Internet use by pregnant women seeking pregnancy-related information: A systematic review

BACKGROUND: The Internet has become one of the most popular sources of information for health consumers and pregnant women are no exception. The primary objective of this review was to investigate the ways in which pregnant women used the Internet to retrieve pregnancy-related information. METHODS: We conducted a systematic review to answer this question. In November 2014, electronic databases: Scopus, Medline, PreMEDLINE, EMBASE, CINAHL and PubMed were searched for papers with the terms “Internet”; “pregnancy”; “health information seeking”, in the title, abstract or as keywords. Restrictions were placed on publication to within 10 years and language of publication was restricted to English. Quantitative studies were sought, that reported original research and described Internet use by pregnant women. RESULTS: Seven publications met inclusion criteria and were included in the review. Sample size ranged from 182 – 1347 pregnant women. The majority of papers reported that women used the Internet as a source of information about pregnancy. Most women searched for information at least once a month. Fetal development and nutrition in pregnancy were the most often mentioned topics of interest. One paper included in this review found that women with higher education were three times more likely to seek advice than women with less than a high school education, and also that single and multiparous women were less likely to seek advice than married and nulliparous women. The majority of women found health information on the Internet to be reliable and useful. CONCLUSION: Most women did not discuss the information they retrieved from the Internet with their health providers. Thus, health providers may not be aware of potentially inaccurate information or mistaken beliefs about pregnancy, reported on the Internet. Future research is needed to address this issue of potentially unreliable information. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-0856-5) contains supplementary material, which is available to authorized users

Sources of information on gestational diabetes mellitus, satisfaction with diagnostic process and information provision

BACKGROUND: This study aimed to investigate the percentage of the needs and expectations of pregnant women with Gestational Diabetes Mellitus (GDM) about the best sources of information on GDM, their satisfaction with the diagnostic process and information provision. METHODS: Questionnaires were completed by 116 pregnant women aged 18–45 years, diagnosed with GDM and recruited from maternity diabetes clinic. Eligible women were invited to participate in the study and informed consent was obtained from each participant prior to enrolment. Descriptive statistics, Kruskal-Wallis test, t-test and chi-square test were used to analyse data. RESULTS: Most women (64.2 %) expected general practitioners (GPs) to be the best source of GDM information, following by diabetes educator nurses (45.9 %), diabetes support groups (33.9 %) and internet (32.1 %). However, women found that diabetes educator nurses were more helpful than GPs (32.6 and 20.2 %, respectively). Participants’ age and country of birth were statistically significant. For women aged over 30 years and women born overseas the internet was the most useful information source (68.9 and 77.1 % respectively). Overall, women were very satisfied (33.0 %) or satisfied (45.0 %) with how they were informed of the GDM diagnosis, although 26.0 % were informed by telephone and 16.0 % by text message. More than one-third (39.0 %) of women were not referred to sources of information by GPs at time of diagnosis of GDM (p <0.0001). Women who were referred reported that they were very satisfied (40.0 %) or satisfied (44.0 %) with information they received. Only 8.0 % of women reported dissatisfaction with the manner of health professionals. CONCLUSION: The results suggest that health professionals should be aware of the needs and expectations of women who have been diagnosed with GDM, with most women expecting to receive information on GDM from their GPs and diabetes educator nurses. The findings suggest that there is scope for improving how women are informed of the GDM diagnosis and given information, and in clinicians’ manner

Use of a web-based educational intervention to improve knowledge of healthy diet and lifestyle in women with Gestational Diabetes Mellitus compared to standard clinic-based education

