A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies.

CONTEXT: Vaginal rings are available for contraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and experiences with rings is urgently needed to inform product development and to optimize ring use. METHODS: Three databases (PubMed, Global Health and CINAHL) were searched for English-language, peer-reviewed articles published between January 1996 and November 2017 that reported qualitative data on barriers to and facilitators of use of female-controlled contraceptive methods. Data on study methods, findings and conclusions pertaining to contraceptive rings were extracted, organized and analyzed. RESULTS: Twenty-six articles, all published since 2008, met the inclusion criteria. Seven studies focused largely or entirely on rings (and involved current, former or potential users), while the others focused on other contraceptive methods but included ring-specific data. Familiarity with the ring was low, and women commonly had initial concerns about the method-often related to insertion and removal, cleanliness and discomfort with touching their vagina-that were typically overcome over time. Other major themes were issues related to ring use and discontinuation, the importance of ring-related properties and characteristics, and considerations related to sexual partners and health care providers. CONCLUSIONS: Qualitative data have the potential to inform ring design and promotion. Future research should further explore women's expectations and experiences with the ring, the value of involving male partners in ring evaluation, and evaluation of interventions to improve patient-provider communication concerning ring choice and use.

RESUMEN Contexto: Los anillos vaginales están disponibles para la anticoncepción y el reemplazo hormonal, y se están desarrollando como tecnologías de prevención del VIH/ETS o de propósitos múltiples. Se necesita con urgencia una comprensión integral de las expectativas y experiencias de las mujeres con los anillos para fundamentar el desarrollo del producto y optimizar el uso del anillo. Métodos: Entre enero de 1996 y noviembre de 2017, se realizaron búsquedas en tres bases de datos (PubMed, Global Health y CINAHL) sobre artículos en idioma inglés sometidos a revisión por pares, que aportaron datos cualitativos sobre barreras y facilitadores del uso de métodos anticonceptivos controlados por mujeres. Los datos sobre los métodos de estudio, hallazgos y conclusiones relacionados con los anillos anticonceptivos se extrajeron, organizaron y analizaron. Resultados: Veintiséis artículos, todos publicados desde 2008, cumplieron con los criterios de inclusión en el análisis. Siete estudios se centraron en gran medida o completamente en los anillos (e involucraron usuarias actuales, anteriores o potenciales), mientras que los otros estudios se centraron en otros métodos anticonceptivos, pero incluyeron datos específicos sobre el anillo. La familiaridad con el anillo era baja y las mujeres generalmente expresaron preocupaciones iniciales sobre el método ­muchas veces en relación con la inserción y extracción, la limpieza y la incomodidad al tocar su vagina­ que típicamente se superaban con el tiempo. Otros temas importantes fueron aspectos relacionados con el uso y la interrupción del uso del anillo, la importancia de las propiedades y características relacionadas con el anillo y consideraciones relacionadas con parejas sexuales y proveedores de servicios médicos. Conclusiones: Los datos cualitativos tienen potencial para fundamentar el diseño y la promoción de los anillos vaginales. Las investigaciones futuras deben explorar más a fondo las expectativas y experiencias de las mujeres con respecto al anillo, el valor de involucrar a los compañeros masculinos en la evaluación del anillo y la evaluación de las intervenciones para mejorar la comunicación entre paciente y proveedor con respecto a la elección y el uso del anillo.

RÉSUMÉ Contexte: L'anneau vaginal, déjà proposé à des fins de contraception et de traitement hormonal de substitution, fait aujourd'hui l'objet d'une mise au point parmi les technologies de prévention du VIH/sida ou polyvalente. Il est impératif de bien comprendre les attentes et le vécu des utilisatrices pour éclairer la mise au point du produit et en optimiser l'usage. Méthodes: Trois bases de données (PubMed, Global Health et CINAHL) ont été consultées à la recherche d'articles en langue anglaise évalués par les pairs et publiés entre janvier 1996 et novembre 2017, faisant état de données qualitatives sur les obstacles et les facteurs propices à l'usage des méthodes contraceptives contrôlées par les femmes. Les données relatives aux méthodes d'étude, aux observations et aux conclusions pertinentes à l'anneau contraceptif en ont été extraites, puis organisées et analysées. Résultats: Vingt-six articles publiés, tous depuis 2018, ont répondu aux critères d'inclusion. Sept études concernaient largement ou exclusivement l'anneau (avec participation des utilisatrices actuelles, passées ou potentielles); les autres examinaient d'autres méthodes contraceptives mais présentaient des données spécifiques à l'anneau. L'anneau n'était guère familier aux femmes, dont les préoccupations initiales à l'égard de la méthode ­ souvent liées aux questions d'insertion et de retrait, d'hygiène et de gêne au contact du vagin ­ se dissipaient toutefois au fil du temps. Les autres grands thèmes touchaient à l'utilisation de l'anneau et à l'arrêt de la méthode, à l'importance de ses propriétés et caractéristiques et à des considérations relatives aux partenaires sexuels et aux prestataires de soins de santé. Conclusions: Les données qualitatives offrent un potentiel utile à la conception et à la promotion de l'anneau. La recherche future devra examiner davantage les attentes et le vécu des femmes à son égard, l'importance de la participation des partenaires masculins à son évaluation et l'évaluation des interventions entreprises pour améliorer la communication entre patientes et prestataires quant au choix et à l'utilisation de la méthode.

