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Published in: European Journal of Medical Research 1/2022

Open Access 01-12-2022 | Vulvovaginal Candidiasis | Research

Barriers and facilitators of adherence to treatment among women with vulvovaginal candidiasis: a qualitative study

Authors: Maryam Erfaninejad, Arash Salahshouri, Nasrin Amirrajab

Published in: European Journal of Medical Research | Issue 1/2022

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Abstract

Background

Non-adherence of patients with vulvovaginal candidiasis (VVC) to treatment recommendations leads to treatment failure and recurrence of infection. Therefore, this qualitative study was conducted to identify barriers and facilitators of observance of treatment among women afflicted with vulvovaginal candidiasis.

Methods

This qualitative study was conducted through 26 in-depth unstructured interviews with 24 patients and 2 gynecologists using purposeful sampling with maximum variation in Ahvaz, southwest Iran. Interviews were conducted in person at health centers and the gynecologist’s offices. MAXQDA 10 software and conventional content analysis were used for data analysis.

Results

The findings showed barriers and facilitator factors of adherence to treatment in women with VVC. Some of these factors lead to an increase in adherence to treatment, and others play the role of hindering factors. These factors were classified into two main categories: patients’ beliefs and patients’ fears and concerns.

Conclusion

The results of this study showed that many of the behaviors of patients from the acceptance of the diagnosis process to treatment are rooted in the patient's beliefs and fears. Therefore, it seems necessary to design and carry out interventions based on the findings of this study, which can be used in the development of appropriate solutions, treatment guidelines, and adopting a policy for treatment adherence.
Footnotes
1
. Having 4 or more episodes per year of VVC was considered RVVC.
 
