WHO guideline on self-care interventions for health and well-being, 2022 revision: web annex A: global values and preferences survey report

WHO Self-Care Interventions for health Global values and preferences survey results WHO guideli e on self-care interventions for health and w ll-being, 2022 revision Web Annex A. Global values and preferences survey report WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report ISBN 978-92-4-005221-5 (electronic version) © World Health Organization 2022 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. 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It is being made publicly available for transparency purposes and information, in accordance with the WHO handbook for guideline development, 2nd edition (2014). iiiContents CONTENTS Acknowledgements vii Acronyms and abbreviations vii 1. About this document 1.1 About the GVPS and focus group discussions 2 1.2 Why is this GVPS report important? 2 1.3 Structure of the report 3 2. Sociodemographic characteristics, self-efficacy, autonomy, and sources of information relating to self-care interventions 2.1 Sociodemographic profile of participants 8 2.2 Sources of information about sexual and reproductive health services 14 2.3 New General Self-Efficacy (NGSE) Scale: respondents’ results (Wave 2) 17 2.4 Sexual and reproductive autonomy scales: respondents’ results (Wave 2) 19 3. Awareness and experience of, and values and preferences relating to self-care interventions for SRHR: quantitative findings 3.1 Survey respondents’ awareness about, usage of, and decision-making considerations on self-care interventions for SRHR 24 3.2 Health workers’ experience of and confidence about providing services related to self-care interventions for SRHR, and related concerns and benefits 51 4. Values and preferences relating to self-care interventions for SRHR: qualitative findings 4.1 Current concerns with self-care SRHR interventions: health workers and laypersons 74 4.2 Potential benefits of self-care SRHR interventions: health workers and laypersons 78 4.3 Preferred conditions for use of self-care interventions for SRHR: health workers and laypersons 81 4.4 Future issues for considerations with self-care SRHR interventions: health workers and laypersons 83 4.5 Perspectives on linkages to health care: health workers only 84 4.6 Perspectives regarding training and information needs: health workers only 86 4.7 Any additional comments: Wave 1 health worker respondents only 87 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey reportiv 5. Health-care engagement and self-care interventions for SRHR 5.1 Accessing self-care interventions for SRHR and sources of relevant information: quantitative findings 90 5.2 Engaging with health workers for self-care SRHR interventions: quantitative and qualitative findings (Wave 1 only) 110 5.3 Ease of access to self-care interventions for SRHR: quantitative findings 113 6. Impacts of COVID-19 on respondents’ use of self-care interventions and access to sexual and reproductive health services Appendices Appendix A: Country of residence of Global Values & Preferences Survey participants, by respondent type and survey “wave” 123 Appendix B: Ages of the Global Values & Preferences Survey participants, by respondent type and survey wave 127 vChapter 1 LIST OF TABLES AND FIGURES Figure 1: Topics and respondents included in GPVS Wave 1 and Wave 2 4 Table 2.1. Sociodemographic characteristics of Global Values & Preferences Survey participants, by respondent type and survey wave 8 Figure 2.1. Sources of information from which GVPS participants reported learning about SRH services, by respondent type (Wave 1 only, 2018) 14 Figure 2.2. Preferences for online information sources from which GVPS participants would like to learn more about SRHR, by respondent type (Wave 1 only, 2018) 15 Figure 2.3. New General Self-Efficacy (NGSE) Scale response frequencies and mean overall scores among all Global Values & Preferences Survey participants, and by respondent type (Wave 2 only, 2020–2021) 17 Figure 2.4. Sexual and reproductive autonomy scale response frequencies and mean overall scores among all Global Values and Preferences Survey participants, and by respondent type (Wave 2 only, 2020–2021) 19 Table 3.1. Awareness, usage and Decision-making considerations of SRH self-care interventions for antenatal, intrapartum and postnatal care by self or partner among Global Values & Preferences Survey participants, by type of respondent (Wave 2 only, 2020–2021) 25 Table 3.2. Awareness, Usage and Decision-making CONSIDERATIONS for use of SRH self-care interventions for family planning among Global Values & Preferences Survey participants, by type of respondent and survey wave 30 Table 3.3. Awareness and ever/recent use of, and decision-making considerations about self-management of medical abortion, among Global Values & Preferences Survey participants, by type of respondent and survey wave 35 Table 3.4. Awareness, uSAge and Decision-making of SRH self-care interventions for sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities, among Global Values & Preferences Survey participants, by type of respondent and survey wave 37 Table 3.5. Awareness, ever use, and decision-making factors for use of SRH self-care interventions for promoting sexual health, among Global Values & Preferences Survey participants, by type of respondent (Wave 2 only, 2020–2021) 44 Table 3.6. Awareness, ever use, and decision-making factors of SRH self-care interventions/information available online and via mobile applications (apps), among Global Values & Preferences Survey participants, by type of respondent (Wave 1 only, 2018) 46 Figure 3.1: Health-care provider responses regarding self-care srhr interventions 51 Figure 3.2: Health-care provider concerns per intervention 52 Figure 3.3: Perceived benefits by health-care providers per intervention 53 Figure 3.4: Health-care provider responses regarding self-care srhr interventions 56 Figure 3.5: Health-care provider concerns per intervention 57 Figure 3.6: Perceived benefits by health-care providers per intervention 58 Figure 3.7: Health-care provider responses regarding self-care srhr interventions 60 Figure 3.8: Health-care provider concerns per intervention 60 Figure 3.9: Perceived benefits by health-care providers per intervention 61 Figure 3.10: Health-care provider responses regarding self-care SRHR interventions 62 Figure 3.11: Health-care provider concerns per intervention 64 Figure 3.12: Perceived benefits by health-care providers per intervention 65 Figure 3.13: Health-care provider responses regarding self-care srhr interventions 67 Figure 3.14: Health-care provider concerns per intervention 67 Figure 3.15: Perceived benefits by health-care providers per intervention 67 Figure 3.16: Health-care provider responses regarding self-care srhr interventions 68 Figure 3.17: Health-care provider concerns per intervention 69 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey reportvi PHOTOGRAPHY AND ART WORK CREDITS Cover: ©Shutterstock/Mila Supinskaya Glashchenko, ©Jonathan Torgovnik/Reportage by Getty Images, ©WHO/Sergey Volkov, ©Getty Images/Images of Empowerment/Paula Bronstein, ©PATH/Gabe Bienczycki , ©WHO/Blink Media - Nikolay Doychi, ©UNICEF/Patricia Willocq, ©UNICEF/Njiokiktjien, ©AJR_photo/Shutterstock p. vii: ©Rawpixel/Shutterstock p. 1: ©Gajendra Bhati/Shutterstock p. 3: art work depicting a nurse by Kirti p. 6: ©krishna - stock.adobe.com p. 16: art work depicting women and an i-pill by Shivani p. 22: ©i_am_zews, Nigeria/Shutterstock p. 43: ©WHO/Anna Kari p. 49: art work depicting an HIV testing screen within a sunflower by Ran p. 50: art work depicting a transgender person browsing self-care products by Karan p. 55: ©WHO/Patrick Brown p. 71: art work depicting a woman by Ashu p. 72: ©Paula Bronstein/The Verbatim Agency/Getty Images p. 88: ©Jonathan Torgovnik/Getty Images/Images of Empowerment p. 109: art work depicting a self-care book in front of the sun by Ashu p. 114: ©Yerchak Uladzimir/Shutterstock p. 115: art work depicting a truck and truck driver by Karan p. 116: © WHO/Blink Media - Nadège Mazars p. 119: © WHO/Tom Pietrasik p. 120: art work depicting two young people by Ashu Figure 3.18: Perceived benefits by health-care providers per intervention 69 Table 5.1: Means of accessing SRH self-care interventions for antenatal, intrapartum and postnatal care, among Global Values & Preferences Survey participants, by respondent type (Wave 2 only, 2020–2021) 90 Table 5.2: Sources of information about SRH self-care interventions for antenatal, intrapartum and postnatal care, among Global Values & Preferences Survey participants, by respondent type (Wave 2 only, 2020–2021) 92 Table 5.3: Means of accessing SRH self-care interventions for family planning among Global Values & Preferences Survey participants, by respondent type and survey wave 94 Table 5.4: Sources of information about SRH self-care interventions for family planning, among Global Values & Preferences Survey participants, by respondent type and survey wave 96 Table 5.5: Means of accessing and sources of information about self-management of medical abortion, among Global Values & Preferences Survey participants, by respondent type and survey wave 99 Table 5.6: Means of accessing SRH self-care interventions for sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities, among Global Values & Preferences Survey participants, by respondent type and survey wave 100 Table 5.7: Sources of information about SRH self-care interventions for sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities, among Global Values & Preferences Survey participants, by respondent type and survey wave 102 Table 5.8: Means of accessing and sources of information about SRH self-care interventions for promoting sexual health, among Global Values & Preferences Survey participants, by respondent type (Wave 2 only, 2020–2021) 105 Table 5.9: Means of accessing online SRH information and mobile applications (apps), among Global Values & Preferences Survey participants, by respondent type (Wave 1 only, 2018) 106 Table 5.10: Sources of information about online SRH information and mobile applications (apps), among Global Values & Preferences Survey participants, by respondent type (Wave 1 only, 2018) 107 Figure 5.11: Experience of and values and preferences for accessing self-care interventions for SRHR with or without the involvement of a health worker, and for having access to a health worker after the use of an intervention (Wave 1 only, 2018) 110 Figure 5.12: Engagement with health care among Global Values & Preferences Survey participants, by respondent type and survey wave 113 Figure 6.1: Impacts of COVID-19 on use of self-care interventions and access to sexual health and reproductive health services, according to Global Values & Preferences Survey participants, by respondent type (Wave 2 only, 2020–2021) 118 vii ACKNOWLEDGEMENTS ACRONYMS AND ABBREVIATIONS COVID-19 Coronavirus disease GVPS Global Values and Preferences Survey HPV human papillomavirus LGBQ+ lesbian, gay, bisexual, queer or other sexual orientation PEP post-exposure prophylaxis PrEP pre-exposure prophylaxis SD standard deviation SRH sexual and reproductive health SRHR sexual and reproductive health and rights STI sexually transmitted infection UNAIDS United Nations Joint Programme on HIV/AIDS WHO World Health Organization This document is a web annex to the 2022 revision of the WHO guideline on self-care interventions for health and well-being. We acknowledge all those who supported work leading up to the development of the guideline and this web annex. Sincere thanks in particular to Carmen Logie, Isha Berry and Clara McNamee (Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada) for administering the online survey and analysing the results. We are also grateful to Ash Pachauri (Center for Human Progress, New Delhi, India) for managing the focus group discussions. We thank all the participants of the survey and focus group discussions for their time and valuable feedback. This document has been coordinated by Manjulaa Narasimhan of the Department of Sexual and Reproductive Health and Research, which includes the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) at the World Health Organization. viii WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report About this document 1 1Table of Contents Chapter summary This report presents the consolidated findings of two “waves” of the Global Values and Preferences Survey (GVPS) on self-care interventions, which were conducted in 2018 and in 2020–2021 among health workers and current or potential end-users of self-care interventions (i.e. laypersons). The survey responses to the first wave of the GVPS were taken into account in developing the new recommendations, as well as in assessing the strength of the recommendations to the 2019 WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights (1). The second wave of the GVPS used the same methods and was conducted to support the updating of the guidance, to create the 2022 revision of the WHO guideline on self-care interventions for health and well-being, to which this is a web annex. The results of the second wave are now being published for the first time in this report, combined with those of the first wave, which were first published in 2019 (2). A total of 1085 respondents from 194 Member States participated in the surveys. The full guideline is available at: https://www.who.int/publications/i/item/9789240030909. “Only if we keep ourselves healthy will we be able to live a better life. If we deal with issues in our daily life, it won’t be possible for us to fulfil our wishes and ultimately live the way we want to.” – Participant from self-care SRHR intervention workshop with men who have sex with men WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report2 Chapter 1 1.1 ABOUT THE GVPS AND FOCUS GROUP DISCUSSIONS 1 Available at: https://www.who.int/publications/i/item/9789240030909 The first GVPS (referred to in this report as “Wave 1”) was available online to respondents in English, French and Spanish and ran for seven weeks from mid-September to mid- November 2018. The second GVPS (“Wave 2”) was updated with an expanded scope and was available online in English, French and Spanish between November 2020 and June 2021. Both waves of the GVPS were self-administered online surveys. In each wave, the survey was open to adults ≥18 years of age; with the ability to complete the survey in English, French, or Spanish; and able to provide web-based informed consent. Participants were recruited through two complementary web-based strategies: (i) the survey was hosted on the WHO Department of Reproductive Health and Research website, and (ii) the survey was purposively shared with various (n=35) SRH listservs. The anonymous survey took approximately 20 minutes to complete and aimed to understand participants’ knowledge, uptake, and preferences on a range of self-care interventions. The study was approved by the University of Toronto Research Ethics Board (Protocol 36022). By beginning the survey, participants acknowledged that they were informed about the study purpose, risks and benefits and completed an online informed consent form before entering the survey. The survey questions included both general questions about health services and self-care interventions and also questions specific to a range of existing self-care interventions. Both versions of the survey provided both quantitative and qualitative data, since some open-ended questions and spaces for additional comments were included. Participant data were analysed separately by survey version (Wave 1 and Wave 2) and type of respondent (health workers and layperson respondents). Further details on the methods are available in related publications (3). There are limitations to this survey. For instance, we cannot infer causality from associations between variables, so a future longitudinal study to support the cross-sectional results may be warranted. The survey was only conducted in three languages (English, French, Spanish), and recruited via SRH listservs, suggesting a bias toward including persons who had prior knowledge on SRHR, self-care interventions and who had access. Internet surveys, while low cost and allowing participation from diverse global regions, may exclude persons without access to internet and mobile technology. This is one of the reasons focus group discussions (FGDs) were held in addition to the survey. Furthermore, Wave 2 of the GVPS was conducted during the COVID-19 pandemic and contributed to the response rates and decreased representativeness in the survey sample. However, despite these limitations, the outcomes noted here was always intended to be in addition to the evidence base presented to the guideline development group, that included systematic, literature, qualitative and costing reviews. Focus group discussions (FGDs) were also held during both waves of the GVPS to gather additional qualitative information to ensure in particular that the voices of underserved individuals and communities – who may not have had access to the online survey – were captured. In conjunction with Wave 1, participants in the FGDs were asked about their knowledge, use and uptake of self-care interventions, as well as any key issues that they experienced or expected in accessing or using the self-care interventions. In Wave 1, these workshops took place in several countries including Canada, India, Kenya, Mexico, Morocco and the United Kingdom of Great Britain and Northern Ireland. In Wave 2 the FGDs were held with in Cameroon, Egypt, India, Mexico, Nigeria and the United Arab Emirates. The FGDs in Wave 2 were held with adolescents and young people who were students or recent graduates, young married couples, drug users, sex workers, young people living with HIV and members of the LGBQ+ community – varying by country and location. During the FGDs in both waves, the groups also participated in creating artworks reflecting their perspectives on self-care in the context of their everyday lives and their communities. Summaries of key findings and selected drawings from these discussion sessions are presented in this document (see pages 16, 49, 50, 71, 109, 115, 120 and 121). 1.2 WHY IS THIS GVPS REPORT IMPORTANT? This report presents in detail the data used to inform the values and preferences component of the 2021 WHO guideline on self-care interventions for health and well-being.1 It presents both the evidence and the people-centred approaches that were central to the development of the guideline. The results from the surveys showed that the values and preferences of the potential end-users were variable and were closely tied to the individuals’ circumstances, needs and desires across the life course, and the environment in which they live. This report aims to showcase this diversity and also reveals gaps in the knowledge and uptake of self-care interventions. 3Chapter 1 1.3 STRUCTURE OF THE REPORT Throughout this report, the results are reported for two separate respondent groups – the health worker respondents and all other respondents, who are referred to throughout as “laypersons” – and data are also reported separately for the two survey waves. For all quantitative data, findings are presented both in tables and summarized in narrative text. Following this introduction, Chapter 2 presents data on the survey respondents’ sociodemographic characteristics, followed by their reported sources of information for learning about sexual and reproductive health (SRH) services derived from questions included in Wave 1 of the GVPS, and finally the results of specific scales on self-efficacy and sexual and reproductive autonomy that were only included in Wave 2 of the GVPS. In Chapter 3, sections 3.1 and 3.2, and in Chapter 5, section 5.1, quantitative findings are grouped under six subsections by type of intervention: (1) Antenatal, intrapartum and postnatal care (asked in Wave 2 only); (2) Family planning; (3) Abortion; (4) Sexually transmitted infections (STIs, including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (5) Promoting sexual health (asked in Wave 2 only); and (6) SRH information online and via mobile apps (asked in Wave 1 only). • The self-care interventions for SRHR included in both survey waves are: over-the-counter hormonal contraception, over-the-counter emergency contraception, contraceptive vaginal ring, self-administered contraception, diaphragm, self-management of medical abortion, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), STI self-sampling and HIV self-sampling (i.e. self-collection of a sample to be submitted for analysis at a facility, whether for screening or diagnostic testing). • Interventions that were only asked about in Wave 1 were: the contraceptive patch, STI and HIV treatment, online information and mobile applications (apps) for reproductive health and for sexual health. • New interventions added to the questions for Wave 2 of the survey included all those relating to antepartum, intrapartum and postnatal care: at-home pregnancy test, self-management of nutrition supplements (folic acid) during pregnancy planning, self-management of nutrition supplements (iron and folic acid) during pregnancy, self- management of nutrition supplements (iron and folic acid) during postpartum, self-monitoring/home-monitoring of blood glucose levels during pregnancy, self-monitoring/ home-monitoring of proteinuria during pregnancy, and self-monitoring/home-monitoring of blood pressure during pregnancy. In addition, Wave 2 also included human papillomavirus (HPV) self-sampling (i.e. self-collection of a sample to be submitted for HPV testing at a facility for purposes of screening for prevention of cervical cancer) and the interventions for promotion of sexual health – lubricants and hormone therapy for gender affirmation. • The first section of Chapter 3 reports on questions relating to respondents’ awareness about self-care interventions for SRHR and where to access them, as well as their or their partners’ experience of using these interventions, and the considerations which underpin their decision-making regarding use of these interventions (e.g. privacy/confidentiality, feelings of non-judgement, empowerment, convenience and access). The second section reports on health workers’ experiences of providing related services (referrals, prescriptions, information), how confident and informed they felt about providing such services, if they had any concerns about providing these services, and what they perceive as the benefits of each self-care intervention. After the presentation of the quantitative data on the above issues, Chapter 4 follows up by summarizing the related qualitative data gathered from respondents through the use of open-ended questions, shedding light on their values and preferences, their concerns and their hopes regarding the use of self-care interventions for SRHR. Four main themes emerged for both respondent groups and another two main themes for health worker respondents specifically, and the chapter thus presents information in six sections: (1) current concerns with self-care SRHR interventions; (2) potential benefits of self-care SRHR interventions; (3) preferred conditions for self-care SRHR intervention implementation; (4) future issues for considerations with self-care SRHR interventions (5) linkages to health care (health workers only); and (6) health worker training and information needs (health workers only). Throughout this document are one-page highlights from discussions with health-care workers and vulnerable population groups. Accompanying these are artworks created by the respective communities, representing their perspectives on self-care interventions. WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report4 Chapter 1 FIGURE 1: TOPICS AND RESPONDENTS INCLUDED IN GPVS WAVE 1 AND WAVE 2 WAVE 1: 2018 – HW & LP WAVE 2: 2020–2021 – HW & LP GVPS sections Sociodemographic questions: CH2 Relationship status was NOT asked Engagement in sex work was asked Self-reported health status was NOT asked Sociodemographic questions: Relationship status was asked Engagement in sex work was NOT asked Self-reported health status was asked Self-efficacy and autonomy scales: CH2 NOT included Self-efficacy and autonomy scales: NGSE Scale included RH and SH autonomy scales included Other: CH2 Sources of info/learning about SRHR and SRH services Other: Sources NOT asked Quantitative questions per intervention CH3 1. Awareness about intervention NOT asked in Wave 1 for at-home pregn test, self-mgmt of nutrition supplements during preg planning, self- mgmt of nutrition supplements during preg, self-mgmt of nutn suppl postpartum, self-monitoring/home- monitoring of blood glucose levels during preg, self- monitoring/home-monitoring of proteinuria during preg, self-monitoring/home-monitoring of blood pressure during preg, lubricant, hormone therapy for gender affirmation, HPV self-sampling 2. Ever use (and recent use) of intervention by self or partner – same items as noted above 3. Decision-making considerations for use of interventions – same items as noted above. Also for each item included, cost and legal restrictions were NOT asked in Wave 1 (but accessibility was asked) 4. Means of accessing interventions – same items as noted above (but response options did NOT include From a peer, outreach or community worker) 5. Sources of information about interventions – same items as noted above 6. HW ONLY: Health workers’ experience of, confidence and concerns about providing self-care SRHR interventions and perceived benefits: quantitative findings – same items as noted above Quantitative questions per intervention 1. Awareness about intervention NOT asked in Wave 2 for contraceptive patch, HIV tx, STI tx, RH online info, RH mobile app, SH online info, SH mobile app. But many others were added (see list on left of items not asked Wave 1). 2. Ever use (recent use NOT asked in Wave 2) of intervention by self or partner – same items as noted above 3. Decision-making considerations for use of interventions – same items as noted above. Also for each item included, accessibility was NOT asked Wave 2 (but cost and legal restrictions were added) 4. Means of accessing interventions – same items as noted above (but response options DID include From a peer, outreach or community worker) 5. Sources of information about interventions – same items as noted above 6. HW ONLY Health workers’ experience of, confidence and concerns about providing self-care SRHR interventions and perceived benefits: quantitative findings – same items as noted above Engaging with HW for interventions CH4 1. Experience of and values and preferences for accessing self-care SRHR interventions with or without the involvement of a health worker, and for having access to a health worker after the use of an intervention: quantatitve data on 4 items - qualitative data (quotes) about the above also 2. Ease of access to interventions: quantitative data only – 2 items only (distance was NOT asked) Engaging with HW for interventions 1. NOT ASKED IN WAVE 2 2. Yes, 3 items, including addition in Wave 2 of distance from health-care facility Chapter 5 includes a combination of both quantitative and qualitative information, focusing on respondents’ experiences with and preferences for accessing self-care interventions for SRHR or information about these interventions, and for engagement with health workers in relation to these interventions. In section 5.1, quantitative findings report on where both types of respondents access self-care interventions for SRHR, as well as where they access information on these interventions, grouped by type of intervention as described above. In section 5.2, quantitative and qualitative data from Wave 1 of the survey are presented, relating to preferences for engaging or not engaging with health workers when using or after using self-care interventions for SRHR. Data providing an overall summary of ease of access to health care and online information are also presented. Chapter 6 provides information on reported changes in participants’ use of self-care interventions for SRHR, and in their access to both sexual health and reproductive health services, as a result of the COVID-19 pandemic. 5Chapter 1 WAVE 1: 2018 – HW & LP WAVE 2: 2020–2021 – HW & LP Qual/open-ended questions on: CH5 1. Current concerns with self-care SRHR interventions – HW and LP 2. Potential benefits of self-care SRHR interventions – HW and LP 3. Preferred conditions for self-care SRHR intervention implementation – HW and LP 4. Future issues for considerations with self-care SRHR interventions – HW and LP 5. Health worker perspectives on linkages to health care – HW ONLY 6. Health worker perspectives on training and information needs – HW ONLY WE HAVE WAVE 2 DATA FOR EACH, except for (4) Future issues for LP (we have it for HW only) COVID-19 CH6 - NA in 2018 COVID-19 Use of self-care interventions changed? Access to RH changed? Access to SH changed? Focus group discussions: underserved communities Focus group discussions: adolescents and young people in 6 countries Inclusivity All individuals have the right to equality and non-discrimination in accessing services. The right to be free from discrimination is stated in the Universal Declaration of Human Rights and in other universal human rights treaties and regional human rights instruments. It has been affirmed that the right to non-discrimination guaranteed by the International Covenant on Economic, Social and Cultural Rights (ICESCR) includes sexual orientation, gender identity and sex characteristics. As stated in the 2018 report of the Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity to the United Nations General Assembly, “the right to effective recognition of one’s gender identity is linked to the right to equal recognition before the law”.(4) Providers of health services must consider the needs of – and provide equal care to – all individuals; gender identity or its expression must not lead to discrimination. References for Chapter 1 1. WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights. Geneva: World Health Organization; 2019 (https://www.who.int/ reproductivehealth/publications/self-care-interventions/en/). 2. WHO Self-care interventions for health: sexual and reproductive health and rights. Web Annex A: Global Values and Preferences Survey report. Geneva: World Health Organization; 2019 (https://apps.who.int/iris/bitstream/ handle/10665/329989/WHO-RHR-19.24-eng.pdf). 3. Logie C, Okumu M, Abela H, Wilson D, Narasimhan M. Sexual and reproductive health mobile apps: results from a cross-sectional values and preferences survey to inform World Health Organization normative guidance on self-care interventions. Glob Health Action. 2020;13(1):1796346. doi: 10.1080/16549716.2020.1796346. 4. Report of the Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity, 12 July 2018. New York (NY): United Nations General Assembly; 2018 (A/73/152; https://undocs. org/A/73/152). 