| 1. |
- Grundström, Hanna, et al.
(författare)
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A protracted struggle
- 2020
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Ingår i: Australian Journal of Advanced Nursing. - : AUSTRALIAN NURSING FEDERATION. - 0813-0531 .- 1447-4328. ; 37:4, s. 20-27
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to identify and describe endometriosis healthcare experiences based on affected individuals blog posts. Background: Endometriosis is a chronic gynaecological disease that often has a negative effect on mental, physical, sexual and social health, resulting in lower quality of life. Endometriosis healthcare experiences have typically been described in terms of normalisation, trivialisation and a lack of knowledge from healthcare professionals. These experiences are often reported via individual interviews or focus group interviews. Studying internet blogs may contribute additional information that might not be disclosed during interviews. Therefore, observing and analysing content from blog posts may present an opportunity to gain additional understanding of how healthcare encounters can be experienced by individuals with endometriosis. Study design and methods: This is an inductive qualitative study based on blog posts. The blog posts were written in Swedish and posted online without passwords. Sixteen blogs written between 2008 and 2019 by people aged 22-34 were included. The bloggers had been diagnosed with endometriosis one to seven years prior to writing the blogs and lived all over Sweden. Data collection was performed in March 2019 using an online search engine. A combination of different research terms was used to find the blogs. After considering the blogs on the basis of inclusion and exclusion criteria, 12 blogs remained, and another four blogs were included via links from one of the blogs. The analysis was conducted using thematic analysis according to Braun and Clarke. Results: The results are presented under one main theme, "A protracted struggle", and two subthemes, "The response plays a significant role" and "The value of competence". The bloggers described their healthcare experiences as a long struggle including contact with a large number of different healthcare professionals (HCPs), where the response was significant for their physical and mental health. They emphasised the advantages of person-centredness, competence and continuity in the HCP contact. Conclusions and implications for practice: The results demonstrate that the journey through healthcare was experienced as a prolonged struggle, including normalisation, trivialisation and distrust. The results imply that more improvement work remains to be done within endometriosis healthcare. Taking patients complaints seriously and providing prompt and effective investigations and treatment may lead to more positive healthcare experiences. What is already known about the topic? Endometriosis healthcare experiences have typically been described in terms of normalisation, trivialisation and a lack of knowledge from healthcare professionals. Previous qualitative studies on the subject are interview studies, which may be influenced by the presence of researchers. What this paper adds: The care-seeking behaviours involved a wide range of strategies. The descriptions varied from extensive care-seeking from different doctors and clinics, to refraining from seeking care due to a fear of being treated badly. The wording used in the blogs was tougher and more unforgiving, and included mostly negative aspects compared to what has been presented in interview studies. This may be explained by the "diary-like" characteristics of blogs and the free way of presenting narratives in a blog.
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| 2. |
- Angelhoff, Charlotte, medicine doktor, 1974-, et al.
(författare)
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Supporting girls with painful menstruation - A qualitative study with school nurses in Sweden
- 2023
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Ingår i: Journal of Pediatric Nursing. - : Elsevier. - 0882-5963 .- 1532-8449. ; 68, s. e109-e115
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Tidskriftsartikel (refereegranskat)abstract
- Background: Painful menstruation is common among girls. To optimize school nurses' work more knowledgeabout their experiences of supporting these girls is needed. The aim of this study was to describe school nurses'experiences of supporting girls with menstrual pain.Methods: Interviews were conducted with 15 school nurses in Sweden and analyzed using thematic analysis.Results: Three themes emerged: Taking menstrual pain seriously, Being a disseminator of knowledge, andExternal conditions for conducting professional work as a school nurse.Conclusion: School nurses felt competent in supporting girls with menstrual pain. However, they lacked struc-tural, written guidelines and routines for how to treat, support, follow-up and refer girls with menstrual pain.Practice implications: School education about menstruation and sexual health needs to be strengthened. Cooper-ation with other healthcare facilities and networks with other school nurses should be increased. Specific guide-lines on how to support girls with menstrual pain should be implemented.
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| 3. |
- Berterö, Carina, et al.
(författare)
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Striving for a biopsychosocial approach : A secondary analysis of mutual components during healthcare encounters between women with endometriosis and physicians
- 2019
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Ingår i: JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS. - : Sage Publications. - 2284-0265 .- 2284-0273. ; 11:3, s. 146-151
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Tidskriftsartikel (refereegranskat)abstract
- Objective:The objective of this study was to identify and describe mutual components during healthcare encounters between women with endometriosis and physicians.Methods:Secondary analysis of data was obtained from two original face-to-face interview studies, one with nine women with endometriosis and one including 16 physicians. Data in this secondary analysis were analysed using thematic analysis.Results:Three themes were identified. (1) Continuity as a foundation for a biopsychosocial approach. The women and the physicians described the importance of continuity and both parties strived for a biopsychosocial approach whereby the female body was not treated as biomedical defect object, but as a part of the unity that constitutes a human being. (2) Listening sensitively. Women and physicians believed that listening sensitively involved more than just hearing the actual words – it required thoughtfulness, reflection and responsiveness. (3) Timing of diagnosis. The physicians tried to protect the women from worrying by treating the painful menstruations without mentioning endometriosis. However, the women regarded not mentioning endometriosis as a lack of competence on the part of the physicians.Conclusion:This study provides new insights into the need for further support in the provision of psychosocial care for women with endometriosis, in the striving towards a biopsychosocial approach.
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| 4. |
- Berterö, Carina, 1959-, et al.
(författare)
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The double-edged experience of healthcare encounters among women with endometriosis : a qualitative study
- 2018
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell Publishing Inc.. - 0962-1067 .- 1365-2702. ; 27:1-2, s. 205-211
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectivesTo identify and describe the experience of healthcare encounters among women with endometriosis.BackgroundEndometriosis is a “hidden” chronic gynaecological disease appearing in every 10th woman of fertile age. Different manifestations of pain are the main symptoms, often leading to impaired physical and mental health, and lower quality of life. Previous research on healthcare experiences among women with endometriosis has focused on diagnostic delay and experiences of encountering general practitioners.DesignA qualitative, interpretive, phenomenological approach was used.MethodsWe interviewed nine women aged 23–55, with a laparoscopy-confirmed diagnosis of endometriosis. The interviews were recorded and transcribed verbatim. The data were analysed following the steps of the interpretive phenomenological approach.ResultsTwo themes were identified in the interview transcripts: being treated with ignorance and being acknowledged. The essence: “the double-edged experience of healthcare encounters” emerged from the themes. The women's experience was double-edged as it involved contradictory feelings: the encounters were experienced as both destructive or constructive. On the one hand, the destructive side was characterised by ignorance, exposure and disbelief. On the other hand, the constructive side made the women feel acknowledged and confirmed, boosting their self-esteem.ConclusionsThe new and important aspects of the findings are that the experience of healthcare encounters is for the first time expressed as double-edged: both destructive and constructive. The experience was of specific importance as it affected the women's perceptions of themselves and of their bodies.Relevance to clinical practiceThe information about the constructive side of the experience is of clinical valuable for all healthcare professionals (nurses, midwives and doctors) encountering these women, as it provides a new level of understanding of the experiences. The findings demonstrate both psychological and practical aspects that can help professionals to improve the encounters.
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| 5. |
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| 6. |
- Brüggemann, Cecilia, et al.
