Web-based education about vulvodynia and its care among student healthcare staff : A quasi-experimental study

WEB-BASED EDUCATION ABOUT VULVODYNIA AND ITS CARE AMONG STUDENT HEALTHCARE STAFF: A QUASI-EXPERIMENTAL STUDY Minna Törnäväa,b,*, Meeri Koivulaa, Mika Helminena,b, Tarja Suominena a University of Tampere, Faculty of Social Sciences, Health Sciences b Tampere University Hospital, Pirkanmaa Hospital District *Corresponding author: Tampere University Hospital, Department of Physical and Rehabilitation Medicine, PFYZ, PO Box 2000, 33521 Tampere, Finland. E-mail addresses: [email protected]i. ACKNOWLEDGMENTS The authors gratefully acknowledge the University of Tampere and Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital (9S069/9U060), Finland, for funding this study. Conflicts of interest The authors have all agreed to the byline order and to submission of the manuscript in this form. No conflict of interest has been declared by the authors. HIGHLIGHTS Web-based education increased awareness and knowledge of vulvodynia and its care The impact of WBE on the subject was statistically and clinically significant WBE is a suitable form of education for nationwide student healthcare providers WBE is suitable for use by organisations that are geographically far from each other © 2018 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This is the post print version of the article, which has been published in Nurse Education in Practice 2018, 31, 194-199. The final publication is available at https://doi.org/10.1016/j.nepr.2018.06.008 ABSTRACT Student healthcare providers are the type of primary healthcare professionals who usually have first contact with young women who have problems with intimacy, such as vulvar pain – known as vulvodynia. However, a need to increase healthcare professionals' level of knowledge of vulvodynia and its care has been identified. This study aimed to assess the awareness and knowledge of vulvodynia and its care among student healthcare providers, before and after Web-based education. The study design was national, descriptive and quasi-experimental, and was conducted across Finland. A total of 79 participants completed baseline measurements, 58 completed web-based education and 30 took part in a follow-up survey. A survey instrument called ‘Awareness and knowledge of vulvodynia and its care’ was developed for this study, and the data were collected using a web-based questionnaire. Descriptive statistical methods were used to evaluate the participants' awareness and knowledge of vulvodynia and its care before and after web-based education. The primary results indicated that the participants' awareness and knowledge of vulvodynia and its care was statistically significantly improved following web-based education. Keywords: Web-based education, student healthcare, vulvodynia, vulvar pain, women’s health, awareness, knowledge, patient care management 1. INTRODUCTION Vulvar pain with no clear aetiology is usually called vulvodynia, and it may result in numerous physical and psychosexual functional disorders in women (Goldstein and Burrows, 2008; Bohm-Starke, 2010; Sadownik, 2014). In Finland, student healthcare providers are the type of primary healthcare professionals who usually have first contact with young women who have problems with intimacy. However, women with vulvodynia have reported negative experiences with Finnish primary healthcare in terms of knowledge of the condition and its care (Törnävä et al., 2012). A recent study also found that the student healthcare providers who meet and care for females of fertile age have insufficient awareness and knowledge of vulvodynia and its care (Törnävä et al., 2017). To date, no study has evaluated the effectiveness of any type of education with regard to increasing the awareness and knowledge of vulvodynia and its care among healthcare providers. 