6 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Sociodemographic characteristics, self-efficacy, autonomy, and sources of information relating to self-care interventions 2 7Table of Contents Chapter summary This chapter presents data tables and a narrative summary of survey respondents’ sociodemographic characteristics for both Wave 1 and Wave 2 of the GVPS, followed by information on Wave 1 respondents’ sources of information for learning about sexual and reproductive health (SRH) services and about sexual and reproductive health and rights (SRHR). Finally, this chapter reports on the results of specific scales on self-efficacy and sexual and reproductive autonomy, which were only included within Wave 2 of the GVPS. For Waves 1 and 2, most of the health worker respondents were resident in the WHO Region of the Americas, the African Region and the European Region. Regarding gender, in Wave 1, about two thirds of health worker respondents reported identifying as women, about one third as men, and one respondent (0.3%) identified as transgender/two spirited/another gender identity. This was similar in Wave 2, when three quarters of health worker respondents identified as women, one fifth as men, and six respondents (3.5%) identified as transgender/two spirited/another gender identity. For both waves, the majority identified their sexual orientation as heterosexual, while a minority identified as sexually diverse (i.e. lesbian, gay, bisexual, queer, or other sexual orientation [LGBQ+]). The average age of health worker respondents was 38.0 years in Wave 1 and 42.8 years in Wave 2. Most health workers reported having a postgraduate degree and working in full-time paid employment in both waves. Among layperson respondents in both waves, most were from the Region of the Americas, the African Region and the European Region. In both waves, most of these respondents self-identified as women with a minority identifying as men, and just six and two people in Waves 1 and 2 respectively did not identify as either. Across waves, the majority of respondents reported their sexual orientation as heterosexual, with a minority identifying as sexually diverse. In Wave 1, the average age of these respondents was 31.9 years, while in Wave 2 it was 34.9. In Waves 1 and 2, most respondents reported having a bachelor’s (undergraduate) or a postgraduate degree, with the majority of each sample reporting their current employment status as full-time or as current students. Wave 1 respondents were asked about the sources of information from which they had received information about various SRH services, and online sources from which they would like to learn more about these services. The top three sources that both health worker and layperson respondents reported accessing information about SRH services from were the internet, school and doctors. The vast majority of health worker and layperson respondents indicated that they would prefer to learn about SRH services from trusted websites. Wave 2 participants were administered scales measuring general self-efficacy and sexual and reproductive autonomy. Altogether, respondents rated their overall self-efficacy highly (mean = 4.0 on a 5-point scale), and reported a high degree of sexual autonomy (mean = 3.2 on a 4-point scale) and reproductive autonomy (mean = 3.5 on a 4-point scale). There were few differences between health worker and layperson respondents. “I use condoms. My peers were the ones who told me to use it. When I first came here, they asked me to take an HIV test and I refused, but they made me understand that this was for my own benefit.” – Commercial sex worker Chapter 2 8 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report 2.1 SOCIODEMOGRAPHIC PROFILE OF PARTICIPANTS While Wave 1 received 837 responses originating from a total of 112 countries, Wave 2 received 260 responses from across 218 countries (see Appendix A for list of countries). Table 2.1 presents the background and sociodemographic characteristics of two respondent groups – health workers and laypersons – in each survey wave and totals for all respondents in each survey wave. Narrative summaries of this information are provided below. In order to define the two respondent groups for the purposes of analysis, all survey respondents were asked if they were “a health worker, educator or researcher”. Of those who responded to this question (Wave 1: n=528; Wave 2: n=260), about two thirds of participants in each wave said “Yes” – they self-identified as being in one of these three professions (Wave 1: 68.2%, n=360; Wave 2: 67.3%, n=175), and they are grouped and referred to in this document as “health workers”, while the remaining third of the respondents said “No”, they were not any of these professions (Wave 1: 31.8%, n=168; Wave 2: 32.7%, n=85), and they are referred to in this document as “laypersons”. Of note, about one third of Wave 1 respondents (36.9%, n=309) did not respond to this question, and were therefore included as laypersons by default for the purpose of further analyses for this report. In Wave 2, only 2 respondents did not indicate their status on this question, and were excluded from all the analyses. Overall, as shown in Table 2.1 below, in Wave 1, 43.0% of respondents were categorized as health workers and 57.0% (n=477) as laypersons, while in Wave 2, a majority of respondents identified as health workers (67.3%), while one third (32.7%) were laypersons. TABLE 2.1. SOCIODEMOGRAPHIC CHARACTERISTICS OF GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE Gender Men Women Transgender/two spirited/another gender identity Prefer not to say Health workersa Wave 1 n=360 30.8%, n=111 68.9%, n=248 0.3%, n=1 0.0%, n=0 Wave 2 n=173 20.8%, n=36 75.7%, n=131 3.5%, n=6 0.0%, n=0 Laypersonsb Wave 1 n=465 30.1%, n=140 68.0%, n=316 1.3%, n=6 0.6%, n=3 Wave 2 n=85 12.9%, n=11 83.5%, n=71 2.4%, n=2 1.2%, n=1 The solid dots represent 10 people The circle outlines represent less than 10 people Total health workers Wave 1 Wave 1Wave 2 Wave 2 360 175 477 85 Layperson respondents Chapter 2 9 Age 18–29 30–39 40–49 50–59 60–69 70+ Health workersa Wave 1 n=358 32.7%, n=117 27.4%, n=98 20.1%, n=72 12.3%, n=44 4.7%, n=17 2.8%, n=10 Wave 2 n=168 16.7%, n=28 28.0%, n=47 26.8%, n=45 19.1%, n=32 8.3%, n=14 1.2%, n=2 Laypersonsb Wave 1 n=464 56.5%, n=262 19.6%, n=91 11.9%, n=55 7.1%, n=33 3.9%, n=18 1.1%, n=5 Wave 2 n=82 48.8%, n=40 17.1%, n=14 19.5%, n=16 7.3%, n=6 6.1%, n=5 1.2%, n=1 WHO region African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region Health workersa Wave 1 n=360 28.3%, n=102 34.7%, n=125 6.1%, n=22 23.3%, n=84 4.7%, n=17 2.8%, n=10 Wave 2 n=143 23.1%, n=33 48.3%, n=69 5.6%, n=8 9.8%, n=14 7.7%, n=11 5.6%, n=8 Laypersonsb Wave 1 n=168 19.1%, n=89 23.4%, n=109 4.3%, n=20 33.8%, n=157 8.0%, n=37 11.4%, n=53 Wave 2 n=75 16.0%, n=12 62.7%, n=47 4.0%, n=3 10.7%, n=8 5.3%, n=4 1.3%, n=1 World Bank income group High income Upper middle income Lower middle income Low income Health workersa Wave 1 - - - - Wave 2 n=140 45.8%, n=65 14.8%, n=21 29.6%, n=42 8.5%, n=12 Laypersonsb Wave 1 - - - - Wave 2 n=73 67.1%, n=49 5.5%, n=4 23.3%, n=17 4.1%, n=3 Sexual orientation Heterosexual/straight Sexually diverse (LGBQ+) Prefer not to say Health workersa Wave 1 n=358 84.9%, n=304 13.4%, n=48 1.7%, n=6 Wave 2 n=172 77.3%, n=133 22.7%, n=39 - Laypersonsb Wave 1 n=464 75.6%, n=351 22.2%, n=103 2.2%, n=10 Wave 2 n=84 64.3%, n=54 35.7%, n=30 - Chapter 2 10 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Disability Yes No Health workersa Wave 1 n=360 2.5%, n=9 97.5%, n=351 Wave 2 n=170 19.4%, n=33 80.6%, n=137 Laypersonsb Wave 1 n=466 3.4%, n=16 96.6%, n=450 Wave 2 n=84 20.2%, n=17 79.8%, n=67 Engaged in sex work Yes No Health workersa Wave 1 n=359 5.0%, n=18 95.0%, n=341 Wave 2 - - Laypersonsb Wave 1 n=465 2.8%, n=13 97.2%, n=452 Wave 2 - - Relationship status No current partner One partner Multiple partners Health workersa Wave 1 - - - Wave 2 n=169 13.6%, n=23 79.9%, n=135 6.5%, n=11 Laypersonsb Wave 1 - - - Wave 2 n=67 22.4%, n=15 59.7%, n=40 17.9%, n=12 Self-reported health status Excellent Good Fair Poor Health workersa Wave 1 - - - - Wave 2 n=174 22.4%, n=39 68.4%, n=119 9.2%, n=16 0.0%, n=0 Laypersonsb Wave 1 - - - - Wave 2 n=83 20.5%, n=17 69.9%, n=58 9.6%, n=8 0.0%, n=0 Chapter 2 11 Size of city/town Big city (> 1 million inhabitants) Large city (300 000– 1 million inhabitants) Small city (100 000– 300 000 inhabitants) Large town (20 000–100 000 inhabitants) Medium town (1000–20 000 inhabitants) Small town or hamlet (< 1000 inhabitants) Health workersa Wave 1 n=357 49.6%, n=177 18.5%, n=66 10.9%, n=39 11.2%, n=40 7.0%, n=25 2.8%, n=10 Wave 2 n=173 49.7%, n=86 23.1%, n=40 11.6%, n=20 8.1%, n=14 4.6%, n=8 2.9%, n=5 Laypersonsb Wave 1 n=167 49.7%, n=83 19.2%, n=32 8.4%, n=14 9.0%, n=15 9.6%, n=16 4.2%, n=7 Wave 2 n=67 47.8%, n=32 16.4%, n=11 16.4%, n=11 14.9%, n=10 3.0%, n=2 1.5%, n=1 Highest level of education Completed high school Undergraduate degree Postgraduate degree Other Health workersa Wave 1 n=358 6.7%, n=24 27.1%, n=97 65.6%, n=235 0.6%, n=2 Wave 2 n=173 2.3%, n=4 15.6%, n=27 63.0%, n=109 19.1%, n=33 Laypersonsb Wave 1 n=178 27.5%, n=49 36.5%, n=65 35.4%, n=63 0.6%, n=1 Wave 2 n=65 13.9%, n=9 38.5%, n=25 40.0%, n=26 7.7%, n=5 Employment statusc Employed – full time Employed – part time Self-employed Casual labour Student Unemployed Health workersa Wave 1 n=357 62.7%, n=224 12.3%, n=44 8.1%, n=29 0.8%, n=3 18.2%, n=65 3.1%, n=11 Wave 2 n=172 67.4%, n=116 11.6%, n=20 13.4%, n=23 1.7%, n=3 9.3%, n=16 2.3%, n=4 Laypersonsb Wave 1 n=166 40.4%, n=67 6.6%, n=11 5.4%, n=9 1.2%, n=2 48.8%, n=81 3.0%, n=5 Wave 2 n=66 45.5%, n=30 13.6%, n=9 4.6%, n=3 0.0%, n=0 27.3%, n=18 13.6%, n=9 Type of health workerc Doctor Researcher Staff at clinic/ agency providing SRH information/ education Activist Health educator Health workersa Wave 1 n=355 27.6%, n=98 - 22.0%, n=78 18.6%, n=66 15.2%, n=54 Wave 2 n=175 18.9%, n=33 32.0%, n=56 10.9%, n=19 17.1%, n=30 17.7%, n=31 Chapter 2 12 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Type of health workerc (continued) Nurse or other health-care professional Community worker Pharmacist Midwife Other Health workersa Wave 1 n=355 11.8%, n=42 6.5%, n=23 22.5%, n=80 3.1%, n=11 19.7%, n=70 Wave 2 n=174 9.7%, n=17 4.6%, n=8 3.4%, n=6 6.9%, n=12 13.1%, n=23 SD: standard deviation. Note: Denominators (subtotals) vary across variables/rows because of non-response on some items. - Indicates that the question or response option was not asked in a given wave. a This group includes all respondents who said “Yes” to a question asking if they were “a health worker, educator or researcher”. b This group includes all respondents who said “No” to being “a health worker, educator or researcher”, and those in Wave 1 who failed to answer that question. c Selection of multiple response options was possible. 2.1.1 Health workers Health worker respondents were asked what kind of health worker they were, with the option to choose all that apply. In the second GVPS (Wave 2), the option of “Researcher” was added, and it was selected by almost a third of respondents, the highest proportion among the available options. Across survey waves, the other top responses for this question were doctor (Wave 1: 27.6%; Wave 2: 18.9%), followed by staff at a clinic/ agency providing SRH information or education (Wave 1: 22%; Wave 2: 10.9%), activist (Wave 1: 18.6%; Wave 2: 17.1%), health educator (Wave 1: 15.2%; Wave 2: 17.7%), and nurse or other health worker (Wave 1: 11.8%; Wave 2: 9.7%). In Wave 1, 22.5% of respondents reported being pharmacists, while in Wave 2 this was just 3.4%. Only a small proportion of health worker respondents reported being community workers or midwives in both waves. Up to a fifth of participants selected “other” without further specification (see Table 2.1). Among the health worker respondents who identified their country of residence, the largest proportion were from the WHO Region of the Americas (Wave 1: 34.6%; Wave 2: 48.3%), followed by the African Region (Wave 1: 28.3%; Wave 2: 23.1%) and the European Region (Wave 1: 23.3%; Wave 2: 9.8%). In both waves, less than 10% resided in the Eastern Mediterranean Region (Wave 1: 4.7%; Wave 2: 7.7%), the South-East Asia Region (Wave 1: 6.1%; Wave 2: 5.6%) and the Western Pacific Region (Wave 1: 2.8%; Wave 2: 5.6%). The countries with the highest numbers of health worker respondents in Wave 1 were Kenya (n=48), the United States of America (USA) (n=44) and Colombia (n=34), while in Wave 2 they were the USA (n=27), Canada (n=16) and Nigeria (n=14) (see Appendix A for details). In Wave 2, respondents were also analysed according to the World Bank income groups of their countries of residence. Almost half of health worker respondents lived in high-income countries (45.8%) and just 8.5% lived in low-income countries. Health worker respondents varied widely in age, ranging from 18 to 87 years in Wave 1, and from 21 to 74 years in Wave 2. In Wave 1, the age group with the greatest number of respondents was 18–29 years (32.7%), followed by 30–39 years (27.4%) and 40–49 years (20.1%). For Wave 2, the age group with the greatest number of respondents was 30–39 years (28.0%), followed by 40–49 years (26.8%) and 50–59 years (19.1%). The mean age of health worker respondents in Wave 1 was 38.0 years and in Wave 2 it was 42.8 years (see Appendix B for details). The majority of health worker respondents in both waves identified as women (Wave 1: 68.9%; Wave 2: 75.7%), while a sizable minority said they were men (Wave 1: 30.8%; Wave 2: 20.8%). A small minority of respondents identified as transgender, two spirited or another gender identity (1 respondent in Wave 1 and 6 in Wave 2). Regarding sexual orientation, the majority of health worker respondents in both waves identified as heterosexual or straight (Wave 1: 84.9%; Wave 2: 77.3%), while a minority identified as sexually diverse (LGBQ+): 13.4% in Wave 1 and 22.7% in Wave 2. In Wave 1, just 2.5% of health worker respondents identified as having a disability, while in Wave 2, it was as high as 19.4%. Data on having ever engaged in sex work were only collected in Wave 1, with 5.0% of health workers reporting this. Relationship status data were only collected in Wave 2, with the majority of health workers reporting having one partner (79.9%), while 13.6% reported having no current partner, and 6.5% reported having multiple partners. In Wave 2, respondents were asked to rate their perceived health. Over 90% rated their health as either “excellent” or “good”, with the remainder selecting “fair”. About half of health worker respondents in each wave reported living in a big city of more than a million inhabitants, while just under a quarter lived in large cities of 300 000 to 1 million. Approximately 1 in 10 health workers in each wave reported living in a city with a population of 100 000–300 000 inhabitants or in large towns of 20 000–100 000 inhabitants. Less than 10% lived in towns of 1000–20 000 inhabitants and approximately 3% in each wave lived in a small town or hamlet of less than 1000 inhabitants. Chapter 2 13 The majority of health workers in both waves reported high educational qualifications, with over 60% reporting having a postgraduate (master’s or higher) degree, about 15–30% having an undergraduate (bachelor’s) degree, and less than 10% reporting high school as their highest education level. Just a couple of Wave 1 respondents and 33 Wave 2 respondents (19.1%) selected “other” without further specification. Regarding current employment at the time of the survey, respondents could select multiple response options. Approximately two thirds of health workers in both survey waves reported full-time employment while around 10–20% of respondents in each wave reported being self-employed, holding part-time paid employment, and being a current student. Less than 5% in both waves were unemployed or were casual labourers. 2.1.2 Layperson respondents Among laypersons – those who did not report being health workers/researchers/educators – the most common WHO regions of residence were the Region of the Americas (Wave 1: 23.4%; Wave 2: 62.7%), the African Region (Wave 1: 19.1%; Wave 2: 16.0%) and the European Region (Wave 1: 33.8%; Wave 2: 10.7%). While 11.4% of Wave 1 laypersons reported residing in the Western Pacific Region, only 1 respondent (1.3%) in Wave 2 reported residing in this region. In both waves, less than 10% reported residing in countries in the Eastern Mediterranean Region (Wave 1: 8.0%; Wave 2: 5.3%) and the South-East Asia Region (Wave 1: 4.3%; Wave 2: 4.0%). In Wave 1, the countries with the most layperson respondents were Portugal (n=61), the USA (n=54), Kenya (n=37) and Singapore (n=31), while in Wave 2 more than half of layperson respondents were concentrated in the USA (n=21) and Canada (n=21) (see Appendix A for details). In Wave 2, respondents were also analysed according to the World Bank income groups of their countries of residence. Two thirds of the layperson respondents lived in a high-income country (67.1%) and just 4.1% were resident in low-income countries (see Table 2.1). Wave 1 participants ranged widely in age from 18 to 83 years, while in Wave 2 they ranged from 18 to 74 years. About half of respondents in both waves were in the 18–29 age group (Wave 1: 56.5%; Wave 2: 48.8%). The next most common age groups were 30–39 years (Wave 1: 19.6%; Wave 2: 17.1%) and 40–49 years (Wave 1: 11.9%; Wave 2: 19.5%). The mean age of Wave 1 layperson respondents was 31.9 years, and in Wave 2 it was 34.9 years (see Appendix B for details). The majority of layperson participants in both waves self- identified as women (Wave 1: 68.0%; Wave 2: 83.5%), while a minority identified as men (Wave 1: 30.1%; Wave 2: 12.9%) and a small number identified as transgender, two spirited or another gender identity (6 in Wave 1, and 2 in Wave 2). Additionally, a total of 4 laypersons preferred not to report their gender. Regarding sexual orientation, the majority of laypersons identified as heterosexual or straight (Wave 1: 75.6%; Wave 2: 64.3%), while in Wave 1 about a fifth identified as sexually diverse/LGBQ+ (22.2%), as did about a third in Wave 2 (35.7%). In Wave 1, just 3.4% of laypersons identified as having a disability, while this was as high as 20.2% in Wave 2 – similar to the data for health workers. Data on having ever engaged in sex work were only collected in Wave 1, with 2.8% of laypersons reporting this. Relationship status data were only collected in Wave 2, with the majority of laypersons reporting having one partner (59.7%), while 22.4% reported having no current partner and 17.9% reported having multiple partners. Wave 2 respondents were also asked to rate their health status. The vast majority of respondents rated their health as either “excellent” or “good” (90.4%), while the remained selected “fair”. Of those who reported the size of the city or town in which they lived, about half of layperson respondents in both waves reported living in a big city with a population of over 1 million, while just under a fifth reported living in a large city with a population between 300 000 and 1 million. Between 10% and 20% of participants in both waves reported living in a small city with a population of 100 000–300 000 or in a a large town with a population of 20 000–100 000. In both waves, under 10% lived in a medium town with 1000–20 000 inhabitants and under 5% lived in a small town or hamlet of less than 1000 inhabitants. Of those layperson participants who responded regarding their highest level of education in each wave, more than a third had a bachelor’s degree (Wave 1: 36.5%; Wave 2: 38.5%), and a similar amount had a postgraduate degree (Wave 1: 35.4%; Wave 2: 40.0%). Over a quarter of Wave 1 respondents reported high school as their highest educational attainment (27.5%), as did 13.9% in Wave 2. Just 1 respondent in Wave 1 and 5 in Wave 2 selected “other” without further specification. Regarding current employment status, participants were able to select multiple options. Similar proportions in both waves reported full-time paid employment (Wave 1: 40.4%; Wave 2: 45.5%). Almost half of Wave 1 participants reported being a current student (48.8%), while just over a quarter of Wave 2 participants (27.3%) said the same. Small numbers of laypersons in each sample reported holding part-time paid employment, being unemployed, self-employed, or holding casual employment. Chapter 2 14 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report 2.2 SOURCES OF INFORMATION ABOUT SEXUAL AND REPRODUCTIVE HEALTH SERVICES This section reports results based on questions in Wave 1 of the GVPS about sources of information on SRH services. The two questions were: (i) Where have you learned about SRH services? (14 options were listed, with instructions to choose all that apply; see Figure 2.1); and (ii) What types of online or social media resources would you like to use to learn more about SRHR? (12 options were listed, with instructions to choose all that apply; see Figure 2.2). FIGURE 2.1. SOURCES OF INFORMATION FROM WHICH GVPS PARTICIPANTS REPORTED LEARNING ABOUT SRH SERVICES, BY RESPONDENT TYPE (WAVE 1 ONLY, 2018) KEY Health workers (n=357) Layperson respondents (n=179) 21.6% 24.0% SOURCES OF INFORMATION ON SRHR SERVICES 66.7% 3.4% 6.2% 5.3% 2.5% 68.2% 1.7% 7.3% 6.7% 1.1% 66.7% 63.7% 45.4% 45.8% 42.9% 57.0% 32.2% 36.3% 22.4% 19.6% 10.1% 26.6% 27.4% INTERNET 70.3% 82.7% 23.2% Own work/profession – 9.5% University – 6.2% Nongovernmental organization or non-profit – 3.6% Own work/profession – 3.9% University – 3.4% Nongovernmental organization or non-profit – 1.7% SCHOOL BROTHER SISTEROTHER FAMILY MEMBERS PARENT SUPPORT GROUP DOCTORS BOOKS AND MAGAZINES FRIENDS TV/FILMS/ VIDEOS/ RADIO PARENT OTHER COMMUNITY OUTREACH OFFICER, WORKER OR NURSE PARTNER For this option, respondents could write in a response. Those responses were coded and the top options for other sources were: Chapter 2 15 2.2.1 Health workers Respondents were asked about the sources of their existing knowledge about SRH services. The majority of health worker respondents reported the internet (70.3%), school (66.7%) and/or doctors (66.7%) as being their sources for SRHR knowledge. Around a third or more also mentioned books/ magazines (45.4%), friends (42.9%) and/or TV/films/videos/ radio (32.2%), while around a quarter mentioned their partner (26.6%), a community outreach officer, worker or nurse (22.4%) and/or a parent (21.6%). Almost a quarter (23.2%) of health worker respondents also chose the “other” option and wrote in a different response. These “other” responses were coded, and the top sources mentioned in this way were work/occupation/ profession, university and nongovernmental (or non-profit) organizations. Respondents were also asked what types of online resources they would prefer to use to learn more about SRHR. Over half of the health worker respondents chose websites that they trust, such as the World Health Organization (WHO) and the United Nations Joint Programme on HIV/AIDS (UNAIDS) (82.0%) and online web search (57.7%). The next most highly preferred resources were mobile phone apps (38.3%), webinars (34.9%), getting emails with information (34.6%), television series (24.0%) and Facebook (20.9%). Less than 20% of respondents mentioned radio (17.1%), getting text messages with information (14.6%), WhatsApp (14.3%) or Twitter (12.9%) as preferred online resources. 2.2.2 Layperson respondents Among layperson survey participants, the top sources for information about SRH services – mentioned by more than half of the respondents – were the internet (82.7%), school (68.2%), doctors (63.7%) and friends (57.0%). Other sources mentioned by a substantial proportion of respondents were books/ magazines (45.8%), TV/films/videos/radio (36.3%), a partner (27.4%); a parent (24.0%); and a community outreach officer, worker or nurse (19.6%). Similar to the health worker respondents, the preferred online SRHR sources most commonly mentioned were trusted websites (e.g. WHO, UNAIDS) (86.0%) and online web searches (56.7%), followed by substantial numbers mentioning mobile phone apps (32.7%), emails with information (29.2%), television series (28.7%), webinars (24.0%), Facebook (17.5%), radio (14.0%) and text messages with information (12.9%). Twitter Other WhatsApp Text messages with information Radio Facebook Television series Emails with information Webinar Mobile phone apps Online searches Websites they trust (e.g. WHO, UNAIDS) 5.3% 5.3% 12.9% 7.1% 9.4%14.3% 12.9%14.6% 14.0%17.1% 17.5%20.9% 28.7%24.0% 29.2%34.6% 24.0%34.9% 32.7%38.3% 56.7%57.7% 86.0%82.0% FIGURE 2.2. PREFERENCES FOR ONLINE INFORMATION SOURCES FROM WHICH GVPS PARTICIPANTS WOULD LIKE TO LEARN MORE ABOUT SRHR, BY RESPONDENT TYPE (WAVE 1 ONLY, 2018) Chapter 2 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Drug-using juvenile girls in conflict with the law This workshop was held in New Delhi, India and involved female participants, the majority of whom were minors. The youngest was 10 years old. Education levels varied, but many were illiterate and came from poor backgrounds. All were accessed via a drug rehabilitation centre. Resource mapping and graffiti were used as tools to promote dialogue during the session. The key issues raised by the participants included: 1. The girls described numerous common physical ailments such as blurred vision, dizziness and sleeplessness, as well as complications resulting from gonorrhoea and the use of unclean needles. 2. Common ailments are often treated at home, after reaching out to family members. 3. The participants had used alcohol, marijuana, adhesive solutions, pain killers, cough syrups, heroin, cocaine and other drugs. 4. They reported frequently visiting pharmacists for medication, with or without prescriptions. Several have also visited “voodoo” practitioners. 5. Participants were largely uneducated about health issues and health care, including having no knowledge of HIV or HIV risk reduction strategies prior to enrolment in the rehabilitation centre. 6. At the centre, they obtained information, testing and treatment for drug- and HIV-related issues and accessed counsellors and doctors. 7. They also reported gathering information about health issues from TV, radio, billboards and newspaper ads and through books. There were two people living with HIV in this group. This group were at risk of HIV and hepatitis C, through shared use of infected needles and sexual transmission (several of the participants were sexually abused, raped or married as minors.) “We come from very poor, uneducated backgrounds and we cannot read or write. So we don’t practise self-care as we don’t know anything about it.” Ease of access was a perceived benefit, although the participants did not report use of many self-care products. Being unable to read or write restricts access to self-care products. Those from a poor, uneducated background do not have access to self-care products or even knowledge about health issues and how to address them. HIGHLIGHTS FROM COMMUNITY WORKSHOPS Benefits and barriers to self-care interventions Artwork from this workshop co mmu nity 16 Chapter 2 17 Drug-using juvenile girls in conflict with the law Artwork from this workshop co mmu nity FIGURE 2.3. NEW GENERAL SELF-EFFICACY (NGSE) SCALE RESPONSE FREQUENCIES AND MEAN OVERALL SCORES AMONG ALL GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, AND BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) Strongly agree Strongly agree Strongly agree Strongly agree Agree Agree Agree Agree Neither agree nor disagree Neither agree nor disagree Neither agree nor disagree Neither agree nor disagree Disagree Disagree Disagree Disagree Strongly disagree Strongly disagree Strongly disagree Strongly disagree Mean score (range 1–5) Mean score (range 1–5) Mean score (range 1–5) Mean score (range 1–5) 37.8 19.3 27.0 25.3 22.7 10.6 22.7 28.8 53.7 60.3 67.3 56.8 56.1 59.1 60.6 43.9 4.9 14.3 3.1 3.113.0 4.4 9.1 15.2 10.6 16.7 7.6 12.1 3.0 7.6 4.6 1.2 2.4 1.9 1.3 1.9 1.3 3.0 3.0 3.0 Health-care providers (%) Health-care providers (%) Health-care providers (%) Health-care providers (%) Laypersons (%) Laypersons (%) Laypersons (%) Laypersons (%) 4.2 3.9 4.2 4.0 3.8 3.6 4.0 3.9 I will be able to achieve most of the goals that I set for myself When facing difficult tasks, I am certain that I will accomplish them In general, I think that I can obtain outcomes that are important to me I believe I can succeed at most any endeavour I set my mind to 2.3 NEW GENERAL SELF-EFFICACY (NGSE) SCALE: RESPONDENTS’ RESULTS (WAVE 2) Wave 2 of the GVPS included the eight-item NGSE Scale (1) for all respondents. The NGSE scale measures general self-efficacy – that is, an individual’s belief that they can achieve their goals across a variety of situations. Participants rated each item on a five-point Likert scale from 1 – “Strongly disagree” to 5 – “Strongly agree”, with higher scores indicating a greater degree of self- efficacy. Response frequencies for individual items and overall mean scores are presented in Figure 2.3. Chapter 2 18 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Strongly agree Strongly agree Strongly agree Strongly agree Agree Agree Agree Agree Neither agree nor disagree Neither agree nor disagree Neither agree nor disagree Neither agree nor disagree Disagree Disagree Disagree Disagree Strongly disagree Strongly disagree Strongly disagree Strongly disagree Mean score (range 1–5) Mean score (range 1–5) Mean overall score (SD) Mean score (range 1–5) Mean score (range 1–5) 26.7 21.1 24.5 29.8 24.6 20.0 27.7 34.4 61.5 60.9 54.1 62.7 56.9 56.9 49.2 53.1 3.7 3.1 7.5 14.3 16.4 5.0 10.8 13.9 18.5 6.3 4.6 9.2 4.6 3.1 0.6 1.9 1.9 1.9 1.2 1.2 3.1 3.1 Health-care providers (%) Health-care providers (%) Health-care providers Health-care providers (%) Health-care providers (%) Laypersons (%) Laypersons (%) Laypersons Laypersons (%) Laypersons (%) 4.1 4.0 4.1 (0.6) 4.0 4.2 4.0 3.9 3.9 (0.7) 4.0 4.1 I will be able to successfully overcome many challenges Even when things are tough, I can perform quite well New General Self-Efficacy Scale scorea Compared to other people, I can do most tasks very well I am confident that I can perform effectively on many different tasks SD: standard deviation Notes: The response options for each question were “strongly disagree” (1), “disagree” (2), “neither agree nor disagree” (3), “agree” (4) and “strongly agree” (5), such that scores for each respondent (and mean scores across all respondents) ranged from 1 to 5 on each item. Denominators (subtotals) vary across variables/rows because of non-response on some items. a The scores of individual items were averaged to create an overall score for each participant who responded to all eight items (health worker [HW] n=156, non-HW n=64, total n=220), and the mean scores are presented here per respondent group and for all respondents combined. Source: The NGSE Scale was created by Chen et al. (2001) (1). Chapter 2 19 For participants who completed all scale items (220 in total), composite scores were created by averaging their scores for all eight items, with possible mean scores ranging between 1 and 5. Overall, participants reported high general self-efficacy (mean=4.0), and there was little difference in mean scores between the health workers (4.1) and the layperson respondents (3.9). 2.4 SEXUAL AND REPRODUCTIVE AUTONOMY SCALES: RESPONDENTS’ RESULTS (WAVE 2) All survey respondents in Wave 2 were also administered the sexual and reproductive autonomy scales. Sexual autonomy describes feeling that one’s sexual behaviours are self- determined and volitional (2). Sexual autonomy questions were derived from a three-item measure of sexual autonomy created by Sanchez et al. (2005) (2), with responses provided on a four-point Likert scale ranging from 1 – “Strongly disagree” to 4 “Strongly agree”. Reproductive autonomy refers to an individual’s control over family planning and contraceptive use within an intimate relationship. Survey respondents were administered the five-item “communication” subscale of the Reproductive Autonomy Scale (3), which specifically assesses an individual’s level of comfort with discussing reproductive health issues with their intimate partner. Respondents indicated their agreement with items on a four-point Likert scale ranging from 1 – “Strongly disagree” to 4 – “Strongly agree”, with higher scores indicating greater comfort with communication about reproductive health. Response frequencies for individual items and overall mean scores per scale are presented in Figure 2.4. FIGURE 2.4. SEXUAL AND REPRODUCTIVE AUTONOMY SCALE RESPONSE FREQUENCIES AND MEAN OVERALL SCORES AMONG ALL GLOBAL VALUES AND PREFERENCES SURVEY PARTICIPANTS, AND BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) Strongly agree Strongly agree Agree Agree Disagree Disagree Strongly disagree Strongly disagree Not applicable Not applicable Mean score (range 1–4) Mean score (range 1–4) 34.8 47.4 40.3 58.1 48.7 42.9 41.9 35.5 11.4 5.2 3.8 3.3 12.9 3.2 4.8 1.3 1.3 3.2 Health-care providers (%) Health-care providers (%) Laypersons (%) Laypersons (%) 3.2 3.4 3.2 3.5 During sex I feel free to be who I am During sex I have a say in what happens and I can voice my opinion SEXUAL AUTONOMY SCALE Chapter 2 20 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Strongly agree Strongly agree Agree Agree Disagree Disagree Strongly disagree Strongly disagree Not applicable Not applicable Mean score (range 1–4) Mean score (range 1–4) 8.7 59.4 11.7 78.6 18.1 24.1 20.0 16.1 40.3 31.5 5.3 26.741.7 1.3 9.8 1.8 1.8 1.81.5 Health-care providers (%) Health-care providers (%) Laypersons (%) Laypersons (%) 3.0 3.5 2.8 3.7 During sex I feel controlled and pressured to be certain waysa REPRODUCTIVE AUTONOMY – COMMUNICATION SUB-SCALE Mean overall score (SD) Health-care providers Laypersons3.2 (0.6) 3.2 (0.7) Scale scoreb My partner would support me if I wanted to use a method to prevent pregnancy Strongly agree Strongly agree Strongly agree Agree Agree Agree Disagree Disagree Disagree Strongly disagree Strongly disagree Strongly disagree Not applicable Not applicable Not applicable Mean score (range 1–4) Mean score (range 1–4) Mean score (range 1–4) 46.9 50.7 55.0 46.3 63.2 68.5 36.1 40.5 30.2 35.2 28.1 24.1 8.2 3.4 4.7 4.1 13.0 7.0 3.7 5.6 4.8 3.4 7.8 Health-care providers (%) Health-care providers (%) Health-care providers (%) Laypersons (%) Laypersons (%) Laypersons (%) 3.3 3.4 3.5 3.2 3.5 3.6 It is easy to talk about sex with my partner If I didn’t want to have sex I could tell my partner If I was worried about being pregnant or not being pregnant I could talk to my partner about it 1.8 1.9 1.9 2.0 2.3 Chapter 2 21 Mean overall score (SD) Health-care providers Laypersons3.4 (0.6) 3.5 (0.6) Sub-scale scorec Strongly agree Agree Disagree Strongly disagree Not applicable Mean score (range 1–4) 54.7 67.3 30.5 21.2 4.7 7.7 7.8 Health-care providers (%) Laypersons (%) 3.5 3.6 If I really did not want to become pregnant I could get my partner to agree with me 1.9 1.9 2.3 SD: standard deviation Notes: The response options for each question were “strongly disagree” (1), “disagree” (2), “agree” (3) and “strongly agree” (4), such that scores for each respondent (and mean scores across all respondents) ranged from 1 to 4 on each item. Denominators (subtotals) vary across variables/rows because of non-response on some items. a Item reverse-scored for scale scoring. b Adapted from Sanchez et al. (2005) (2). The scores of individual items were averaged to create an overall score for each participant who responded to all three items (health worker [HW] n=145, non-HW n=59, total n=204), and the average scores are presented here per respondent group and for all respondents combined. c Adapted from Upadhyay et al. (2014) (3). The scores of individual items were averaged to create an overall score for each participant who responded to all five items (HW n=107, non-HW n=48, total n=155), and the average scores are presented here per respondent group and for all respondents combined. For the sexual autonomy scale, after reverse-scoring the negatively worded items, overall scores per scale were calculated by averaging items for participants who responded to all questions (204 in total). Possible scores ranged from 1 to 4, with higher scores indicating a greater degree of sexual autonomy. The mean scores among the survey respondents indicated a high degree of sexual autonomy with a total mean score of 3.2 for each respondent group and for both groups combined. For participants who responded to all reproductive autonomy subscale items (155 in total), a composite score was derived by averaging the scores for the five scale items with the potential score ranging between 1 and 4. Overall, respondents demonstrated a high degree of comfort with communicating about reproductive health, with a total mean score of 3.5 for both respondent groups combined (3.4 for health workers and 3.5 for laypersons). References for Chapter 2 1. Chen G, Gully SM, Eden D. Validation of a New General Self-Efficacy Scale. Organizational Research Methods. 2001;4(1):62-83. doi:10.1177/109442810141004 2. Sanchez DT, Kiefer AK, Ybarra O. Sexual submissiveness in women: costs for sexual autonomy and arousal. Pers Soc Psychol Bull. 2006;32(4):512-24. doi:10.1177/0146167205282154 3. Upadhyay UD, Dworkin SL, Weitz TA, Foster DG. Development and validation of a reproductive autonomy scale. Stud Fam Plann. 