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  • 1. Bodin, Maja
    et al.
    Käll, Lisa
    Tydén, Tanja
    Stern, Jenny
    Sophiahemmet University.
    Drevin, Jennifer
    Larsson, Margareta
    Exploring men's pregnancy-planning behaviour and fertility knowledge: a survey among fathers in Sweden2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 2, p. 127-135Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Research about pregnancy-planning behaviour mostly focuses on women, even though pregnancy planning usually also concerns men. The purpose of this study was to investigate how men plan for family, and to measure their fertility knowledge after having become fathers.

    MATERIAL AND METHODS: Data were collected in 2014 as part of a Swedish longitudinal pregnancy-planning study. Men were recruited through their female partner one year after childbirth. Participants were asked to fill out a questionnaire about pregnancy planning, lifestyles, and fertility.

    RESULTS: Of the 796 participants, 646 (81%) stated that the pregnancy had been very or fairly planned, and 17% (n = 128) had made a lifestyle adjustment before pregnancy to improve health and fertility. The most common adjustments were to reduce/quit the consumption of alcohol, cigarettes, or snuff, and to exercise more. First-time fathers and those who had used assisted reproductive technology to become pregnant were more likely to have made an adjustment. Fertility knowledge varied greatly. Men with university education had better fertility knowledge than men without university education.

    CONCLUSION: Our findings indicate that there is variation in how men plan and prepare for pregnancy. Most men did not adjust their lifestyle to improve health and fertility, while some made several changes. Both pregnancy-planning behaviour and fertility knowledge seem to be related to level of education and mode of conception. To gain deeper understanding of behaviour and underlying factors, more research is needed.

  • 2. Delbaere, Ilse
    et al.
    Stern, Jenny
    Sophiahemmet University.
    Fertility2020In: Preconception health and care: A life course approach / [ed] Jill Shawe, Eric A.P. Steegers & Sarah Verbiest, Springer , 2020, 1, p. 53-79Chapter in book (Other academic)
  • 3. Drevin, Jennifer
    et al.
    Kristiansson, Per
    Stern, Jenny
    Sophiahemmet University.
    Rosenblad, Andreas
    Measuring pregnancy planning: A psychometric evaluation and comparison of two scales2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 11, p. 2765-2775Article in journal (Refereed)
    Abstract [en]

    AIMS: To psychometrically test the London Measure of Unplanned Pregnancy and compare it with the Swedish Pregnancy Planning Scale.

    BACKGROUND: The incidence of unplanned pregnancies is an important indicator of reproductive health. The London Measure of Unplanned Pregnancy measures pregnancy planning by taking contraceptive use, timing, intention to become pregnant, desire for pregnancy, partner agreement, and pre-conceptual preparations into account. It has, however, previously not been psychometrically evaluated using confirmatory factor analysis. The Likert-scored single-item Swedish Pregnancy Planning Scale has been developed to measure the woman's own view of pregnancy planning level.

    DESIGN: Cross-sectional design.

    METHODS: In 2012-2013, 5493 pregnant women living in Sweden were invited to participate in the Swedish Pregnancy Planning study, of whom 3327 (61%) agreed to participate and answered a questionnaire. A test-retest pilot study was conducted in 2011-2012. Thirty-two participants responded to the questionnaire on two occasions 14 days apart. Data were analysed using confirmatory factor analysis, Cohen's weighted kappa and Spearman's correlation.

    RESULTS: All items of the London Measure of Unplanned Pregnancy contributed to measuring pregnancy planning, but four items had low item-reliability. The London Measure of Unplanned Pregnancy and Swedish Pregnancy Planning Scale corresponded reasonably well with each other and both showed good test-retest reliability.

    CONCLUSION: The London Measure of Unplanned Pregnancy may benefit from item reduction and its usefulness may be questioned. The Swedish Pregnancy Planning Scale is time-efficient and shows acceptable reliability and construct validity, which makes it more useful for measuring pregnancy planning.

  • 4. Ekstrand Ragnar, Maria
    et al.
    Grandahl, Maria
    Stern, Jenny
    Sophiahemmet University.
    Mattebo, Magdalena
    Important but far away: adolescents' beliefs, awareness and experiences of fertility and preconception health2018In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 23, no 4, p. 265-273Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim was to explore adolescents' beliefs and awareness regarding fertility and preconception health, as well as their views and experiences of information about fertility and preconception health directed at their age group.

    METHODS: We performed seven semi-structured focus group interviews among upper secondary school students (n = 47) aged 16-18 years in two Swedish counties. Data were analysed by qualitative content analysis.