(författare)
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Labor dystocia and oxytocin augmentation before or after six centimeters cervical dilatation, in nulliparous women with spontaneous labor, in relation to mode of birth
- 2022
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Ingår i: BMC Pregnancy and Childbirth. - : BMC. - 1471-2393. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The effects of diagnosing and treating labor dystocia with oxytocin infusion at different cervical dilatations have not been fully evaluated. Therefore, we aimed to examine whether cervical dilatation at diagnosis of dystocia and initiation of oxytocin infusion at different stages of cervical dilatation were associated with mode of birth, obstetric complications and womens birthing experience. Methods A retrospective cohort study, including 588 nulliparous term women with spontaneous onset of labor and dystocia requiring oxytocin augmentation. The study population was divided into three groups according to cervical dilatation at diagnosis of dystocia and initiation of oxytocin-infusion (<= 5 cm, 6-10 cm, fully dilated) with mode of birth as the primary outcome. Secondary outcomes were obstetrical and neonatal complications and women s experience of childbirth. Statistical comparison between groups using Chi-square and ANOVA was performed. The risk of operative birth (cesarean section and instrumental birth) was assessed using binary logistic regression with suitable adjustments (maternal age, body mass index and risk assessment on admission to the labor ward). Results The cesarean section rate differed between the groups (p < 0.001); 12% in the <= 5 cm group, 6% in the 6-10 cm group and 0% in the fully dilated group. There was no increased risk for operative birth in the <= 5 cm group compared to the 6-10 cm group, adjusted OR 1.28 95%CI (0.78-2.08). The fully dilated group had a decreased risk of operative birth (adjusted OR 0.48 95%CI (0.27-0.85). The rate of a negative birthing experience was high in all groups (28.5%, 19% and 18%) but was only increased among women in the <= 5 cm group compared with the 6-10 cm group, adjusted OR 1.76 95%CI (1.05-2.95). Conclusions Although no difference in the risk of operative birth was found between the <= 5 cm and 6-10 cm cervical dilatation-groups, the cesarean section rate was highest in women with dystocia requiring oxytocin augmentation at <= 5 cm cervical dilatation. This might indicate that oxytocin augmentation before 6 cm cervical dilatation could be contra-productive in preventing cesarean sections. Further, the increased risk of negative birth experience in the <= 5 cm group should be kept in mind to improve labor care.
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| 7. |
- Düringer, Caroline, et al.
(författare)
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Agonist-specific patterns of beta(2)-adrenoceptor responses in human airway cells during prolonged exposure.
- 2009
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Ingår i: British Journal of Pharmacology. - : Wiley. - 1476-5381 .- 0007-1188. ; 158, s. 169-179
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: beta(2)-Adrenoceptor agonists (beta(2)-agonists) are important bronchodilators used in the treatment of asthma and chronic obstructive pulmonary disease. At the molecular level, beta(2)-adrenergic agonist stimulation induces desensitization of the beta(2)-adrenoceptor. In this study, we have examined the relationships between initial effect and subsequent reduction of responsiveness to restimulation for a panel of beta(2)-agonists in cellular and in vitro tissue models. Experimental approach: beta(2)-Adrenoceptor-induced responses and subsequent loss of receptor responsiveness were studied in primary human airway smooth muscle cells and bronchial epithelial cells by measuring cAMP production. Receptor responsiveness was compared at equi-effective concentrations, either after continuous incubation for 24 h or after a 1 h pulse exposure followed by a 23 h washout. Key findings were confirmed in guinea pig tracheal preparations in vitro. Key results: There were differences in the reduction of receptor responsiveness in human airway cells and in vitro guinea pig trachea by a panel of beta(2)-agonists. When restimulation occurred immediately after continuous incubation, loss of responsiveness correlated with initial effect for all agonists. After the 1 h pulse exposure, differences between agonists emerged, for example isoprenaline and formoterol induced the least reduction of responsiveness. High lipophilicity was, to some extent, predictive of loss of responsiveness, but other factors appeared to be involved in determining the relationships between effect and subsequent loss of responsiveness for individual agonists. Conclusions and implications: There were clear differences in the ability of different beta(2) agonists to induce loss of receptor responsiveness at equi-effective concentrations.
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| 8. |
- Eldestrand, E., et al.
(författare)
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Supporting young women with menstrual pain – Experiences of midwives working at youth clinics
- 2022
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier B.V.. - 1877-5756 .- 1877-5764. ; 34
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Tidskriftsartikel (refereegranskat)abstract
- Background: Menstrual pain is relatively common among young girls. Many girls turn to youth clinics when seeking care for menstrual problems. Objective: The objective of the study was to describe midwives’ experiences of supporting girls with menstrual pain. Methods: This is a qualitative study with an inductive approach. Semi-structured interviews were conducted with 15 midwives working at Swedish youth clinics. Interviews were held in September 2021. The recordings were transcribed and analyzed using thematic analysis. Results: Two main themes, consisting of three subthemes each, emerged: Guiding and educating young women about menstrual pain and Striving toward pain relief. It was important to the midwives to increase young womens knowledge of menstrual pain and coping strategies, and to guide them in finding a method for menstrual pain relief. Hormonal contraceptives were often a natural choice and an effective method for pain relief, although the midwives occasionally faced resistance from young women or their mothers when recommending this. The midwives also referred to a gynecologist if needed. Conclusion: The results highlight that midwives working at youth clinics have an important role in the care of young women with menstrual pain. The midwives found it important to increase young womens knowledge about menstrual pain and coping strategies, since they had noticed knowledge gaps in these areas. The results suggest a need to improve education about menstrual pain and coping strategies for young women, preferably in school and in cooperation with healthcare professionals. © 2022 The Author(s)
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| 9. |
- Grundström, Hanna, et al.
(författare)
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“A challenge” – healthcare professionals' experiences when meeting women with symptoms that might indicate endometriosis
- 2016
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 7, s. 65-69
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe aim of the study was to identify and describe the experiences of healthcare professionals when meeting women with symptoms that might indicate endometriosis.MethodsSemi-structured interviews were conducted with 10 gynecologists, six general practitioners and nine midwives working at one university hospital, one central hospital, one private gynecology clinic and five healthcare centers in south-east Sweden. The interviews were recorded and transcribed verbatim and analyzed using qualitative conventional content analysis.ResultsThree clusters were identified: the corroborating encounter, the normal variation of menstruation cycles, and the suspicion of endometriosis. The healthcare professionals tried to make a corroborating encounter by acknowledging the woman, taking time to listen, and giving an explanation for the problems. Healthcare professionals had different ways to determine what was normal as regards menstrual pain, ovulation pain and dyspareunia. They also needed to have the competence to act and react when the symptoms indicated endometriosis.ConclusionsMeeting women with symptoms that might indicate endometriosis is challenging and demands a certain level of competence from healthcare professionals. Sometimes the symptoms are camouflaged as “normal” menstruation pain, making it hard to satisfy the needs of this patient group.
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| 10. |
- Grundström, Hanna, 1982-, et al.
(författare)
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Associations between pain thresholds for heat, cold and pressure, and Pain Sensitivity Questionnaire scores in healthy women and in women with persistent pelvic pain
- 2019
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Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 23:9, s. 1631-1639
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe Pain Sensitivity Questionnaire (PSQ) is a self‐rating instrument developed as a time‐ and cost‐saving alternative to quantitative sensory testing (QST). The aims of the study were to assess (a) the associations between PSQ scores and QST in women with persistent pelvic pain and in pain‐free controls and (b) to what extent demographic variables and psychological distress influenced PSQ scores.MethodsFifty‐five healthy women and 37 women with persistent pelvic pain participated. All filled in the PSQ and Hospital Anxiety and Depression Scale and had QST (heat, cold and pressure pain thresholds) performed on six locations on the body. Information on age, body mass index, smoking habits and pain duration were collected. Principal component analysis and orthogonal partial least square regressions were used.ResultsThe patients scored significantly higher on PSQ than the controls. Significant multivariate correlations between pain thresholds and PSQ scores were found only in the patient group. In the patient group, the heat and cold pain thresholds correlated more strongly with PSQ scores than the pressure pain threshold.ConclusionsThe PSQ score was significantly higher in pelvic pain patients, and correlations between QSTs and the PSQ were only found for patients.SignificanceThe PSQ reflects pain sensitivity in women with PPP and can be used as a non‐invasive and painless way to assess this condition in clinical practice.
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| 11. |
- Grundström, Hanna, 1982-, et al.
