Bedouin Women's Gender Preferences When Choosing Obstetricians and Gynecologists

Clients' satisfaction with cervical cancer screening services and influencing factors at public health facilities in Debre Markos town, Northwest Ethiopia, 2022/23: a convergent parallel mixed method

BACKGROUND

Satisfaction is defined as the perceived fulfillment of patient or client needs and desires through the delivery of healthcare services. In developed countries, more than 60% of women have been screened for cervical cancer. However, only 12% of women in sub-Saharan Africa have been screened for precancerous cervical lesions. There is limited evidence on client satisfaction with cervical cancer screening services (CSCCSS) in Ethiopia, particularly, there is no study conducted by mixed method in the Amhara region.

OBJECTIVE

The study aimed to assess clients' satisfaction with cervical cancer screening services and influencing factors among women screened in Debre Markos town public health facilities in Northwest Ethiopia, 2022/23.

METHODS

A convergent parallel mixed methods design was conducted in Debre Markos town's public health facilities from October 10th, 2022 to January 10th, 2023. For the quantitative wing, a total of 401 cervical cancer screening service users were selected using a systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. Clients were interviewed on exit in a private area far from the screening unit and the data were entered into Epi-data version 4.6.0.2, then exported to STATA version 14 for analysis. A binary logistic regression model was fitted to identify factors associated with client satisfaction with cervical cancer screening services. The qualitative data were collected through in-depth and key informant interviews using a semi-structured topic guide. The data were analyzed using a thematic analysis approach with Open code software (version 4.0.2.3).

RESULT

The quantitative wing revealed that overall, 65% (95% CI: 60-69) of respondents were satisfied with the cervical cancer screening services they received. Gender of the provider (AOR: 6.11, 95% CI: 3.23-11.55, p-value = 0.000), waiting time (AOR: 4.77, 95% CI: 1.32-17.31, p-value = 0.017), clients' knowledge (AOR: 0.26, 95% CI: 0.12-0.59, p-value = 0.001), and clients' attitude (AOR: 6.43, 95% CI: 3.43-12.03, p-value = 0.000) were significantly associated with CSCCSS.

QUALITATIVE RESULT

The thematic analysis revealed three themes. Theme 1: facility-related barriers (shortage of skilled manpower, shortage of infrastructure, providers' skill gap, unavailability of full service, leadership problem, long waiting time). Theme 2: client-related barriers (poor knowledge and attitude, gender preference). Theme 3: facility-related facilitators (free service, presence of supportive partners).

CONCLUSION

According to the findings of this study, two-thirds of clients were satisfied with cervical cancer screening services, which was lower than the national target of 80%. Long waiting time, male gender of the service provider, unfavorable attitude, and good knowledge of clients were identified as significant factors negatively affecting client satisfaction with cervical cancer screening.

The association between emotion regulation and pain during the immediate postpartum period

PURPOSE

The present study aims to investigate the association between emotion regulation difficulties and pain perception during the immediate postpartum period.

METHODS

A cross-sectional study was performed in women during the immediate postpartum period. Women completed the Difficulties in Emotion Regulation Scale (DERS) questionnaire to measure difficulties in emotion regulation. A second analysis was conducted for the six subdomains of the DERS questionnaire. The visual analog scale (VAS) was used to measure pain intensity. The association between DERS scores and VAS score was assessed. Multivariable logistic regression models were constructed to control for potential confounders.

RESULTS

A total of 150 women were included in the final analysis, of whom 112 (74.6%) delivered vaginally and 38 (25.4%) had a cesarean delivery. Higher DERS scores, indicating more difficulties in emotion regulation, were significantly associated with higher VAS scores regardless of mode of delivery. Likewise, higher emotion regulation scores in 5 of 6 subdomains were associated with higher VAS scores (p < 0.001). Using multivariate logistic regression models higher DERS scores were independently associated with higher VAS scores.

CONCLUSION

Difficulties in emotion regulation are associated with higher pain perception during the immediate postpartum period. Interventions designed to improve emotion regulation may improve maternal well-being in the immediate postpartum period and possibly reduce use of pain medication.

