Women's Health Care Providers Research Articles

Speculum self-insertion: an alternative method for gynaecological examination?

Speculum examination is an intrusive practice in the clinical care of women. It requires privacy and patients may experience discomfort or anxiety related to the procedure, which can result in delays or avoidance of necessary healthcare. Speculum self-insertion originated in the United States in the 1970s as part of the self-help movement. However, this clinical practice is largely unknown among healthcare providers and has rarely been assessed. This study investigates the women's views and healthcare providers' experiences of the self-insertion method. A qualitative study was conducted between December 2021 and October 2022, including fieldwork combining semi-structured interviews (10 women) and focus groups associated with individual interviews of 13 healthcare providers. The data collected were independently coded by 2 authors and analysed using an inductive approach and grounded theory method. Speculum self-insertion was described as a way to decrease discomfort and facilitate speculum insertion. Self-insertion was proposed as a means of allowing women to participate in the examination, reducing their vulnerability against power imbalances in the doctor-patient relationship. Both patients and healthcare providers have reported that speculum self-insertion is a method that can contribute to improving trust and communication during the examination. The practice of speculum self-insertion during the consultation is an alternative to traditional practitioner insertion and may be offered to all women by any practitioner who wishes to use this technique.

HPV Vaccine Uptake, Willingness to Receive, and Causes of Vaccine Hesitancy: A National Study Conducted in Saudi Arabia Among Female Healthcare Professionals.

Epidemiological evidence has shown that human papillomavirus (HPV) is the most frequent cause of sexually transmitted infection, and vaccination is an essential measure to prevent associated diseases and complications. This study aimed to assess the HPV vaccine uptake and its associated factors as well as HPV vaccine hesitancy by female healthcare workers (HCWs) in Saudi Arabia. This online, questionnaire-based, cross-sectional study involved female HCWs in Saudi Arabia between July and October 2022. The study tool included questions about sociodemographic, occupational, and reproductive characteristics, uptake of HPV vaccination, and reasons of hesitancy. Chi-squared and t-tests were used for bivariate analyses, and multivariable logistic regression was used to adjust for confounders. The total number of participants was 1857. Around 20% of HCWs received at least one dose of the HPV vaccine, and around 45% were willing to take it this year. Lower odds of vaccine uptake were reported among older participants and those with a higher level of education. However, nurses, HCWs with a previous HPV infection, those with a family history of cervical cancer, or those with a previous cervical cancer screening test had higher odds of receiving the vaccine. On the other hand, older participants and diploma degree holders were less willing to take the HPV vaccine. Higher odds of willingness were reported in married HCWs, those with a previous HPV infection, those who received a previous HPV vaccine dose, or those who were screened for cervical cancer. Lack of knowledge and some misconceptions were the most reported reasons for hesitancy. Certain factors that affect HCWs personal decisions to take the vaccine were identified. By targeting these issues, epidemiologists, public health officialsand women's health care providers can work to increase HPV vaccine uptake and reduce the burden of HPV-related diseases in this population.

An Integrative Review of Adverse Childhood Experiences and Reproductive Traumas of Infertility and Pregnancy Loss.

Adverse childhood experiences (ACEs) can lead to chronic diseases and mental health conditions; however, less is known about the associations of ACEs to the reproductive traumas of infertility and pregnancy loss. The purpose of this integrative review was to explore relationships between ACEs and the reproductive traumas of infertility and pregnancy loss. We searched PubMed, SocINDEX, PsycINFO, and CINAHL databases in December 2021 and 2022. Inclusion criteria were qualitative or quantitative research, systematic or integrative reviews, or meta-analysis articles in English that were peer-reviewed and full-text, addressing any ACE from the ACE Checklist and infertility or pregnancy loss. A total of 20 articles were included in the review. We used Whittemore and Knafl's integrative review framework, Preferred Reporting Items for Systematic Reviews and Meta-analyses for reporting, and Covidence software for data management. A quality appraisal using Joanna Briggs Institute critical appraisal tools was performed. Relevant data were extracted into a matrix for iterative comparison. Twenty studies were included in the review. Results support there may be an association between pregnancy loss and infertility in women with a history of ACE, although results are mixed between infertility and ACEs. We also identified other concepts related to ACEs and the reproductive traumas of infertility and pregnancy loss and include racial and ethnically diverse populations, social determinants of health, modifiable risk factors, and stress appraisals. Midwives and other women's health care providers should be aware that ACEs may be associated with pregnancy loss and infertility, although additional research is needed to further explore the relationships with infertility, mental health, and hypothalamic-pituitary-adrenal axis dysregulation from allostatic load. Trauma-informed care and the development of effective interventions are warranted for women who experience ACEs. Providers should consider earlier interventions, including emotional services, for women with a history of ACE or reproductive trauma.