Flow chart of recruitment procedure. (PDF 103 kb

Menopause and breast cancer

Background: Although 27% of women will be premenopausal at diagnosis; treatment for BC may cause menopause/menopausal symptoms in up to 80% of these women. Both short term symptoms and long term health problems such as osteoporosis and heart disease are associated with early menopause (EM). Menopausal symptoms have a major negative impact on quality of life, sexual dysfunction and changes in body image and self-esteem in BC women. Overseas studies indicate that 2/3 of postmenopausal women with BC report hot flushes and more severe menopausal symptoms are experienced by women with BC, however there is little Australian data. Women with BC and menopause benefit from partner support yet little is known about partners experience/perception of menopause. BC women consult multiple clinicians including gynaecologists, endocrinologists, oncologists, breast surgeons and general practitioners (GPs); however, there is a lack of evidence based guidelines and management practices of these clinician groups regarding menopause. Culture also influences menopause symptoms/perception with limited information and understanding of the menopausal experience of women in a developing country (Laos) compared to a Western developed country (Australia). Aims: This work aimed to: (1) investigate the perception/experience of menopause, diagnosis and therapies, information provided and health behaviours, in younger women with BC, (2) investigate menopausal symptoms, psychological function, sexual function and body image and the effect of different BC treatments on these parameters, (3) describe the partners’ perception, understanding and personal experience of menopause, and menopausal therapy in women with BC, (4) determine current clinical understanding and management of menopause by Australian clinicians (gynaecologists, endocrinologists, oncologists, breast surgeons and GPs), (5) examine culture influences on women’s understanding and management of menopausal symptoms as assessed in a group of Australian and Laotian women, and (6) to inform a translation program providing information to consumers and health professionals. Methods: Participants: Participants for study 1 and 2 included 114 menopausal/perimenopausal women aged 40-51 years with non-metastatic BC. Participants for study 3 included 50 partners of BC women. Participants for study 4 included 176 clinicians: 35 gynaecologists, 35 endocrinologists, 36 oncologists, 35 breast surgeons and 35 GPs. Participants for study 5 included 108 women (56 Australian and 52 Laotian; aged 40-65 years) attending gynaecological outpatient clinics in Australia and Laos. Procedure: Studies 1, 2 and 3 utilised both validated and internally developed questionnaires. Women with BC and their partners were recruited from the general community, from hospital outpatient clinics, from community support groups and via the Jean Hailes for Women Health (JH) website. A questionnaire including an index case was used in study 4 to assess the understanding and management of EM by Australian clinicians. Clinicians were randomly selected from Medicare Australia, referring doctors to menopause/oncology clinics and the general medical community via the JH website. The same questionnaire in English and Lao was completed by women in study 5. Analysis: Analysis was performed using SPSS software (version 17.0). Descriptive statistics, chi-square tests, student t-test, Mann-Whitney U were used where appropriate. Results: Study 1: Most BC women were satisfied with the manner in which they were informed of both BC (69%) and menopause (59%) diagnosis. Although 80% of women were given BC information, only 54% were given menopause information at diagnosis. Weight gain (68%) and osteoporosis (67%) were the most common problems/fears regarding menopause; however, only 56% reported having relevant screening investigations including blood sugar and bone density tests. Study 2: Commonest reported menopausal symptoms in BC women were tiredness/lacking energy, loss of libido and hot flushes. Anxiety/depression scores were high overall. Women perceived exercise (68%) and improving lifestyle (61%) as most effective in alleviating symptoms of menopause. Most women reported that they did not understand the risks/benefits of “bioidentical hormones” (79%) and herbal therapies (78%); while 58% perceived hormone replacement therapies as associated with an increased risk of BC. Psychological symptoms, vasomotor symptoms and sexual dysfunction scores were significantly higher in BC women with ovariectomy compared to BC women without ovariectomy (p<0.05). Feelings of physical health, attractiveness, overall appearance and satisfaction were significantly lower in ovariectomised women (p<0.05). Study 3: Most partners of BC women perceived hot flushes as the meaning of menopause (68%) and loss of sexuality as the key problem/fears about being menopausal (60%). Partners perceived exercise (72%) and reducing stress (64%) as most effective in alleviating menopausal symptoms. Most partners reported that they did not understand the risks/benefits of hormone therapy (50%), “bioidentical” (90%) and herbal therapies (84%). As with BC women, the GP was considered the best source of information on menopause (68%). Partners expected menopause to affect a women’s everyday life and relationships with family and partner, particularly to cause intermittent stress on the relationship (66%) and decrease libido/sexual interest (64%). Study 4: There was a lack of consensus between gynaecologists, endocrinologists, oncologists, breast surgeons and GPs in their investigation, diagnosis and management of EM in BC women. Significant differences between clinician groups regarding EM diagnostic criteria were observed (p<0.05). Non-hormonal treatment was preferred by most clinicians for treatment of menopausal symptoms. Exercise and nutrition were selected by most gynaecologists for relief of hot flushes, whereas most endocrinologists, oncologists, breast surgeons and GPs prescribed Venlafaxine. Most clinicians reported that the main problem with therapies was failure to resolve hot flushes. Exercise, life style and stress management were commonly recommended by all groups as treatment for anxiety/depression. Study 5: Psychological symptoms, depression, vasomotor symptoms and sexual dysfunction were significantly higher in Australian women compared to Laotian women (p<0.05). Australian women perceived the meaning of menopause as ageing (57%), whereas most (81%) Laotian women reported not knowing the meaning of menopause. Laotian women demonstrated a lack of knowledge regarding menopausal therapies compared with Australian women (83% reporting “don’t know” compared with 21% respectively). Conclusions and future direction: The studies performed in this thesis demonstrate the importance of the provision of BC and menopause information to women at the time of BC diagnosis. The present study showed that women experienced a range of menopausal symptoms and anxiety/depression is common in younger BC women. Importantly, we have highlighted the significant adverse effect of ovariectomy on menopausal symptoms, psychological impact and sexual function. Healthcare providers and women with BC need to be aware of the impact of BC treatment, particularly ovariectomy, in younger women with BC and further education resources and support should be targeted to these women. These novel studies provide understanding of the personal experience of having a female partner with BC and emphasise the gaps in understanding of menopause/menopausal therapies that partners of women with BC have. In another novel study, we revealed a lack of consensus between clinician groups in their investigation, diagnosis and management of EM in BC women. As a consequence, women may receive different diagnosis or treatments depending on the type of clinician consulted. In the cross-cultural study, we observed differences in symptoms experienced, understanding, attitude towards and perception of the meaning of menopause between Laotian and Australian women. This study revealed a lack of understanding of menopause/menopausal therapies by Laotian women compared to Australian women, highlighting the importance of education for women. This work has informed education and translation to address these knowledge gaps and highlighted the need for more research

