scholarly journals Why women choose abortion through telemedicine outside the formal health sector in Germany? A mixed-methods study

2020 ◽  
Author(s):  
Margit Endler ◽  
Kristina Killinger ◽  
Hazal Atay ◽  
Rebecca Gomperts ◽  
Sophie Gunther
Keyword(s):  
Content Analysis ◽  
Mixed Methods ◽  
Health Sector ◽  
Mixed Methods Study ◽  
Vulnerable Groups ◽  
Formal Sector ◽  
Provider Attitudes ◽  
Cross Sectional ◽  
Telemedicine Service ◽  
Barriers To Access

Introduction: In April 2019 the abortion telemedicine service Women on Web (WoW) opened their helpdesk to Germany and saw a progressive rise in consultations. Our aim was to understand the motivations, and perceived barriers to access, for women who choose telemedicine abortion outside the formal health sector in Germany. Methods: We conducted a parallel convergent mixed-methods study among 1090 women in Germany, who requested medical abortion through WoW between January 1st and December 31st, 2019. We performed a cross-sectional study of data contained in online consultations and a content analysis of 108 email texts. Analysis was done until saturation; results were merged, and triangulation was used to validate results. Results: Frequent reported reasons for choosing telemedicine abortion in the consultation forms were quote: I need to keep the abortion a secret from my partner or family (48%), and quote: I would rather keep my abortion private (48%). The content analysis developed two main themes and seven subsidiary categories: 1) internal motivations for seeking telemedicine abortion encompassing i) autonomy, ii) perception of external threat, iii) shame and stigma, and 2) external barriers to formal abortion care, encompassing : (iv) financial stress, v) logistic barriers to access vi) provider attitudes, and vii) vulnerability of foreigners). The findings in the quantitative and qualitative analysis were consistent. Conclusion: Women in Germany who choose telemedicine abortion outside the formal health sector do so both from a place of empowerment and a place of disempowerment. Numerous barriers to abortion access exist in the formal sector which are of special relevance to vulnerable groups such as adolescents and undocumented immigrants.

scholarly journals Why women choose abortion through telemedicine outside the formal health sector in Germany: a mixed-methods study

2020 ◽  
pp. bmjsrh-2020-200789
Author(s):  
Kristina Killinger ◽  
Sophie Günther ◽  
Rebecca Gomperts ◽  
Hazal Atay ◽  
Margit Endler
Keyword(s):  
Content Analysis ◽  
Mixed Methods ◽  
Health Sector ◽  
Mixed Methods Study ◽  
Vulnerable Groups ◽  
Formal Sector ◽  
Provider Attitudes ◽  
Cross Sectional ◽  
Telemedicine Service ◽  
Barriers To Access

IntroductionWomen on Web (WoW) is a global medical abortion telemedicine service operating outside the formal health sector. In April 2019 they opened their helpdesk to Germany. Our aim was to understand the motivations, and perceived barriers to access, for women who choose telemedicine abortion outside the formal health sector in Germany.MethodsWe conducted a parallel convergent mixed-methods study among 1090 women consulting WoW from Germany between 1 January and 31 December 2019. We performed a cross-sectional study of data contained in online consultations and a content analysis of 108 email texts. Analysis was done until saturation; results were merged and triangulation used to validate results.ResultsThe quantitative analysis found that the need for secrecy (n=502, 48%) and the wish for privacy (n=500, 48%) were frequent reasons for choosing telemedicine abortion. Adolescents were more likely to report secrecy, cost, stigma and legal restrictions as reasons for using telemedicine abortion compared with older women. The content analysis developed two main themes and seven subsidiary categories, (1) internal motivations for seeking telemedicine abortion encompassing (i) autonomy, (ii) perception of external threat and (iii) shame and stigma, and (2) external barriers to formal abortion care encompassing (iv) financial stress, (v) logistic barriers to access, (vi) provider attitudes and (vii) vulnerability of foreigners.ConclusionsWomen in Germany who choose telemedicine abortion outside the formal health sector do so both from a place of empowerment and a place of disempowerment. Numerous barriers to abortion access exist in the formal sector which are of special relevance to vulnerable groups such as adolescents and undocumented immigrants.

