Search

Background: Women's pelvic health is a globally important subject, included in international and United Kingdom health policies, emphasising the importance of improving information and access to pelvic health services. Consequences of pelvic symptoms are intimate, personal, and varied, often causing embarrassment and shame, affecting women's quality of life and wellbeing. AIM: To understand the experience of seeking healthcare for stigmatised pelvic health symptoms by synthesising all types of published primary research and mapping the results to behavioural theory, to identify potential targets for intervention. Methods: Systematic search of MEDLINE, CINAHL, PsycINFO, SocINDEX, PubMED databases, CDSR and CENTRAL registers, from inception to May 2023 for all types of research capturing women's views and experiences of seeking help with stigmatised urogenital and bowel symptoms. Studies only reporting prevalence, predictors of help-seeking, non-health related help-seeking, or written in languages other than English, German, French, Spanish and Swedish were excluded. Reference checking and forward citation searching for all included studies was performed. A results-based synthesis approach was used to integrate quantitative and qualitative data. Themes were mapped to the Common-Sense model and Candidacy framework. The Mixed Methods Appraisal Tool was used for critical appraisal. Grading of Recommendations Assessment, Development and Evaluation - Confidence in Evidence from Reviews of Qualitative research for assessing certainty of review findings. Results: 86 studies representing over 20,000 women from 24 high income countries were included. Confidence was high that barriers to help-seeking were similar across all study types and pelvic symptoms: stigma, lack of knowledge, women's perception that clinicians dismissed their symptoms, and associated normalising and deprioritising of low bother symptoms. Supportive clinicians and increased knowledge were key facilitators. Conclusions: Using the Common-Sense Model to explore women's help-seeking behaviour with stigmatised pelvic symptoms reveals problems with cognitive representation of symptom identity, emotional representations of embarrassment and shame, and a subjective norm that women believe their symptoms will be trivialised by clinicians. Together these barriers frustrate women's identification of their candidacy for healthcare. Addressing these issues through behavioural change interventions for women and clinicians, will help to achieve universal access to pelvic healthcare services (United Nations Sustainable Development Goal 3.7). Systematic Review Registration: PROSPERO CRD42021256956. [ABSTRACT FROM AUTHOR]

Simulation and role-play have a proven track record as pedagogic techniques to provide students with insights into geopolitics, diplomacy, and international relations. Since the first Model United Nations (MUN) in 1947, simulations have proliferated within secondary and tertiary educational settings. However, these activities overwhelmingly focus on recognised nation-states, neglecting polities that are not UN member states, but that are often acutely affected by conflict and human rights abuses. This paper is part of a broader project that is seeking to bring the realities and stories from such communities, territories, and peoples – a number of which have come together as the 'Unrepresented Nations and Peoples Organization' (UNPO) – to a wider audience. Loosely based on MUN simulations, the 'Model UNPO' exercise involves participants being assigned a UNPO member, researching that polity's context and rights claims, and coming together for a structured role-play debate. Drawing on participant observation of Model UNPO exercises with 16–18 year old students at thirteen UK secondary schools we examine how geopolitics can be taught and learned within school classroom settings, how young people make sense of geopolitics, and how they imagine and articulate alternative internationals. We assess what simulation exercises can offer to understandings of the intersection of young peoples' geopolitics and geographies of education. In doing so, we analyse how students draw on 'known worlds' and advocate for possible worlds through role-playing unrepresented diplomats, and examine the role of clause writing in the scripting of geopolitical imaginaries, and how role-playing forges empathy and solidarities. We conclude by making the case for foregrounding young people as critical and creative geopolitical thinkers. [ABSTRACT FROM AUTHOR]