2014;45(1):19-41. doi:10.1111/ j.1728-4465.2014.00374.x. 22 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 Awareness and experience of, and values and preferences relating to self- care interventions for SRHR: quantitative findings 3 23Chapter 3 Chapter summary This chapter presents quantitative findings based on survey respondents’ answers to several questions about a wide range of self-care interventions for SRHR. The findings in both sections of the chapter are grouped under six subsections by type of intervention: (1) Antenatal, intrapartum and postnatal care (asked in Wave 2 only); (2) Family planning; (3) Abortion; (4) Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (5) Promoting sexual health (asked in Wave 2 only); and (6) SRH information online and via mobile apps (asked in Wave 1 only). The first section (3.1) focuses on both groups of respondents’ awareness about self-care interventions for SRHR and where to access them, as well as their or their partners’ experience of using these interventions, and the considerations which underpin their decision- making regarding use of these interventions (e.g. privacy/ confidentiality, feelings of non-judgement, empowerment, convenience and access). Overall, the majority of respondents were generally aware about the interventions and where to access them, though this was somewhat higher for health worker respondents than for laypersons. Experience of using the interventions varied widely depending on the particular interventions, and there were substantial proportions of respondents who had no need for some of the interventions. Convenience and privacy/ confidentiality tended to be the most important factors in decision-making about using the interventions, although in some cases accessibility and cost also featured strongly. The second section (3.2) reports on health workers’ experiences of providing related services (referrals, prescriptions, information), how confident and informed they felt about providing such services, if they had any concerns about providing these services, and what they perceive as the benefits of each intervention. Quantitative data on these topics are reported in tabular form and summarized in narrative text, with separate data for health workers and layperson respondents and for each survey wave. “When home or Internet-based information regarding remedies are not an option, we heavily depend on pharmacies. It’s always paracetamol for basic conditions, if you ask for 20, they don’t refuse to give you 20. No prescriptions required. We go to doctors only when nothing else works out.” – A youth from the Dalit community, India 24 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 3.1 SURVEY RESPONDENTS’ AWARENESS ABOUT, USAGE OF, AND DECISION-MAKING CONSIDERATIONS ON SELF-CARE INTERVENTIONS FOR SRHR This section presents the quantitative findings on survey participants’ awareness about, usage of, and basis for decision-making on the use of self-care interventions for SRHR – both health workers and laypersons. The data are derived from questions asking participants (i) whether they knew of each intervention and where to access it; (ii) whether they or their partners have ever used the intervention (or recently used it in the past 3 months – asked in Wave 1 only); and (iii) what their considerations are for decision-making about using an intervention. The findings are both provided in tables and summarized in narrative form (separate for health worker and layperson respondents), grouped under six subsections by type of intervention: (3.1.1) Antenatal, intrapartum and postnatal care; (3.1.2) Family planning; (3.1.3) Abortion; (3.1.4) Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (3.1.5) Promoting sexual health; and (3.1.6) SRH information online and via mobile apps. 3.1.1 Antenatal, intrapartum and postnatal care Questions regarding all the interventions in this subsection were added in Wave 2 of the survey and not asked in Wave 1. The findings are presented in Table 3.1 – please refer to these tables as needed for details not included in the narrative summary. 25Chapter 3 TABLE 3.1. AWARENESS, USAGE AND DECISION-MAKING CONSIDERATIONS OF SRH SELF-CARE INTERVENTIONS FOR ANTENATAL, INTRAPARTUM AND POSTNATAL CARE BY SELF OR PARTNER AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT (WAVE 2 ONLY, 2020–2021) AT-HOME PREGNANCY TEST SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (FOLIC ACID) DURING PREGNANCY PLANNING SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (IRON AND FOLIC ACID) DURING PREGNANCY AWARENESS n=168 n=77 n=169 n=77 n=169 n=77 Aware of intervention and where to access it (%) 88.7 90.9 79.3 59.7 81.7 55.8 Aware of intervention but not where to access it (%) 7.7 7.8 13.6 29.9 12.4 31.2 Not aware of intervention (%) 3.6 1.3 7.1 10.4 5.9 13.0 USAGE n=166 n=74 n=165 n=74 n=167 n=74 I/my partner have used intervention (%) 57.8 54.1 37.0 16.2 40.7 20.3 I and my partner have not used intervention (%) 19.9 27.0 29.7 39.2 25.2 33.8 I don’t need to use this (%) 22.3 18.9 33.3 44.6 34.1 46.0 DECISION-MAKING CONSIDERATIONS n=145 n=57 n=142 n=47 n=140 n=46 Privacy and confidentiality (%) 56.6 57.9 24.7 21.3 25.0 17.4 Lack of judgement (%) 27.6 40.4 14.1 10.6 13.6 13.0 Empowerment (%) 28.3 24.6 31.0 25.5 29.3 28.3 Convenience (%) 59.3 56.1 61.3 59.6 62.9 63.0 Cost (%) 45.5 45.6 52.8 36.2 51.4 37.0 Legal restrictions (%) 6.2 7.0 7.0 2.1 6.4 0.0 % respondents Health workers Layperson respondents KEY 26 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (IRON AND FOLIC ACID) POSTPARTUM SELF-MONITORING/HOME- MONITORING OF BLOOD GLUCOSE LEVELS DURING PREGNANCY SELF-MONITORING/ HOME-MONITORING OF PROTEINURIA DURING PREGNANCY AWARENESS n=167 n=77 n=170 n=79 n=167 n=77 Aware of intervention and where to access it (%) 79.6 57.1 59.4 29.1 37.1 14.3 Aware of intervention but not where to access it (%) 12.6 28.6 25.3 44.3 26.4 31.2 Not aware of intervention (%) 7.8 14.3 15.3 26.6 36.5 54.6 USAGE n=165 n=74 n=167 n=75 n=165 n=74 I/my partner have used intervention (%) 35.8 17.6 18.6 4.0 12.7 2.7 I and my partner have not used intervention (%) 28.5 37.8 49.1 48.0 52.7 50.0 I don’t need to use this (%) 35.8 44.6 32.3 48.0 34.6 47.3 DECISION-MAKING CONSIDERATIONS n=139 n=47 n=141 n=46 n=141 n=47 Privacy and confidentiality (%) 24.5 19.2 27.0 23.9 27.7 21.3 Lack of judgement (%) 14.4 10.6 12.1 17.4 12.8 12.8 Empowerment (%) 29.5 25.5 30.5 23.9 29.8 27.7 Convenience (%) 61.2 61.7 59.6 58.7 59.6 59.6 Cost (%) 54.0 40.4 53.2 41.3 52.5 42.6 Legal restrictions (%) 5.0 2.1 6.4 2.2 6.4 0.0 % respondents Health workers Layperson respondents KEY 27Chapter 3 SELF-MONITORING/ HOME-MONITORING OF BLOOD PRESSURE DURING PREGNANCY AWARENESS n=169 n=77 Aware of intervention and where to access it (%) 71.6 39.0 Aware of intervention but not where to access it (%) 18.9 37.7 Not aware of intervention (%) 9.5 23.4 USAGE n=164 n=74 I/my partner have used intervention (%) 28.1 10.8 I and my partner have not used intervention (%) 38.4 43.2 I don’t need to use this (%) 33.5 46.0 DECISION-MAKING CONSIDERATIONS n=141 n=47 Privacy and confidentiality (%) 27.7 17.0 Lack of judgement (%) 13.5 14.9 Empowerment (%) 30.5 23.4 Convenience (%) 63.8 61.7 Cost (%) 51.1 38.3 Legal restrictions (%) 6.4 2.1 % respondents Note: Denominators (subtotals) vary across variables/rows because of non-response on some items. - Indicates that question or response option was not asked in a given wave. 28 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 At-home pregnancy test Health workers: The vast majority of health worker respondents reported being aware of at-home pregnancy testing and knowing how to access it (88.7%). However, some reported knowing what it is but not how to access it (7.7%) and a few were unaware of it (3.6%). Over half of the health worker respondents reported that they themselves and/or their partner had ever used an at- home pregnancy test (57.8%), while a about a fifth each reported not having used it before (19.9%) and not having a need for it (22.3%). For health workers, the most important considerations when deciding to use at-home pregnancy testing were convenience (selected by 59.3%), privacy and confidentiality (56.6%) and cost (45.5%). Other reasons included to feel empowered (28.3%) and so as not to feel judged (27.6%) and nine mentioned legal restrictions (6.2%). Laypersons: Among laypersons, almost all participants reported being aware of at-home pregnancy testing and how to access it (90.9%), while a few respondents reported knowing what it is but not how to access it (7.8%) or not knowing what it is (1.3%). With respect to usage, 54.1% reported they themselves and/or their partner had ever used at-home pregnancy testing. Additionally, about a quarter reported not having used it (27.0%) and the remaining participants reported not having a need for it (18.9%). For layperson respondents, the most important considerations when deciding to use at-home pregnancy testing were privacy and confidentiality (57.9%), convenience (56.1%) and cost (45.6%). Participants also mentioned not feeling judged (40.4%) and feeling more empowered (24.6%) and four mentioned legal restrictions (7.0%). Self-management of nutrition supplement (folic acid) during pregnancy planning Health workers: The majority of health worker respondents reported knowing about self-management of folic acid supplementation during pregnancy planning and where to access it (79.3%), while some reported knowing about it but not how to access it (13.6%) or not knowing what it is (7.1%). Regarding usage, 37.0% reported having used folic acid supplements during pregnancy planning, with about another third each reporting not having used it (29.7%) or that it is not relevant to them (33.3%). The most important factors for self-management of folic acid during pregnancy planning were convenience (61.3%) and cost (52.8%). Other factors were empowerment (31.0%), privacy and confidentiality (24.7%), not feeling judged (14.1%) and legal restrictions (7.0%). Laypersons: Over half of layperson respondents reported knowing about self-management of folic acid during pregnancy planning and how to access it (59.7%), while almost a third reported knowing about it but not how to access it (29.9%) and 10.4% reported not knowing what it is. In terms of self-reported usage, almost half of layperson respondents (44.6%) reported not having a need for this, while just 16.2% reported having used folic acid during pregnancy planning and just over another third reported not having used this intervention (39.2%). The most important factors for respondents when deciding to use folic acid during pregnancy planning were convenience (59.6%) and cost (36.2%). Smaller proportions of respondents also reported that empowerment (25.5%), privacy and confidentiality (21.3%), not feeling judged (10.6%) and legal restrictions (2.1%) were important in decision-making. Self-management of nutrition supplements (iron and folic acid) during pregnancy Health workers: The majority of health worker respondents reported knowing about self-management of iron and folic acid supplements during pregnancy and where to access them (81.7%), but a small proportion reported knowing about them but not how to access them (12.4%) or not knowing what they are (5.9%). In terms of usage, 40.7% reported that they or their partner had used iron and folic acid during pregnancy, while a quarter reported not having used them during pregnancy (25.2%) and a third indicated that this intervention is not relevant to them (34.1%). The most important factors for deciding to use these supplements during pregnancy were convenience (62.9%) and cost (51.4%). Smaller numbers of respondents also noted the importance of empowerment (29.3%), privacy and confidentiality (25.0%), not feeling judged (13.6%) and legal restrictions (6.4%). Laypersons: Over half of layperson respondents reported knowing about self-management of iron and folic acid during pregnancy and how to access these supplements (55.8%), while almost a third of respondents reported knowing about them but not how to access them (31.2%) and 13.0% reported not knowing what they are. Almost half of laypersons reported not having a need for this intervention (46.0%), but about a fifth (20.3%) reported they or their partner have used iron and folic acid during pregnancy; the remaining third reported not having used this intervention (33.8%). Respondents indicated that the most important factors when deciding to use iron and folic acid during pregnancy were convenience (63.0%), cost (37.0%) and empowerment (28.3%). A small number of respondents also mentioned the importance of privacy and confidentiality (17.4%) and not feeling judged (13.0%). No respondents mentioned legal restrictions as a deciding factor. Self-management of nutrition supplements (iron and folic acid) postpartum Health workers: The majority of health worker respondents reported knowing about self-management of iron and folic acid supplementation during the postpartum period, and where to access them (79.6%), while 12.6% reported knowing about them but not how to access them and 7.8% reported not knowing what they are. About a third of respondents each reported that they themselves and/or their partner had ever used postpartum iron and folic acid supplements (35.8%), that they have not used them (28.5%) or that they had no need for them (35.8%). The most commonly reported factors considered important when deciding to engage with these supplements postpartum were convenience (61.2%) and cost (54.0 %), while substantial 29Chapter 3 numbers also mentioned empowerment (29.5%), privacy and confidentiality (24.5%) and not feeling judged (14.4%), and a few reported legal restrictions (5.0%) as deciding factors. Laypersons: Over half of layperson respondents reported knowing about self-management of iron and folic acid during postpartum and how to access these supplements (57.1%), while over a quarter reported knowing about them but not how to access them (28.6%) and 14.3% reported not knowing what they are. In terms of usage, 17.6% reported having used iron and folic acid during postpartum and 37.8% reported not having used this intervention; nearly half (44.6%) indicated having no need for these supplements. Among laypersons, the most important factors when deciding to use iron and folic acid during the postpartum period were convenience (61.7%) and cost (40.4%), while some also mentioned empowerment (25.5%), privacy and confidentiality (19.2%) and not feeling judged (10.6%) and one person mentioned legal restrictions. Self-monitoring/home-monitoring of blood glucose levels during pregnancy Health workers: Over half of health worker respondents reported knowing about self-monitoring/home-monitoring of blood glucose levels during pregnancy and where to access it (59.4%) and another quarter reported knowing about it but not how to access it (25.3%). However, 15.3% reported not knowing what it is. In terms of usage, 18.6% reported that they and/or their partner had ever used this intervention during pregnancy. However, half of the health worker respondents had not used it (49.1%), and another third said that it was not relevant for them (32.3%). The most important factors for deciding to engage in self-monitoring/home-monitoring of blood glucose levels during pregnancy were convenience (59.6%) and cost (53.2%). Some respondents also mentioned empowerment (30.5%), privacy and confidentiality (27.0%) and not feeling judged (12.1%), and a few reported legal restrictions (6.4%) as being important in their decision-making. Laypersons: Just under a third of laypersons reported knowing about this intervention and how to access it (29.1%), while 44.3% reported that while they know about it, they did not know how to access it and a quarter said they do not know what it is (26.6%). About half of the layperson respondents reported not having used this intervention (48.0%) or not having a need for it (48.0%), and just a few (4.0%) reported having engaged with self-monitoring/home-monitoring blood glucose levels during pregnancy. The most important factors when deciding to use this intervention were convenience (58.7%) and cost (41.3%), but empowerment (23.9%), privacy and confidentiality (23.9%) and not feeling judged (17.4%) were also important, and one respondent mentioned legal restrictions. Self-monitoring/home-monitoring of proteinuria during pregnancy Health workers: Over a third of health worker respondents reported knowing about self-monitoring/home-monitoring of proteinuria during pregnancy and where to access it (37.1%), while a quarter reported knowing about it but not how to access it (26.4%) and 36.5% reported not knowing what it is. Among health workers, 12.7% reported that they and/or their partner have used this intervention during pregnancy, but the majority reported not having used it (52.7%), and a third said it is not relevant to them (34.6%). The most important factors in deciding to use this intervention were convenience (59.6%) and cost (52.5%), and additional factors mentioned by fewer respondents were empowerment (29.8%), privacy and confidentiality (27.7%), not feeling judged (12.8%) and legal restrictions (6.4%). Laypersons: Among laypersons, only 14.3% of respondents reported knowing about this intervention and how to access it while a third (31.2%) reported knowing about it but not how to access it; the majority of respondents (54.6%) were unaware of this intervention. Half of the laypersons reported not having used this intervention (50.0%) or not having a need for it (47.3%), and only two reported that they and/or their partner had used self-monitoring/home-monitoring of proteinuria during pregnancy. Among laypersons, the factors most often mentioned as being important when deciding to use this intervention were convenience (59.6%) and cost (42.6%). Some almost mentioned empowerment (27.7%), privacy and confidentiality (21.3%) and not feeling judged (12.8%). No participants reported legal restrictions as a deciding factor for using this intervention. Self-monitoring/home-monitoring of blood pressure during pregnancy Health workers: The majority of health worker respondents reported knowing about self-monitoring/home-monitoring of blood pressure during pregnancy and where to access it (71.6%), while 18.9% reported knowing about it but not how to access it and 9.5% reported not knowing what it is. About a third each of health worker respondents reported that they themselves and/or their partner have used this intervention (28.1%), have not used it (38.4%), or that it is not relevant for them (33.5%). The most important factors for deciding to self-monitor/home- monitor blood pressure during pregnancy were convenience (63.8%) and cost (51.1%). A substantial number also mentioned empowerment (30.5%) and privacy and confidentiality (27.7%), and a small number felt that not feeling judged (13.5%) and legal restrictions (6.4%) were also important factors. Laypersons: Over a third of layperson respondents reported knowing about this intervention and how to access it (39.0%), and a similar number reported being aware of it but not how to access it (37.7%) and a quarter reported not knowing what it is (23.4%). Among layperson respondents, 10.8% reported they and/or their partner have used this intervention during pregnancy, but the vast majority have either opted not to use it (43.2%) or not had a need for it (46.0%). The most important factors for deciding to self-monitor/home-monitor blood pressure during pregnancy were convenience (61.7%), cost (38.3%) and empowerment (23.4%). Small number of laypersons also mentioned privacy and confidentiality (17.0%) and not feeling judged (14.9%) and one mentioned legal restrictions (2.1%). 30 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 3.1.2 Family planning Among the six interventions in this subsection, questions about one of them (the contraceptive patch) were only asked in Wave 1 of the survey. The findings are presented in Table 3.2 – please refer to these tables as needed for details not included in the narrative summary. TABLE 3.2. AWARENESS, USAGE AND DECISION-MAKING CONSIDERATIONS FOR USE OF SRH SELF-CARE INTERVENTIONS FOR FAMILY PLANNING AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT AND SURVEY WAVE OVER-THE-COUNTER HORMONAL CONTRACEPTION (EXCLUDING EC) OVER-THE-COUNTER EMERGENCY CONTRACEPTION (EC) WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS n=360 n=423 n=174 n=79 n=359 n=421 n=172 n=79 Aware of intervention and where to access it (%) 98.1 93.4 90.8 87.3 92.8 85.3 90.1 84.8 Aware of intervention but not where to access it (%) 1.1 5.7 6.9 11.4 4.7 8.8 7.6 11.4 Not aware of intervention (%) 0.8 0.9 2.3 1.3 2.5 5.9 2.3 3.8 USAGE n=354 n= 366 n=172 n=75 n=346 n=361 n=168 n=75 I/my partner have used intervention (%) 48.6 38.8 61.6 58.7 36.4 29.6 39.3 52.0 I/my partner used in past 3 months (%) 6.2 7.4 - - 4.0 3.6 - - I and my partner have not used intervention (%) 26.6 26.5 19.2 21.3 35.0 31.0 36.9 25.3 I don’t need to use this (%) 18.6 27.3 19.2 20.0 24.6 35.7 23.8 22.7 DECISION-MAKING CONSIDERATIONS n=320 n=193 n=154 n=66 n=292 n=175 n=150 n=64 Privacy and confidentiality (%) 48.4 43.0 56.5 42.4 55.8 51.4 64.7 56.3 Lack of judgement (%) 25.3 22.3 37.7 30.3 32.9 28.6 40.7 50.0 Empowerment (%) 31.3 24.9 35.1 42.4 27.1 20.6 29.3 31.3 Convenience (%) 56.6 56.0 65.6 59.1 49.3 41.7 56.7 53.1 Cost (%) - - 47.4 59.1 - - 44.0 50.0 Legal restrictions (%) - - 15.6 9.1 - - 20.0 12.5 Accessibility (%) 52.8 64.2 - - 51.7 52.6 - - % respondents Health workers Layperson respondents KEY 31Chapter 3 CONTRACEPTIVE PATCH CONTRACEPTIVE VAGINAL RING WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS n=356 n=420 - - n=357 n=420 n=171 n=79 Aware of intervention and where to access it (%) 74.4 66.0 - - 69.2 61.0 60.8 63.3 Aware of intervention but not where to access it (%) 16.6 17.9 - - 24.4 26.9 32.2 31.7 Not aware of intervention (%) 9.0 16.2 - - 6.4 12.1 7.0 5.1 USAGE n=346 n=361 - - n=343 n=362 n=165 n=75 I/my partner have used intervention (%) 5.5 5.0 - - 4.1 5.8 9.1 14.7 I/my partner used in past 3 months (%) 0.0 0.8 - - 0.9 0.8 - - I and my partner have not used intervention (%) 71.7 60.4 - - 70.3 57.7 65.5 56.0 I don’t need to use this (%) 22.8 33.8 - - 24.8 35.6 25.5 29.3 DECISION-MAKING CONSIDERATIONS n=267 n=155 - - n=264 n=156 n=144 n=58 Privacy and confidentiality (%) 41.2 36.1 - - 43.9 36.5 46.5 29.3 Lack of judgement (%) 23.6 20.0 - - 23.9 23.1 28.5 20.7 Empowerment (%) 27.3 25.2 - - 24.2 23.7 29.2 24.1 Convenience (%) 53.6 45.8 - - 50.4 46.8 58.3 58.6 Cost (%) - - - - - - 47.2 53.5 Legal restrictions (%) - - - - - - 10.4 6.9 Accessibility (%) 44.9 54.2 - - 44.3 51.9 - - % respondents 32 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 SELF-ADMINISTERED INJECTABLE CONTRACEPTION2 DIAPHRAGM OR CERVICAL CAP WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS n=356 n=418 n=169 n=78 n=353 n=417 n=170 n=78 Aware of intervention and where to access it (%) 69.1 57.4 47.3 37.2 73.4 63.3 57.1 46.2 Aware of intervention but not where to access it (%) 16.6 21.1 36.7 34.6 21.0 24.7 34.7 32.1 Not aware of intervention (%) 14.3 21.5 16.0 28.2 5.7 12.0 8.2 21.8 USAGE n=345 n=360 n=164 n=75 n=344 n=363 n=166 n=73 I/my partner have used intervention (%) 4.3 4.4 9.2 6.7 6.1 5.0 9.6 6.9 I/my partner used in past 3 months (%) 0.6 0.8 - - 0.0 0.8 - - I and my partner have not used intervention (%) 71.0 58.9 67.1 62.7 70.6 59.2 64.5 65.8 I don’t need to use this (%) 24.1 35.8 23.8 30.7 23.3 35.0 25.9 27.4 DECISION-MAKING CONSIDERATIONS n=268 n=152 n=144 n=55 n=254 n=148 n=139 n=52 Privacy and confidentiality (%) 41.0 39.5 49.3 32.7 42.1 34.5 46.8 26.9 Lack of judgement (%) 23.9 23.0 30.6 20.0 22.4 23.0 29.5 21.2 Empowerment (%) 23.5 27.0 34.0 25.5 22.8 24.3 32.4 21.2 Convenience (%) 55.2 46.1 54.2 50.9 49.2 45.3 48.9 53.9 Cost (%) - - 47.2 58.2 - - 44.6 51.9 Legal restrictions (%) - - 16.0 9.1 - - 16.0 9.6 Accessibility (%) 44.4 53.3 - - 44.9 54.1 - - Notes: Denominators (subtotals) vary across variables because of non-response on some items. In Wave 1, the “have used intervention” data do not include those who reported use “in past 3 months”, whereas in Wave 2, these data are combined in “have used intervention” since the separate response option on recent use was not available. - Indicates that question or response option was not asked in a given wave. 2 In Wave 1, the response option was “Self-injectable long-acting contraceptive” and in Wave 2 it was revised to “Self-administered contraception (e.g. self-injectable contraception)”. % respondents Health workers Layperson respondents KEY 33Chapter 3 Over-the-counter hormonal contraception (excluding emergency contraception – see next item) Health workers: The vast majority of health worker respondents in both waves reported having heard of over-the-counter (OTC) hormonal contraception and knowing where to access it (Wave 1: 98.1%; Wave 2: 90.8%), while a very small minority reported knowing of it but not know how to access it (Wave 1: 1.1%; Wave 2: 6.9%) or not being aware of this intervention (Wave 1: 0.8%; Wave 2: 2.3%). A majority of health workers reported that they themselves or their partner had ever used OTC hormonal contraception (in Wave 1, 6.2% had used it in the past 3 months and another 48.6% had used it previously; in Wave 2, 61.6% had ever used it), while the remainder reported not having used it (Wave 1: 26.6%; Wave 2: 19.2%) or that they did not have a need for it (Wave 1: 18.6%; Wave 2: 19.2%). The most important factors for deciding to use OTC hormonal contraception – mentioned by half or more health workers across both waves – were convenience (Wave 1: 56.6%; Wave 2: 65.6%), accessibility (Wave 1 only: 52.8%), privacy and confidentiality (Wave 1: 48.4%; Wave 2: 56.5%) and cost (Wave 2 only: 47.4%). A quarter to a third of health workers also reported not feeling judged (Wave 1: 25.3%; Wave 2: 37.7%) and feeling empowered (Wave 1: 31.3%; Wave 2: 35.1%), while a small number mentioned legal restrictions (Wave 2 only: 15.6%). Laypersons: Among laypersons, the vast majority reported knowing about OTC hormonal contraception and where to access it (Wave 1: 93.4%; Wave 2: 87.3%), while a only small numbers reported knowing about it but not where to access it (Wave 1: 5.7%; Wave 2: 11.4%) and a few respondents were not aware of this intervention (Wave 1: 0.9%; Wave 2: 1.3%). Almost half of laypersons in Wave 1 (7.4% in the past 3 months and another 38.8% previously) and over half in Wave 2 (58.7%) reported having ever used OTC hormonal contraception. About a fifth to a quarter of the respondents in each wave reported not having used this intervention (Wave 1: 26.5%; Wave 2: 21.3%) or not needing it (Wave 1: 27.3%; Wave 2: 20.0%). In terms of factors in their decision-making about using this intervention, the majority of laypersons across both waves mentioned accessibility (Wave 1 asked: 64.2%), convenience (Wave 1: 56.0%; Wave 2: 59.1%) and cost (Wave 2 only: 59.1). Substantial numbers also mentioned privacy and confidentiality (Wave 1: 43.0%; Wave 2: 42.4%) and empowerment (Wave 1: 24.9%; Wave 2: 42.4%) and not feeling judged (Wave 1: 22.3%; Wave 2: 30.3%), while only a few mentioned legal restrictions (Wave 2: 9.1%). Over-the-counter emergency contraception Health workers: The vast majority of health worker respondents reported being aware of and knowing where to access OTC emergency contraception (Wave 1: 92.8%; Wave 2: 90.1%). Less than 10% reported knowing what it is but not how to get it (Wave 1: 4.7%; Wave 2: 7.6%) or not knowing what it is (Wave 1: 2.5%; Wave 2: 2.3%). About 40% of health workers 3 Questions regarding the contraceptive patch were only asked in Wave 1. reported they and/or their partner had ever used OTC emergency contraception (in Wave 1, 4.0% had used it in the past 3 months and another 36.4% had used it previously; in Wave 2, 39.3% had ever used it). Another third reported not having used it (Wave 1: 35.0%; Wave 2: 36.9%) and about a quarter reported not having a need for it (Wave 1: 24.6%; Wave 2: 23.8%). The most important factors for deciding to use OTC emergency contraception for health workers were privacy and confidentiality (Wave 1: 55.8%; Wave 2: 64.7%), accessibility (Wave 1 only: 51.7%), convenience (Wave 1: 49.3%; Wave 2: 56.7%), cost (Wave 2 only: 44.0%) and not feeling judged (Wave 1: 32.9%; Wave 2: 40.7%). Smaller numbers also mentioned feeling empowered (Wave 1: 27.1%; Wave 2: 29.3%) and legal restrictions (Wave 2: 20.0%) as important considerations. Laypersons: The large majority of laypersons reported being aware of OTC emergency contraception and knowing where to access it (Wave 1: 85.3%; Wave 2: 84.8%), while small numbers reported having heard of it but not knowing where to access it (Wave 1: 8.8%; Wave 2: 11.4%) or not knowing what it is (Wave 1: 5.9%; Wave 2: 3.8%). In Wave 1, approximately equal numbers of participants reported having ever used OTC emergency contraceptives (3.6% in the past 3 months plus another 29.6% ever previously), not having used them (31.0%) and having no need for them (35.7%). However, in Wave 2 over half of laypersons reported having used this intervention (52.0%), while about a quarter each reported not having used it (25.3%) or not having a need for it (22.7%). The most important factors when deciding to use emergency contraception were accessibility (Wave 1 only: 52.6%), privacy and confidentiality (Wave 1: 51.4%; Wave 2: 56.3%), convenience (Wave 1: 41.7%; Wave 2: 53.1%) and cost (Wave 2 only: 50.0%). In Wave 1 not feeling judged was less commonly cited (28.6%), while this was an important deciding factor for more participants in Wave 2 (50.0%). Some laypersons also mentioned feeling empowered (Wave 1: 20.6%; Wave 2: 31.3%) and legal restrictions (Wave 2: 12.5%). Contraceptive patch3 Health workers: Three quarters of health worker respondents reported knowing what the contraceptive patch is and where to access it (74.4%), while the remainder reported knowing what it is but not how to access it (16.6%) or not knowing what it is (9.0%). A small minority of health workers reported that they or their partner had ever used the contraceptive patch (5.5% – none in the past 3 months), while most had not used it (71.7%) and less than a quarter reported not having a need for this intervention (22.8%). More than half of respondents mentioned convenience as an important consideration when deciding to use the patch (53.6%), which smaller numbers mentioned accessibility (44.9%), privacy and confidentiality (41.2%), feeling of empowerment (27.3%) and not feeling judged (23.6%). Laypersons: Two thirds of layperson respondents reported knowing about the contraceptive patch and where to access it (66.0%), while the remaining respondents reported knowing what it is but not knowing how to access it (17.9%), or not knowing what it is (16.2%). A minority of these respondents (or their partners) had ever used this intervention (only 0.8% 34 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 in the past 3 months, and another 5.0% previously), while the majority had not opted to use it (60.4%) and a third had no need for it (33.8%). The most commonly selected considerations for deciding to use the contraceptive patch among laypersons were its accessibility (54.2%) and convenience (45.8%), while smaller numbers mentioned privacy and confidentiality (36.1%), feeling empowered (25.2%) and not feeling judged (20.0%). Contraceptive vaginal ring Health workers: Over half of health worker respondents in both waves reported knowing what the contraceptive vaginal ring is and where to access it (Wave 1: 69.2%; Wave 2: 60.8%). A considerable minority reported knowing what it is but not how to access it (Wave 1: 24.4%; Wave 2: 32.2%) and less than 10% reported not knowing what it is (Wave 1: 6.4%; Wave 2: 7.0%). A small minority of health workers reported that they or their partner had ever used this method (in Wave 1, 0.9% had used it in the past 3 months and another 4.1% had used it previously; in Wave 2, 9.1% had ever used it), while the majority had not (Wave 1: 70.3%; Wave 2: 65.5%) and a quarter reported not having a need for it (Wave 1: 24.8%; Wave 2: 25.5%). When deciding to use the contraceptive vaginal ring, important considerations included convenience in both waves (Wave 1: 50.4%; Wave 2: 58.3%), cost (Wave 2 only: 47.2%), accessibility (Wave 1 only: 44.3%), and privacy and confidentiality (Wave 1: 43.9%; Wave 2: 46.5%). Some health workers also mentioned feeling empowered (Wave 1: 24.2%; Wave 2: 29.2%), not feeling judged (Wave 1: 23.9%; Wave 2: 28.5%) and legal restrictions (Wave 2: 10.4%) as key considerations. Laypersons: Among laypersons in each wave, almost two thirds reported knowing about the contraceptive vaginal ring and where to get it (Wave 1: 61.0%; Wave 2: 63.3%), while the remaining participants reported knowing what it is but not how to access it (Wave 1: 26.9%; Wave 2: 31.7%), or not knowing what it is (Wave 1: 12.1%; Wave 2: 5.1%). A minority of layperson respondents reported having ever used this intervention (in Wave 1, 0.8% had used it in the past 3 months and another 5.8% had used it previously; in Wave 2, 14.7% had ever used it). Most laypersons had never used it (Wave 1: 57.7%; Wave 2: 56.0%) and about a third had no need for it (Wave 1: 35.6%; Wave 2: 29.3%). The most important factors for deciding to use the contraceptive vaginal ring were accessibility (Wave 1 only: 51.9%), convenience (Wave 1: 46.8%; Wave 2: 58.6%) and cost (Wave 2: 53.5%). Some respondents also mentioned privacy and confidentiality (Wave 1: 36.5%; Wave 2: 29.3%), feeling of empowerment (Wave 1: 23.7%; Wave 2: 24.1%), not feeling judged (Wave 1: 23.1%; Wave 2: 20.7%) and legal restrictions (Wave 2: 6.9%). Self-administered injectable contraception Health workers: A majority of Wave 1 health worker respondents reported knowing about self-administered contraception and where to access it (69.1%), compared with just under half of those in Wave 2 (47.3%). A smaller proportion of respondents in both waves reported knowing what it is but now how to access it (Wave 1: 16.6%; Wave 2: 36.7%) or not knowing what it is (Wave 1: 14.3%; Wave 2: 16.0%). Only a few health workers reported having ever used self-administered contraception (in Wave 1, 0.6% had used it in the past 3 months and another 4.3% had used it previously; in Wave 2, 9.2% had ever used it). The majority reported not having used it (Wave 1: 71.0%; Wave 2: 67.1%), and about a quarter in each wave said they have no need for it (Wave 1: 24.1%; Wave 2: 23.8%). When deciding to use this intervention, convenience was the most important consideration in both waves (Wave 1: 55.2%; Wave 2: 54.2%), followed by accessibility (Wave 1 only: 44.4%), privacy and confidentiality (Wave 1: 41.0%; Wave 2: 49.3%) and cost (Wave 2 only: 47.2%). Smaller numbers of health workers mentioned empowerment (Wave 1: 23.5%; Wave 2: 34.0%), not feeling judged (Wave 1: 23.9%; Wave 2: 30.6%) and legal restrictions (Wave 2 only: 16.0%) as important considerations. Laypersons: Over half of Wave 1 layperson respondents reported having heard of self-administered contraception and knowing where to access it (57.4%), compared with about a third of Wave 2 respondents (37.2%). The remaining participants in each wave reported knowing about it but not knowing where to access it (Wave 1: 21.1%; Wave 2: 34.6%), or not knowing what it is (Wave 1: 21.5%; Wave 2: 28.2%). A small minority of respondents reported that they or their partner had ever used self-administered contraceptives (in Wave 1, 0.8% had used it in the past 3 months and another 4.4% had used it previously; in Wave 2, 6.7% had ever used it). The majority reported not having used this intervention (Wave 1: 58.9%; Wave 2: 62.7%) and about a third reported not having a need for it (Wave 1: 35.8%; Wave 2: 30.7%). Regarding important considerations when deciding to use self- administered contraception, laypersons most often mentioned cost (Wave 2 only: 58.2%), accessibility (Wave 1 only: 53.3%) and convenience (Wave 1: 46.1%; Wave 2: 50.9%). Other considerations included privacy and confidentiality (Wave 1: 39.5%; Wave 2: 32.7%), feeling empowered (Wave 1: 27.0%; Wave 2: 25.5%), not feeling judged (Wave 1: 23.0%; Wave 2: 20.0%) and legal restrictions (Wave 2 only: 9.1%). Diaphragm or cervical cap Health workers: The majority of health worker respondents reported knowing about the diaphragm or cervical cap and where to access it (Wave 1: 73.4%; Wave 2: 57.1%), while a sizable minority reported knowing about it, but not how to access it (Wave 1: 21.0%; Wave 2: 34.7%), and the remainder reported not knowing what it is (Wave 1: 5.7%; Wave 2: 8.2%). Only a small proportion had ever used this contraceptive method (Wave 1: 6.1% [none in the past 3 months]; Wave 2: 9.6%), while the majority reported not having used it (Wave 1: 70.6%; Wave 2: 64.5%), and just under a quarter of health workers in each wave reported not having a need for it (Wave 1: 23.3%; Wave 2: 25.9%). The most important factors when deciding to use the diaphragm or cervical cap were convenience (Wave 1: 49.2%; Wave 2: 48.9%), privacy and confidentiality (Wave 1: 42.1%; Wave 2: 46.8%), cost (Wave 2 only: 44.6%) and accessibility (Wave 1 only: 44.9%). Smaller 35Chapter 3 numbers also mentioned empowerment (Wave 1: 22.8%; Wave 2: 32.4%), not feeling judged (Wave 1: 22.4; Wave 2: 25.9%) and legal restrictions (Wave 2: 16.0%). Laypersons: Among laypersons, just under two thirds of Wave 1 participants reported knowing what the diaphragm or cervical cap is and how to access it (Wave 1: 63.3%), compared with just under half of Wave 2 participants (Wave 2: 46.2%). The remaining participants reported knowing what it is but not how to access it (Wave 1: 24.7%; Wave 2: 32.1%), or not knowing what it is (Wave 1: 12.0%; Wave 2: 21.8%). A small minority of respondents reported that they themselves and/or their partner had ever used this method (in Wave 1, 0.8% had used it in the past 3 months and another 5.0% had used it previously; in Wave 2, 6.9% had ever used it). The majority reported not having used it (Wave 1: 59.2%; Wave 2: 65.8%) and about a quarter to a third reported not having a need for it (Wave 1: 35.0%; Wave 2: 27.4%). The most important factors when deciding to use a diaphragm or cervical cap were accessibility (Wave 1 only: 54.1%), convenience (Wave 1: 45.3%; Wave 2: 53.9%) and cost (Wave 2: 51.9%). Smaller numbers of laypersons also reported privacy and confidentiality (Wave 1: 34.5%; Wave 2: 26.9%), feeling empowered (Wave 1: 24.3%; Wave 2: 21.2%), not feeling judged (Wave 1: 23.0%; Wave 2: 21.2%) and legal restrictions (Wave 2: 9.6%) as important considerations. 