Transgender women sex workers' experiences accessing sexual health care in Iran: a qualitative study.

BACKGROUND: This study aimed to examine the experiences of transgender women who work in the sex industry regarding their access to health care facilities for sexual health. Transgender women sex workers are recognised worldwide as a high-risk group for HIV and sexually transmitted infections (STIs). METHODS: In Iran, between January and May 2022, we employed a snowball sampling technique to recruit a diverse group of 22 transgender women sex workers aged 19-42 years. Semi-structured interviews were conducted with these participants to provide insights into their experiences with accessing sexual health care. RESULTS: The data was analysed using thematic analysis, revealing four overarching themes: experiences of violence, contextual barriers to health, socioeconomic challenges and HIV/STI risk practices, and 11 sub-themes. The results demonstrate that many participants experienced difficulties in accessing sexual health services due to violence, discrimination, financial difficulties and lack of awareness about STIs. CONCLUSION: Sex workers face extraordinarily challenging occupational risks, including sexual and physical abuse, mental health issues, and HIV and STIs. Targeted public intervention programs and research for this group are urgently needed. Outreach programs engaging with underserved transgender women sex workers have the potential to enhance access to healthcare services, and contribute to the reduction of HIV transmission rates.

The effect of interventions in alleviating fear of childbirth in pregnant women: a systematic review.

BACKGROUND: The Fear of Childbirth (FOC) is regarded as a general problem, which affects women's health and well-being, justifying demanding caesarean section. Several primary studies have been performed in relation to the interventions performed to reduce the fear of childbirth, which show contradictions between the results of these studies. OBJECTIVE: This review aims to provide a comprehensive review of the different types of interventions used to reduce the fear of childbirth in pregnant mothers. METHODS: In this study, systematic review of study information related to the effect of different therapies on reducing the fear of childbirth using subject-related keywords and validated with MeSH in SID, MagIran, IranMedex, IranDoc, Embase, ProQuest, Scopus, PubMed, Web of Science (ISI) databases and Google Scholar Search Engine were extracted without any time limit until February 2021. RESULTS: After removing duplicates and irrelevant works from among the 5396 articles found, 63 articles remained in the study. The participants in these 63 articles were 5415 cases and 5770 controls. In addition, three studies were on epidural anesthesia, 33 on the effects of psychotherapy, 19 on the effects of education, and eight on the influence of other interventions on alleviating FOC. As shown by the results, psychotherapy intervention and education decreased FOC significantly. CONCLUSION: According to the results of this study, to prevent the fear of childbirth, pregnancy training and prenatal preparation courses are recommended to empower pregnant women. It also seems beneficial to use psychotherapy approaches for women who are afraid of childbirth.

Development of the short form Iranian women childbirth experience questionnaire: a confirmatory factor analysis approach item reduction.

INTRODUCTION: Considering that childbirth experience has short- and long-term effects on women's lives, it is necessary to examine their delivery experiences. This study aimed to prepare the short form of a 52-item Iranian women's childbirth experience questionnaire with seven factors: professional support, preparation, control, positive perception, baby, family support, and fear. METHODS: This methodological research was conducted on women aged 15 to 49 years (n = 770) with uncomplicated vaginal delivery. The short form of the Iranian women's childbirth experience questionnaire was prepared in four stages. The first stage was exploratory factor analysis, conducted on 250 samples, the second stage was confirmatory factor analysis which was performed on 260 samples, independent of the first stage, to report goodness and fit indices, and the third stage employed items from modification indices, expected parameter change, and standardized residual covariance, leading to the short form of Iranian women childbirth experience questionnaire. Finally, confirmatory factor analysis was run on 260 samples, independent of the previous two stages, to confirm the short form and compare it with the original questionnaire for psychometric analysis. RESULTS: In the exploratory factor analysis stage, nine items with a factor load of less than 0.4 were removed, and the number of domains was reduced to five. The second stage showed that the questionnaire had a goodness of fit index. However, the third stage resulted in removing 11 overlapping items and making a short questionnaire with 33 items. Finally, the confirmatory factor analysis in the last stage showed appropriate goodness of fit for the short form of the Iranian women's childbirth experiences questionnaire (𝛘2/df = 2.352, CFI = 0.881, PCFI = 0.750, RMSEA = 0.072, SRMR = 0.0862). CONCLUSION: The short form of the Iranian women's childbirth experiences questionnaire enjoyed from an appropriate psychometric evaluation. It is recommended when applying the original questionnaire is not feasible due to lack of time.