2. BACKGROUND 2.1. Web-based education Web-based education (WBE) is a cost-effective way of educating large numbers of healthcare providers, in terms of travel costs, as well as personnel time and trainer costs, enabling them to deliver the same consistent programme (Cook et al., 2010; Brown and Bullock, 2014; Lahti et al., 2014a). Well-designed WBE is also a dynamic, innovative and rich method of providing nursing staff with education on specific topics. It allows learners to access the particular website, follow lectures or complete assignments according to their own schedules, and the learners have sole control over the content, place and time of learning (Durkin, 2008; Cheng, 2012; Lahti et al., 2014a). Evaluation of WBE interventions has shown that interactivity, practice exercises, repetition and feedback improve learning outcomes. A comparison of WBE interventionand nonintervention-related knowledge has shown promising results in the medical field, although the findings have sometimes been contradictory (Cook et al., 2010; Lahti et al., 2014a). However, there remains a lack of evidence regarding the impact of WBE methods in nursing education (Lahti et al., 2014a). 2.2. Vulvodynia and its care The International Society for the Study of Vulvar Diseases (ISSVD, 2016) defines vulvodynia as chronic pain or discomfort involving the vulva for more than 3 months, and for which no obvious aetiology can be found (Haefner, 2007). The exact causes of vulvodynia remain uncertain; however, previous studies have identified some possibilities, including inflammation, genetic factors, hormonal factors and contributory psychosocial factors (Goldstein and Burrows, 2008; Bohm-Starke, 2010; Danby and Margesson, 2010; Reed et al., 2014). Vulvodynia may be triggered during sexual intercourse and/or by nonsexual activities, such as wearing tight-fitting clothing or even sitting (Harlow and Stewart, 2003; Danby and Margesson, 2010; Sadownik, 2014). It can be classified according to the anatomical site of the pain; it may be localised to a specific area (localised vulvodynia) or to all over the vulva (generalised vulvodynia). It can also be categorised on the basis of whether the experienced pain is provoked or unprovoked (Haefner, 2007; Danby and Margesson, 2010; Sadownik, 2014). Localised, provoked vulvodynia is the most common form of the condition, and the patients are usually young nulliparous women. The lifetime prevalence of unexplained vulvar pain can be as high as 16%; generalised, unprovoked vulvodynia is less common, with a 6–7% prevalence. Generalised vulvodynia presents as a diffuse, constant, burning or raw pain anywhere on the genitals and/or the pelvic area. (Harlow et al., 2001; Danby and Margesson. 2010). The lack of randomised trials means that the care of women with vulvodynia is primarily based on clinical experience, descriptive studies and reports made by expert committees. An individualised multidisciplinary approach is recommended to address both the physical and psychosexual aspects of the condition (Danby and Margesson, 2010; Nunns et al., 2010; ASCCP, 2016). It has been shown that such an approach increases women's knowledge of vulvodynia and helps them to gain the skills they need to address their pain, and also encourages them to take responsibility for their own care (Munday et al., 2007; Sadownik et al., 2012; Törnävä et al., 2012). Counselling by healthcare personnel with regard to gentle self-care of the vulva area and other instructions to address pain is first-line treatment in minimising vulva irritation (Cox and Neville, 2012; Lindstrom and Kvist, 2015; ASCCP, 2016). It has also been shown that pelvic floor physiotherapy, such as biofeedback, electrical stimulation and pelvic floor manipulation, reduces pain in women with vulvodynia (Bergeron et al., 2001; Nunns et al., 2010; Melnik et al., 2012; Murina et al., 2013; Morin et al., 2016). Moreover, psychosexual interventions are effective in reducing vulvar pain and in improving associated psychosexual outcomes for these women and their partners (Bergeron et al., 2014; Davis et al., 2015). Medical interventions include topical, oral and injectable medical substances (Nunns et al., 2010; ASCCP, 2016); if conservative treatments have not been useful, and the pain is due to localised, provoked vulvodynia, a surgical procedure known as vestibulectomy may be effective (Andrews, 2011; Tommola et al., 2011). 