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Abstract
Objective To explore the experiences of patients with ectopic pregnancies with delayed medical care, with the goals to promote timely access to care, reduce subsequent physical and psychological impacts, and provide recommendations for improved management of ectopic pregnancies.
Design A qualitative study.
Setting A 1000-bed urban edge hospital located in the suburban area of Guangzhou, China, between December 2022 and February 2023.
Participants 21 patients with delays in seeking medical care for ectopic pregnancy.
Primary and secondary outcome measures Semistructured, in-depth, face-to-face interviews were conducted to understand the experience and expectations of these women.
Results Three main themes emerged, including delaying medical care, physical and psychological experiences, and expectations of their healthcare providers. Each of these main themes had several subthemes. The central theme of reasons for delaying medical care had five subthemes, including lack of knowledge on early symptoms of ectopic pregnancy, family dynamics and circumstances, traditional fertility ideology and intentions, avoidance of medical treatment behaviour, and medical delays. The main theme of physical and psychological experiences had two subthemes, including learnings from the experiences and negative impacts of the experiences. The main theme of expectations of their healthcare providers included three subthemes that were reducing the length of outpatient examinations and waiting times, increasing public understanding of early symptoms of ectopic pregnancy and increasing male awareness of safe contraceptive methods.
Conclusions A lack of knowledge about the early symptoms of ectopic pregnancy was the main reason for delays in seeking medical care and had a dual impact on patients’ physical and mental health, affecting their recovery and future healthcare. A collective effort from patients, families, healthcare providers and medical institutions is required for better medical education, family support, specialised professional training and local fertility policy to decrease the incidence of delayed medical care and achieve satisfactory pregnancy outcomes.
- Nursing Care
- Anaesthesia in obstetrics
- Fetal medicine
Data availability statement
Data are available on reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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STRENGTHS AND LIMITATIONS OF THIS STUDY
We performed the first qualitative study on women with ectopic pregnancy who lived on the urban edge of China and had delays in seeking medical care.
This study can let us understand the reasons, experiences and expectations of women with ectopic pregnancy and delays in seeking medical care.
The study limitations included a small number of patients in a single hospital.
The reasons, experiences and expectations of women with ectopic pregnancy might also vary significantly among different countries with different socioeconomic statuses, cultural backgrounds and local fertility policies.
Background
An ectopic pregnancy is when a fertilised egg implants and develops outside the body cavity of the uterus. About 95% of ectopic pregnancies occur in the fallopian tubes and are rare in the abdomen, ovaries and cervix.1 The incidences of ectopic pregnancy vary in different regions of the world. For example, the incidences of ectopic pregnancy were reported from 7.0‰ to 8.3‰ during 2006–2010 in the USA,2 whereas, in China, the incidence of ectopic pregnancy decreased from 7.6% in 2011 to 4.3% in 2020, probably due to improved contraceptive knowledge and a decreased prevalence of sexually transmitted diseases.3
Ectopic pregnancy is a medical emergency and the leading cause of death in early pregnancy.4 An embryo in the fallopian tube can cause it to rupture with subsequent intra-abdominal haemorrhage.5 Without prompt treatments, it not only endangers the patient’s life but may also lead to infertility.6 7 Hendriks et al reported improved survival rates and fertility preservations when ectopic pregnancies were diagnosed and managed promptly.8 In addition, early detection and treatment increased the likelihood of conservative treatment options.6 Therefore, timely access to medical care can effectively reduce poor physical and psychological outcomes in patients with ectopic pregnancy. However, it was reported that delays in seeking medical care could happen in pregnant women with ectopic pregnancy.9–12 Delays in seeking medical care were associated with increases in maternal morbidity and mortality.13 Understanding the reasons for delays in seeking medical care, maternal physical and psychological experiences, and the needs of patients with ectopic pregnancy might help them develop a sense of proper access to care and reduce the negative emotions, stress, and physical and psychological consequences associated with untimely access to care. Existing studies on ectopic pregnancy were mainly on the high-risk factors, diagnosis and treatments, with little in-depth investigation on the delays in seeking medical care in patients with ectopic pregnancy.