Terrorist attacks against women's healthcare facilities 1970-2018.

Targeted acts of violence against women's healthcare facilities and healthcare providers are a continued threat to the safety and well-being of those seeking reproductive care as well as those who provide it around the world. This study aims to review and analyze terrorist attacks against facilities and providers who offer women's healthcare services globally. A thorough analysis of data coming from the Global Terrorism Database (GTD) was performed. This database is run by the National Consortium for the Study of Terrorism and Responses to Terrorism. Two hundred and seventy-one incidents registered in the GTD between 1970 and 2018 were found to be terrorist attacks on women's healthcare facilities, the majority of which occurred in the United States. The method of attack or weapons used varied greatly. While the majority of these attacks targeted facilities, a number of attacks focused on individuals, namely, healthcare providers. Facilities and providers associated with women's healthcare services, particularly reproductive health, remain at risk of terror attack. Although carried out by a variety of groups and with diverse methods, these attacks appear most prevalent, or most reported, in Western society and threaten essential reproductive healthcare.

Homeopathy: A State of the Science Review With Recommendations for Practical Therapies in Midwifery Practice.

A substantial proportion of adults and children in the United States use complementary and alternative health practices, including homeopathy. Many homeopathic therapies are readily available over the counter, and many individuals access and self-administer these therapies with little or no guidance from health care practitioners. In addition, patients and health care providers are often confused by terminologies associated with complementary practices and may be unable to distinguish homeopathy from naturopathy, herbalism, holistic medicine, Ayurveda, traditional Chinese medicine, or other forms of health care. Compared with European and Asian countries, education in the United States about complementary and alternative health practices is not typically found within traditional nursing, midwifery, or medical education curricula. Given this lack of education and the broad acceptance and popularity of homeopathy, it is necessary for health care practitioners to improve their knowledge regarding similarities and differences among therapies so they can fully inform and make appropriate recommendations to patients. The intent of this article is therefore to examine the state of existing science of homeopathy, distinguish it from other complementary methods, and provide midwives and women's health care providers with an introduction to common homeopathic therapies that may be recommended and safely used by persons seeking midwifery care. This review also presents the evidence base, pharmacology, manufacturing, and regulation of homeopathic therapies. We also consider controversies and misunderstandings regarding safety and efficacy of homeopathic remedies relevant to women and birthing persons. Examples of practical applications of homeopathic therapies for use in midwifery practice are introduced. Implications for practice and sample guidelines are included.

Pre- and peri-traumatic event stressors drive gender differences in chronic stress-related psychological sequelae: A prospective cohort study of COVID-19 frontline healthcare providers

Women are at heightened risk for chronic stress-related psychological sequelae (SRPS), including major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) in response to potentially traumatic events, including the COVID-19 pandemic. However, few studies have examined pre- and peri-event stressors that could account for gender differences in chronic SRPS. To address this gap, we conducted a prospective cohort study of healthcare providers (HCPs) caring for patients with COVID-19 at a large tertiary care hospital in New York City, and measured mental health risk factors and symptoms of MDD, GAD, and PTSD at baseline (April 2020) and at a 7-month follow-up (December 2020). We defined chronic SRPS as the presence of probable MDD, GAD, and/or PTSD at both timepoints. We conducted a mediation analysis to evaluate whether pre- and peri-event stressors explained women's increased risk for chronic SRPS. Among our sample of 786 HCPs, 571 (72.6%) were women. Compared with men, women were twice as likely to have chronic SRPS (18.7% vs. 8.8%, χ2[1] = 11.38, p < 0.001). However, after accounting for pre- and peri-event stressors, being a woman was no longer associated with chronic SRPS (p = 0.58). The pre- and peri-event stressors that accounted for this heightened risk among women included being in a woman-prevalent profession (specifically nursing; estimate = 0.08, SE = 0.04, p = 0.05), pre-pandemic burnout (estimate = 0.11, SE = 0.05, p = 0.04), greater family-related (estimate = 0.09, SE = 0.03, p = 0.004), infection-related (estimate = 0.06, SE = 0.02, p = 0.007), and work-related concerns (estimate = 0.11, SE = 0.03, p < 0.001), and lower leadership support (estimate = 0.07, SE = 0.03, p = 0.005). These findings can inform institutional interventions to mitigate the risk of chronic SRPS among women HCPs.

