Background and Objective: Prenatal diagnosis for chromosomal anomalies is frequently used worldwide. It is important that pregnant women receive adequate counselling to make informed decisions regarding prenatal diagnosis. The aim of this study was to explore what factors influence pregnant women's decision-making process when accepting or declining prenatal screening and diagnosis. Methods: A qualitative study using inductive qualitative content analysis. Individual, semi-structured phone interviews were carried out during a five-month period in 2016-2017 with 24 pregnant women in the first trimester, living in a medium-sized Swedish city. Findings: Two main themes emerged: (1)"Individual factors - The women's experiences, perceptions and values" with three categories "Attitude towards anomalies", "Worry and need for reassurance", "Self-perceived risk" and (2)"External factors - The women's perception of the test and others' views" with two categories "Test characteristics" and "Influence from others". Conclusions: Pregnant women's decision-making process regarding prenatal tests is multidimensional, affected by both individual factors such as experiences, perceptions and values, and external factors such as test characteristics and influence from others. Information about both test characteristics and the conditions tested is of help pregnant women in the decision-making process since it provides a better understanding of how having a child with the condition in question can affect them and their family. It is important that healthcare professionals giving information about and offering prenatal tests for chromosomal anomalies are aware of how their attitudes can influence women's decisions.

Objective: To study pregnant women's subjective viewpoints on what is important when receiving information prior to decision-making regarding prenatal testing for chromosomal anomalies.

Method: Data were collected using Q methodology. During January 2020—October 2021, 45 pregnant women in Sweden completed a 50-item Q sort. Statements regarding what is important when receiving information about prenatal screening and diagnosis were prioritized through ranking in a fixed sorting grid on an 11-point scale, from “most important” to “least important.” Socio-demographics and coping styles were surveyed through questionnaires.

Results: Three groups represented different viewpoints on what pregnant women consider important when receiving information about prenatal screening and diagnosis. Factor 1: Stepwise information and decision-making: viewing information and decision-making as a step-by-step process. Factor 2: Decision-making as a continuous process based on couple autonomy: Striving for an informed decision as a couple about tests, test results and conditions screened. Factor 3: As much information as early as possible—the importance of personal autonomy in decision-making: Prioritizing autonomous decision-making based on non-directive information early in the pregnancy.

Conclusion: This study highlights the complexities involved when providing information. As shown by the differing viewpoints in this study, pregnant women's informational needs differ, making individual and personalized information preferable.

Introduction: Although the prevalence of pain persisting after pregnancy or labour decreases with time, up to 35 % of women report pain 8 months to 12 years after childbirth. To prevent the development and reduce the impact of chronic pain, researchers and clinicians emphasize the importance of early diagnosis as well as timely and appropriate treatment. Previous studies have shown that when women with post-childbirth morbidities consult healthcare professionals during the first year following birth, their problems are often neglected, and they do not receive adequate treatment.

Objective: To explore how women with pain persisting for eight months after childbirth experienced encounters with healthcare.

Methods: A descriptive qualitative design with 20 face-to-face, semi-structured interviews. Data were analysed using inductive qualitative content analysis.

Results: “Pain ignored by healthcare” was identified as an essential theme and included four categories: “Questioned pain experience,” “Inadequate pain management,” “Lost in healthcare,” and “Insufficient postpartum care “

Conclusion: The women experienced that their pain was often not recognized or adequately treated, but instead ignored or trivialized. Recurring were descriptions of experienced knowledge gaps among the healthcare providers regarding pain and its management. There was an overall desire among women for a well-defined and well-functioning chain of care with better accessibility and scope.

OBJECTIVE: the possibility of experiencing adverse reactions is an important aspect of contraceptive decision-making and information about this topic is highlighted as an essential aspect of contraceptive counseling. The aim of this study was to explore experiences of contraceptive counseling about potential adverse reactions of intrauterine contraception.

DESIGN: exploratory qualitative study of messages in discussion boards, analyzed with inductive qualitative content analysis.

SETTING: two large public Swedish web-based discussion boards about sexual and reproductive health.

