Women's Self-management Research Articles

'No matter what time of day': The value of joining Facebook groups supporting women's self-management of gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) affects a significant and growing proportion of pregnant women each year. The condition entails additional monitoring, self-management and healthcare use during pregnancy, and some women also join GDM support groups on Facebook. Little is known about the practices inside these groups, but examining them may elucidate support needs, women's experience of healthcare and improve overall outcomes. The aims of this study were to explore motivations for joining GDM Facebook groups and the perceived value and benefits of such spaces. A cross-sectional design using a web-based survey collected data from two peer-led GDM Facebook groups; relevant quantitative and qualitative data were extracted from open and closed questions, and analysed using descriptive statistics and content analysis. A total of 340 women responded to the survey, with 306 (90%) tendering their motivations to join a GDM Facebook group. Their answers were classified into six categories: peer support; information and practical advice; lived experiences; community; a safe place to ask questions and being recommended. The most commonly reported benefits of membership were 'reading about food ideas' and 'finding helpful information and tips'. Respondents reported finding their group strongly sympathetic, sincere, compassionate, heart-felt, tolerant, sensitive, warm and supportive. GDM Facebook groups are valuable for informational and emotional support, and the sharing and perusal of lived experiences; another key benefit for women is feeling belonging to a community. GDM Facebook groups provide women with access to more tailored and readily available support, filling gaps not addressed by healthcare providers. This study was led by a person with lived experience of GDM, and the survey was pilot tested with women who had also experienced GDM, which contributed to its development.

Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study

IntroductionMaternal glycemia is associated with pregnancy outcomes. Thus, supporting the self-management experiences and preferences of pregnant women with type 1 and type 2 diabetes is crucial to optimize glucose control and perinatal outcomes.Research design and methodsThis paper describes the mixed methods integration of a sequential comparative case study. The objectives are threefold, as we integrated the quantitative and qualitative data within the overall mixed methods design: (1) to determine the predictors of glycemic control during pregnancy; (2) to understand the experience and diabetes self-management support needs during pregnancy among women with pre-existing diabetes; (3) to assess how self-management and support experiences helpe to explain glycemic control among women with pre-existing diabetes in pregnancy. The purpose of the mixing was to integrate the quantitative and qualitative data to develop rich descriptive cases of how diabetes self-management and support experiences and preferences in women with type 1 and type 2 diabetes during pregnancy help explain glucose control. A narrative approach was used to weave together the statistics and themes and the quantitative results were integrated visually alongside the qualitative themes to display the data integration.ResultsThe quantitative results found that women achieved “at target” glucose control (mean A1C of the cohort by the third visit: 6.36% [95% Confidence Interval 6.11%, 6.60%]). The qualitative findings revealed that feelings of fear resulted in an isolating and mentally exhausting pregnancy. The quantitative data also indicated that women reported high levels of self-efficacy that increased throughout pregnancy. Qualitative data revealed that women who had worked hard to optimize glycemia during pregnancy were confident in their self-management. However, they lacked support from their healthcare team, particularly around self-management of diabetes during labour and delivery.ConclusionsThe achievement of optimal glycemia during pregnancy was motivated by fear of pregnancy complications and came at a cost to women’s mental health. Mental health support, allowing women autonomy, and the provision of peer support may improve the experience of diabetes self-management during pregnancy. Future work should focus on developing, evaluating and implementing interventions that support these preferences.

Self-reported barriers in self-management of women with gestational diabetes: A systematic review of qualitative studies.

To provide a systematic review of the qualitative literature on self-reported barriers to self-management in pregnant women with gestational diabetes mellitus (GDM). Systematic review. This systematic review followed the Joanna Briggs Institute meta-aggregation approach and was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Qualitative studies on the barriers to self-management among GDM pregnancy survivors conducted until 17 May 2022, were searched. A total of 30 studies were included, of which seven were in Chinese and 23 were in English, and 10 findings resulted in three themes: (a) Knowledge and belief, (b) Skills and abilities and (c) Environment and social support. By summarizing the self-reported barriers to self-management in patients with GDM and recommends precise interventions for these barriers, thereby saving health resources and helping to increase their willingness and ability to engage in self-management.

