Designing, validation and evaluation of the expert system of "Healthy Menopause" and assessing its effect on the management of menopause symptoms: an exploratory mixed method study protocol.

BACKGROUND: Menopause is a period of women's life that has the especial physical, psychological and social challenges. So provision of an effective, practical and affordable way for meeting women's related needs is important. In addition, women should be able to incorporate such programs into their daily work. Considering the dearth of suitable services in this regard, this study will be conducted with the aim of designing, validating and evaluating the "Healthy Menopause" expert system on the management of menopausal symptoms. METHODS/DESIGN: A mixed methods exploratory design will be used to conduct this study in 3 phases. The first phase is a qualitative conventional content analysis study with purposes of exploring the women's experience of menopausal symptoms and extracting their needs, and collecting data about their expectations from a healthy menopause expert system.. The purposive sampling (In his phase data will be gathered through interviewing menopaused women aged 40 to 60 years old and other persons that have rich information in this regard and will be continued until data saturation. The second phase includes designing a healthy menopause expert system in this stage, the needs will be extracted from the qualitative findings along with a comprehensive literature review. The extracted needs will be again confirmed by the participants. Then, through a participatory approach (Participatory Design) using nominal group or Delphi technique the experts' opinion about the priority needs of menopaused women and related solutions will be explored based on the categories of identified needs. Such findings will be used to design a healthy menopause expert system at this stage. The third phase of study is a quantitative research in which the evaluation of the healthy menopause expert system will be done through a randomized controlled clinical trial with the aim of determining the effect of the healthy menopause expert system on the management of menopause symptoms by menopausal women themselves. DISCUSSION: This is the first study that uses a mixed method approach for designing, validating and evaluating of the expert system "Healthy Menopause". This study will fill the research gap in the field of improving menopausal symptoms and designing a healthy menopause expert system based on the needs of the large group of menopause women. We hope that by applying this expert system, the menopausal women be empowered to management and improving their health with an easy and affordable manner.

Menopause is a period of women's life that has the especial physical, psychological and social challenges. So provision of an effective, easy for use and affordable way for managing related problems and meeting related needs is important. Menopause is a period of women's life that has physical, psychological and social consequences. It is important to identify methods that are effective, practical and affordable. New technologies can increase women's ability to access educational information. This is the first study for designing, validating and evaluating of the expert system "Healthy Menopause". A mixed methods exploratory design will be used to conduct this study in 3 phases. The first phase (qualitative): The conventional content analysis method will be used. The second phase: Designing a healthy menopause expert system: It is based on the codes of women's challenges from the first phase, along with conducting interviews and literature review. The participatory approach (Participatory Design) through nominal group or if needed, Delphi method based on the categories of needs and solutions by considering the opinions of the participants, available experts related to this issue will be listed. It should be used to design a healthy menopause expert system at this stage. The third phase (quantitative): The evaluation of the healthy menopause expert system will be a randomized clinical trial that determine the effect of the healthy menopause expert system on the management of menopause symptoms. In the present study an expert system (ES) will be designed that can be installed on mobile phones and computers. This tool is not only educational but also interactively helps to adapt to continuous changes, so by asking questions about menopause the system will respond as if an expert (midwife or gynecologist) is giving advice.

Sexual function after childbirth: a meta-analysis based on mode of delivery.

Although many women report sexual dysfunction in the postpartum period, controversial research has been reported the relationship between delivery mode and sexual function. This meta-analysis aimed to investigate the sexual function after childbirth and identify the difference of sexual function based on the female sexual function index (FSFI) questionnaire in women with elective cesarean section, vaginal delivery with episiotomy and vaginal delivery without episiotomy. Studies were found by searching in Medline, PubMed, Web of Science, Scopus and considering the references of the related papers from their start dates until September 2021. All observational studies in English that reported the mean and SD of score of sexual function and its domains based on the mode of delivery were included in this meta-analysis. Random effect model was used to combine the results of included studies on female sexual function and its subdomains. Finally, 17 articles with a total population of 3410 were included in the meta-analysis. Total mean (95 percent CI) of sexual function was 24.27 (22.82, 25.72) with substantial heterogeneity among studies (χ2 = 7487.63, P < .001; I2 = 99.45). In subgroup analyses, the mean score of sexual function was significantly differed in terms of time elapsed since delivery (P = .04) and studied country (P < .001). But, the mode of delivery has no significant effect on postpartum sexual function and subdomains. The result indicated that elective cesarean section, vaginal delivery with episiotomy, vaginal delivery without episiotomy are not associated with the female sexual function.

The association of mode of delivery and dyspareunia: a systematic review and meta-analysis.

This meta-analysis aimed to examine the association between the mode of delivery and dyspareunia worldwide. Epidemiologic studies evaluating the link between the mode of delivery and dyspareunia (published up to July 2019) were included in this research. These studies were selected by searching several databases such as MEDLINE, ClinicalTraial.gov, PubMed, Web of Science, Scopus and Google Scholar and considering the list of selected articles extracted from references. Then, meta-analyses, subgroup analyses and meta-regressions of the studies were conducted to evaluate the association between the mode of delivery and dyspareunia. In this study, 23 out of 1099 articles were identified and used in the final analysis. Dyspareunia differed according to the mode of delivery although this difference was not statistically significant. In terms of the mode of delivery, a difference was found between instrumental vaginal delivery and caesarean section, but it was not significant. It seems that more studies with a larger sample size should be considered to determine the difference.

The Effect of Sexual Education based on Sexual Health Model on the Sexual Function of Women with Infertility.

BACKGROUND: Infertility has deep psychological impacts on the sexual function of women such as a sense of fear, failure, and incompetence. It can also result in reduced sexual desire, unattained orgasm, and other sexual disorders. However, sexual education is assumed to improve the sexual function in these cases. Therefore, we study the effect of sexual education based on Sexual Health Model (SHM) on sexual function disorders in women with infertility. MATERIALS AND METHODS: A singleblind, randomized controlled trial was conducted on 108 women with infertility (54 intervention group and 54 control group) aged between 18 and 40 years at the Milad Infertility Center of Mashhad in 2016. The intervention comprised three 90-min sessions administered during 1 week. At first, a pretest (Female Sexual Function Index [FSFI]) was completed, and 1 month after the end of the intervention, the posttest (FSFI) was completed. To analyze the data, independent t-test, Mann-Whitney test, and Wilcoxon test were run. RESULTS: The mean (Standard Deviation [SD]) age of women and their spouses was 30.61 (5.42) and 34.42 (5.73)years, respectively. Results of Mann-Whitney test showed that after 1 month of intervention, there was a significant difference between intervention and control groups (Z = -4.87, p < 0.001). Moreover, results of Wilcoxon test showed a significant difference in the sexual function in the intervention group before and after the intervention (Z = 2.81, p < 0.001). CONCLUSIONS: Given the positive effects of SHM-based sexual education, this method could be considered as a subset of sexual education materials used for women with infertility suffering from sexual disorders.