PARTICIPANTS: threads related to the aim were identified through searches in the discussion boards during 2019 and 2020, resulting in in 43 included posters who had written 140 messages in total.

FINDINGS: the themes 'difficulties making an informed decision due to insufficient and untrustworthy information about adverse reactions' and 'feeling dismissed when communicating about experienced adverse reactions' illustrate the results. Posters emphasized the importance of sufficient information about adverse reactions. However, professionals were perceived as overly optimistic regarding intrauterine contraception and focusing on mild or common reactions. The importance of feeling that their adverse reactions were acknowledged was articulated, but posters felt that some professionals dismissed the reactions when being told about it, resulting in frustration and dissatisfaction with care. The discussion boards contained narratives describing a resistance among professionals to send in a formal report about the adverse reaction.

KEY CONCLUSIONS: according to statements made by posters who have experience of adverse reactions of intrauterine contraception, contraceptive counseling have room for improvement in regard to inclusion of comprehensive information about adverse reactions. The findings illustrate the importance that clients who experience adverse reactions of intrauterine contraception feel they are acknowledged and offered adequate support.

IMPLICATIONS FOR PRACTICE: echoing guidelines for high-quality contraceptive counseling, the narratives provide further weight that professionals need to have adequate training and resources to offer comprehensive information about adverse reactions of intrauterine contraception. The findings call attention to the importance of follow-up services for clients who experience adverse reactions.

BACKGROUND: Access to information is essential to achieving individual empowerment; meaning the ability to exercise control, manage one's own condition and make informed decisions. However, studies have shown that information provided to women regarding physiological changes during the postpartum period and postpartum health was inadequate, incorrect, or inconsistent.

METHODS: The aim of this study was to explore informational support about pain persisting after childbirth and its consequences. A sequential explanatory mixed methods design was used. In the first, quantitative phase, 1,171 women, who gave birth eight months earlier, completed a self-administered questionnaire. In the second, qualitative phase, 20 women who experienced chronic pain were interviewed. Descriptive statistics and qualitative content analysis were used to analyse the data.

RESULTS: The majority of the women did not receive information about pain persisting after childbirth, or the information was insufficient or incorrect. They did not know when and where to seek help and did not consult health care professionals. In addition, the lack of information had a negative impact on women's psychological well-being. All women expressed the need to be informed by health care professionals, irrespective of the individual risk of developing chronic pain.

CONCLUSIONS: Health services should ensure availability of information to give the women opportunity to achieve empowerment to make good health decisions, increase control over their health and well-being as well as to enhance their self-efficacy. We propose that a booklet or leaflet with relevant information about the risk of developing chronic pain, symptoms and treatment, along with advice about appropriate health care settings should be provided as part of antenatal or postnatal care.

Objective: Non-invasive prenatal testing (NIPT) identifies the risk of abnormalities in pregnancy, potentially reducing the risk of miscarriage associated with invasive tests. This study aimed to understand the preferences of current and future mothers about the content, format and timing of information provision about NIPT.

Methods: An online discrete choice experiment (DCE) was designed comprising four attributes: when in the pregnancy information is provided (4 levels); degree of detail (2 levels); information format (6 levels); cost to women for gathering information (5 levels). Respondents included women identified by an online-panel company in Sweden. The mathematical design was informed by D-efficient criteria. Choice data were analysed using uncorrelated random parameters logit (RPL) and latent class models.

Results: One thousand Swedish women (56% current mothers) aged 18 to 45 years completed the survey. On average, women preferred extensive information provided at/before 9 weeks of pregnancy. There was heterogeneity in preferences about the desired format of information provision (website, mobile app or individual discussion with a midwife) in the population.

Conclusion: Women had clear preferences about the desired content, format and timing of information provision about NIPT. It is important to tailor information provision to enable informed choices about NIPT.

BACKGROUND: The management of the active second stage in labor and perineal protection varies between countries and is rarely described regarding waterbirths. The objective of this study was to describe how midwives manage the active second stage of labor in waterbirths compared to conventional births. A secondary aim was to compare clinical outcomes between the two groups.