    RESULTS: One theme ('important but far away') and five categories ('starting a family far down on the list'; 'high awareness but patchy knowledge of fertility and preconception health'; 'gender roles influence beliefs about fertility and preconception health'; 'wish to preserve fertility and preconception health in order to keep the door to procreation open'; 'no panacea - early and continuous education about fertility and preconception health') emerged from the interviews. Participants recognised the importance of preconception health and were highly aware of the overall importance of a healthy lifestyle. Their knowledge, however, was patchy and they had difficulties relating to fertility and preconception health on a personal and behavioural level. Participants wanted more information but had heterogeneous beliefs about when, where and how this information should be given.

    CONCLUSION: The adolescents wanted information on fertility and preconception health to be delivered repeatedly as well as through different sources.

  • 5. Fooladi, Ensieh
    et al.
    Weller, Carolina
    Salehi, Maryam
    Abhari, Farideh Rezaee
    Stern, Jenny
    Sophiahemmet University.
    Using reproductive life plan-based information in a primary health care center increased Iranian women's knowledge of fertility, but not their future fertility plan: A randomized, controlled trial2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 77-86, article id S0266-6138(18)30286-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Reproductive Life Plan (RLP)-based information in counseling has been reported in the USA and Sweden to increase women's knowledge of fertility and informed decision making about future fertility plans. This study examined if utilizing the RLP tool would have the same impact on Iranian women.

    DESIGN: A randomized, three-armed, controlled trial. 181 women were randomly allocated to the intervention group (IG, n = 61), control group 1 (CG1, n = 60) or control group 2 (CG2, n = 60).

    SETTING: A primary health care center in the Sari city, the Provincial capital of Mazandaran, Iran.

    PARTICIPANTS: Women of reproductive age who were able to conceive.

    INTERVENTIONS: The intervention group received oral and written information about fertility based on the RLP tool. Participants were contacted 2 months after the intervention. The primary outcome measure was the change in women's knowledge of fertility, particularly folic acid intake prior to pregnancy, over a 2 month period. The change in women's family planning intentions were also assessed. The participants in the IG shared their experiences at follow-up.

    FINDINGS: At baseline, there was no difference between the groups regarding the mean knowledge of fertility score. At 2 months, after adjustment for age, history of pregnancy and baseline values, the between group difference in change from baseline was 5.8 (p < 0.001). While there was no significant difference between the IG and CG1 for folic acid intake prior to pregnancy at baseline, the group difference for folic acid intake prior to pregnancy post intervention was statistically significant (85% vs 25%, p < 0.001). At follow-up, women's desire to have more children, preferred age to conceive the last child and the desired age gap between children in the IG and CG1 did not significantly change over time. Women reported the RLP counseling tool used by midwives as useful.

    KEY CONCLUSIONS: Provision of RLP-based information for Iranian women with a clear pregnancy intention in the context of a stable relationship, increased knowledge of fertility without changing their future fertility plan. The RPL counseling tool was appreciated by study participants. The lack of improvement in women's fertility intentions over time may reflect the involvement of other factors influencing decision making about childbearing in Iran. Whether the RLP can change women's behavior is yet to be established.

    IMPLICATIONS FOR PRACTICE: The RLP can be used by health care professionals, especially midwives, as a tool to increase women's fertility knowledge, which may result in fertility behavior change.

  • 6. Grandahl, Maria
    et al.
    Bodin, Maja
    Stern, Jenny
    Sophiahemmet University.
    In everybody's interest but no one's assigned responsibility: midwives' thoughts and experiences of preventive work for men's sexual and reproductive health and rights within primary care2019In: BMC Public Health, E-ISSN 1471-2458, Vol. 19, no 1, article id 1423Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sexual and reproductive health and rights (SRHR) have historically been regarded as a woman's issue. It is likely that these gender norms also hinder health care providers from perceiving boys and men as health care recipients, especially within the area of SRHR. The aim of this study was to explore midwives' thoughts and experiences regarding preventive work for men's sexual and reproductive health and rights in the primary care setting.

    METHODS: An exploratory qualitative study. Five focus group interviews, including 4-5 participants in each group, were conducted with 22 midwives aged 31-64, who worked with reproductive, perinatal and sexual health within primary care. Data were analysed by latent content analysis.

    RESULTS: One overall theme emerged, in everybody's interest, but no one's assigned responsibility, and three sub-themes: (i) organisational aspects create obstacles, (ii) mixed views on the midwife's role and responsibility, and (iii) beliefs about men and women: same, but different.

    CONCLUSIONS: Midwives believed that preventive work for men's sexual and reproductive health and rights was in everybody's interest, but no one's assigned responsibility. To improve men's access to sexual and reproductive health care, actions are needed from the state, the health care system and health care providers.