Effectiveness of a mixed lifestyle program in couples undergoing assisted reproductive technology: a study protocol.

BACKGROUND: The desire for fertility is the manifestation of yearning for immortality. Infertility and assisted reproductive technology (ART) expose couples to great affective, anxiety, stress, and financial burden. Increasing evidence emphasize the impact of lifestyle on infertility. One of the most crucial factors affecting the fertility process is the nutrition patterns, the amount and quality of physical activities, emotional problems management; modulate stressors, relief from anxiety, and the living conditions of couples. Most ART treatment interventions in Iran are not integrated into lifestyle programs. Therefore, this research will investigate the impact of mixed fertility health-promoting programs in couples who use ARTs. METHODOLOGY/DESIGN: This study entails three steps. The first step includes the systematic review of literature on a health-promoting lifestyle in infertile couples undergoing ARTs, a systematic review of observational studies and interventions in couple's lifestyle, then, a systematic review of qualitative studies on infertility in couples and their lifestyle, and in the final step couple's life style literature systematically will evaluate in Iran. In case of failure to obtain the required results from systematic reviews, cross-sectional studies will be carried out to determine the lifestyle of infertile couples receiving ARTs. In the second stage, by holding a panel of experts, an intervention is planned based on the results of the previous stages in order to improve the lifestyle of couples. In the final step, the designed intervention will be administered as a random clinical trial-on ART candidates, in intervention or control groups in one of Iran University of Medical Sciences hospitals. Afterward, the data's will be evaluated by using standard questionnaires, that include health-promoting lifestyle questionnaire (HPLII), Beck's depression inventory (BDI), international physical activity questionnaire-short form (IPAQ-SF), and food frequency questionnaire (FFQ). The statistical analysis will be carried out in SPSS software. During the study, subjects meeting the inclusion criteria were randomly selected and randomized into the intervention and control groups. The health-promoting lifestyle training program will be executed for the intervention group while the standard care program is administered to the control group. The content of this program will be obtained from the consensus opinions of the expert panel. The program includes diet recommendations, physical activity, and stress management. Appropriate time, frequency, duration and number of activities will be considered. Communication with subjects will be possible through private meeting special comfort room. Support to the participants will also be through clinical visits social media, SMS and phone calls. Nutritional changes, physical activity amount, anxiety and stress level, abdominal circumference (AC), and body mass index (BMI) will be measured after the completion of the specified time interval. The initial outcome includes examining chemical pregnancy (2 weeks after the transmission) and clinical pregnancy by ultrasound (6 weeks after). The secondary outcome will be live birth rate. Retrieved oocyte and embryo numbers will also be reported. DISCUSSION: Health-promoting lifestyle programs are essential in assisted reproductive technologies to improve pregnancy results and live birth. These programs in association with in-vitro fertilization (IVF) influence the outcome of fertilization. In addition, enhancing parental health leads to healthy pregnancy outcome. Despite the frequency of lifestyle risk factors, employing proper methods helps reduce anxiety and stress, modify dietary patterns, and perform qualitatively and quantitatively balanced physical activities. In addition, having coping skills and mental health management methods, in nowadays modern world challenges seems crucial and effective in solving fertility problems and reducing them before pregnancy.