Barriers to Adopting Healthy Lifestyle and Health Promotion among Ethnic Minority Bedouin Women in Southern Israel: A Qualitative Study

BACKGROUND

A healthy lifestyle is a crucial step in disease prevention and management, as well as a significant predictor of health promotion. Yet, despite an increase in chronic morbidity among Bedouin women in southern Israel, little research has been conducted on their health behaviors. Therefore, the aim of this study is to examine barriers to adopting a healthy lifestyle and health promotion among ethnic minority Bedouin women in southern Israel.

METHODS

This qualitative study was based on data collected through focus groups during June and July 2021. Participants included 44 Bedouin women aged 18-55. Focus groups were recorded and transcribed. Transcriptions were thematically analyzed and coded using the ecological model.

RESULTS

We found multiple barriers at various levels that prevent Bedouin women from adopting a healthy lifestyle and health promotion. At the individual level, such factors included the impact of financial limitations on healthful nutrition, as well as a lack of awareness or knowledge regarding healthy lifestyle and health promotion. At the organizational level, barriers include a lack of clinics, accessibility, and availability of health services and cultural incompatibility of the health services. At the community level, impediments to a healthy lifestyle include inaccessibility to sports facilities and suppression of physical activity. At the public policy level, participants, especially those living in unrecognized villages, described difficult living conditions related to environmental and social neglect as affecting their health status and ability to maintain a healthy lifestyle.

CONCLUSION

Study findings emphasize the need for policymaking and a systemic approach to address health disparities and ensure equal health promotion for the Bedouin population.

Understanding the needs of women undergoing breast ultrasound: Are male radiologists still needed?

INTRODUCTION

A trend towards less male radiologists specializing in breast ultrasound was observed. A common notion in the field of breast radiology is, that female patients feel more comfortable being treated by female radiologists. The aim of the study was to understand and report the needs of women undergoing breast ultrasound with regards to the sex of the radiologist performing the investigation.

METHODS

Informed consent was obtained from all patients prior to inclusion in a prospective bi-center quality study. At center 1 (72 patients), the women were examined exclusively by female radiologists, at center 2 (100 patients) only by male radiologists. After the examination the patients were asked about their experiences and their wishes for the future.

RESULTS

Overall, women made no distinction between female and male radiologists; 25% of them wanted a female radiologist and 1.2% wanted a male radiologist. The majority (74%) stated that it made no difference whether a female or male radiologist performed the examination. The majority of women in group 2, who were investigated exclusively by male radiologists, stated that they had no preferences with regard to the sex of the radiologist (93%); 5% of the women wished to be investigated solely by a female radiologist and 2% exclusively by a male radiologist.

DISCUSSION

The majority of women undergoing breast ultrasound are unconcerned about the radiologist's sex. It would appear that women examined by male radiologists are less selective about the sex of the examining radiologist.

TRIAL REGISTRATION

Written informed consent was obtained from all patients. All patient data were anonymized. The physicians had no access to any further personal data. National regulations did not require dedicated ethics approval with anonymized lists or retrospective questionnaires.

Does the gender of nurses matter to patients? A qualitative analysis of gender preferences of patients

Background

This study argues that the gender of a nurse could give patients the emotional and psychological support they need in their healing process. Nonetheless, in many developing countries, these intricate preferences of patients are usually ignored due to poor staffing and logistical capacities of health facilities. As a contribution to this professional and operation gap, this paper explores patients' preference for nurses' gender in health care at the Komfo Anokye Teaching Hospital in Ghana. The paper further explores the importance of these preferences to the delivery of patient-centred care in Ghana and across Africa.

Objective

The paper has two specific objectives: (a) to explore patients' preferences for the gender of nurses who attend to them while on admission; and (b) to find out the range of factors that inform these preferences.

Methods

Qualitative exploratory descriptive design was used to select adult patients who were not seriously ill and nursed by male and female nurses at the medical and surgical wards of the Komfo Anokye Teaching Hospital in Ghana for at least 5 days from January to March 2017 and before their discharge. Participants were recruited using purposive sampling technique. A semi-structured interview guide was used to elicit information from 14 participants after seeking their written informed consent. The data were analysed using content analysis.

Results

Two major themes emerged. These were: the Preferred Gender of a Nurse in Nursing Care and the Reasons for the Preference or no Preference for Nurses' Gender in Nursing Care. Under each of these themes, the associated aspects were also discussed. Patients had varying preference for a particular nurse during care but gender was not particularly significant in patients' preference for nurses. Majority of the participants emphasized their preference for nurses with professional expertise and good virtues to determine a preferred nurse and both genders of nurses can possess these qualities. However, nurses of the same gender as the patient were preferred for intimate procedures to ensure privacy and satisfaction.

