Design and psychometric properties of a questionnaire for assessing sexual and reproductive health needs of married adolescent women: an exploratory sequential mixed methods study.

To date, there is no valid and reliable instrument to specifically evaluate married adolescent women's sexual and reproductive health (SRH) needs. Hence, the aim of this study was to develop and evaluate the psychometric properties of a questionnaire for assessing married adolescent women (MAW)'s SRH needs. The current exploratory sequential mixed method study was performed in two phases. In the first phase, a preliminary questionnaire was developed based on in-depth interviews with 34 MAW and four key informants as well as a comprehensive literature review. In the second phase, validity of the questionnaire was assessed using face, content, and construct validity and reliability of the questionnaire was assessed using internal consistency and test-retest reliability. Based on qualitative content analysis and literature review, 137 items were extracted. After several modifications of the generated items, a 108-item questionnaire was prepared for the psychometric process. After checking face and content validity, 85 items remained in the study. In the exploratory factor analysis, 11 items were removed and the remaining 74 items were categorised into nine factors. Cronbach's alpha coefficient and the intraclass correlation coefficient were found to be 0.878 and 0.99 for the whole scale, respectively.Impact StatementWhat is already known on this subject? Sexual and reproductive health (SRH) needs of married adolescent women (MAW) are different from those of married adult women or unmarried, sexually active adolescents. However, there are to date no valid and reliable instruments to specifically evaluate the SRH needs of this group of women.What do the results of this study add? The final version of questionnaire consists of 74 items in nine domains including need to improve MAW's sexual quality of life, promote MAW's SRH self-care, improve MAW's SRH self-efficacy, increase MAW's SRH knowledge, increase husband's involvement in MAW's SRH, improve the performance of health care providers, strengthen the family support to married adolescent women, improve family involvement in SRH education of MAW, and provide specific premarital counselling to MAW.What are the implications of these findings for clinical practice and/or future research? The 74-item questionnaire has acceptable validity and reliability. Therefore, it can be used by researchers and policymakers as an appropriate instrument for assessing MAW's SRH needs.

Predictors of genital self-image in Iranian women: a cross-sectional study.

BACKGROUND AND AIM: Several factors influence women's perception of their genitalia. Understanding the elements associated with genital self­image (GSI) can significantly contribute to enhancing women's sexual experiences. Therefore, the present study aimed to identify the predictors of GSI in Iranian women. MATERIALS AND METHODS: This online cross-sectional study was conducted on 722 healthy married reproductive-aged women with records in Amol-Iran health centers during 2022. Participants were selected using a random sampling method from all the healthcare centers. Data were collected through a checklist of socio-demographic and obstetrics information, the Female Genital Self-Image Scale (FGSI), the 6-item Female Sexual Function Index (FSFI-6), the Female Sexual Distress Scale - revised (FSDS-R), and the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ) for assessing sexual esteem and sexual satisfaction. The general linear model was employed to assess the impact of each independent variable (socio-demographic and obstetrics characteristics, sexual function, sexual distress, sexual esteem, and sexual satisfaction) on the dependent variable (GSI). RESULTS: The mean score of GSI was 21.70 ± 3.82. Based on the Pearson correlation test, there were significant correlations between GSI and sexual function, sexual esteem, sexual satisfaction, and sexual distress (r = 0.20, r = 0.43, r = 0.42, r = -0.28 respectively; p < 0.001). Using the adjusted general linear model, with the increasing scores of sexual esteem and sexual satisfaction, the GSI score also increased (ß = 0.19, 95% CI: 0.10 to 0.27, ß = 0.14, 95% CI: 0.06 to 0.22, respectively; p < 0.001). Additionally, age, abnormal vaginal discharge, genital feedback from partners, and satisfaction with body image were identified as other predictors of GSI. CONCLUSION: Based on the study results, it was observed that sexual esteem, sexual satisfaction, and certain socio-demographic variables served as predictors of GSI. Consequently, considering the potential impact of GSI on various aspects of women's lives, healthcare providers can enhance their counseling techniques to improve GSI by gaining an appropriate understanding of the factors that influence it.

