The Enablers and Barriers to Accessing Women's Health and Wellbeing Services for Women Aged 40-65 Years: A Qualitative Study.

Abstract

Introduction: Midlife women, aged 40-65 years, are an under-researched population with poor and inequitable access to Women's Health and Wellbeing Services (WHWS). This study, which was supported by a Patient and Public Involvement group, explored the enablers and barriers to WHWS, with a focus on sexual health and wellbeing services, cervical and breast screening, menopause care, contraception, and incontinence services.

Methods: Semi-structured focus groups and interviews were conducted with sixty self-identifying women and gender non-binary participants aged 40-65 years living in the South-East of England. Recruitment was focused in underserved geographic areas and in underserved groups. Framework Analysis, also using the Socioecological Model, through an intersectionality lens, was used to analyse the enablers and barriers to WHWS. A feminist pragmatist approach was employed to interlink the findings into suggestions to improve access. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results: Three main themes emerged: the lack of prioritisation of midlife women; the widespread deficits in knowledge of the needs of midlife women; and the impact of stigma on access to care, particularly sexual health and genitourinary syndrome of menopause services. The intersectional disadvantage of belonging to underserved groups for example due to ethnicity, income, and disability, overlapped across the themes. Participants advocated for integrated, holistic, community-based, women-only services.

Conclusion: Further research, education, and policy investment is required to address the complex, and often highly sensitive nature of many health and wellbeing issues that face midlife women. These challenges are compounded by belonging to an underserved group.