Conclusion

The gender of a nurse is not on top of the preferences list of patients in the study context. This may be attributed to the long-term practice that the participants have not had the chance to be choosing a preferred nurse's gender, so most patients are tolerant and familiar with both male and female nurses. Instead, patients' preferences are determined by the performance and quality of service provided by nurses. Age, maturity and social connections were also found to influence patients' preferences.

Levels of PFAS concentrations in the placenta and pregnancy complications

BACKGROUND

Recent research has raised concerns about the potential health effects of perfluoroalkyl and polyfluoroalkyl substances (PFAS) exposure, particularly during critical periods of development such as pregnancy. In this study, we sought to investigate the presence and potential impacts of PFAS in the placenta.

METHODS

We measured 13 PFAS compounds in placental tissue samples among 50 women who gave birth at a tertiary medical center in southern Israel. The sample comprised of 10 women with pregnancy-related complications (preterm birth, preeclampsia, gestational diabetes or small-for-gestational age) and 40 women without complications individually matched to cases by age.

RESULTS

For five (5) out of 13 PFAS compounds (Perfluorooctane Sulfonate (PFOS), perfluorooctanoic acid (PFOA), Perfluorohexanesulphonic acid (PFHxS), Perfluorononanoic acid (PFNA), Perfluorodecanoic acid (PFDA)) median concentrations were lower or comparable to placental measurements in different international populations. Geometric mean was estimated at 0.09 ng/g (90%CI:0.07;0.10) for PFOA, 0.05 ng/g for PFNA (90%CI:0.04;0.07), 0.03 ng/g for PFDA (90%CI:0.01;0.03), 0.06 ng/g for PFHxS (90%CI:0.05;0.07), 0.23 ng/g for PFOS linear measurement (90%CI:0.20;0.26) and 0.25 ng/g (90%CI:0.22;0.30) for PFOS summed concentrations that included non-linear isomers. Composite outcome of pregnancy-related complications was associated with elevated PFOA placental concentrations at an odds ratio (OR)= 1.82 (90%CI:1.06;3.13) for an increase of one quintile of PFOA value and adjusted to maternal gravidity in a conditional logistic regression.

CONCLUSION

This pilot study indicates a widespread exposure to multiple PFAS compounds in placental tissue of pregnant women in Israel. These findings warrant further validation through comprehensive national human biomonitoring initiatives.

Preference of birth attendant gender and associated factors among antenatal care attendants at Debre Markos town public health facilities, Northwest Ethiopia: A cross-sectional study design 2021

OBJECTIVE

To assess the preference of birth attendant gender and associated factors among antenatal care attendants in Debre Markos town public health facilities, northwest Ethiopia, 2021.

METHOD

A facility-based cross-sectional study was conducted from 8 January 2021 to 28 February 2021 at Debre Markos town public health facilities. A total of 662 study participants were selected by systematic random sampling technique. Pretested interviewer-administered structured questionnaires were used for data collection. Data were entered using Epi Data version 3.1 and analyzed using SPSS version 25. Bivariable and multivariable logistic regression were applied to identify factors associated with birth attendant gender preference. Association was described by the "odd ratio" along with a 95% confidence interval. Finally, a P value < 0.05 in the adjusted analysis was used to declare a significant association.

RESULT

In this study, 644 women participated making a response rate of 97.3%. Of the total study participants, 108 (16.8%; 95% confidence interval: 13.8-19.4) preferred male birth attendants, while 232 (36%; 95% confidence interval: 32.5-39.8) preferred female birth attendants. Age (15-24) (adjusted odds ratio = 4.81, 95% confidence interval: 1.79, 12.94), no formal education (adjusted odds ratio = 2.94, 95% confidence interval: 1.32, 6.52), and primary education (adjusted odds ratio = 2.42, 95% confidence interval: 1.07, 5.47) were significantly associated with female birth attendant preference. A lack of formal education (adjusted odds ratio = 0.08; 95% confidence interval: 0.01, 0.68), secondary education (adjusted odds ratio = 0.34; 95% confidence interval: 0.16, 0.71), and history of assisted vaginal delivery (adjusted odds ratio = 3.72; 95% confidence interval: 1.40, 9.87) were significantly associated with a male birth attendant preference.

