Understanding factors which affect willingness to self-manage a pessary for pelvic organ prolapse: A mixed methods study aiming to improve access to pessary self-management.

Pelvic organ prolapse is descent of the uterus, vaginal compartments and/or neighbouring organs which causes bothersome symptoms for 10% of UK women.

While surgical management is an option, mechanical support from a vaginal pessary provides alternative, effective management. Pessary follow-up tends to be biannual which requires significant healthcare resources and is burdensome for women. Self-management is the woman's ability to remove and reinsert her pessary.

In addition to reducing hospital appointments, self-management offers women autonomy regarding how to use their pessary.

Pessary self-management was identified by patients and healthcare professionals as a James Lind Alliance priority for research in 2017. There is currently an NIHR funded study exploring whether pessary self-management improves quality of life. Recruitment has highlighted many women are unwilling to self-manage their pessary.

At present there is a dearth of evidence regarding factors which affect willingness to self-manage.

Barriers previously reported include; physical inability; preference for clinician-led care; difficulty; the intimate nature of pessary self-management; pain; emotional barriers; age; insufficient cognitive ability; inability to attend self-management teaching, personal circumstances and lacking willingness.

Further exploration is required to understand causes of the lack of willingness and whether this can be overcome.

Research aims To determine whether women can remove and insert their shelf or gell-horn pessary To gain a deeper understanding of factors affecting willingness to self-manage a pessary for prolapse To investigate the presence of these factors in a larger population of pessary users and prioritise the influence of factors Clinical aims To develop a questionnaire for clinical practice to help women identify and communicate concerns about pessary self-management To develop resources to help women overcome factors that influence their willingness to self-manage Exploratory sequential mixed methods underpinned by a pragmatic paradigm will be used.

The methods will incorporate quantitative findings which inform sampling, qualitative interview and quantitative questionnaire data collected using The Delphi technique.

Work package 1- Study of 45 shelf and gell-horn users at Manchester University NHS Foundation Trust (MFT) to determine whether women are able to insert and remove these pessaries. Work package 2- Grounded theory exploration of factors which affect willingness to self-manage a pessary. Data will be collected through semi-structured interviews with 20-30 women with the initial sample recruited at MFT.

Work package 3- Delphi survey questionnaires completed by 30 women who don't self-manage their pessary from 5 UK hospitals. Respondents will quantify and prioritise factors which affect willingness to self-manage.

Work package 4- Creation of a clinical questionnaire and resources to support women to overcome factors which affect willingness If factors negatively affecting willingness to self-manage a pessary can be overcome through support or education, this may increase the number of women empowered to self-manage.

Findings will be submitted for presentation at conferences and publication.

The applicant will utilise her position on the National Pessary Best Practice Group to ensure findings are disseminated to clinical leaders.

Findings will also be shared via Facebook support groups for women with prolapse, on Twitter, in an e-newsletter and a webinair.