Healthcare professionals' needs when providing perinatal bereavement care: A qualitative study.

BACKGROUND: Caring for and supporting bereaved parents with fetal loss requires preparation, training, and attention to a set of needs of health workers to provide optimal services. This is although it has been less addressed in the educational curriculum and in-service training. This study aims to investigate the experiences of Iranian healthcare professionals regarding the needs related to the care of bereaved parents with perinatal loss. MATERIALS AND METHODS: This research was a qualitative study conducted in Shahroud City, Iran, to explore healthcare professionals' needs from June 2021 to December 2022. Semi-structured in-depth interviews on purposive sample of 14 participants were conducted. The participants were care providers who worked in OB-GYN ward, general midwifery clinics, and a private office. The interviews were recorded verbatim, transcribed, and analyzed using an inductive content analysis. MAXQDA software version 10 was used for data analysis. Granheim and Lundman's approach was used to analyze the data. RESULTS: Two major themes, four categories, and nine subcategories emerged. The themes included the "existence of protective laws and policies" and "skill and training needs." Protective laws and policies included "Government Rules and guidelines" and "organizational Rules protecting the individual." Skills and training needs consisted of two categories: "communication skills" and "Self-Care needs." CONCLUSIONS: Educational policies, development of guidelines for the care of bereaved mothers based on culture, training programs for dealing with bereaved parents, providing self-care programs for employees, and improving the physical and emotional conditions of the workplace were among the needs expressed by the participants. Meeting the needs of healthcare professionals is effective in job satisfaction, feeling of value, and high quality of services for bereaved parents.

Desired Care for Perinatal Bereavement: Meeting the Needs of Mothers After Discharge From the Hospital-a Qualitative Study.

This study aimed to investigate the understanding and experiences of mothers who have suffered perinatal loss regarding their needs after being discharged from the hospital. Data were collected through semi-structured face-to-face and telephone interviews using purposive sampling with maximum diversity. The sample included 15 mothers and 6 midwives who had experienced fetal loss and perinatal bereavement. The interviews were audio-recorded and transcribed verbatim. Conventional content analysis was used to analyze the data. Sampling was conducted from July 2022 to March 2023, continuing until data saturation was reached. The study identified 2 main categories of needs for mothers who have experienced perinatal loss: continuous healthcare (including the Comprehensive Mother Tracking System, provision of psychological welfare, and educational needs) and provision of a support network, including "spouse and family support" and "peer and colleague support." The primary theme of this study was "Deliberating Care for Grieving Mothers." The study results indicate that mothers who experience perinatal loss require continuity of care after being discharged. Psychological screening and counseling support are essential for both parents. Considering the significant impact of spousal, familial, and community support on an individual's life, it is crucial to prepare the community to comprehend and embrace grieving parents.

Effect of couples' online training on maternal-fetal attachment in pregnant women.

BACKGROUND: Due to the importance of maternal fetal attachment (MFA) in women mental health improvement and considering the fathers' role in MFA promoting, this study conducted to investigate the effect of couple education on maternal fetal attachment. MATERIALS AND METHOD: This randomized controlled trial was conducted on 100 pregnant women and their husbands referred to six health centers in Sari from May to June 2021. The sampling method was stratified random sampling. Data collection tools included demographic information form and the Cranley MFA Scale with 24 questions. The intervention group took part in four session's weekly training about spouse support, attachment behaviors, and gender preference of parents, while the control group received only the routine antenatal care. Both groups completed Cranley's questionnaire before and 4 weeks after the intervention. Data were analyzed using Chi-square test, Fisher's exact test, paired and independent t-test by SPSS 21. RESULTS: MFA mean scores, pre-training and post-training in intervention group were 3.27 (0.54) and 3.75 (0.42), respectively; in the control group, were, 3.24 (0.49) and 3.21 (0.48). There was a significant difference between the two groups' MFA mean scores after intervention (P < 0.001). CONCLUSION: The findings of this study revealed that couple training regarding spouse support, attachment behaviors, and gender preference during pregnancy can promotes MFA even online training.