3.1.3 Abortion Questions regarding self-management of medical abortion were asked in both waves of the survey. The findings are presented in Table 3.3 – please refer to the table as needed for details not included in the narrative summary. TABLE 3.3. AWARENESS AND EVER/RECENT USE OF, AND DECISION-MAKING CONSIDERATIONS ABOUT SELF-MANAGEMENT OF MEDICAL ABORTION, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT AND SURVEY WAVE SELF-MANAGEMENT OF MEDICAL ABORTION WAVE 1 WAVE 2 AWARENESS n=357 n=420 n=171 n=78 Aware of intervention and where to access it (%) 65.3 57.1 56.1 35.9 Aware of intervention but not where to access it (%) 28.0 33.6 33.9 51.3 Not aware of intervention (%) 6.7 9.3 9.9 12.8 USAGE n=345 n=361 n=166 n=74 I/my partner have used intervention (%) 5.5 6.9 10.2 8.1 I/my partner used in past 3 months (%) 0.6 0.6 - - I and my partner have not used intervention (%) 67.5 53.2 53.6 62.2 I don’t need to use this (%) 26.4 39.3 36.1 29.7 % respondents Health workers Layperson respondents KEY 36 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 SELF-MANAGEMENT OF MEDICAL ABORTION WAVE 1 WAVE 2 DECISION-MAKING CONSIDERATIONS n=261 n=144 n=141 n=59 Privacy and confidentiality (%) 65.6 59.0 61.0 61.0 Lack of judgement (%) 38.3 41.0 43.3 44.1 Empowerment (%) 31.8 27.8 29.8 37.3 Convenience (%) 43.7 32.6 39.0 39.0 Cost (%) - - 33.3 42.4 Legal restrictions (%) - - 42.6 30.5 Accessibility (%) 43.3 47.2 - - Note: Denominators (subtotals) vary across variables/rows because of non-response on some items. - Indicates that question or response option was not asked in a given wave. Self-management of medical abortion Health workers: Over half of health worker respondents reported knowing what self-management of medical abortion is and where to get it (Wave 1: 65.3%; Wave 2: 56.1%), while about a third reported knowing what it is but not how to access it (Wave 1: 28.0%; Wave 2: 33.9%) and small numbers were not aware of this self-care intervention (Wave 1: 6.7%; Wave 2: 9.9%). Few health workers reported having ever used this intervention (in Wave 1, 0.6% had used it in the past 3 months and another 5.5% had used it previously; in Wave 2, 10.2% had ever used it). Over half reported not having used it (Wave 1: 67.5%; Wave 2: 53.6%) and the remaining health workers reported not having a need for it (Wave 1: 26.4%; Wave 2: 36.1%). A sizable majority of health worker respondents in each wave reported privacy and confidentiality (Wave 1: 65.6%; Wave 2: 61.0%) as the most important consideration when deciding to use self-management of medical abortion. Large proportions of the respondents in both waves also mentioned other important considerations: accessibility (Wave 1 only: 43.3%), not feeling judged (Wave 1: 38.3%; Wave 2: 43.3%), legal restrictions (Wave 2 only: 42.6%), convenience (Wave 1: 43.7%; Wave 2: 39.0%), cost (Wave 2 only: 33.3%) and to feel empowered (Wave 1: 31.8%; Wave 2: 29.8%). Laypersons: Among laypersons in Wave 1, more than half reported having heard of self-management of medical abortion and knowing how to access it (57.1%), with an additional third reporting knowing what it is but not how to get it (33.6%). This was reversed among laypersons in Wave 2, with about a third knowing what it is and how to access it (35.9%) and another half knowing what it is but not how to access it (51.3%). Around 10% of participants in each wave reported not knowing what it is (Wave 1: 9.3%; Wave 2: 12.8%). Less than 10% of laypersons in each survey wave reported that they and/or their partner have ever used self-management of medical abortion (in Wave 1, 0.6% had used it in the past 3 months and another 6.9% had used it previously; in Wave 2, 8.1% had ever used it). Over half of laypersons reported not having used this intervention (Wave 1: 53.2%; Wave 2: 62.2%) and the remainder had no need for it (Wave 1: 39.3%; Wave 2: 29.7%). Laypersons most frequently mentioned privacy and confidentiality (Wave 1: 59.0%; Wave 2: 61.0%) as an important consideration when deciding to use self-management of medical abortion. Substantial numbers all mentioned accessability (Wave 1 only: 47.2%), not feeling judged (Wave 1: 41.0%; Wave 2: 44.1%), cost (Wave 2 only: 42.4%), convenience (Wave 1: 32.6%; Wave 2: 39.0%), feeling empowered (Wave 1: 27.8%; Wave 2: 37.3%) and legal restrictions (Wave 2: 30.5%). 3.1.4 Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities Questions regarding four of the interventions in this subsection were asked in both waves of the survey, while questions about two of them (HIV and STI treatment) were only asked in Wave 1 and questions about HPV self-sampling (for cervical cancer screening) were only asked in Wave 2. The findings are presented in Table 3.4 – please refer to these tables as needed for details not included in the narrative summary. 37Chapter 3 TABLE 3.4. AWARENESS, USAGE AND DECISION-MAKING OF SRH SELF-CARE INTERVENTIONS FOR SEXUALLY TRANSMITTED INFECTIONS (INCLUDING HIV), REPRODUCTIVE TRACT INFECTIONS, CERVICAL CANCER AND OTHER GYNAECOLOGICAL MORBIDITIES, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT AND SURVEY WAVE PrEP (PHARMACY ACCESS) PEP (PHARMACY ACCESS) WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS n=355 n=412 n=171 n=79 n=356 n=416 n=169 n=79 Aware of intervention and where to access it (%) 64.5 48.5 38.6 30.4 69.7 51.7 44.4 31.7 Aware of intervention but not where to access it (%) 25.4 25.5 44.4 25.3 21.1 23.6 38.5 26.6 Not aware of intervention (%) 10.1 26.0 17.0 44.3 9.3 24.8 17.2 41.8 USAGE n=343 n=361 n=166 n=77 n=344 n=359 n=167 n=77 I/my partner have used intervention (%) 2.0 1.7 3.6 6.5 3.8 2.5 7.8 7.8 I/my partner used in past 3 months (%) 1.7 1.4 - - 0.6 0.6 - - I and my partner have not used intervention (%) 66.2 64.8 64.5 61.0 66.3 64.3 61.7 59.7 I don’t need to use this (%) 30.0 32.1 31.9 32.5 29.4 32.6 30.5 32.5 DECISION-MAKING CONSIDERATIONS n=262 n=148 n=141 n=49 n=266 n=149 n=144 n=51 Privacy and confidentiality (%) 56.5 54.1 68.8 53.1 57.9 57.7 70.8 56.9 Lack of judgement (%) 33.6 30.4 39.0 42.9 32.0 29.5 38.9 37.3 Empowerment (%) 26.3 28.4 29.8 22.5 24.8 26.8 28.5 25.5 Convenience (%) 41.2 36.5 42.6 42.9 42.5 36.2 43.1 47.1 Cost (%) - - 40.4 44.9 - - 38.9 45.1 Legal restrictions (%) - - 14.9 10.2 - - 13.9 9.8 Accessibility (%) 43.1 48.6 - - 45.5 49.0 - - % respondents Health workers Layperson respondents KEY 38 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 HPV SELF-SAMPLING STI SELF-SAMPLING (NOT INCLUDING HIV OR HPV) WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS - - n=171 n=77 n=356 n=419 n=167 n=79 Aware of intervention and where to access it (%) - - 28.1 20.8 48.9 44.4 34.7 24.1 Aware of intervention but not where to access it (%) - - 46.2 35.1 36.2 36.0 44.9 51.9 Not aware of intervention (%) - - 25.7 44.2 14.9 19.6 20.4 24.1 USAGE - - n=168 n=75 n=346 n=362 n=167 n=77 I/my partner have used intervention (%) - - 7.7 4.0 9.2 7.2 11.4 7.8 I/my partner used in past 3 months (%) - - - - 3.2 2.8 - - I and my partner have not used intervention (%) - - 69.6 66.7 69.7 63.8 62.9 66.2 I don’t need to use this (%) - - 22.6 29.3 17.9 26.2 25.8 26.0 DECISION-MAKING CONSIDERATIONS - - n=148 n=36 n=280 n=157 n=146 n=56 Privacy and confidentiality (%) - - 63.5 60.7 61.4 65.6 67.8 64.3 Lack of judgement (%) - - 32.4 30.4 34.6 38.9 42.5 39.3 Empowerment (%) - - 22.3 25.0 26.1 30.6 32.2 23.2 Convenience (%) - - 50.7 44.6 47.9 40.8 45.9 55.4 Cost (%) - - 42.6 44.6 - - 32.9 46.4 Legal restrictions (%) - - 13.5 7.1 - - 13.7 10.7 Accessibility (%) - - - - 43.2 49.0 - - % respondents Health workers Layperson respondents KEY 39Chapter 3 HIV SELF-SAMPLING HIV TREATMENT WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS n=357 n=417 n=171 n=79 n=356 n=419 - - Aware of intervention and where to access it (%) 56.9 48.9 42.1 31.7 89.9 72.8 - - Aware of intervention but not where to access it (%) 33.9 34.8 43.9 46.8 7.3 20.0 - - Not aware of intervention (%) 9.2 16.3 14.0 21.5 2.8 7.2 - - USAGE n=346 n=360 n=167 n=77 n=338 n=361 - - I/my partner have used intervention (%) 13.3 7.5 14.4 10.4 4.7 3.9 - - I/my partner used in past 3 months (%) 2.3 3.6 - - 0.6 1.1 - - I and my partner have not used intervention (%) 65.3 65.0 67.1 67.5 56.5 55.4 - - I don’t need to use this (%) 19.1 23.9 18.6 22.1 38.2 39.6 - - DECISION-MAKING CONSIDERATIONS n=278 n=156 n=144 n=58 n=262 n=150 - - Privacy and confidentiality (%) 64.4 64.1 73.6 63.8 59.2 57.3 - - Lack of judgement (%) 35.3 39.1 41.7 46.6 29.0 34.0 - - Empowerment (%) 24.8 27.6 32.6 24.1 23.7 26.0 - - Convenience (%) 46.8 39.7 46.5 55.2 40.5 36.7 - - Cost (%) - - 34.0 41.4 - - - - Legal restrictions (%) - - 13.9 8.6 - - - - Accessibility (%) 41.7 50.0 - - 42.0 51.3 - - % respondents 40 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 STI TREATMENT WAVE 1 WAVE 2 AWARENESS n=353 n=415 - - Aware of intervention and where to access it (%) 87.3 71.6 - - Aware of intervention but not where to access it (%) 7.9 16.4 - - Not aware of intervention (%) 4.8 12.0 - - USAGE n=345 n=356 - - I/my partner have used intervention (%) 15.4 11.2 - - I/my partner used in past 3 months (%) 1.2 2.5 - - I and my partner have not used intervention (%) 52.5 50.0 - - I don’t need to use this (%) 31.0 36.2 - - DECISION-MAKING CONSIDERATIONS n=268 n=156 - - Privacy and confidentiality (%) 60.1 60.3 - - Lack of judgement (%) 32.1 35.3 - - Empowerment (%) 22.8 23.1 - - Convenience (%) 41.0 39.1 - - Cost (%) - - - - Legal restrictions (%) - - - - Accessibility (%) 43.3 54.5 - - HPV: human papillomavirus; PEP: post-exposure prophylaxis; PrEP: pre-exposure prohylaxis; STI: sexually transmitted infection Note: Denominators (subtotals) vary across variables/rows because of non-response of some items. - Indicates that question or response option was not asked in a given wave. % respondents Health workers Layperson respondents KEY 41Chapter 3 Pre-exposure prophylaxis (PrEP) Health workers: Among health worker respondents in Wave 1, almost two thirds reported having heard of PrEP and knowing where to get it (64.5%), while this was reported by only about a third of Wave 2 respondents (38.6%). The remaining health workers reported knowing what it is but not how to access it (Wave 1: 25.4%; Wave 2: 44.4%), or not knowing what it is (Wave 1: 10.1%; Wave 2: 17.0%). Very few health workers reported that they and/or their partner had ever used PrEP (Wave 1: 1.7% in the past 3 months and another 2.0% previously; Wave 2: 3.6%). Instead, most reported they had not used it (Wave 1: 66.2%; Wave 2: 64.5%) or that it was not relevant for them (Wave 1: 30.0%; Wave 2: 31.9%). The most important factors for deciding to use PrEP were privacy and confidentiality (Wave 1: 56.5%; Wave 2: 68.8%), accessibility (Wave 1 only: 43.1%), convenience (Wave 1: 41.2%; Wave 2: 42.6%) and cost (Wave 2 only: 40.4%). Smaller numbers also mentioned not feeling judged (Wave 1: 33.6%; Wave 2: 39.0%), feeling empowered (Wave 1: 26.3%; Wave 2: 29.8%) and legal restrictions (Wave 2: 14.9%) as important considerations. Laypersons: A third to half of layperson respondents reported knowing about PrEP and how to access it (Wave 1: 48.5%; Wave 2: 30.4%), with an additional quarter reporting knowing what it is but not how to access it (Wave 1: 25.5%; Wave 2: 25.3%). Additionally, 26.0% of Wave 1 laypersons did not know what PrEP is, while this was 44.3% among Wave 2 respondents. A small minority of respondents reported that they themselves and/or their partner had ever used PrEP (Wave 1: 1.4% in the past 3 months and another 1.7% previously; Wave 2: 6.5%), but over 60% had never used this intervention (Wave 1: 64.8%; Wave 2: 61.0%) and a third had no need for it (Wave 1: 32.1%; Wave 2: 32.5%). The most important factors for deciding to use PrEP were privacy and confidentiality (Wave 1: 54.1%; Wave 2: 53.1%), accessibility (Wave 1 only: 48.6%), cost (Wave 2 cost: 44.9%), convenience (Wave 1: 36.5%; Wave 2: 42.9%) and not feeling judged (Wave 1: 30.4%; Wave 2: 42.9%). Smaller numbers of laypersons also reported feeling empowered (Wave 1: 28.4%; Wave 2: 22.5%) and legal restrictions (Wave 2: 10.2%) as key considerations. Post-exposure prophylaxis (PEP) Health workers: Over two thirds of Wave 1 health worker respondents reported knowing about PEP and where to access it (69.7%), compared with less than half of those in Wave 2 (44.4%). A sizable minority in both waves reported knowing about PEP but did not know where to access it (Wave 1: 21.1%; Wave 2: 38.5%), with the remaining respondents reporting not knowing what it is (Wave 1: 9.3%; Wave 2: 17.2%). Few participants reported that they and/or their partner have ever used PEP (Wave 1: 0.6% in the past 3 months and another 3.8% previously; Wave 2: 7.8%), while the majority reported not having used PEP (Wave 1: 66.3%; Wave 2: 61.7%), or not having a need for it (Wave 1: 29.4%; 4 Questions regarding HPV self-sampling were only asked in Wave 2. Wave 2: 30.5%). For health workers, the most important factors when deciding to use PEP were privacy and confidentiality (Wave 1: 57.9%; Wave 2: 70.8%), accessibility (Wave 1 only: 45.5%) and convenience (Wave 1: 42.5%; Wave 2: 43.1%). Substantial numbers also mentioned cost (Wave 2 only: 38.9%), not feeling judged (Wave 1: 32.0%; Wave 2: 38.9%), and feeling empowered (Wave 1: 24.8%; Wave 2: 28.5%), while a few mentioned legal restrictions (Wave 2 only: 13.9%). Laypersons: Among laypersons, about half of Wave 1 participants reported knowing what PEP is and how to access it (51.7%), compared with about a third of Wave 2 participants (31.7%). About a quarter of respondents in each wave reported knowing what PEP is but not how to access it (Wave 1: 23.6%; Wave 2: 26.6%) and another quarter of Wave 1 respondents reported not knowing what it is (24.8%), compared with 41.8% in Wave 2. Few layperson respondents reported that they and/ or their partner had ever used PEP (Wave 1: 0.6% in the past 3 months and another 2.5% previously; Wave 2: 7.8%), while the majority of respondents reported not having used this intervention (Wave 1: 64.3%; Wave 2: 59.7%), or not having a need for it (Wave 1: 32.6%; Wave 2: 32.5%). The most important factors when deciding to use PEP were privacy and confidentiality (Wave 1: 57.7%; Wave 2: 56.9%), accessibility (Wave 1 only: 49.0%), convenience (Wave 1: 36.2%; Wave 2: 47.1%) and cost (Wave 2 only: 45.1%). Some participants also reported that not feeling judged (Wave 1: 29.5%; Wave 2: 37.3%), feeling empowered (Wave 1: 26.8%; Wave 2: 25.5%) and legal restrictions (Wave 2 only: 9.8%) influenced their decisions. HPV self-sampling4 Health workers: Among health worker respondents, just over a quarter reported awareness of HPV self-sampling and how to access it (28.1%), almost half reported knowing what it is but not how to access it (46.2%) and another quarter reported not knowing what it is (25.7%). Very few health workers reported that they themselves and/or their partner had ever used HPV self-sampling (7.7%), while more than two thirds had never used it (69.6%) and 22.6% reported not having a need for it. The factors most commonly reported as being important when deciding to use HPV self-sampling were privacy and confidentiality (63.5%), convenience (50.7%) and cost (42.6%). Smaller numbers of health workers also mentioned not feeling judged (32.4%), feeling empowered (22.3%) and legal restrictions (13.5%). Laypersons: Among layperson respondents, 20.8% reported knowing about HPV self-sampling and how to access it, 35.1% reported knowing what it is but not how to access it and 44.2% reported not know what it is. Only three laypersons reported that they and/or their partner had ever used HPV self-sampling (4.0%), while two thirds reported not having used it (66.7%) and almost a third reported not having a need for it (29.3%). Factors influencing decisions about using HPV self-sampling were privacy and confidentiality (60.7% of respondents), convenience (44.6%), cost (44.6%), not feeling judged (30.4%), feeling empowered (25.0%) and legal restrictions (7.1%). 42 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 STI self-sampling (not including HIV or HPV) Health workers: In Waves 1 and 2, between a third to half of health worker respondents reported being aware of STI self-sampling and where to access it (Wave 1: 48.9%; Wave 2: 34.7%), with similar proportions reporting awareness of it but not how to access it (Wave 1: 36.2%; Wave 2: 44.9%), while the remaining respondents were unaware of this self-care intervention (Wave 1: 14.9%; Wave 2: 20.4%). Just over 10% of health workers in each wave reported that they and/or their partner had ever used STI self-sampling (Wave 1: 3.2% in the past 3 months and another 9.2% previously; Wave 2: 11.4%), while around two thirds reported not having used it (Wave 1: 69.7%; Wave 2: 62.9%), and some said they had no need for it (Wave 1: 17.9%; Wave 2: 25.8%). Factors mentioned as important when deciding to use STI self-sampling were privacy and confidentiality (Wave 1: 61.4%; Wave 2: 67.8%), convenience (Wave 1: 47.9 %; Wave 2: 45.9%), accessibility (Wave 1 only: 43.2%) and not feeling judged (Wave 1: 34.6%; Wave 2: 42.5%). Some health workers also mentioned cost (Wave 2 only: 32.9%), feeling empowered (Wave 1: 26.1%; Wave 2: 32.2%) and legal restrictions (Wave 2: 13.7%). Laypersons: Among laypersons, almost half in Wave 1 (44.4%) and a quarter in Wave 2 (Wave 2: 24.1%) reported knowing about STI self-sampling and where to get it, while about a third of respondents in Wave 1 (36.0%) and half in Wave 2 (51.9%) reported knowing about it but not where to access it, and the remainder reported not knowing about this intervention (Wave 1: 19.6%; Wave 2: 24.1%). A small proportion reported that they or their partner had ever used STI self-sampling (Wave 1: 2.8% in the past 3 months and another 7.2% previously; Wave 2: 7.8%), while two thirds reported not having used it (Wave 1: 63.8%; Wave 2: 66.2%) and the remainder reported not needing it (Wave 1: 26.2%; Wave 2: 26.0%). Factors mentioned as important considerations when deciding to use STI self-sampling included privacy and confidentiality (Wave 1: 65.6%; Wave 2: 64.3%), convenience (Wave 1: 40.8%; Wave 2: 55.4%), accessibility (Wave 1 only: 49.0%), cost (Wave 2 only: 46.4%). Some also mentioned not feeling judged (Wave 1: 38.9%; Wave 2: 39.3%), empowerment (Wave 1: 30.6%; Wave 2: 23.2%) and legal restrictions (Wave 2 only: 10.7%). HIV self-sampling Health workers: Around half of health workers in each wave reported knowing about HIV self-sampling and where to access it (Wave 1: 56.9%; Wave 2: 42.1%), while a sizable proportion reported knowing about it but not how to access it (Wave 1: 33.9%; Wave 2: 43.9%) and a smaller minority reported not knowing what it is (Wave 1: 9.2%; Wave 2: 14.0%). In terms of usage, about 15% of health workers in each wave reported that they and/or their partner had ever used HIV self-sampling (Wave 1: 2.3% in the past 3 months and another 13.3% previously; Wave 2: 14.4%), while about two thirds reported not having used it (Wave 1: 65.3%; Wave 2: 67.1%) and just under a fifth had not need for it 5 Questions regarding HIV treatment were only asked in Wave 1. (Wave 1: 19.1%; Wave 2: 18.6%). The most important factors when deciding to use HIV self-sampling were privacy and confidentiality (Wave 1: 64.4%; Wave 2: 73.6%), convenience (Wave 1: 46.8%; Wave 2: 46.5%), accessibility (Wave 1 only: 41.7%) and not feeling judged (Wave 1: 35.3%; Wave 2: 41.7%). Smaller numbers also mentioned cost (Wave 2 only: 34.0%), empowerment (Wave 1: 24.8%; Wave 2: 32.6%) and legal restrictions (Wave 2 only: 13.9%). Laypersons: Half of Wave 1 and a third of Wave 2 laypersons reported knowing what HIV self-sampling is and how to access it (Wave 1: 48.9%; Wave 2: 31.7%), while about a third of those in Wave 1 and half in Wave 2 reported knowing what it is but not how to access it (Wave 1: 34.8%; Wave 2: 46.8%) and the remainder reported not knowing what it is (Wave 1: 16.3%; Wave 2: 21.5%). About 10% of laypersons reported they and/ or their partner have ever used HIV self-sampling (Wave 1: 3.6% in the past 3 months and another 7.5% previously; Wave 2: 10.4%). Two thirds reported not having used it (Wave 1: 65.0%; Wave 2: 67.5%) and just under a quarter had no need for it (Wave 1: 23.9%; Wave 2: 22.1%). The most important factors influencing decisions for using HIV self-sampling were privacy and confidentiality (Wave 1: 64.1%; Wave 2: 63.8%), accessibility (Wave 1 only: 50.0%), convenience (Wave 1: 39.7%; Wave 2: 55.2%) and not feeling judged (Wave 1: 39.1%; Wave 2: 46.6%). Smaller numbers also mentioned the importance of cost (Wave 2 only: 41.4%), feeling empowered (Wave 1: 27.6%; Wave 2: 24.1%) and legal restrictions (Wave 2: 8.6%). HIV treatment (i.e. antiretroviral therapy; ART)5 Health workers: The vast majority of health worker respondents reported knowing about ART and where to get it (89.9%), while less than 10% of respondents knew about it but not how to access it (7.3%), and just 2.8% did not know what it is. Few health worker respondents reported that they and/or their partner had ever used ART (0.6% in the past 3 months and another 4.7% had used it previously), while over half reported not having used it (56.5%) and over a third reported not having a need for it (38.2%). For health workers, the most important factors when deciding to use ART were privacy and confidentiality (59.2%), accessibility (42.0%) and convenience (40.5%). Some also mentioned not feeling judged (29.0%) and feeling empowered (23.7%). Laypersons: Almost three quarters of layperson respondents reported knowing about ART and how to access it (72.8%), while a fifth reported knowing about it but not how to access it (20.0%), and the remaining participants reported not knowing what it is (7.2%). A small minority of respondents and/or their partners had ever used ART (1.1% in the past 3 months and another 3.9% had used it previously) while just over half had not used it (55.4%), and over a third reported not having a need for it (39.6%). For laypersons’ decisions to use HIV treatment, the most endorsed factors were privacy and confidentiality (57.3%), accessibility (51.3%) and convenience (36.7%). Additional factors were not feeling judged was (34.0%) and feeling empowered (26.0%). 43Chapter 3 Medical treatment for STIs6 Health workers: The vast majority of health worker respondents reported knowing about STI medical treatment and where to access it (87.3%), while a small minority reported knowing about it but not where to get it (7.9%), or not knowing what it is (4.8%). A minority of health workers and/or their partners had ever used STI treatment (1.2% had used it in the past 3 months and another 15.4% had used it previously), while over half had never used it (52.5%) and nearly a third reported not having a need for it (31.0%). The most important factors when deciding to use STI treatment were privacy and confidentiality (60.1%), accessibility (43.3%) and convenience (41.0%). Some participants also mentioned the importance of not feeling judged (32.1%) and feeling empowered (22.8%). 6 Questions regarding STI medical treatment were only asked in Wave 1. Laypersons: Just under three quarters of laypersons reported knowing about STI treatment and how to access it (71.6%), while the remainder reported knowing about it but not how to access it (16.4%), or not knowing what it is (12.0%). A minority of laypersons reported that they and/ or their partners had ever used STI treatment (2.5% in the past 3 months and another 11.2% previously) while half had not used it (50.0%) and just over a third reported not having a need for it (36.2%). The factors most commonly mentioned as important when deciding to use STI treatment were privacy and confidentiality (60.3%) and accessibility (54.5%), while substantial numbers also mentioned convenience (39.1%), not feeling judged (35.3%) and feeling empowered (23.1%). 44 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 TABLE 3.5. AWARENESS, EVER USE, AND DECISION-MAKING FACTORS FOR USE OF SRH SELF-CARE INTERVENTIONS FOR PROMOTING SEXUAL HEALTH, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT (WAVE 2 ONLY, 2020–2021) LUBRICANTS FOR SEXUAL HEALTH HORMONE THERAPY FOR GENDER AFFIRMATION WAVE 2 ONLY WAVE 2 ONLY AWARENESS n=168 n=76 n=166 n=77 Aware of intervention and where to access it (%) 84.5 85.5 32.5 29.9 Aware of intervention but not where to access it (%) 9.5 10.5 46.4 41.6 Not aware of intervention (%) 6.0 4.0 21.1 28.6 USAGE n=164 n=74 n=165 n=73 I/my partner have used intervention (%) 63.4 59.5 3.6 2.7 I and my partner have not used intervention (%) 22.0 27.0 34.6 37.0 I don’t need to use this (%) 14.6 13.5 61.8 60.3 DECISION-MAKING CONSIDERATIONS n=146 n=57 n=119 n=44 Privacy and confidentiality (%) 52.7 36.8 56.3 52.3 Lack of judgement (%) 29.5 26.3 42.9 40.9 Empowerment (%) 33.6 31.6 35.3 29.6 Convenience (%) 54.8 47.4 30.3 36.4 Cost (%) 40.4 52.6 32.8 45.5 Legal restrictions (%) 5.5 7.0 33.6 36.4 Note: Denominators (subtotals) vary across variables/rows because of non-response on some items. - Indicates that question or response option was not asked in a given wave. % respondents Health workers Layperson respondents KEY 3.1.5 Promoting sexual health Questions regarding the interventions in this subsection – lubricant and hormone therapy for gender affirmation – were only asked in Wave 2 of the survey and were not asked in Wave 1. The findings are presented in Table 3.5 – please refer to the table as needed for details not included in the narrative summary. 45Chapter 3 Lubricants for sexual health Health workers: Almost all health worker respondents reported having heard of lubricant and knowing where to access it (84.5%), although small numbers reported knowing what it is but not how to access it (9.5%) or not knowing what it is (6.0%). Over half of the health workers reported that they themselves and/or their partner have used lubricant (63.4%), while a minority reported not having used lubricant (22.0%) or not needing it (14.6%). The most important factors when deciding to use lubricant were convenience (54.8%), privacy and confidentiality (52.7%) and cost (40.4%). Smaller numbers mentioned the importance of empowerment (33.6%) and not feeling judged (29.5%) and several mentioned legal restrictions (5.5%). Laypersons: Almost all layperson respondents were aware of lubricant and how to access it (85.5%), with another 10.5% reporting knowing what it is but not how to access it while a few were not aware of it (4.0%). Over half of laypersons and/ or their partners had used lubricant (59.5%), while 27.0% reported not having used this intervention and 13.5% reported not having a need for it. The main factors mentioned as important when deciding to use lubricant were cost (52.6%) and convenience (47.4%), while substantial numbers also mentioned privacy and confidentiality (36.8%), empowerment (31.6%) and not feeling judged (26.3%), and just a few mentioned legal restrictions (7.0%). Hormone therapy for gender affirmation Health workers: A third of health worker respondents reported knowledge of hormone therapy for gender affirmation and how to access it (32.5%), while almost half reported knowing what it is but not how to access it (46.4%) and about a fifth reported not knowing what it is (21.1%). A very small number of health workers reported that they and/or their partner have used this intervention (3.6%), while a third reported not having used it (34.6%) and the majority indicated having no need for it (61.8%). The most important considerations when deciding to use hormone therapy for gender affirmation were privacy and confidentiality (56.3%) and lack of judgement (42.9%), but substantial numbers also mentioned empowerment (35.3%), legal restrictions (33.6%), cost (32.8%) and convenience (30.3%). Laypersons: Just under a third of layperson respondents reported knowing what hormone therapy for gender affirmation is and how to access it (29.9%) and about the same number don’t know what it is (28.6%), but the largest proportion reported knowing what it is but not how to access it (41.6%). Just a couple of laypersons reported that they themselves and/or their partner had used this intervention (2.7%), while over a third reported they had not used it (37.0%) and most said they had no need for it (60.3%). Laypersons reported that important factors for deciding to use hormone therapy for gender affirmation were privacy and confidentiality (52.3%), cost (45.5%) and not feeling judged (40.9%). Smaller numbers of respondents mentioned the importance of legal restrictions (36.4%), convenience (36.4%) and empowerment (29.6%). 