Supporting self-management in women with pre-existing diabetes in pregnancy: a protocol for a mixed-methods sequential comparative case study

IntroductionFor women with pre-existing type 1 and type 2 diabetes, glycaemic targets are narrow during the preconception and prenatal periods to optimise pregnancy outcomes. Women aim to achieve glycaemic targets...

The Remotivation Process as a Telehealth OT Program to Promote Self-Management in Women With Breast Cancer–Related Lymphedema

Abstract Date Presented 04/02/2022 Lymphedema affects 65% of women with breast cancer. Self-management programs (SMPs) are used to manage lymphedema. The study explored the effect of the Remotivation Process on the motivation of 12 women to perform an SMP every day. It was provided through a telehealth platform. Analysis showed significant change in motivation and outcome measures. This study found that the Remotivation Process is a potentially useful OT intervention to address the motivational needs of women with lymphedema. Primary Author and Speaker: Kaye Rubio Contributing Authors: Patricia Bowyer, Vidya Pingale, Sherry Hite, Gayle Hersch, Christine Raber, Wyona Freysteinson

The Remotivation Process as a Telehealth OT Program to Promote Self-Management in Women With Breast-Cancer-Related Lymphedema

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Lymphedema affects 65% of women with breast cancer. Self-management programs (SMPs) are used to manage lymphedema. The study explored the effect of the Remotivation Process on the motivation of 12 women to perform a SMP every day. It was provided through a telehealth platform. Analysis showed significant changes in motivation and outcome measures. This study found that the Remotivation Process is a potentially useful OT intervention to address the motivational needs of women with lymphedema. Primary Author and Speaker: Kaye Rubio Contributing Authors: Patricia Bowyer, Sherry Hite, Vidya Pingale, Wyona Freysteinson, Gayle Hersch, and Christine Raber

Improving pregnancy care during the COVID-19 pandemic for pregnant women as vulnerable groups through assistance at the primary health care facility

Since it was found in December 2019, the novel Coronavirus Disease 2019 (COVID-19) has spread from Wuhan, China, to many other countries. A rapid increase of newly found cases was observed, and finally, in March 2020, the World Health Organization declared that Coronavirus Disease 2019 (COVID-19) is a global pandemic. As one of the vulnerable groups, pregnant women need to avoid COVID-19 transmission and maintain pregnancy health during the pandemic. This study aimed to improve pregnant women's self-management during the COVID-19 pandemic in the working area of the Padangsari Primary Health Care Services, Semarang City. The research method used an experimental design with a pre-posttest without a control group. A Smartphone application, namely "SEHARI," was used to share the module and video about pregnancy health guidelines; furthermore, various activities of this study included online classes for pregnant women via a WhatsApp group, pregnancy care behavior surveys, and evaluations. The offline activity was done in 1 meeting for 90-120 minutes, while online activities were done as needed. This study's target population was 22 pregnant women in Puskesmas Padangsari Semarang City's working area selected by purposive sampling. A questionnaire was used that measures mother's behavior while engaging in pregnancy care and pregnancy examination screening. The validity and reliability tests showed that the instrument was valid and reliable to improve self-management of pregnant women during the COVID-19 pandemic in the working area. Bivariate data analysis of the independent variable's effect on the dependent variables used paired and independent t-tests to measure the self-management of pregnant women. The results showed that 50% of pregnant women fulfilled nutritional needs well, 59.1% of pregnant women did tetanus immunization, and 59.1% did pregnancy examinations and visits. Despite being a vulnerable group, pregnant women must continue their antenatal care during the pandemic with a strict health protocol. Specially designed online classes and Smartphone application can be used as media to deliver the essential health meassages so that pregnant women can still monitor their pregnancy health and have a way to bridge the existing programs in primary health care.

COMPARATIVE STUDY OF ADULTHOOD: THE CASE STUDIES OF UNIVERSITY STUDENTS AND STUDENTS OF VOCATIONAL TRAINING ON THE ISLAND OF LEMNOS, GREECE

A comparative study of adulthood was conducted to explore the levels of self-esteem and the parameters of adulthood among students at the Aegean University, Department of Food Science and Nutrition (D.F.S.N.) and the students of public Institute of Vocational Training (Greek: IEK), both located on the Greek island of Lemnos. Thus, maturity, responsibility, autonomy, self-management and the sense of social responsibility were measured on a Likert scale and Rosenberg’s self-esteem scale. The research investigated whether being a student of Tertiary Education or a student of Vocational Training has an effect on the concept of adulthood or influences the level of individual self-esteem. The quantitative results brought to light that adulthood can be attained without direct relevance to the Educational Institute whereas the degree of self-esteem and self-management in women was determined to some extent by the choice of School. This conclusion has raised issues of major importance for further research.
 