Psychosexual counseling intervention to improve women's genital self-image: Study protocol for a randomized controlled trial based on a multistage mixed method design.

Background: Genital self-image (GSI) is a major barrier to reproductive and sexual health for women. This practical randomized trial aims to evaluate the effect of psychosexual counseling based on a cognitive-behavioral approach to promoting GSI for reproductive-age married Iranian women. Methods: Married women aged 15-49 years under the coverage of health centers will be invited to join the study. The study will be conducted using a multistage mixed method design in three phases. In the first phase, semi-structured interviews with women and key informants will be conducted to understand better the GSI concept, the factors influencing it, and the interventions promoting it. Simultaneously, a literature review will be conducted by searching electronic databases to find the factors influencing GSI and the interventions to enhance it.In the second phase, the GSI-related factors, sexual and reproductive health outcomes correlated with GSI, and intervention programs for promoting GSI in women will be extracted from the integration of qualitative study and literature review. Then, based on the expert panel's priority, a suitable program will be prepared.In the third phase, at first, a cross-sectional study will be conducted to identify women with poor GSI and the factors relating to GSI, and then psychosexual counseling intervention will be performed. For the randomized controlled trial study, participants will be randomly allocated into two groups: (1) the intervention group and (2) the control group. Data will be collected using the Female Genital Self-Image Scale and sexual and reproductive health outcomes correlated with GSI at baseline, immediate, and 2-month follow-up assessments. The impact of the intervention on the promotion of GSI will be evaluated. Discussion: This study provides a counseling program for promoting GSI. If this interventional program is successful, it has practical potential to be generalized for Iranian Women with poor GSI.

Evaluating the effect of prenatal interventions on maternal-foetal attachment: A systematic review and meta-analysis.

Aim: This study aimed to evaluate the effect of prenatal interventions on maternal foetal attachment. Design: Systematic review and meta-analysis. Methods: In this study, a comprehensive review was performed to find articles published from January 2000 - December 2019 in the form of randomized and non-randomized clinical trials. To this end, online databases including PubMed, Scopus, Google Scholar, ScienceDirect, Proquest, Ovid, CINAHL and JAMA were searched. Duplicate articles were also excluded using Endnote X7 Reference. The results were then analysed via RevMan 5.3 software. Results: The results showed that foetal movement counting did not seem to be effective in increasing MFA by itself. But, this intervention alongside other attachment behaviours such as touching the belly and talking to foetus could enhance MFA. Therefore, the best interventions to improve MFA might be combined ones implemented in the form of counselling and training sessions.

Perceived Barriers to Accessing Pregnancy-Related Health Information Among Married Adolescent Women: A Qualitative Study in Iran.

STUDY OBJECTIVE: To date, no study has reported barriers to accessing pregnancy-related health information among married women younger than the age of 19 years. Indeed, the voice of the girls being married is absent in the literature. We sought to explore the barriers to accessing pregnancy-related health information from the perspective of Iranian married adolescent women. DESIGN: Qualitative study. SETTING: The research was conducted in Mashhad city (health care centers) and Shahrood County (a maternity teaching hospital, and urban/rural health care centers) in Iran. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Twenty-four married adolescent women aged 14-19 years were recruited through purposive sampling. Individual in-depth interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis. Prolonged engagement with participants, maximum-variation sampling, member checking, peer deferring, and external audit were used to enhance the rigor of the study. RESULTS: The results showed 3 categories: "structural barriers," "individual barriers," and "sociocultural barriers." The structural barriers category consisted of 2 subcategories, namely, poor quality of education and counseling in the health care centers, and transportation barriers. The 2 subcategories of the individual barriers category consisted of affective barriers and cognitive barriers. The sociocultural barriers category included the following 2 subcategories: husband's decision-making power and fear of being labeled infertile. CONCLUSION: The barriers identified in this study should be considered when designing educational interventions for married adolescent women. Moreover, further research is needed to enhance current knowledge on this topic.