For most people, children are the meaning of life. In some cultures, children are regarded as a family function and thus infertility is displeasing problem. In public believes, children are divine blessings. Not having children signifies a sick body and incomplete identity, which give rise to psychological and socio-economic consequences. Studies show that fertility and childbearing are biomarkers of survival and affect infertile men and women subconsciously. Since childbearing is one of the most crucial pillars of human marital life, an increase in infertile cases and use of ARTs by infertile couples, the lack of physical activity, sedentary lifestyle, unhealthy diet, stress, anxiety, and psychological problems caused by infertility problems, and the side effects of using ARTs preoccupy couples and distract their attention from healthy lifestyle and well-being issues. Despite the crucial importance of prevention in the modern world and the cost-effectiveness of prevention till treatment, numerous research findings expressing the importance of health education and disease ameliorates. These dimensions are still overlooked. Considering the importance of the issue, to the reduction of damages caused by chronic diseases, such as preventable NCDs problems including infertility, to promote fertility results, improving before conception. Oocyte retrieving time and in window period could improve embryo-maternal outcomes. Ensures couples' health, increases individuals' life satisfaction, and promotes health and lifespan of individuals, which is the ultimate goal of the healthcare system are the other purpose of health promoting process. It seems that health promotion lifestyle programs in Iran for infertile couples have not yet been integrated. Therefore, the combination of these programs with ART can be effective in achieving the goals of improving reproductive health. This research seeks to promote programs based on improving the health of infertile couples, increasing childbearing and increasing live births in people who are candidates for ART. A mixed study in the first step will be carried out by a systematic review of studies on ART candidate couples 'lifestyles. If the desired results are not achieved, a cross-sectional study will be conducted. In the second step, an intervention will be designed and developed to execute the lifestyle program following the specialists' opinions concerning nutrition, physical activity, and stress management. The next step will be carried out by implementing RCT. This intervention will be executed and evaluated at the end.

Effect of Brief Cognitive Behavioral Counseling and Debriefing on the Prevention of Post-traumatic Stress Disorder in Traumatic Birth: A Randomized Clinical Trial.

OBJECTIVE: Planning to promote the health of mothers in postpartum is important in all countries. This study aimed to determine the effectiveness of two counseling method on prevention of post-traumatic stress after childbirth. METHODS: In this clinical trial, 193 of mothers who had experienced a traumatic birth were randomly assigned to three groups. Participants were assessed using IES_R questionnaire at 4-6 weeks and 3 months after delivery. RESULTS: Debriefing and brief cognitive behavioral counseling (CBC) significantly improved the symptoms of postpartum traumatic stress disorder. After 3 months, CBC had a significant effect on the symptoms. CONCLUSION: Screening of traumatic childbirth, implementation of supportive care, and early counseling prior to the initiation of post-traumatic stress are recommended. TRIAL REGISTRATION NUMBER: IRCT2015072522396N2. http://en.search.irct.ir/view/24735 .

The effect of cognitive-behavioural and solution-focused counselling on prevention of postpartum depression in nulliparous pregnant women.

OBJECTIVE: The aim of this study was to evaluate the effect of cognitive-behavioural approach and solution-focused counselling on prevention of postpartum depression in nulliparous pregnant women. BACKGROUND: Maternity blues is a common disorder and postpartum depression is a serious disorder. Therefore, the use of preventive measures and timely intervention is of particular importance. METHODS: In this randomised clinical trial, 85 nulliparous pregnant women at 30-35 weeks were randomly divided into three groups: cognitive-behavioural counselling (n = 25), solution-focused counselling (n = 25) and control (n = 35). Counselling meetings were held on a weekly basis. The cognitive-behavioural group received four sessions of counselling and the solution-focused group received three sessions of counselling. The control group received only routine pregnancy healthcare services. Maternity blues and postpartum depression were, respectively, measured on postpartum days 5 and 15 through the Austin Inventory and Edinburgh Postnatal Depression Scale. The mean scores of the three groups were compared using one-way ANOVA. RESULTS: The results of this study showed that the maternity blues mean scores of the three groups of cognitive-behavioural counselling, solution-focused counselling and control groups were 6.1 ± 4.6, 4.2 ± 3.6 and 6.7 ± 4.9, respectively, and the difference between the scores was significant. The mean scores of postnatal depression on the 15th postpartum day in the three groups were 6.7 ± 5.3, 4.4 ± 4.4 and 10.4 ± 5.9, respectively. The results showed that cognitive-behavioural and solution-focused counselling significantly reduced the maternity blues and postpartum depression scores compared with the control group and no difference was observed between the scores of these two counselling methods. The odds ratio of being depressed in women with maternity blues was 7.6 (95% CI: 2.1-27.5). CONCLUSION: Integration of solution-focused and cognitive-behavioural counselling programmes in prenatal care can be effective for improving the mental health of pregnant women.