Qualitative research is an in-depth holistic exploration of the study phenomenon using data collection methods such as interviews, observations and physical analysis. It was used to study patients’ experiences with delays in seeking medical care for certain diseases, such as diabetic complications and cancer.14 15 However, we did not find any previous qualitative study to explore women’s experience with delays in seeking medical care for ectopic pregnancy.
Therefore, we performed the present qualitative research on patients with delays in seeking medical care for ectopic pregnancy. We aimed to explore the reasons for delays in seeking medical care, understand the physical and psychological impacts, and provide evidence for policy-making on early prevention, intervention and the development of holistic optimisation measures for women with ectopic pregnancy.
Methods
Design
A phenomenological qualitative research design was used, with data collected through in-depth interviews and observations, using a comprehensive 32-item checklist developed by Tong et al as a guide to ensure accurate findings and complete reports of the qualitative research.16
Participants
A purposive sampling method was used to select patients who presented for ectopic pregnancy and underwent laparoscopic surgery for in-depth interviews. The participants were recruited from a 1000-bed urban edge hospital located in the suburban area of Guangzhou, the capital city of Guangdong province in southern China, between December 2022 and February 2023. Inclusion criteria were women with (1) diagnosis of ectopic pregnancy confirmed by the postoperative pathology1; (2) age ≥18 years; (3) stable mental state, able to understand the research questions and communicate with the researcher; (4) informed consent for voluntary participation in this study; (5) no other serious physical or mental illnesses ; (6) delay in seeking medical treatment, which was defined as the behaviour of individuals who failed to seek medical treatment on time after the presence of abnormal physical symptoms, including missed or late menses, abdominal pain, or vaginal bleeding.17 Those patients who disagreed with the treatment or were involved in medical disputes were excluded from the study. To make the interviewees more representative, the selection of interviewees took into account as much diversity as possible, including whether the ectopic pregnancy was ruptured, whether the embryo of the tubal pregnancy was alive, whether there was any previous history of ectopic pregnancy and whether the pregnancy was conceived spontaneously.
Data collection
Consistent with the aims of this study, the relevant literature was reviewed, and the opinions of gynaecologists and senior nurses were sought to develop a preliminary interview outline. Three patients were selected for preinterviews, and the outline was revised, resulting in a formal interview outline (box 1). Between December 2022 and February 2023, we conducted semistructured, in-depth, face-to-face interviews with eligible patients on the third or fourth postoperative day. We did not select the first and second postoperative days because we wanted to avoid disruption in their recovery if interviews happened too early after the surgery. We also did not want to delay the interview beyond the fourth postoperative day because we wanted to avoid recall bias. In addition, we performed the interviews in the afternoon to avoid interruption by any treatments. We kept the length of the interview to 30–60 min. The interviews were conducted in a conversation room or single-person ward to avoid interference from others. Notes were taken on the content of the interview (including non-verbal information about the interviewee), and all of the conversations were audiorecorded for later analysis. During the interview, the interviewers followed the outline and guided the patients through the process, listening carefully and observing body language, avoiding leading questions and interruptions to better explore the patients’ actual thoughts and inner experiences. The sample size was considered saturated when information was repeated during the interview.18
Outlines of the interview
Since when have you been feeling unwell? What did you do then?
What was the reason why you did not see a doctor right away? Was there any other reason?
What new symptoms did you have before coming to the hospital? Were any symptoms getting worse? What did you do? What help did you get? What difficulty did you have when you tried to get help?
What psychological changes did you have since the doctor informed you of your condition?
Was there any psychological change after the surgery? What impact did this surgery have on your future life?
How much did you know about ectopic pregnancy? How did you learn about it? In what ways do you think medical personnel can help you understand this disease?
Do you have anything else to say about your illness and your delay in seeing a doctor?