Literature
1.
go back to reference Pereira LC, Correia AF, da Silva ZDL, de Resende CN, Brandão F, Almeida RM, et al. Vulvovaginal candidiasis and current perspectives: new risk factors and laboratory diagnosis by using MALDI TOF for identifying species in primary infection and recurrence. Eur J Clin Microbiol Infect Dis. 2021;40(8):1681–93.CrossRef Pereira LC, Correia AF, da Silva ZDL, de Resende CN, Brandão F, Almeida RM, et al. Vulvovaginal candidiasis and current perspectives: new risk factors and laboratory diagnosis by using MALDI TOF for identifying species in primary infection and recurrence. Eur J Clin Microbiol Infect Dis. 2021;40(8):1681–93.CrossRef
2.
go back to reference Yano J, Sobel JD, Nyirjesy P, Sobel R, Williams VL, Yu Q, et al. Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes. BMC Women’s Health. 2019;19(1):48.CrossRef Yano J, Sobel JD, Nyirjesy P, Sobel R, Williams VL, Yu Q, et al. Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes. BMC Women’s Health. 2019;19(1):48.CrossRef
3.
go back to reference Shi Y, Zhu Y, Fan S, Liu X, Liang Y, Shan Y. Molecular identification and antifungal susceptibility profile of yeast from vulvovaginal candidiasis. BMC Infect Dis. 2020;20(1):287.CrossRef Shi Y, Zhu Y, Fan S, Liu X, Liang Y, Shan Y. Molecular identification and antifungal susceptibility profile of yeast from vulvovaginal candidiasis. BMC Infect Dis. 2020;20(1):287.CrossRef
4.
go back to reference Rosati D, Bruno M, Jaeger M, Ten Oever J, Netea MG. Recurrent vulvovaginal candidiasis: an immunological perspective. Microorganisms. 2020;8(2):144.CrossRef Rosati D, Bruno M, Jaeger M, Ten Oever J, Netea MG. Recurrent vulvovaginal candidiasis: an immunological perspective. Microorganisms. 2020;8(2):144.CrossRef
5.
go back to reference Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 2016;214(1):15–21.CrossRef Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 2016;214(1):15–21.CrossRef
6.
go back to reference Ghaddar N, Anastasiadis E, Halimeh R, Ghaddar A, Dhar R, AlFouzan W, et al. Prevalence and antifungal susceptibility of Candida albicans causing vaginal discharge among pregnant women in Lebanon. BMC Infect Dis. 2020;20(1):32.CrossRef Ghaddar N, Anastasiadis E, Halimeh R, Ghaddar A, Dhar R, AlFouzan W, et al. Prevalence and antifungal susceptibility of Candida albicans causing vaginal discharge among pregnant women in Lebanon. BMC Infect Dis. 2020;20(1):32.CrossRef
7.
go back to reference Jang SJ, Lee K, Kwon B, You HJ, Ko G. Vaginal lactobacilli inhibit growth and hyphae formation of Candida albicans. Sci Rep. 2019;9(1):8121.CrossRef Jang SJ, Lee K, Kwon B, You HJ, Ko G. Vaginal lactobacilli inhibit growth and hyphae formation of Candida albicans. Sci Rep. 2019;9(1):8121.CrossRef
8.
go back to reference Lírio J, Giraldo PC, Amaral RL, Sarmento ACA, Costa APF, Gonçalves AK. Antifungal (oral and vaginal) therapy for recurrent vulvovaginal candidiasis: a systematic review protocol. BMJ Open. 2019;9(5): e027489.CrossRef Lírio J, Giraldo PC, Amaral RL, Sarmento ACA, Costa APF, Gonçalves AK. Antifungal (oral and vaginal) therapy for recurrent vulvovaginal candidiasis: a systematic review protocol. BMJ Open. 2019;9(5): e027489.CrossRef
9.
go back to reference Carr PL, Felsenstein D, Friedman RH. Evaluation and management of vaginitis. J Gen Intern Med. 1998;13(5):335–46.CrossRef Carr PL, Felsenstein D, Friedman RH. Evaluation and management of vaginitis. J Gen Intern Med. 1998;13(5):335–46.CrossRef
10.
go back to reference Rezaei-Matehkolaei A, Shafiei S, Zarei-Mahmoudabadi A. Isolation, molecular identification, and antifungal susceptibility profiles of vaginal isolates of Candida species. Iran J Microbiol. 2016;8(6):410–7. Rezaei-Matehkolaei A, Shafiei S, Zarei-Mahmoudabadi A. Isolation, molecular identification, and antifungal susceptibility profiles of vaginal isolates of Candida species. Iran J Microbiol. 2016;8(6):410–7.
11.
go back to reference Qin F, Wang Q, Zhang C, Fang C, Zhang L, Chen H, et al. Efficacy of antifungal drugs in the treatment of vulvovaginal candidiasis: a Bayesian network meta-analysis. Infect Drug Resist. 2018;11:1893–901.CrossRef Qin F, Wang Q, Zhang C, Fang C, Zhang L, Chen H, et al. Efficacy of antifungal drugs in the treatment of vulvovaginal candidiasis: a Bayesian network meta-analysis. Infect Drug Resist. 2018;11:1893–901.CrossRef
12.
go back to reference Sobel JD. Factors involved in the patient’s choice of oral or vaginal treatment for vulvovaginal candidiasis. Patient Prefer Adherence. 2014;8:31–4. Sobel JD. Factors involved in the patient’s choice of oral or vaginal treatment for vulvovaginal candidiasis. Patient Prefer Adherence. 2014;8:31–4.
13.