Psychiatric Symptoms in Women with High-risk Pregnancy in the Postpartum Period: A Case-control Study.

Psychiatric symptoms are common mental issues in pregnancy and the postpartum period. There is limited information regarding the psychiatric symptoms of women with high-risk pregnancy in the postpartum period. This study aimed to compare the severity of psychiatric symptoms and psychological distress in women with high-risk and low-risk pregnancies in the postpartum period. This case-control study examined 250 women in the postpartum period in two groups with low-risk (n = 112) and high-risk (n = 138) pregnancies. Women completed the Brief Symptom Inventory-53 (BSI-53) and the Risk Postnatal Psychosocial Depression Risk Questionnaire (PPDRQ). The mean severity of psychiatric symptoms in women with high-risk pregnancies was significantly higher than that in women with low-risk pregnancies (39.34 ± 17.51 vs. 30.26 ± 17.08). Additionally, the frequency of psychological distress in women with high-risk pregnancies was approximately twice higher than that in women with low-risk pregnancies (30.3% vs. 15.2%). Furthermore, the risk factors for depression in women with high-risk pregnancies were almost 1.5 times (59.8% vs. 39.8%) higher than the factors in women with low-risk pregnancies. The results of the logistic analysis indicated that high-risk pregnancies could be twice the odds ratio of developing postpartum psychological distress (ß = 2.14, 95% CI 1.4-6.3, p= 0.036). Psychiatric symptoms and the psychological distress index are higher in postpartum women with high-risk pregnancies than in postpartum women with low-risk pregnancies. The study suggests that obstetricians and pregnant women's health care providers should strongly consider screening of psychiatric symptoms in women with high-risk pregnancies both during pregnancy and after delivery as the women's routine care priorities.

