User testing a patient information resource about potential complications of vaginally inserted synthetic mesh

Pain and other complications of pelvic mesh: a systematic review of qualitative studies and thematic synthesis of women's accounts

OBJECTIVES

Synthesis of the experience of women with pain from pelvic or vaginal mesh or its removal, to identify pain-related problems and to formulate psychological aspects of pain.

DESIGN

Systematic review and thematic analysis of qualitative studies of pain from pelvic or vaginal mesh, or mesh removal, in women over 18 years, using individual interviews, focus groups, free text, or written or oral contributions to formal enquiries.

DATA SOURCES

Medline, Embase and PsycINFO, from inception to 26 April 2023.

ELIGIBILITY CRITERIA

Qualitative studies of pain and other symptoms from pelvic or vaginal mesh or its removal; adults; no language restriction.

DATA EXTRACTION AND SYNTHESIS

Line-by-line coding of participant quotations and study author statements by one author to provide codes that were applied to half the studies by another author and differences resolved by discussion. Codes were grouped into subthemes and themes by both authors, then scrutinised and discussed by a focus group of mesh-injured women for omissions, emphasis and coherence. Studies were appraised using an amalgamation of the CASP and COREQ tools.

RESULTS

2292 search results produced 9 eligible studies, with 7-752 participants, a total of around 2000. Four recruited patients, four totally or partially from mesh advocacy groups, and two were national enquiries (UK and Australia). Four major themes were as follows: broken body, broken mind; distrust of doctors and the medical industry; broken life and keeping going-a changed future. Psychological content mainly concerned the loss of trust in medical care, leaving women unsupported in facing an uncertain future. Mesh-injured women strongly endorsed the findings.

CONCLUSIONS

Pain and other problems associated with pelvic mesh are profound and far-reaching for women affected. Worse, they feel subject to continued gaslighting, including denial of their mesh-related problems and dismissal of their concerns about continued mesh insertion.

PROSPERO REGISTRATION NUMBER

CRD42022330527.

Evaluation of the quality of information available on the internet on vaginal meshes

OBJECTIVE

The objective of this study was to evaluate the quality of information on the internet about vaginal meshes available to the general population.

STUDY DESIGN

The terms "vaginal sling," "sling vagina," "vaginal mesh," "mesh vagina," "vaginal tape," and "tape vagina" were used every time on three major search engines, and the first 10 websites retrieved by each search engine were selected and evaluated using the DISCERN questionnaire. The websites were divided into four categories based on the type of agency that created the website. These included websites created by private health institutions, non-private health institutions, and non-health institutions and websites for encyclopedias, libraries, articles and scientific papers. They were compared in terms of the reliability, information quality, and total DISCERN score.

RESULTS

The survey yielded 98 different websites; after applying the exclusion criteria, 62 sites were selected. Websites for articles, magazines, libraries, and encyclopedias and those by non-private health services had significantly high scores for the reliability dimension of the DISCERN tool as compared to the other two website categories (p < 0.05). Regarding the quality of information, websites for non-specific health services and those for articles, magazines, libraries, and encyclopedias presented significantly lower scores as compared to the other two website categories. Websites for non-specific health services had significantly lower average total DISCERN points when compared to other website categories. The websites for private health services and those for articles, magazines, libraries, and encyclopedias had significantly lower DISCERN scores than the websites for non-private health services did.

CONCLUSION

Our findings showed that the quality of information regarding vaginal meshes on the first 10 websites on major search engines was moderate.