Barriers and Facilitators to Accessing Sexual and Reproductive Health Services Among Transgender People: A Meta-Synthesis.

The availability and accessibility of sexual and reproductive health (SRH) services for transgender individuals are crucial. This population is deprived of health care due to rejection, stigma, gender-based discrimination, confidentiality, and violence. This review attempts to provide readers with an account of the fundamental problems that the transgender population faces regarding experiences of SRH. This meta-synthesis review applied the Social-Ecological Model (SEM) to address trans individuals' SRH factors. The databases were searched using "SRH" and "transgender" keywords. Fifty studies were finally selected. All studies were qualitative, including 36 semi-structured/ in-depth interviews, two focus group studies, and 12 interviews and focus group studies. The Social-Ecological Model application illustrates the impact of individual, interpersonal, institutional, and social factors on the condition of SRH among transgender individuals. This meta-synthesis reinforces multiple levels of factors that influence the SRH of transgender individuals. These include limited information, lack of awareness, low socioeconomic status, stigma and discrimination, and social deprivation. Interventions are urgently needed to provide better sexual and reproductive well-being for transgender individuals.

The Parturient Women's Privacy Preservation in the Delivery Rooms: A Qualitative Study.

Introduction: Parturient women's privacy preservation and respectful maternity care (RMC) in delivery room is an important principle in the high quality of midwifery care to achieve maternal satisfaction and positive childbirth experience. Hence, it is essential to make natural vaginal delivery (NVD) a positive experience and increase the mothers' satisfaction. This study aimed to investigate the privacy preservation of parturient women's in the delivery room. Methods: Using conventional content analysis, this qualitative study was conducted from June 2018 to December 2020 at two hospitals and three health centers in Shahroud, Iran. Purposeful sampling was employed and it was continued till data saturation through in-depth interviews with 37 participants. Results: The results of interviews with 21 women with NVD experience and 16 maternity health service providers resulted in the extraction of four themes including physical, spiritual-mental, informational, and social privacy. Conclusion: Various mechanisms were found to promote the privacy and satisfaction of parturient women in the delivery room. They included the necessity continuous education, monitoring about mother's privacy preservation and intervention to improve effective communication skills among staff in delivery rooms.

Challenges and Needs of HPV-Positive Women.

HPV is the most prevalent sexually transmitted diseases causing a variety of clinical manifestations ranging from warts to cancer. This study aimed to examine the challenges and needs of HPV-positive women. In this qualitative study, we analyzed data extracted from semi-structured face-to-face interviews with 31 Iranian HPV-positive women using a conventional content analysis approach using MAXQDA.10 software. Data were collected from her at the women's clinic from 21 January 2022 to her 19 February 2022. The sampling process was purposeful, and the accuracy of this study was ensured according to her 4 criteria suggested by Guba and Lincoln. Four themes were identified from the interviewing of HPV-positive women that include: Needing support and counseling to adapt to the disease, needing counseling and training to improve the disease, needing a qualified health care provider, needing proper health care services. HPV-positive women had many adverse such as reproductive health challenges (Menstruation cycle, delivery type, fertility, pregnancy, and breastfeeding), low control, confusion, cancer-related concerns, relationship problems, sexual concerns, uncertainty, stigma, low trust, social impact, non-disclosure of results, idiosyncratic prevention, indirect clinical interaction, changes in sexual behavior. HPV-positive women face many challenges and seek information to address them. Therefore, at the primary level, providers need to be aware of the needs of these patients needs in order to make the necessary consultations.