METHODS: A prospective cohort study, based on 323 women who gave birth at three clinics in Sweden, between Dec 2015-May 2019. The women were both primiparous and multiparous; 153 gave birth in water and 170 had a conventional uncomplicated birth. A protocol was completed by the attending midwife after birth, describing characteristics and management of the active second stage of labor as well as perineal protection.

RESULTS: The active second stage of labor differed in several aspects between waterbirths and conventional births. Maternal pushing was spontaneous to a higher extent among women giving birth in water and the use of manual perineal protection was lower. The technique of manual perineal protection differed as well as birth positions. Giving birth in water was associated with less second-degree tears among primiparous women but with no differences among multiparas.

CONCLUSIONS: In waterbirth, the midwife took the role of a more watchful attendee, making less interventions. Waterbirths were associated with less directed pushing and less manual perineal protection. However, there was still a widespread use of manual perineal protection, showing it is possible to use in the same way as in conventional births if needed.

Background Following the outbreak of the coronavirus disease 2019, adequate public information was of outmost importance. The public used the Web extensively to read information about the pandemic, which placed significant responsibility in, for many, an unfamiliar situation as the disease spread across the globe. The aim of this review was to synthesize the quality of web-based information concerning the coronavirus disease 2019 published during the first year of the pandemic.

Materials and methodsA rapid systematic review was undertaken by searching five electronic databases (CINAHL, Communication & Mass Media Complete, PsycINFO, PubMed, Scopus). Empirical infodemiology reports assessing quality of information were included (n = 22). Methodological quality and risk of bias was appraised with tools modified from previous research, while quality assessment scores were synthesized with descriptive statistics. Topics illustrating comprehensiveness were categorized with content analysis.

ResultsThe included reports assessed text-based content (n = 13) and videos (n = 9). Most were rated good overall methodological quality (n = 17). In total, the reports evaluated 2,654 websites or videos and utilized 46 assessors. The majority of the reports concluded that websites and videos had poor quality (n = 20). Collectively, readability levels exceeded the recommended sixth grade level. There were large variations in ranges of the reported mean or median quality scores, with 13 of 15 total sample scores being classified as poor or moderate quality. Four studies reported that ≥ 28% of websites contained inaccurate statements. There were large variations in prevalence for the six categories illustrating comprehensiveness.

ConclusionThe results highlight quality deficits of web-based information about COVID-19 published during the first year of the pandemic, suggesting a high probability that this hindered the general population from being adequately informed when faced with the new and unfamiliar situation. Future research should address the highlighted quality deficits, identify methods that aid citizens in their information retrieval, and identify interventions that aim to improve the quality of information in the online landscape.

Background: The COVID-19 pandemic has caused significant morbidity and mortality. To mitigate its spread, members in the general population were prompted to apply significant behavioral changes. This required an effective dissemination of understandable information accessible for people with a wide range of literacy backgrounds. The aim of this study was to investigate the readability, understandability and language accessibility of Swedish consumer-oriented websites containing information about COVID-19.

Methods: Websites were identified through systematic searches in Google.se (n = 76), and were collected in May 2020 when the pandemic spread started in Sweden. Readability and understandability were assessed with the Readability Index, the Ensuring Quality Information for Patients (EQIP) tool, and the Patient Education Materials Assessment Tool Understandability subscale (PEMAT-PU).

Results: The median total sample score for Readability Index was 42.0, with the majority of scores being classified as moderate (n = 30, 39%) or difficult (n = 43, 57%). Median total sample scores were for EQIP 54.0% (IQR = 17.0, Range = 8–75) and for PEMAT-PU 60.0% (IQR = 14.75, Range = 12–87). The majority of the websites did not have any texts or links containing information in an alternative language (n = 58, 76%).

Conclusions: Swedish websites contained information of difficult readability and understandability at the beginning of the coronavirus disease 2019 pandemic, with few providing information available in alternative languages. It is possible that these deficits contributed to the spread and impact of the virus. There is a need for studies investigating methods aiming to enhance the readability, understandability and language accessibility of web-based information at the beginning of an epidemic or pandemic.