2.3. Knowledge of vulvodynia and its care Previous research into knowledge of vulvodynia and its treatment among healthcare professionals has primarily focused on the perspectives of either patients (Gordon et al., 2003; Buchan et al., 2007; Törnävä et al., 2012) or physicians (Updike and Wiesenfeld. 2005; Toeima and Nieto. 2011; Phillips et al., 2013); only one study also assessed the perspectives of nursing and therapy staff (Törnävä et al., 2017). The studies that investigated women's experiences of the care they received reported that the knowledge of healthcare staff was inadequate from the patients' perspective (Gordon et al., 2003; Buchan et al., 2007; Törnävä et al., 2012). In addition, an estimated 40% of women seeking treatment fail to receive help, and this estimate may even be conservative (Harlow and Stewart, 2003; Goldstein and Burrows. 2008). It has been reported that junior gynaecologists have insufficient understanding of vulvodynia and its management (Toeima and Nieto, 2011), although Updike and Wiesenfeld (2005) and Phillips et al. (2013) reported a good awareness among obstetricians and gynaecologists. A recent study found that student healthcare providers who meet and care for women of fertile age have insufficient awareness and knowledge of vulvodynia and its care and, creation of educational programs was recommended to provide evidence-based care for women with the condition (Törnävä et al., 2017). 3. AIMS The present study aimed to assess awareness and knowledge of vulvodynia and its care among student healthcare providers before and after WBE. 4. METHODS 4.1. Design and sample The study design was national, descriptive and quasi-experimental, and it was conducted in student healthcare, which is part of primary healthcare in Finland. All student healthcare providers (N = 191) who serve students of universities and other institutions of higher education, were chosen as the target group, and were recruited nationwide from all 12 student healthcare units. These individuals were invited to participate in the survey, and to receive WBE on vulvodynia and its care. They were invited via an email, which included information on the study, sent by the nurses in charge of the student healthcare units. A baseline survey was conducted between February and April 2015. A letter reminding the participants of the follow-up survey was sent by the nurses in charge of the units at 2, 4 and 6 weeks after the survey began. WBE on vulvodynia and its care was provided for a duration of 4 weeks, between October 2015 and November 2015. The follow-up survey was carried out 2 weeks after the completion of WBE, between December 2015 and February 2016. 4.2. Survey instrument The web-based questionnaire consisted of individual background factors, demographic factors and three questions self-assessing each participant's own skills with regard to caring for women with vulvodynia (Table 1), as well as the ‘Awareness and knowledge of vulvodynia and its care’ (AKVDC) survey instrument developed by the authors (Table 2). The latter consisted of two parts: ‘Awareness of vulvodynia and its care’ (Part 1) and ‘Knowledge of vulvodynia and its care’ (Part 2). Part 1 was developed on the basis of patient-related qualitative research findings on the care experiences of women with vulvodynia (Törnävä et al., 2012, 2013), while Part 2 was based on previous studies of vulvodynia (e.g. Bohm-Starke, 2010; Reed et al., 2014; Sadownik, 2014) and its management (e.g. Danby and Margesson, 2010; Nunns et al., 2010; Melnik et al., 2012). Part 1 covers four main dimensions of awareness: the identification of vulvodynia (14 items), the treatment of vulvodynia (13 items), the significance of encountering patients (15 items) and the significance of providing