María Inmaculada De Molina-Fernández

Background: The choice of a contraceptive method is a complex decision in which decisional conflict can occur, which can lead to poor adherence and unplanned pregnancies. The objective was to assess whether a web-based Decision Support Tool (DST) reduced decisional conflict compared with usual contraceptive counselling. Methods: A parallel, controlled cluster randomised clinical trial was carried out in 43 clinical contraceptive counselling units in Spain between 2019 and 2021. Seventy-one professionals were randomly assigned to intervention group or control group and recruited a sample of 895 women. Participants in the intervention group (IG, n = 478) received professional counselling supported by the DST, after brief training in its use, while those in the control group (CG, n = 417) received the same professional counselling without the tool (usual care). Decisional conflict, a prespecified secondary outcome of the trial, was measured with O’Connor’s 16-item Decisional Conflict Scale. Results: Decisional conflict was low in both groups; only 1.9% of participants in the intervention group and 1.7% in the control group had DCS scores above 37.5. After accounting for the clustering effect by professional and adjusting for baseline covariates, no statistically significant differences in total decisional conflict were observed between the groups (adjusted mean difference: 2.2 points; 95% CI: −1.9 to 6.3; p = 0.297), nor in any of the subscales (all p ≥ 0.13). Variability between professionals was considerable (ICC = 0.37 for the total score; between 0.24 and 0.34 for the subscales), and the results remained unchanged in a three-level sensitivity analysis. Conclusions: In this cluster-randomised trial, we found no evidence that the decision support tool (DST) reduced decisional conflict among women receiving contraceptive counselling; after accounting for the clustering effect by provider, decisional conflict did not differ significantly between groups and was generally low. A substantial portion of the residual variability in decisional conflict was attributable to the providers offering the counselling rather than to the tool itself. Therefore, the DST may be more useful as a complement to professional counselling than as a substitute for it. Trial registration: ISRCTN58279944. Registered 15 April 2019 (prospectively registered).

Background/Objectives: Adolescent pregnancy remains a global public health challenge associated with adverse outcomes for both mothers and newborns. This study aimed to use two instruments and several multivariate techniques to identify a minimal set of variables that reproduces the instrument-based classification of adolescent pregnancy risk, while remaining parsimonious with the original instruments. Methods: A cross-sectional, quantitative methodological study was conducted among Colombian schoolgirls, comprising 160 adolescents in the face-validity phase and 319 in the risk-estimation and modeling phase. The IRENE and REND instruments, originally developed to assess the risk of adolescent pregnancy, underwent cultural adaptation, face validity and content validity. Subsequently, the instruments were administered to estimate the risk. Finally, Factor Analysis and Categorical Principal Component Analysis were applied as exploratory dimensionality reduction techniques to identify the most relevant variables for retention, thereby preserving the parsimony of the original versions. Results: Overall, 80.3% of participants were classified as not at risk, while the remainder were classified as at risk by one or both instruments. The results suggest that variables such as who the adolescent lives with, the age at which the adolescent had their first complete sexual intercourse, and how the adolescent would respond to an unplanned pregnancy are factors associated with the instrument-based risk classification. Subsequently, dimensionality reduction and logistic regression analyses identified a small subset of variables that can be used to reproduce the instrument-based classification of adolescent pregnancy risk. Conclusions: The reduced set of variables reproduced the instrument-based risk classification with high internal accuracy. Because the predictors and the outcome derive from the same instruments, these findings reflect internal reproduction of the instrument classification rather than prediction of an observed pregnancy, and they require external validation. Overall, the reduced and optimized set of variables from the IRENE and REND instruments offers a parsimonious approach that reproduces the instrument-based risk classification and that may support rapid screening once validated in independent adolescent samples. The main limitations are the use of a single institution, the non-probabilistic convenience sample, and the absence of an observed pregnancy outcome.

Combined oral contraceptives (COC) are a very popular form of birth control. Incorrect use and lack of adherence to treatment reduce the effectiveness of this method. Having a standard tool to identify poor-adherence profiles quickly and objectively can be helpful for midwives and potentially for COC users. The MMAS-4 adherence scale has been used in various medical fields, but there is little evidence of its potential in contraceptive consultation. This paper presents a piece of multicenter observational research based on a sample of 327 women who had attended contraceptive counselling in Spain and were COC users or had informed the midwife that they want to start to use this method. Two interviews were conducted: at the time of consultation and after one year. In our research, the MMAS-4 identified high-risk behaviors: during the 1-year follow-up period, COC users classified as poorly adherent had a significantly higher risk of missed contraceptive pills, more incidents and problems related to the method of contraception, as well as a lower degree of satisfaction with the contraceptive method. One case of unplanned pregnancy and two cases of emergency contraception were identified, all of them corresponding to poorly adherent women. The use of MMAS-4 in consultation can improve midwives’ contraceptive counselling.