CONCLUSION

A female birth attendant is preferred by almost one-third of pregnant mothers, while one-sixth preferred a male. The clients who were younger in age and lower in educational status were more likely to prefer female birth attendants, whereas those who had a history of assisted vaginal delivery were more likely to prefer male birth attendants. To have a mother in the continuum of care, it is crucial to take her preferences into account when providing services.

Temporal Stability of Responses to the Edinburgh Postpartum Depression Scale by Bedouin Mothers in Southern Israel

The detection and treatment of mental illness during pregnancy and postpartum are essential for the well-being of both mother and child. For this study, we set out to estimate the prevalence of perinatal depression among Bedouin mothers in southern Israel and determine if the latent structure of responses to the Edinburgh Postpartum Depression Scale (EPDS)-including depression, anxiety, and anhedonia-previously reported also applies to this population. A total of 332 women completed the EPDS during pregnancy (26-38 weeks) and again 2-4 months postpartum. Confirmatory factor analyses were performed to determine if first-order factors were correlated, or instead measure a second- or higher-order latent construct. We next performed temporal invariance analyses to compare the latent structure of EPDS responses over time. When pregnant, 35% of women provided EPDS responses suggestive of elevated depressive symptomology; this decreased to 23% postpartum. At both points, each EPDS factor significantly measures a higher-order, latent construct. The EPDS appears to measure three factors, labeled sadness, anxiety, and anhedonia. This latent structure appears stable (i.e., during pregnancy and postpartum). Further research is needed to validate EPDS responses versus structured clinical interviews. The construct validity of EPDS factors should be examined across other at-risk groups and over time.

Perinatal outcome and long-term infectious hospitalizations of offspring born to women with known drug allergy

PROBLEM

Maternal drug allergy has been associated with altered immune status and an inflammatory environment, which may affect the risk of future infectious diseases in the offspring.

OBJECTIVES

We aimed to evaluate perinatal outcomes and long-term infectious hospitalization in the offspring of women with documented drug allergy.

METHOD OF STUDY

The study was conducted at the Soroka University Medical Center, a tertiary medical center. For perinatal outcomes, generalized estimation equation (GEE) models were used controlling for maternal age, maternal diabetes mellitus, smoking, and hypertensive disorders. The study groups were followed until 18 years of age for infectious-related hospitalizations. A Kaplan-Meier survival-curve was used to compare cumulative incidence of long-term infectious hospitalizations. A Cox proportional hazards model was conducted to control for confounders.

RESULTS

During the study period, 243,682 deliveries met the inclusion criteria, of which 9,756 (4.0%) occurred in women with documented drug allergy. Using GEE, maternal drug allergy was found to be a significant independent risk factor for hypertensive disorders, diabetes mellitus, intra-uterine growth restriction (IUGR) and preterm delivery. Offspring also had significantly higher rates of long-term infectious hospitalizations. Kaplan-Meier survival-curves demonstrated significantly higher cumulative incidence rates of infectious hospitalization (log rank p<0. 001). In a Cox proportional hazards model, being born to a mother with documented a drug allergy was independently associated with infectious hospitalization of the offspring in the long-term.

CONCLUSIONS

Maternal documented drug allergy is independently associated with adverse perinatal outcome such as IUGR and preterm delivery and increased risk of long- term infectious hospitalization of the offspring. This article is protected by copyright. All rights reserved.

Maternal condyloma acuminata infection in pregnancy and offspring long-term respiratory and infectious outcome

BACKGROUND

Maternal condyloma acuminata infection may be vertically transmitted to the offspring during pregnancy and childbirth. Our study aimed to investigate the possible impact of maternal condyloma acuminata infection in pregnancy on offspring respiratory and infectious morbidity.

METHODS

A population-based cohort analysis including all singleton deliveries occurring between 1991 and 2014 at a tertiary medical center. Long-term infectious and respiratory morbidities were compared between children with and without exposure to maternal condyloma infection during pregnancy. A Kaplan-Meier survival curve was used to compare cumulative hospitalization rate and a Cox regression analyses to control for confounders.