(författare)
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Cross-cultural adaptation of the Swedish version of Endometriosis Health Profile-30
- 2020
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Ingår i: Journal of Obstetrics and Gynaecology. - : Informa UK Limited. - 0144-3615 .- 1364-6893. ; 40:7, s. 969-973
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Tidskriftsartikel (refereegranskat)abstract
- The Endometriosis Health Profile-30 (EHP-30) is focusing on the effect of endometriosis symptoms upon health-related quality of life. The aim of this study was to pre-test and culturally adapt the Swedish version of EHP-30. Eighteen Swedish-speaking women with laparoscopically verified diagnosis of endometriosis answered the questionnaire and 17 were interviewed regarding their interpretations of the questionnaire. Demographics, distribution of answers, roof-ceiling effects and missing answers were analysed. The interviews were analysed using the qualitative approach proposed by Beaton et al. The Swedish version of EHP-30 was experienced as accessible with 100% data completeness and a roof effect (11%) in one dimension. Some women had difficulties with the instructions and one word should be replaced in order to culturally adapt the questionnaire. In conclusion, the Swedish version of EHP-30 is a useful and well-accepted questionnaire for women with endometriosis in Sweden, but a minor change of wording is recommended.Impact statement What is already known on this subject? Cross-cultural adaptation and psychometric testing are crucial when introducing translated questionnaires. Cross-cultural adaptation is a process that looks at both translational and cultural issues when a questionnaire is being prepared for use in another country than the original. EHP-30 has been translated into Swedish but has not yet been cross-culturally adapted. What do the results of this study add? The Swedish version of EHP-30 was experienced as a useful and well-accepted questionnaire for women with endometriosis, but a minor change of wording is recommended in one question to make the questionnaire convergent with the original version.
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| 12. |
- Grundström, Hanna, 1982-, et al.
(författare)
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Demographic and clinical characteristics determining patient-centeredness in endometriosis care
- 2023
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Ingår i: Archives of Gynecology and Obstetrics. - : Springer. - 0932-0067 .- 1432-0711. ; 307, s. 1047-1055
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The primary aim of this study was to assess patient-centeredness of endometriosis care in a national sample of Swedish women with endometriosis. The secondary aims were to assess the importance of different dimensions of endometriosis care and to analyze demographic and clinical determinants associated with the experience of patient-centeredness.Methods: This cross-sectional study included 476 women with confirmed endometriosis. An invitation to participate was sent to 1000 randomly selected women aged ≥ 18 years having any endometriosis diagnosis and who had visited a gynecological clinic due to endometriosis problems any time during the past five years. Participants were recruited from ten different-sized gynecology clinics all over Sweden. The invitation letter had a link to the digital survey, which consisted of demographic and clinical questions, and the ENDOCARE questionnaire (ECQ). ECQ measures experiences, importance and patient-centeredness of ten dimensions of endometriosis care. Univariate and multiple regression analyses were used to analyze which patient-specific demographic and clinical determinants were associated with the experience of patient-centeredness.Results: The response rate was 48%. The results indicate that Swedish women with endometriosis experience low patient-centeredness and rate relational aspects with healthcare professionals as the most important aspects of care. Having a gynecologist with patient responsibility was an independent predictor for high patient-centeredness.Conclusion: Women with endometriosis in Sweden experience low patient-centeredness, reflecting the urgent need for improvement. More effort should be given to develop the relational aspects of care. Women with endometriosis should have a responsible gynecologist to care for treatment and follow-up.
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| 13. |
- Grundström, Hanna, 1982-
(författare)
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Disclosing the invisible : experiences, outcomes and quality of endometriosis healthcare
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Many women with endometriosis report that their symptoms are normalized and trivialized when they seek medical care and they often experience diagnostic delays, ineffective treatments and physiological, psychological and social consequences. However, there is a knowledge gap when it comes to women’s experiences of different aspects of endometriosis healthcare, and the quality of that care. Aim: The aim of this thesis was to identify, describe and analyse the experiences, encounters and outcomes of endometriosis healthcare from different perspectives. Design and Method: This thesis is a summary of four studies with different methods and designs. Study I and II were qualitative interview studies in which nine women with a laparoscopy-verified endometriosis diagnosis (study I) and 25 healthcare professionals (HCPs) (study II) described their experiences of healthcare encounters related to endometriosis symptoms. The interviews were analysed using interpretive phenomenology (study I) and conventional content analysis (study II). Study III was a cross-sectional observational comparative study measuring pain thresholds, health-related quality of life (HRQoL) and symptoms of anxiety and depression using quantitative sensory testing (QST) and questionnaires in order to determine pain thresholds in healthy women (n=55) and women with persistent pelvic pain (PPP), with (n=14) and without (n=23) a confirmed diagnosis of endometriosis. The correlations between pain thresholds and duration of PPP, HRQoL and symptoms of anxiety and depression were also analysed. Study IV was a quantitative observational study using register data from the National Quality Register for Gynaecological Surgery. Patient-reported experience measures (PREM) and patient-reported outcome measures (PROM) after benign hysterectomy were analysed and compared in women with and without PPP and endometriosis (study IV). Results: The results of the thesis are summarized in three themes: The struggle to visualize the pain, The endometriosis diagnosis as a key to understanding and enduring persistent pelvic pain and Healthcare encounters as potentially life changing. In the first theme, women and HCPs described the healthcare encounters concerning endometriosis symptoms as troublesome (study I, II). The women struggled with disclosing, visualizing and communicating their hidden pain to the HCPs (study I), and HCPs expressed insecurity and limited knowledge when caring for these women (study II). Study III showed widespread reduced pain thresholds among women with PPP compared with healthy controls, and a significant positive correlation between duration of PPP and reduced pain thresholds . Study III also showed a reduced HRQoL and higher prevalence of anxiety and depressive symptoms among women with PPP, which were also described by the women (study I).The importance of getting a diagnosis was described in the second theme by both women and HCPs (study I, II), but women with PPP with and without endometriosis diagnosis did not differ significantly in their pain thresholds or psychosocial outcomes in study III. Likewise, women with PPP with and without endometriosis gave more equal PREM and PROM answers than women in the pain-free comparison group. Overall, women undergoing hysterectomy on benign indications were satisfied with the experience and outcomes of the surgery (study IV).As described in the last theme, healthcare encounters could be constructive or destructive. Positive experiences could make the symptoms easier to endure. The constructive encounters were often characterized by a holistic approach and a care structured in multidisciplinary teams. Conclusion and clinical implications: The results suggest that PPP should be taken seriously and treated actively in order to minimize the risk of physiological and psychological consequences, such as reduced pain thresholds, lower HRQoL and symptoms of anxiety and depression. Unrelieved PPP could also be an explanatory factor for long-term physiological consequences, such as lower PREM and PROM after hysterectomy.High-quality endometriosis healthcare should provide an interaction of physical, psychological and social factors. If women experience that HCPs acknowledge their pain and the effect of pain on HRQoL and mental health, and are offered proper pain-relieving treatment, healthcare encounters could change their lives.
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| 14. |
- Grundström, Hanna, et al.
(författare)
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Experiences of communication in women with endometriosis : perceived validation and invalidation in different contexts, and associations with health-related quality of life
- 2023
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Ingår i: Journal of Psychosomatic Obstetrics and Gynaecology. - : Taylor & Francis. - 0167-482X .- 1743-8942. ; 44:1
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Tidskriftsartikel (refereegranskat)abstract
- Endometriosis, a chronic gynecological disease affecting approximately 10% of women of reproductive age, has a significant impact on physical and mental health. This cross-sectional study aimed to explore experiences of validating and invalidating communication in three contexts (with healthcare providers, employers, and family/friends), and whether this may predict health-related quality of life (HRQoL) in women with endometriosis. Data was collected through a digital survey distributed to women with self-reported endometriosis in Sweden. The survey included measures of validating and invalidating communication, depressive symptoms, anxiety, and HRQoL. A total of 427 women participated. The results indicated that women experienced varying levels of validating and invalidating communication in different contexts, with close family/friends providing the highest level of validation, and healthcare providers the lowest. Furthermore, a combined construct of high levels of validation and low levels of invalidation from healthcare providers and from close family and friends were significant predictors of HRQoL. These findings highlight the importance of supportive communication and understanding from healthcare providers and close social networks in promoting the well-being of women with endometriosis. Future research should further explore the impact of validating communication within healthcare settings and develop interventions to improve communication and support for women with endometriosis.