Can we determine burdensome transitions in the last year of life based on time of occurrence and frequency? An explanatory mixed-methods study

2021 ◽  
pp. 1-9
Author(s):  
Nicolas Schippel ◽  
Gloria Dust ◽  
Christian von Reeken ◽  
Raymond Voltz ◽  
Julia Strupp ◽  
...  
Keyword(s):  
Content Analysis ◽  
Mixed Methods ◽  
Quantitative Data ◽  
Qualitative Data ◽  
Mixed Methods Study ◽  
Subjective Burden ◽  
Insufficient Information ◽  
Cross Sectional ◽  
Explanatory Mixed Methods ◽  
Patients Experience

Abstract Objective Burdensome transitions are typically defined as having a transition in the last three days or multiple hospitalizations in the last three months of life, which is seldom verified with qualitative accounts from persons concerned. This study analyses types and frequencies of transitions in the last year of life and indicators of burdensome transitions from the perspective of bereaved relatives. Method Cross-sectional explanatory mixed-methods study with 351 surveyed and 41 interviewed bereaved relatives in a German urban area. Frequencies, t-tests, and Spearman correlations were computed for quantitative data. Qualitative data were analyzed using content analysis with provisional and descriptive coding/subcoding. Results Transitions rise sharply during the last year of life. 8.2% of patients experience a transition in the last three days and 7.8% three or more hospitalizations in the last three months of life. An empathetic way of telling patients about the prospect of death is associated with fewer transitions in the last month of life (r = 0.185, p = 0.046). Professionals being aware of the preferred place of death corresponds to fewer hospitalizations in the last three months of life (1.28 vs. 0.97, p = 0.021). Qualitative data do not confirm that burden in transitions is linked to having transitions in the last three days or multiple hospitalizations in the last three months of life. Burden is associated with (1) late and non-empathetic communication about the prospect of death, (2) not coordinating care across settings, and (3) not considering patients’ preferences. Significance of results Time of occurrence and frequency appear to be imperfect proxies for burdensome transitions. The subjective burden seems to be associated rather with insufficient information, preparation, and management of transitions.

scholarly journals Why women choose at-home abortion via teleconsultation in France: drivers of telemedicine abortion during and beyond the COVID-19 pandemic

2021 ◽  
pp. bmjsrh-2021-201176
Author(s):  
Hazal Atay ◽  
Helene Perivier ◽  
Kristina Gemzell-Danielsson ◽  
Jean Guilleminot ◽  
Danielle Hassoun ◽  
...  
Keyword(s):  
Content Analysis ◽  
Mixed Methods ◽  
Medical Abortion ◽  
Cross Sectional Study ◽  
Mixed Methods Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Individual Level ◽  
Manifest Content ◽  
At Home

ObjectivesIn an attempt to understand the demand and main drivers of telemedicine abortion, we analysed the requests that Women on Web (WoW), an online telemedicine abortion service operating worldwide, received from France throughout 2020.MethodsWe conducted a parallel, convergent, mixed-methods study among 809 consultations received from France at WoW between 1 January and 31 December 2020. We performed a cross-sectional study of data obtained from the WoW consultation survey and a manifest content analysis of anonymised email correspondence of 140 women consulting with the WoW helpdesk from France.FindingsWe found that women encounter macro-level, individual-level and provider-level constraints while trying to access abortion in France. The preferences and needs over secrecy (n=356, 46.2%), privacy (n=295, 38.3%) and comfort (n=269, 34.9%) are among the most frequent reasons for women from France to choose telemedicine abortion through WoW. The COVID-19 pandemic seems to be an important driver for resorting to telemedicine (n=236, 30.6%). The lockdowns had a significant impact on the number of consultations received at WoW from France, increasing from 60 in March to 128 in April during the first lockdown and from 54 in October to 80 in November during the second lockdown.ConclusionsThe demand for at-home medical abortion via teleconsultation increased in France during the lockdowns. However, drivers of telemedicine abortion are multidimensional and go beyond the conditions unique to the pandemic.