Abstract P1-08-09: DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women

Abstract Breast cancer is now the most common cancer. Thirty years of increased awareness, early diagnosis, and treatment access contributed to a 40% decline in breast cancer deaths. Yet, in 2021, more than 281,550 new cases of invasive and 49,290 new cases of non-invasive breast cancer will be diagnosed in U.S. women. Black women are 40% more likely to die of breast cancer - the highest breast cancer death rate across racial and ethnic groups. Today, the Black-white breast cancer mortality gap persists, and Black metastatic breast cancer (MBC) patients have a poorer prognosis. The pandemic exacerbated breast cancer disparities. In 2020, delays and avoidance contributed to an 85% breast cancer screening drop while MBC patients’ risk of severe illness and death from COVID-19 elevated. Therapy interruptions and abandonment increased, and conversely, clinical trial enrollment decreased. COVID-19 has accelerated the digital platform shift to telemedicine, online psychosocial support programs, virtual patient navigation, and digital engagement across the oncology care continuum. DC Pink Divas Intervening Virtually to Advance Saving Lives (DIVAS) is an award-winning evidence-based training, outreach, and patient navigation program developed to address the educational needs of Black early-stage, MBC breast cancer patients, survivors, and caretakers and provide strategies to educate, empower and impact women by increasing breast health knowledge, decreasing gaps in screenings and access, increasing awareness of MBC to ensure that where a woman lives, will not determine if she lives through a 1-year commitment of attendance in 8 cohort-based education modules where Black breast cancer mortality is highest. The DIVAS Health Behavioral Change Model adapts the Precaution Adoption Process Model, Health Behavior Model, and Social-Ecological Model. DIVAS implements innovative virtual outreach programs, training, and intervention strategies to empower Advocates to educate peers, providers, and policymakers. 3 Cohorts of Black women impacted by breast cancer trained as Lay Breast Health Advocates from 2011, 2020, and 2021 (N = 57; 77.5 % 45 years or younger; 36.7% early-stage 0-II, 50% late stage III-IV, 10.3% caretakers) self-reported their lifestyle behaviors, breast cancer diagnosis, breast health education, social media use, and interest in a digital-based lifestyle intervention. Participants completed pre-and post-surveys, interviews, and journaling over 10.5+ hours of education modules to understand their breast health, provider-related challenges, and community-related resources. Findings provide evidence that cohort-tailored education is a successful method of supporting Black women in a behavioral-health intervention. The provision of printed culturally attuned information along with the digital-based instruction from a Black woman health care provider or public health expert is effective in helping Black breast cancer survivors transition into patient empowerment, improve QOL and contribute to better patient outcomes. After the intervention and completion of breast health modules, participants reported increased: self-efficacy in communicating with providers (70%) and self-efficacy in making treatment decisions (70%) self-confidence (85%), and a decrease in lifestyle risk factors (87%). Patient-centric behavioral health interventions in breast cancer education must be advanced digitally to address the pandemic’s compounded crisis. DC Pink Divas provides insights to combat rising disparities by educating, empowering, and mobilizing Black lay breast health advocates to improve outcomes. Collaborative digital interventions across the care continuum to improve awareness, access, adherence, infrastructure, culturally attuned training, and support are evidence-based methods for navigating the cancer care transformation accelerated by COVID-19 to advance breast health equity. DIVAS Logic Model 2011- 2022 Logic model demonstrating inputs, activities, outputs and short and long term outcomes 2020- 2021 Cohort Sentiments and Behaviors Cohort outcomes from DC Pink Divas DIVAS In-Person vs Virtual Training Lay Breast Health Advocates recorded outcomes from cohorts 2011, 2020, and 2021 Citation Format: Falasha Zuend, Shyrea Thompson, Lori Wilson. DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-08-09.

Effect of an Educational Intervention on Women's Health Care Provider Knowledge Gaps About Breast Cancer Risk Model Use and High-risk Screening Recommendations.

To assess effectiveness of a web-based educational intervention on women's health care provider knowledge of breast cancer risk models and high-risk screening recommendations. A web-based pre- and post-test study including 177 U.S.-based women's health care providers was conducted in 2019. Knowledge gaps were defined as fewer than 75% of respondents answering correctly. Pre- and post-test knowledge differences (McNemar test) and associations of baseline characteristics with pre-test knowledge gaps (logistic regression) were evaluated. Respondents included 131/177 (74.0%) physicians; 127/177 (71.8%) practiced obstetrics/gynecology. Pre-test, 118/177 (66.7%) knew the Gail model predicts lifetime invasive breast cancer risk; this knowledge gap persisted post-test [(121/177, 68.4%); P = 0.77]. Just 39.0% (69/177) knew the Gail model identifies women eligible for risk-reducing medications; this knowledge gap resolved. Only 48.6% (86/177) knew the Gail model should not be used to identify women meeting high-risk MRI screening guidelines; this deficiency decreased to 66.1% (117/177) post-test (P = 0.001). Pre-test, 47.5% (84/177) knew the Tyrer-Cuzick model is used to identify women meeting high-risk screening MRI criteria, 42.9% (76/177) to predict BRCA1/2 pathogenic mutation risk, and 26.0% (46/177) to predict lifetime invasive breast cancer risk. These knowledge gaps persisted but improved. For a high-risk 30-year-old, 67.8% (120/177) and 54.2% (96/177) pre-test knew screening MRI and mammography/tomosynthesis are recommended, respectively; 19.2% (34/177) knew both are recommended; and 53% (94/177) knew US is not recommended. These knowledge gaps resolved or reduced. Web-based education can reduce important provider knowledge gaps about breast cancer risk models and high-risk screening recommendations.

Gender and Racial Diversity Among the Head Medical and Athletic Training Staff of Women's Professional Sports Leagues.