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A racionalidade substantiva das práticas de autogestão: uma análise sobre as dinâmicas organizativas de mulheres na economia solidária sob a perspectiva da história oral

Purpose – The research aims to discuss substantive rationality in the context of Solidarity Economy (SE) and women's self-management practices in the Solidarity and Feminist Economy Network [SFEN], based on the voices of women themselves.Design/methodology/approach – The research uses an exploratory and qualitative, from the perspective of thematic oral history. It is a search for representativeness of other forms of organization through otherness and a post-colonial view of the Administration.Findings - The productive groups of women of the SFEN are configured as substantive organizations. Under the self-management paradigm, reveal an alternative way of producing and commercialization, bringing together the dimensions of work and life in order to allow the construction of an inclusive economy, which could be alignment with the enclave “isonomy” of Guerreiro Ramos.Research limitations/implications – As an exploratory study, it was not possible in this article go deepen the gender issue in the daily practice of women in the productive group.Practical implications – The use of the self-management paradigm in an inclusive economy situation presents these production groups with a real alternative to understanding themselves as active participants in the economy.Social implications - The study brings the reflection of the participants of the productive groups about their active position in society, generates a self-assessment of their activities, serving the analysis also as an opening for reassessments and reapplications of the self-knowledge process of such groups.Originality/value – There is a gap in management research discussing solidarity economy, self-management, feminist organizations and substantive organizations by Guerreiro Ramos.

Implementing self-management: a mixed methods study of women\u2019s experiences of a postpartum hypertension intervention (SNAP-HT)

BackgroundSelf-management strategies are effective in a number of medical conditions; however, implementation studies have demonstrated adoption into clinical practice can be problematic. The process of implementation was explored during a pilot randomised controlled trial evaluating postpartum blood pressure self-management in women with medicated hypertensive disorders of pregnancy.MethodsA mixed methods study using semi-structured interviews with a qualitative and a scored (quantitative) component were undertaken as part of a pilot randomised controlled trial (SNAP-HT) in postnatal women with medicated gestational hypertension or pre-eclampsia. Women were randomised to usual care or blood pressure self-management. Self-management entailed daily home blood pressure monitoring and automated medication reduction via telemonitoring. Women from both groups optionally consented to participate in audio-recorded interviews at 4 weeks and 6 months postpartum. Interview questions were developed to explore the proposed benefits of self-management and the constructs of normalisation process theory. Participants provided a score (Likert scale 1–5) for each question and were encouraged to expand upon these answers through further discussion. The interviews were transcribed and analysed using the framework approach.ResultsSixty-eight women, 34 from each randomised group, completed at least one audio-recorded interview. Several overarching themes emerged from analysis of 126 interview transcripts: control; convenience; confidence, communication and knowledge; concern; constraints; and components of the intervention. In the scored component of the analysis, both groups reported feeling more in control of their condition postpartum compared to during pregnancy, more so in those self-managing at both 4 weeks and 6 months: adjusted differences 0.6 (95% confidence interval [CI] 0.2 to 1.1) and 0.7 (95% CI 0.3 to 1.2) respectively.ConclusionsInterviews and quantitative data showed that self-management enhanced women’s sense of control and improved their blood pressure-related anxiety. Prior to taking part, a few women anticipated that home monitoring might increase anxiety, but stated that it had the opposite effect. Self-management was perceived as more flexible and reactive and as enabling more targeted down-titration of medication. These data provide considerable support for blood pressure self-management postpartum and reinforce the effectiveness of the intervention used in this study.Trial registrationClinicalTrials.gov: NCT02333240. Prospectively registered on 7 January 2015.

About me as a person not only the disease - piloting Guided Self-Determination in an outpatient endometriosis setting.