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| 15. |
- Grundström, Hanna, et al.
(författare)
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Factors related to a positive childbirth experience - a cross-sectional study
- 2024
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Ingår i: Journal of Reproductive and Infant Psychology. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 0264-6838 .- 1469-672X.
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Tidskriftsartikel (refereegranskat)abstract
- Background/aimsGiving birth is a life-changing experience for women. Most previous studies have focused on risk factors for a negative childbirth experience. The primary aim of this study was to assess childbirth experience in a sample of postnatal Swedish women. The secondary aim was to analyse demographic and clinical determinants associated with a positive birth experience.Design/MethodsA digital survey including the instrument Childbirth Experience Questionnaire 2 (CEQ2) was answered by 619 women six to 16 weeks postpartum. Regression analyses were made assessing the impact that different factors had on the overall childbirth experience and the four subscales of CEQ2: Own Capacity, Perceived Safety, Professional Support and Participation.ResultsOverall, women were satisified with their birthing experience. Several factors contributed to a positive childbirth experience. Having a vaginal mode of birth (without vacuum extraction) together with not having ongoing mental health problems were the factors with the most influence on the total childbirth experience. Not having maternal complications postpartum and receiving much support from a trusted birth companion were two other important factors.ConclusionAlthough Swedish women tend to express satisfaction with their childbirth experiences, there is a necessity to advocate for a childbirth approach that optimises the chance of giving birth vaginally rather than with vacuum extraction or acute caesarean section, and reduces the risk for complications whenever possible. During pregnancy, mental health problems should be appropriately addressed. Healthcare professionals could also more actively involve the birth companion in the birthing process and equip them with the necessary tools to effectively support birthing women.
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| 16. |
- Grundström, Hanna, et al.
(författare)
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Fear of childbirth postpartum and its correlation with post-traumatic stress symptoms and quality of life among women with birth complications - a cross-sectional study
- 2022
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Ingår i: Archives of Women's Mental Health. - Wien : Springer. - 1434-1816 .- 1435-1102. ; 25:2, s. 485-491
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim of the study was to analyze differences in post-traumatic stress symptoms (PTSS) and quality of life (QoL) between women with and without severe fear of childbirth postpartum (PP FOC). The secondary aims were to analyze the correlation between PP FOC and PTSS, and PP FOC and QoL, in women undergoing complicated childbirth. This cross-sectional study was conducted in South-East Sweden. Women aged >= 18 years who had undergone complicated childbirth (i.e., acute or emergency cesarean section, vacuum extraction, child in need of neonatal care, manual placenta removal, sphincter rupture, shoulder dystocia, or hemorrhage >= 1000 ml) were invited. Seventy-six women answered demographic questions and three validated instruments measuring PP FOC, PTSS, and QoL. The study population was divided into two sub groups: severe PP FOC or no severe PP FOC. Statistical analyses were conducted using Mann-Whitney U-test, chi-square test or Fishers exact test, and Spearmans rank-order correlation. Severe PP FOC was reported by 29% of the women, and 18% reported PTSS indicating post-traumatic stress disorder. Women with severe PP FOC reported significantly higher levels of PTSS, and significantly lower QoL in five dimensions: physical role functioning, emotional role functioning, energy/fatigue, emotional well-being, and social functioning. There was a positive significant correlation between level of PP FOC and PTSS. There were also significant negative correlations between level of PP FOC and most of the QoL dimensions. In conclusion, almost one-third of the women with complicated childbirth reported severe PP FOC, and almost one-fifth reported PTSS indicating post-traumatic stress disorder. PP FOC correlated with PTSS and deteriorated QoL.
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| 17. |
- Grundström, Hanna, 1982-, et al.
(författare)
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Healthcare Consumption and Cost Estimates Concerning Swedish Women with Endometriosis
- 2020
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Ingår i: Gynecologic and Obstetric Investigation. - : KARGER. - 0378-7346 .- 1423-002X. ; 85:3, s. 237-244
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Tidskriftsartikel (refereegranskat)abstract
- Introduction:Endometriosis is known for its substantial effect on women's wellbeing and quality of life. In order to evaluate disease burden, treatments and health services, assessments of healthcare consumption and cost estimates are necessary.Objectives:The aim of this study was to estimate healthcare consumption and annual cost per woman with endometriosis in Sweden and to examine healthcare consumption and costs in different age groups.Methods:A questionnaire was distributed to 400 members of the Endometriosis Association and to 400 randomly selected women with surgically confirmed endometriosis. Official statistics were obtained via correspondence, publications, and database searches.Results:Analysis of the 431 returned questionnaires showed that women under 30 years utilized more inpatient and outpatient care than older women. The mean annual cost among all women was EUR 8,768/woman. The direct healthcare cost of managing the disease was EUR 4,282, while the indirect cost was EUR 4,486. Absence from work was reported by 32% of the women, while 36% reported reduced time at work because of endometriosis.Conclusion:Our results confirm the substantial negative effect of endometriosis upon women's lives and their relatively high healthcare consumption.
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| 18. |
- Grundström, Hanna, et al.
(författare)
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Impact of Pelvic Pain and Endometriosis on Patient-Reported Outcomes and Experiences of Benign Hysterectomy: A Study from the Swedish National Register for Gynecological Surgery
- 2018
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Ingår i: Journal of Women's Health. - : MARY ANN LIEBERT, INC. - 1540-9996 .- 1931-843X. ; 27:5, s. 691-698
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Tidskriftsartikel (refereegranskat)abstract
- Background: The study objective was to analyze and compare patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) after hysterectomy in women with and without a preoperative complaint of pelvic pain associated with and without a confirmed diagnosis of endometriosis. Methods: Retrospective nationwide register study. Data on 28,776 hysterectomies performed on benign indication between 2004 and 2016 were retrieved from the Swedish National Register for Gynecological Surgery. Multivariable logistic regression models were used to compare the PREMs and PROMs items. The results are presented as adjusted odds ratios (aORs) and 95% confidence intervals (CI). Results: Regardless of the occurrence of pelvic pain preoperatively and a diagnosis of endometriosis, 1 year after surgery, the women were satisfied or very satisfied (amp;gt;90%) with the hysterectomy, and their medical condition was improved or much improved (amp;gt;95%). The women with a preoperative complaint of pelvic pain and endometriosis more often reported excessively short hospital stays (aOR 1.45, 95% CI 1.17-1.79), more severe complications after discharge (aOR 2.02, 95% CI 1.59-2.66) at the 8-week follow-up and at the 1-year follow-up (aOR 2.31, 95% CI 1.57-3.39), and more dissatisfaction with the operation (aOR 1.83, 95% CI 1.35-2.48) than preoperative pelvic pain-free women without endometriosis at the 1-year follow-up. Conclusions: The majority of the women were satisfied after their hysterectomy. The women with pelvic pain and endometriosis were at a higher risk of being dissatisfied. Pelvic pain per se seemed to be the main factor affecting the rating in the PREMs and PROMs, and the endometriosis was a significant contributing factor.
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| 19. |
- Grundström, Hanna, 1982-, et al.