Despite increased awareness for promoting diversity, orthopaedics remains one of the least diverse specialties. Studying health care providers in women's professional sports provides a unique opportunity to analyze gender and racial diversity. There would be low female and minority representation across the various women's professional sports leagues. There would be an increased number of female head certified athletic trainers (ATCs) when compared with head team physicians (HTPs). Cross-sectional study. We evaluated the perceived race and sex of designated HTPs and ATCs in the Women's National Basketball Association, National Women's Soccer League, and National Women's Hockey League. Type of doctorate degree, specialty, and years in practice were also collected. Kappa (κ) coefficient measurements were used to determine interobserver agreement on race. Categorical and continuous variables were analyzed using chi-square and t tests, respectively. There were significantly more female ATCs than female HTPs (74.1% vs 37.5%; P = .01). Minority representation between HTPs and ATCs was not significantly different (20.8% vs 40.7%; P = .13). Black HTPs (12.5%) and Black ATCs (22.2%) composed the largest proportion among the minority groups. There was high interobserver agreement of perceived race across HTPs (κ = 1.0) and ATCs (κ = 0.95). Although there were more female ATCs than HTPs in women's professional sports leagues, both cohorts lack perceived racial diversity. These data suggest an opportunity for diversification in medical and training staff of women's professional sports.

Migraine treatment in pregnancy: A survey of comfort and treatment practices of women's healthcare providers.

The objective of this study was to assess women's healthcare providers' treatment practices for pregnant women with migraine. Migraine is associated with several maternal and fetal complications during pregnancy, including preeclampsia and preterm birth. Migraine treatment during pregnancy can present significant challenges due to lack of controlled clinical trials and risks associated with specific medications. Women's healthcare providers were queried regarding practice patterns and comfort with use of acute and preventive migraine treatments during pregnancy. The survey was distributed online. The survey was completed by 92 women's healthcare providers (response rate 22.9% [92/402]), with most specializing in general obstetrics and gynecology (91% [83/92]). Approximately one-fourth (26% [24/92]) of respondents indicated they counseled women on migraine treatment in pregnancy as early as before pregnancy contemplation, while over one-third (35% [32/92]) counseled on migraine treatment once the patient became pregnant. The majority of respondents reported feeling somewhat or very comfortable with recommending (63% [58/92]) or continuing (64% [59/92]) acute treatments for pregnant patients with migraine, with highest comfort levels for acetaminophen (100% [92/92] for prescribing or continuing) and caffeine (94% [85/90] prescribing, 91% [82/90] continuing). Higher levels of discomfort were reported with triptans (88% [80/91] rarely or never prescribe during pregnancy). Survey respondents felt less comfortable with recommending preventive migraine treatments to pregnant patients (40% [37/92] somewhat or very comfortable), compared with a higher comfort level with continuing preventive medications (63% [58/92] somewhat or very comfortable). Highest comfort levels were reported with use of magnesium (69% [63/91] comfortable prescribing, 82% [75/92] comfortable continuing) and non-pharmacologic approaches (70% [62/89] comfortable prescribing, 84% [75/89] comfortable continuing). Nearly 40% (35/92) of respondents reported that they typically refer to neurologists or headache specialists for migraine treatment during pregnancy. This survey of women's healthcare providers revealed varying levels of comfort regarding migraine management during pregnancy, and highlights the need for additional education regarding migraine treatment safety data during pregnancy.

The Effect of Base Theory Educational Intervention on Health-Promoting Lifestyle in Women Susceptible to Cardiovascular Diseases: Application of the Theory of Planned Behavior.

Cardiovascular diseases are the second leading cause of mortality, disability, and reduced productivity in women over 40 years and the first cause of mortality in women over 60 years. Therefore, the present study aimed to determine the effect of educational intervention based on theory of planned behavior (TPB) on health-promoting lifestyle in women susceptible to cardiovascular diseases. This quasiexperimental study was conducted on 200 women susceptible to cardiovascular diseases referred to health centers in Fasa city, Fars province, Iran. The available sampling was performed on women who referred to the centers and had a family record. In this study, two health-promoting lifestyle questionnaires consisting of 49 questions and the theory of planned behavior questionnaire consisting of 50 questions were used. The obtained data were analyzed by using the SPSS software version 24 in two stages before and six months after the educational intervention through paired t-test, independent t-test, chi-square test, and McNemar test. The mean age of women in the experimental and control groups was 38.74 ± 9.22 and 39.14 ± 9.08 years, respectively. The results showed a significant increase in the experimental group after six months of intervention in terms of health-promoting lifestyle and constructs of the theory of planned behavior. Also, mean blood pressure, fasting blood sugar, and smoking of experimental group decreased six months after the educational intervention. Considering the irreplaceable role of education in adopting healthy behaviors and the role of women in strengthening the family foundation, quality educational programs should be designed and regularly implemented by health care providers for women.

