Analysis of the barriers and enablers to implementing lifestyle management practices for women with PCOS in Singapore.
BACKGROUND
Polycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and manifests with adverse reproductive, metabolic and psychological consequences. Evidence-based PCOS guidelines recommend lifestyle management first line for infertility. In Singapore women with PCOS can attend the PCOS Clinic at the Kandang Kerbau Women and Children's Hospital for infertility treatment. However lifestyle integration into infertility management is currently limited and barriers and enablers to progress remain unclear.


METHODS
All PCOS clinic staff undertook semi-structured interviews to investigate perceived barriers for staff and consumers for the integration of lifestyle into infertility management. This study utilised various tools including an 8P Ishikawa diagram model to identify and categorise barriers. A modified Hanlon method was then used to prioritise barriers within the Singaporean context considering organisational, cultural and financial constraints. Propriety, economics, acceptability, resources and legality (PEARL) criteria were also incorporated into this decision-making tool.


RESULTS
In the 8P model, there were five factors contributing to the 'procedure (consultations and referral processes)' barrier, one 'policy (government and hospitals)' factor, five 'place' factors, two 'product (lifestyle management programme)' barriers, two 'people (programme capacity)' factors, four 'process (integration)' factors, three 'promotion' barriers and three 'price' factors. Of the prioritised barriers, two were identified across each of 'procedures', 'place', 'product' and 'people' and four related to 'processes'. There were no barriers identified that for 'policies', 'promotion' and 'price' that can be addressed.


CONCLUSIONS
There is a clear need to integrate lifestyle into infertility management in PCOS, in line with current national and international evidence-based guidelines. The highest priority identified improvement opportunity was to develop a collaborative lifestyle management programme across hospital services. Reductions in variation of delivery and strengthening support within the lifestyle programme are other identified priorities. The strength of this study is that this is the first study to utilise a pragmatic quality improvement method for barriers identification and prioritisation in the area of lifestyle management for women with PCOS. This project identified factors that may provide easy improvements, but also identified some local factors that may be very difficult to change. The major limitation of this study is that it is only looking at the Singapore setting, so may have limited applicability to other countries. However, results from quality improvement projects are meant to be context specific.
SingHealth Centre for Health Services Research, Singapore Health Services Pte Ltd, 20 College Road, The Academia, Discovery Tower, Level 7 Translational and Clinical Research Hub, Singapore, 169856, Singapore. henry.ko@ctc.usyd.edu.au.|SingHealth and Duke-NUS Academic Medicine Research Institute, Duke-NUS Graduate Medical School, Academia, Singapore Health Services Pte Ltd, 20 College Road, Singapore, 169856, Singapore. henry.ko@ctc.usyd.edu.au.|NHMRC Clinical Trials Centre, University of Sydney, Levels 4-6, Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia. henry.ko@ctc.usyd.edu.au.
Henry
H
Ko
Monash Centre for Health Research & Implementation, School of Public Health, Monash University, Level 1, 43-51, Kanooka Grove, Clayton, VIC, 3168, Australia.
Helena
H
Teede
Monash Centre for Health Research & Implementation, School of Public Health, Monash University, Level 1, 43-51, Kanooka Grove, Clayton, VIC, 3168, Australia.|The Robinson Research Institute, University of Adelaide, Norwich Centre, Ground Floor, 55 King William Road, North Adelaide, SA, 5006, Australia.
Lisa
L
Moran
D000328:Adult; D000465:Algorithms; D019468:Disease Management; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D008019:Life Style; D010342:Patient Acceptance of Health Care; D011085:Polycystic Ovary Syndrome / Q000150:complications*; D012846:Singapore
Barriers; Clinical practice guideline; Lifestyle management; Polycystic ovary syndrome; Prioritisation