Cognitive behavioral counselling in post abortion grief: A randomized controlled trial.

BACKGROUND: Abortion is can led to certain psychological problems that may decreased self-esteem, and concerns about future fertility. Abortions have multiple psychological consequences such as grief, anxiety, depression, and post-traumatic stress. The purpose of this study is to examine the effect of cognitive behavioral counseling intervention on women in post-abortion period. MATERIAL AND METHODS: This research was a randomized, controlled trial study that was conducted on 168 women during the post-abortion period at the Khalill Azad Center of Larestan (Iran), where the women were selected randomly from February 2019 to January 2020. Data were collected using post-abortion grief questionnaire. All women in the post-abortion period answered the perinatal grief scale questions at the beginning of the intervention, immediately after the intervention and three months after the end of the intervention. Data were analyzed through descriptive statistics and repeated measures analysis of variance (ANOVA) with time and group were used to evaluate the effect of intervention. RESULTS: By using repeated measures ANOVA, the comparison of the mean score of grief in the two groups indicated that the scores decreased over time and it was lower in the intervention group. The mean score of grief between the intervention and control groups at the end of the intervention was 67.59 ± 13.21 and 75.42 ± 12.7, respectively (P < 0.001). Mean post-abortion grief score in the intervention and control groups three months after the intervention were 59.41 ± 13.71 and 69.32 ± 12.45, respectively (P < 0.001). CONCLUSION: According to results of this study, it can be concluded that the use of cognitive behavioral counselling can reduce post-abortion grief intensity or prevent the occurrence of complicated grief. Therefore, this method can be used as a preventive or therapeutic approach to control post-abortion grief and other psychological disorders.

Care Providers' Perspectives on Quality Prenatal Care in High-risk Pregnancies: A Qualitative Study.

Background: A high-risk pregnancy (HRP) is adversely affects the health of the mother, baby, or both. Most prenatal care research, rather than quality concepts, focuses on the adequacy of prenatal care and describes the emotional-psychological experiences of women with HRP. The main purpose of this study was to explore the perspectives of healthcare professionals regarding the quality of prenatal care for women with HRP. Methods: This qualitative study was conducted in three university hospitals and 12 comprehensive health centers in Ahvaz (Iran) from December 2020 to May 2021. In the present study, 10 midwives, 2 executive directors, and 7 specialists were purposefully selected with maximum diversity. In-depth semi-structured individual interviews were used to collect the data. Data were analyzed concurrently using Elo and Kinga's content analysis. The MAXQDA software version 10 was used for data analysis. Results: During data analysis, the 6 main categories "infrastructure for care provision", "optimal clinical care", "organizing referrals", "preconception care", "risk assessment", and "family-centered care" and 14 subcategories were identified. Conclusion: Our findings showed that professional groups focused on the technical aspects of caring. The findings from this study highlight several conditions that can affect the quality of prenatal care for women with HRP. Healthcare providers can use these factors to effectively manage HRPs, thereby improving pregnancy outcomes among women with HRPs.

The Effectiveness of Prenatal Care Programs on Reducing Preterm Birth in Socioeconomically Disadvantaged Women: A Systematic Review and Meta-Analysis.