(författare)
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Incidence of self-reported pelvic pain and risk factors for pain 1 year after benign hysterectomy : A register study from the Swedish National Quality Registry for Gynecological Surgery
- 2023
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 102:10, s. 1359-1370
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The primary aim of this study was to determine the incidence of patient-reported pain 1 year after hysterectomy for benign gynecological conditions in relation to occurrence of preoperative pain. The secondary aim was to analyze clinical risk factors for pain 1 year after the hysterectomy in women with and without preoperatively reported pelvic/lower abdominal pain. Material and methods This was a historical cohort study using data from the Swedish National Quality Registry for Gynecological Surgery on 16 694 benign hysterectomies. Data were analyzed using multivariable logistic regression models. Results One year after surgery, 22.4% of women with preoperative pain reported pelvic pain and 7.8% reported de novo pelvic pain. For those with preoperative pain younger age (adjusted odds ratio [aOR] 1.75, 95% confidence interval [CI] 1.38-2.23 and aOR 1.21, 95% CI 1.10-1.34 for women aged <35 and 35-44 years, respectively), not being gainfully employed (aOR 1.43, 95% CI 1.26-1.63), pelvic pain as the main symptom leading to hysterectomy (aOR 1.51, 95% CI 1.19-1.90), endometriosis (aOR 1.18, 95% CI 1.06-1.31), and laparoscopic hysterectomy (aOR 1.30, 95% CI 1.07-1.58), were clinically relevant independent risk factors for pelvic/lower abdominal pain 1 year after surgery, as were postoperative complications within 8 weeks after discharge. Meanwhile, clinically relevant independent risk factors for reporting de novo pain 1 year after surgery were younger age (aOR 2.05, 95% CI 1.08-3.86 and aOR 1.29, 95% CI 1.04-1.60 for women aged <35 and 35-44 years, respectively), and postoperative complications within 8 weeks after discharge. Conclusions The incidence of pelvic pain and de novo pain 1 year after hysterectomy was relatively high. Women with and without reported preoperative pelvic/lower abdominal pain represented clinically different populations. The risk factors for pelvic pain seemed to differ in these two populations. The differences in risk factors could be taken into consideration in the preoperative counseling and in the decision-making concerning method of hysterectomy, provided that large well-designed studies confirm these risk factors.
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| 20. |
- Grundström, Hanna, 1982-, et al.
(författare)
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Pain catastrophizing is associated with pain thresholds for heat, cold and pressure in women with chronic pelvic pain
- 2020
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Ingår i: Scandinavian Journal of Pain. - : WALTER DE GRUYTER GMBH. - 1877-8860 .- 1877-8879. ; 20:3, s. 635-646
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Psychological traits such as pain catastrophizing may play a role in the development of chronic pelvic pain (CPP). Pain catastrophizing is the tendency to amplify negative cognitive and emotional pain processes. The Pain Catastrophizing Scale (PCS) assesses elements of pain catastrophizing divided into three subgroups of factors (rumination, helplessness and magnification). Previous studies have shown associations between CPP and increased pain sensitivity, widespread generalized hyperalgesia, and decreased pain thresholds, but the relation between pain catastrophizing and specific pain thresholds has not yet been widely examined in this patient group. The aims of this study were (a) to determine if catastrophizing is increased in women with CPP compared with pain-free women, (b) to assess the importance of pain catastrophizing, psychological distress variables, and subjective pain sensitivity for pain thresholds of heat, cold and pressure in these two groups, and (c) to determine whether psychological variables or pain thresholds best contribute to the differentiation between CPP and controls. Methods: Thirty-seven women with chronic pelvic pain who underwent diagnostic laparoscopy on the suspicion of endometriosis participated along with 55 healthy and pain-free controls. All underwent quantitative sensory testing on six locations on the body to determine heat (HPT), cold (CPT) and pressure (PPT) pain thresholds. The PCS, the Pain Sensitivity Questionnaire (PSQ), the Hospital Anxiety Depression Scale, (HAUS) demographics and clinical data were collected prospectively. Principal component analysis and orthogonal partial least square regressions were used to assess the associations between PCS scores and pain thresholds. Results: The women with CPP scored significantly higher on PCS than the healthy controls. PCS-helplessness, PCS-rumination and HADS-depression were significantly associated with pain thresholds for the whole group. In the CPP group, PCS-rumination, body mass index and PSQ were significant regressors for HPT and CPT. The PCS and the HADS subscales were strongly intercorrelated in women with CPP and were stronger regressors of group membership than the three pain thresholds. In the group of healthy control women, no relationships were found to be significant. The psychological variables were somewhat stronger significant regressors than pain thresholds (also significant) for group membership. Conclusions: Women with CPP have significantly higher pain catastrophizing scores than women without CPP. The pain catastrophizing rumination factor is significantly associated with pain thresholds of heat and cold in CPP women. PCS and HADS are strongly intercorrelated and PSQ correlates positively with these variables. It seems that the psychological variables are important for group differentiation.
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| 21. |
- Grundström, Hanna, et al.
(författare)
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Perceived Professional Support During Pregnancy, Childbirth, and Postpartum Among Women Reporting Severe Fear of Childbirth Postpartum
- 2021
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Ingår i: Journal of reproductive medicine. - : SCI PRINTERS & PUBL INC. - 0024-7758 .- 1943-3565. ; 66:3-4, s. 89-96
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe how women with severe fear of childbirth postpartum recall the professional support they received before, during, and after childbirth. STUDY DESIGN: This is a qualitative study based on telephone interviews with 10 women reporting fear of childbirth postpartum and who had given birth in 2018. They were interviewed using a semi-structured interview guide. The interviews were digitally recorded, transcribed verbatim, and analyzed using thematic analysis according to Braun and Clarke. RESULTS: The results showed that most women expressed satisfaction with the support they received from the healthcare professionals before, during, and after childbirth, and most of them could not identify any lacking support. The experiences were categorized into 3 themes: "validation and trust," "guidance," and "being in control." CONCLUSION: In summary, the womens reported fear of childbirth postpartum did not seem related to any perceived lack of professional support. The supposed association between fear of childbirth, negative childbirth experiences, and perceived support may need further illumination.
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| 22. |
- Grundström, Hanna, et al.
(författare)
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Previous Trauma Exposure and Its Associations with Fear of Childbirth and Quality of Life among Pregnant Lesbian, Bisexual, Transgender, and Queer People and Their Partners
- 2023
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Ingår i: LGBTQ FAMILY-AN INTERDISCIPLINARY JOURNAL. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 2770-3371 .- 2770-338X. ; 19:2, s. 175-185
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim of this study was to determine the prevalence of previous trauma exposure among expectant birth-giving parents and their partners within a LBTQ population. The secondary aims were to compare fear of childbirth (FOC) and quality of life (QoL) in relation to previous trauma exposure in pregnant LBTQ people and their partners. A further aim was to analyze associations between severe FOC and clinical and demographic factors in this population. Data was collected from a Swedish LGBTQ competent antenatal clinic. Trauma-exposed pregnant (n = 32) and non-pregnant (n = 21) individuals and pregnant (n = 48) and non-pregnant (n = 30) individuals without previous trauma experiences responded to instruments measuring FOC (Wijma Delivery Expectancy Questionnaire) and QoL (EuroQol 5 D-index/-visual analogue scale, VAS). Differences between groups were assessed using non-parametric tests. The proportion of trauma exposure was similar among pregnant responders and their partners (40.0% vs. 41.2%). Trauma-exposed pregnant respondents had a significantly higher prevalence of severe FOC compared to the pregnant respondents without previous trauma. Pregnant trauma-exposed respondents scored lower on EQ5D-VAS than pregnant respondents without trauma, as did non-pregnant trauma exposed respondents compared with non-pregnant -respondents without trauma. Furthermore, trauma-exposed non-pregnant respondents scored lower on the EQ5D-index compared to non-pregnant respondents without trauma. Previous trauma was the only clinical and demographic factor that had any significant association withto severe FOC in the regression analysis. In conclusion, our results suggest that previous trauma exposure may contribute to the risk of suffering from severe FOC and lower QoL among LBTQ-identifying prospective parents.
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| 23. |
- Grundström, Hanna, 1982-, et al.