Perceptions and experiences of Laotian women living in Australia with managing menopause

A more universal approach to an understanding of menopause can offer health professionals a broader view of the phenomenon. Menopause is an important time in a woman's life. As her body is going through changes that can affect her social life, her feelings about herself and her ability to work. In the past, menopause was often surrounded by misconceptions and myths. Now, it is recognized that menopause is a natural step in the process of aging. However, different ethnic cultures perceive and experience menopause differently. Women in some Asian cultures, such as Chinese, Indian and Laotian cultures hold more esteemed positions in their culture when they are older and menopausal, while western societies may devalue the role of women as they age. The purpose of this thesis was to examine the perceptions and the experiences of women with Laotian cultural backgrounds living in Victoria, Australia, in regards to how they manage menopause, and to examine the Laotian cultural influence on the perceptions of menopause. The research methodology was decided to use surveys or structured interviews as the means of collecting data. The survey was used to collect demographic data, and record social demographic and cultural factors, menopausal symptoms and menopausal management. Data was collected from 55 Laotian women residing in Victoria. Participating women were recruited by word of mouth, and through a Laotian community representative of Victoria. One of the three methods, such as interviewer-administered questionnaire, self-administered questionnaire and telephone interviewing was used to survey Laotian women who were aged between 45 and 65years old