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  • 7. Grandahl, Maria
    et al.
    Stern, Jenny
    Sophiahemmet University.
    Funkquist, Eva-Lotta
    Longer shared parental leave is associated with longer duration of breastfeeding: a cross-sectional study among Swedish mothers and their partners2020In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 20, no 1, article id 159Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breastfeeding is associated with health benefits for both the mother and infant and is therefore important to support; moreover, parental leave is a beneficial factor for breastfeeding. The Swedish parental leave is generous, allowing each parent to take 90 days; additionally, a further 300 days can be taken by either parent. Generally, mothers take 70% of the parental leave days, mainly during the first year. However, breastfeeding duration has declined in the last decade, and it is not known how shared parental leave is associated with the duration of breastfeeding.

    AIM: To investigate how parental leave is associated with the duration of exclusive and partial breastfeeding of the infant during the first 12 months after birth. An additional aim was to describe infants' and parents' characteristics and mode of birth in association with the duration of exclusive and partial breastfeeding.

    METHODS: This cross-sectional study was part of the Swedish Pregnancy Planning Study, conducted in Sweden in 2012-2015. The parents were recruited at 153 antenatal clinics in nine counties. In total, 813 couples completed a follow-up questionnaire 1 year after birth. Linear regression models were used to analyse the association between parental leave and the duration of breastfeeding.

    RESULTS: Infants were exclusively breastfed for, on average, 2.5 months (range 0-12 months) and partially breastfed, on average, 7 months (range 0-12 months). Most of the parental leave was taken by the mother (mean = 10.9 months) during the infant's first 12 months, while the partner took 3 months, on average. The parental leave (used and planned) during the infant's first 24 months were, on average, 21 months. In the multivariate linear regression analysis, mothers' and partners' high level of education (p < 0.001, p = 0.044, respectively), mothers' higher age (p = 0.049), non-instrumental vaginal birth (p = 0.004) and longer parental leave for the first 24 months (p < 0.001) were associated with longer duration of partial breastfeeding.

    CONCLUSION: The duration of partial breastfeeding was associated with higher parental educational level, higher age, non-instrumental vaginal birth and longer parental leave.

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  • 8. Ragnar Ekstrand, Maria
    et al.
    Grandahl, Maria
    Brolin, Liselotte
    Friman, Susanne
    Kalinsky, Alexandra
    Sjöö, Helén
    Stern, Jenny
    Sophiahemmet University.
    Kvinnor har positiva upplevelser första gynekologiska cellprovskontrollen - och ännu bättre om besöket sker på ungdomsmottagning2023Conference paper (Other academic)
  • 9. Salih Joelsson, L
    et al.
    Tydén, T
    Wanggren, K
    Georgakis, M K
    Stern, Jenny
    Sophiahemmet University.
    Berglund, A
    Skalkidou, A
    Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 45, p. 212-219, article id S0924-9338(17)32929-2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Infertility has been associated with psychological distress, but whether these symptoms persist after achieving pregnancy via assisted reproductive technology (ART) remains unclear. We compared the prevalence of anxiety and depressive symptoms between women seeking for infertility treatment and women who conceived after ART or naturally.

    METHODS: Four hundred and sixty-eight sub-fertile non-pregnant women, 2972 naturally pregnant women and 143 women pregnant after ART completed a questionnaire in this cross-sectional study. The Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A≥8) and Edinburgh Postnatal Depression Scale (EPDS≥12) were used for assessing anxiety and depressive symptoms, respectively. Multivariate Poisson regression models with robust variance were applied to explore associations with anxiety and depressive symptoms.

    RESULTS: The prevalence of anxiety and depressive symptoms among sub-fertile, non-pregnant women (57.6% and 15.7%, respectively) were significantly higher compared to women pregnant after ART (21.1% and 8.5%, respectively) and naturally pregnant women (18.8% and 10.3%, respectively). History of psychiatric diagnosis was identified as an independent risk factor for both anxiety and depressive symptoms. The presence of at least one unhealthy lifestyle behavior (daily tobacco smoking, weekly alcohol consumption, BMI≥25, and regular physical exercise<2h/week) was also associated with anxiety (Prevalence Ratio, PR: 1.24; 95%CI: 1.09-1.40) and depressive symptoms (PR: 1.25; 95%CI: 1.04-1.49).

    CONCLUSIONS: Women pregnant after ART showed no difference in anxiety and depressive symptoms compared to naturally pregnant women. However, early psychological counseling and management of unhealthy lifestyle behaviors for sub-fertile women may be advisable, particularly for women with a previous history of psychiatric diagnosis.

  • 10.
    Stern, Jenny
    Sophiahemmet University.
    The reproductive life plan2017Conference paper (Other academic)
  • 11.
    Stern, Jenny
    et al.
    Sophiahemmet University.
    Funkquist, Eva-Lotta
    Grandahl, Maria
    The association between early introduction of tiny tastings of solid foods and duration of breastfeeding2023In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 18, no 1, article id 4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Conflicting advice and non-evidence-based recommendations have a negative effect on breastfeeding. Since 2011, the National Food Agency in Sweden has informed parents that they can introduce tiny tastings (1 mL of solid food, i.e. other sources of nutrition than breastmilk/formula) to infants from four months of age. It is unknown how national recommendations, which differ from the Word Health Organisation's recommendation, affect breastfeeding. We hypothesised that introduction of tiny tastings of solid foods would shorten the duration of continued breastfeeding.