(författare)
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Psychometric evaluation of the Swedish version of the 30-item endometriosis health profile (EHP-30)
- 2020
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Ingår i: BMC Women's Health. - : BMC. - 1472-6874. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The 30-Item Endometriosis Health Profile (EHP-30) is a specific instrument measuring quality of life among women with endometriosis. Although the Swedish version of EHP-30 is widely used in research and clinical settings, it has not yet been evaluated psychometrically. Ensuring validity and reliability is of most importance when using translated instruments. Therefore, the aim of the study was to evaluate the psychometric properties of the Swedish version of the EHP-30. Methods: This study was conducted at a Swedish referral university hospital specializing in endometriosis. Data collection was performed in January 2013. The EHP-30 was sent to 369 randomly selected women with a laparoscopy-verified endometriosis diagnosis. The psychometric evaluation included evaluation of data completeness, score distributions, floor and ceiling effects, internal consistency, factor analysis and test-retest reliability. Results: Out of the 211 women with endometriosis who answered the questionnaire, 128 were native Swedish speakers who had experienced symptoms of endometriosis during the past 4 weeks, and were included in the psychometric evaluation. Data completeness was 99.5%. The highest median score was found in the Control and Powerlessness subscale, and lowest in Pain. Distributions towards ill health were found in all subscales except for the pain subscale, but there were no noteworthy floor or ceiling effects. Internal consistency was good (Cronbach's alpha 0.83-0.96). Factor analysis could roughly confirm three of the five subscales. The test-rest analysis showed good reliability. Scores were systematically lower during the second measurement. Conclusions: We conclude that the Swedish version of EHP-30 is a valid and reliable instrument to measure health-related quality of life in women with endometriosis. It is understandable, acceptable and usable and can be recommended for use in clinical daily routines and for research purposes.
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| 24. |
- Grundström, Hanna, 1982-, et al.
(författare)
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Reduced pain thresholds and signs of sensitization in women with persistent pelvic pain and suspected endometriosis
- 2019
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 98:3, s. 327-336
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Endometriosis is a gynecological disorder that may cause considerable pelvic pain in women of fertile age. Determining pain mechanisms is necessary in order to optimize the treatment of the disease. The objective of the study was to evaluate pain thresholds in women with persistent pelvic pain with and without confirmed endometriosis, and healthy, unaffected controls, and analyze how pain thresholds in these cohorts related to duration of pelvic pain, quality of life, and symptoms of anxiety and depression.MATERIAL AND METHODS: Pain thresholds for heat, cold and pressure were assessed with quantitative sensory testing on six locations on a reference group of 55 healthy women and on 37 women with persistent pelvic pain who had been admitted for diagnostic laparoscopy on the suspicion of endometriosis. Validated instruments were applied to assess quality of life and symptoms of anxiety and depression. Data were analyzed by means of uni- and multivariate analysis of variance and Spearman's rank-order correlation.RESULTS: The women with persistent pelvic pain had significantly lower pain thresholds compared with the reference women. In the women with pain, no differences were observed in pain thresholds between women with (n = 13) and women without (n = 24) biopsy-proven endometriosis. The duration of pelvic pain correlated significantly positively with reduced pain thresholds, ie, the longer the duration, the more sensitization. In the persistent pelvic pain group, pain thresholds for heat correlated significantly with the Short Form Health Survey 36 dimension of bodily pain, and thresholds for cold correlated with Short Form Health Survey 36 bodily pain and with symptoms of depression.CONCLUSIONS: Our results showed widespread alterations in pain thresholds in women with persistent pelvic pain that are indicative of central sensitization and a time-dependent correlation. Women with pelvic pain and suspicion of endometriosis should probably be treated more thoroughly to prevent or at least minimize the concomitant development of central sensitization.
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| 25. |
- Grundström, Hanna, et al.
(författare)
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Supporting womens reproductive capabilities in the context of childbirth : Empirical validation of a midwifery theory synthesis
- 2022
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Ingår i: Midwifery. - : Elsevier Science Ltd. - 0266-6138 .- 1532-3099. ; 110
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To conduct an empirical validation of the theoretical model of midwifery care suggested by Peters et al. (2020). Design: A qualitative deductive methodology was used to validate the theoretical model of aims and objectives of midwifery care. The existing model was validated for midwifery care before, during and after childbirth by interviewing women who had reported high satisfaction with childbirth and low fear of childbirth postpartum. Setting: Data were collected via interviews with women who had given birth from January to March 2018 at a middle-sized hospital in south-east Sweden. Participants: Swedish-speaking women aged > 18 years, were invited by midwives to participate at a postpartum maternal healthcare ward, and they received oral and written information. They filled in a demographic questionnaire, a grading of their birth experience on a 0-10 numeric rating scale (NRS) and the Wijma Delivery Experience Questionnaire Version B (W-DEQ B). We used >7 as the cut-off for high satisfaction with childbirth (NRS), and a sum score <= 60 for low fear of childbirth (W-DEQ B). Of 172 women, 28 were eligible, of whom 20 were interviewed 8-13 months postpartum. The interviews were analysed using qualitative content analysis with a directed approach. Findings: All of the models levels and their aspects were found in the interviews. All women had experienced a trusting relationship, including individual and woman-centred care, communication, choice and continuity, prompt attention and an empathic attitude. A majority described midwifery in terms of promoting security, and almost all had experienced aspects of personal control. The objective of midwifery care, described as the facilitation of womens reproductive capabilities, was described as being met by half of the women. The importance of pep talks and coaching was emphasized, and partner support could be added to the model. Key conclusions and implications for practice: Our findings indicate that the theoretical model proposed by Peters et al. (2020) is mainly applicable to midwifery care of women reporting high satisfaction with their birth experience and low postpartum fear of childbirth. Our findings suggest that this model may serve as a clarification of the unique objective of midwifery care, and could be used by midwives in daily clinical work and in midwifery education programs.
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| 26. |
- Grundström, Hanna, et al.
(författare)
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Translation and validation of the Swedish version of the Birth Satisfaction Scale-Revised (BSS-R)
- 2023
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Ingår i: Midwifery. - : ELSEVIER SCI LTD. - 0266-6138 .- 1532-3099. ; 124
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Tidskriftsartikel (refereegranskat)abstract
- Background: Optimizing womens childbirth experience is essential for development of quality mother infant relationships. The Birth Satisfaction Scale-Revised ( BSS-R ) can be used to measure birth satisfaction. Aim: The current investigation sought to translate and validate a Swedish version of the BSS-R. Method: Following translation, a comprehensive psychometric validation of the Swedish - BSS-R ( SW-BSS-R ) was carried out using a multi-model, cross-sectional, between- and within-subjects design. Participants: A total of 619 Swedish-speaking women participated, from which 591 completed SW-BSS-R and were eligible for analysis. Data analysis: Discriminant, convergent, divergent and predictive validity, internal consistency, test-retest reliability, and factor structure were evaluated. Results: The SW-BSS-R was found to have excellent psychometric properties and hence is a valid translation of the original UK(English)-BSS-R . Important insights into relationships between mode of birth, posttraumatic stress disorder (PTSD), and postnatal depression (PND) were observed. Conclusions and implications for practice: The SW-BSS-R is a psychometrically valid translation of the original BSS-R and is suitable for use in a Swedish-speaking population of women. The study has also highlighted important dynamics between birth satisfaction and areas of significant clinical concern (i.e., mode of birth, PTSD and PND) in Sweden.
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| 27. |
- Grundström, Hanna, et al.