Background: Preterm Birth (PTB) is one of the leading causes of infant morbidity and mortality. Prenatal care is an effective way to improve pregnancy outcomes but there is limited evidence of effective interventions to improve perinatal outcomes in disadvantaged pregnant women. This review was conducted with the aim to assess the effectiveness of prenatal care programs in reducing PTB in socioeconomically disadvantaged women. Materials and Methods: We searched the Scopus, PubMed, Web of Science, and Cochrane Library databases from January 1, 1990 to August 31, 2021. The inclusion criteria included clinical trials and cohort studies focusing on prenatal care in deprived women with the primary outcome of PTB (< 37 weeks). Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias and the Newcastle-Ottawa Scale. Heterogeneity was evaluated using the Q test and I2 statistics. The pooled odds ratio was calculated using random-effects models. Results: In total, 14 articles covering 22,526 women were included in the meta-analysis. Interventions/exposures included group prenatal care, home visits, psychosomatic programs, integrated intervention on socio-behavioral risk factors, and behavioral intervention through education, social support, joint management, and multidisciplinary care. The pooled results showed that all types of interventions/exposure were associated with a reduction in the risk of PTB [OR = 0.86; 95% confidence interval: (0.64, 1.16); I2 = 79.42%]. Conclusions: Alternative models of prenatal care reduce PTB in socioeconomically disadvantaged women compared with standard care. The limited number of studies may affect the power of this study.

Men's knowledge of preconception health: A systematic review.

Preconception health is defined as the physical and psychological well-being of women and men throughout their reproductive life. It is a method that raises healthy fertility and focuses on activities that persons can take to minimize risks, raise healthy lifestyles, and increase preparation for pregnancy. The purpose of this systematic review study was to assess men's knowledge of preconception health. Electronic databases, including Web of Science, PubMed, Scopus, Sciencedirect, ProQuest, Cochrane, SAGE, Springer, Google Scholar, were searched for published studies from 2000 to March 2021 to identify the studies carried out on men's knowledge of preconception health. The quality assessment was done using the critical appraisal skills program tool for qualitative studies and the Newcastle-Ottawa scale for cross-sectional studies. Of the 1195 references identified in the initial search, 11 studies met the inclusion criteria. Because of the diversity in the study design and the data collection tools used in studies, meta-analysis was impossible. All the studies of the present systematic review found that men's preconception health knowledge is poor. This systematic review showed that men's preconception health knowledge is low. Due to the limited studies of men's knowledge about the importance of optimizing their health before pregnancy, further study of the issue is still required.

Qualitative Exploration of the Needs of Pregnant Women to Manage the Fear of Childbirth.

Background: Some women experience the Fear of Childbirth (FOC) during pregnancy, labor, and birth which can have consequences for their health and well-being. To provide the right conditions for having a positive experience of childbirth, the needs of pregnant women must be correctly recognized. The present study was conducted with the aim of investigating the needs of women in managing the FOC with a qualitative design. Materials and Methods: This qualitative study was conducted using conventional content analysis from January to November 2021. To this aim, 15 pregnant women, 21 healthcare providers, and four maternal health policymakers were purposefully selected from Kermanshah health centers, with maximum diversity. Data were collected through in-depth semi-structured interviews. Data accuracy was guaranteed using Lincoln and Guba criteria. The MAXQDA software was used for data analysis. Results: From the analysis of the data obtained from the interviews, three main categories emerged concerning the needs of mothers to properly manage the FOC: "need to provide awareness and empowerment of mother and family," and "the need to pay attention to the mental health of pregnant women," and "supporting needs (seeking support)." Conclusions: Identifying and paying attention to woman's needs in the areas of education, mental health, and support can help them manage crisis-ridden situations, including the FOC. In response to the needs of mothers to empower them in managing the FOC, it is recommended to formulate special guidelines in this field.

The effect of cognitive-behavioral counseling on maternal-fetal attachment among pregnant women with unwanted pregnancy in Iran: A randomized clinical Trial.

