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. 2018 Jul 27:2:21.
doi: 10.1186/s41927-018-0029-4. eCollection 2018.

Identifying the unmet information and support needs of women with autoimmune rheumatic diseases during pregnancy planning, pregnancy and early parenting: mixed-methods study

Rhiannon Phillips  1 , Bethan Pell  2 , Aimee Grant  2 , Daniel Bowen  1 , Julia Sanders  3 , Ann Taylor  4 , Adrian Edwards  1 , Ernest Choy  5 , Denitza Williams  1
Affiliations

Identifying the unmet information and support needs of women with autoimmune rheumatic diseases during pregnancy planning, pregnancy and early parenting: mixed-methods study

Rhiannon Phillips et al. BMC Rheumatol. .

Abstract

Background: Autoimmune rheumatic diseases (ARDs) such as inflammatory arthritis and Lupus, and many of the treatments for these diseases, can have a detrimental impact on fertility and pregnancy outcomes. Disease activity and organ damage as a result of ARDs can affect maternal and foetal outcomes. The safety and acceptability of hormonal contraceptives can also be affected. The objective of this study was to identify the information and support needs of women with ARDs during pregnancy planning, pregnancy and early parenting.

Methods: This mixed methods study included a cross-sectional online survey and qualitative narrative interviews. The survey was completed by 128 women, aged 18-49 in the United Kingdom with an ARD who were thinking of getting pregnant in the next five years, who were pregnant, or had young children (< 5 years old). The survey assessed quality-of-life and information needs (Arthritis Impact Measurement Scale Short Form and Educational Needs Assessment Tool), support received, what women found challenging, what was helpful, and support women would have liked. From the survey participants, a maximum variation sample of 22 women were purposively recruited for qualitative interviews. Interviews used a person-centered participatory approach facilitated by visual methods, which enabled participants to reflect on their experiences. Interviews were also carried out with seven health professionals purposively sampled from primary care, secondary care, maternity, and health visiting services.

Results: Survey findings indicated an unmet need for information in this population (ENAT total mean 104.85, SD 30.18). Women at the pre-conception stage reported higher needs for information on pregnancy planning, fertility, giving birth, and breastfeeding, whereas those who had children already expressed a higher need for information on pain and mobility. The need for high quality information, and more holistic, multi-disciplinary, collaborative, and integrated care consistently emerged as themes in the survey open text responses and interviews with women and health professionals.

Conclusions: There is an urgent need to develop and evaluate interventions to better inform, support and empower women of reproductive age who have ARDs as they navigate the complex challenges that they face during pregnancy planning, pregnancy and early parenting.

Keywords: Autoimmune rheumatic disease; Family planning; Infant feeding; Information; Parenting; Pregnancy; Qualitative; Support; Timeline; Visual methods.

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Conflict of interest statement

The lead author (RP) is a Health Psychologist and health services researcher with a long-standing interest in musculoskeletal complaints and in maternal and child health. RP worked with a multi-disciplinary team of co-authors, with expertise in Rheumatology (EC), General Practice (AE), pain management (AT), psychology (DW), midwifery (JS), social media communication (DB), qualitative research (AG, BP, RP, DW).Ethical approval for the study, including the consent process, was granted by the Cardiff University School of Medicine Research Ethics Committee on 20/10/16. Online survey participants provided informed consent online. All patients participating in interviews provided written consent. Health professionals taking part in Interviews in writing for face-to-face interviews, and written and/or verbally consent for telephone interviews. Verbal consent was audio-recorded prior to the interviews and stored in a separate audio file to the main body of the interview. The written informed consent forms used for the qualitative interviews included a specific statement to confirm agreement for anonymised quotations to be used in papers and presentations based on this research.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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