(författare)
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Translation, Cross-Cultural Adaptation, and Psychometric Evaluation of the Swedish Version of ENDOCARE : An Instrument to Measure Patient Centeredness of Endometriosis Care
- 2021
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Ingår i: Gynecologic and Obstetric Investigation. - : S. Karger AG. - 0378-7346 .- 1423-002X. ; 86:3, s. 283-292
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The need for quality improvement within endometriosis healthcare is widely acknowledged. The ENDOCARE questionnaire (ECQ) measures patient centeredness of endometriosis care. The aims of this study were (1) to translate and culturally adapt ECQ into Swedish, (2) to evaluate validity (construct validity), and (3) to measure reliability (internal consistency and test-retest reliability).Design: This is a cross-sectional randomized study.Participants, Setting, and Methods: ECQ was first translated according to a well-established guideline and was thereafter sent to 500 randomly selected women with endometriosis, who had visited participating clinics during the past 3 years. The first 150 women who returned their questionnaires were immediately sent the same questionnaire again. The ECQ consists of 3 parts. The first part contains demographic and clinical questions, while part II has 38 items that are answered according to 2 aspects: percentage of negative experience of care and mean personal importance. A patient-centeredness score (PCS) is calculated based on these 2 aspects. The items are also divided into 10 dimensions of care. Part III is a grading of overall experience and an open-ended question on any missing aspect in the questionnaire.Results: A total of 187 native Swedish-speaking women participated. Data completeness was high (>90%). The overall PCS median was 3.5. The highest median PCS was found in the dimension regarding endometriosis clinic staff and the lowest in emotional support and alleviation of fear and anxiety and the involvement of significant others. Factor analysis could roughly confirm 2 of the 10 dimensions. The Cronbach's alpha coefficient for PCS ranged from 0.35 to 0.73. The test-rest analysis showed acceptable reliability.Limitations: The most important limitation was the relatively low participation rate and the risk of recall bias. It is likely that women gave their answers based on their most recent experiences.Conclusions: Overall, our results indicate that the Swedish version of the ECQ is a usable instrument to measure patient centeredness in endometriosis care, but due to the unstable factor analysis, conclusions based on the dimensions should be made with caution.
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| 28. |
- Grundström, Hanna, et al.
(författare)
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'You expose yourself in so many ways': young women's experiences of pelvic examination
- 2011
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Ingår i: Journal of Psychosomatic Obstetrics and Gynaecology. - : Informa Healthcare. - 0167-482X .- 1743-8942. ; 32:2, s. 59-64
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to identify and describe young women's experiences of pelvic examination (PE). Qualitative interviews were conducted with nine women aged 18--23 years, who had undergone at least one PE. Data were analysed using an interpretative phenomenological approach. Three general themes were identified: (1) relinquishing and regaining control, (2) facilitation of the situation by the examiner and (3) PE is an unpleasant necessity. These general themes had a common structure that represented the essence: an intimate situation. The women experienced PE as an intimate situation, which they associated with their sexuality. They felt exposed both bodily and mentally and were placed in a vulnerable situation. PE was considered as unpleasant but necessary to confirm their health. During the PE, the women felt that they lost control of the situation by exposing their intimate parts. To regain control, the women felt a need for continuous information from the examiner. The vulnerable situation could be made less vulnerable if the examiner built a trusting relationship and made the women feel secure and seen as individuals. A deeper understanding of the situation from the women's perspective could facilitate the examiner's performance of PE, leading to more positive experiences among young women.
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| 29. |
- Grundström, Jenna, et al.
(författare)
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Associations between relationship status and mental well-being in different life phases from young to middle adulthood
- 2021
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Ingår i: SSM - Population Health. - : Elsevier. - 2352-8273. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess the associations between relationship status and mental well-being in four different phases during the life course, and to identify whether relationship quality moderated these associations. We used a broader concept of relationship status (instead of marital status) and also included the positive dimension of mental health. Participants in a Finnish cohort study were followed up at ages 22 (N = 1,656), 32 (N = 1,471), 42 (N = 1,334), and 52 (N = 1,159). Measures in all study panels covered relationship status (marriage, cohabitation, dating, single and divorced/widowed), Short Beck Depression Inventory (S-BDI), self-esteem (seven items) and relationship quality (six items). Analyses were carried out using linear regression. Compared to marriage, being single or being divorced/widowed were associated with depressive symptoms at every age in men. For women, in turn, being single - but not being divorced/widowed - was associated with depressive symptoms. Among men, being single or being divorced/widowed were also associated with lower self-esteem at age 32, 42 and 52, but in women, only one association between lower self-esteem and being single was found at age 32. Of the age stages, the age 32 is highlighted in men, at which point all relationship statuses were risk factors compared to marriage. There were only few indications of the moderating role of the relationship quality. Compared to marriage, being single or being divorced/widowed were quite consistently associated with poorer mental well-being during the life course, especially among men. For dating and cohabiting the associations were more fragmented depending on age and gender; particularly among women, these relationship statuses tended not to differ from marriage in terms of mental well-being. These observations on mental well-being across five relationship statuses are important in our contemporary society, where the number of marriages is decreasing, and other forms of relationships are becoming more common.
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| 30. |
- Grundström, Jenna, et al.
(författare)
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Reciprocal associations between parenthood and mental well-being - a prospective analysis from age 16 to 52 years
- 2024
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Ingår i: Current Psychology. - : Springer. - 1046-1310 .- 1936-4733. ; 43:3, s. 2238-2252
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The present study examines the bidirectional nature of the associations between parenthood and mental well-being using 36-year longitudinal data.Background: Mental well-being can affect if and when one becomes a parent (selection hypothesis), and the characteristics of parenthood can affect mental well-being (causation hypothesis). However, life course research has infrequently studied these hypotheses in parallel. Previous studies have also typically only focused on one aspect of parenthood (e.g., having children) and on the negative aspects of the mental well-being construct.Method: The participants in the Finnish 'Stress, Development and Mental Health (TAM)' cohort study were followed up at ages 16, 22, 32, 42, and 52 (N = 1160). The measures of parenthood (having children, timing of parenthood, and number of children) and mental well-being at ages 16 and 52 (depressive symptoms, self-esteem, and meaningfulness) were based on self-report.Results: For men, higher self-esteem in adolescence was associated with having children, and having children was associated with higher self-esteem in middle age. For women, depressive symptoms at age 16 were associated with becoming a parent at age 24 or younger. For both genders, having children was associated with a higher sense of meaningfulness in middle age.Conclusion: Studied within the life course perspective, our results indicate that parenthood has a positive effect on mental well-being in mid-adulthood even when accounting for selection effects.
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| 31. |
- Hallström, Sofia, et al.
(författare)
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Fear of childbirth and mental health among lesbian, bisexual, transgender and queer people : a cross-sectional study
- 2022
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Ingår i: Journal of Psychosomatic Obstetrics and Gynaecology. - : Taylor & Francis Ltd. - 0167-482X .- 1743-8942. ; 43:4, s. 526-531
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most studies of fear of childbirth (FOC) are conducted on heterosexual cisgender pregnant populations of birth-giving parents. Among lesbian and bisexual women, as well as transgender and queer people (LBTQ), minority stress can add an extra layer to FOC. Gender binary and cisnormative assumptions leave it to the patient to educate and navigate healthcare providers, which can increase mental health problems. Objective: The aim of this study is to compare FOC and mental illness among expecting birth-giving parents and their partners in an LBTQ population. Materials and methods: This cross-sectional study recruited 80 self-identified pregnant LBTQ persons and their 54 non-pregnant partners at a LBTQ specialized antenatal clinic in a large Swedish city of over one million inhabitants. The survey included socio-demographic characteristics, sexual and gender orientation, obstetric history, previous mental health, previous trauma exposure and measures of FOC and mental health. Results: Levels of FOC were significantly higher for the pregnant participants (median W-DEQ 67.5) than for partners (median W-DEQ 60.0). The proportion of severe FOC was higher for pregnant participants (20.3%) than for partners (9.4%), although this difference was not statistically significant. Mental illness was significantly associated with FOC. Conclusion: The results add valuable information to our understanding of the specific needs of pregnant LBTQ people and their partners and may help us to develop healthcare in the future.
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| 32. |
- Klittmark, Sofia, et al.