go back to reference Kiasat N, Rezaei-Matehkolaei A, Zarei Mahmoudabadi A, Hamidavi Mohamadpour K, Molavi S, Khoshayand N. Prevalence of vulvovaginal candidiasis in Ahvaz, Southwest Iran: a semi-large scale study. Jundishapur J Microbiol. 2019;12(3): e89815. Kiasat N, Rezaei-Matehkolaei A, Zarei Mahmoudabadi A, Hamidavi Mohamadpour K, Molavi S, Khoshayand N. Prevalence of vulvovaginal candidiasis in Ahvaz, Southwest Iran: a semi-large scale study. Jundishapur J Microbiol. 2019;12(3): e89815.
14.
go back to reference Kiasat N, Rezaei-Matehkolaei A, Mahmoudabadi AZ. Microsatellite typing and antifungal susceptibility of Candida glabrata strains isolated from patients with Candida Vaginitis. Front Microbiol. 2019;10:1678.CrossRef Kiasat N, Rezaei-Matehkolaei A, Mahmoudabadi AZ. Microsatellite typing and antifungal susceptibility of Candida glabrata strains isolated from patients with Candida Vaginitis. Front Microbiol. 2019;10:1678.CrossRef
15.
go back to reference Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: epidemiology, microbiology and risk factors. Crit Rev Microbiol. 2016;42(6):905–27.CrossRef Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: epidemiology, microbiology and risk factors. Crit Rev Microbiol. 2016;42(6):905–27.CrossRef
16.
go back to reference Bradfield Strydom M, Walpola RL, McMillan S, Khan S, Ware RS, Tiralongo E. Lived experience of medical management in recurrent vulvovaginal candidiasis: a qualitative study of an uncertain journey. BMC Womens Health. 2022;22(1):384.CrossRef Bradfield Strydom M, Walpola RL, McMillan S, Khan S, Ware RS, Tiralongo E. Lived experience of medical management in recurrent vulvovaginal candidiasis: a qualitative study of an uncertain journey. BMC Womens Health. 2022;22(1):384.CrossRef
17.
go back to reference Mostafavi-Darani F, Zamani-Alavijeh F, Mahaki B, Salahshouri A. Exploring the barriers of adherence to dietary recommendations among patients with type 2 diabetes: a qualitative study in Iran. Nurs Open. 2020;7:1735–45.CrossRef Mostafavi-Darani F, Zamani-Alavijeh F, Mahaki B, Salahshouri A. Exploring the barriers of adherence to dietary recommendations among patients with type 2 diabetes: a qualitative study in Iran. Nurs Open. 2020;7:1735–45.CrossRef
18.
go back to reference Mostafavi F, Alavijeh FZ, Salahshouri A, Mahaki B. The psychosocial barriers to medication adherence of patients with type 2 diabetes: a qualitative study. Biopsychosoc Med. 2021;15(1):1.CrossRef Mostafavi F, Alavijeh FZ, Salahshouri A, Mahaki B. The psychosocial barriers to medication adherence of patients with type 2 diabetes: a qualitative study. Biopsychosoc Med. 2021;15(1):1.CrossRef
19.
go back to reference Norenhag J, Du J, Olovsson M, Verstraelen H, Engstrand L, Brusselaers N. The vaginal microbiota, human papillomavirus, and cervical dysplasia: a systematic review and network meta-analysis. BJOG. 2020;127(2):171–80.CrossRef Norenhag J, Du J, Olovsson M, Verstraelen H, Engstrand L, Brusselaers N. The vaginal microbiota, human papillomavirus, and cervical dysplasia: a systematic review and network meta-analysis. BJOG. 2020;127(2):171–80.CrossRef
20.
go back to reference Kalia N, Singh J, Kaur M. Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review. Ann Clin Microbiol Antimicrob. 2020;19(1):5.CrossRef Kalia N, Singh J, Kaur M. Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review. Ann Clin Microbiol Antimicrob. 2020;19(1):5.CrossRef
21.
go back to reference Grace D, Gaspar M, Paquette R, Rosenes R, Burchell AN, Grennan T, et al. HIV-positive gay men’s knowledge and perceptions of Human Papillomavirus (HPV) and HPV vaccination: a qualitative study. PLoS ONE. 2018;13(11): e0207953.CrossRef Grace D, Gaspar M, Paquette R, Rosenes R, Burchell AN, Grennan T, et al. HIV-positive gay men’s knowledge and perceptions of Human Papillomavirus (HPV) and HPV vaccination: a qualitative study. PLoS ONE. 2018;13(11): e0207953.CrossRef
22.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
23.
go back to reference Rezapour M, Zarghami M, Sheikhmoonesi F. Psychological experience and needs of front-line nurses during COVID-19 outbreak in Iran: a qualitative study. J Mazandaran Univ Med Sci. 2021;31(196):125–35. Rezapour M, Zarghami M, Sheikhmoonesi F. Psychological experience and needs of front-line nurses during COVID-19 outbreak in Iran: a qualitative study. J Mazandaran Univ Med Sci. 2021;31(196):125–35.
25.
go back to reference Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRef Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRef
26.
go back to reference Bilardi J, Walker S, McNair R, Mooney-Somers J, Temple-Smith M, Bellhouse C, et al. Women’s management of recurrent bacterial vaginosis and experiences of clinical care: a qualitative study. PLoS ONE. 2016;11(3): e0151794.CrossRef Bilardi J, Walker S, McNair R, Mooney-Somers J, Temple-Smith M, Bellhouse C, et al. Women’s management of recurrent bacterial vaginosis and experiences of clinical care: a qualitative study. PLoS ONE. 2016;11(3): e0151794.CrossRef
27.
