How Do Mexican Patients With Rheumatoid Arthritis Define Sexual and Reproductive Health? A Content Analysis Study.

BACKGROUND: A patient-centered approach is essential for promoting sexual health (SH) and reproductive health (RH) in rheumatoid arthritis patients. The study aimed to describe and interpret Mexican rheumatoid arthritis outpatients' testimonies of their SH and RH definitions. METHODS: Qualitative and quantitative content analysis was conducted on free-text comments from 219 and 223 descriptions of patients' SH and RH definitions, respectively. A comprehensive system of major themes, categories, and subcategories was structured for each definition. The representational foundations of these categories and the context of their production were analyzed. Integration of quantitative and qualitative content analysis was used to comprehend patients' definitions of SH and RH. Internal review board approved the study. RESULTS: Ten major themes emerged for each definition, and their assigned frequencies differed between SH and RH definitions, and between groups of patients integrated according to age, education level, and sex. Both definitions had similar contents, expressed in the shared major themes and categories, and in managing at the same time SH- and RH-related contents within each definition. The "overall prevention-patient oriented care" major theme defined a common core for both definitions' contents. Meanwhile, a diversity of meanings was also evident particularly at the subcategory level. CONCLUSIONS: In our population, SH content was distinguished by related diseases and their consequences, individual actions directed to prevention, and couple mentions. Meanwhile, RH was distinguished by a primarily biological perspective of the reproductive function, which was required at a particular life stage to concrete a family project.

Sexual and reproductive health while living with rheumatoid arthritis: The impact of the disease stage on patient perspectives.

BACKGROUND: Rheumatoid arthritis (RA) is one of the most prevalent rheumatic diseases that harms all aspects of patients' lives, including sexual and reproductive health (SRH), often neglected in patients' care. The study aimed to explore the sexual and reproductive experiences of Mexican outpatients with RA from a narrative perspective. PATIENTS AND METHODS: From July 2020 to October 2021, 30 adult patients with RA from the Department of Immunology and Rheumatology outpatient clinic of a national referral center for rheumatic diseases had in-depth interviews audiotaped, transcribed, and analyzed using a thematic analysis approach. Results are presented in a descriptive and interpretative manner and integrated into a theoretical model for the topic understanding. RESULTS: Five intertwined major themes emerged: I) RA onset: Absence of SRH contents, II) Healthcare for RA: Emerging SRH contents, III) RA's impact: Proliferation of SRH contents, IV) Coping with the process of living with RA: SRH-related strategies, and V) The impact of the COVID-19 pandemic on patients' experiences: Increased SRH burden. SRH contents emerged through these major themes (but at RA onset), mostly when inquired and mainly when narrating the RA impact and coping. Patients identified that RA affected their couple dynamics, sexual function, and reproductive project. The SRH care was considered relevant but limited and focused on reproductive contents. It worsened during the COVID-19 pandemic. We proposed a theoretical model where patients' SRH experiences are embedded across their RA biography and integrated with the RA impact and the copy with the disease process. These intertwined experiences were also evident during the COVID-19 pandemic, which challenged participants' biopsychosocial resources. CONCLUSIONS: The sexual and reproductive experiences narrated by the RA outpatients concerning their disease-related biography showed that even when the SRH appeared as not prioritized at the disease onset, it was widely expressed during the process of living and coping with the disease and was additionally affected by the COVID-19 pandemic.

Biopsychosocial factors are associated with impaired sexual function in Mexican patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease with worldwide representation that impacts every domain of a patient´s life, extending to sexual and reproductive domains. The study characterized sexual health (SH) and reproductive health (RH) in Mexican RA outpatients and identified factors associated with impaired sexual function (ISF). METHODS: From September 1, 2020-January 31, 2022, consecutive RA participants had semi-structured interviews focusing on their SH and RH biographies, and self-administered questionnaires were applied to assess patient-reported outcomes, including fatigue with the Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F). ISF was defined based on published cut-offs of the International Index of Erectile Function (IIEF) in males and the Female Sexual Function Index (FSFI) in females (≥1 sexual intercourse in the last four weeks was required for index scoring). Multivariable logistic regression analysis was used to identify the factors associated with ISF. RESULTS: There were 268 participants, and 246 (91.8%) were females. Participants had 13 years of disease duration. Among females, 151 (61.4%) had FSFI applied, and the satisfaction domain was impaired in 111 (73.5%). Among males (N = 22), 17 (77.3%) had IIEF applied, and erectile dysfunction was present in 5 (29.4%). Almost half of the participants denied using a family planning method, were in their 50s, and receiving teratogenic drugs; 89.7% of the participants had children. ISF was detected in 94 (62.3%) females and 3 (17.6%) males. Male sex (aOR: 0.07, 95%CI: 0.01-0.36, p = 0.001), FACIT-F score (aOR: 0.96, 95%CI: 0.92-1.00, p = 0.03), and cohabitation with the couple (aOR: 0.32, 95%CI: 0.11-0.96, p = 0.04) were associated with ISF. CONCLUSIONS: We observed a disproportionate burden of ISF among women with RA compared to male participants. Male sex, lesser fatigue, and cohabitation with the couple were protective against ISF. Regardless of the prevalent use of teratogenic medications, contraceptive use was suboptimal among the participants.