Postpartum Psychosis: The Role of Women’s Health Care Providers and the Health Care System

The postpartum period is a time of high risk for serious psychiatric symptoms and hospitalization. Postpartum psychosis (PPP) is the most severe disorder that emerges during this time, with significant and wide-ranging consequences that can include suicide and infanticide. A PubMed, MEDLINE, and PsycINFO search was completed for English-language publications about PPP, including subtopics (eg, infanticide, maternal suicide). Citations in these articles were also reviewed for relevant references. Although it is clear that the triggering event for PPP is childbirth, the processes by which this occurs are not fully understood, which is a critical need for being able to predict, prevent, and manage PPP. There are risk factors that contribute to PPP, and specific groups of women may be at increased risk (eg, women with bipolar disorder). Many questions and challenges remain related to the phenomenology, nosology, prevention, and treatment of PPP. However, there are changes that women's health care providers and systems can take to improve the care of women at risk of and experiencing PPP. Of the 1382 articles reviewed, 8 met eligibility criteria, representing 6 distinct cohorts and 726 subjects. Synthetic slings available for review were either tension-free vaginal tape (TVT) or minisling. The vast majority of studies demonstrated similar short- and long-term success rates of AFS and SS procedures utilizing a range of outcome measures. Both AFS and TVT sling had low recurrence rates in short- and long-term follow-up. However, AFS had significantly longer operative time, and longer hospital stay. Bladder perforation, on the other hand, occurred more commonly in TVT sling. Health-related quality-of-life scores, including sexual function, were similar between groups. Postpartum psychosis is a rare but serious condition. However, recovery is possible. Women's health care providers and systems can improve the care by better understanding the needs of women and families, offering patient-centered discussions and options for care, particularly those that promote recovery, minimize risk, and limit the interruption of the maternal-infant bond. Improving the prevention and treatment of PPP can have a broad impact for women, children, and families.

P010Healthcare at the margins: The role of healthcare providers in self-managed abortion near the us-mexico border

<h3>Objectives</h3> To examine the role of healthcare providers in women's experiences attempting self-managed abortion. <h3>Methods</h3> This study draws from in-depth interviews with women who attempted a self-managed abortion within the past 10 years. Respondents were recruited using social media advertisements and were eligible if they were at least 14 years old, spoke English or Spanish, and lived in the US near the Mexican border. I thematically indexed transcripts and applied analytic codes to explore the role of healthcare providers in women's experiences. <h3>Results</h3> Between June 2020 and January 2021, 55 women participated in an interview. Most interview respondents (n=39) had had contact with a pharmacist, clinic staff member, or medical provider prior to or following their self-managed abortion attempt. They did so through both formal pathways (eg, clinic-based information or services such as ultrasound) and informal pathways (eg, information and medications from people in their social networks and south of the US border). Respondents who contacted a healthcare provider reported a range of experiences, including positive responses that provided comfort and validation, neutral responses that normalized self-management, and negative responses that resulted in emotional stress and led women to conceal their health needs and experiences. <h3>Conclusions</h3> As abortion becomes further restricted in the US, more people will turn to self-managed abortion. Providers should be made aware of the consequences of negative reactions toward people seeking care and understand the critical role they might play (both formally and informally) in reducing risk, harm, and stigma in this new legal landscape.

Experiences of Mothers Participating in a Mother-Child Video Therapy Program.