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697349
Author(s):  
Anna Lalonde ◽  
Emma Teasdale ◽  
Ingrid Muller ◽  
Joanne Chalmers ◽  
Peter Smart ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Information Needs ◽  
Qualitative Data ◽  
Information Provision ◽  
Mixed Methods Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face ◽  
Patient Information Needs ◽  
History Of

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

scholarly journals Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Christophe Millien ◽  
Anatole Manzi ◽  
Arlene M. Katz ◽  
Hannah Gilbert ◽  
Mary C. Smith Fawzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mixed Methods ◽  
Black Women ◽  
Uterine Fibroids ◽  
Mixed Methods Study ◽  
University Hospital ◽  
Gynecologic Surgery ◽  
Cross Sectional ◽  
Women's Lives

Abstract Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

scholarly journals Experiences of GP trainees in undertaking telephone consultations: a mixed-methods study

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101008 ◽  
Author(s):  
Umar Chaudhry ◽  
Judith Ibison ◽  
Tess Harris ◽  
Imran Rafi ◽  
Miles Johnston ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Clinical Information ◽  
Mixed Methods Study ◽  
Strong Positive Correlation ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Electronic Survey ◽  
Positive Experiences ◽  
Positive Correlations ◽  
Observation Tools

BackgroundPrimary care telephone consultations are increasingly used for patient triage, reviews, and providing clinical information. They are also a key postgraduate training component yet little is known about GP trainees’ preparation for, or experiences and perceptions of, them.AimTo understand the experiences, perceptions, and training of GP trainees in conducting telephone consultations.Design & settingA mixed-methods study was undertaken of North Central and East London (NCEL) GP trainees.MethodA cross-sectional electronic survey of trainees was performed with subsequent semi-structured interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis.ResultsThe survey response was 16% (n = 100/618), and 10 participated in semi-structured interviews. Trainees felt least confident with complicated telephone consulting, and there was a strong positive correlation between the percentage reporting having received training and their confidence (R2 = 0.71, P<0.0001). Positive experiences included managing workload and convenience. Negative experiences included complex encounters, communication barriers, and absence of examination. Trainees reported that training for telephone consultations needed strengthening, and that recently introduced audio-clinical observation tools (COTs) were useful. Positive correlations were found between the length of out-of-hours (OOH) but not in-hours training and the level of supervision or feedback received for telephone consultations.ConclusionThis project sheds light on GP trainees’ current experiences of telephone consultations and the need to enhance future training. The findings will inform a wider debate among stakeholders and postgraduate learners regarding training for telephone consultations, and potentially for other remote technologies.

scholarly journals Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries

PLoS ONE ◽  
2014 ◽  
Vol 9 (4) ◽  
pp. e93763 ◽  
Author(s):  
Benjamin Palafox ◽  
Edith Patouillard ◽  
Sarah Tougher ◽  
Catherine Goodman ◽  
Kara Hanson ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Private Sector ◽  
Mixed Methods Study ◽  
Cross Sectional

scholarly journals Integrated decision-making model for community-based rehabilitation service utilisation among persons with severe mental illness in China: protocol for a cross-sectional, mixed-methods study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021528 ◽  
Author(s):  
Ruoxi Wang ◽  
Shangfeng Tang ◽  
Ian Shaw ◽  
Zhanchun Feng ◽  
Zhuo Chen ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Mixed Methods ◽  
Mixed Methods Study ◽  
Service Utilisation ◽  
Community Based ◽  
Cross Sectional ◽  
Community Based Rehabilitation ◽  
Integrated Decision Making ◽  
Different Levels

