Women's Health Care Experiences Research Articles

“The healthcare system did fail me repeatedly”: a qualitative study on experiences of healthcare among Canadian women with Cushing’s syndrome

BackgroundAs a rare endocrine disorder, Cushing’s Syndrome (Cushing’s) is characterized by numerous symptoms and a non-specific presentation, leading to a delay to diagnosis for patients with this disease. To date, research examining the lived experiences of patients with Cushing’s in healthcare is absent in the literature. This preliminary inquiry into the healthcare experiences of women with Cushing’s aimed to examine the utility of this line of inquiry to support the patient centered care of individuals with Cushing’s.MethodsSeven women from across Canada with endogenous Cushing’s participated in the study. Semi-structured interviews were conducted examining participants’ healthcare and body-related experiences with Cushing’s. Results pertaining to healthcare experiences were analyzed for the current study using reflexive thematic analysis.ResultsFour themes emerged whereby women with Cushing’s experienced (1) a lack of patient centered care, characterized by provider miscommunication and medical gaslighting; (2) a misunderstanding of their symptoms as related to weight gain; (3) weight stigma in healthcare encounters; and (4) a shift in their quality of care following diagnosis.ConclusionsThe results highlight the importance of patient centered care as well as the negative impact of commonly reported barriers to patient centered care. Cushing’s specific barriers to patient centered care may include weight stigma as well as the rare incidence of Cushing’s. Further research is needed to better understand the healthcare experiences of people with Cushing’s in Canada.

Psychological Impact of Medical Gaslighting on Women: A Systematic Review

This systematic review aimed to evaluate the experiences of medical gaslighting in women. Medical gaslighting is used to describe the dismissive, invalidating, and biased experiences of people with the healthcare system that result in frustration, doubt, and feelings of isolation. Women have significantly negative experiences with healthcare providers when seeking diagnosis and/or treatment, which defines how they signify their experiences as medical gaslighting. To conduct the review, Google Scholar, JSTOR, PubMed, ScienceDirect, Semantic Scholar, Psychology of Health, Jacobs Health Institute of Women, and Journal of Thrombosis and Haemostasis were explored with the keywords of medical gaslighting, women's health, and healthcare experiences of women. 10 articles were selected for the systematic review after data extraction based on the inclusion and exclusion criteria. Seven themes emerged from the selected articles: 1) denial and dismissal of symptoms 2) delayed diagnosis 3) negative experiences with healthcare professionals 4) gender bias in healthcare 5) the need for self-advocacy 6) stigmatization of mental health by healthcare professionals 7) anxiety and trauma. The experiences of women with the healthcare system are overwhelmingly negative and encompassed in medical gaslighting, leading to the worsening of health conditions. The healthcare system requires many reforms, starting with decreasing gender biases in hospitals, healthcare providers and research.

Inequality in Health Care and the Experiences of Women From the Irish Traveller Community

ObjectiveTo explore the health care experiences of women from the Irish Traveller community, which is an indigenous ethnic minority group in Ireland and Great Britain. DesignA descriptive qualitative methodology underpinned by naturalistic inquiry was adopted. SettingHalting sites where the participating Traveller women permanently reside. ParticipantsThe sample consisted of 24 women from the Traveller community in Ireland. Intervention/MeasurementData were collected via two focus group interviews using semi-structured interviews. Inductive content analysis was used to analyze the data. ResultsThree overarching themes emerged: Conceptualizing What It Means to Be in Receipt of Health Care; Respecting Ethnic Customs Around Death and Dying; and Strategies for Enhancing Cultural Competence. Women from the Traveller community experienced many challenges when requiring health care services. Some recalled a health care environment that lacked compassion and was discriminatory toward them. A lack of dignity and privacy afforded to women during the “passing” of a loved one was an important finding in this study. ConclusionStrategies to improve Traveller women’s access to and engagement with health services are urgently required. These include cultural awareness training for health care providers and visual aids for Travellers accessing health services.