Summary: The current state of knowledge indicates that regular sports practice helps prevent and treat non-communicable diseases. The promotion of sport is, therefore, an important community health intervention for maintaining and improving the health of individuals and populations. Culture is identified as being associated with sports practice and sedentary behaviour of ethnic and national minorities. This study aims qualitatively to analyse the potential for culture as a basis for the promotion of sport among immigrants in four regions of Mediterranean Europe. Ten focus groups (n = 62) were conducted with immigrants—adults and young people over the age of 11—and people involved in promoting sport. Thematic content analysis was conducted. The results enabled identifying two major issues: sport as a vehicle for cultural expression and synergies between sport and culture. Accordingly, sport serves to express global, local and non-ethno-national cultural belonging. Regarding synergies, culture and sport feed each other positively and contribute to immigrants’ health and cultural well-being. Culture as a strategy for promoting sports practice requires an interdisciplinary approach that involves collaboration between healthcare practitioners and social sciences professionals. There is also a need to use the various axes of cultural definition—global, local and non-ethno-national—of those involved, and for them to take part themselves in designing sports activities. Moreover, promoting sport through non-ethno-national axes of cultural definition may help with immigrants’ social inclusion, as intercultural relations between migrants and newcomers are promoted.

Introduction: Contraception has played a central role in much of human history. Since the separation of reproduction from sexuality, in addition to preventing sexually transmitted diseases, contraceptive methods have been used as a tool for birth control, varying in their presentation throughout history, influenced by socioeconomic and cultural processes. Method: A narrative review was conducted in the biomedical databases: Scielo, Pubmed, Dialnet, CUIDEN and Google Scholar. The literature search was conducted between August and December 2021. Results: Initial search strategies identified a total of 48247 articles. Once exclusion criteria were applied, 19 journal articles (6 in Scielo, 3 in Pubmed, 2 in Dialnet, 2 in CUIDEN, and 6 in Google Scholar) and 2 books were selected. Conclusions: The resources and culture of society have conditioned sexuality and reproduction in each historical moment. In the 20th century, the struggle for women's rights and freedom over birth control began, thus implementing family

This paper presents the process of co-design, co-production, piloting, evaluation and revision of an Integrated Digital Literacy and Language Toolkit for Vulnerable Migrant Students (VMs) in Higher Education (HE). The language element focuses on academic language skills of reading, writing, listening and speaking required for effective involvement in both the host society and HE learning; the acquisition and improvement of digital literacy skills enable VMs to successfully participate in, and contribute to, university and societal collaboration, creativity and content curation. The Toolkit resulted from the co -operation and collaboration of five EU universities and was based on the ASSURE instructional design model. The Toolkit offers a self- access, self- paced, non-linear, fully online set of ten stand-alone units which offer a range of materials and activities to develop those skills pertinent to VM academic language and digital literacy needs. Evaluation by a group of VMs resident in EU countries highlight the positive impact of the Toolkit and validates the instrument as fit for purpose. Noteworthy aspects include its usefulness in supporting student autonomy, improving digital capabilities and academic language mastery,a positive experience of a flexible learning experience along with access to open resources of international scope and dissemination under the Creative Commons licence.

Background: The choice of contraceptive method is a complex decision, and professionals should offer counselling based on the preferences, values and personal situation of the user(s). Some users are unsatisfied with the counselling received, which may, among other consequences, adversely affect method use adherence. In view of this situation, we propose exploring the experiences and needs of users and professionals for contraceptive counselling, in the context of creating a web-based contraceptive decision support tool. Methods/design: Qualitative research was conducted through focus group discussions (64 users split into eight groups, and 19 professionals in two groups, in Tarragona, Spain) to explore the subjects’ experiences and needs. The data were categorized and the categories were defined and classified based on the three-step protocol or framework for Quality on Contraceptive Counseling (QCC), created by experts, which reviews the quality of interactions between user and professional during the counselling process. Results: In counselling, users demand more information about the different methods, in an environment of erroneous knowledge and misinformation, which lead to false beliefs and myths in the population that are not contrasted by the professional in counselling. They complain that the method is imposed on them and that their views regarding the decision are not considered. Professionals are concerned that their lack of training leads to counselling directed towards the methods they know best. They acknowledge that a paternalistic paradigm persists in the healthcare they provide, and decision support tools may help to improve the situation. Conclusions: Users feel unsatisfied and/or demand more information and a warmer, more caring approach. Professionals are reluctant to assume a process of shared decision-making. The use of a contraception DST website may solve some shortcomings in counselling detected in our environment.

Background: First-time mothers require greater nursing accompaniment in the postpartum period due to their lack of expertise and preparation for the new challenges of motherhood. Information and communication technologies (ICTCs) allow easy access to learning habits for the transition into motherhood; however, the lack of technological appropriation for postpartum monitoring becomes evident in developing countries and in the Western world. Methods: This study developed the Amacompri postpartum nursing tracking information system, which is based on Mercer's theory of becoming a mother and discusses the vital environment: First-time mother’s family and friends. The Amacompri software was designed using the SCRUM methodology, java web technologies and PostgreSQL database. Results: This information system features a web version and a mobile App. The technical validation involved 10 experts, and the validation by population 10 first-time mothers. This first group reviewed the quality of presentation and content in the early stages of the software. Finally, the Amacompri system was used for 4 months by 33 first-time mothers, who evaluated the application for design, usability, and applicability. Amacompri software was effective for non-face-to-face nursing accompaniment to first-time mothers. Conclusions: The Amacompri software was designed based on Mercer's theory of becoming a mother, and has been technically validated (experts) and validated by population (first mothers), demonstrating its quality in both presentation and content. Its evaluation demonstrated its effectiveness in meeting the development objective. In this context, the Amacompri software meets multimedia requirements in the functional, technical-esthetic, and pedagogical aspects.