Endometriosis is a chronic disease affecting 5-10% of women in the reproductive age. Despite surgical and medical treatment, many women struggle with pain, infertility, sexual dysfunction, depression, distress and reduced workability, affecting their overall quality of life. The usual follow-up procedures may not support the women's self-management of this condition. Therefore, person-centred empowerment-based approaches are needed. To assess if the implementation of the Guided Self-Determination method targeted women with complex endometriosis appeared feasible and supported self-management. Guided Self-Determination was offered to 10 out-patients with complex endometriosis. Each of the women had five conversations based on prefilled disease-specific reflection sheets. A qualitative evaluation was conducted in 2016-2017 covering semi-structured, telephone interviews and focus group interviews, which were analysed using thematic analysis. Additionally, we assessed if the women changed the self-reported questionnaires, Endometriosis Health Profile 30 and the Patient Activation Measure from before and after the conversations. We identified four themes: feeling alone with the disease; establishing a meaningful relationship with healthcare professionals in a traditional hospital setting; person-specific knowledge facilitated new behaviours and; accepting a chronic condition - the beginning of a process. All dimensions of the Endometriosis Health Profile 30 and the Patient Activation Measure appeared to improve at two weeks and so did almost all the dimensions of Endometriosis Health Profile 30 after 1year. The implementation of the Guided Self-Determination method appeared feasible and the women developed self-management skills in relation to endometriosis and its symptoms. This was achieved by increasing insight into their needs and behaviours and gaining new knowledge about the disease itself. The before-and-after assessment suggested benefit of the intervention, but this should be further tested in a randomised trial.

Self-management strategies amongst Australian women with Endometriosis: a national online survey

Endometriosis has a significant negative impact on the lives of women, and current medical treatments often do not give sufficient pain relief or have intolerable side effects for many women. The majority of women with primary dysmenorrhea use self-management strategies (including self-care techniques or lifestyle choices) to help manage period related symptoms, but little is known about self-management in women with endometriosis. The aim of this survey was to determine the prevalence of use, safety, and self-rated effectiveness of common forms of self-management. A cross-sectional online survey was distributed via social media using endometriosis support and advocacy groups in Australia between October and December 2017. Women were eligible to answer the survey if they were 18–45, lived in Australia, and had a confirmed diagnosis of endometriosis. Survey questions covered the types of self-management used, improvements in symptoms or reduction in medication, and safety. Four hundred and eighty-four valid responses were received. Self-management strategies, consisting of self-care or lifestyle choices, were very common (76%) amongst women with endometriosis. The most common forms used were heat (70%), rest (68%), and meditation or breathing exercises (47%). Cannabis, heat, hemp/CBD oil, and dietary changes were the most highly rated in terms of self-reported effectiveness in pain reduction (with mean effectiveness of 7.6, 6.52, 6.33, and 6.39, respectively, on a 10-point scale). Physical interventions such as yoga/Pilates, stretching, and exercise were rated as being less effective. Adverse events were common, especially with using alcohol (53.8%) and exercise (34.2%). Self-management was very commonly used by women with endometriosis and form an important part of self-management. Women using cannabis reported the highest self-rated effectiveness. Women with endometriosis have unique needs compared to women with primary dysmenorrhea, and therefore any self-management strategies, especially those that are physical in nature, need to be considered in light of the potential for ‘flare ups’.

Self-management in women with stress incontinence: strategies, outcomes and integration into clinical care.

The objective of this review is to present and discuss up-to-date conservative treatment strategies for the management of stress urinary incontinence (SUI) in women. This review aims to provide an overview of the importance of initial self-management strategies and conservative management options for women with SUI and how these treatments can be integrated into clinical practice. The various treatment modalities available including pelvic floor physiotherapy, biofeedback, and neuromuscular electrical stimulation devices, in addition to lifestyle changes which can significantly affect symptoms, are discussed. The relevance and importance of individual assessment and training programs is highlighted in addition to additional adjuncts available to facilitate rehabilitation and symptom improvement. Expected outcomes for women with mild to moderate SUI who participate in targeted individualized conservative management programs are generally good, with a high likelihood of substantial improvement in symptoms.

