Validated Patient Infographic leaflet on vaginal discharge in Pregnancy - Quality Improvement Project

Aim: To create a patient-friendly resource designed to reduce anxiety, educate and improve help-seeking, on vaginal discharge (vaginitis) during pregnancy.

Background: Patients have expressed anxiety associated with vaginal discharge -a common feature of Vaginitis - and difficulty with “starting the conversation” regarding this. This anxiety often carries on into pregnancy; resulting in difficulty to explore what is normal and seek help for what isn't, due to STI related stigma. Our aim is to “start the conversation”, empowering pregnant women with the knowledge to identify aetiology of their discharge and seek help appropriately. Moreso as pregnancy is a key time in a woman’s life when they must be vigilant in identifying changes in discharge. This led to the design of the patient Infographic leaflet (PIL).

Methods: A two-part survey was conducted, before and after reading the 1-paged PIL, to compare knowledge regarding vaginal discharge in pregnancy and confidence in knowing when to seek help. The independent use of online survey and peer-reviewed paper-based PIL- were distributed randomly in the outpatient areas of the maternity hospital at Hull Royal Infirmary over 2 weeks. Statistical analysis was done with Excel and in-app algorithms. The primary outcomes measured include self-reported knowledge of discharge in pregnancy, objective identification of what changes are ‘normal’, confidence in knowing when to seek medical help, and opinions on the readability of the PIL. Ethical permission was approved by the local Audit Committee.

Results: Of the 50 participants of reproductive age (~1% of yearly maternities); 66% were pregnant, 28% not pregnant and 6% post-partum. 78% of patients could not identify the normal changes in discharge during pregnancy from a multiple-choice list initially. But after PIL administration, 90% reported an improvement in knowledge on vaginal discharge-vaginitis, with a mean increase of 1.80 on a 0-5 rating scale (2.04 to 3.84). 74% felt more confident in knowing when to seek help regarding vaginal discharge, with a mean increase of 1.44 (from 2.76 to 4.20). Patient satisfaction of the readability and use of the resource was high, with 4.62 mean rating on the likelihood they would use it if included in the antenatal pack and 4.44 as mean rating of its readability.

Conclusion:This resource was seen to be a useful patient-friendly tool whilst significantly improving knowledge in 90%. Potential limitations include the small sample size, lack of randomisation and the requirement of participants to be proficient in English Language.