46 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 3.1.6 SRH information online and via mobile applications Questions regarding the interventions in this subsection were only asked in Wave 1 of the survey. The findings are presented in Table 3.6 – please refer to these tables as needed for details not included in the narrative summary. TABLE 3.6. AWARENESS, EVER USE, AND DECISION-MAKING FACTORS OF SRH SELF-CARE INTERVENTIONS/INFORMATION AVAILABLE ONLINE AND VIA MOBILE APPLICATIONS (APPS), AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT (WAVE 1 ONLY, 2018) ONLINE REPRODUCTIVE HEALTH (RH) INFORMATION MOBILE REPRODUCTIVE HEALTH (RH) APPS WAVE 1 ONLY WAVE 1 ONLY AWARENESS n=356 n=420 n=355 n=420 Aware of intervention and where to access it (%) 91.0 87.9 56.1 53.8 Aware of intervention but not where to access it (%) 5.6 7.4 26.8 22.9 Not aware of intervention (%) 3.4 4.8 17.2 23.3 USAGE n=347 n=365 n=341 n=362 I/my partner have used intervention (%) 54.8 45.5 17.6 20.4 I/my partner used it in the past 3 months (%) 11.2 10.1 7.0 2.8 I and my partner have not used online RH information (%) 22.2 24.1 57.2 51.1 I don’t need to use this (%) 11.8 20.3 18.2 25.7 DECISION-MAKING CONSIDERATIONS n=276 n=156 n=267 n=153 Privacy and confidentiality (%) 44.2 41.0 40.8 42.5 Lack of judgement (%) 24.6 24.4 21.7 19.0 Empowerment (%) 31.2 24.4 31.1 24.8 Convenience (%) 47.5 45.5 50.6 45.8 Accessibility (%) 54.7 58.3 50.2 54.2 % respondents Health workers Layperson respondents KEY 47Chapter 3 ONLINE SEXUAL HEALTH (SH) INFORMATION MOBILE SEXUAL HEALTH (SH) APPS WAVE 1 ONLY WAVE 1 ONLY AWARENESS n=355 n=420 n=357 n=422 Aware of intervention and where to access it (%) 89.6 87.1 47.3 41.7 Aware of intervention but not where to access it (%) 6.5 8.3 29.4 27.7 Not aware of intervention (%) 3.9 4.5 23.2 30.6 USAGE n=347 n=364 n=344 n=363 I/my partner have used intervention (%) 53.3 46.4 12.2 12.7 I/my partner used it in the past 3 months (%) 10.7 10.2 3.5 2.8 I and my partner have not used online RH information (%) 24.8 25.5 66.0 60.3 I don’t need to use this (%) 11.2 17.9 18.3 24.2 DECISION-MAKING CONSIDERATIONS n=276 n=155 n=268 n=154 Privacy and confidentiality (%) 46.4 40.6 41.0 42.2 Lack of judgement (%) 25.0 24.5 22.8 19.5 Empowerment (%) 31.5 23.9 29.1 24.0 Convenience (%) 46.4 45.8 50.0 46.1 Accessibility (%) 54.3 58.7 50.0 53.9 Note: Denominators (subtotals) vary across variables/rows because of non-response on some items. - Indicates that question or response option was not asked in a given wave. % respondents Health workers Layperson respondents KEY Online reproductive health information Health workers: The vast majority of health worker respondents reported knowing about online reproductive health (RH) information and how to access it (91.0%), while the remainder reported knowing what it is but not know how to access it (5.6%), or not knowing what it is (3.4%). Over half of health workers reported that they and/or their partner had ever accessed online RH information (11.2% in the past 3 months and another 54.8% previously), while the remainder either had not used it (22.2%) or had no need for it (11.8%). Health workers mentioned the following important considerations when deciding to use online RH information: accessibility (54.7%), convenience (47.5%), privacy and confidentiality (44.2%), empowerment (31.2%) and not feeling judged (24.6%). Laypersons: The vast majority of laypersons also reported knowing about online RH information and how to access it (87.9%), while 7.4% reported knowing what it is but not how to access it and 4.8% did not know what it is. Over half of respondents reported that they and/or their partner had ever 48 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 used online RH information (10.1% in the past 3 months and another 45.5% previously). About a quarter reported not having used it (24.1%), while another fifth reporting not having a need for it (20.3%). Important considerations when deciding to use online RH information were being able to access it (58.3%), convenience (45.5%), privacy and confidentiality (41.0%), not feeling judged (24.4%) and to feel empowered (24.4%). Mobile reproductive health apps Health workers: More than half of health worker respondents reported knowing about mobile RH apps and where to access them (56.1%). Over a quarter reported knowing what they are but not how to access them (26.8%), while the remainder did not know what they are (17.2%). About a quarter of health worker respondents and/or their partners had ever used a mobile RH app (7.0% in the past 3 months and another 17.6% previously). Over half had not used this type of app (57.2%) and 18.2% reported not having a need for this. The top considerations when deciding to use a mobile RH phone app among health worker respondents were convenience (50.0%), being able to access it (50.2%), and privacy and confidentiality (40.8%). Smaller numbers also mentioned that using mobile RH apps was important to feel empowered (31.1%) and not to feel judged (21.7%). Laypersons: Over half of layperson respondents reported knowing what mobile RH apps are and how to access them (53.8%), while about a fifth of respondents reported knowing what they are but not how to access them (22.9%) or not knowing what they are (23.3%). Over a fifth of respondents reported that they and/or their partners had ever used a mobile RH app (2.8% in the past 3 months and another 20.4% previously). Over half of respondents had not used them (51.1%), while about a quarter reported not having a need for them (25.7%). The most commonly mentioned factors considered important when deciding to use a mobile RH app were being able to access them (54.2%), convenience (45.8%) and privacy and confidentiality (42.5%). Some also mentioned to feel empowered (24.8%) and not to feel judged (19.0%). Online sexual health information Health workers: The vast majority of health worker respondents reporting knowing about online sexual health (SH) information and where to access it (89.6%), while about 10% were aware of it but not how to access it (6.5%) or were unaware of it (3.9%). Almost two thirds of health workers had used online SH information (10.7% in the past 3 months and another 53.3% previously), while a quarter had not used it (24.8%) and 11.2% reported not needing it. Among health workers, the most important considerations when deciding to use online SH information were accessibility (54.3%), convenience (46.4%) and privacy and confidentiality (46.4%), while some also mentioned empowerment (31.5%) and not feeling judged (25.0%). Laypersons: The vast majority of laypersons reported knowing about online SH information and how to access it (87.1%), while a minority knew what it was but not how to access it (8.3%) or were unaware of it (4.5%). Over half of respondents reported having used online SH information (10.2% in the past 3 months and another 46.4% previously). About a quarter had not used this service (25.5%) and 17.9% reported not having a need for it. The most common considerations reported by laypersons when deciding to use online SH information were being able to access it (58.7%), convenience (45.8%) and privacy and confidentiality (40.6%). About a quarter also felt that not feeling judged (24.5%) and feeling empowered (23.9%) were important factors. Mobile sexual health apps Health workers: Just under half of health worker respondents had heard of mobile SH apps and knew where to access them (47.3%), while almost a third reported knowing about them but not how to access them (29.4%), and almost a quarter reported not knowing what they are (23.2%). About 15% of health workers had used a mobile SH app (3.5% in the past 3 months and another 12.2% previously), while two thirds had not used one (66.0%) and the remainder reported not having a need for it (18.3%). The most important considerations for using a mobile SH app were convenience (50.0%), accessibility (50.0%) and privacy and confidentiality (41.0%). Some respondents also mentioned empowerment (29.1%) and not feeling judged (22.8%). Laypersons: Among layperson respondents, 41.7% reported knowing about mobile SH apps and how to access them, while a quarter were aware of them but not how to access them (27.7%) and nearly a third reported not knowing what they are (30.6%). A minority of respondents reported ever using a mobile SH app (2.8% in the past 3 months and another 12.7% previously), while almost two thirds had not used them (60.3%) and an additional quarter reporting not needing them (24.2%). For laypersons, the top considerations when deciding to use a mobile SH app were accessibility (53.9%), convenience (46.1%) and privacy and confidentiality (42.2%). Some participants also mentioned the importance of feeling empowered (24.0%) and not feeling judged (19.5%). Artwork fro m th is w ork sho p c om m un ity 49Chapter 3 Artwork fro m th is w ork sho p c om m un ity African and Caribbean women service providers The participants at this workshop were young women of African or Caribbean descent living in Toronto, Canada. All of the participants work in the community or public health sector and have at least a high school education. Two thirds of the group actively shared and participated in the discussion. The key issues that emerged include: 1. In Canada, African and Caribbean Black women face high levels of stigma, racism and judgement that deter them from accessing health care and services. 2. Health-care centres are not easily accessible to these communities because distance and clinic hours are inconvenient. 3. Community Health Ambassadors can potentially overcome many of the cultural barriers to health care by speaking the same language and being present in the communities they serve. 4. The community lacks trust in doctors and the health- care system. This lack of trust is embedded in their culture with roots in the exploitative history lived by African communities. 5. Women feel they are expected to uphold the image of a “strong Black female” – always putting their family’s needs before their own. While they value self-reliance, which could serve as a springboard for self-care, it is uncommon in their cultures to talk openly about health or mental health. 6. Intimate partner violence is prevalent but many women do not realize that their relationship is violent and lack positive examples of healthy relationships. HIGHLIGHTS FROM COMMUNITY WORKSHOPS Benefits and barriers to self-care interventions People can avoid judgement and stigma through the more confidential and anonymous nature of self-care products and services. Access is needed to wide community networks and peers who speak their language. Literacy poses a barrier to reading and following directions for medication. Lack of knowledge and awareness about self-care products and services poses a barrier. 49 50 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 Transgender people, male and transgender sex workers, and men who have sex with men Resource mapping and graffiti tools were used to support dialogue and gather information at this workshop in India, which had 15 participants. The key issues raised by the participants included: 1. The community often visits unqualified practitioners and gurus (i.e. community leaders) for treatment, health- care advice and sex reassignment surgery (SRS). Those who are literate rely on social media and the Internet for information. 2. They also self-medicate, re-use and exchange prescriptions for treatment of STIs and common ailments. 3. This community is largely faceless, voiceless and highly marginalized by society. 4. Debt is ubiquitous among the participants because of the high cost of care and SRS, forcing them into sex work and putting them at greater risk of HIV and STIs. 5. Outward beauty and appearance is often emphasized over health. 6. The community strongly feels the need for reliable transgender resources (health, legal and others) and the need to sensitize health-care providers. 7. The community wants access to safe HIV and STI testing facilities. 8. The government health system is not trusted due to stigma, discrimination and the fear of breach of confidentiality. Government hospitals are often the last resort for help. 9. The National AIDS Control Organization and the governmental AIDS programmes do not encourage self-testing as they are concerned that the community may not access treatment if needed. Therefore, the community is not aware that HIV self-testing and other self-testing kits exist. A rtw ork from this w orkshop com m unity HIGHLIGHTS FROM COMMUNITY WORKSHOPS Educated men who have sex with men, male sex workers and transgender people access health-care information online, allowing them to manage interventions on their own and guide their peers. There is no stigma or fear of disclosure in accessing self-care products. There is no support system to guide the community in case of failure or complications as a result of using self-care products. Since many of the services the community accesses are illegal, there is no recourse or remedial measure available when self-care products fail. Benefits and barriers to self-care interventions Global Values a d Prefe nces Survey report 51Chapter 3 20.7% 36.3% 38.5% 4.4% A rtw ork from this w orkshop com m unity SELF-MONITORING/HOME- MONITORING OF BLOOD GLUCOSE LEVELS DURING PREGNANCY SELF-MONITORING/HOME- MONITORING OF PROTEINURIA DURING PREGNANCY FIGURE 3.1: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS AT-HOME PREGNANCY TEST SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (FOLIC ACID) DURING PREGNANCY PLANNING QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 50.9%82.8% 58.6% 31.0% 36.5% 41.7% 23.3% 27.0% 11.2% 25.0% 10.3% 19.8% Feel confident and informed Need more information Need training 3.2 HEALTH WORKERS’ EXPERIENCE OF AND CONFIDENCE ABOUT PROVIDING SERVICES RELATED TO SELF-CARE INTERVENTIONS FOR SRHR, AND RELATED CONCERNS AND BENEFITS In this section, collated quantitative findings are presented for survey questions that were asked exclusively to health worker respondents about their experiences with, their knowledge levels about and their perspectives on a range of self-care interventions for SRHR. The data are derived from questions asking the health workers (i) if they had ever provided services (i.e. referrals, prescriptions, information) for any of the listed interventions; (ii) how confident and informed they felt about providing such services for the listed interventions; (iii) if they had any concerns about providing these services for each intervention; and (iv) what they perceive as the benefits of each intervention. For the questions about concerns and benefits, participants could select all the answers that applied. As in section 3.1, the findings are both provided in tables and summarized in narrative form, grouped under six subsections by type of intervention: (3.2.1) Antenatal, intrapartum and postnatal care; (3.2.2) Family planning; (3.2.3) Abortion; (3.2.4) Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (3.2.5) Promoting sexual health; and (3.2.6) SRH information online and via mobile apps. 3.2.1 Antenatal, intrapartum and postnatal care Questions regarding all seven of the interventions in this subsection were added in Wave 2 of the survey and not asked in Wave 1. The findings are presented in Figure 3.1, 3.2 and 3.3 – please refer to these figures as needed for details not included in the narrative summary. 11.9% 53.7% 32.8% 1.5% 17.8% 43.7% 38.5% 0.0% 26.1% 26.9% 39.6% 7.5% KEY YesNoIt is not related to my jobIt is not available where I live 52 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 18.7% 41.0% 38.8% 1.5% 12.6% 48.2% 37.8% 1.5% SELF-MONITORING/HOME- MONITORING OF BLOOD PRESSURE DURING PREGNANCY SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (IRON AND FOLIC ACID) POSTPARTUM I feel confident and informed I need more information I need training to provide this service/referral KEY Yes No It is not related to my job It is not available where I live 56.9%61.4% 62.1% 27.6% 19.8% 23.7% 21.6% 19.3% 19.8% SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (IRON AND FOLIC ACID) DURING PREGNANCY FIGURE 3.2: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety Quality of product Incorrect use Reducing health care access At-home pregnancy test 21.4% 32.9% 47.1% 38.6% Self-management of nutrition supplements (folic acid) during pregnancy planning 31.9% 29.2% 40.3% 36.1% Self-management of nutrition supplements (iron and folic acid) during pregnancy 31.4% 31.4% 41.4% 37.1% Self-management of nutrition supplements (iron and folic acid) postpartum 31.4% 28.6% 42.9% 40.0% Self-monitoring/ home-monitoring of blood glucose levels during pregnancy 25.6% 18.0% 57.7% 39.7% Self-monitoring/ home-monitoring of proteinuria during pregnancy 23.5% 18.5% 50.6% 44.4% Self-monitoring/ home-monitoring of blood pressure during pregnancy 24.4% 25.6% 53.9% 42.3% 17.8% 43.0% 38.5% 0.7% 53Chapter 3 FIGURE 3.3: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions Convenient for client Reduces barriers for client Reduces health worker workload Empowering for client Less expensive for client At-home pregnancy test 75.9% 39.1% 59.8% 50.6% 37.9% Self-management of nutrition supplements (folic acid) during pregnancy planning 73.1% 23.1% 51.3% 44.9% 32.1% Self-management of nutrition supplements (iron and folic acid) during pregnancy 72.2% 21.5% 54.4% 43.0% 35.4% Self-management of nutrition supplements (iron and folic acid) postpartum 70.9% 21.5% 55.7% 41.8% 34.2% Self-monitoring/ home-monitoring of blood glucose levels during pregnancy 69.3% 29.3% 52.0% 48.0% 33.3% Self-monitoring/ home-monitoring of proteinuria during pregnancy 66.2% 28.2% 53.5% 49.3% 26.8% Self-monitoring/ home-monitoring of blood pressure during pregnancy 71.4% 22.1% 53.3% 45.5% 33.8% At-home pregnancy test About half (53.7%) of health worker respondents reported they have provided services7 for at-home pregnancy testing, while 11.9% have not. Only two participants reported it was not available where they live (1.5%) and one third of them reported it was not related to their job (32.8%). The vast majority of respondents reported feeling confident and informed about at-home pregnancy testing (82.8%), while 11.2% reported needing more information and 10.3% reported needing more training to enable them to provide relevant services. Concerns regarding this intervention were that people would not use it correctly (47.1%), or would not access health care if needed (38.6%), and concerns about the quality (32.9%) and 7 Here and in the rest of this section, “services” encompasses referrals, prescriptions and/or information. safety (21.4%) of the product. The perceived benefits of this intervention were convenience for the user (75.9%), reduced health worker workload (59.8%), empowerment (50.6%), reduced barriers (39.1%) and affordability for the user (37.9%). Self-management of nutrition supplements (folic acid) during pregnancy planning Less than half of health workers reported having provided services for the self-management of folic acid during pregnancy planning (43.7%), while 17.8% had not. No health workers reported that this intervention was unavailable where they live and 38.5% reported that this was not related to their job. Over half of health workers felt confident and informed about this self-care intervention (58.6%), while a quarter needed more 54 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 information (25.0%) and a fifth reported needing more training before they could provide relevant services (19.8%). Concerns surrounding the self-management of folic acid during pregnancy planning included that people would do it incorrectly (40.3%), or they may not access health care when needed (36.1%), and concerns about safety (31.9%) and the quality of the product (29.2%). The perceived benefits of this intervention were convenience for the user (73.1%), reduced health worker workload (51.3%), and better empowerment (44.9%), affordability (32.1%) and reduced barriers (23.1%) for the user. Self-management of nutrition supplements (iron and folic acid) during pregnancy About half of the health workers had provided services for the self-management of iron and folic acid during pregnancy (48.2%), while 12.6% had not. A couple of health workers noted that this intervention is unavailable where they live (1.5%) and 37.8% reported that this was not related to their job. The majority of health workers felt confident and informed about this self-care intervention (61.4%), while almost a quarter felt they needed more information (23.7%) and almost a fifth reported needing more training to provide relevant services (19.3%). Concerns surrounding the self-management of iron and folic acid during pregnancy included that people would do it incorrectly (41.4%), or may not access health care when needed (37.1%), and concerns about safety (31.4%) and product quality (31.4%). The reported benefits of this intervention were convenience for the user (72.2%), reduced health worker workload (54.4%), and better empowerment (43.0%), affordability (35.4%) and reduced barriers (21.5%) for the user. Self-management of nutrition supplements (iron and folic acid) postpartum Less than half of health workers reported having provided services for the self-management of iron and folic during the postpartum period (43.0%), while 17.8% had not. One participant (0.7%) reported that this intervention was unavailable where they live and 38.5% reported that this was not related to their job. Over half of health workers felt confident and sufficiently informed to provide services relevant to this self-care intervention (62.1%), while about a fifth needed more information (21.6%) and another fifth reported needing more training (19.8%). Concerns surrounding postpartum self-management of iron and folic acid included that people would do it incorrectly (42.9%), or may not access health care when needed (40.0%), and concerns about safety (31.4%) and product quality (28.6%). Most health workers felt that the benefits of this intervention were convenience for the user (70.9%) and reduced health worker workload (55.7%), while some also mentioned better empowerment (41.8%), affordability (34.2%) and reduced barriers (21.5%) for the user. Self-monitoring/home-monitoring of blood glucose levels during pregnancy Over a third of health workers reported having provided services for self-monitoring/home-monitoring of blood glucose levels during pregnancy (36.3%), while 20.7% had not. A small minority of respondents indicated that this intervention was unavailable where they live (4.4%), while 38.5% reported that this was not related to their job. About half of health workers felt confident and informed about this self-care intervention (50.9%), while 31.0% needed more information and 23.3% reported needing more training before they could provide relevant services. Concerns surrounding the self-monitoring/home-monitoring of blood glucose levels during pregnancy included incorrect use (57.7%), clients not accessing health care when needed (39.7%), and concerns about safety (25.6%) and product quality (18.0%). Most health workers viewed the benefits of this intervention as being convenience for users (69.3%) and reduced health worker workload (52.0%), while substantial numbers also mentioned better empowerment (48.0%), affordability (33.3%) and reduced barriers (29.3%) for users of the intervention. Self-monitoring/home-monitoring of proteinuria during pregnancy About a quarter of health workers had provided services for the self-monitoring/home-monitoring of proteinuria during pregnancy (26.9%), while another quarter (26.1%) had not. Additionally, 7.5% providers reported that this intervention was unavailable where they live and 39.6% said it was not related to their job. Less than half of health workers felt sufficiently confident and informed about the intervention to provide relevant services (41.7%), with 36.5% reporting needing more information and 27.0% reporting needing more training. Health workers’ main concerns about this intervention were the risk of incorrect use (50.6%) and clients not accessing health care when needed (44.4%), while some had concerns about safety (23.5%) and the quality of the product (18.5%). The main perceived benefits of this intervention were convenience for the user (66.2%) and reduced health worker workload (53.5%), while substantial numbers also mentioned more empowerment (49.3%), reduced barriers (28.2%) and better affordability (26.8%) for users. 55Chapter 3 Self-monitoring/home-monitoring of blood pressure during pregnancy Less than half health workers had ever provided services related to self-monitoring/home-monitoring of blood pressure during pregnancy (41.0%) and an additional 18.7% had not. A couple of health workers (1.5%) reported that this intervention was unavailable where they live and 38.8% reported that this was not related to their job. Over half of health workers felt sufficiently confident and informed about this intervention to provide related services (56.9%), while 27.6% needed more information and 19.8% reported needing more training. Health workers reported concerns that the intervention would be used incorrectly (53.9%), that clients may not access health care when needed (42.3%), and concerns about the quality of the product (25.6%) and about safety (24.4%). Most health workers viewed the benefits of the intervention as convenience for the client (71.4%) and reduced health worker workload (53.3%), while substantial number also mentioned increased empowering (45.5%), better affordability (33.8%) and reduced barriers (22.1%) for the user. 56 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 25.9% 25.2% 34.1% 14.8% 3.2.2 Family planning Among the six interventions in this subsection, questions about one of them (the contraceptive patch) were only asked in Wave 1 of the survey. The findings are presented in Figures 3.4, 3.5 and 3.6 – please refer to these tables as needed for details not included in the narrative summary. FIGURE 3.4: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 78.7% 53.0% 75.4% 82.3% 49.0% 80.7% 50.8% 14.8% 25.6% 17.0% 13.1% 23.9% 11.9% 11.4% 35.8% 13.0% 35.9% Question or response option was not asked in a given wave. Question or response option was not asked in a given wave. 9.2% 20.3% 8.3% 16.6% Feel confident and informed Need more information Need training Wave 1 Wave 1 Wave 1 Wave 1 Wave 2 Wave 2 Wave 2 Wave 2 OVER-THE-COUNTER HORMONAL CONTRACEPTION (EXCLUDING EC) CONTRACEPTIVE VAGINAL RING OVER-THE-COUNTER EMERGENCY CONTRACEPTION (EC) CONTRACEPTIVE PATCH KEY YesNoIt is not related to my jobIt is not available where I live 6.8% 74.8% 18.5% 0.3% 10.9% 52.9% 32.6% 3.6% 12.6% 67.9% 18.6% 1.3% 15.6% 48.9% 32.6% 3.0% 29.0% 40.6% 20.6% 10.3% 33.0% 37.3% 20.8% 10.9% 57Chapter 3 27.4% 28.2% 34.1% 10.4% 53.0% 52.4% 51.5% 35.0% 37.6% 27.0% 29.9% 24.4% 33.1% 33.3% 21.3% 19.6% Feel confident and informed Need more information Need training Wave 1 Wave 1 Wave 2 Wave 2 SELF-ADMINISTERED INJECTABLE CONTRACEPTION DIAPHRAGM OR CERVICAL CAP KEY YesNoIt is not related to my jobIt is not available where I live - Question or response option was not asked in a given wave. FIGURE 3.5: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety Quality of product Incorrect use Reducing health care access Over-the-counter hormonal contraception (excluding EC) 53.6% 27.8% 58.6% 31.6% 58.3% 28.1% 56.3% 38.5% Over-the-counter emergency contraception (EC) 45.7% 26.3% 59.9% 39.3% 46.7% 24.4% 57.8% 40.0% Contraceptive patch 28.4% 15.5% 38.9% 37.2% - - - - Contraceptive vaginal ring 37.7% 23.3% 59.6% 35.0% 40.0% 21.3% 62.5% 26.3% Self-administered injectable contraception 52.0% 21.0% 47.2% 40.2% 41.8% 22.0% 70.3% 26.4% Diaphragm or cervical cap 35.2% 22.7% 63.9% 36.1% 30.5% 26.8% 61.0% 29.3% Wave 2 Wave 1 28.2% 41.2% 20.8% 11.0% 18.5% 29.6% 31.9% 20.0% 33.2% 36.5% 20.5% 11.7% 58 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 FIGURE 3.6: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions Convenient for client Reduces barriers for client Reduces health worker workload Empowering for client Less expensive for client Over-the-counter hormonal contraception (excluding EC) 75.7% 44.2% 40.4% 49.8% 40.1% 76.3% 37.1% 37.1% 52.6% 48.5% Over-the-counter emergency contraception (EC) 73.1% 47.9% 34.3% 49.2% 35.5% 76.7% 56.7% 42.2% 54.4% 36.7% Contraceptive patch 69.6% 35.5% 40.1% 46.5% 27.6% - - - - - Contraceptive vaginal ring 65.0% 36.0% 37.9% 46.7% 25.7% 56.0% 41.3% 38.7% 49.3% 18.7% Self-administered injectable contraception 68.8% 35.5% 44.6% 48.2% 30.8% 65.8% 50.0% 55.3% 48.7% 25.0% Diaphragm or cervical cap 67.2% 31.4% 37.3% 44.6% 25.5% 57.1% 35.7% 40.0% 47.1% 21.4% - Question or response option was not asked in a given wave. Wave 2 Wave 1 Over-the-counter hormonal contraceptives (excluding emergency contraception – see next item) Among health workers, almost three quarters of Wave 1 respondents (74.8%) and over half of Wave 2 respondents (52.9%) reported that they have provided services for OTC hormonal contraceptives while a small minority had not (Wave 1: 6.8%; Wave 2: 10.9%). Very few health workers said this intervention is not available where they live (Wave 1: 0.3%; Wave 2: 3.6%), but a substantial number reported that it is not related to their job (Wave 1: 18.5%; Wave 2: 32.6%). Across survey waves, most respondents reported feeling confident and sufficiently informed to provide relevant services (Wave 1: 82.3%; Wave 2: 78.7%), although small numbers of health workers reported that they needed more information (Wave 1: 11.4%; Wave 2: 14.8%) or more training (Wave 1: 9.2%; Wave 2: 13.1%). Health workers’ main concerns about OTC hormonal contraceptives were safety (Wave 1: 53.6%; Wave 2: 58.3%) and incorrect usage (Wave 1: 58.6%; Wave 2: 56.3%), while some were also concerned about the user not accessing health care when needed (Wave 1: 31.6%; Wave 2: 38.5%) and the quality of product (Wave 1: 27.8%; Wave 2: 28.1%). The main perceived benefits of this intervention were convenience (Wave 1: 75.7%; Wave 2: 76.3%), user empowerment (Wave 1: 49.8%; Wave 2: 52.6%) and cost (Wave 1: 40.1%; Wave 2: 48.5%), and substantial numbers also mentioned reduced barriers for users (Wave 1: 44.2%; Wave 2: 37.1%) and reduced health worker workload (Wave 1: 40.4%; Wave 2: 37.1%). Over-the-counter emergency contraception Most health workers in each wave reported they have provided services for OTC emergency contraception (Wave 1: 67.9%; Wave 2: 48.9%), while a small proportion had not (Wave 1: 12.6%; Wave 2: 15.6%). Just a few health workers said this intervention was not available where they live (Wave 1: 1.3%; Wave 2: 3.0%) and some reported that it is not related to their job (Wave 1: 18.6%; Wave 2: 32.6%). Most health workers reported feeling confident and sufficiently informed to provide services related to this intervention (Wave 1: 80.7%; Wave 2: 75.4%), but small numbers reported needing more information 59Chapter 3 (Wave 1: 13.0%; Wave 2: 17.0%) or more training (Wave 1: 8.3%; Wave 2: 11.9%). Health workers reported concerns about incorrect use of OTC emergency contraception (Wave 1: 59.9%; Wave 2: 57.8%), concerns about safety (Wave 1: 45.7%; Wave 2: 46.7%), concerns that users would not access health care if needed (Wave 1: 39.3%; Wave 2: 40.0%) and concerns about the quality of the product (Wave 1: 26.3%; Wave 2: 24.4%). But they also perceived major benefits of this intervention: convenience (Wave 1: 73.1%; Wave 2: 76.7%), reduced barriers for users (Wave 1: 47.9%; Wave 2: 56.7%), empowerment (Wave 1: 49.2%; Wave 2: 54.4%), reduced health worker workload (Wave 1: 34.3%; Wave 2: 42.2%) and affordability (Wave 1: 35.5%; Wave 2: 36.7%). Contraceptive patch8 Fewer than half of health worker respondents reported having provided services for the contraceptive patch (40.6%), while 29.0% said they had not. For 10.3% of respondents, the intervention was not available where they live, and a fifth said it was unrelated to their job (20.6%). About half of respondents reported feeling confident and sufficiently informed to provide services related to this intervention (50.8%), while more than a third reported needing more information (35.9%) and 16.6% stated they would need training. Health worker concerns were most commonly about incorrect use (38.9%), that users may not access health care if needed (37.2%), concerns about safety (28.4%) and about the quality of the product (15.5%). The most commonly cited benefits were convenience (69.6%) and empowerment (46.5%) for the user, and substantial numbers also mentioned reduction in health worker workload (40.1%), removal of barriers for users (35.5%) and more affordable (27.6%). Contraceptive vaginal ring Over a third of Wave 1 health worker respondents (37.3%) and about a quarter of those in Wave 2 (25.2%) reported having provided services for the vaginal ring, with similar proportions also reporting that they had not (Wave 1: 33.0%; Wave 2: 25.9%). A minority of health workers said this contraceptive was not available where they live (Wave 1: 10.9%; Wave 2: 14.8%), and for between a fifth and a third it was unrelated to their job (Wave 1: 20.8%; Wave 2: 34.1%). About half of respondents in each survey wave reported feeling confident and sufficiently informed about this intervention to provide relevant services (Wave 1: 49.0%; Wave 2: 53.0%), while more than a quarter reported needing more information (Wave 1: 35.8%; Wave 2: 25.6%) and more than a fifth stated they need training (Wave 1: 20.3%; Wave 2: 23.9%). The main health worker concerns regarding the vaginal ring were incorrect use (Wave 1: 59.6%; Wave 2: 62.5%), concerns about safety (Wave 1: 37.7%; Wave 2: 40.0%), concerns that clients would not access health care if needed (Wave 1: 35.0%; 8 Questions regarding the contraceptive patch were only asked in Wave 1. Wave 2: 26.3%) and concerns about the quality of the product (Wave 1: 23.3%; Wave 2: 21.3%). In terms of benefits, the majority of health workers stated that the vaginal ring was convenient (Wave 1: 65.0%; Wave 2: 56.0%) and empowering (Wave 1: 46.7%; Wave 2: 49.3%) for users. Many also mentioned reduced barriers for users (Wave 1: 36.0%; Wave 2: 41.3%), reduced health worker workload (Wave 1: 37.9%; Wave 2: 38.7%) and cheaper for the client (Wave 1: 25.7%; Wave 2: 18.7%). Self-administered injectable contraception Less than half of health workers in each survey wave reported they have provided services for self-administered contraceptives (Wave 1: 41.2%; Wave 2: 29.6%), while a smaller minority had not (Wave 1: 28.2%; Wave 2: 18.5%). Some health workers reported it was not available where they live (Wave 1: 11.0%; Wave 2: 20.0%) and between a fifth and a third reported it was not related to their job (Wave 1: 20.8%; Wave 2: 31.9%). Less than half of health workers reported feeling confident and sufficiently informed about self-administered contraception to provide relevant services (Wave 1: 52.4%; Wave 2: 37.6%), while more than a third reported they need more information (Wave 1: 33.1%; Wave 2: 35.0%) and a smaller number reported that they would need training to provide relevant services (Wave 1: 21.3%; Wave 2: 29.9%). Key concerns among health worker respondents about self- administered contraceptives were regarding incorrect use (Wave 1: 47.2%; Wave 2: 70.3%), safety (Wave 1: 52.0%; Wave 2: 41.8%), clients not accessing health care if needed (Wave 1: 40.2%; Wave 2: 26.4%) and the quality of the product (Wave 1: 21.0%; Wave 2: 22.0%). The main perceived benefits of this self-care intervention were convenience for users (Wave 1: 68.8%; Wave 2: 65.8%), reduced health worker workload (Wave 1: 44.6%; Wave 2: 55.3%), reduced barriers (Wave 1: 35.5%; Wave 2: 50.0%), empowerment (Wave 1: 48.2%; Wave 2: 48.7%) and lower cost for users (Wave 1: 30.8%; Wave 2: 25.0%). Diaphragm or cervical cap Over a third of health workers in Wave 1 (36.5%) and a quarter in Wave 2 (28.2%) reported they have provided services for the diaphragm or cervical cap, while around a third in each wave had not (Wave 1: 33.2%; Wave 2: 27.4%). About 10% of health workers said it was not available where they live (Wave 1: 11.7%; Wave 2: 10.4%) and the remainder reported it was unrelated to their job (Wave 1: 20.5%; Wave 2: 34.1%). Approximately half of respondents in each survey wave reported feeling confident and sufficiently informed about the diaphragm or cervical cap to provide relevant services (Wave 1: 51.5%; Wave 2: 53.0%), while around a third reported needing more information (Wave 1: 33.3%; Wave 2: 27.0%) and almost a quarter would need training (Wave 1: 19.6%; Wave 2: 24.4%). Among health worker respondents, by far the main concern relating to diaphragms or cervical caps was the risk of incorrect use (Wave 1: 63.9%; Wave 2: 61.0%). Much smaller 60 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 25.4% 21.6% 30.6% 22.4% numbers were also concerned about safety (Wave 1: 35.2%; Wave 2: 30.5%), about clients not accessing health care if needed (Wave 1: 36.1%; Wave 2: 29.3%), and about product quality (Wave 1: 22.7%; Wave 2: 26.8%). Also by far the main perceived benefit of the diaphragm or cervical cap was convenience (Wave 1: 67.2%; Wave 2: 57.1%), while a minority of health workers also mentioned empowerment (Wave 1: 44.6%; Wave 2: 47.1%), reduced health worker workload (Wave 1: 37.3%; Wave 2: 40.0%), and reduced barriers (Wave 1: 31.4%; Wave 2: 35.7%) and increased affordability (Wave 1: 25.5%; Wave 2: 21.4%) for users. 