information and support to patients (24 items). A 6–point Likert scale, ranging from 1 (completely disagree) to 6 (completely agree) or ranging from 1 (I know it remarkably poorly) to 6 (I know it remarkably well), was used to measure the participants’ awareness. Part 2 of the AKVDC instrument includes 20 items relating to the participants’ knowledge of vulvodynia and its care. This part of the instrument is a knowledge test in which three possible options for the answers are given: true, false and not sure. The face validity and content of the AKVDC instrument was tested in a pilot study by an independent panel of multi-professional healthcare staff (N = 9), composed of uro/gynaecological nurses, pelvic floor physiotherapists, sex counsellors and gynaecologists, prior to the survey. They commented on the structure, phrasing, clarity, comprehensibility, relevance and assessment scale of the instrument. The instrument was modified as appropriate, in accordance with their work experience with women with vulvodynia. The reliability of the AKVDC instrument was assessed using a pilot group of student healthcare staff (N = 34), who were not part of the baseline and follow-up survey. The pilot study participants were asked to complete the questionnaire and to give feedback regarding any questions that were unclear. The internal reliability of Part 1 of the AKVDC was tested by calculating the Cronbach's alpha (α) for each subscale. Acceptable internal consistency (α > 0.70) was found for all subscales, with the exception of ‘awareness of the significance of meeting patients’ (α = 0.69). Thus, several questions under the dimension of awareness were clarified. Prior to the actual study with student healthcare providers, the instrument was modified and clarified on the basis of the pilot study. At baseline (Törnävä et al., 2017) and in the follow-up survey, all four subscales in Part 1 showed acceptable internal consistency (Table 2). 4.3. Web-based education intervention WBE content on vulvodynia and its care, named ‘Woman with vulvodynia – how should we take care of them?’ was created by a multi-professional team of vulvodynia specialists, on the basis of previous studies (e.g. Danby and Margesson, 2010; Nunns et al., 2010; Reed et al., 2014; Sadownik, 2014) and clinical experience. This multi-professional healthcare team was composed of three uro/gynaecological nurses, two pelvic floor physiotherapists, one psychotherapist, two gynaecologists and one general practitioner. The educational content was created to follow the structure of the AKVDC instrument, and the areas of emphasis were established on the basis of the baseline survey (Törnävä et al., 2017). WBE was provided via three modules in a Moodle virtual learning environment. Each of the three different modules were provided for the duration of 1 week, and took an estimated 15– 25 min for the participants to complete. For the purposes of the study, each module was opened separately, one-by-one. The module provided in the fourth week was a revision module, which gave the participants an opportunity to repeat the previous modules, if required. The WBE intervention included the text, anatomical pictures, videos of patient situations and the stories of women who had experienced vulvodynia. The participants also had the opportunity to contact the Web tutor if they experienced any technical problems with the learning environment. Table 3 shows the content and learning methods for each of the WBE modules. 4.4. Ethical considerations The study protocol was approved by the board of trustees of the student healthcare administrative units. All the participants were sent an information letter by email, detailing the objectives of the study and explaining that completion of the Web-based survey implied their consent. The information letter also stated that participation in the surveys and WBE was voluntary, and that the survey was completely anonymous (Helsinki Declaration, 2013). 