Data analysis
The data analysis followed the Colaizzi’s seven-step method.19 Briefly, two researchers converted the contents of the recordings into textual material by listening to the tapes individually and repeatedly within 48 hours after the interviews. They also paid attention to the non-verbal information of the interviewees, reviewed the electronic medical records and read the interview transcripts to find and refine the contents of the interviewees’ expressions relevant to this study. They marked and coded the content into categories and unified the information into analysable language that could be reviewed and recalled. Finally, the translations were transformed into themes, and the themes were refined. When there was any disagreement about the distilled themes, the research team discussed and finalised the themes, which were returned to the interviewees for confirmation if necessary.
Patient and public involvement
There was no patient or public involvement in setting the research agenda.
Results
We reached theme saturation after interviewing 18 patients. We interviewed three additional patients to ensure no new theme emerged (figure 1). Finally, 21 patients with ectopic pregnancy were included in the study and analysed. They all had a fallopian tubal pregnancy. Their information is shown in table 1.
Participant selection and study flow chart.
General information of interviewees (N=21)
The three themes identified in the interview were the reasons for delaying medical care, physical and psychological experiences, and expectations of their healthcare providers.
Reasons for delaying medical care
This theme had five subthemes, including lack of knowledge about early symptoms of ectopic pregnancy, family dynamics and circumstances, traditional fertility ideology and intentions, avoidance of medical treatment behaviour, and medical delays.
Lack of knowledge on early symptoms of ectopic pregnancy
Most women of childbearing age used menstruation as a common method of ruling out pregnancy. Many women had irregular periods and did not accurately record their menstrual cycles. At the early stages of ectopic pregnancy, they could consider vaginal bleeding to be menstruation and abdominal pain to be dysmenorrhoea, which led to misjudgements. The lack of knowledge about ectopic pregnancy symptoms and the poor ability to assess the risk of the disease, as well as the atypical symptoms of early pregnancy, were the main reasons for their delay in seeking medical attention in this study. N3: ‘I frequently had irregular menstrual cycles. Whenever my period was irregular, I visited a Chinese medicine clinic and received medication to regulate my cycle. This time, I missed my period again, so I went to that clinic for the same medication. I did not realize that I was pregnant at that time. All of these resulted in my delayed seeking care for an ectopic pregnancy.’N7: ‘The doctor diagnosed me as having polycystic ovary syndrome before. Sometimes, I got my period once every 2–3 months or once every 6 months. The doctor said it was difficult for me to get pregnant, and I did not think about getting pregnant.’ N14: ‘I had an ectopic pregnancy last year and had one fallopian tube removed. At that time, the doctor said to prevent habitual ectopic pregnancy. I thought that I would not have another ectopic pregnancy if I had one fallopian tube removed. I always thought this pregnancy was a miscarriage (puzzled expression). How could it be possible to have an ectopic pregnancy?’ N6: ‘I also suspected that I had an ectopic pregnancy, but ectopic pregnancy can have bleeding and abdominal pain. I thought that my abdominal pain was caused by the inflammation from the pelvic inflammatory disease. I do not have vaginal bleeding. I do not think it is an ectopic pregnancy.’ N10: ‘I had some abdominal pain a few days ago. I was very busy at work and under stress. I also had an iced drink that day. I thought it was acute gastroenteritis and I would get better with some hot water. The pain was not so bad in the following days. So I did not take it seriously or was too careless.’
Family dynamics and circumstances
Patient health was greatly affected by the family status. Family members were the most important supporters of patients. Smooth communication, emotional support and problem-solving skills of family members had a crucial impact on patients’ timely medical care. Family economic status was also the main reason why patients decided whether to seek medical attention immediately when they had physical discomforts. Those with low income tended to choose to self-manage their symptoms at home. The distance between the family and the nearest medical institution also often affected the patient’s medical decision. N2: ‘My husband works in another city far away from home field, and I live in the countryside with my parents-in-law and children. I have difficulty communicating with my parents-in-law, and there is relatively little communication. My husband said that he heard miscarriage could happen very often during early pregnancy. If I have a miscarriage, the whole family will find it very hard to accept it and get disappointed. So, do not tell others yet.’ N17: ‘My husband is usually afraid of trouble. He said that it would be better if I took the pain reliever. He did not care about this so much. Sometimes he also ignores me (with a sad expression).’ N9: ‘I have systemic lupus erythematosus. The medicine costs me 1000 yuan (1 dollar converts approximately to 6.927 yuan) every month. Usually, I can only do easy work and cannot stay up late. The main source of family income is from my husband.’ N8: ‘My family lives in a town, relatively far away from a large hospital. If there is a small problem, I usually go to the town’s health centre to get some medicine prescribed and take it. It is not convenient to go to the county hospital to see a doctor. The public buses to the county are available only in the morning. However, I also have to cook breakfast for the child in the morning.’
