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- Hess Engström, Andrea
(författare)
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Internet-based treatment for vulvodynia
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Localized provoked vulvodynia is the most common cause of sexual pain and most often affects women between 20 and 30 years old. The etiology of provoked vulvodynia remains unclear, but an interplay of biomedical and psychosocial mechanisms is believed to contribute to the onset. The choice of treatment for provoked vulvodynia depends on locally available resources. Internet interventions can reach patients in distant geographical areas and may thus promote equal access to healthcare services. A few studies have investigated the effects of cognitive behavioral therapy on provoked vulvodynia. However, there appear to be no studies of the effects of an internet intervention using an acceptance and commitment therapy approach, also called third-wave cognitive behavioral therapy, for women with provoked vulvodynia.The aim of this thesis was to investigate the effects and patient experiences of a guided internet-based intervention for women with provoked vulvodynia during the waiting period for clinical treatment. All four studies included in this thesis were tied to a multicenter randomized controlled study: the EMBLA study. Participants were randomized to a six-week guided internet intervention or a waiting list before treatment as usual. Pain during intercourse, other pain-related variables, and pain acceptance were variables used to assess the effects of the intervention. Later, interviews were carried out with participants to ascertain their experiences of this internet-based treatment. Lastly, health-related quality of life and healthcare utilization were assessed to obtain a health economic evaluation of the intervention. Internet-based treatment had a positive effect on pain during intercourse and pain acceptance, but the results should be interpreted with caution due to the small sample size. This form of treatment was perceived as credible and helpful for managing provoked vulvodynia, but some difficulties related to the internet-based treatment were also reported. The intervention contributed to meaningful clinical effects at low costs per patient, indicating that internet-based treatment is not inferior to the standard of care. Internet-based treatment may serve as a complement to regular care, especially for patients living in geographical locations with low access to specialized care or where there are long waiting lists to initiate treatment.
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| 2. |
- Widarsson, Margareta
(författare)
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Journey from Pregnancy to Early Parenthood : Perceived Needs of Support, Fathers’ Involvement, Depressive Symptoms and Stress
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The overall aim was to describe the perceived needs for support and fathers’ involvement among expectant parents, and to examine depressive symptoms and parental stress in early parenthood among mothers and fathers.Methods: Two qualitative studies using focus groups and individual interviews, and three quantitative comparative studies using three questionnaires were conducted.Results: The expectant parents had different needs and suggestions for health-care improvement. One improvement of these was better involvement of expectant fathers, as fathers were described as the mothers’ best means of support and also had needs of their own. The fathers used different strategies to get involved during the pregnancy, but sometimes found it difficult to know what was expected of them. The mothers perceived more depressive symptoms and parental stress than the fathers. The mothers also perceived higher dyadic consensus than the fathers. Parents with depressive symptoms reported lower consensus than those without. There was a negative correlation between dyadic consensus and depressive symptoms in both mothers and fathers. Mothers perceived higher parental stress than fathers in the sub-areas ‘Incompetence regarding parenthood’, ‘Role restriction’, ‘Spouse relationship problems’, and ‘Health problems’, and overall. In contrast, fathers perceived higher stress than mothers in the sub-area ‘Social isolation’. Low education, lack of a role model and poor sense of coherence promoted more stress in mothers in the sub-areas ‘Social isolation’ and ‘Spouse relationship problems’, while lack of a role model and low sense of coherence promoted stress in fathers in the sub-area ‘Social isolation’.Conclusions and clinical implications: The expectant parents’ needs of support were not consistent with the support offered from health care services. These services need to become more client-centred, for example by offering customized individual support and peer support in groups. Further, they should also meet the needs of expectant fathers which can benefit the whole family. To promote parents’ health and family stability, health professionals should consider depressive symptoms and parental stress. They should also take gender norms into account so that parents become prepared for parenthood and get adequate support during early parenthood.
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