4.5. Data analysis The Statistical Package for the Social Sciences for Windows, version 23 (IBM 2015), was used to analyse the data, and the Cronbach alpha score was used to calculate whether the aggregate of Part 1 of the AKVDC instrument was valid. The items in Part 1 were rated using a 6point Likert scale. The subscale scores were obtained by summing the responses given for each item and calculating the mean response. The averaged scores of the subscales created the total score for awareness, which was divided into six equal classes, as follows: 1.00–1.82 (extremely poor awareness), 1.83–2.66 (poor awareness), 2.67–3.50 (somewhat poor awareness), 3.51–4.34 (somewhat good awareness), 4.35–5.18 (good awareness) and 5.19–6.00 (extremely good awareness). In order to calculate the participants’ knowledge of the items in Part 2 of the AKVDC instrument, all correct answers were recorded as equal to 1; all wrong or uncertain answers were recoded as 0. The data from the 20 questions were analysed by totalling all the answers given by each participant, resulting in an individual knowledge score of between 0 and 20. Descriptive statistics using absolute (n) and relative (%) frequencies were applied to analyse the categorical data, while the mean, median (Md), quartile (Q1, Q3) and interquartile range (IQR) were used to calculate the participants’ awareness and knowledge of vulvodynia and its care. Fisher’s exact test and the Mann–Whitney U test were used to analyse differences between baseline and the follow-up survey. A p value of < 0.05 was considered statistically significant, and a 20% change in awareness and knowledge of vulvodynia and its care compared to baseline was considered clinically and statistically significant. Durkin, G.J., 2008. A comparison of the effectiveness of computer-based learning courses among nursing staff. Journal for Nurses in Staff Development - JNSD. 24(2), 62-66. Eaton-Spiva, L., Day, A., 2011. Effectiveness of a computerized educational module on nurses' knowledge and confidence level related to diabetes. Journal for Nurses in Staff Development - JNSD. 27(6), 285-289. Feng, J., Chang, Y., Chang, H., Erdley, W.S., Lin, C., Chang, Y., 2013. Systematic review of effectiveness of situated e-learning on medical and nursing education. Worldviews on EvidenceBased Nursing 10(3), 174-183. Finlex, Finland's Ministry of Justice, 2003. Finnish Statue on Continuing Vocational Education, 1194/2003. (Available at: http://www.finlex.fi/fi/laki/alkup/2003/20031194?search[type]= pika&search[pika]=1194%2F2003, accessed 11 January 2017) Finlex, Finland's Ministry of Justice, 2010. Finnish statue on education needed to prescribe medication,1089/2010. (Available at: http://www.finlex.fi/fi/laki/alkup/2010/20101089?search[type] =pika&search[pika]=1089%2F2010, accessed 11 January 2017) Goldstein, A.T., Burrows, L., 2008. Vulvodynia. Journal of Sexual Medicine 5(1), 5-14. Gordon, A.S., Panahian-Jand, M., Mccomb, F., Melegari, C., Sharp, S., 2003. Characteristics of women with vulvar pain disorders: responses to a Web-based survey. J.Sex Marital Ther. 29(Suppl 1), 45-58. Haefner, H.K., 2007. Report of the International Society for the Study of Vulvovaginal Disease terminology and classification of vulvodynia. Journal of Lower Genital Tract Disease 11(1), 48-49. Harlow, B.L., Stewart, E.G., 2003. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia?. Journal of the American Medical Womens Association 58(2), 82-88. Harlow, B.L., Wise, L.A., Stewart, E.G., 2001. Prevalence and predictors of chronic lower genital tract discomfort. American Journal of Obstetrics & Gynecology 185(3), 545-550. Hart, P., Eaton, L., Buckner, M., Morrow, B.N., Barrett, D.T., Fraser, D.D., Hooks, D., Sharrer, R.L., 2008. Effectiveness of a computer-based educational program on nurses' knowledge, attitude, and skill level related to evidence-based practice. Worldviews on Evidence-Based Nursing 5(2), 7584. Helsinki Declaration, 2013. WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. (Available at: http://www.wma.net/en/30publications/10policies/b3/, accessed 