The far-reaching burden of Hyperemesis Gravidarum – an exploration of women’s experiences and perceptions of healthcare support

ABSTRACT Hyperemesis Gravidarum (HG) is a rare condition of pregnancy that exerts a profound effect on a woman’s physical and psychological health, but limited research regarding women’s perceptions of healthcare for this condition exists. The aim of this study was to gain insight into the personal and healthcare experiences of women with HG. Eligible participants included women who had experienced HG in a current or recent pregnancy and were referred to the dietitian at the National Maternity Hospital, Dublin, Ireland. Suitable women were invited to participate by letter, with a follow-up phone call to confirm eligibility. Four semi-structured focus groups were conducted (n = 11). Audio recordings were transcribed and data was thematically analyzed using an inductive, data-driven approach. Participants emphasized the psychological hardship of HG, which manifested in many different ways, and unveiled the far-reaching burden of HG. Women advocated for a dedicated service for HG and the need for increased knowledge, understanding and support for HG, in order to ensure optimal HG management and woman-centered care. Women also highlighted the need for obvious clinical leadership of HG and a continuum of care throughout pregnancy and post-partum. Improvements to the day ward setting and access to HG-specific mental health support would be welcomed. At a government level, timely resolution of the financial assistance for first-line anti-emetics is needed. Overall, greater awareness and understanding of the condition is needed to improve support from family, friends and colleagues. Further research is warranted to determine whether these recommendations would result in improved pregnancy outcomes.

(028) A Comparison of Genital Self-Image and Sexual Functioning among Women with Vulvar and Non-Vulvar Dermatologic Disease

Abstract Introduction Inflammatory dermatologic diseases of the vulva represent a significant morbidity burden for affected women. Genital itching, pain, and skin changes have a profound impact on sexual function. Research also suggests women with generalized, non-vulvar dermatologic diseases have impaired sexual function. The Female Genital Self-Image Scale (FGSIS) was developed and validated in a large sample of American women a decade ago. Despite developers’ suggestion that the FGSIS could be used to further understand the burden of genital disease, there remains a paucity of research in this area. Both vulvar and non-vulvar inflammatory skin disease have yet to be fully characterized with regards to impact on genital self-image (GSI), a key mediator in sexual health and behavior. Objectives The present study describes GSI, sexual function, and sexual behaviors among women with vulvar and non-vulvar inflammatory dermatoses. Methods A 20-minute Qualtrics survey was distributed between September and November 2020 through three primary means: 1) targeted social media ads, 2) relevant social media support groups, and 3) online research volunteer recruitment services. Women in the US over age 18 who have ever been diagnosed with an inflammatory dermatosis persisting longer than one month were eligible to participate. The present data were collected as part of a larger study examining sexual health, quality of life, and health care experiences of women with skin disease. Survey items analyzed included the FGSIS, the Female Sexual Function Index (FSFI), and sexual behavior histories. Results The sample consisted of 320 women with a mean age of 42.7±15.5 (Range=19-81). Most participants were pre-menopausal (n=200; 62.5%), Caucasian (n=278; 86.9%), and heterosexual (n=263; 82.2%). Nearly one-third of women (n=98; 30.6%) reported inflammatory dermatologic disease isolated to the vulva, while 150 (46.9%) had strictly non-vulvar disease, and 72 (22.5%) experienced both vulvar and non-vulvar manifestations. The average FGSIS score among women with any vulvar disease was 16.9±4.1 (range=7-28) and was significantly (p<.01) lower than that of women with non-vulvar disease (M=21.2±4.3; range=9-28), with a higher score indicating a more positive FGSIS. A similar trend was seen with the FSFI, which was significantly (p<.01) different among women with vulvar disease (M=15.4±9.7, range=2.0-35.1) compared to women with non-vulvar disease (M=21.2±10.1, range=2.0-35.1), with higher scores indicating better functioning. When stratified by category, FSFI remained significant for desire (p=.04) and pain (p<.01), but not for arousal, lubrication, orgasm, or satisfaction. Women with vulvar disease were significantly less likely to receive (p=.02) or give (p=.04) oral sex or to engage in vaginal intercourse (p<.01) during the last four weeks. Conclusions This study demonstrates severe sexual health morbidity associated with inflammatory vulvar dermatoses, characterized by very low FGSIS and FSFI scores. Pain and desire shaped sexual function for women with vulvar disease, despite non-significant differences in other domains including satisfaction. Results also indicated low FSFI scores in women with non-vulvar disease, with FGSIS scores similar to previously-described healthy controls. A more precise understanding of the role of GSI in both vulvar and non-vulvar disease will provide opportunities for improved patient-centered disease management in the realm of sexual health. Disclosure No.