Responsive and sensitive parenting promotes the development of self-regulation and lowers stress in children, which in turn is associated with greater educational and economic achievement and better physical and emotional health later in life. Dyadic parent-child video-feedback programs can help parents learn effective parenting skills, yet these programs are estimated to retain only about half of eligible participants. Programs vary widely, and little is known about what is valued by parents who do complete these programs. The purpose of this qualitative study was to understand the goals, experiences, and outcomes important to mothers who completed a video-feedback program. Transcripts of exit interviews of participants in a video-feedback program (N = 31) were analyzed using qualitative description methodology. Trustworthiness was achieved through deep engagement with the material, following an iterative process in analyzing transcripts, and member checks to confirm results. Mothers enrolled in the program to better understand their child, help their child learn, and to develop closer connections with their child. Elements of the program that helped mothers achieve these goals were (1) positive feedback and support by the therapist, (2) dedicated one-on-one time spent with their infant, (3) help with concrete needs, and (4) learning from watching videotaped play sessions. As a result, mothers reported greater confidence as caregivers, use of more responsive and sensitive parenting strategies, and improvements in their children's behaviors and their own mental health. Incorporating elements of the program found to be most useful in this study into video-feedback programs may make video-feedback programs more attractive to parents and increase retention. Midwives and women's health care providers may incorporate elements of the program into their clinical practice and advocacy, with special attention to elements most valued by parents themselves.

Prevalence of depression and associated factors among pregnant women attending antenatal care in public health institutions of Awabale Woreda, East Gojjam Zone, Northwestern Ethiopia: A cross-sectional study.

Antenatal depression is a serious health problem and has negative consequences for the mother, fetus, and the entire family. However, it is a neglected component of care especially bay health care providers for women in pregnancy. The purpose of this study was to assess the prevalence of depression and associated factors among pregnant women attending antenatal clinics in public health institutions, in the Awabale Woreda. An institutional-based cross-sectional study was conducted in 2018 and a stratified sampling technique was used to select the study health institutions. All seven public health institutions in Awabale District were included to select 393 mothers and the sample size was proportionally allocated based on the number of target mothers. We used EpiData version 3.1software for data entry and SPSS version 20 software for cleaning and analysis. A Bivariable logistic regression analysis was used to identify the association between each outcome variable and the factor. Again, a multivariable logistic regression analysis was employed to identify factors associated with each outcome variable, and variables with a p-value less than 0.05 were taken as significant variables. Edinburgh Postnatal Depression Scale was used to declare the presence of antenatal depression with a cut point score of 13 and above. This study showed that 63(17.8%) pregnant mothers had antenatal depressive symptoms. Women who were employed 85% reduced to develop antenatal depression than housewives [AOR = 0.15(0.001-0.25)]. Pregnant women who attended high school and above educational level were 18 times more likely to develop antenatal depression than women who had no formal education [AOR18.15 (2.73-120.76)]. Women who had poor husband feeling on the current pregnancy were 4.94 more likely to develop antenatal depression than women who had good partner feeling on the current pregnancy [AOR = 4.94(95%CI: 1.78-13.72)]. Women who had a history of depression were 8.2 times to develop antenatal depression than women who had no history of depression [AOR = 8.22 (95%CI: 2.87-23.57)]. This study revealed that approximately one-fifth of pregnant women developed antenatal depression. Women's occupational status, educational status, previous history of depression, and poor husband feeling on the current pregnancy were the significant factors of antenatal depression.

COVID-19 Vaccine Acceptance and Its Risk Factors in Iranian Health Workers 2021.

Background: Ensuring vaccine acceptance in societies is a growing challenge for healthcare systems worldwide. This study aimed to identify factors associated with vaccine acceptance rates.Methods: This cross-sectional study was conducted as a national web-based survey from February 9th-13th, 2021, just before the release of the COVID-19 vaccine in Shiraz, Iran. Independent variables included age, gender, occupation, history of COVID-19 infection, underlying diseases, and source of information. The willingness to be vaccinated was the dependent variable. A logistic regression analysis was performed to determine the relationship between different variables and the willingness to receive the COVID-19 vaccine. The significance level was set at less than 0.05. The data were analyzed using SPSS software version 21.Results: Of 2,699 healthcare respondents, 70.3% indicated a willingness to receive the COVID-19 vaccine, of whom 49.2% preferred to receive a foreign vaccine and 24.68% desired to receive an Iranian vaccine. The women were more willing to receive the vaccine (67.6%) than the men (78.2%). Based on the results of logistic regression, gender (P<0.001) and job (P=0.005) were the most important associating factors to the willingness to receive the COVID-19 vaccine.Conclusion: Although the majority of participants were willing to receive the COVID-19 vaccine, 29.6% were not yet ready. Women’s healthcare providers were more hesitant to recommend the vaccine. As a result, the findings of this study can help policymakers and decision-makers in the field of health, treatment, and prevention of COVID-19 in raising the level of vaccination awareness among healthcare workers.