Background: Unwanted pregnancy is an important public health concern that can have significant health, social, and economic effects on the mother, the baby and her family. The establishment and enhancement of maternal-fetal attachment (MFA) play a role in the promotion of emotional communication between the mother and the child in the future. This study aimed at investigating the effect of cognitive-behavioral counseling on maternal-fetal attachment among pregnant women with unwanted pregnancy. Methods: In this randomized clinical trial, 60 eligible pregnant women with unwanted pregnancy and gestational age of 22-28 weeks who had referred to health centers in Mashhad, a city in the northeast of Iran, were selected and they were through random block assignment divided into two groups of counseling with the cognitive-behavioral approach (n = 30) and the control group (n = 30). In addition to the routine pregnancy care, the cognitive-behavioral counseling group received four group counseling sessions on a weekly basis, while the control group only received the routine pregnancy care from healthcare providers. Maternal-fetal attachment before and after intervention in the two groups was assessed through Cranley's Maternal-Fetal Attachment Scale. Comparison of mean scores within and between the two groups was performed using SPSS 21 through independent and paired t-tests. Results: At the end of the study and after the intervention, the mean scores of maternal-fetal attachment in the intervention and control groups were 94.06 ± 11.73 and 80.16 ± 10.09, respectively, and the difference between the groups was significant. Although the difference between the mean scores of each group at the beginning and the end of the study was significant, this difference between the two groups was also noticeable (21.56 ± 12.16 vs 7.40 ± 12.39) and statistically significant. Conclusions: Cognitive-behavioral counseling can be effective in enhancing the maternal-fetal attachment in unwanted pregnancies; therefore, it is recommended to be integrated into pregnant women's healthcare programs.

Reproductive health needs of Human papillomavirus (HPV) positive women: A systematic review.

OBJECTIVES: Human papillomavirus is one of the most important causes of cervical cancer. Participating in an HPV test and receiving an HPV diagnosis can create questions about the needs and preferences. The present systematic review was conducted to determine the reproductive health needs of women with HPV. METHODS: We searched PubMed, Scopus, Web of Science, Google Scholar and Magiran, SID and Iranmedex. Without language restrictions and time constraints. We also searched the grey literature and carried out forward/backward citation searches. RESULTS: In the first, 1056 articles were retrieved, and, after removing them, 13 articles published were entered. The studies were qualitative (N = 9), quantitative (N = 3), and one was unclear. Most qualitative studies collected data using individual interviews (N = 7), two qualitative studies, narratives of HPV patients from a website of patient experiences and questions. Women wanted further information on different HPV viral types, transmission, implications for sexual partners, prevalence, latency and regression of HPV, their management options and the implications of infection for cancer risk and fertility. Women's experience of searching the Internet for further information about HPV was reported as difficult, anxiety provoking and contributing to the stigma of the infection because information was often located in the context of other sexually transmitted infections, with multiple sexual partners highlighted as a risk factor for infection. CONCLUSION: Surveys showed that the majority of women had unanswered questions about their HPV test results. The information that women thought was helpful in interpreting their test results included having a high-risk type of HPV, and cancer survival statistics for the virus. Women also needed information about sexual transmission, how HPV tested positive in a long-term relationship, and the potential consequences for their partners and the risk of re-infection. Younger women had questions about whether HPV could affect fertility.

Quality of perinatal care for women with high-risk pregnancies during the COVID-19 pandemic in Iran.

BACKGROUND: COVID-19 has had a catastrophic effect on the healthcare system. Healthcare quality assessment measures the difference between expected and actual performances to identify gaps in the healthcare system. This study aimed to evaluate the quality of perinatal care for women with high-risk pregnancies (HPR) during the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study enrolled 450 women with HPR from health centers in Ahvaz, Iran, from December 2020 to May 2021, using a multi-stage sampling method. Quality of care was assessed using an observational checklist adapted from Ministry of Health guidelines. Data were analyzed using descriptive and statistical methods. RESULTS: The quality of the assessed aspect in comprehensive health centers and in peripartum, perinatal, and postpartum wards was moderate. The overall score for peripartum care was significantly positively correlated with the length of the retraining period, and the quality of perinatal care was significantly related to the proportion of elective cesarean sections and preterm delivery. CONCLUSION: The development of care practices in health centers in Iran should focus on education and counseling. Practices in peripartum wards should emphasize the use of partographs, physical/mental support, and privacy for mothers, while perinatal wards should focus on timely counseling.