IntroductionA common problem low-income and middle-income countries face is the scarcity of community-based rehabilitation (CBR) resources and low service utilisation among persons with severe mental illness (SMI). Despite this problem, the factors and pathways followed influencing one’s decision on service utilisation in China have not been fully comprehended. This study aims to develop a theory-based model that systematically describes the integrated decision-making process of mental health CBR utilisation among persons with SMI in China.Methods/DesignThis cross-sectional, mixed-methods study involves three main stages and is expected to last 3 years, from January 2018 to December 2020. In stage 1, the Social Exchange Theory is deployed as an analytical framework to comprehensively capture factors associated with tendency to use CBR services in China using semistructured interview methodology involving patients with SMI, their primary caregivers and CBR service providers. In stage 2, interpretive structural modelling will be applied to analyse the relationships between factors in different dimensions, at different levels and with different levels of impact. Stage 3 involves a multiregion survey among at least 300 family decision-makers (either the patient or their caregivers) in six communities in three cities to statistically validate the initial model derived in stage 2 using a further structural equation modelling.Ethics and disseminationEthical approval was granted by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (No 2017S319). All interviewees will be provided with written information about the study, and a signed consent will be retrieved prior to the interview. Rules on confidentiality and anonymity of data will be strictly followed. The findings of this study will be disseminated via international and domestic peer-reviewed journals, reports, conference presentations and symposium discussions. Reports will be submitted to the National Natural Science Foundation of China.

scholarly journals Reasons to stop drinking alcohol among patients with rheumatoid arthritis in Sweden: a mixed-methods study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024367 ◽  
Author(s):  
Ingrid Larsson ◽  
Maria L E Andersson
Keyword(s):  
Rheumatoid Arthritis ◽  
Content Analysis ◽  
Mixed Methods ◽  
Qualitative Content Analysis ◽  
Well Being ◽  
Work And Family ◽  
Drinking Alcohol ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Open Question

ObjectivesThe aims were to identify patients with rheumatoid arthritis (RA) who had stopped drinking alcohol and compare them with patients drinking alcohol, and to explore reasons for stopping drinking alcohol.DesignA sequential explanatory mixed methods design was used.SettingSix rheumatology clinics in Southern Sweden Better Anti-Rheumatic FarmacOTherapy cohort.ParticipantsA total of 1509 patients completed the questions about alcohol and were included in the study. 86 of these had stopped drinking alcohol and 72 responded to the open question and their answers were analysed with qualitative content analysis.Outcome measuresThe quantitative data were from a cross-sectional survey assessing disease severity, physical function (Health Assessment Questionnaire, HAQ) and health-related quality of life (EuroQol five dimensions, EQ5D), pain, fatigue, patient global assessment (PatGA) and lifestyle factors, for example, alcohol. The questions assessing alcohol included an open question ‘Why have you stopped drinking alcohol?’ResultsThe patients who stopped drinking alcohol were older (median (min-max) 69 (36–90) vs 66 (23–95), p=0.011), had worse HAQ (1.00 (0–2.75) vs 0.50 (0–3.00), p<0.001), worse EQ5D (0.69 (−0.02–1.00) vs 0.76 (−0.58–1.00), p<0.001) worse PatGA (5 (0–10) vs 3 (0–10), p<0.001), more pain (5 (0–10) vs 3 (0–10), p<0.001) and more fatigue (6 (0–10) vs 4 (0–10), p<0.001 compared with patients drinking alcohol. The qualitative content analysis revealed five categories describing reasons for patients with RA to stop drinking alcohol: illness and treatment; health and well-being; work and family; faith and belief; and dependences and abuse.ConclusionsThe patients who had stopped drinking had worse physical functioning and higher levels in pain-related variables. Most stopped drinking due to their illness or a desire to improve health.

Sign in / Sign up

Export Citation Format

Share Document