go back to reference Brock H, Hany M. Obsessive-Compulsive Disorder. In: Brock H, editor. StatPearls. Treasure Island: StatPearls Publishing; 2021. Brock H, Hany M. Obsessive-Compulsive Disorder. In: Brock H, editor. StatPearls. Treasure Island: StatPearls Publishing; 2021.
28.
go back to reference Khosravani V, Samimi Ardestani SM, Sharifi Bastan F, McKay D, Asmundson GJG. The associations of obsessive-compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive-compulsive disorder: the role of specific stress responses to COVID-19. Clin Psychol Psychother. 2021. https://doi.org/10.1002/cpp.2602.CrossRef Khosravani V, Samimi Ardestani SM, Sharifi Bastan F, McKay D, Asmundson GJG. The associations of obsessive-compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive-compulsive disorder: the role of specific stress responses to COVID-19. Clin Psychol Psychother. 2021. https://​doi.​org/​10.​1002/​cpp.​2602.CrossRef
29.
go back to reference Krebs G, Heyman I. Obsessive-compulsive disorder in children and adolescents. Arch Dis Child. 2015;100(5):495–9.CrossRef Krebs G, Heyman I. Obsessive-compulsive disorder in children and adolescents. Arch Dis Child. 2015;100(5):495–9.CrossRef
30.
go back to reference Pérez-Vigil A, Fernández de la Cruz L, Brander G, Isomura K, Gromark C, Mataix-Cols D. The link between autoimmune diseases and obsessive-compulsive and tic disorders: a systematic review. Neurosci Biobehav Rev. 2016;71:542–62.CrossRef Pérez-Vigil A, Fernández de la Cruz L, Brander G, Isomura K, Gromark C, Mataix-Cols D. The link between autoimmune diseases and obsessive-compulsive and tic disorders: a systematic review. Neurosci Biobehav Rev. 2016;71:542–62.CrossRef
31.
go back to reference Khalesi ZB, Simbar M, Azin SA. A qualitative study of sexual health education among Iranian engaged couples. Afr Health Sci. 2017;17(2):382–90.CrossRef Khalesi ZB, Simbar M, Azin SA. A qualitative study of sexual health education among Iranian engaged couples. Afr Health Sci. 2017;17(2):382–90.CrossRef
32.
go back to reference Mobbs D, Adolphs R, Fanselow MS, Barrett LF, LeDoux JE, Ressler K, et al. Viewpoints: approaches to defining and investigating fear. Nat Neurosci. 2019;22(8):1205–16.CrossRef Mobbs D, Adolphs R, Fanselow MS, Barrett LF, LeDoux JE, Ressler K, et al. Viewpoints: approaches to defining and investigating fear. Nat Neurosci. 2019;22(8):1205–16.CrossRef
33.
go back to reference Anstey Watkins J, Ross JDC, Thandi S, Brittain C, Kai J, Griffiths F. Acceptability of and treatment preferences for recurrent bacterial vaginosis-topical lactic acid gel or oral metronidazole antibiotic: qualitative findings from the VITA trial. PLoS ONE. 2019;14(11): e0224964.CrossRef Anstey Watkins J, Ross JDC, Thandi S, Brittain C, Kai J, Griffiths F. Acceptability of and treatment preferences for recurrent bacterial vaginosis-topical lactic acid gel or oral metronidazole antibiotic: qualitative findings from the VITA trial. PLoS ONE. 2019;14(11): e0224964.CrossRef
35.
go back to reference Tzur Bitan D, Grossman-Giron A, Bloch Y, Mayer Y, Shiffman N, Mendlovic S. Fear of COVID-19 scale: psychometric characteristics, reliability, and validity in the Israeli population. Psychiatry Res. 2020;289:113100.CrossRef Tzur Bitan D, Grossman-Giron A, Bloch Y, Mayer Y, Shiffman N, Mendlovic S. Fear of COVID-19 scale: psychometric characteristics, reliability, and validity in the Israeli population. Psychiatry Res. 2020;289:113100.CrossRef
36.
go back to reference Bialy A. Gynecologic examination. In: Bialy A, editor. StatPearls. Treasure Island: StatPearls Publishing; 2022. Bialy A. Gynecologic examination. In: Bialy A, editor. StatPearls. Treasure Island: StatPearls Publishing; 2022.
37.
go back to reference O’Laughlin DJ, Strelow B, Fellows N, Kelsey E, Peters S, Stevens J, et al. Addressing anxiety and fear during the female pelvic examination. J Prim Care Community Health. 2021;12:2150132721992195. O’Laughlin DJ, Strelow B, Fellows N, Kelsey E, Peters S, Stevens J, et al. Addressing anxiety and fear during the female pelvic examination. J Prim Care Community Health. 2021;12:2150132721992195.
38.
go back to reference Pinto CN, Niles JK, Kaufman HW, Marlowe EM, Alagia DP, Chi G, et al. Impact of the COVID-19 pandemic on Chlamydia and Gonorrhea screening in the U.S. Am J Prev Med. 2021;61(3):386–93.CrossRef Pinto CN, Niles JK, Kaufman HW, Marlowe EM, Alagia DP, Chi G, et al. Impact of the COVID-19 pandemic on Chlamydia and Gonorrhea screening in the U.S. Am J Prev Med. 2021;61(3):386–93.CrossRef
Metadata
Title
Barriers and facilitators of adherence to treatment among women with vulvovaginal candidiasis: a qualitative study
Authors
Maryam Erfaninejad
Arash Salahshouri
Nasrin Amirrajab
Publication date
01-12-2022
Publisher
BioMed Central
Published in
European Journal of Medical Research / Issue 1/2022
Electronic ISSN: 2047-783X
DOI
https://doi.org/10.1186/s40001-022-00938-y

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