Explaining the Psychological Distress of Women with High-Risk Pregnancies in Iran: A Qualitative Study.

Background: Psychological Distress (PD) is one of the most common mental disorders during pregnancy and involves stress, anxiety, and depression. According to the literature, High-Risk Pregnancy' (HRP) is a major physiological risk factor associated with PD during pregnancy. The main purpose of this study was to explore the perception and experience of women with HRP who, based on standard questionnaires, had moderate-to-severe stress and anxiety scores. Materials and Methods: This qualitative study was conducted using conventional content analysis from December 2020 to June 2021. To this aim, 16 women with HRP were purposefully selected from Imam Khomeini Hospital in Ahvaz, Iran, with maximum diversity. In-depth, semi-structured, individual interviews were conducted to collect the data. The MAXQDA software was used for data analysis. Results: Data analysis led to the extraction of two main categories and nine subcategories. "Disrupted peace" and "inefficient adaptation to the situation" were the two extracted categories. The former included the five subcategories of concerns about pregnancy complications, concerns about the parenting process, concerns about the couple's relationship, fear of Covid-19, and occupation-related stress. The latter included the three subcategories of unpleasant feelings, current pregnancy experiences, and previous pregnancy experiences. Conclusions: This study highlighted a wide range of psychosocial factors involved in the PD of women with HRP. These findings can be used to design appropriate prevention strategies to manage the mental health problems of these women in order to turn their pregnancy into a pleasurable experience.

Women's and Care Providers' Perspectives of Quality Preconception Care: A Qualitative Descriptive Study.

Background: A growing body of evidence is showing that Preconception Care (PCC) can increase the health and well-being of women and couples and improve subsequent pregnancy and child health outcomes. The present study aimed to determine the quality of preconception care from women's and care providers' perspectives. Materials and Methods: This qualitative study was conducted in 2020 using conventional content analysis approach. Face to face Semi-structured interviews were conducted with 13 reproductive age women and 12 midwives recruited from urban health centers across Shahroud, Iran. Data were analyzed using qualitative content analysis. Results: Three major themes based on Donabedian's model emerged during data analysis: structure, process and outcome of care. Midwives and women's experiences of quality of preconception care included problems in organizing care, poor education performance of personnel and low-sensitivity about importance of preconception care in women. Conclusions: The findings suggest key considerations for the organizing and delivery of preconception care. Most especially, it seems necessary to adopt appropriate strategies to improve public awareness about the importance of pre-pregnancy care.

The Status, Policies, and Programs of Preconception Risk Assessment in Iran: A Narrative Review.

Introduction: Preconception care is defined as a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through risk assessment, health promotion, and medical and psychosocial interventions. This study aimed to review the status, policies, and programs of preconception risk assessment in Iran. Methods: We searched scientific databases including Medline, PubMed, Web of Science, Scopus, CINAHL, Magiran, Iran Medex, SID, Iran Doc, Science Direct, and Google Scholar using key words such as "preconception care", "pre-pregnancy care", "instruction", "guideline", "risk assessment", "program", "policy", "Iran" and their combinations. No time limit was considered in searching the databases and all studies were published until February 1, 2020. Our search strategy resulted in the retrieval of 66 articles and guidelines, of which nine articles met the inclusion criteria and entered the study. Results: Multiple guidelines have been designed to assess the general health of women and men of childbearing age, with pay little attention to the reproductive health assessment in Iran. Assessment of reproductive health is specific to the integrated maternal health care program, which the reproductive health risk assessment from pre-pregnancy to postpartum period. The preconception care is a component of integrated maternal health care program that is faced in its content and faces challenges in implementation. Conclusion: Several strategies have been developed in the field of risk assessment for general health in Iran, but risk assessment in pre-pregnancy period is only exclusive to preconception care program that is moderate in performance.