A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies.

CONTEXT: Vaginal rings are available for contraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and experiences with rings is urgently needed to inform product development and to optimize ring use. METHODS: Three databases (PubMed, Global Health and CINAHL) were searched for English-language, peer-reviewed articles published between January 1996 and November 2017 that reported qualitative data on barriers to and facilitators of use of female-controlled contraceptive methods. Data on study methods, findings and conclusions pertaining to contraceptive rings were extracted, organized and analyzed. RESULTS: Twenty-six articles, all published since 2008, met the inclusion criteria. Seven studies focused largely or entirely on rings (and involved current, former or potential users), while the others focused on other contraceptive methods but included ring-specific data. Familiarity with the ring was low, and women commonly had initial concerns about the method-often related to insertion and removal, cleanliness and discomfort with touching their vagina-that were typically overcome over time. Other major themes were issues related to ring use and discontinuation, the importance of ring-related properties and characteristics, and considerations related to sexual partners and health care providers. CONCLUSIONS: Qualitative data have the potential to inform ring design and promotion. Future research should further explore women's expectations and experiences with the ring, the value of involving male partners in ring evaluation, and evaluation of interventions to improve patient-provider communication concerning ring choice and use.

Effects of Direct-To-Consumer Advertising on Patient Prescription Requests and Physician Prescribing: A Systematic Review of Psychiatry-Relevant Studies.

OBJECTIVE: To systematically analyze the effects of direct-to-consumer advertising (DTCA) on patient requests for medication and physician prescribing across psychiatry-relevant studies. DATA SOURCES: MEDLINE, PsycINFO, Thomson Reuters' ISI Web of Knowledge, and Google Scholar were searched (1999-2014) using variations of the terms direct-to-consumer advertising and psychiatric. Reference lists and an online repository of DTCA manuscripts were also scrutinized. STUDY SELECTION: English-language studies collecting data at the point of service, focusing on or including psychiatric medication, and assessing the effects of DTCA on patient and/or physician behavior were included. Of 989 articles identified, 69 received full-text review. Four studies across 5 manuscripts met inclusion criteria. DATA EXTRACTION: Data were extracted on participants, study design, methodological quality, and results. Methodological quality of individual studies was assessed using adapted criteria from the Effective Public Health Practice Project. Confidence in conclusions across studies was determined using principles from the well-established GRADE system. FINDINGS: Due to lack of replication across strong randomized controlled trials (RCTs), no conclusions merited high confidence. With moderate confidence, we concluded that DTCA requests (1) are granted most of the time (1 RCT, 3 observational), (2) prompt higher prescribing volume (1 RCT, 1 observational), (3) promote greater adherence to minimally acceptable treatment guidelines for patients with depression (1 RCT), and (4) stimulate overprescribing among patients with an adjustment disorder (1 RCT). CONCLUSIONS: Findings suggest that DTCA requests are typically accommodated, promote higher prescribing volume, and have competing effects on treatment quality. More methodologically strong studies are needed to increase confidence in conclusions.

Dimensions of Treatment Quality Most Valued by Adolescent Substance Users and their Caregivers.

Professional psychologists are increasingly encouraged to document and evaluate the quality of the treatment they provide. However, there is a significant gap in knowledge about the extent to which extant definitions of treatment quality converge with patient perceptions. The primary goal of this study was to examine how adolescent substance users (ASU) and their caregivers perceive treatment quality. The secondary goal was to determine how these perceptions align with expert-derived definitions of ASU treatment quality and dimensions of perceived quality used frequently in other service disciplines. Focus groups and individual interviews were conducted with 24 ASU and 29 caregivers to explore how participants conceptualize a quality treatment experience. Content analysis identified three major dimensions of perceived treatment quality, each of which contained three sub-dimensions: Therapeutic Relationship (i.e., Acceptance, Caring, Connection), Provider Characteristics (i.e., Experience, Communication Skills, Accessibility), and Treatment Approach (i.e., Integrated Care, Use of Structure, and Parent Involvement). Results revealed modest convergence between patient perceptions and existing definitions of quality, with several meaningful discrepancies. Most notably, the Therapeutic Relationship was the most important dimension to ASU and their caregivers, while expert-derived definitions emphasized the Treatment Approach. Implications for practicing psychologists to enhance training and supervision, quality improvement, and health education initiatives are discussed.