Traditional fertility ideology and intentions
Young patients believed it was difficult to speak up during premarital pregnancy. They were worried that others treated them differently. In addition, a patient’s willingness to get pregnant determined her responses to abnormal symptoms during the pregnancy. N3: ‘I am not married yet. I did not have my menstrual period the other day. I was so scared. After the test, I found out that I was pregnant, but I did not know what to do. I was struggling until the pain was severe that day. The B-scan ultrasonography said it was ectopic pregnancy.’ N20: ‘I broke up with my boyfriend and did not dare to tell my parents when I found out I was pregnant. I was on duty that day and suddenly had severe pain. My coworker sent me to the hospital.’ N11: ‘My pregnancy was an accident. I took emergency birth control pills, but I do not know why I was pregnant. I have two children now. I did not feel any discomfort anyway. I was thinking of going to the hospital for an abortion a few days later.’
Avoidance of medical treatment behaviour
In this study, seven patients reported avoiding medical treatment, mainly due to long waiting times, cumbersome medical procedures, inability to complete the treatment process independently and concerns about the high costs. N5: ‘There were too many people in the hospital. I had to wait in line to see a doctor, check, and pay fees. It took a whole day to go there.’ N16: ‘I have a low education background. It is difficult for me to go to a large hospital. I cannot find a direction and follow the instructions. It also costs a considerable amount of money. I am not sure that they can tell any problem to me.’
Medical delays
Limited availability of medical facilities, unequal distribution of medical resources and difficult differential diagnosis of early pregnancy were the leading reasons for medical-related delays. N16: ‘At that time, I had a pain around my umbilicus and was rolling in bed. We did not have a B-scan. The doctor said it was a stone.’ N11: ‘I came to see the doctor that time. I received the blood test and a B-scan. The doctor said that my pregnancy was too early to see clearly. I was asked to go back there in one week.’
Physical and psychological experiences
In this study, we found substantial physical and mental experiences of patients after delays in seeking medical care. This topic was summarised into two subthemes, including learnings from the experiences and negative impacts of the experiences.
Learnings from the experiences
During the treatment process, patients had a specific understanding of the relevant knowledge of ectopic pregnancy, became aware of the dangers of delays in seeking medical care, understood that women need to pay attention to their menstrual cycle, took safe contraceptive measures during sex life and received more family and social supports. 10 patients mentioned that, through this experience of delays in seeking medical care, they realised the importance and necessity of timely medical treatment and would pay more attention to their physical condition. N1: ‘After this time, I will not be so careless. When I find abnormalities, I need to seek medical attention on time. I will not take it for granted that it will end in a few days.’ N10: ‘This time, I had one side of my fallopian tubes removed, which will have an impact on future pregnancies. I'm not married yet, so I need to pay more attention to my body in the future.’ N3: ‘In the future, I will record my menstrual period on the calendar. If my period does not come, I will do a pregnancy test right away. If my period is irregular, I need to see a doctor as soon as possible.’ N19: ‘The doctor told me that neither external ejaculation nor the safe day calculation can guarantee contraception. The emergency contraceptive pill is also unsafe. I will pay attention to these in the future.’ N6:’ Now I know that ectopic pregnancy can cause abdominal pain and bleeding. Even if the symptoms are not severe, I must see a doctor. I also have to see a doctor once I know that I am pregnant. I should monitor the symptoms in pregnancy.’ N14: ‘The doctor said that every pregnancy has a risk of ectopic pregnancy. The number of pregnancies, history of pelvic and abdominal surgery, choice of contraceptives, and previous history of ectopic pregnancy are all risk factors for ectopic pregnancy.’ N8: ‘My husband did not care about it before. After our local hospital did a B-scan that suspected an ovarian tumour, he became nervous and asked us to go to a large hospital immediately. Now he is very kind to me and starts caring about me.’ N13: ‘Several neighbors helped me call 120 for an emergency. In recent days, many neighbors have asked me how I am recovering. Indeed, distant relatives are not as good as close neighbors.’