3.2.3 Abortion Questions regarding self-management of medical abortion were asked in both waves of the survey. The findings are presented in Figures 3.7, 3.8 and 3.9 – please refer to the figures as needed for details not included in the narrative summary. FIGURE 3.7: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 48.8% 33.0% 40.2% 32.1% 33.6% 22.7% Feel confident and informed Need more information Need training Wave 1 Wave 2 EXPERIENCE PROVIDING SERVICES FOR SELF-MANAGEMENT OF MEDICAL ABORTION KEY YesNoIt is not related to my jobIt is not available where I live FIGURE 3.8: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety Quality of product Incorrect use Reducing health care access Concerns about providing services for self-management of medical abortion 54.0% 24.9% 51.9% 53.6% 46.7% 21.7% 54.4% 54.4% Wave 2 Wave 1 30.6% 37.1% 22.5% 12.1% 61Chapter 3 FIGURE 3.9: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions Convenient for client Reduces barriers for client Reduces health worker workload Empowering for client Less expensive for client Perceived benefits of self-management of medical abortion 59.4% 62.2% 41.5% 52.5% 33.2% 57.5% 62.5% 45.0% 51.3% 26.3% Wave 2 Wave 1 Self-management of medical abortion Substantial numbers of health worker respondents reported having provided services for self-management of medical abortion (Wave 1: 37.1%; Wave 2: 21.6%), while many also had not done so (Wave 1: 30.6%; Wave 2: 25.4%). Other health workers said it was not available where they live (Wave 1: 12.1%; Wave 2: 22.4%) or that it was not related to their job (Wave 1: 22.5%; Wave 2: 30.6%). Less than half of respondents in each survey wave reported feeling confident and sufficiently informed to provide services relevant to self-management of medical abortion (Wave 1: 48.8%; Wave 2: 40.2%), while a third reported needing more information (Wave 1: 33.6%; Wave 2: 33.0%) and slightly smaller numbers reported needing training (Wave 1: 22.7%; Wave 2: 32.1%). The main reported concerns regarding self-management of medical abortion were that clients would not implement the procedures correctly (Wave 1: 51.9%; Wave 2: 54.4%), clients would not access health care if needed (Wave 1: 53.6%; Wave 2: 54.4%), and concerns about safety (Wave 1: 54.0%; Wave 2: 46.7%), while smaller numbers of health workers were also concerned about product quality (Wave 1: 24.9%; Wave 2: 21.7%). Health workers viewed the main benefits of this self- care intervention as reduced barriers (Wave 1: 62.2%; Wave 2: 62.5%), improved convenience (Wave 1: 59.4%; Wave 2: 57.5%) and increased empowerment (Wave 1: 52.5%; Wave 2: 51.3%) for abortion seekers. Smaller numbers also mentioned reduced health worker workload (Wave 1: 41.5%; Wave 2: 45.0%) and reduced cost for abortion seekers (Wave 1: 33.2%; Wave 2: 26.3%). 62 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 3.2.4 Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities Questions regarding four of the interventions in this subsection were asked in both waves of the survey, while questions about two of them (HIV and STI treatment) were only asked in Wave 1 and questions about HPV self-sampling were only added later in Wave 2. The findings are presented in Figures 3.10, 3.11 and 3.12 – please refer to these figures as needed for details not included in the narrative summary. FIGURE 3.10: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 49.5% 32.2% 35.0% 41.0% 32.2% 40.0% 29.1% 40.0% 45.8% 37.6% 19.7% 18.3% Feel confident and informed Need more information Need training Wave 1 Wave 1 Wave 2 Wave 2 PRE-EXPOSURE PROPHYLAXIS (PREP) – PHARMACY ACCESS POST-EXPOSURE PROPHYLAXIS (PEP) – PHARMACY ACCESS KEY YesNoIt is not related to my jobIt is not available where I live 41.7% 25.2% 35.7% Wave 1 Wave 2HPV SELF-SAMPLING Question or response option was not asked in a given wave. Question or response option was not asked in a given wave. 31.6% 41.2% 21.6% 8.3% 29.4% 22.8% 35.3% 12.5% 26.4% 48.9% 22.1% 4.2% 23.5% 32.4% 32.4% 11.8% 27.0% 14.6% 31.4% 27.0% 63Chapter 3 54.4% 55.3% 33.6% 39.7% 37.1% 32.8% 31.9% 34.5% 43.1% 42.8% 32.8% 34.6% 49.2% 34.2% 19.9% 18.9% 15.6% 21.7% Wave 1 Wave 1 Wave 1 Wave 1 Wave 2 Wave 2 Wave 2 Wave 2 HIV SELF-SAMPLING HIV TREATMENT STI TREATMENT STI SELF-SAMPLING (NOT INCLUDING HIV OR HPV) KEY YesNoIt is not related to my jobIt is not available where I live Question or response option was not asked in a given wave. Question or response option was not asked in a given wave. Question or response option was not asked in a given wave. Question or response option was not asked in a given wave. HPV: human papillomavirus; STI: sexually transmitted infection. Feel confident and informed Need more information Need training 35.8% 32.6% 19.5% 15.6% 25.0% 18.4% 32.4% 24.3% 30.9% 40.2% 19.0% 14.1% 21.2% 26.3% 29.9% 22.6% 20.7% 56.9% 21.7% 1.0% 17.8% 61.2% 20.1% 1.3% 64 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 - Question or response option was not asked in a given wave. FIGURE 3.11: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety Quality of product Incorrect use Reducing health care access Pre-exposure prophylaxis (PrEP) – pharmacy access 40.9% 17.8% 52.9% 54.2% 27.4% 16.7% 53.6% 56.0% Post-exposure prophylaxis (PEP) – pharmacy access 42.4% 17.9% 52.7% 53.6% 30.1% 18.1% 49.4% 61.5% HPV self-sampling - - - - 23.1% 22.0% 55.0% 52.8% STI self-sampling (not including HIV or HPV) 25.7% 24.3% 53.6% 57.2% 20.0% 24.4% 61.1% 52.2% HIV self-sampling 24.4% 20.0% 53.3% 58.2% 19.8% 24.2% 55.0% 62.6% HIV treatment 49.1% 22.6% 52.7% 53.1% - - - - STI treatment 42.6% 23.8% 54.7% 54.3% - - - - HPV: human papillomavirus; STI: sexually transmitted infection. Wave 2 Wave 1 Pre-exposure prophylaxis (PrEP) Among health workers, a greater proportion of Wave 1 respondents (41.2%) than Wave 2 respondents (22.8%) reported having provided services for PrEP, while just under a third in both survey waves reported they had not (Wave 1: 31.6%; Wave 2: 29.4%). Additionally, a minority reported it was not available where they live (Wave 1: 8.3%; Wave 2: 12.5%) and a substantial proportion said it was unrelated to their job (Wave 1: 21.6%; Wave 2: 35.3%). Less than half of respondents reported feeling confident and informed enough to provide services related to PrEP (Wave 1: 45.8%; Wave 2: 32.2%), while 40.0% reported needing more information (Wave 1: 40.0%; Wave 2: 40.0%) and others reported needing training (Wave 1: 19.7%; Wave 2: 32.2%). The main health worker concerns were that PrEP users would not access health care if needed (Wave 1: 54.2%; Wave 2: 56.0%) and that they would not use it correctly (Wave 1: 52.9%; Wave 2: 53.6%). Smaller numbers were concerned about safety (Wave 1: 40.9%; Wave 2: 27.4%) and product quality (Wave 1: 17.8%; Wave 2: 16.7%). The majority of health workers perceived the benefits of PrEP as being convenience for clients (Wave 1: 65.4%; Wave 2: 59.2%) and reduced barriers (Wave 1: 58.9%; Wave 2: 52.6%). Substantial numbers also mentioned empowerment (Wave 1: 50.0%; Wave 2: 48.7%), reduced health worker workload (Wave 1: 42.1%; Wave 2: 48.7%) and better affordability for the user (Wave 1: 27.1%; Wave 2: 22.4%). Post-exposure prophylaxis (PEP) Between a third and half of health workers reported they have provided services for PEP (Wave 1: 48.9%; Wave 2: 32.4%), while a quarter said they have not (Wave 1: 26.4%; Wave 2: 23.5%). Additionally, a minority of health workers reported PEP was not available where they live (Wave 1: 4.2%; Wave 2: 11.8%) and the remainder reported it was unrelated 65Chapter 3 FIGURE 3.12: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions Convenient for client Reduces barriers for client Reduces health worker workload Empowering for client Less expensive for client Pre-exposure prophylaxis (PrEP) – pharmacy access 65.4% 58.9% 42.1% 50.0% 27.1% 59.2% 52.6% 48.7% 48.7% 22.4% Post-exposure prophylaxis (PEP) – pharmacy access 66.7% 62.0% 37.5% 45.8% 25.9% 58.1% 59.5% 47.3% 46.0% 21.6% HPV self-sampling - - - - - 51.4% 47.3% 43.2% 46.0% 20.3% STI self-sampling (not including HIV or HPV) 64.1% 61.5% 44.6% 48.5% 30.3% 49.3% 57.5% 46.6% 45.2% 23.3% HIV self-sampling 64.4% 63.9% 43.8% 50.6% 29.2% 57.7% 59.0% 50.0% 43.6% 25.6% HIV treatment 62.3% 58.5% 40.1% 50.2% 24.2% - - - - - STI treatment 66.5% 60.4% 39.6% 47.2% 25.5% - - - - - HPV: human papillomavirus; STI: sexually transmitted infection. - Question or response option was not asked in a given wave. Wave 2 Wave 1 to their job (Wave 1: 22.1%; Wave 2: 32.4%). Less than half of health workers in each wave reported feeling sufficiently confident and informed to provide services related to PEP (Wave 1: 49.5%; Wave 2: 41.0%), with over a third needing more information (Wave 1: 37.6%; Wave 2: 35.0%), and smaller numbers needing training (Wave 1: 18.3%; Wave 2: 29.1%). Health workers’ main concerns about PEP were that clients would not access health care if needed (Wave 1: 53.6%; Wave 2: 61.5%) and that they would use PEP incorrectly (Wave 1: 52.7%; Wave 2: 49.4%). Substantial numbers were also concerned about safety (Wave 1: 42.4%; Wave 2: 30.1%) and product quality (Wave 1: 17.9%; Wave 2: 18.1%). By far the main perceived benefits of PEP were that it removes barriers for users (Wave 1: 62.0%; Wave 2: 59.5%) and it is convenient (Wave 1: 66.7%; Wave 2: 58.1%). Substantial numbers also noted that it reduces health worker workload (Wave 1: 37.5%; Wave 2: 47.3%), and 9 Questions regarding HPV self-sampling were only asked in Wave 2. improves empowerment (Wave 1: 45.8%; Wave 2: 46.0%) and affordability (Wave 1: 25.9%; Wave 2: 21.6%) for users. HPV self-sampling9 A minority of health worker respondents reported that they have provided services for HPV self-sampling (14.6%), while over a quarter reported not having done so (27.0%) and the same number said that HPV self-sampling is not available where they live (27.0%). The remaining 31.4% of health workers said this intervention was unrelated to their job (31.4%). A quarter of health workers reported feeling confident and informed enough to provide services related to HPV self-sampling (25.2%), while a greater proportion reported needing more information (41.7%) or needing more training (35.7%). 66 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 Health workers’ main concerns regarding HPV self-sampling were incorrect use (55.0%) and that clients may not access health care if needed (52.8%), while some were also concerned about safety (23.1%) and product quality (22.0%). Health workers identified the main benefits of HPV self-sampling as convenience for the user (51.4%), reduced barriers (47.3%), client empowerment (46.0%) and reduced health worker workload (43.2%), while some also mentioned reduced cost for the user (20.3%). STI self-sampling (not including HIV or HPV) About a third of health workers in Wave 1 (32.6%) and a fifth in Wave 2 (18.4%) reported they have provided services related to STI self-sampling, while between a quarter and a third (Wave 1: 35.8%; Wave 2: 25.0%) had not. Additional respondents reported that it was not available where they live (Wave 1: 15.6%; Wave 2: 24.3%) or that it was unrelated to their job (Wave 1: 19.5%; Wave 2: 32.4%). Less than half of health workers reported feeling sufficiently confident and informed about STI self-sampling to provide relevant services (Wave 1: 34.2%; Wave 2: 32.8%), while most said they would either need more information (Wave 1: 49.2%; Wave 2: 37.1%) or more training (Wave 1: 21.7%; Wave 2: 34.5%). Health workers’ main concerns about this intervention related to incorrect usage (Wave 1: 53.6%; Wave 2: 61.1%) and clients not accessing health care if needed (Wave 1: 57.2%; Wave 2: 52.2%). Substantial number were also concerned about product quality (Wave 1: 24.3%; Wave 2: 24.4%) and safety (Wave 1: 25.7%; Wave 2: 20.0%). The main perceived benefits were reduced barriers (Wave 1: 61.5%; Wave 2: 57.5%) and improved convenience for users (Wave 1: 64.1%; Wave 2: 49.3%), reduced health worker workload (Wave 1: 44.6%; Wave 2: 46.6%) and client empowerment (Wave 1: 48.5%; Wave 2: 45.2%), while some also mentioned improved affordability for the client (Wave 1: 30.3%; Wave 2: 23.3%). HIV self-sampling In Wave 1, 40.2% of health workers reported having provided services related to HIV self-sampling, while this was just 26.3% in Wave 2. The remaining health workers reported that they had not provided services related to this intervention (Wave 1: 30.9%; Wave 2: 21.2%), that it was not available where they live (Wave 1: 14.1%; Wave 2: 22.6%) or that it was not related to their job (Wave 1: 19.0%; Wave 2: 29.9%). Less than half of respondents reported feeling sufficiently confident and informed to provide services related to HIV self-sampling (Wave 1: 42.8%; Wave 2: 39.7%), with others saying they would need more information (Wave 1: 43.1%; Wave 2: 33.6%) or training (Wave 1: 19.9%; Wave 2: 31.9%). Health workers’ main concerns regarding HIV self-sampling were that clients would not access health care if needed 10 Questions regarding HIV treatment were only asked in Wave 1. 11 Questions regarding STI treatment were only asked in Wave 1. (Wave 1: 58.2%; Wave 2: 62.6%) and that they would not use it correctly (Wave 1: 53.3%; Wave 2: 55.0%). Smaller numbers were also concerned about product quality (Wave 1: 20.0%; Wave 2: 24.2%) and safety (Wave 1: 24.4%; Wave 2: 19.8%). The main perceived benefits were reduced barriers (Wave 1: 63.9%; Wave 2: 59.0%) and convenience (Wave 1: 64.4%; Wave 2: 57.7%) for clients, while substantial numbers also mentioned reduced health worker workload (Wave 1: 43.8%; Wave 2: 50.0%), client empowerment (Wave 1: 50.6%; Wave 2: 43.6%) and affordability for the client (Wave 1: 29.2%; Wave 2: 25.6%). HIV treatment (i.e. antiretroviral therapy; ART)10 The majority of health workers reported that they have provided services for ART (56.9%), while 20.7% have not. For three respondents (1.0%), ART is not available where they live, and 21.7% said it is not related to their job. More than half of respondents reported feeling sufficiently confident and informed to provide services related to HIV treatment (54.4%), while 32.8% reported needing more information, and 18.9% reported needing training before they could provide these services. Health workers’ main concerns regarding ART were that the client would not access health care if needed after/while using ART (53.1%) and that the client would not use the treatment correctly (52.7%). Many were also concerned about safety (49.1%) and product quality (22.6%). The key benefits identified by health workers were convenience (62.3%) and reduced barriers (58.5%), while many also mentioned client empowerment (50.2%), reduction of health worker workload (40.1%) and reduced cost to the client (24.2%). Medical treatment of STIs11 The majority of health worker respondents reported that they have provided services for STI treatment (61.2%), while 17.8% had not. For four respondents (1.3%), it was not available where they live, and 20.1% said it was not related to their job. Over half of respondents reported feeling sufficiently confident and informed about STI treatment to provide relevant services (55.3%), while 34.6% reported needing more information, and 15.6% reported needing training. The top concerns identified by health worker respondents were that clients would not take the treatment correctly (54.7%) and that they would not access health care if needed (54.3%), and some were also concerned about safety (42.6%) and product quality (23.8%). The main benefits selected were convenience (66.5%) and reduced barriers (60.4%) for the client. Substantial numbers also mentioned empowerment (47.2%), reduction of health worker workload (39.6%) and reduced costs to the client (25.5%). 67Chapter 3 3.2.5 Promoting sexual healths Questions regarding the interventions in this subsection – lubricant and hormone therapy for gender affirmation – were only asked in Wave 2 of the survey. The findings are presented in Figures 3.13, 3.14 and 3.15 – please refer to the figure as needed for details not included in the narrative summary. FIGURE 3.13: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 72.4% 46.9% 18.0% 44.1% 19.0% 13.8% Feel confident and informed Need more information Need training FIGURE 3.14: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety Quality of product Incorrect use Reducing health care access Lubricants for sexual health 28.6% 36.5% 52.4% 28.6% Hormone therapy for gender affirmation 33.8% 27.0% 56.8% 56.8% FIGURE 3.15: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions Convenient for client Reduces barriers for client Reduces health worker workload Empowering for client Less expensive for client Lubricants for sexual health 71.8% 42.3% 32.1% 53.9% 26.9% Hormone therapy for gender affirmation 42.7% 52.9% 42.7% 55.9% 22.1% HORMONE THERAPY FOR GENDER AFFIRMATIONLUBRICANTS FOR SEXUAL HEALTH 20.7% 46.7% 30.4% 2.2% 28.0% 17.4% 46.2% 8.3% KEY YesNoIt is not related to my jobIt is not available where I live 68 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 Lubricants for sexual health About half of health worker respondents reported that they have provided services for lubricant (46.7%), while 20.7% had not. A few participants reported it was not available where they live (2.2%) and an additional 30.4% reported it was unrelated to their job. The majority of health workers reported feeling confident and informed enough to provide services related to personal lubricant (72.4%), while 19.0% said they would need more information and 13.8% would need training. Health workers’ main concern regarding lubricant was that clients would not use it correctly (52.4%), while some were also concerned about product quality (36.5%), safety (28.6%) and that clients would not access health care if needed (28.6%). The perceived benefits of lubricant were convenience for the client (71.8%), empowerment (53.9%), reduced barriers for clients (42.3%), reduced health worker workload (32.1%) and reduced cost for clients (26.9%). Hormone therapy for gender affirmation A minority of health worker respondents reported they had provided services for hormone therapy for gender affirmation (17.4%), while 28.0% had not. Additionally, 8.3% reported that this intervention is not available where they live and 46.2% said it was unrelated to their job. Less than a fifth of health workers reported feeling sufficiently confident and informed to provide services related to hormone therapy for gender affirmation (18.0%), while 46.9% said they would need more information and 44.1% would need training. Among the health workers, the main concerns about this intervention were that clients would not access health care if needed (56.8%) and that clients would not use it correctly (56.8%), while smaller numbers were concerned about product quality (27.0%), and safety (33.8%). A majority identified client empowerment (55.9%) and reduced barriers (52.9%) as the benefits of hormone therapy for gender affirmation, while some also mentioned reduced health worker workload (42.7%), convenience for the client (42.7%) and affordability for the client (22.1%). 3.2.6 SRH information online and via mobile applications Questions regarding the interventions in this subsection were only included in Wave 1 of the survey. The findings are presented in Tables 3.16, 3.17 and 3.18 – please refer to these tables as needed for details not included in the narrative summary. ONLINE SEXUAL HEALTH INFORMATION MOBILE SEXUAL HEALTH APPS FIGURE 3.16: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS ONLINE REPRODUCTIVE HEALTH INFORMATION MOBILE REPRODUCTIVE HEALTH APPS QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 39.9% 35.2% 19.9% 5.6% 66.6%68.5% 29.3% 47.4% 40.8% 7.6% 15.6% 27.1% 45.7% 42.6% 7.2% 15.1% Feel confident and informed Need more information Need training KEY YesNoIt is not related to my jobIt is not available where I live 20.5% 63.0% 15.9% 1.0% 19.4% 63.8% 15.8% 1.0% 41.0% 34.3% 20.0% 5.3% 69Chapter 3 FIGURE 3.17: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety (e.g. side-effects) Quality of product Incorrect use Access to health care if needed Reproductive health information found online 19.9% 30.3% 46.0% 48.3% Reproductive health mobile phone app 15.1% 29.8% 44.9% 46.8% Sexual health information found online 19.1% 30.1% 45.5% 48.8% Sexual health mobile phone app 16.0% 29.1% 44.2% 48.1% FIGURE 3.18: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions It is more convenient for patient/client It will remove barriers such as stigma It reduces health-care provider workload It is empowering It is cheaper for the client Reproductive health information found online 67.8% 50.2% 44.1% 57.3% 37.9% Reproductive health mobile phone app 66.4% 44.4% 38.1% 58.3% 36.8% Sexual health information found online 68.4% 51.1% 43.6% 58.7% 36.9% Sexual health mobile phone app 68.4% 45.3% 37.3% 56.9% 35.1% Online reproductive health information The majority of health workers reported that they have referred people to online reproductive health (RH) information (63.8%), while 19.4% had not. For three respondents, it was not available where they live (1.0%), and for 15.8%, it was not related to their job. The majority of health workers reported feeling confident and informed enough about RH information that is available online (68.5%), while 27.1% reported needing more information, and 7.2% reported needing training before they could assist people with this. Health workers’ main concerns were that clients would not access health care if needed (48.3%) and that they would not use these online resources correctly (46.0%), and there were also concerns about the quality of the RH information (30.3%), and safety (19.9%). The top benefits identified were convenience for the client (67.8%), empowerment (57.3%), reduced barriers (50.2%), reduced health worker workload (44.1%), and affordability (37.9%). 70 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 Mobile reproductive health apps Over a third of health workers reported they have provided a referral to or information about mobile RH apps (35.2%), while 39.9% have not. For 5.6%, it was not available where they live, and for 19.9%, it was unrelated to their job. Less than half of health workers reported feeling confident and informed about RH apps (42.6%), while 45.7% reported that they would need more information, and 15.1% reported needing training before they could provide a relevant referral to an RH app. The top concerns identified by health workers were that clients would not access health care if needed (46.8%) and that they would not use the RH app correctly (44.9%), and some were also concerned about the quality of the product (29.8%), and safety (15.1%). The key perceived benefits were convenience (66.4%) and empowerment (58.3%), while substantial numbers also mentioned reduced barriers (44.4%), reduced health worker workload (38.1%), and affordability (36.8%). Online sexual health information The majority of health worker respondents reported they have referred people to sexual health (SH) information online (63.0%), while 20.5% have not. For three respondents, it was not available where they live (1.0%), and for 15.9%, it was not related to their job. Two thirds of respondents reported feeling confident and informed about online SH information (66.6%), while 29.3% reported needing more information, and 7.6% reported needing training before they would be able to refer people to appropriate online resources. The top concerns identified by health worker respondents were that clients would not access health care if needed (48.8%) and they may not use the SH information correctly (45.5%), and there were also concerns about the quality of the resources (30.1%), and safety (19.1%). The main perceived benefits reported were convenience for the client (68.4%), empowerment (58.7%), reduced barriers (51.1%), reduced health worker workload (43.6%), and affordability (36.9%). Mobile sexual health apps About a third of health workers reported having provided a referral to or information about mobile SH apps (34.3%), while 41.0% had not. For 5.3%, such apps were not available where they lived, and 20.0% said this was unrelated to their job. Fewer than half of respondents reported feeling confident and informed about SH apps (40.8%), while 47.4% reported needing more information, and 15.6% reported needing training before they could provide a referral to an appropriate SH app. Health workers’ top concerns were that the client would not access health care if needed (48.1%) and that they would not use the app correctly (44.2%), in addition to concerns about product quality (29.1%), and safety (16.0%). The main perceived benefits were convenience for the client (68.4%) and empowerment (56.9%), while substantial numbers also mentioned reduced barriers (45.3%), reduced health worker workload (37.3%), and affordability (35.1%). 71Chapter 3 Chapter 4 Transformative training for health professionals on self-care SRHR interventions New approaches and changes in training and education of health-care providers are needed in order to institutionalize sensitive and effective use of self-care interventions. It is crucial for a revised curriculum to be embedded in principles of human rights, gender equality, and increased user autonomy and health literacy to improve empowerment and support confident decision-making. Recognizing the importance of such training, the WHO Department of Reproductive Health and Research convened the first consultation of early-career health professionals from the fields of midwifery, nursing, pharmacy, public health and medicine. For this session of the meeting, panelists were invited from different WHO departments and United Nations agencies to talk about their experiences and approaches to health education and ending stigma and discrimination in health care. After the discussion, recommendations for the new types of training and transformation to accommodate self-care interventions were made by participants and are listed here. Participant recommendations for transformative training: • Focus on competency-based curricula, with a special emphasis on communication, compassion and a person-centred approach to care. • Integrate self-care interventions into the curricula for health professional education and training. • Support students and young health professionals to take active roles in university governing bodies, societies and academic communities to advocate for appropriate advances and innovations in curricula. • Provide early training on holistic and integrated health care and sensitization, to institutionalize empathetic attitudes among health professionals that take into account the broader social, psychological, spiritual and religious context of people’s lives. • Emphasize and operationalize inter-professional collaborations and build teamwork skills for more effective integrated service delivery, including mobility and access to opportunities for skills exchange at global, regional and national levels. • Address issues of power and vulnerability to support increased user autonomy and empowerment. • Integrate the use of innovative research, technologies, digital and online resources, interactive learning and other innovative forms of training to reinforce comprehensive learning of information and practical skills. • Facilitate continuous quality improvement through implementation of appropriate accountability and feedback mechanisms. HIGHLIGHTS FROM HEALTH-CARE COMMUNITY CONSULTATIONS Chapter 4 72 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Values and preferences relating to self-care interventions for SRHR: qualitative findings 4 Chapter 4 73 Chapter summary This chapter presents the qualitative data gathered from respondents through the use of open-ended questions, shedding light on their values and preferences, their concerns and their hopes regarding the use of self-care interventions for SRHR. Four main themes emerged for both respondent groups (health workers and laypersons) and another two main themes for health worker respondents specifically: • current concerns with self-care interventions for SRHR • potential benefits of self-care interventions for SRHR • preferred conditions for use of self-care interventions for SRHR • future issues for consideration with self-care interventions for SRHR • linkages to health care (health workers only) • health worker training and information needs (health workers only). In Wave 1, 172 health worker respondents provided qualitative feedback. In Wave 1, the most prominent issues mentioned by health workers were accessibility, stigma and discrimination, cost, information and knowledge, misuse, expertise, culture and beliefs, confidentiality and legitimacy. In Wave 2, 76 health workers provided qualitative feedback and the most prominent issues mentioned fell within those same themes as well as the issues of availability and linkage to care. In Wave 1, 74 laypersons provided qualitative feedback, as did 20 laypersons in Wave 2. In both waves, the most prominent issues mentioned by laypersons in relation to the first four themes listed above were accessibility, stigma and discrimination, information and knowledge, cost, expertise, misuse, culture and beliefs, confidentiality and legitimacy. “Only men have easy access to condoms in the pharmacy. Women like us are given judgemental looks and sometimes asked what we need it for! This is the same problem when we try to access self-testing pregnancy kits.” – A female college student Chapter 4 74 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Survey respondents in both waves were asked to share their thoughts reflecting their values and preferences about self-care interventions for SRHR by providing written responses to the open-ended questions provided in the box below. Open-ended survey questions In Wave 1 and 2: • Is there anything you would like to share with us about self-initiated interventions? This could include thoughts about access, cost, stigma and discrimination. We are interested in what you like or don’t like about these and other relevant interventions, or any concerns you have about them. • Are there any other benefits you can see regarding self-initiated interventions? (Note: in Wave 2, the end of this question was modified with the following addition: particularly for marginalized or vulnerable clients) • How do you think we can help to link patients/clients to health care if needed after using a self-initiated intervention (e.g. after a positive result from an HIV self- test?) (only asked to health workers) • What specific training, information or skills would you like regarding self-initiated interventions? (only asked to health workers) • Any other comments? • Additional question added in Wave 2 only: • Is there anything you would like to share about your experience within health facilities, and/or of stigma and discrimination, when you were accessing these products? All of the qualitative responses were collated and coded thematically based on the topics mentioned or discussed in respondents’ comments. The findings are presented here, including selected quotes, grouped according to several main themes that emerged from this analysis for both health workers and layperson respondents for each wave of the GVPS. Four main themes emerged for both respondent groups and another two main themes for health worker respondents specifically, within their responses to the questions listed above: • current concerns with self-care interventions for SRHR • potential benefits of self-care interventions for SRHR • preferred conditions for use of self-care intervention for SRHR • future issues for consideration with self-care interventions for SRHR • linkages to health care (health workers only) • health worker training and information needs (health workers only). 