Experiences and Challenges of African American and Sub-Saharan African Immigrant Black Women in Completing Pap Screening: a Mixed Methods Study.

Understanding Black women's Papanicolaou (Pap) screening experiences can inform efforts to reduce cancer disparities. This study examined experiences among both US-born US Black women and Sub-Saharan African immigrant women. Using a convergent parallel mixed methods design, Black women born in the USA and in Sub-Saharan Africa age 21-65 years were recruited to participate in focus groups and complete a 25-item survey about patient-centered communication and perceived racial discrimination. Qualitative and quantitative data were integrated to provide a fuller understanding of results. Of the 37 participants, 14 were US-born and 23 were Sub-Saharan African-born Black women. The mean age was 40.0 ± 11.0, and 83.8% had received at least one Pap test. Five themes regarding factors that impact screening uptake emerged from the focus groups: (1) positive and negative experiences with providers; (2) provider communication and interaction; (3) individual barriers to screening uptake, (4) implicit bias, discrimination, and stereotypical views among providers, and (5)language barrier. Survey and focus group findings diverged on several points. While focus group themes captured both positive and negative experiences with provider communication, survey results indicated that most of both US-born and Sub-Saharan African-born women experienced positive patient-centered communication with health care providers. Additionally, during focus group sessions many participants described experiences of discrimination in health care settings, but less than a third reported this in the survey. Black women's health care experiences affect Pap screening uptake. Poor communication and perceived discrimination during health care encounters highlight areas for needed service improvement to reduce cervical cancer disparities.

Reproductive health care appointments: How the institutional organization of obstetric/gynecological work shapes the experiences of women with female genital cutting in Toronto, Canada.

We investigated the social relations shaping the reproductive health care experiences of women with female genital cutting (FGC) in Toronto, Canada. Using Institutional Ethnography, we interviewed eight women with FGC and seven obstetrician/gynecologists (OB/GYN). We found a disjuncture between women's needs during appointments that extended beyond the reproductive body and range of care that doctors were able to provide. Women engaged in emotional healthwork during appointments by explaining FGC to doctors, reading doctors' body language, and getting through vulvar/vaginal examinations. Women reported that if they had emotional reactions during appointments, they were often referred to a mental health specialist, a referral on which they did not act. OB/GYNs described their specialty as "surgical"-training centered around treating reproductive abnormalities and not mental health issues. Therefore, the disjuncture between women's needs and OB/GYNs' institutional training highlights the difficulties inherent when bodies of "difference" encounter the reproductive health care system.

Exploring the health care experiences of women diagnosed with vulvodynia.

Although seeking diagnosis and treatment for chronic pain should be straightforward, this is not typically the case for those living with vulvodynia, who often describe it as a battle, frequently involving misdiagnosis, dismissal, and gender-based discrimination. This study explored the health care experiences of women living with vulvodynia in the United Kingdom. As they are less explored in literature, experiences postdiagnosis and across varying health care settings were specifically considered. Interviews were conducted with 6 women aged 21 to 30 years to explore their experiences when seeking help for vulvodynia. Through interpretative phenomenological analysis, 5 themes emerged: the impact of diagnosis, patients' perception of health care, self-guidance and lack of direction, gender as a barrier to effective care, and a lack of consideration of psychological factors. Women often experienced difficulties before and after diagnosis, and many felt that their pain was dismissed and ignored due to their gender. Pain management was felt to be prioritized by health care professionals over well-being and mental health. There is a need for further exploration of gender-based discrimination experiences among patients with vulvodynia, health care professionals' perceptions of their capabilities in working with such patients, and the impact of improving professionals' training in working with these patients2. Health care experiences after diagnosis are rarely examined within literature, with studies predominantly focusing on experiences surrounding diagnosis, intimate relationships, and specific interventions. The present study provides an in-depth exploration of health care experiences through participants' lived experiences and gives insight into an underresearched area. Women with negative experiences of health care may have been more likely to participate than those with positive experiences, which may have resulted in their overrepresentation. Furthermore, participants were predominantly young White heterosexual women, and almost all had comorbidities, further limiting generalizability. Findings should be used to inform health care professionals' education and training to improve outcomes for those seeking care for vulvodynia.