Self-management strategies amongst Australian women with endometriosis: a national online survey

BackgroundEndometriosis has a significant negative impact on the lives of women, and current medical treatments often do not give sufficient pain relief or have intolerable side effects for many women. The majority of women with primary dysmenorrhea use self-management strategies (including self-care techniques or lifestyle choices) to help manage period related symptoms, but little is known about self-management in women with endometriosis. The aim of this survey was to determine the prevalence of use, safety, and self-rated effectiveness of common forms of self-management.MethodsA cross-sectional online survey was distributed via social media using endometriosis support and advocacy groups in Australia between October and December 2017. Women were eligible to answer the survey if they were 18–45, lived in Australia, and had a confirmed diagnosis of endometriosis. Survey questions covered the types of self-management used, improvements in symptoms or reduction in medication, and safety.ResultsFour hundred and eighty-four valid responses were received. Self-management strategies, consisting of self-care or lifestyle choices, were very common (76%) amongst women with endometriosis. The most common forms used were heat (70%), rest (68%), and meditation or breathing exercises (47%). Cannabis, heat, hemp/CBD oil, and dietary changes were the most highly rated in terms of self-reported effectiveness in pain reduction (with mean effectiveness of 7.6, 6.52, 6.33, and 6.39, respectively, on a 10-point scale). Physical interventions such as yoga/Pilates, stretching, and exercise were rated as being less effective. Adverse events were common, especially with using alcohol (53.8%) and exercise (34.2%).ConclusionsSelf-management was very commonly used by women with endometriosis and form an important part of self-management. Women using cannabis reported the highest self-rated effectiveness. Women with endometriosis have unique needs compared to women with primary dysmenorrhea, and therefore any self-management strategies, especially those that are physical in nature, need to be considered in light of the potential for ‘flare ups’.

Exploring Iranian obese women's perceptions of barriers to and facilitators of self-management of obesity: A qualitative study.

Background:Despite the clinical importance of self-management for obesity, poor compliance or noncompliance with the treatment regimen is a prevalent and persistent problem concerning people with obesity.Aims:The aim of this study was to explore Iranian obese women's perceptions regarding the barriers to and facilitators of self-management of obesity.Materials and Methods:In this qualitative study, the participants were selected through purposeful sampling and the data were collected using semistructured interviews and focus groups between July 2017 and September 2018. Nineteen participants between the age range of 28–50 years and mean age of 38.56 years were interviewed. A focus group with seven participants was conducted to reach data saturation. All the interviews and the focus group were transcribed verbatim and the data were analyzed using constant comparative method.Results:The perceived barriers to obese women's self-management for obesity were identified and classified into four main categories: (I) restrictions, (II) the pressures of being in the group, (III (temptation, (IV) resonators. In addition, seven main categories emerged as facilitators of obese women's self-management for obesity: (I) achieving self-awareness, (II) positive consequences for weight loss success, (III) positive outcomes of exercise and physical activity, (IV) peers experience, (V) correct and logical program, (VI) autonomy and empowerment, and (VII) having supporting umbrella.Conclusion:This qualitative research provided a range of facilitators and barriers to self-management of obesity perceived by an obese woman to improve our understanding of the complex nature of self-management of obesity. Healthcare providers may consider this issue while designing and implementing appropriate interventions to upgrades woman's ability for self-management of obesity.

Effects of Written Information and Counseling on Illness-Related Uncertainty in Women With Vulvar Neoplasia.

To determine whether written information and/or counseling decreases illness-related uncertainty in women with vulvar neoplasia. 49 women with vulvar neoplasia from four Swiss hospitals and one Austrian hospital. A longitudinal, multicenter, randomized phase 2 study was performed. The written information group received a set of leaflets. The counseling group received five consultations with an advanced practice nurse (APN) from diagnosis to six months postsurgery that focused on symptom self-management, healthcare services, and decision making. Uncertainty was measured as a secondary outcome five times by the Mishel Uncertainty in Illness Scale. Total uncertainty and the subscales of ambiguity, inconsistency, and unpredictability improved significantly over time within the counseling group but not within the written information group. In addition, counseling improved inconsistency over time, and total uncertainty, inconsistency, and unpredictability at distinct time points more efficiently than written information. Counseling can reduce illness-related uncertainty. APNs are valuable healthcare providers who promote women's self-management and may support them in becoming more familiar with illness-related events and common symptoms during this rare disease.

A Qualitative, Systems Thinking Approach to Study Self-Management in Women With Migraine.