Negative impacts of the experiences
After surgery, patients showed concerns about their physical condition. They found that delays in seeking medical care affected their health, interrupting treatment effects and postoperative recovery. They increased the financial burden and negative emotions among family members. N10: ‘The doctor said that my fallopian tube was broken, and there was no way to repair it. He cut off the fallopian tube. I lost much blood and had a blood transfusion, and now I still have anemia, which will take a long time for recovery.’ N7: ‘My current boyfriend is very kind and considerate to me. I want to marry him. However, I lost one fallopian tube. I also had abortions before. I do not know if I can get pregnant again (sobbing) in the future.’ N9: ‘Previously, a rheumatic doctor told me not to get pregnant, but now I am not only pregnant but also having an ectopic pregnancy. I do not know if the hormone level changes will have an impact on my condition or whether they will worsen (with a worried expression and hands clenched).’ N2: ‘My family’s income was very tight. Now I have to spend money every day in the hospital, which will increase the pressure on my husband.’ N4: ‘My parents and my parents-in-law are urging us to have a child. Now, I had an ectopic pregnancy. They all regret that they should not rush me.’ N12: ‘My husband is the only child in the family. His parents are relatively conservative. If we cannot have another child, we do not know how to deal with it.’ N13: ‘I got my life back this time, but my husband and I were terrified.’ N18: ‘I have had two miscarriages before. Now, I have an in vitro fertilization, but I found out it was an ectopic pregnancy. Why is it so hard for me to have a baby (with a thoughtful, helpless expression)?’
Expectations of their healthcare providers
This theme included three subthemes: reducing the length of outpatient examinations and waiting times, increasing public understanding of early symptoms of ectopic pregnancy and increasing male awareness of safe contraceptive methods.
Respondents hoped that medical service institutions would reduce outpatient examinations and waiting times, strengthen public understanding of early symptoms of ectopic pregnancy, enable women of childbearing age to have a certain ability to identify the reasons and early symptoms of ectopic pregnancy and encourage men to choose safe contraceptive methods to reduce the physical harm caused to women by unplanned pregnancies or unsafe contraceptive methods. N1: ‘I came to the emergency room at night and received the blood tests. I was also given a saline infusion. Because I had abdominal hematocele and could not see clearly by B-scan ultrasonography. I had to undergo CT and wait for a long time. This could easily delay my illness.’ N6: ‘There were many patients in the hospital. I had to wait in a line to see the doctor and then wait in another line for the B-scan ultrasonography. I waited all morning to finish all of these.’ N1: ‘The hospital can make and put some short educational videos on their website and update them regularly.’ N15: ‘Local community can also arrange health lectures for people of different ages.’ N20: ‘My boyfriend does not like wearing condoms. He gets angry if I remind him about it. Sometimes, he did external ejaculation. Sometimes, he even asked me to take emergency contraceptive pills. If he could listen to what the doctor said, I would not get pregnant.’ N6: ‘After I had an intrauterine device, I started to have irregular menstruation and severe back pain. I had to remove it. Sometimes, I was too busy and forgot to take the short-acting contraceptive pills. My husband did not like to use condoms. I am also agitated. Why don’t men care about us (a bit angry)?’
Discussion
We performed a qualitative study with women who had experienced ectopic pregnancy and delays in seeking medical care. Three main themes emerged from the analysis, including reasons for delaying medical care, physical and psychological experiences, and expectations of their healthcare providers. Each main theme also included several subthemes to let us better understand the physical and mental health, as well as requirements, of these women. In the following paragraphs, we discuss our findings and recommendations to improve healthcare for women at risk of ectopic pregnancy.