Association Between Availability of Women's Health Services and Women Veterans' Care Experiences.

Few studies have focused on determinants of women's ratings of care experiences in primary care. We assessed associations between availability of women's health services and women veterans' ratings of care experiences. In a cross-sectional analysis, we linked Fiscal Year (FY) 2017 (October 1, 2016, to September 30, 2017) survey data from 126 Veterans Health Administration (VA) primary care leaders to 4,254 women veterans' ratings of care from VA's Survey of Healthcare Experiences of Patients-Patient Centered Medical Home (FY 2017). The dependent variables were ratings of optimal access (appointments, information), care coordination, comprehensiveness (behavioral health assessment), patient-provider communication, and primary care provider. Key independent variables were number of women's health services 1) routinely available all weekday hours (compared with some hours or not available) and 2) available in VA general primary care vs. other arrangements. In multilevel logistic regression models, we adjusted for patient-, facility-, and area-level characteristics. A greater number of women's health services routinely available in VA primary care was associated with a higher likelihood of optimal ratings of care coordination (adjusted odds ratio [AOR], 1.06; 95% confidence interval [CI], 1.01-1.10), provider communication (AOR, 1.08; 95% CI, 1.002-1.16), and primary care provider (AOR, 1.07; 95% CI,1.02-1.13). A greater number of services available in VA primary care was associated with a lower likelihood of optimal ratings for access (AOR, 0.94; 95% CI, 0.88-0.99). For the most part, routine availability of women's health services in VA primary care clinics enhanced women's healthcare experiences. These empirical findings offer healthcare leaders evidence-based approaches for improving women's care experiences.

How Canadian Law Shapes the Health Care Experiences of Women with Female Genital Mutilation/Cutting/Circumcision and Their Providers: A Disjuncture Between Expectation and Actuality

This study explored how the reproductive health care experiences of women with female genital mutilation/cutting/circumcision (FGC) were shaped. We used Institutional Ethnography, a sociological approach which allows for the study of social relations and the coordination of health care. From qualitatively interviewing eight women with FGC, we learned that they felt excluded within the Canadian health care system because they were unable to access reconstructive surgery, which was not covered by Ontario’s universal health coverage (Ontario Health Insurance Plan). We then talked with seven obstetricians/gynecologists (OB/GYNs) and learned that while it was legal to perform certain genital (e.g., female genital cosmetic surgery) and reproductive (e.g., elective caesarean section) surgeries commonly requested by Western-born women, it was not legal for them to perform other genital surgeries often requested by immigrant populations (e.g., reinfibulation), nor were these covered by OHIP (e.g., clitoral reconstructive surgery). From participants’ comparison of clitoral reconstructive surgery and reinfibulation to female genital cosmetic and gender confirming surgeries, it became clear that the law and policies within the health care system favored surgeries elected by Western adults over those wished for by women with FGC. We found that the law had an impact on the choices that OB/GYNs and the women they treated could make, shaping their respective experiences. This created ethical dilemmas for OB/GYNs and a sense of exclusion from the health care system for women with FGC.

A scoping review of gestational diabetes mellitus healthcare: experiences of care reported by pregnant women internationally

BackgroundGestational diabetes mellitus (GDM) is a condition associated with pregnancy that engenders additional healthcare demand. A growing body of research includes empirical studies focused on pregnant women’s GDM healthcare experiences. The aim of this scoping review is to map findings, highlight gaps and investigate the way research has been conducted into the healthcare experiences of women with GDM.MethodsA systematic search of primary research using a number of databases was conducted in September 2021. Studies were included if they had an explicit aim of focusing on GDM and included direct reporting of participants’ experiences of healthcare. Key data from each study was extracted into a purposely-designed form and synthesised using descriptive statistics and thematic analysis.ResultsFifty-seven articles were included in the analysis. The majority of studies used qualitative methodology, and did not have an explicit theoretical orientation. Most studies were conducted in urban areas of high-income countries and recruitment and research was almost fully conducted in clinical and other healthcare settings. Women found inadequate information a key challenge, and support from healthcare providers a critical factor. Experiences of prescribed diet, medication and monitoring greatly varied across settings. Additional costs associated with managing GDM was cited as a problem in some studies. Overall, women reported significant mental distress in relation to their experience of GDM.ConclusionsThis scoping review draws together reported healthcare experiences of pregnant women with GDM from around the world. Commonalities and differences in the global patient experience of GDM healthcare are identified.