The Liberal Social Values of Swedish Healthcare Providers in Women's Healthcare: Implications for Clinical Encounters in a Diversified Sexual and Reproductive Healthcare.

Objectives: Women’s healthcare is a potential source of cross-cultural conflicts. Diverging values between healthcare providers and patients challenges the provision of culturally sensitive care and meeting migrant women’s needs. The aim is to investigate healthcare providers’ values in relation to sexual and reproductive rights, gender equality, migration and religion in Swedish sexual and reproductive healthcare. Methods: A national cross-sectional study was carried out. The questionnaire was distributed through a non-probability sample to midwives or other nurses, gynaecologists and obstetricians, and hospital social workers (n = 1,041). Through descriptive statistics, we mapped their values, comparing healthcare provider data to external representative population survey data. Results: Healthcare providers in sexual and reproductive healthcare displayed homogeneous liberal social values, being permissive towards sexual and reproductive rights and restrictive against gender-based violence. They were for gender equality, expressed low anti-immigrant sentiments, and had even more liberal values than the Swedish population and a demographically comparative sub-population. Conclusion: Individuals with very liberal values are selected to work in Swedish sexual and reproductive healthcare. Healthcare providers need self-reflexivity to avoid conflicts in clinical encounters in a diversified society.

Gynecological management of the breast cancer survivor.

Survival from breast cancer has continued to increase since the 1990's, and quality of life and gynecologic issues have been an increasingly important part of overall care. Common women's health issues such as contraception, pregnancy, menopause, and sexual functioning are uniquely affected by breast cancer diagnosis and treatment. Two-thirds of breast cancers are hormone-sensitive and adjuvant hormonal therapies like tamoxifen or aromatase inhibitors have substantially decreased the disease recurrence and contralateral breast cancer. These hormonal therapies can cause menopausal and sexual side effects, and women's healthcare providers need to understand safe and effective treatment options to manage them. Providingcounseling and evidence-based education is important for primary care providers and gynecologists who care for those women who have or previously had breast cancer. This review will focus on specific women's health issues pertaining to breast cancer and treatment.

Public Health Detailing to Promote HIV Pre- and Postexposure Prophylaxis Among Women's Healthcare Providers in New York City

Equitable access to HIV pre- and postexposure prophylaxis for women is essential to ending the HIV epidemic. Providers' lack of knowledge and comfort in discussing and prescribing pre-exposure prophylaxis to women persist as barriers. From May to November 2019, the New York City Health Department conducted its first public health detailing campaigns among women's healthcare providers to promote pre- and postexposure prophylaxis and the associated best practices. Over 2 campaigns (10 weeks each), trained Health Department representatives visited providers for 1-on-1 visits at select practices to promote key messages. Representatives distributed an Action Kit that addressed knowledge gaps and practice needs on providing pre-exposure prophylaxis and postexposure prophylaxis to cisgender and transgender women. Providers completed an assessment at the beginning of initial and follow-up visits, used to compare responses across visits. Statistically significant changes were evaluated by generalized linear models of bivariate outcomes, adjusted for nonindependence of providers at the same practice. Representatives visited 1,348 providers specializing in primary care (47%), women's health (30%), adolescent health (7%), infectious disease (4%), and other (12%) at 860 sites; 1,097 providers received initial and follow-up visits. Provider report of ever prescribing pre-exposure prophylaxis increased by 12% (n=119 providers); increases were reported in measures of taking sexual history, asking about partners' HIV status, providing postexposure prophylaxis, recognizing pre-exposure prophylaxis's effectiveness, and discussing and referring for pre-exposure prophylaxis. After public health detailing, women's healthcare providers report increased adoption of recommended practices that promote pre- and postexposure prophylaxis uptake and sexual wellness among women. Detailing may be adaptable to other regions and contexts to reach providers.