Menopause and breast cancer

Background: Although 27% of women will be premenopausal at diagnosis; treatment for BC may cause menopause/menopausal symptoms in up to 80% of these women. Both short term symptoms and long term health problems such as osteoporosis and heart disease are associated with early menopause (EM). Menopausal symptoms have a major negative impact on quality of life, sexual dysfunction and changes in body image and self-esteem in BC women. Overseas studies indicate that 2/3 of postmenopausal women with BC report hot flushes and more severe menopausal symptoms are experienced by women with BC, however there is little Australian data. Women with BC and menopause benefit from partner support yet little is known about partners experience/perception of menopause. BC women consult multiple clinicians including gynaecologists, endocrinologists, oncologists, breast surgeons and general practitioners (GPs); however, there is a lack of evidence based guidelines and management practices of these clinician groups regarding menopause. Culture also influences menopause symptoms/perception with limited information and understanding of the menopausal experience of women in a developing country (Laos) compared to a Western developed country (Australia). Aims: This work aimed to: (1) investigate the perception/experience of menopause, diagnosis and therapies, information provided and health behaviours, in younger women with BC, (2) investigate menopausal symptoms, psychological function, sexual function and body image and the effect of different BC treatments on these parameters, (3) describe the partners’ perception, understanding and personal experience of menopause, and menopausal therapy in women with BC, (4) determine current clinical understanding and management of menopause by Australian clinicians (gynaecologists, endocrinologists, oncologists, breast surgeons and GPs), (5) examine culture influences on women’s understanding and management of menopausal symptoms as assessed in a group of Australian and Laotian women, and (6) to inform a translation program providing information to consumers and health professionals. Methods: Participants: Participants for study 1 and 2 included 114 menopausal/perimenopausal women aged 40-51 years with non-metastatic BC. Participants for study 3 included 50 partners of BC women. Participants for study 4 included 176 clinicians: 35 gynaecologists, 35 endocrinologists, 36 oncologists, 35 breast surgeons and 35 GPs. Participants for study 5 included 108 women (56 Australian and 52 Laotian; aged 40-65 years) attending gynaecological outpatient clinics in Australia and Laos. Procedure: Studies 1, 2 and 3 utilised both validated and internally developed questionnaires. Women with BC and their partners were recruited from the general community, from hospital outpatient clinics, from community support groups and via the Jean Hailes for Women Health (JH) website. A questionnaire including an index case was used in study 4 to assess the understanding and management of EM by Australian clinicians. Clinicians were randomly selected from Medicare Australia, referring doctors to menopause/oncology clinics and the general medical community via the JH website. The same questionnaire in English and Lao was completed by women in study 5. Analysis: Analysis was performed using SPSS software (version 17.0). Descriptive statistics, chi-square tests, student t-test, Mann-Whitney U were used where appropriate. Results: Study 1: Most BC women were satisfied with the manner in which they were informed of both BC (69%) and menopause (59%) diagnosis. Although 80% of women were given BC information, only 54% were given menopause information at diagnosis. Weight gain (68%) and osteoporosis (67%) were the most common problems/fears regarding menopause; however, only 56% reported having relevant screening investigations including blood sugar and bone density tests. Study 2: Commonest reported menopausal symptoms in BC women were tiredness/lacking energy, loss of libido and hot flushes. Anxiety/depression scores were high overall. Women perceived exercise (68%) and improving lifestyle (61%) as most effective in alleviating symptoms of menopause. Most women reported that they did not understand the risks/benefits of “bioidentical hormones” (79%) and herbal therapies (78%); while 58% perceived hormone replacement therapies as associated with an increased risk of BC. Psychological symptoms, vasomotor symptoms and sexual dysfunction scores were significantly higher in BC women with ovariectomy compared to BC women without ovariectomy (p<0.05). Feelings of physical health, attractiveness, overall appearance and satisfaction were significantly lower in ovariectomised women (p<0.05). Study 3: Most partners of BC women perceived hot flushes as the meaning of menopause (68%) and loss of sexuality as the key problem/fears about being menopausal (60%). Partners perceived exercise (72%) and reducing stress (64%) as most effective in alleviating menopausal symptoms. Most partners reported that they did not understand the risks/benefits of hormone therapy (50%), “bioidentical” (90%) and herbal therapies (84%). As with BC women, the GP was considered the best source of information on menopause (68%). Partners expected menopause to affect a women’s everyday life and relationships with family and partner, particularly to cause intermittent stress on the relationship (66%) and decrease libido/sexual interest (64%). Study 4: There was a lack of consensus between gynaecologists, endocrinologists, oncologists, breast surgeons and GPs in their investigation, diagnosis and management of EM in BC women. Significant differences between clinician groups regarding EM diagnostic criteria were observed (p<0.05). Non-hormonal treatment was preferred by most clinicians for treatment of menopausal symptoms. Exercise and nutrition were selected by most gynaecologists for relief of hot flushes, whereas most endocrinologists, oncologists, breast surgeons and GPs prescribed Venlafaxine. Most clinicians reported that the main problem with therapies was failure to resolve hot flushes. Exercise, life style and stress management were commonly recommended by all groups as treatment for anxiety/depression. Study 5: Psychological symptoms, depression, vasomotor symptoms and sexual dysfunction were significantly higher in Australian women compared to Laotian women (p<0.05). Australian women perceived the meaning of menopause as ageing (57%), whereas most (81%) Laotian women reported not knowing the meaning of menopause. Laotian women demonstrated a lack of knowledge regarding menopausal therapies compared with Australian women (83% reporting “don’t know” compared with 21% respectively). Conclusions and future direction: The studies performed in this thesis demonstrate the importance of the provision of BC and menopause information to women at the time of BC diagnosis. The present study showed that women experienced a range of menopausal symptoms and anxiety/depression is common in younger BC women. Importantly, we have highlighted the significant adverse effect of ovariectomy on menopausal symptoms, psychological impact and sexual function. Healthcare providers and women with BC need to be aware of the impact of BC treatment, particularly ovariectomy, in younger women with BC and further education resources and support should be targeted to these women. These novel studies provide understanding of the personal experience of having a female partner with BC and emphasise the gaps in understanding of menopause/menopausal therapies that partners of women with BC have. In another novel study, we revealed a lack of consensus between clinician groups in their investigation, diagnosis and management of EM in BC women. As a consequence, women may receive different diagnosis or treatments depending on the type of clinician consulted. In the cross-cultural study, we observed differences in symptoms experienced, understanding, attitude towards and perception of the meaning of menopause between Laotian and Australian women. This study revealed a lack of understanding of menopause/menopausal therapies by Laotian women compared to Australian women, highlighting the importance of education for women. This work has informed education and translation to address these knowledge gaps and highlighted the need for more research

Additional file 1: of Internet use by pregnant women seeking pregnancy-related information: a systematic review

PRISMA 2009 Checklist*. PRISMA Checklist contains 27 checklist items relevant to the content of a systematic review, which includes the title, abstract, introduction, methods, results, discussion and funding. (DOC 58 kb