Healthcare experiences of uninsured and under-insured American Indian women in the United States

BackgroundExtensive health disparities exist for American Indian groups throughout the United States. Although insurance status is linked to important healthcare outcomes, this topic has infrequently been explored for American Indian tribes. For state-recognized tribes, who do not receive healthcare services through the Indian Health Service, this topic has yet to be explored. The purpose of this study is to explore how having limited access to health insurance (being uninsured or under-insured) impact American Indian women's healthcare experiences?.MethodsIn partnership with a community advisory board, this study used a qualitative description approach to conduct thirty-one semi-structured life-course interviews with American Indian women who are members of a state-recognized tribe in the Gulf Coast (United States) to explore their Western healthcare experiences. Interview were conducted at community centers, participant homes, and other locations identified by participants. Interviews were transcribed verbatim and findings were analyzed in NVivo using conventional content analysis. Findings were presented at tribal council meetings and to participants for member checking.ResultsThemes identified by participants included: (a) lack of insurance as a barrier to healthcare; (b) pre-paying for childbirth when uninsured; and (c) access to public health insurance coverage. Twenty-four women mentioned the role or importance of insurance in discussing their healthcare experiences, which was referenced a total of 59 times.ConclusionThese findings begin to fill an important gap in the literature about the health insurance experiences of American Indian tribal members. Not having insurance was an important concern for participants, particularly for elderly and pregnant tribal members. Not having insurance also kept tribal members from seeking healthcare services, and from getting needed prescriptions. In addition to promoting knowledge about, and expanding insurance options and enrollment, increased sovereignty and resources for state-recognized tribes is needed to address the health disparities experienced by American Indian groups.

Emotional Health Work of Women With Female Genital Cutting Prior to Reproductive Health Care Encounters.

We used institutional ethnography to explore the social relations that shaped the reproductive health care experiences of women with female genital cutting. Interviews with eight women revealed that they engaged in discourse that opposed the practices of cutting female genitals as a human-rights violation. This discourse worked to protect those affected by the practices, but also stigmatized female genital cutting, making participants anticipate experiencing stigmatization during health care. Women’s engagement in this discourse shaped their emotional health work to prepare for such encounters. This work included navigating feelings of worry, shame, and courage to understand what to expect during their own appointment; learning from family/friends’ experiences; and seeking a clinic with the reputation of best care for women with female genital cutting. It is important to strive for more inclusive health care in which women do not have to engage in emotional health work to prepare for their clinical encounters.

Insurance Barriers, Gendering, and Access: Interviews with Central North Carolinian Women About Their Health Care Experiences.

Women face unique logistical and financial barriers to health care access. They also have higher health care expenditures and higher rates of morbidity. Women's experiences while utilizing health care are historically less well researched and warrant exploration. We conducted 14 semistructured interviews about women's health care experiences with 11 women health consumers and 3 women health care practitioners in central North Carolina. When discussing their experiences, participants noted scheduling challenges, barriers related to insurance and cost, and dismissive or negative in-person encounters. Participants frequently discussed lack of resources for care postpartum. Practitioners noted lack of knowledge of disease burden, overmedicalization of women's care, lack of care postpartum, and trends around changes in primary care.Women health consumers in this study faced challenges related to access and in-person experience of care delivery, which were echoed by the clinician interviewees. Barriers to optimal women's health care exist even for those with insurance coverage and point to systemwide constraints as well as deficits in organizational culture. Future clinical and research efforts should include 1) increasing awareness of and facilitating access to affordable postpartum care, 2) easing burdens around scheduling appointments and improved care coordination, and 3) more research exploring women's experiences during in-person health care encounters. Concerns and barriers that women described may be due to systems-level requirements and constraints.

Experiences of homeless women in accessing health care in community-based settings: a qualitative systematic review.

