228689 Gynecological examination issues and concerns of women with developmental disabilities: A qualitative study

Monday, November 8, 2010 : 11:06 AM - 11:24 AM

Ritika Bhawal, MBBS, MPH , Department of Applied Health Science, Indiana University, Bloomington, IN
Nancy T. Ellis, HSD, MPH , Department of Applied Health Science, Indiana University, Bloomington, IN
The American Congress of Obstetricians and Gynecologists recommends all women receive regular gynecological exams, but research is sparse about understanding the gynecological experience through the eyes of women with developmental disabilities. Using the Health Belief Model, this qualitative study examined knowledge, needs, barriers and cues to action regarding the gynecological exam for “self-advocates,” an organized group of empowered women with disabilities that promote self-sufficiency, independence, and equality among persons with disabilities. Twenty-five self advocates were recruited throughout the State via the Indiana Institute on Disability & Community. Six focus groups (60 minutes; 4-5 participants each) were asked 12 questions to ascertain 1) what is the current knowledge and needs among self-advocates concerning the gynecological examination? 2) What barriers prevent these women from accessing gynecological examinations? Sessions were recorded, transcribed and analyzed thematically. About 70% of self-advocates did not receive any information regarding gynecological exams; knowledge was primarily limited to pap smears for cancer prevention. Respondents living in communal homes get gynecological exams more frequently than those in private residences. The majority of self-advocates expressed concerns about: disability focused care only, lack of direct communication with medical provider; physical difficulties with instruments/procedures; discomfort with accessing/remaining on exam table. Four-fifths were embarrassed about gynecological exam due to previous negative experiences. Typically omitted were issues about sexually transmitted infections, contraceptive and reproductive health alternatives. Findings and recommendations target personal care givers and medical providers to improve preparation for and during the gynecological exam and to address gynecologic health disparities of women with disabilities.

Learning Areas:
Assessment of individual and community needs for health education
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Identify the knowledge, needs and concerns that women with developmental disabilities have regarding gynecological examinations. List social and physical barriers regarding the gynecological exam for women with developmental disabilities. Analyze and apply study findings to initiate cues to action collaboratively by both patients with disabilities and health care providers to improve access, comfort, and education about the gynecological exam.

Keywords: Women, Disability

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have medical and public health degrees and have worked with women with disabilities at the Indiana Institute on Disability and Community
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.