RESULTS

No significant differences were found in total respiratory and infectious related hospitalizations between the study groups. The survival curves demonstrated no difference in the cumulative incidence between the two groups in both respiratory hospitalizations (log-rank, p = 0.18) and infectious hospitalizations (log-rank, p = 0.95). Cox multivariable analyses demonstrated that exposure to maternal condyloma infection during pregnancy is not a risk factor for neither infectious (aHR 0.91, [CI] 0.49-1.69) nor respiratory (aHR 0.37, [CI] 0.09-1.51) morbidity during childhood and adolescence.

CONCLUSION

Exposure to maternal condyloma infection during pregnancy does not appear to be an independent risk factor for later respiratory or infectious morbidity throughout childhood and adolescence.

A Non-Randomized Controlled Trial for Reducing Postpartum Depression in Low-Income Minority Women at Community-Based Women's Health Clinics

OBJECTIVE

To analyze an intervention that delivered tailored clinic staff training on postpartum depression (PPD) followed by awareness raising and social support aimed at lowering PPD among low-income Bedouin women in southern Israel.

METHODS

We conducted a non-randomized controlled trial at two women's health clinics. The study included 332 of the 384 eligible women recruited at baseline (intervention = 169, control = 163), who completed two face-to-face interviews, one at 26-38 weeks of pregnancy (Time 1) and one 2-4 months postpartum (Time 2). PPD was measured by the Edinburgh Postnatal Depression Scale (EPDS) and dichotomized using a ≥ 10 score cutoff. We calculated EPDS change (rate difference of dichotomous EPDS from Time 1 to Time 2) (no change, positive change, or negative change), and compared EPDS changes in a control clinic vs. an intervention clinic.

RESULTS

The intervention group showed a greater decrease in dichotomous EPDS ≥ 10 between times 1 and 2 (38.5% to 17.2%) than the control group (31.9% to 29.4%, PV = 0.008). Multinomial logistic regression showed that high PPD awareness significantly contributed to positive EPDS change in the intervention group (PV = 0.003) and high social support significantly protected against negative EPDS change in both groups, intervention (PV = 0.001) and control (PV = 0.003).

CONCLUSIONS

In low-income women, an intervention focusing on increasing PPD awareness and social support following staff training was associated with reduced EPDS and positive EPDS change following the intervention. Similar interventions should be implemented in women's clinics during pregnancy.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov NCT02862444.

Direct and indirect determinants of prenatal depression among Arab-Bedouin women in Israel: The role of stressful life events and social support

OBJECTIVE

Prenatal depression (PND) negatively affects the health and well-being of both mother and child. The aim of this study was to identify the direct and indirect determinants of prenatal depression symptoms (PNDS) among Arab-Bedouin women in southern Israel.

DESIGN

Data collection was conducted in two women's health centers from October 2017 to February 2018.

SETTING

Participants were recruited during visits to women's health centers in southern Israel.

PARTICIPANTS

We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. All women were 18+ years of age and 26-38 weeks of gestational age.

MEASUREMENTS

PNDS were measured by an Arabic version of the Edinburgh Postnatal Depression Scale. We computed path analyses to identify direct and indirect determinants of PND and estimated the contribution of stressful life events and social support.

RESULTS

Positive direct associations emerged between stressful life events, history of depression and gestational age, and PNDS; direct inverse associations were found between social support, PND awareness, and education, and PNDS. History of depression was the single strongest direct predictor of PNDS yet when considering combined direct and indirect effects, the contribution of stressful life events is greater. Stressful life events (via history of depression and PND awareness) and education (via PND awareness) had both direct and indirect effects on PNDS. Age of the mother indirectly affects PNDS via education and PND awareness. Polygamy emerged as neither a direct nor indirect predictor of PNDS.

CONCLUSIONS

PNDS in the underserved and understudied Bedouin women has serval direct and indirect predictors. Interventions aiming at reducing stress and increasing social support, via PND awareness might be successful in reducing PND and possibly future postpartum depression.

