Understanding factors which affect willingness to self-manage a pessary for pelvic organ prolapse: a questionnaire-based cross-sectional study

Introduction
Pessary self-management offers benefits to women with no increased risk of complications. However, many women are unwilling to self-manage, preferring clinician-led care. This study aimed to explore factors associated with women’s willingness to self-manage a pessary.

Methods
Women attending the pessary clinic at an NHS TrustUK hospital were asked to complete a questionnaire providing responses on pessary use, comorbidities, female genital self-image, self-management experience and willingness, as well a free text response explaining reasons behind willingness (or not) to learn self-management. Based upon statistical advice we aimed to recruit 90 women. Data were was analysed using non-parametric Kruskal-Wallis test and Chi2 test. Free text data was analysed thematically.

Results
89 women completed the questionnaire. Thirty-three women (38%) had previously been taught pessary self-management. Of the remaining women, 12 (21%) were willing to learn, 288 (50%) were not willing and 16 (29%) were unsure. Younger women were more willing to learn self-management (P= <0.001). Willing women were motivated by reduced follow-up visits. Women already sSelf-managing women reported benefits such asincluding increased autonomy, cleanliness and giving their body ‘a break’. Reasons discouraging women from self-managing were; a lack of confidence; feeling physically unable to self-manage; wanting to see a healthcare professionalclinician-led care; fear of problems or previous problems with their pessary, meaning they wanted regular clinician reassurance.

Conclusions
Most women were either unsure about pessary self-management or unwilling to self-manage their pessary. Age was the only factor we found had a significant relationship with willingness to self-manage a pessary. With robust self-management teaching, support and follow-up, it is likely that many of the barriers women report can be overcome.
Age was the only statistically significant factor which affected willingness to self-manage a pessary. With robust self-management teaching, support and follow-up, it is likely that many of the barriers women report can be overcome.