Title: Experiences and Challenges with Chronic Vulvovaginal Thrush in Primary Care: A Qualitative Study
Funder: Department of Health and Social Care

Abstract: BackgroundVulvovaginal candidiasis, known colloquially as thrush, is a common gynaecological condition and a major burden to primary care. Symptoms include genital itching, burning, discomfort, and changes in vaginal discharge. 75% of women will experience thrush at least once, but 6% present symptoms on a repeated or constant basis for many years. Current guidelines recommend long-term anti-fungal medications, but these fail for 10-20% of patients. Chronic thrush is poorly understood and difficult to treat. Patients report being bounced between primary care, secondary care, and self-treatment. These infections can result in poor mental health, disengagement from medical care, and the misuse of antifungal treatments. The launch of the Women's Health Strategy and recent call for evidence highlights the need for targeted attention, research, and action on the wellbeing of women, including common gynaecological conditions. The strategy highlights the importance of centring women's voices in evidence-based solutions. Research Question What are the experiences of patients and healthcare professionals in managing chronic thrush, and how might these insights underpin improvements? Aim: This study aims to improve understandings of how chronic thrush is experienced in the UK and provide resources to support self-management and clinical treatment. Methods 1: Determine what is currently known about chronic thrushA narrative review of current literature will be undertaken to assess what information is available and potentially used by healthcare professionals and patients. 2: Gather the experiences of people who have had chronic thrush in the UK Narrative and semi-structured interviews will be conducted with a diverse sample of up to 40 women and people assigned female at birth who have had chronic thrush. Interview transcripts will be analysed thematically to identify patients' main priorities, expectations, and concerns.3. Build an understanding of how healthcare professionals interpret patient experiences with chronic thrushA clinical scenario and findings from patient interviews will be presented to 3 focus groups of doctors, pharmacists, and sexual health practitioners to determine how they interpret these experiences. 4. Develop an online resource for those affected by chronic thrush and their healthcare providersFindings will be used to create a Healthtalk.org module with multi-media excerpts of patients' experiences of living with chronic thrush. TimelineYear 1: Conduct narrative review and interviews with patients Year 2: Host focus groups with healthcare professionals Year 3: Create Healthtalk.org module on chronic thrush Dissemination and ImpactThis study will answer the call to listen to women's voices and improve current management of chronic thrush. Findings will be shared as a module on the award-winning platform Healthtalk.org to provide a comprehensive resource for the 1.2 million women living with chronic thrush in the UK, their partners, and their healthcare professionals. This online module will be shared by other patient charities, health service networks, and through media. Findings will also be presented through publications, conferences, and research meetings. The study's outputs will empower patients to make informed decisions about consulting healthcare professionals or self-managing, further educate clinicians on patient needs, and work towards de-stigmatising conversations on chronic thrush.

Lay abstract: Background Vaginal thrush is a genital infection that causes itching, burning, discomfort, and changes in vaginal fluids. Three-quarters of women will have thrush in their lifetime. Most cases go away in a few days with medication. Yet, some women will have many or constant infections over years. In the UK, 1.2 million women have this repetitive experience, known as chronic thrush. The newly launched Women's Health Strategy says that we need to listen to women's voices and research women's common health issues. Chronic thrush has negative impacts on women, their relationships, and healthcare systems like the National Health Service (NHS). This condition is hard to manage and can cause poor mental health, low self-image, and strained relationships with healthcare services.Aim This study aims to improve understandings of how chronic thrush is experienced in the UK and provide resources to support self-management and medical treatment. Methods The study will reach this goal in 5 ways: 1. Find out what is known about chronic thrush I will look at studies, online resources, and guidelines published on chronic thrush in the UK to inform my study. 2. Gather the experiences of people who have had chronic thrush in the UK I will speak with up to 40 people who have had chronic thrush to see how and why they use or don't use existing health services. I will speak with women and people assigned female at birth.3. Understand how healthcare workers interpret patient experiences with chronic thrush I will present a fictional patient history as well as actual excerpts from patient interviews to explore how healthcare workers understand these cases.4. Develop an online resource for those living with chronic thrush and their healthcare providers I will create a module on chronic thrush and publish it on Healthtalk.org. This award-winning online platform provides multi-media information on health conditions to educate patients, healthcare workers, and the public and reaches over 8.5 million users a year.Patient and Public Involvement (PPI) Two patients have guided the design, language, and focus of this proposal. Patients and the public will provide ongoing support through the rest of the study to make sure patient voices are centered. A Patient and Public Involvement group will: Share ideas on how to get people to take part in the study; Give advice on the topics and questions which will guide interviews and focus groups with patients and healthcare workers; Discuss and give feedback on findings from the interviews and focus groups Co-write papers and presentationsThe group will make sure that I ask important questions and reach key groups. I will provide ongoing support and training to the group to complete these tasks and learn more about research. Dissemination I will share my findings as an online module on chronic thrush for Healthtalk.org. This module will provide information and support to the 1.2 million women living with chronic thrush in the UK, their partners, and their healthcare providers. I will draw on my existing networks with health charities and build relationships with other health service networks to promote this resource. With my PPI group, I will engage with the public through the press, on podcasts, blogs, and online networks. I will share my findings with other researchers through meetings, conferences, and publications.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INFECTION