A dearth of effective and affordable treatment options has rendered nonpharmacological self-management a crucial part of living with migraine-a debilitating neurobiological condition without cure that disproportionately disables vulnerable women. The aim of the study was to describe the development and use of a systems thinking, problem-structuring data collection approach that was applied to the study of migraine self-management with women in diverse social locations. Two systems mapping activities were developed for use in focus groups: one to unpack a migraine episode (system support map) and the other (connection circle [CC]) to construct a mental model of self-management. Later in the process, a strengths-based problem-solving tool was developed to replace the CC. The CCs-often enlightening for affluent participants-left marginalized women feeling overwhelmed and defeated, as a solution to one challenge became the cause of another. Through constant comparison analysis, we recalibrated the approach using a theory, clinical experience, and participant feedback and replaced the CC with a strengths-based problem-solving activity highlighting relationships and trade-offs in a more agential, actionable way. Bringing a critical lens and strengths-based approaches to work with vulnerable populations can replace traditional deficit thinking in healthcare, developing options for leveraging resources and understanding complex health behaviors without losing sight of systemic, distributional justice issues. These systems thinking tools can provide a way to extrapolate the complexities of actual self-management behaviors and challenges faced by vulnerable women with migraine versus what they may be instructed to do by a medical model that does not always account for the social and structural determinants of equity and health.

Exploring the Feasibility of Use of An Online Dietary Assessment Tool (myfood24) in Women with Gestational Diabetes.

myfood24 is an online 24 hr dietary recall tool developed for nutritional epidemiological research. Its clinical application has been unexplored. This mixed methods study explores the feasibility and usability of myfood24 as a food record in a clinical population, women with gestational diabetes (GDM). Women were asked to complete five myfood24 food records, followed by a user questionnaire (including the System Usability Scale (SUS), a measure of usability), and were invited to participate in a semi-structured interview. Of the 199 participants, the mean age was 33 years, mean booking body mass index (BMI) 29.7 kg/m2, 36% primiparous, 57% White, 33% Asian. Of these, 121 (61%) completed myfood24 at least once and 73 (37%) completed the user questionnaire; 15 were interviewed. The SUS was found to be good (mean 70.9, 95% CI 67.1, 74.6). Interviews identified areas for improvement, including optimisation for mobile devices, and as a clinical management tool. This study demonstrates that myfood24 can be used as an online food record in a clinical population, and has the potential to support self-management in women with GDM. However, results should be interpreted cautiously given the responders’ demographic characteristics. Further research to explore the barriers and facilitators of uptake in people from ethnic minority and lower socioeconomic backgrounds is recommended.

Impacting diabetes self-management in women with gestational diabetes mellitus using short messaging reminders.

Gestational diabetes mellitus (GDM) has been associated with multiple complications, including increase risk of gestational hypertension, cesarean delivery, macrosomia, stillbirth, and preeclampsia. The purpose of this study was to determine the acceptability of text messaging in women with GDM and further refine intervention materials and study procedures (recruitment, enrollment, intervention, retention, and data collection). Nineteen women diagnosed with GDM completed a baseline demographic questionnaire followed by 4 weeks of daily text messages that included either a direct reminder to test their blood glucose levels and keep up with their treatment plan or an educational message. A postintervention survey was administered to assess the satisfaction with the messaging program. The use of daily text messages in the treatment plan of patients diagnosed with GDM seems to be acceptable shown by an overall satisfaction with the messages and a willingness to use the messages in future pregnancies. Half of the participants also felt that the messages helped them to eat healthier. This study demonstrated a real opportunity for a low-cost intervention in the management plan of GDM.

Education and self-management for women with polycystic ovary syndrome; a narrative review of literature

Polycystic ovary syndrome (PCOS) is the most common endocrine condition in women of reproductive age and is associated with high risk of long term metabolic and psychological conditions such as diabetes, cardiovascular disease and depression. These patients present at a young age to the health care system and seek information about their condition. A structured education program seems to be able to answer these questions. Structured education selfmanagement programs are pragmatic and cost-effective patient-centered group educations which are underpinned by learning theories and empower patients to take control of their management and reduce their associated long term risks. In this paper, we introduce structured education programs and review the evidence of education programs for women with PCOS.