The Significance of True Knot of the Umbilical Cord in Long-Term Offspring Neurological Health

We aimed to study both the short- and long-term neurological implications in offspring born with confirmed knotting of the umbilical cord-"true knot of cord". In this population based cohort study, a comparison of perinatal outcome and long-term neurological hospitalizations was performed on the basis of presence or absence of true knot of cord. A Kaplan-Meier survival curve was constructed to compare the cumulative incidence of neurological hospitalizations between the study groups. Multivariable regression models were used to assess the independent association between true knot of cord, perinatal mortality and long term neurological related hospitalizations, while controlling for potential confounders. The study included 243,639 newborns, of them 1.1% (n = 2606) were diagnosed with true knot of the umbilical cord. Higher rates of intrauterine fetal demise (IUFD) were noted in the exposed group, a finding which remained significant in the multivariable generalized estimation equation, while controlling for confounders. The cumulative incidences of neurological hospitalizations over time were comparable between the groups. The Cox regression confirmed a lack of association between true knot of cord and total long term neurological related hospitalizations. While presence of true knot of the umbilical cord is associated with higher IUFD rates, in our population, however, its presence does not appear to impact the long term neurological health of exposed offspring.

Characteristics Related to Choice of Obstetrician-Gynecologist among Women of Ethiopian Descent in Israel

BACKGROUND

Patient satisfaction with the quality of health care services is complex with many known factors impacting upon satisfaction, among them the choice of physician. Previous studies examined characteristics of a woman's choice of gynecologist, but information regarding reasons for these choices among women of Ethiopian descent is lacking. The objective of this study was to identify characteristics related preference of an obstetrician-gynecologist based on gender among women of Ethiopian descent.

METHOD

Analysis of anonymous self-reported questionnaire distributed to 500 women of Ethiopian descent who visited an obstetrician-gynecologist at least once in the past three years (Mean age 29.5; SD = 8.2). Trust in physician was examined using the TPS scale; service quality was checked using the SERVQUAL; and the 5Qs model was used to measure patient's satisfaction of health care.

RESULTS

Very religious (84.1%) and religious (53.6%) women of Ethiopian descent were more likely to prefer a female obstetrician-gynecologist compared to traditional (39.3%) or secular (34.4%) women (p < 0.001). Participants had higher probability to prefer a male gynecologist if they had more employment hours (OR = 3.57, 95% CI = 1.72-7.42, p < 0.001), and the responsiveness of the physician was less important to them (OR = 0.77, 95% CI = 0.60-0.99, p < 0.05). Age of participants, country of birth, years in Israel, family status, being a mother, education or health status were not associated with choosing a female obstetrician-gynecologist. Religious women would prefer to wait longer for a female gynecologist due to modesty imperatives, even at the cost of compromising their health as a result of waiting longer.

CONCLUSIONS

The findings of this research highlight the importance of accessibility to female obstetrician-gynecologists for women of Ethiopian descent and demonstrate that determinants in the host population rather than immigrant's past culture, affect the women's decision. This study demonstrates the importance of the health care system in Israel to enable more female obstetrician-gynecologists to treat women of Ethiopian descent.

Measurement Model of Women's Preferences in Obstetrician and Gynecologist Selection in the Private Sector: Exploratory and Confirmatory Factor Analysis

Background:

The purpose of this study is to construct and validate a measurement model of women’s preferences in Obstetrician and Gynecologist (OB/GYN) selection in the private sector of non-clinical parameters.

Methods:

This methodological study included 462 respondents in OB/GYN’s offices to a researcher-made questionnaire. The patients visited 57 offices of OB/GYNs in the city of Mashhad in Iran and completed women’s preferences in OB/GYN selection questionnaire over a 2-month period from January to February 2018. Exploratory Factor Analysis (EFA) was conducted to verify the instrument’s construct validity. Confirmatory Factor Analysis (CFA) was used to test whether the data fit our hypothesized model obtained from EFA model.

Results:

The first draft of the questionnaire was prepared with 118 items based on literature review. The outcome of content validity assessment was a 51-item questionnaire. Scale-Content Validity Index (S-CVI) turned out to be 0.80. The results of EFA yielded an instrument with 33 items in six domains, which explained 52.657% of the total variance of the questionnaire. With performing CFA, the 6-factor model with 29 items demonstrated a good fit with the data (CFI=0.952, CMIN/DF=1.613, RMSEA=0.036). Availability and Accessibility, Communicational Skills, Office Environment, Recommendation by Others, Special Services, and Cost and Insurance were found to define the women’s preferences in OB/GYN selection in private sector, Iran.