    METHODS: This retrospective study utilises data from the longitudinal 'Swedish Pregnancy Planning Study', in which mothers were recruited at antenatal clinics on a national level. The participants completed three questionnaires up to one year after birth (n = 1,251). Linear regression models were used to analyse the association between the introduction of solid foods and the duration of breastfeeding.

    RESULTS: As hypothesised, introduction of tiny tastings shortened the duration of continued breastfeeding. Half of all infants (48%) were fed with tiny tastings already in the fourth month. The correlation analysis showed that the earlier the infants started with tiny tastings, the earlier they ate larger amounts of solid food. In a multivariate linear regression analysis, five factors were identified as having a negative effect on the duration of breastfeeding: low infant age upon introduction of tiny tastings, low maternal age, low level of maternal education, high maternal BMI and twin birth.

    CONCLUSIONS: Early introduction of tiny tastings of solid foods shortened the duration of breastfeeding. It is difficult to influence most conditions that affect breastfeeding, for example, the mother's educational level, BMI, age and if she has given birth to twins. In contrast, national guidelines can always be updated. Recommendations from the Swedish authorities should adhere to the WHO's recommendation, which states exclusive breastfeeding for six months and continued breastfeeding for at least two years or longer.

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  • 12.
    Stern, Jenny
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Carlsson, Tommy
    Quality of web-based information about the coronavirus disease 2019: A rapid systematic review of infodemiology studies published during the first year of the pandemic2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 1734Article, review/survey (Refereed)
    Abstract [en]

    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 METHODS: A 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.

    RESULTS: The 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.

    CONCLUSION: The 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.

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  • 13.
    Stern, Jenny
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Carlsson, Tommy
    Quality of web-based information at the beginning of a global pandemic: A cross-sectional infodemiology study investigating preventive measures and self care methods of the coronavirus disease 20192021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 1141Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: reducing the spread and impact epidemics and pandemics requires that members of the general population change their behaviors according to the recommendations, restrictions and laws provided by leading authorities. When a new epidemic or pandemic emerges, people are faced with the challenge of sorting through a great volume of varied information. Therefore, the dissemination of high-quality web-based information is essential during this time period. The overarching aim was to investigate the quality of web-based information about preventive measures and self care methods at the beginning of the COVID-19 pandemic.

    METHODS: in May 2020, consumer-oriented websites written in Swedish were identified via systematic searches in Google (n = 76). Websites were assessed with inductive content analysis, the JAMA benchmarks, the QUEST tool and the DISCERN instrument.

    RESULTS: seven categories and 33 subcategories were identified concerning preventive measures (md = 6.0 subcategories), with few specifying a method for washing hands (n = 4), when to sanitize the hands (n = 4), and a method for sanitizing the hands (n = 1). Eight categories and 30 subcategories were identified concerning self care methods (md = 3.0 subcategories), with few referring to the national number for telephone-based counseling (n = 20) and an online symptom assessment tool (n = 16). Overall, the median total quality scores were low (JAMA = 0/4, QUEST =13/28, DISCERN = 29/80).

    CONCLUSIONS: at the beginning of the pandemic, substantial quality deficits of websites about COVID-19 may have counteracted the public recommendations for preventive measures. This illustrates a critical need for standardized and systematic routines on how to achieve dissemination of high-quality web-based information when new epidemics and pandemics emerge.

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  • 14.
    Stern, Jenny
    et al.
    Sophiahemmet University.
    Hasselberg, Isabell
    Lundstedt, Rebecka
    Grandahl, Maria
    Availability of youth clinics and association with health outcomes: A Swedish register-based cross-sectional study2022Conference paper (Other academic)
  • 15.
    Stern, Jenny
    et al.
    Sophiahemmet University.
    Lundberg, Angelica
    Grip Orreborn, Lovisa
    Swedish midwifery students’ education about men’s reproductive, perinatal, and sexual health: An empirical study of learning objectives2022Conference paper (Other academic)
  • 16.
    Stern, Jenny
    et al.
    Sophiahemmet University.
    Molin, Moa Sterner
    Sophiahemmet University.
    Fernaeus, Maja
    Sophiahemmet University.
    Georgsson, Susanne
    Carlsson, Tommy
    Contraceptive counseling about adverse reactions of intrauterine contraception: Exploration of narratives found in web-based discussion boards2022In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 104, article id 103166Article in journal (Refereed)
    Abstract [en]

    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.

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