11 January 2017) IBM: International Business Machines Corporation, 2015. Armonk, NY, USA. (Available at: https://www.ibm.com/products/spss-statistics, accessed 11 January 2017). ISSVD: International Society for the Study of Vulvar Diseases, 2016. (Available at: http://www.issvd.org/resources/terminology/, accessed 11 January 2017). Lahti, M., 2014. Evaluation of an e-learning course : coercion practices in psychiatric nursing. Annales Universitatis Turkuensis. Doctoral thesis. D.Medica-Odontologica (1121). Painosalama Oy - Turku, Finland 2014. Lahti, M., Hatonen, H., Valimaki, M., 2014a. Impact of e-learning on nurses' and student nurses knowledge, skills, and satisfaction: a systematic review and meta-analysis. Int.J.Nurs.Stud. 51(1), 136-149. Lahti, M., Kontio, R., Pitkanen, A., Valimaki, M., 2014b. Knowledge transfer from an e-learning course to clinical practice. Nurse Educ.Today 34(5), 842-847. Lindstrom, S., Kvist, L.J., 2015. Treatment of Provoked Vulvodynia in a Swedish cohort using desensitization exercises and cognitive behavioral therapy. BMC Womens Health 15(108), DOI 10.1186/s12905-015-0265-3. Melnik, T., Hawton, K., McGuire, H., 2012. Interventions for vaginismus. Cochrane Database of Systematic Reviews 12, 12:CD001760, doi: 10.1002/14651858.CD001760.pub2. Morin, M., Dumoulin, C., Bergeron, S., Mayrand, M., Khalife, S., Waddell, G., Dubois, M., 2016. Provoked vestibulodynia (PVD) Study Group. Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods. Contemporary Clinical Trials 46, 52-59. Munday, P., Buchan, A., Ravenhill, G., Wiggs, A., Brooks, F., 2007. A qualitative study of women with vulvodynia: II. Response to a multidisciplinary approach to management. J.Reprod.Med. 52(1), 19-22. Murina, F., Graziottin, A., Felice, R., Radici, G., Tognocchi, C., 2013. Vestibulodynia: synergy between palmitoylethanolamide + transpolydatin and transcutaneous electrical nerve stimulation. Journal of Lower Genital Tract Disease 17(2), 111-116. Nalle, M.A., Wyatt, T.H., Myers, C.R., 2010. Continuing education needs of nurses in a voluntary continuing nursing education state. J.Contin.Educ.Nurs. 41(3), 107-115. Nunns, D., Mandal, D., Byrne, M., McLelland, J., Rani, R., Cullimore, J., Bansal, D., Brackenbury, F., Kirtschig, G., Wier, M., 2010. British Society for the Study of Vulval Disease (BSSVD) Guideline Group. Guidelines for the management of vulvodynia. Br.J.Dermatol. 162(6), 1180-1185. Phillips, A., Large, E., Bird, M., Hitt, W., Eastham, D., Pulley, L., Hutchings, D., 2013. Vulvodynia in Arkansas: A Survey of Arkansas Gynecologists' Practice Experience and Management of Vulvar Pain. The Journal of the Arkansas Medical Society 109(10), 206-208. Reed, B.D., Legocki, L.J., Plegue, M.A., Sen, A., Haefner, H.K., Harlow, S.D., 2014. Factors associated with vulvodynia incidence. Obstetrics & Gynecology 123(2 Pt 1), 225-231. Sadownik, L.A., 2014. Etiology, diagnosis, and clinical management of vulvodynia. International Journal of Women's Health 6, 437-449. Sadownik, L.A., Seal, B.N., Brotto, L.A., 2012. Provoked vestibulodynia-women's experience of participating in a multidisciplinary vulvodynia program. Journal of Sexual Medicine 9(4), 10861093. Toeima, E., Nieto, J., 2011. Junior doctors' understanding of vulval pain/vulvodynia: a qualitative survey. Archives of Gynecology & Obstetrics 283(1), 101-104. Tommola, P., Unkila-Kallio, L., Paavonen, J., 2011. Long-term follow up of posterior vestibulectomy for treating vulvar vestibulitis. Acta Obstet.Gynecol.Scand. 90(11), 1225-1231. Törnävä, M., Koivula, M., Suominen, T., 2012. Vulvodyniaa sairastavien naisten hoitokokemuksia. (Care experiences of the women with vulvodynia). Tutkiva hoitotyö. 10, 32-39. Törnävä, M., Koivula, M., Suominen, T., 2013. Naisten kokemuksia vulvodynian vaikutuksesta parisuhteeseen. (Women’s experiences the effects of vulvodynia on the pair relationship). Hoitotiede. 