Women’s healthcare education
This study found that interviewees were not aware of the symptoms of ectopic pregnancy. Some patients only knew specific symptoms or attributed abnormal symptoms to other diseases. This might be because the early signs of ectopic pregnancy are neither sensitive nor specific. It also indicated that patients lacked adequate knowledge about disease symptoms, particularly identifying early symptoms, diagnosing worsening conditions and understanding the medical emergency of ectopic pregnancy. All of these could lead to delays in seeking medical care. This was consistent with the study from Kulp and Barnhart.20 The subjective physical feelings, the severity of their self-evaluations of the disease, the symptoms and the duration of the disease were the most critical factors that led to individuals’ decisions about whether to seek medical services.21 According to the theory of protective motivation, patients who were fully aware that their conditions could cause severe damage to their bodies would be more willing to pay attention to their abnormal symptoms and change their lousy living habits.22 23 Therefore, medical personnel and community medical workers should educate women of reproductive age, improve their healthcare knowledge, draw their attention to abnormal symptoms related to their reproductive system and make them respond to abnormal symptoms and signs appropriately. The prevention and treatment of risk factors for ectopic pregnancy should be fully explained to these women. At the same time, it is necessary to pay attention to the health education needs of patients, recommend appropriate education opportunities for different patients and emphasise the outcomes of delays in seeking medical care and bad habits. In addition, health education content should be personalised and innovative for future healthcare, not limited to the current patient requirement.
Emotional and family support
This study found that tight family economic budgets, lack of companionship at the onset of symptoms or lack of support from family members were significant factors that led to delays in seeking medical care. Low-income family conditions could exacerbate the fears of medical treatment and medical expenses. These patients would want to wait and delay medical care due to the stress from the discomforts caused by illness and lack of adequate psychological preparation.24 25 When these patients had abnormal symptoms, they could suffer from varying degrees of tension and anxiety, making it difficult to make rational judgments. If family members accompany them, they might provide assistance and help the patient promptly seek medical treatment.24 Therefore, it is critical to explain the importance of family support to patients and their families. The family members should give more support to women and seek medical care immediately if necessary. They should be educated that the medical cost could be much lower if they seek medical care immediately. The entire family should fully establish a correct attitude toward immediate medical care.
Fertility needs
In recent years, the adoption of ‘two-child policy’ and ‘three-child policy’, as well as the widespread development of assisted reproductive technology in China, have led to a rising trend in the proportion of pregnant women over 35 years of age. This could lead to an increasing increased incidence of ectopic pregnancy. Other factors, such as history of caesarean section, induced abortion, intrauterine device placement, pelvic inflammatory disease, pelvic surgery and a previous ectopic pregnancy, could also increase the risk for ectopic pregnancy. In addition, unintended pregnancy, choosing safe contraceptives and conceiving safely are challenging for women of childbearing age.26 In many developing countries, men are the breadwinners who bring the most household income. Men often determine the medical expenses and opportunities to access medical treatments for women. Therefore, partner involvement should be encouraged to improve maternal health outcomes.27 Therefore, medical personnel and community workers should proactively promote and guide family planning to reduce women’s physical and psychological stress caused by unplanned pregnancies or unsafe contraceptive methods. This study found that education, age and marital status were sociodemographic factors contributing to patients’ delay in seeking medical treatment. Patients with a low education level lacked adequate knowledge of the disease and did not understand the importance of timely medical attention.28 Married women and women with children were likely to report symptoms earlier, consistent with the study by Sefogah et al.29 Young and unmarried women tended to avoid medical attention due to traditional reproductive thinking, fearing that others would look at them differently. Research by Asah-Opoku et al showed that single women with multiple sexual partners were at high risk for sexually transmitted diseases, including pelvic inflammatory disease, associated with ectopic pregnancy.30 Therefore, medical and community health institutions should develop personalised reproductive health guidance for women with different cultural levels, ages and reproductive needs, especially their spouses, parents and sexual partners.