4.1.1 HEALTH WORKERS Wave 1 Health worker respondents were asked “What other concerns do you have about self-initiated interventions?” and presented with the list of response options as shown below, from which they could select all that apply. A total of 316 health workers responded to this question in Wave 1 with the results as shown below. • age restrictions (54.1%, n=171) • spousal consent laws (31.6%, n=100) • the patient/client may not use it correctly (64.6%, n=204) • concerns about where the patient/client would go if they used it incorrectly (56.6%, n=179) • no concerns (9.5%, n=30). The health worker respondents also had the option to express and elaborate on their concerns through a qualitative written response, and 66 health workers did so, providing valuable qualitative data, as presented below. The most common themes in these written responses were sociocultural issues (especially stigma and discrimination), the importance of knowledge and information, lack of accessibility, side-effects and potential complications. Sociocultural issues, especially stigma, were mentioned in the written responses of 18 health workers. These issues were described as a concern present at the individual level through shame; at the community level through stigmatizing norms; and at the state level through lack of supportive policies. A 21-year-old female respondent in Poland who identifies as bisexual described this issue as: “Shame accompanying using them, e.g. because of social stereotypes.” A 32-year-old male health worker in Nigeria noted that there could be challenges in accessing self-care interventions due to low community acceptance and stigma, highlighting the need for: “Accessibility to self-interventions without prejudice.” A 33-year-old female 4.1 CURRENT CONCERNS WITH SELF-CARE SRHR INTERVENTIONS: HEALTH WORKERS AND LAYPERSONS Chapter 4 75 health worker in Cameroon described how sociocultural issues may exist on the macro level, through “traditional and discriminatory state policy”. A 27-year-old male respondent in Thailand explained the impact of stigma and discrimination: “Stigma and discrimination in traditional communities by health-care providers and pharmacy employees creates barrier to access any of STI self-treatment methods.” Similarly, facing negative judgement when accessing health care was a concern expressed by some participants. A 30-year-old male respondent in the Philippines explained the importance of this issue: “Non-judgemental and quality care and service is the paramount consideration.” Those concerns of facing stigma and poor treatment when accessing services were connected to culture and beliefs. A 22-year-old male respondent in Türkiye explained the phenomenon in the local context: Especially in Türkiye, people are very strict about sexual relationships. They have some rules, like two young people cannot have sex before the marriage… When they go to the doctor they come face to face with unacceptable behaviours. Young people are exposed to ill treatment by the doctor. This issue was identified as a barrier to accessing SRH services. A 45-year-old female respondent in Colombia wrote of the consequences of health workers’ beliefs: “In health centres, many times they do not give information with what they do not agree with, or they are not within the pos.” Seventeen health workers also expressed concerns about knowledge and information. A 39-year-old female health worker in the USA explained this issue: “I think there is a lot of false information out there, and it can be hard to distinguish the credible sources from the ones that aren't.” The lack of appropriate information can have consequences for people’s health-care decisions. A 43-year-old female health worker in Spain expanded on this concern: “Incomplete information to make a really informed choice.” Lack of accessibility was also a major concern expressed by 10 health workers. A 60-year-old male respondent in Brazil wrote: “High costs and difficulty of access are issues important for some methods.” This issue was connected to health workers controlling access to self-care interventions for SRHR. A 47-year-old female respondent in the USA explained: “Doctors, pharmacists or any other health-care staff should not be gatekeepers.” Overreliance on health workers was identified as a barrier to self-care interventions. A 31-year-old female respondent in the USA elaborated: “The field is too medicalized. Patients have been taught to go to the doctor for everything. It will take time and effort for people to fight for and access some of these interventions without the use of a health-care provider.” A 56-year-old female respondent in Italy described this lack of accessibility: “Lack of access to health services when needed even if they exist, due to many barriers.” This was mentioned as particularly an issue for certain underserved populations. A 42-year-old female respondent in Portugal notes the issue of “lack of access by disabled people”. Concerns about side-effects and potential complications were also raised by nine health worker respondents in Wave 1. They expressed concern about what the user of an intervention would do in the event that they experience side- effects. A 54-year-old male respondent in Kenya noted the concern of “handling of complications”. Some respondents expressed concerns about potentially harmful consequences. A 27-year-old female health worker in the Republic of Moldova explained her view of the impact this could have: “Side- effects [are a concern] and as result decision to quit and refuse the self-initiated interventions in the potential future.” A 54-year-old female respondent in Switzerland also discussed the importance of linking people to health care as needed following use of self-care interventions: “Access to and support provided by health services if the patient has used something incorrectly and needs treatment/support to correct that.” Wave 2 A total of 54 health workers in Wave 2 expressed current concerns with self-care interventions for SRHR through their written responses. The main themes that emerged from their responses were accessibility, stigma and discrimination, lack of community awareness and product quality. Accessibility was the most common theme to emerge among the concerns expressed by 24 health worker respondents. Within this theme, three broad categories could be distinguished: cost, availability and insurance coverage. The respondents expressed concern about the high cost of self-care interventions for SRHR. A 34-year-old female health worker in Zambia explained that “affordability of these interventions for ordinary people is a major issue”. The high cost of some products impacted individuals’ ability to access them. A 22-year-old respondent from Canada (gender not specified) found that the “accessibility to sexual health services/products is largely influenced by whether you can afford these products”. Lack of availability impacted access and was a concern for many. In some countries, respondents reported that self- care intervention products were not only hard to find but not available at all. A 63-year-old female respondent from Zimbabwe explained that while “some of the products like lubricants are not readily available” some were not sold in Zimbabwe as “there is no over-the-counter abortion pill in our country”. Health workers noted a difference in availability based on location, a 49-year-old male respondent in Morocco said that “there is an unavailability of certain products, particularly in rural and in isolated areas”. Finally, health worker respondents highlighted that certain products were continually unavailable. A 57 year-old female respondent from Nigeria said that “pre/ post prophylaxis is not easily accessible with high rate of nonavailability”, and a 34-year-old female health worker from Zambia said “services including syphilis tests are not readily available at public health centres”. Additionally, there were also concerns about youths’ ability to access self-care interventions for SRHR. A 30-year-old female health worker in Australia felt that: “It’s important that legal restrictions related to age don’t impede access; younger Chapter 4 76 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report people who might be among those most able to benefit from self-administered interventions are barred from accessing them.” Additionally, a 49-year-old male health worker from Rwanda felt that for “youth is not easy to get services without accompaniment with parents”. The final concern related to accessibility of self-care interventions for SRHR was that many of the interventions were not covered by health insurance, which therefore rendered them unaffordable and inaccessible. As a 59-year-old female health worker from the USA wrote, “Access within a reasonable amount of time is difficult for people like me with poor insurance coverage. The products that are available in my area are expensive.” The lack of insurance coverage for self-care interventions for SRHR make them unaffordable to many, as explained by a 59-year-old female health worker from Zimbabwe: Access to basic services such as these is a privilege of a few and beyond the reach of many. Public institutions that are supposed to provide the services hardly have them or enough of the resources. The next most common theme, expressed by 21 health worker respondents in Wave 2, was stigma and discrimination. A 35-year-old queer respondent (country non-specified) summarized the concerns surrounding stigma expressed by numerous respondents by saying, “Stigma is the biggest barrier to accessing these self-care interventions.” Stigma was said to impact access to both products and information on products. A 57-year-old female respondent from India said: There is stigma and discrimination related to purchase, getting information on and use of medicines and products related to contraception, STI (including HIV) and abortion. There is also stigma related to use of pregnancy-related products and services for unmarried women or young girls, such as use of the pregnancy test. Highlighting how stigma impacted women accessing self- care interventions for SRHR was common in health worker responses. A 38-year-old woman from Bolivia wrote, “Unfortunately, it is difficult to access public health services, it is not given due importance, there is still discrimination for being a woman and looking for condoms.” Stigma was particularly felt by single/unmarried women. A 49-year-old male respondent from Morocco shared that access to self-care interventions for SRHR was difficult for “single women who are not considered as the target population in the national programme”. In Wave 2, multiple health workers specifically highlighted concerns about stigma surrounding gender identity. A 59-year-old female respondent from the USA explained, “People of certain gender identities, races and religions encounter prejudice in health-care settings and therefore do not like to go. Direct access to these items could be important for them.” Further, a 30-year-old transgender respondent from Chile said: It is very difficult to access hormone replacement therapy, since trans identities are pathologized despite the fact that the Gender Identity Law prohibits it. It is required to go through a highly bureaucratic process that ends up being a barrier to access, in addition to other people requesting psychological and psychiatric certificates to access. Another concern about self-care interventions for SRHR expressed by six health workers was the lack of public/ community awareness about these interventions and their usage. A 48-year-old female health worker explained that “information is required for safe self-care and what to do or where to go in case of side-effects”. Further, a 59-year-old female health worker from the USA said that: Most people are not well educated regarding which contraceptives are most reliable, how to use them properly, and when STI testing is needed. Direct access needs to come with a lot of consumer education. Finally, four health workers expressed concern about the quality of products, noting possible counterfeit self-care interventions. For instance, a 38-year-old female health worker from Zimbabwe stressed that “standards and quality for self- care test kits on the market need to be checked frequently by regulatory authorities” and that the “supply chain for contraceptives need to be strengthened to prevent shortages and street trading of these commodities”. Chapter 4 77 4.1.2 LAYPERSON RESPONDENTS Wave 1 In their written responses, layperson respondents in Wave 1 described concerns that fell within the following major themes: poor accessibility, stigma and discrimination, and culture and beliefs. Respondents mentioned barriers that exist in accessing self- care interventions for SRHR. A 45-year-old female respondent in Canada expressed how the lack of affordable interventions leads to poor access: “Cost is indeed a big barrier to some.” Other factors, such as lack of availability and provider unwillingness, also make it difficult to access specific self-care interventions for SRHR. A 21-year-old woman in Poland explained the barriers in a local context: “In Poland, to get an emergency contraception you first have to go to the doctor and not all of them want to prescribe it. Some pharmacies also do not want to sell it.” Stigma and discrimination were recognized by respondents as being a major concern relevant to self-care interventions for SRHR. A 25-year-old female respondent in Colombia stated: “The principal concern is stigma related to the use of sexual and reproductive health products.” This was specifically expressed as a problem for certain populations. A 27-year-old female respondent from the Republic of Korea elaborated on the circumstances in which stigma becomes a barrier: When teenagers and young women visit to the hospital in obstetrics and gynaecology for many reasons, consulting on ovulation pain, unregular ovulation, STI test, etc., there is a social stigma from older women and relevant people and regarded as not moral person. This social stigma blocks many young women to access and take care of their health. Lastly, culture and beliefs, particularly traditional or conservative beliefs, were perceived by layperson respondents as being a significant concern relevant to self-care interventions for SRHR. A 26-year-old female respondent in Panama explained how this manifests in regard to accessing abortion: “Voluntary abortion is illegal in my country and there is a lot of religious (Christian) stigma when expressing wanting it.” The impact of religion on access to SRH services was also mentioned by other respondents. A 29-year-old female respondent in Croatia explained: “I would like religion groups stay away from affecting laws and directives about contraception. They mess up a lot of things.” Wave 2 Some layperson respondents in Wave 2 also wrote down their concerns regarding self-care interventions for SRHR. The major themes were limited availability, high cost, and stigma and discrimination. Poor availability and accessibility was related to the location of self-care interventions for SRHR. A 39-year-old female respondent from Côte d’Ivoire described that “emergency contraception is incredibly expensive and often locked away/ behind the counter.” Further, the high cost was also seen as a barrier to access for self-care interventions for SRHR. A 39-year-old woman from Australia explained: I’ve also struggled to access the morning-after pill/ emergency contraception – I acquired it from the local chemist, but was shocked by the price, which left my partner and I without money as we’re both on welfare and thus below the poverty line. Stigma and discrimination was another theme among layperson respondents’ written contributions. A 31-year- old female respondent from Spain shared, “I have felt some judgement about my sexual activity when using contraception services.” Similarly, a 40-year-old woman from Nigeria explained, “The process and procedure of accessing some of the above listed are cumbersome and quite discriminatory.” Stigma was said to be associated with certain products. For example, a 31-year-old from Kenya said, “There still exists a lot of stigma accessing HIV-related and abortion-related products.” Stigma was tied to local cultural beliefs, as explained by a 28-year-old respondent from Pakistan: “There is cultural, social and religious barrier to access these products.” For self-care interventions that required a prescription, a 23-year-old female respondent from Canada said she “had to go to multiple doctors at a clinic to find someone who would prescribe it, severe stigma associated with it leading to decline in mental health”. Chapter 4 78 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report 4.2.1 HEALTH WORKERS Wave 1 A total of 112 health workers provided written responses in Wave 1 about the benefits of self-care interventions for SRHR. The most common theme expressed was that there are no benefits, but many others also wrote about intrapersonal benefits, reduced exposure to stigma and discrimination, and increased usage, convenience, knowledge and confidentiality (1). The most common sentiment, mentioned by 31 health workers, was that there are no benefits to self-initiated interventions. For instance, a 34-year-old male health worker in Lebanon explains: “[No benefits] at all! People should go see a doctor, otherwise all self-initiated interventions are a failure.” Twenty-five other respondents recognized the intrapersonal benefits of these interventions. Many noted how their use promotes empowerment, self-confidence and better-informed decision-making. A 54-year-old female health worker in Switzerland noted that these interventions provide “increased power to people”. Similarly, a 33-year-old female health worker in Ecuador observed the benefit of providing “people with autonomy”. Some described the personal benefits that self-care interventions would provide to higher risk populations. A 25-year-old female health worker in Kenya explained how self-care interventions “enable [young women] to make informed decisions without being pressured by anyone”. Fifteen respondents noted that the self-initiated aspect of these products could lead to increased use of the interventions in the population. A 59-year-old female health worker in the USA noted: “There is greater uptake and adherence of interventions if self-initiated.” This was identified as especially beneficial for populations who may not engage in SRH services as often as needed. A 56-year-old female provider in Italy described the benefits of these interventions for young people: “Many of them are excellent for increasing access by youth to RH [reproductive health] services, as they are often deprived.” Increased convenience was also mentioned by 15 respondents, explained in terms of ease of access and time saved. A 56-year-old female health worker in New Zealand noted that this type of intervention “removes gatekeepers”. A 31-year-old female health worker in Serbia explained this benefit as: “Faster treatment if patient don't have time to wait in health clinics and hospitals.” This was specified as being particularly beneficial for certain interventions. A 28-year-old female health worker in France wrote: “Better accessibility and quicker process (abortion/self-diagnosis STI/HIV).” Fourteen health workers identified the benefit of increased knowledge. Self-care interventions for SRHR were described as having the potential to increase the population’s knowledge and information on SRHR, which benefits their health and well-being in multiple ways. A 65-year-old male health worker in Kenya noted this benefit: “This can lead to improvement of knowledge and confidence.” A 58-year-old female health worker in Peru explained how this can benefit a patient’s interactions with the health system: “It helps to know better the functioning of your body. It will have better elements for dialogue with health personnel.” Eleven health worker respondents noted the benefit of increased confidentiality with self-care interventions for SRHR. A 40-year-old female health worker in Canada described how this would help those who are marginalized, such as women in abusive relationships: “Privacy [is a benefit], especially for women in abusive situations where husbands may control medical care.” A 32-year-old male health worker in Nigeria wrote that “confidentiality will be maintained” with these interventions. A 32-year-old male health worker in Argentina wrote of “greater respect and privacy” as being benefits to self- care interventions. The benefit of greater confidentiality was supported by a 26-year-old female health worker in Kenya: “… needless to say, my confidentiality will be better safeguarded”. Nine health worker respondents identified improved health as an advantage of self-care interventions for SRHR. A 30-year- old male health worker in the Philippines explained how these interventions will “encourage health seeking behaviour of the public”. A number of health workers mentioned that self-care interventions for SRHR help to address issues related to stigma and discrimination. A 21-year-old female health worker in Poland explained: “I think that having these interventions easily accessible and without stigmatization or shame would make these interventions easier, more pleasant and safer.” A 26-year-old female health worker in Uganda elaborated on its potential in certain regions: “I believe self- initiated interventions can play a huge role in reducing barriers to accessing services due to stigma associated around it, especially in sub-Saharan Africa.” A 38-year-old male health worker in Thailand discussed how the risk of discrimination against sexual and gender minorities can be a barrier to access that could be addressed by self-care interventions: Access would be the most important. While I don’t have concerns visiting a doctor or health centre as I am out and comfortable with my sexuality, those who are not out would be unlikely to access a health service and disclose their sexuality to a doctor. Health worker respondents discussed how the affordable cost of self-care interventions is a potential benefit. A 38-year- 4.2 POTENTIAL BENEFITS OF SELF-CARE SRHR INTERVENTIONS: HEALTH WORKERS AND LAYPERSONS Chapter 4 79 old male respondent in Malawi explained how there is “less cost because there is no service fee for the health provider”. A 70-year-old male health worker in the United Kingdom supported the affordability of self-care interventions: “Good idea, will save cost and time.” Increased confidentiality and reduced stigma and cost all act to improve accessibility to the interventions. Wave 2 A total of 33 health worker respondents shared written responses in Wave 2 about the benefits of self-care interventions for SRHR. The most common themes in their responses were increasing access to care, addressing stigma and discrimination, improving confidentiality and linkage to care, reducing costs and addressing concerns surrounding gender-based violence. The most common theme, mentioned by 10 health workers, was that self-care interventions for SRHR increased access to care. A 37-year-old woman from Nigeria articulated a commonly held sentiment among health workers, that self-care interventions “increase access to effective SRHR services”. By increasing access to care, self-care interventions for SRHR were understood to in turn improve health. The subsequent reduction in health inequities was mentioned by a 45-year-old female respondent in Canada: “Self-care reduces inequality between those who can afford to go to health care centre and those who cannot.” Others discussed reduced mortality, as expressed by a female health worker in Cameroon: “They will easily access sexual and reproductive health services which will reduce mortality and morbidity rate among these groups of persons.” One avenue through which self-care interventions for SRHR were understood to increase access was by reducing costs when compared with interventions that require an appointment or extensive interactions with health-care personnel or facilities. For instance, a 69-year-old female health worker (country non-specified) said that self-care interventions for SRHR were beneficial because they are “cost-effective and minimizes encounters with health providers”. Additionally, a 43-year-old Kenyan female health worker said that when these interventions are low cost, this increases access to care because they “could be cheaper and then more accessible”. The lower cost of these interventions helped individuals in “avoiding financial strain”, as mentioned by a 25-year-old female health worker from the Philippines. Addressing stigma and discrimination was mentioned as a benefit by eight health worker respondents in Wave 2. A 60-year-old male health worker (country non-specified) explained they were considering providing self-care options to some of their patients as it helped address patient experiences of stigma and discrimination. He elaborated as follows: I was thinking of providing a self-care test kit for example injectables (contraceptives), HCG test kit, and HIV test kit. Most of them hardly visit any health clinics as they are sometimes discriminated against by other people. Related to increased access to care, four health worker respondents noted that self-care interventions for SRHR could lead to more timely diagnoses and pathways to care. One respondent (no socio-demographic information provided) wrote that self-care interventions for SRHR facilitated “the timely detection of diseases such as HPV infection, HIV, as well as the diagnosis of pregnancy”. Further, a 48-year-old female health worker (country non-specified) felt that these interventions “increase access, timeliness to care, limits complications due to delayed care.” A few health worker respondents also noted that self-care interventions for SRHR had the potential to address concerns around confidentiality and privacy. A 39-year-old female health worker from the USA summarized this point by saying, “Discretion and privacy is the major benefit of self-care.” More specifically, being able to use self-care interventions at home was highlighted as a major potential benefit. A 50-year-old male bisexual health worker (country non-specified) said that one of the “numerous benefits” of self-care interventions for SRHR for individuals who might experience stigma is “the capability to manage themselves privately, away from stigmatizers.” A few health worker respondents also mentioned another benefit of self-care interventions for SRHR: their ability to address some concerns surrounding gender-based violence. A 45-year-old female health worker (country non-specified) shared that one of the benefits of self-care interventions for SRHR was their potential to “reduce intimate partner violence”. A 31-year-old female health worker from the United States elaborated on this benefit, explaining, “Some of these methods also reduce gender-based violence – particularly products that allow women to prevent pregnancy and HIV acquisition in ways that are discreet.” Chapter 4 80 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report 4.2.2 LAYPERSON RESPONDENTS Wave 1 A number of laypersons in Wave 1 mentioned the potential benefits associated with self-care interventions for SRHR. The most common themes were decreased barriers to access and reduced stigma and discrimination. Respondents expressed how self-care interventions for SRHR have the potential to increase access to SRHR interventions by reducing barriers to access. A 29-year-old female respondent in the USA described the existing barriers that these interventions could help to reduce as well as the benefits for women in particular: I think it's really important to have self-initiated interventions available over the counter at pharmacies at a low cost so that people can access them without having to visit a health-care provider, which adds an additional cost in both monetary value and lost time. Oftentimes going to a health- care provider to access some of these self-initiated options makes women feel shameful and some health-care providers don’t do a great job of making it a safe, empowering space for women to choose the method that is right for them. It would be amazing to have more options available, more easily accessible to women in the United States. A 31-year-old female respondent in the USA elaborated on the potential for improved access to SRHR interventions for women: “Going to a health-care provider can be a major barrier for women to access RH [reproductive health] services. Putting care directly into the hands of women to manage is an important way to overcome this barrier.” Another potential benefit recognized by layperson respondents was how self-care options could reduce the stigma and discrimination often associated with SRHR interventions. A 41-year-old man in Uganda explained: “I think an option for self-initiated interventions is good to reduce stigma and discrimination.” Some respondents specified that online sources for SRHR information would be particularly helpful for youth. A 25-year-old female respondent in Croatia explained how this would address stigma: “A majority of the public are not informed well enough about them, due to stigma surrounding these interventions. A reliable, up-to-date and simple-to-use online, mobile source of information would be highly beneficial, especially to the younger population.” Wave 2 Most layperson respondents in Wave 2 discussed the potential benefits associated with self-care SRHR interventions. The most common theme was that self-care strategies held the potential to reduce stigma and discrimination. Respondents noticed that when they had accessed self-care interventions for SRHR in the past, they did not feel stigmatized. As a 36-year-old woman from the USA described, “I used emergency contraception twice in my early 20s. Went to Planned Parenthood to obtain the EC [emergency contraception] – they were supportive and nonjudgemental.” As seen in this response, the respondents highlighted specific locations where they did not feel judged. A similar sentiment was expressed by a 22-year-old woman from Canada: When accessing birth control on university campus I felt a sense of comfort and non-judgement, but going to a pharmacy I felt the judgement from the pharmacist behind the counter when seeking out Plan B. The difference in care was a little scary for me and so I wouldn’t want to go back to a pharmacy for that particular concern again because I have a young face and I think I would receive that treatment again. Chapter 4 81 4.3.1 HEALTH WORKERS Wave 1 The major themes that emerged when health worker respondents provided their qualitative answers about their preferred conditions for use of self-care interventions for SRHR were: ease of access and availability; information, knowledge and education; and confidentiality and privacy. Respondents indicated a preference for self-care interventions that are easily accessible and available. A 30-year-old male health worker in Kenya explained: “The interventions should be readily available and at minimal cost.” A 37-year-old female health worker in the USA discussed what that would look like: “Access and cost should be minimized for these [interventions] – ideally non- prescription, over the counter, with an ability to seek additional guidance.” Health worker respondents recognized the need for better information, increased knowledge and more education about self-care interventions. A 70-year-old male health worker in India mentioned the need for widespread knowledge on these interventions: “Self-initiated interventions require awareness, good educational background and community participation.” Similarly, a 40-year-old male health worker in Uganda described how this is important for use of the self-care interventions: “Availability of information for users is important and also how to interface with health system after use.” Better confidentiality and privacy were also mentioned by health workers as important conditions for successful use of self-care SRHR interventions. A 40-year-old female health worker in the USA emphasized this issue: “Privacy and confidentiality are key for self-initiated SRH interventions.” A 25-year-old female health worker in Nigeria explained the significance of this issue in her local context: “Stigma in Nigeria is still a huge issue. I’d like for more discreet means of accessing SIIs [self-initiated interventions] in such countries.” Wave 2 A number of health worker respondents expressed their preferred conditions for use of self-care interventions for SRHR in the written responses. The major themes of these responses were cost, and knowledge and information. A 54-year-old male health worker from the United Kingdom summarized these themes saying: “I would support the range of self-care interventions being made as widely available but would also want access to be as simple, discrete and cost effective as possible.” Health workers highlighted that it was important to provide information and education when giving out self-care interventions for SRHR. This included general information on the availability of self-care interventions. A female health worker in Cameroon (age not specified) asked that there be “community awareness on the concept and products of self- care”. Health workers felt that greater general knowledge about self-care interventions for SRHR would lead to more people accessing these interventions. A 54-year-old male health worker in the United Kingdom said, “I would also like to see greater promotion of and education about the range of self-care commodities available to increase uptake.” Health workers also felt it was important for information on side-effects to be widely known. A 31-year-old female respondent in Venezuela expressed concerned over the lack of information on side-effects: I do not like that health providers do not inform women well about complications, side-effects or warning signs about contraceptive methods, they offer them as innocuous and 100% safe or effective, which is not as true. Participants recommended that information on side-effects should be provided at the point of care or point of purchase. Health worker respondents felt that information would also help link individuals to care. As a 48-year-old female health worker (country not specified) wrote, “information is required for safe self- care and what to do or where to go in case of side-effects”. 