ADHERENCE AND FOLLOW-UP TO PESSARYUSING EDUCATIONAL VIDEO: PROSPECTIVE COURT
L. S. BEZERRA1, C. T.VASCONCELOS 2, J. VASCONCELOS NETO 3, K. D.BEZERRA 4, D. M. SABOIA 5, M. O. ORIA 6,T. S. DO NASCIMENTO 5, R. N. REBOUCAS 5, V. F.VIANA 5;
1Saúde Materno Infantil, FederalUniv. of Ceara, Fortaleza, Brazil, 2Univ.e Federal doCearŸ, Fortaleza, Brazil, 3Hosp. Geral de Fortaleza,Fortaleza, Brazil, 4NURSE DEPARTMENT, FEDERAL Univ. OFCEARA, Fortaleza, Brazil, 5NURSE DEPARTMENT, Federal Univ.of Ceara, Fortaleza, Brazil, 6Federal Univ. of Ceara,Fortaleza, Brazil.
Introduction: The pessary is asilicone device made available in a variety of shapes and sizes,whose use has been gaining greater projection for good results;Whether they are related to women or to treatment, with a low indexof side effect, low risk, cost reduction and queue for surgicalprocedures.
Objective: The objective was to evaluate theadherence and follow-up of women with genital prolapse to the vaginalpessary and evaluate an easy-to-access video instrument in simplelanguage to inform about prolapse and to guide, stimulate andconsolidate the use of vaginal pessaries.
Methods: All 104women with symptomatic prolapse referred to the outpatient clinicwere included in an observational study of the Urogynecology andPelvic floor Dysfunction of two tertiary reference public hospitals.Both services have a team and have made available, in addition toother therapeutic approaches, conservative treatment using pessarysince November 2013 in one of the hospitals and in 2015 in the other.This therapeutic modality is indicated by the physician and conductedby nurses, with the support of the interdisciplinary team. Allpatients were informed during the medical consultation about theavailable therapeutic options (surgery, physiotherapy and pessaries)and applicable for their case. Those who were referred to the nursingconsultation, in order to have information about the treatment withthe pessary, were invited to participate in the study, knowing thatat any time they could choose another type of treatment. Those thatpresented any contraindication for the use of the pessary wereexcluded. To evaluate the adherence to the device, it was calculatedthe percentage of women referred to the nursing consultation in orderto know this option and who decided to try the use. In relation tofollow-up, the following variables were evaluated: number of attemptsuntil finding the adequate pessary, number of pessaries most used,rate of success at insertion, rate of withdrawal / discontinuity. Allthe women attended an educational video with orientations on what isgenital prolapse, its diagnosis and on the use of pessaries. Thevideo titled "Let's give the pessary a try?" Is an shortproduction that portrays situations through testimony in which womendemonstrate in their daily lives how they manage to use vaginalpessaries to correct the symptoms of pelvic organ prolapse. The videoproduction was based on theoretical on the "Self-EfficacyTheory" (the belief that the individual has about his or herability to successfully perform a particular activity)1
Results:All 104 patients with symptomatic POP referred to the nursingconsultation in order to know the conservative alternative for thetreatment of POP using the pessary wished to test the device. The ageranged from 36 to 98 years, with a mean of 67.5 ± 10.6 years.Patients reported spontaneously as the main reason for the demand forspecialized care, the complaint of "ball in the vagina" (n= 57 / 61.3%) isolated or associated with urinary complaints (n = 35/ 61.3%), . The sample studied was composed of menopausal women (n =76 / 88.4%), multigesters (Md: 6.4 ± 4.5), large multiparous women(Md: 5.4 ± 3.8), mainly (Md: 5.1 ± 3.8), with the largest newbornsweighing, on average, 3,979.79g (± 917.01). Only 25 (29.1%) womendid not perform any previous gynecological surgical procedure. Atphysical examination, it was observed that only 11 (18.3%) did notpresent vaginal lacerations and that the majority had markedprolapses, stage 3 and 4 (n = 76 / 87.3%). The mean number ofattempts to insert the appropriate number is 1.6 ± 1.0, the mostcommonly used size being number 3 (n = 22 / 24.7%). Success wasachieved in 77.8% (n = 77) of the inserts and of these, more thanhalf continued using the device (n = 54 / 57.4%).
Conclusions:This study offers important evidences about the experiences of womenwho use pessaries to correct POPs even in very precarioussocioeconomic and educational contexts in an underdeveloped Country.They had never had access before to information on prolapse andpessaries in their lives. We present increasing acceptance andencouraging results in relation to follow-up, showing an effectiveoption to be used. The use of educational video in association withinterdisciplinary conduct is responsible for presenting theindication of the treatment with pessary and explain the proceduresfor implantation, in addition to drawing attention to the stories ofthe main characters and of support, with truthful testimonies thatgive life to the plot and bring to the viewer more information andKnowledge, helping to overcome difficulties about the device andprolapse
References: 1-Bandura A, Self-efficacy: Toward aunifying theory of behavioral change. Psychological Review, Vol84(2), Mar 1977, 191-215.