Views of Mexican outpatients with rheumatoid arthritis on sexual and reproductive health: A cross-sectional study.

BACKGROUND: Rheumatoid arthritis (RA) impacts sexual and reproductive health (SRH), which is a prominent component of a patient´s quality of life and highly influenced by the cultural background. The aim of the study was to explore the interest of Mexican outpatients with RA in SRH and to examine patient view on SRH. METHODS: This cross-sectional study surveyed 303 consecutive outpatients with RA on their perceptions of SRH importance, SRH satisfaction, access to SRH information, preferences regarding SRH communication with healthcare professionals, and understanding of SRH (qualitative open-ended descriptions). Descriptive statistics and inferential analysis were used. Patient knowledge of each dimension of SRH was rated based on pre-specified criteria. Two assessors assigned ten major themes to each patient´s description of both dimensions of SRH. RESULTS: Patients perceived their SRH as an important component of their general health and wished to address the topic, although few had access to such communication. Female patients assigned lesser importance to SRH, showed lesser degree of satisfaction with SRH, and expressed preference for a truthful physician. Age showed a linear association with individual survey responses, except for satisfaction with reproductive health dimension. There was a linear association between increased age and decreased years of formal education with a lower level of SRH knowledge. Ten major themes emerged for each of the two dimensions of the SRH construct, although most individual descriptions were assigned to one or two major themes. CONCLUSIONS: Further education and assessment of SRH in Mexican patients with RA is warranted.

COVID-19 vaccine hesitancy among Mexican outpatients with rheumatic diseases.

Vaccine hesitancy (VH) has emerged as a recognized threaten to contain the COVID-19 pandemic. Historically, low vaccine acceptance rates had been described among patients with rheumatic diseases (RMDs). The study objective was to determine COVID-19 VH among Mexican outpatients with RMDs and validate the COVID-19 VH questionnaire. This cross-sectional study was developed in three steps. Step 1 consisted of translation/cultural adaptation of the Oxford-COVID-19-VH questionnaire. Step 2 consisted of pilot testing and questionnaire feasibility, content, construct and criterion validity, reliability (internal consistency and temporal stability) and questionnaire sensitivity to change. Step 3 consisted of VH phenomenon quantification in patients from two metropolitan tertiary-care-level centers. Step 1 followed ISPOR-task-force recommendations. Patients who participated in step 2 (n = 50 for pilot testing/feasibility and n = 208 for questionnaire validation [91 in test-retest and 70 in questionnaire-sensitivity to change]) and step 3 (n = 600) were representative outpatients with RMDs. The seven-item COVID-19 VH questionnaire was found feasible, valid (experts' agreement ≥80%; a 1-factor structure accounted for 60.73% of the total variance; rho = 0.156, p = .025 between COVID-19 VH questionnaire and score from the Spanish version of the Vaccine Hesitancy Scale; and lower questionnaire scores in patients who reported 5 years-previous influenza vaccination), reliable (Cronbach's ɑ = 0.889, intra-class correlation coefficient = 0.933 and 95% confidence interval = 0.898-0.956) and sensitive to change (effect size = 1.17 and 0.86, respectively, in patients who decreased [n = 34] and increased [n = 31] questionnaire-score after intervention). VH phenomenon was 35.5%. VH phenomenon was present in a substantial number of Mexican patients with RMDs. The COVID-19 VH questionnaire showed good psychometric properties to assess COVID-19 VH in our population.