(författare)
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When complications arise during birth: LBTQ people?s experiences of care
- 2023
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Ingår i: Midwifery. - : ELSEVIER SCI LTD. - 0266-6138 .- 1532-3099. ; 121
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the care experiences of lesbian, bisexual, transgender, and queer (LBTQ) people dur-ing births where complications have arisen.Design: Data were collected through semi-structured interviews with self-identified LBTQ people who had experienced obstetrical and/or neonatal complications.Setting: Interviews were conducted in Sweden. Participants: A total of 22 self-identified LBTQ people participated. 12 had experienced birth complications as the birth parent and ten as the non-birth parent.Findings: Most participants had felt invalidated as an LBTQ family. Separation of the family due to com-plications elevated the number of hetero/cisnormative assumptions, as new encounters with healthcare professionals increased. Dealing with normative assumptions was particularly difficult in stressful and vulnerable situations. A majority of the birth parents experienced disrespectful treatment from healthcare professionals that violated their bodily integrity. Most participants experienced lack of vital information and emotional support, and expressed that the LBTQ identity made it harder to ask for help.Conclusions: Disrespectful treatment and deficiencies in care contributed to negative experiences when complications arose during birth. Trusting care relationships are important to protect the birth experience in case of complications. Validation of the LBTQ identity and access to emotional support for both birth and non-birth parents are crucial for preventing negative birth experiences. Implications for practice: To reduce minority stress and create conditions for a trusting relationship, healthcare professionals should specifically validate the LBTQ identity, strive for continuity of carer and zero separation of the LBTQ family. Healthcare professionals should make extensive effort s to transfer LBTQ related information between wards.(c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )
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| 33. |
- Loewinski, Tess, et al.
(författare)
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Translation, cross-cultural adaptation, and validation of the Swedish version of the female genital self-image scale
- 2022
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier Ireland Ltd. - 1877-5756 .- 1877-5764. ; 33
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The objective of the study was to translate and culturally adapt the Female Genital Self-Image Scale (FGSIS-7) into a valid and reliable Swedish version, and to test the instrument.Methods: The instrument was translated into Swedish in a three-stage process of translation, back-translation and synthesis. The face validity of the pre-final translation was tested in a cognitive debriefing with a test group of eight women, while construct validity was tested in a group of six subject matter experts. Internal consistency, data completeness, score distributions, and floor and ceiling effects were measured using an online survey with a cross-sectional design.Results: The Swedish version of the instrument (SWE-FGSIS-7) was perceived as a comprehensible, under-standable and user-friendly instrument by the test group and the experts. The online survey included 147 re-sponders with 100 % data completeness and no floor or ceiling effects. The internal consistency was good (Cronbachs Alpha coefficient 0.82). The total mean score was 22.44 (SD = 3.98). Conclusion: SWE-FGSIS-7 is a user-friendly, understandable, valid and reliable instrument for estimating genital self-image, which can be used to initiate a dialogue that may contribute to increased knowledge about womens own bodies and strengthen their reproductive and sexual health.
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| 34. |
- Pontoppidan, Karin, et al.
(författare)
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Clinical factors associated with quality of life among women with endometriosis : a cross-sectional study
- 2023
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Ingår i: BMC Women's Health. - : BioMed Central (BMC). - 1472-6874. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundEndometriosis often leads to a decrease in Quality of Life (QoL), due to its impact on various aspects of women's lives, such as social life, mental health, sex life, and working capacity. Although previous studies have assessed QoL in women with endometriosis, few studies have explored the impact of different clinical variables on QoL. The aim of this study was to investigate how women with endometriosis perceive their QoL, and to analyze which clinical factors are associated with QoL.MethodsThe Endometriosis Health Profile-30 and the ENDOCARE Questionnaire were distributed to 1000 women diagnosed with endometriosis from 10 different clinics across Sweden. The responses from 476 women were included in univariate and multivariable regression analyses, where the clinical factors were correlated with overall QoL and QoL dimensions.ResultsThe women participating in this study reported a low QoL. The clinical factors that showed a significant correlation with overall QoL were age at first onset of endometriosis symptoms (beta= -0.64, p < 0.001), having more than 10 visits to general practitioners before referral to a gynecologist (beta = 5.58, p = 0.036), current or previous mental health issues (beta = 7.98, p < 0.001) patient-centeredness (beta= -2.59, p < 0.001) and use of opioids (beta = 7.14, p = 0.002).ConclusionsThis study shows that opioid use and mental health issues were associated with a worse QoL, whereas a higher degree of patient-centeredness was associated with a better QoL. The association between opioid use and a worse QoL might not entirely be caused by the opioid use itself but also by symptom severity and mental health issues. An improved patient-centeredness and more focus on taking care of mental health issues would reasonably result in a better QoL for women with endometriosis.
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| 35. |
- Sten, Greta, et al.
(författare)
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Assessment of Maternal Posttraumatic Stress Disorder Following Childbirth: Psychometric Properties of the Swedish Version of City Birth Trauma Scale
- 2023
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Ingår i: Psychological Trauma. - : EDUCATIONAL PUBLISHING FOUNDATION-AMERICAN PSYCHOLOGICAL ASSOC. - 1942-9681 .- 1942-969X. ; 15:7, s. 1153-1163
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Tidskriftsartikel (refereegranskat)abstract
- Objective: City Birth Trauma Scale (City BiTS) is an instrument designed to evaluate and diagnose postpartum posttraumatic stress disorder (PTSD) according to the 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). No validated Swedish instrument exists to measure postpartum PTSD according to DSM-5. Therefore, the primary aim of this study was to assess the psychometric properties of the Swedish version of the City BiTS (City BiTS-Swe) and to examine the latent factor structure of postpartum PTSD. The secondary aim was to report the Swedish prevalence of PTSD following childbirth. Method: A total of 619 women, who had given birth at five clinics in the past 6-16 weeks, completed an online version of City BiTS-Swe and the Edinburgh Postnatal Depression Scale (EPDS). Additionally, sociodemographic and medical data were collected. A second questionnaire was answered by 110 women to examine reliability over time. Results: The confirmatory factor analysis using the two-factor model gave best fit to the data. We found a high internal consistency (a = .89-.87) and good test-retest reliability (ICC = 0.53-0.90). Divergent reliability with EPDS showed significant correlations with satisfying results for the subscale birth-related symptoms (r = .41). We also found discriminant validity concerning mode of birth, parity, gestational age, mental illness, history of traumatic childbirth, and history of traumatic event as expected. The prevalence of PTSD was 3.8%. Conclusions: The City BiTS-Swe is a valid and reliable instrument to assess and diagnose PTSD following childbirth.
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| 36. |
- Strömberg, Clara, et al.
(författare)
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Age-related differences in experienced patient-centred care among women with endometriosis
- 2022
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Ingår i: Journal of Obstetrics and Gynaecology. - : Taylor & Francis Group. - 0144-3615 .- 1364-6893. ; 42:7, s. 3356-3361
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Tidskriftsartikel (refereegranskat)abstract
- Younger women with endometriosis report lower quality of life and seek more care. Patient-centeredness is a central part of quality of care. The aim of this study was to investigate if women younger than 35 years experience endometriosis care as less patient-centred than women 35 years and older. The ENDOCARE Questionnaire was sent to 1000 randomly selected women with verified endometriosis from 10 clinics in Sweden. Answers from 469 women were analysed using Mann-Whitney's U-test and Spearman's correlation. Our findings show that younger women experience care as less patient-centred regarding 'Physical comfort,' 'Continuity,' 'Access to care,' 'Technical skills,' and overall patient-centeredness score in comparison with older women. On the contrary, younger women experience more patient-centeredness in 'Emotional support'. Positive correlations were found for age and 'Access to care' and 'Technical skills', while a negative correlation was found for age and 'Emotional support'. Impact Statement What is already known on this subject? There is a need for improvement of quality of endometriosis care. Patient-centeredness is an important part of care improvement work. Many factors have an impact on experienced patient-centeredness in endometriosis care, whereof age is one possible determinant. Given the impact of age on QoL and care seeking behaviour, age may also have influence on the experience patient-centeredness. What do the results of this study add? Our findings show that younger women experience their endometriosis care as less patient-centred than older women. What are the implications of these findings for clinical practice and/or further research? Our results highlight the need of improvement of endometriosis care, especially for younger women. The results contribute to the understanding of the experience of patient-centeredness, which may be used as a guidance to how healthcare recourses should be allocated. Further research is needed to identify other factors contributing to the experience of patient-centeredness. Future studies could also evaluate how different interventions can improve patient-centeredness.
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