Women from diverse minority ethnic or religious backgrounds desire more infertility education and more culturally and personally sensitive fertility care.

STUDY QUESTION: What are the views, experiences and healthcare needs of infertile women from a minority ethnic or religious background living in Wales? SUMMARY ANSWER: Women from ethnic and religious minority backgrounds consider that their communities have highly pronatalistic attitudes and stigmatize infertility, and express the need for more infertility education (for themselves and their communities), as well as more socio-culturally and interpersonally sensitive fertility care. WHAT IS ALREADY KNOWN: Some people from minority ethnic or religious groups perceive pressure to conceive from their communities, experience social costs when they are unable to have children and stressful interactions with the fertility healthcare system while attempting to conceive. STUDY DESIGN, SIZE, DURATION: This study was based on a one-day drawing workshop to collect visual (artwork produced by participants) and textual (all conversations and discussions during the workshop) data about the participants' views and experiences of infertility and their fertility care needs. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were nine adult women with a minority ethnic or religious status living in Wales, UK, who were experiencing or had experienced infertility in the past. The workshop comprised five activities: (i) small and large group discussion of infertility-related drawings, (ii) lide-based lecture consisting of an introduction to the basics of drawing objects and people and (iii) thoughts and feelings, (iv) free drawing session and (v) group sharing. Audio recordings of the workshop were transcribed verbatim. Textual data was analysed with thematic analysis. Risk for bias was addressed via individual coding by two authors followed by joint presentation and discussion of results with the research team and participants. MAIN RESULTS AND THE ROLE OF CHANCE: Forty-one themes were identified and grouped into eight distinct higher order themes. These themes described the emotional, relational and social burden of infertility experienced by women, which they perceived to result from their communities' highly pronatalistic attitudes and stigmatization of infertility. Themes also captured women's adaptive coping strategies and critical attitude towards pronatalist ideologies. Lastly, themes captured their overall positive evaluation of their fertility health care, their desire for more infertility education (for themselves and their communities) and for culturally competent and interpersonally sensitive care. LIMITATIONS, REASONS FOR CAUTION: Our participants were a small, non-random sample recruited in collaboration with a local charity, which may mean that all participants were well integrated in their communities. Analysis focused on capturing commonalities in participants' experiences and this may sometimes result in homogenising diverse experiences. WIDER IMPLICATIONS OF THE FINDINGS: More education about the infertility experiences of minority ethnic and religious groups at the community and healthcare delivery level may translate into lessened negative attitudes towards infertility and more culturally competent care, which can be beneficial for women. STUDY FUNDING/COMPETING INTEREST(S): This research was funded by Welsh Crucible. The authors have no conflict of interests to declare.

DrawingOut - An innovative drawing workshop method to support the generation and dissemination of research findings.

A growing body of literature has explored the potential for arts-based methods to generate and disseminate research, particularly on sensitive or complex topics. This article presents DrawingOut, a metaphor-centred drawing workshop designed to collect visual and textual data about individuals' experiences of sensitive or taboo health experiences. The visual data, consisting of the artwork produced by participants, and the textual data, all conversations and discussions occurring during the workshop, can also be used to create engaging outputs for dissemination. We piloted DrawingOut in a study of nine women with a minority ethnic or religious background in Cardiff, UK. The women were invited to participate in a series of structured drawing activities. The conversations occurring during the workshop were recorded and then subjected to thematic analysis. Results showed that women's views and experiences could be grouped in eight major themes covering their wellbeing, relationship with others, and healthcare views and experiences. We produced an A5 16-page booklet that presents the pilot study results, illustrated with participants' own drawings and quotes, which was disseminated among participants, their community and other relevant stakeholders. This pilot study supports the view that healthcare actors can use the DrawingOut method to engage people to talk about sensitive health topics, while simultaneously providing them with an enjoyable and empowering research experience. In our pilot study the DrawingOut was successful in eliciting rich visual and textual data that captures a diversity of views and experiences, with the added benefit that these can be used to produce engaging outputs for dissemination.