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Vasudevan G, Filipink R, Gaesser J, Kazmerski TM, Sogawa Y, Kirkpatrick L. Preferences and experiences of parents/guardians of youth with epilepsy and intellectual disability on reproductive health counseling. Epilepsy Behav 2024; 152:109658. [PMID: 38277851 DOI: 10.1016/j.yebeh.2024.109658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/23/2023] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE To explore the experiences and preferences of parents/guardians of adolescents and young adults (AYA) of childbearing potential with co-occurring epilepsy and intellectual disability (ID) regarding counseling by neurologists on sexual and reproductive health (SRH) topics such as pregnancy, contraception, menstruation, and folic acid supplementation. METHODS We conducted semi-structured interviews with parents/guardians of AYAs (12-28 years old) of childbearing potential with co-occurring epilepsy and ID, recruited from a tertiary-care children's hospital. We confirmed the diagnoses of epilepsy and ID with the patient's neurologist and parent/guardian. All degrees of ID (e.g. mild/moderate/severe) were eligible. We audio-recorded and transcribed interviews. Two coders performed qualitative thematic analysis. RESULTS Twenty-five parents/guardians completed interviews. Themes included: (1) Parents/guardians believe their child to be immune from sexual abuse due to their supervision, yet desire counseling about abuse recognition and prevention, which they also report not occurring (2) A common opinion was that counseling on menstruation was more relevant to their child's life than counseling about pregnancy-related topics (3) Parents/guardians reported a lack of counseling on pregnancy-related topics such as folic acid supplementation and teratogenesis and generally also reported some degree of interest in hearing about these topics from neurologists (4) Parents/guardians also reported a lack of counseling on drug interactions between contraception and ASMs, and were highly interested in learning more about this topic (5) Parents/guardians want neurologists to initiate annual comprehensive SRH counseling at puberty about most topics, but report that they often initiate SRH discussions themselves. CONCLUSION Parents/guardians of AYAs with epilepsy and ID prefer more frequent, neurologist-initiated, comprehensive conversations surrounding SRH particularly emphasizing menstruation and sexual abuse recognition/prevention. Findings may inform professional and patient education and health systems interventions including development of discussion guides and/or decision aides to improve SRH care for AYAs with epilepsy and ID.
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Affiliation(s)
- Geetha Vasudevan
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA.
| | - Robyn Filipink
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA.
| | - Jenna Gaesser
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA.
| | - Traci M Kazmerski
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA; Division of Adolescent and Young Adult Medicine, University Center, 120 Lytton Avenue, Mezzanine Floor, Suite M060, Pittsburgh, PA 15213, USA; Center for Innovative Research on Gender Health Equity, 230 McKee Place, Pittsburgh, PA 15213, USA.
| | - Yoshimi Sogawa
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA.
| | - Laura Kirkpatrick
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA.
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Kuper H, Heydt P, Davey C. A focus on disability is necessary to achieve HIV epidemic control. THE LANCET HIV 2022; 9:e293-e298. [DOI: 10.1016/s2352-3018(21)00345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 10/18/2022]
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Kirkpatrick L, Collins A, Harrison E, Miller E, Patterson C, Sogawa Y, Van Cott AC, Kazmerski TM. Pediatric Neurologists' Perspectives on Sexual and Reproductive Health Care for Adolescent and Young Adult Women With Epilepsy and Intellectual Disability. J Child Neurol 2022; 37:56-63. [PMID: 34657501 DOI: 10.1177/08830738211041824] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore perspectives of pediatric neurologists regarding sexual and reproductive health care for adolescent women with epilepsy (WWE) and intellectual disability. METHODS We interviewed pediatric neurologists regarding sexual and reproductive health for WWE with intellectual disability. We audio-recorded and transcribed interviews and conducted qualitative analysis. RESULTS 16 pediatric neurologists participated. Themes included the following: (1) Pediatric neurologists have differing perspectives about how intellectual disability affects WWE's sexual and reproductive health needs, (2) pediatric neurologists provide sexual and reproductive health counseling variable in content and frequency to this population, (3) pediatric neurologists tend to recommend longer-term methods of contraception for this population, and (4) pediatric neurologists are asked to be involved in decision-making around sterilization, yet express ethico-legal reservations. CONCLUSION Our findings suggest pediatric neurologists provide variable, often suboptimal, sexual and reproductive health care for WWE and intellectual disability. Themes reveal ethical concerns among neurologists about sexual and reproductive health practices including sterilization. More tailored clinical guidelines and provider training on sexual and reproductive health for this population may be beneficial.
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Affiliation(s)
- Laura Kirkpatrick
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Collins
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Allegheny Reproductive Health Center, Pittsburgh, PA, USA
| | - Elizabeth Harrison
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Christina Patterson
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Yoshimi Sogawa
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Anne C Van Cott
- Department of Neurology, UPMC Presbyterian Hospital, Pittsburgh, PA, USA.,Veterans Affairs Neurology Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, USA
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Gray SH, Byrne R, Christensen S, Williams D, Wylie M, Fowler E, Gaebler-Spira D, Marciniak C, Glader L. Women with cerebral palsy: A qualitative study about their experiences with sexual and reproductive health education and services. J Pediatr Rehabil Med 2021; 14:285-293. [PMID: 34092661 PMCID: PMC8673520 DOI: 10.3233/prm-210020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To explore the recalled experiences of women with CP regarding sexual health education and services they received. METHODS Semi-structured interviews and focus groups were conducted at four academic tertiary hospitals with 33 adult women with CP. Templates were used to ask about four key content domains: appointment planning (including planning for a gynecologic exam), accessibility of services, experiences with providers, and recommendations for improvement. Sessions were transcribed verbatim and analyzed to generate a coding dictionary. Blinded coding was carried out for each transcript, with duplicate coding used to confirm identified themes. Iterative analysis was used to identify and consolidate coding and key themes. RESULTS Similar barriers were discussed at the four sites, including lack of accessible exam tables, hospital staff unfamiliar with physical disabilities, and assumptions that women with CP are not sexually active. Many described the sexual education they received as brief, omitted, or mistimed. Self-advocacy was crucial, and recommended strategies ranged from pre-gynecologic exam medication to visit checklists. CONCLUSION Reproductive health education for young women with CP is frequently inadequate. Medical professionals lack relevant knowledge and awareness; medical facilities lack necessary infrastructure. Recommendations for improvements are made.
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Affiliation(s)
- Susan Hayden Gray
- University of Virginia Teen and Young Adult Health Center, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.,University of Virginia Teen and Young Adult Health Center, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | | | - David Williams
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Eileen Fowler
- Tarjan Center at UCLA, Center for Cerebral Palsy at UCLA, Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | - Deborah Gaebler-Spira
- Department of Physical Medicine and Rehabilitation, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Shirley Ryan Ability Lab, Chicago, IL, USA
| | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Shirley Ryan Ability Lab, Chicago, IL, USA
| | - Laurie Glader
- Division of Complex Care, Comprehensive Cerebral Palsy Program, Nationwide Children's Hospital. The Ohio State University, Columbus, OH, USA.,University of Virginia Teen and Young Adult Health Center, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
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