Homelessness among women is on the rise in the US and continues to be a concern globally. The challenges homeless women face are unique and vast, yet how they experience health care can greatly affect their desire to access health care in the future. The ability to shed light on what is meaningful to homeless women in their health care experiences can guide the changes necessary to provide appropriate patient-centered, impactful care with the goal of increasing access by this vulnerable population. This review aimed to identify, appraise and synthesize existing qualitative evidence on the experiences of homeless women when accessing community-based health care services. This review included studies on homeless women, both previously or currently, aged 18 or older. The phenomena of interest were homeless women's health care experiences, including perspectives, narratives and/or reflections, at any time during their period of homelessness. The review included health care services received by homeless women in community-based settings, shelter-based clinics and/or mobile clinics. Qualitative data including, but not limited to, the designs of phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research were considered. Using a three-step search strategy, databases of published and unpublished articles were searched from database inception to 2018. All included studies were assessed by two independent reviewers for methodological quality, and data was extracted and pooled using the JBI System for the Unified Management, Assessment and Review of Information. Findings were rated according to their level of credibility, categorized based on similarity in meaning, and subjected to a meta-synthesis. Two reviewers utilized a meta-aggregative approach. A total of 196 qualitative articles were identified of which 24 were included after critical appraisal. Meta-synthesis generated three synthesized findings: (1) Homeless women who access health care services at community-based settings feel as if their homelessness qualifies them as second-class citizens, which impedes future access; (2) Homeless women have an expectation of therapeutic communication from their health care providers, the lack of which can incite negative emotional responses, fear and knowledge deficits; (3) Homeless women with limited resources struggle to prioritize competing needs, such as transportation, time and money, which influences their ability to access health care. These synthesized findings were derived from 47 study findings that were subsequently aggregated into 10 categories. Of the 47 study findings, 32 were rated as unequivocal and 15 were rated as credible. The overall ConQual for each of the three synthesized findings was low due to common dependability issues across the included studies. A total of 454 participants were included. The included studies were published from 1997 to 2017. The review identified that homeless women's experiences when accessing health care in community-based settings, particularly in the US, have been poor and have negatively affected their desire to access health care in the future. The synthesized findings illustrate clear indicators for use of cultural competence and addressing provider bias in the delivery of health care to homeless women. This review also highlights the importance of understanding clinical experiences of providing direct care for these women in order to shed light on the type of advocacy needed to ensure equitable access to health care services. While this review uncovered issues with some global health care systems, the predominance of system constraints within the US highlights the need for health policy reform to improve the experiences of homeless women when accessing health care.

A mixed methods study exploring methadone treatment disclosure and perceptions of reproductive health care among women ages 18–44 years, Los Angeles, CA

IntroductionOpioid use disorder (OUD) and methadone treatment are increasing among women ages 18–44 years old, a population with unique healthcare needs. Despite this increase, there is little research on the healthcare experiences of women with OUD, particularly experiences with reproductive healthcare. MethodsWe designed a sequential, mixed-methods study in three Los Angeles methadone clinics. In the first phase, we conducted in-depth interviews with women in methadone treatment (n = 22) (September–December 2016). After thematic coding and analysis, we designed and administered a survey to understand patterns in women's experiences and reproductive health knowledge, attitudes, and behavior (n = 50) (January–April 2018). We conducted descriptive statistics, then integrated the quantitative and qualitative findings to contextualize and understand perceptions and experiences with healthcare providers among women in methadone treatment. ResultsWe found that women experienced and anticipated that providers would treat them poorly when they disclosed that they were in methadone treatment for OUD. Women's actual experiences with disclosure, shared in in-depth interviews, varied by whether they had disclosed their status intentionally or inadvertently. Approximately one-third (37%) of survey respondents thought a healthcare provider would scold them if they became pregnant; however, all who had been pregnant in the past while on methadone (n = 11) reported disclosing methadone treatment during pregnancy to their provider. Under a quarter of all women (22%) said having a healthy pregnancy while on methadone was likely or very likely. These perceptions were reinforced by negative experiences with providers, or, in many cases, women in the survey reported that they had never discussed the recommendations for a healthy pregnancy while on methadone with a healthcare provider. DiscussionWomen experience and anticipate experiencing negative interactions with their healthcare providers if and when they disclose their methadone treatment. These perceptions and experiences impact subsequent treatment seeking and disclosure. The majority of women did not discuss pregnancy with healthcare providers. To improve quality of care, healthcare providers can provide a safe space for women to disclose methadone treatment through nonjudgmental communication that intentionally alleviates stigma. Additionally, healthcare providers should understand medical guidelines and laws/policies around methadone during pregnancy and communicate this understanding to all patients who may wish to become pregnant or who are at risk for unintended pregnancy.