Learnings from medical delays
This study found that, due to patients’ different family environments and reproductive needs, the physiological, mental, and social roles caused by surgery were different, resulting in different postoperative physical and mental experiences. This was similar to the study by Farren et al.31 Women with ectopic pregnancy often experience high levels of post-traumatic stress, anxiety and depression. Although distress might decrease over time, it could remain at a clinically important level at 9 months post partum.31 All of these could seriously impact the quality of life and physical and mental health of women.32 Adequate nursing care could alleviate the psychological pressure and negative emotions and establish appropriate coping strategies in women with ectopic pregnancy.31 Therefore, in the postoperative care of patients with ectopic pregnancy, medical personnel should take the initiative to care for the patients. We can assess their medical experience and reproductive needs, understand their physical and mental experiences,33 guide them to attach importance to and use positive influences, encourage them to actively participate in medical activities, answer questions, and provide more assistance and support. At the same time, the trust, understanding, and recognition of patients and their families can be obtained through professional nursing services, good communication and targeted psychological interventions.34 Patients’ negative experiences and emotions can be managed to improve their post-traumatic stress, anxiety and depression, reshape their medical experience, and promote their physical and mental recovery.
Medical resources and social supports
The research results showed that the convenience of therapy significantly impacted how patients seek medical care.35 The distance between the residence and the medical institution could affect patients’ medical decision-making.36 Limited medical resources in rural areas could easily lead to misdiagnosis and delays in seeking medical care.37 Therefore, more attention should be paid to areas with little or lacking high-quality medical resources. The quality and level of medical services in the local community should be improved. At the same time, we should also improve access to healthcare, especially in the urban edge area. During the interviews, nearly half of the patients reported their experience of avoiding medical treatment due to high medical expenses, cumbersome procedures, long waiting times and the inability to complete the medical treatment process independently. Therefore, the local government should make policies to optimise the resident medical health insurance system,38 reduce the prenatal cost for women and decrease their economic burden.39 In addition, we can also use the mobile medical facility40 and simplify the clinical steps to shorten patient waiting time. At the same time, medical personnel should continuously strengthen their service quality, enhance their professional skills and avoid excessive medical tests and treatments to improve patients’ experience and allow them to obtain medical care services more timely and efficiently.
Strengths and limitations
To our knowledge, we performed the first qualitative study on women with ectopic pregnancy and delays in seeking medical care in China. However, our study was limited by its small number of patients in a single hospital. In addition, patients’ experiences might change depending on different socioeconomic status, cultural backgrounds and local fertility policies. The results of our study might not be fully generalised to other regions in China and other countries. More studies are required to validate our results here.
Conclusions
The main reason for delaying medical care was the lack of knowledge about the early symptoms of ectopic pregnancy. Delays in seeking medical care negatively impacted patients’ physical and mental health, recovery and future healthcare. It could also lead to secondary infertility, pelvic inflammatory disease, post-traumatic stress, anxiety, depression and prolonged distress. Better medical education, family support, healthcare provider training and local fertility policies should be optimised to facilitate access to healthcare, reduce delayed medical treatments, improve pregnancy outcomes and decrease the incidences of maternal morbidity and mortality in these women.
Data availability statement
Data are available on reasonable request.
Ethics statements
Patient consent for publication
Ethics approval
The study was approved by the hospital ethics committee (ethics approval number: GYWY-L2022-98). Before the beginning of each interview, the investigator introduced the purpose, significance, time required and confidentiality principle of this study to the interviewees to obtain the patients’ informed consent, trust and cooperation. All patients were informed that they could withdraw from the study at any time without affecting the follow-up treatment, and all information would be used for the analysis only.
References
Footnotes
JL and YL are joint first authors.
Contributors JL and JZ were involved in the study design and data analysis; JL, YL and YS performed the patient recruitment, data collection and manuscript drafting. JZ is responsible for the overall content as the guarantor. All authors (JL, YL, JZ, YS and HSL) participated in the manuscript writing and performed critical revisions of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.