Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Linda Fan

Abstract

Study Objective: Menstrual health has been understudied in the United States. We aimed to assess patient and provider perspectives surrounding menstrual health management and screening.
Design: Our mixed-methods approach consisted of medical staff surveys, patient surveys, and patient interviews.
Each study component mentioned above was completed in both an adult and adolescent population. Setting: Adult participants were recruited from a hospital-based clinic, a community-based clinic, and a free clinic. Adolescent participants were recruited from a pediatric gynecology practice or an adolescent medicine clinic at an urban tertiary academic center. Participants: Adult study participants included medical staff from clinical sites as well as residents and faculty in the hospital OB/GYN department and patients from the clinical sites age 18 and older. Adolescent study participants included pediatrics faculty or residents and patients aged 13-24 years. Intervention: Participants completed an anonymous survey or semi-structured interview about their experiences with menstrual health. Main Outcome Measures: Descriptive statistics and thematic content analysis were used for quantitative and qualitative data, respectively. Convergent parallel analysis elucidated key findings in both data sets.
 Results: (Adult Study) The medical staff survey had a response rate of 72% (54/75). Only 7% (4/54) of medical staff consistently asked patients about menstrual products, while 54% (29/54)
were concerned that patients could not afford menstrual products. The patient survey response rate was 91% (186/205). Twenty-two percent (40/185) of respondents showed menstrual hygiene insecurity, which was associated with annual income $<30,000 (p<0.001). Forty-five percent (85/186) of participants missed commitments during their menses; 53% (98/186)
never discussed menstrual products with their healthcare provider. Seventeen patients were invited to interview; thematic saturation required 10.
 (Adolescent Study) The medical staff survey response rate was 65% (69/106); 13% (9/69) of providers consistently asked patients about menstrual products, whereas 39% (27/68) were concerned patients could not afford products. The patient survey response rate was 85% (101/119); 19% (19/101) of respondents reported menstrual hygiene insecurity, 55% (55/101) missed commitments during menses, and 45% (45/101) discussed menstrual products with providers. Fifteen patients were invited for qualitative interviews; 10 were conducted, and thematic saturation occurred. Interviews highlighted the importance of comprehensive early menstrual health education and providers’ role in menstrual management.
 Conclusion: A more holistic approach towards menstrual health education and screening is needed in the U.S. The quantitative data showed menstruation’s impact on quality-of-life factors and the inconsistency of screening practices. The qualitative interviews highlighted potential areas for support and education regarding menstrual health. In particular, adolescence is a crucial point of entry into health care. Because taboos surrounding menstruation could limit access to health care, menstrual health education must be emphasized. Menstrual health education is provided piecemeal by parents, schools, and providers. Current practice should be reevaluated to consider comprehensive educational approaches in which health care leads.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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