could not at that time become pregnant (35%). Ninety percent of the women planned to use contraception after the abortion.

CONCLUSION

Women's decisions regarding induced abortion are multifactorial. One important reason was "poor economy". One out of three did not use any contraception, as they believed they could not become pregnant. Women presenting for induced abortion are a risk-group for further terminations. Counseling must include information about the fertile window, effective contraceptives and the emergency contraceptive pill.