A Sisterhood of Women: The Process of Co-Creating Recommendations for Improved Pessary Self-Management Support.

aimsThis work aimed to explore barriers to pessary self-management and co-create strategies to address these.

designParticipatory Action Research.

methodsIn October 2024, eight pessary-using women living in the United Kingdom participated in cooperative inquiry, discussion and co-creation of strategies in two virtual workshops.

resultsPessary using women who participated in this research identified challenges affecting willingness to self-manage a pessary and proposed solutions to address these and better support women. Pessary practitioners should assess physical capabilities, consider softer, more malleable pessaries, and explore the possibility of a pessary applicator. Peer support was seen as empowering, enabling self-advocacy and improved care; therefore, establishing peer networks was prioritised. Major barriers included difficulty navigating services and limited access to a full range of pessaries, leading some women to buy devices online without medical oversight, creating a two-tier system based on ability to pay. The group called for improved, standardised pessary care, and for self-management to be reframed to avoid women feeling 'fobbed off' through better follow-up, positive language, and compassionate care.

conclusionsThe group identified strategies to address barriers to pessary self-management which require further exploration. Pessary practitioners have a responsibility to listen to these voices and take steps to improve care for women in the future. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: To support women's willingness to self-manage their pessary, pessary practitioners should consider and support women to overcome physical and emotional barriers; improve information provision; maximise social support; boost women's perceived self-efficacy; reframe pessary self-management and ensure robust, accessible follow-up is in place. This will ensure pessary-using women are supported to make an informed decision about pessary self-management. This research offers pessary practitioners insight into barriers women perceive to pessary self-management and guidance as to how women can be supported to self-manage their pessary. IMPACT: Only 21% of women are willing to self-manage their pessary. Therefore, this research aimed to co-create strategies to better support women to self-manage their pessary and overcome barriers to willingness. Women reported individual, societal and service factors which affect willingness to self-manage a pessary. These research findings should be translated into clinical practice and care delivery for pessary using women in both a community and hospital setting. REPORTING

methodCOREQ (COnsolidated criteria for REporting Qualitative research) Checklist. PATIENT OR PUBLIC CONTRIBUTION: Patients and members of the public were involved in research prioritization, study design, data analysis, interpretation of findings and dissemination. STUDY REGISTRATION: Study not registered.