Improving Health Equity for Women Involved in the Criminal Legal System.

Improving Health Equity for Women Involved in the Criminal Legal System.

Female genital mutilation and women's healthcare experiences with general practitioners in the Netherlands: A qualitative study.

ObjectivesWhile the general practitioner (GP) in the Netherlands is the first point of entry to and gatekeeper of the healthcare system, no study exists to explore the experiences of women with female genital mutilation or cutting (FGM/C) in general practice. Therefore, the aim of this study is to look into the experiences of women with FGM/C in Dutch general practice.MethodsSemistructured interviews were held with 16 women with FGM/C. Sampling was purposeful. The interview guide and thematic analysis were based on the Illness Perception Model and Kleinman’s Explanatory model. Interviews were held in English or Dutch. All data were anonymized, and recordings were transcribed verbatim. Transcripts were coded and thematically analyzed.ResultsThe women considered FGM/C to be connected to a range of health problems, for which not all of them sought medical care. They had difficulty discussing such a sensitive topic with their GP, did not know their problems could be relieved or perceived GPs to have insufficient knowledge of FGM/C. Lack of time during consultations and overall dissatisfaction with Dutch GP care hampered trust. They strongly preferred the GP to be proactive and ask about FGM/C.ConclusionThere is room for improvement as most women would like their GP to discuss their health problems related to FGM/C. GPs should take a proactive attitude and ask about FGM/C. In addition, to develop the trusted relationship needed to discuss sensitive topics and provide culturally sensitive person-centered care, sufficient time during consultations is needed.

Intimate Partner Violence and Body Shame: An Examination of the Associations Between Abuse Components and Body-Focused Processes.

Intimate partner violence (IPV) is a stigmatizing, interpersonal violation with elements that confer risk for body shame. This study examined the role of body-focused processes (i.e., self-objectification and body surveillance) in the development of body shame within a sample of 61 primarily African American women, exposed to moderate to severe IPV. Severity of sexual coercion, physical assault, and psychological abuse were significantly associated with increased body shame and self-objectification. Mediation analyses revealed that self-objectification was a unique mediator of the relationship between psychological abuse, physical assault, sexual coercion, and body shame. Implications for women's health care experiences are discussed.

Exploring women's health care experiences through an equity lens: Findings from a community clinic serving marginalised women.

To explore how marginalised women perceive and rate equity-oriented health care at a primary care clinic using items that evaluate patients' experiences of care. Despite an increased recognition of the importance of health care that is equity-oriented, and that understands the patient within the context of the broader social determinants of health, inequities in health remain prevalent around the world. Items from the "EQUIP Primary Health Care"research programme were used to explore patients' experiences of equity-oriented healthcare. Women were invited to complete the questionnaire with the explicit aim of gainingtheir input to improve quality of care at the clinic. The Strengthening the Reporting of Observational Studies in Epidemiology Statement was followed for the study. Sixty-seven women who experienced significant health and social inequities, and were seeking care at a women's only nurse practitioner primary health care clinic in Canada, were invited to complete the questionnaire. For quality improvement purposes, correlational analyses were used to explore women's experiences of care. Women's responses showed that Promote Emotional Safety and Trust and Overall Quality of Care were the most highly correlated domains, indicating the importance of the health care teamin establishing trusting relationships, particularly for women who experience stigma and negative judgement when seeking care. Seeking feedback from patients on their experiences of care using items developed to explicitly tap into equity issues is useful in understanding how patients experienceequity-oriented healthcare. Responses from the women highlight the importance of understanding not only the what of equity-oriented care but also the how. The results of this study illustrate the importance of establishing trusting relationships, tailoring care, and using a nondiscriminatory approach when working with women who experience negative judgements when seeking care.