25, 241-252. Törnävä, M., Koivula, M., Helminen, M., Suominen, T., 2017. Women with vulvodynia: awareness and knowledge of its care among student healthcare staff. Scandinavian Journal of Caring Sciences. doi: 10.1111/scs.12455. Updike, G.M., Wiesenfeld, H.C., 2005. Insight into the treatment of vulvar pain: a survey of clinicians. American Journal of Obstetrics & Gynecology 193(4), 1404-1409. Table 1 Demographic variables and experience-based skills of study participants Demographic Variables Baseline Follow-up N (%) N (%) p Gender Female 74 (93.7) 29 (96.7) - Male 5 (6.3) 1 (3.3) Age 27–40 25 (31.6) 8 (26.7) 0.895 41–53 26 (32.9) 11 (36.7) 54–65 28 (35.4) 11 (36.7) Years of work experience 1–14 24 (30.4) 7 (23.3) 0.662 in health care 15–27 28 (35.4) 10 (33.3) 28–40 27 (34.2) 13 (43.3) Education Nursing and therapy staff 57 23 0.809 Public health nurse 33 (41.8) 16 (53.3) Registered nurse 4 (5.1) 1 (3.3) Psychologist 11 (13.9) 3 (10.0) Physiotherapist 4 (5.1) 2 (6.7) Other 5 (6.3) 1 (3.3) Physician staff 22 7 Physician 22 (27.8) 7 (23.7) Type of job contract Regular 68 (86.1) 28 (93.3) - Fixed-term 10 (12.6) 2 (6.7) Hourly 1 (1.3) 0 Specialization in Yes 11 (13.9) 5 (83.3) 0.765 Sexology No 68 (85.1) 25 (16,7) Frequency of meetings Never 14 (17.7) 2 (6.7) 0.370 with VD patients < 1 x a month 50 (63.3) 22 (73.3) >1x a month 15 (19.0) 6 (20.0) Experienced-based skills in taking care of VD patients Poor (scale of 1–3) 60 (75.9) 11 (36.7) < 0.001 Good (scale of 4–6) 19 (24.1) 19 (63.3) taking care of VD couples Poor (scale of 1–3) 64 (81.0) 16 (53.3) 0.007 Good (scale of 4–6) 15 (19.0) 14 (46.7) naturally discussing intimate Poor (scale of 1–3) 36 (45.6) 3 (10.0) 0.001 issues Good (scale of 4–6) 43 (54.4) 27 (90.0) p = Fisher’s Exat Test (2-sided), VD = vulvodynia. Table 2 The Awareness and Knowledge of Vulvodynia and its Care (AKVDC) survey instrument AKVDC Items Answering scale Part 1: 66 A 6-point Likert scale The Cronbach’s alpha Awareness of From 1=completely disagree to 6=completely agree OR From 1=I know it remarkably poorly to 6=I know it remarkably well αP α0 αF how to identify VD 14 0.81 0.83 0.84 the treatments for VD 13 0.78 0.80 0.72 the significance of encountering VD patients 15 0.69 0.89 0.92 the significance of providing information and support to VD patients 24 0.86 0.91 0.95 Part 2: Knowledge of VD and its care 20 True, false or unsure VD = vulvodynia. αP = Pilot, α0 = Baseline, αF = Follow-up Table 3 Content and learning methods of web-based education on vulvodynia and its care. The WBE intervention: Woman with vulvodynia – how should we take care of them? Week Module Educational content Learning methods 1 1 Introduction to WBE How to identify VD Text Anatomical pictures Experiences of women with VD Tutoring of technical issues 2 2 Treatments for VD • Self-care • Psychosexual interventions Text Anatomical pictures Experiences of women with VD Videos of a patient situations Tutoring of technical issues 3 3 Treatments for VD • Physiotherapy • Medical interventions The significance of encountering VD patients The significance of receiving information and support to VD patients Text Anatomical pictures Experiences of women with VD Video of a patient situation Tutoring of technical issues 4 1 - 3 Revision Revision WBE = Web-based education, VD = vulvodynia Table 4 Awareness and Knowledge of Vulvodynia and its Care on baseline and on follow-up Awareness of how to identify VD treatments for VD the significance of encountering VD patients the significance of providing information and support to VD patients N Md IQR p Md IQR p Md IQR p Md IQR p Base line 79 3.86 0.86 3.23 1.00 5.00 1.00 5.17 0·88 Follow-up 30 Attended on WBE on VD Yes 24 5.07 0.55 <0.001 4.50 0.50 <0.001 5.40 0.55 0.004 5.58 0.86 0.002 No 6 4.32 1.20 0.023 3.58 0.52 0.071 5.47 0.90 0192 5.27 1.21 0.662 Knowledge of VD and its care N Mean min Q1 Q3 max Md p Base line 79 9.34 0 6.00 13.00 20 10.00 Follow-up 30 Attended on WBE on VD Yes 24 15.33 4 14.00 17.00 20 16.00 <0.001 No 6 10.83 7 7.75 14.25 15 10.50 0.547 VD = vulvodynia, WBE = web-based education. Md = Median, IQR = Interquartile range, min = Minimum, Q = quartiles, max = Maximum.