'Getting comfortable with the uncomfortable': barriers, facilitators and influences on reproductive health discussions from Hispanic women with systemic lupus erythematosus in the USA - a qualitative study.

OBJECTIVE

Systemic lupus erythematosus (SLE) primarily affects women of reproductive age, necessitating complex conversations surrounding pregnancy and contraception use. Hispanic women in the USA bear a disproportionate and severe burden of SLE, facing language and cultural barriers to care, and higher rates of unplanned pregnancy and under-representation in reproductive health research. This study explores patient-reported barriers and facilitators to reproductive health conversations as well as their attitudes and perceptions on how these conversations can be improved.

METHODS

We conducted 30 semistructured interviews in both English and Spanish with Hispanic women aged 18-45 with SLE. Participants were recruited from Los Angeles General Medical Center and Lupus LA. Eligible participants were heterosexually active or considering pregnancy within 3 years. Interviews were analysed using grounded theory to identify themes related to barriers and facilitators in clinical reproductive health interactions.

RESULTS

Three major themes emerged: (1) barriers to reproductive health conversations were often driven by competing clinical priorities as well as discomfort discussing sensitive topics; (2) facilitators to reproductive health conversations included the presence of genuine clinician-patient rapport, well-controlled disease activity and patient proactiveness; (3) areas of improvement included both a more encompassing and thorough data-driven approach to reproductive health discussions throughout disease course.

CONCLUSION

Findings reported herein underscore the importance of early, individualised reproductive health counselling for women with SLE. Enhanced clinician communication with sensitive topics, refined patient education and frequent interdisciplinary collaboration can help address the emotional, medical and informational needs of Hispanic women with SLE navigating reproductive decisions.