Conclusion:

The developed measurement model considers the patient’s preferences that influence decision-making process on OB/GYN selection. It can provide useful knowledge for OB/GYNs and policymakers to design appropriate and efficient marketing strategies according to the consumer preferences priority.

"I did not know it was a medical condition": Predictors, severity and help seeking behaviors of women with female sexual dysfunction in the Volta region of Ghana

Objectives

The study’s main objective was to describe the prevalence and severity of female sexual dysfunction (FSD) amongst a group of Ghanaian women in the outpatient setting of the predominantly rural Volta region of Ghana. Additionally we determine the predictors of FSD severity and care seeking behaviors of women with the condition.

Study design and setting

This was a cross sectional study conducted in the outpatient setting of the Ho Teaching Hospital in the rural-savannah, agro-ecological zone of Volta Region, Ghana.

Methods and procedures

FSD was assessed using the Female Sexual Function Index (FSFI) questionnaire. FSD was defined with a cutoff of ≤23 so as not to under-estimate the prevalence in this conservative setting. FSFI score >23 was designated “no FSD”. We further categorized women with FSD as having mild (FSFI Total score 18–23), moderate (FSFI Total score <18 to >10) or severe (FSFI Total score ≤10) FSD. Due to sample size restrictions, we combined the moderate and severe FSD groups in our analyses and defined “moderate/severe FSD” as an FSFI Total score < 18. Participants with FSD were further asked to indicate whether or not they sought help for their conditions, the reasons they sought help, and the types of help they sought. We used p<0.05 to determine statistical significance for all analyses and logistic regression models were used to determine crude and age-adjusted effect estimates.

Results

FSD Prevalence: Out of 407 women approached, 300 (83.8%) agreed and consented to participate in the study. The prevalence of FSD was 48.3% (n = 145). Compared to those without FSD, over a third of the FSD women resided in rural settings (37.90% vs 20.60%; p = 0.001) and tended to be multiparous, with a significantly greater proportion having at least three children (31.70% vs 18.10%; p = 0.033).

FSD Severity: Over a quarter of the sample (27.6%, n = 40) met the cut-off for moderate to severe FSD. In age-adjusted models, lubrication disorder was associated with 45 times the odds of moderate/severe FSD (age-adj. OR: 45.38, 95% CI: 8.37, 246.00; p<0.001), pain with 17times the odds (age-adj. OR: 17.18, 95% CI: 4.50, 65.50; p<0.001) and satisfaction almost 5times the odds (age-adj. OR: 4.69, 95% CI: 1.09, 20.2; p = 0.04). Compared to those with 1–3 children, nulliparous women had 3.5 times higher odds of moderate/severe sexual dysfunction as well (age-adj. OR:3.51, 95% CI:1.37,8.98; p = 0.009).

FSD-related Health Seeking Behaviors: Statistically significant predictors of FSD-related care seeking included having FSD of pain disorder (age-adj. OR: 5.91, 95% CI:1.29, 27.15; p = 0.02), having ≥4 children (age-adj. OR: 6.29, 95%CI: 1.53, 25.76; p = 0.01). Of those who sought help, seven in 10 sought formal help from a healthcare provider, with General Practitioners preferred over Gynecologist. About one in 3 (31.3%) who did not seek help indicated that they did not know their sexual dysfunction was a medical condition, over a quarter (28.9%) “thought it was normal” to have FSD, and interestingly, 14.1% did not think a medical provider would be able to provide them with assistance.

Conclusions

Sexual dysfunctions are prevalent yet taboo subjects in many countries, including Ghana. Awareness raising and efforts to feminize the physician workforce are necessary to meet the healthcare needs of vulnerable members of Ghanaian society.

Do women with pelvic floor disorders prefer to be treated by female urogynecologists?

The researchers' aim was to assess provider gender preference among women attending the urogynecology clinic. Two hundred women with pelvic floor disorders completed a detailed questionnaire regarding possible gender preferences in choosing their urogynecologist. One-third of women preferred a female doctor while two-thirds had no preference. We found that embarrassment during the pelvic examination was the main reason for same-gender preference. This preference was significantly associated with educational level and being religious. In conclusion, although one-third of female patients prefer female urogynecologists, professional skills are considered to be more important factors when it comes to actually make a choice.