4.3.2 LAYPERSON RESPONDENTS Wave 1 Layperson respondents described their preferred conditions for use of self-care interventions for SRHR in their qualitative responses, and the major themes of their answers were: accessibility and availability; information and knowledge; cost; and privacy and confidentiality. These respondents viewed it as ideal for self-care interventions to be accessible and available as an option for SRH services. A 32-year-old female respondent in the USA explained: “Self- initiated interventions are somewhat rare in the USA – I wish they were more common.” This was noted as being especially important for certain marginalized or higher-risk populations and in particular 4.3 PREFERRED CONDITIONS FOR USE OF SELF-CARE INTERVENTIONS FOR SRHR: HEALTH WORKERS AND LAYPERSONS Chapter 4 82 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report contexts. A 33-year-old male respondent in North Macedonia highlighted the need for access to self-care interventions among sexual and gender minorities: “As a gay man who has regular safe sex with other men, I would like to have PrEP and PEP accessible and affordable in my country.” Access for rural communities was suggested as a priority. A 20-year-old female respondent in Kenya wrote: “Access to birth control pills should be made available even in the remote areas.” Similarly, easy access was mentioned as ideal for youth, with some respondents providing suggestions on how that would work. A 37-year-old respondent in Uganda explained: “Mobile application on SRH is very important currently for young people, since every one at least has a smartphone.” Being better informed and educated was described as essential for making informed decisions on SRHR. A 23-year- old female respondent in Portugal explained: “I just want to be well informed of the interventions and choices I have, and then I want to choose by myself without needing a doctor.” Another participant in Portugal, a 20-year-old female respondent, supported widespread education about these interventions: “People must be more informed about all of these self-initiated interventions.” This was also discussed as being particularly important in certain regional contexts. A 21-year-old female respondent in Argentina wrote: “I would like that in Argentina there would be more sexual education.” Costs and affordability of self-care interventions were viewed as important by layerson respondents, who provided some suggestions on how that would work. A 58-year-old female respondent in the USA explained: “Cost is an issue. I would want interventions to be covered by insurance or provided for free or on a sliding scale based on income.” This was supported by other respondents. A 21-year-old female respondent in Panama wrote: “It would be useful if they were presented in a variety of pharmacies with different price ranges.” Affordable self-care interventions were seen as important for reducing STI rates in the population. A 20-year-old male respondent in Portugal explained, “I think that the cost of any sexual health product needs to be the lowest or free. That could help decrease the amount of people infected with any kind of sexual disease.” Among these respondents, the final major theme that emerged relating to preferred conditions for self-care interventions for SRHR was the protection of privacy and confidentiality for the user when accessing the intervention. A 34-year-old female respondent in Mexico explained how anonymity can be improved and why it is important: “Stocking them not behind the counter, [so they are available] without an ID is important – there can be just as much judgement from a pharmacist, especially in conservative places.” A 26-year-old female respondent in Sweden elaborated on the consequences when there is a lack of privacy and confidentiality: “I think anonymity is still very important for SRH, and often it is forgotten in services and that’s why many people don't access care through health-care providers.” Wave 2 A number of layperson respondents also shared their preferred conditions for use of self-care interventions for SRHR in Wave 2. The major themes that emerged were that open discussion, widely available information, and reduced costs all help to increase access and availability. Creating public dialogue and having widely available information about self-care interventions for SRHR was seen as beneficial to wider use and access. A 36-year-old woman from the USA explained, “I think that self-care will become more socialized and normalized if it is a topic that is discussed and advocated upon in peer groups, such as women’s groups or youth groups.” Some respondents shared that access to information facilitated access to care. A 43-year-old woman in the USA shared: I myself was well into my own sexual experience/activity before I had access to education on how to access contraception, methods and differences, largely due to education curricula and norms in safe conversations within family. Respondents felt information on self-care interventions for SRHR was not readily available. To illustrate, a 31-year-old woman from Kenya wrote that “Family planning education on use of FP products is not freely accessible in the public sphere (one needs to actively seek through doctor consultations or internet searches).” In another example, a 28-year-old woman from Spain described that, “Where I live, it is not that easy to find out where to get tested or to find out further information. Everything is 'hush hush' and there are no easy websites to access where to get help or find a clinic that can help you.” Ultimately for wider implementation and use of self-care interventions for SRHR, the same participant from Kenya explained, “There needs to be more awareness-raising and deeper understanding of self-care interventions.” Another emergent theme surrounding the preferred conditions for use of self-care interventions for SRHR was the importance of reducing costs to increase access. The high cost of some of the products and interventions was mentioned. A 28-year-old from Spain said, “The cost of the pill here in Valencia (Spain) is quite expensive and contributed to my decision to come off it.” A 26-year-old in Germany felt that high cost should not present access barriers to these interventions, particularly among young and/or economically insecure persons. They explained: I think all the interventions stated here are extremely expensive for a student or young individuals who are unemployed. But this shouldn't be a hindrance to get access to health products. For example, I use birth control solely for my period since it is a life-stopping pain. And I need to pay ~20 euros per package, which is basically my grocery cost per week. So when I buy birth control I need to decide what to eat and not to eat for that week. Finally, participants noted simply that increased and easier access would help with the wider use of self-care interventions for SRHR. For example, a 36-year-old respondent from the USA shared that their “ob-gyn offers a 1-year prescription and then I do mail order restocking every 3 months – very convenient.” Chapter 4 83 4.4 FUTURE ISSUES FOR CONSIDERATIONS WITH SELF-CARE SRHR INTERVENTIONS: HEALTH WORKERS AND LAYPERSONS 4.4.1 HEALTH WORKERS Wave 1 Health worker respondents identified and discussed potential issues with self-care SRHR interventions that may arise in the future, and which should thus be considered at early stages of roll-out. The major topics discussed were: the importance of expertise, the legitimacy (authenticity and quality) of interventions, and the potential for incorrect use. Many health worker respondents raised the issue of lack of expertise among the average user of self-care interventions, and the importance of accessing health workers for any SRHR interventions. A 65-year-old male health worker in India warned: “Self-initiated interventions need to be avoided as far as possible. Always consult doctor when there arises problem.” Similarly, a 58-year-old female health worker in Congo emphasized the need for medical professionals: “There should be very strong counselling communication on the need to consult a doctor or other health-care worker should the patient not be happy with results or if they should develop complications.” The risks of illegitimate self-care interventions were also raised for consideration by a number of health workers. A 46-year- old male health worker in Uganda explained why this issue should be considered: “Private drug shops, clinics need to be well regulated and could be sources of more burden and challenges.” A 35-year-old female health worker in the USA explained how this is particularly an issue with online sources, “I would want to make sure they are trusted, not counterfeit, if I buy them online.” Another potential issue that emerged in the responses was about the misuse or incorrect use of the interventions, which can have serious consequences. A 56-year-old woman in Italy described how this can be a result of poor knowledge among the population: “There is a risk for the general public of abuse or misuse due to lack of knowledge. There is a lot of misinformation out there so there must be safeguards and some control.” Those risks can impact one’s health, and some health workers expressed a preference for consulting with a medical professional as a result of such risks. The opinion of a 63-year- old female health worker in Pakistan was that: “An intervention led by a doctor or health-care provider is safer and maintains safer reproductive health.” Wave 2 Health worker respondents in Wave 2 discussed future issues to consider for self-care interventions for SRHR. The main theme that emerged in the written qualitative responses was the need for more training related to these interventions for health workers. Health worker respondents wanted training to learn more about where self-care interventions for SRHR could be accessed about how users could be linked to care. A 45-year- old female health worker (country not specified) said there was a need for: Communication through service providers in shops/ pharmacies where self-care products are mostly accessed. These service providers need to emphasize the need to seek medical attention where needed. Health worker respondents also expressed the need for additional training about the self-care interventions themselves. A 50-year-old male health worker (country not specified) mentioned this, describing: At times we do not know how to administer some of the products ourselves. I at times make mistakes. So there is need for some (group) trainings. At present, training was described as not widely available for many participants. For instance, a 57-year-old female health worker from Bolivia stated: Sexual and reproductive health is not a prioritized programme in the health system. This weakness also translates into the lack of trained personnel in the services. 4.4.2 LAYPERSON RESPONDENTS Wave 1 (not collected in Wave 2) Among non-health-worker respondents, with regard to potential future issues to consider for self-care SRHR interventions, the relevant themes that emerged in the qualitative responses were the same as among health workers: the risk of incorrect use, the importance of expertise, and concerns about product legitimacy. Chapter 4 84 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report The potential for incorrect use of self-initiated interventions for SRHR with negative consequences was clearly an area of concern. A 20-year-old female respondent in Indonesia wrote: “Just make sure there’s a risk management.” In particular, this was noted as more of an issue for some interventions than for others. A 48-year-old female respondent in Kenya elaborated on the interventions for which this would be a problem: Simple interventions can be feeling self-initiated like birth control or morning-after pills or self-testing. But abortion pills, HIV medication pre- and post-exposure, STI medication should be through a health provider because of complications arising from the condition or from the medication taken. This was also discussed as being a particularly important issue for individuals with lower educational attainment. A 32-year-old male respondent in Uganda wrote: “Self-initiated interventions are only good for literates – health, reading, writing, digital, etc. I feel they might be misused by illiterates.” Many respondents emphasized the importance of medical expertise when it came to SRHR interventions. A 67-year- old male respondent in Mexico expressed this concern and cautioned against using self-care interventions for SRHR: “Warning: only your medical team had the knowledge, avoid self-treatment, and [health] conditions and drug response are very personal.” A 22-year-old female respondent in Kenya explained the need for medical experts: “I just hope they don’t eliminate the need of a health-care provider because really, anything could go wrong really.” This was discussed as being particularly important for specific services. A 44-year-old female respondent in Uganda elaborated on this need: “Some interventions need counselling before they are used, how will that happen in self-initiated interventions?” Respondents also commented on the importance of the legitimacy and quality of the intervention products and services. A 40-year-old male respondent in Pakistan explained that important issues include “availability of full information and quality of the products.” This was noted as a particular concern for online sources for self-care interventions. A 26-year-old female respondent in Sweden emphasized the need for ways of obtaining self-care interventions without purchasing them online: “Simple STI tests, pregnancy tests and the like should be more readily available because going online also puts people at risk for illegal medication/tests and the like.” It was also mentioned that certain populations are especially vulnerable to SRHR products that lack legitimacy or are low quality. A 19-year-old male respondent in China explained: “Some girls may need emergency contraception after unprotected sex, but they may buy it online due to other's attitudes and the drugs online are not really safe.” 4.5 PERSPECTIVES ON LINKAGES TO HEALTH CARE: HEALTH WORKERS ONLY Wave 1 Health workers were asked open-ended questions about how they thought patients/clients could be linked to any health services they may need following use of self-care interventions for SRHR. A total of 212 health workers provided written responses on this question in Wave 1. The most common themes that emerged here were: provide contact information, set up a referral system, increase education, use mobile applications (apps), provide support and include instructions on the next steps. Sixty seven health workers suggested providing contact information (telephone number, website, QR code, etc.) with the intervention to enable users to seek further care if needed. It was suggested by several respondents that the phone number provided should also include anonymous and confidential text messaging (SMS) services. Having a referral directory or other referral system in place was the next most common suggestion (mentioned by 56 health workers). Respondents explained different ways referrals could work for users of self-care interventions. A 49-year-old female health worker in Nigeria recommended to “involve health workers before commencement to ensure linkages”. A 24-year- old gender non-binary provider in Türkiye discussed the ideal qualities of a referral system: There needs to be a directory of clinics/doctors/health- care providers that are sensitive and not prejudiced against people who need health-care services for SRH problems. Patients/clients could be matched to the nearest doctor/clinic through a web application. The next most common suggestion was to increase education (mentioned by 47 health workers) to better facilitate linkages to care. As described by respondents, this could be done through raising awareness/knowledge levels and health literacy among the population. Some suggested the use of the media and prominent public figures, while others thought increasing education on the community level would be most effective. A 26-year-old female health worker in Nepal suggested: “More awareness and more media coverage could help.” Similarly, a 21-year-old female health worker in Poland supported “spreading information about that in the community”. This was explained in further detail by a 36-year-old male health worker in Paraguay: “By educating people, letting them know that if something is not right and they need more information or an intervention from health personnel, they should go – for the good of their health.” Increasing education was identified as helpful for reducing the impact of negative community beliefs on self-care SRHR interventions. A 71-year-old male health worker in the USA described the need for “education for community leaders to mitigate sociological, cultural, religious factors”. Chapter 4 85 Thirty six health workers wrote about the use of mobile applications (apps) as being helpful for enabling linkages to care, by involving interactive features that encourage linkage to health care. A 30-year-old female health worker in Kenya suggested, “In the app, there is a constant reminder for the patient to visit a health-care provider and log the details in the app with follow-ups.” Mobile apps were noted as being especially useful in certain regions of the world. A 30-year-old male provider in the United Republic of Tanzania explained the potential for “online services, especially considering the growing internet coverage in African countries”. Provision of support was described by 25 health workers as an option to ensure linkages to care. The types of support mentioned included counselling, psychological care and guidance. A 24-year-old female health worker in Uganda explained how this could work: “A toll-free number that provides quality counselling services should be put on the products used in the interventions so that people can easily talk to someone who will guide them on what to do.” Some respondents gave their views on who would best be able to provide support and guidance. A 32-year-old female health worker in Cameroon explained how community health workers would be well equipped for this: “Patients need assurance of confidentiality and trust in the personnel. Thus, through the use of professional and empathetic community health workers.” The next most common response about how to ensure linkages to care was to include instructions on next steps along with the self-care SRHR intervention, clearly outlining how to proceed following the use of the intervention (mentioned by 23 respondents). A 56-year-old female health worker in Italy explained: “This should be an integral part of all interventions with clear guidance provided on all platforms of how to access services if needed.” A 32-year-old female health worker in Nigeria explained that for self-testing kits, this would work “by outlining steps to follow after each test result, either negative or positive”. Wave 2 Health workers were asked how they thought patients/clients could be linked to any health services they may need following use of self-care interventions for SRHR, and 66 of them provided written responses to this question in Wave 2. The most commonly suggested strategies to link users of these interventions to health care were to use eHealth solutions, accessible education and information, and working with peer navigators and existing community support organizations. The most common response to facilitate linkages to care, mentioned by 24 health worker respondents, was eHealth solutions. Health worker respondents recommended using hotlines, social media, web pages and other telemedicine interventions to link users of self-care interventions for SRHR to care. The most commonly suggested eHealth solution suggestion was a hotline/helpline. For example, a 45-year- old health worker from Swaziland (gender not specified) suggested “a toll-free number that patients can call and be advised on what to do next after getting a positive HIV result”. Similarly, health workers felt that hotlines could be used to direct individuals to care appointments or locations. As a 36-year-old female health worker in Mexico suggested “to have a hotline or Telecomunicaciones Indigenas Comunitarius (TIC) service to find attention”. Similarly, a 59-year-old female health worker from the USA noted the benefits of a “hotline call number to talk with a nurse or counsellor who can tell them to get care and give ideas of how to access that care”. For those who could not immediately access care, virtual appointments were suggested as an option. A 48-year-old female health worker in Canada suggested that linkage to care could be facilitated by “providing access to health professionals through virtual means (telephone, video- conference, text)”. A 57-year-old female health worker from Bolivia described “virtual office, counselling and follow-up to help with adherence to treatment”. On a different theme, 16 health worker respondents stressed the importance of linking individuals to care at the point of purchase or prescription, including through providing referrals and/or education and information. A 46-year-old man from Malawi suggested to “provide referral contacts at the counter”. Similarly, a 38-year-old female from Zimbabwe suggested that linkage to care could be facilitated through the point of purchase of a self-test kit as follows: At point of purchase, advise client on options if they test positive or advise them to return. Alternatively offer a follow-up option to the client so that you can find out outcome and have opportunity to provide further guidance. Health worker respondents also suggested that clear information be provided on the packaging of self-care interventions for SRHR, to link users to health-care resources. A 43-year-old female health worker from Kenya suggested a combination of providing verbal information at the point of purchase as well as on the package, stating: “The vendor could provide some basic information explaining the importance of health care. The package can also contain similar information.” A 46-year-old female health worker from Hungary suggested that information be “clearly printed in big red letters on the product itself, not just the accompanying small printed paper”. Finally, nine health workers wrote positively about engaging with peer navigators and existing community support organizations to connect users to health care. For instance, a 59-year-old male health worker suggested, “We can work with trained peer educators who can reach out, help test and help in linking them.” Some respondents suggested that peer navigators would be one component in linking individuals to care. As a female health worker respondent from Cameroon (age not specified) envisioned specifically for HIV self-testing interventions: A mobile network (e.g. WhatsApp) should be created in every community linking clients, peer educators and counsellors, community relay agents and the health facility service provider. Positive tests results are communicated to the community relay agent by the peer educator/counsellor who in turn identifies and links the patient to the community relay agent. Chapter 4 86 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report A non-binary 35-year-old health worker (country not specified) similarly described ways to link people to care: Having trained community members check in with folks whenever possible after distributing the self-care item, having peer supporters available to help with making calls and appointments, having health care options that are more convenient than typical med services (e.g. a community nurse van, docs on call at community orgs, etc.). 4.6 PERSPECTIVES REGARDING TRAINING AND INFORMATION NEEDS: HEALTH WORKERS ONLY Wave 1 Health workers had the option to provide a written response on what specific training they would like to receive, and what information or skills they would like to learn relating to self- care SRHR interventions. Among the 181 health workers who provided written responses, the main themes were more information on specific interventions, instructions and next steps after use, related linkages to care and relevant counselling skills, safety-related information, evidence about the interventions, and information on digital technology. The most common response, expressed by 54 health workers, was a desire for more information on new, common or specific interventions. Specific interventions mentioned include HIV self-testing, contraceptives and self-management of medical abortion. Respondents mentioned wanting to know about the currently available interventions. A 44-year-old female health worker in Mozambique explained that she wants “information about the range of self-initiated interventions currently available and their status (i.e. which have been tested in which settings; as well as information about new technologies in the pipeline)”. The next most common response was about the need for instructions and next steps on how to proceed after using a self- care intervention (mentioned by 39 health workers). Respondents described the need for guidelines and specific details on how to implement the interventions, how the interventions are used, and how to provide follow-up care. A 29-year-old female health worker in China suggested there was a need for information on “correct usage of these interventions; also standard protocol in following steps.” A 25-year-old male health worker in Kenya asked for more information on “rolling it out”. Specific training for health workers was the next most common request in response to this item, mentioned by 34 health workers. This training would need to include how to administer the interventions, provide appropriate linkages to care and offer relevant counselling to patients/clients. A 25-year-old female health worker in Egypt described wanting training on “the power of trust and contact between the health- care provider and the patients”. The need for specifics on who will facilitate the training was mentioned by some respondents. A 32-year-old female health worker in Cameroon suggested: “Creating women health educators’ groups within communities who will train trainers.” Others offered further details on how the training could be disseminated. A 29-year-old female health worker in the USA explained: Maybe a webinar or some sort of online course, but that could be a barrier for some. I think that empowering pharmacists or those dispensing self-initiated interventions (if they are not bought online) should be trained to give training on them. The next most common response was about the need for safety-related information (mentioned by 22 health workers), particularly regarding side-effects, adverse reactions, contraindications and risks associated with the self-care SRHR interventions. A 33-year-old female health worker in the USA explained what information is needed: “How to identify bad side-effects, and where to go to seek medical help.” The need for complete training and information was the next most common response (11%, n=20). Many respondents described wanting extensive knowledge on all aspects of self- care interventions. A 52-year-old female health worker in Nigeria explained: “All the necessary knowledge and skills regarding self-initiated interventions.” Another respondent, a 20-year-old male health worker in Tunisia, described wanting “all that is possible at my level of knowledge. This concerns me strongly.” Seventeen health worker respondents expressed a need for evidence on these interventions. Preferred sources of evidence mentioned by respondents included reliable online sources that provide accurate and up-to-date information on self-care SRHR interventions. A 63-year-old female health worker in Pakistan described wanting “SRHR information on [web]sites that are authentic and registered for the work”. A few respondents make specific references to sources like the World Health Organization (WHO), while others describe seeking additional updated evidence more generally. A 27-year-old female health worker in the Republic of Moldova expressed a desire for additional accessible evidence: “More research on this field made public and translated in a couple of international languages.” Other respondents mentioned the importance of accurate evidence on specific interventions. A 21-year- old female health worker in Poland explained wanting “more information about contraceptives that can be 100% trusted – information about safe abortion and information about access to abortion”. Finally, 15 respondents also wrote about wanting information and training on digital technology, including mobile phone apps, webinars and online sources. A 50-year-old female health worker in Kenya explained that she wanted more information and training on “all matters digital. Mobile phone apps, online access confirmation”. A 44-year-old male health worker in the United Chapter 4 87 Kingdom described wanting to access “online tutorials by health- care providers” for information and training. Wave 2 Health workers in Wave 2 also had the option to provide a written response on what specific training, information or skills they would like regarding self-care interventions for SRHR, and 61 provided written responses. The primary themes included information on risks and complications, training on specific interventions/products, and training for working with specific populations. In their responses, seven health workers expressed the desire to learn more about the risks and complications associated with self-care interventions for SRHR. For instance, a 69-year- old female health worker wanted to know “more on risks and benefits of self-care”. A 55-year-old woman from Colombia wanted to know more about “how to respond on time if an adverse condition develops. Who will be responsible if something goes wrong?” Another common theme was the desire to be trained on specific self-care interventions for SRHR, mentioned by 14 health workers. This was especially true among health workers who did not have any previous experience working with an intervention. To illustrate, a 45-year-old from Eswatini (gender not specified) wanted training on “HPV self-testing and the hormonal therapy for gender affirmation, since these services not available in our country.” Similarly, health workers were interested in information and training on the services that were most pertinent to their role. A 33-year-old female health worker from Argentina described: As I work with families and babies, I would like to have specific information about family planning and detection of difficulties or obstacles when accessing all self-care [interventions] for a better quality of sexual life. The final common theme from the responses was the desire to learn more about working with self-care interventions for SRHR among specific populations, mentioned by six health workers. For instance, a 23-year-old female health worker (country not specified) wanted training to work with self-care interventions that would be most useful to sexually and gender diverse individuals, because she was “an outreach worker, mainly working with the LGBQ+ population, for over a year at a low-income clinic.” The need to feel prepared for working with specific populations extended to self-care SRHR resources in multiple languages. To illustrate, a 54-year-old woman from India wrote that she needed “communications materials that are publicly accessible in local language.” 4.7 ANY ADDITIONAL COMMENTS: WAVE 1 HEALTH WORKER RESPONDENTS ONLY In the final question of the health worker portion of the survey in Wave 1, respondents were asked to provide any additional comments in the form of written responses, and 48 health workers provided comments. The responses were most commonly regarding specific issues and perspectives on what is needed for self-care interventions for SRHR. A 28-year-old female health worker in South Africa, for example, described the potential for these interventions and what is needed for their success: Self-testing could revolutionize disease detection within the public health sphere. With the right amount of support channels this could empower people to take ownership of their health. There has been a lot of negative flack around self-testing, but I feel that to empower people is the rationale of thought leadership practices, which could be successful for public health initiatives. Some health workers mentioned the need for community-level empowerment and awareness. A 58-year-old male provider in Kenya explained: “It is important to empower the community with information about their sexual and reproductive health.” A 42-year-old female provider in Nigeria expanded further: “Community-based patient education rather than health facility-based health talks will drive uptake of the self- initiated care better, because oftentimes non-utilization is often due to lack of or inadequate awareness or knowledge about them.” Respondents brought up additional issues relevant to the topic of these interventions. A 32-year-old female provider in Nigeria explained the impact of social factors: “Family planning services are still not widely accepted in many parts of Africa, especially Nigeria. This is as a result of cultural and religious beliefs. There is a lot of emphasis on continuous education of the reproductive age group.” References for Chapter 4 1. Narasimhan M, Logie CH, Gauntley A, Gomez Ponce de Leon R, Gholbzouri K, Siegfried N, et al. Self-care interventions for sexual and reproductive health and rights for advancing universal health coverage. Sexual and Reproductive Health Matters. 2020;28(2):1778610. doi:10.10 80/26410397.2020.1778610. 88 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 Health-care engagement and self-care interventions for SRHR 5 89Chapter 5 Chapter summary This chapter focuses on respondents’ experiences with and preferences for accessing self-care interventions for SRHR or information about these interventions, and for engagement with health workers in relation to these interventions. First, in section 5.1, we present the quantitative findings on where both types of respondents access self-care interventions for SRHR, as well as where they access information on these interventions. The data are reported in tabular form and summarized in narrative text, with separate data for health workers and layperson respondents and for each survey wave. As in Chapter 3, the findings are grouped under six subsections by type of intervention: (1) Antenatal, intrapartum and postnatal care (asked in Wave 2 only); (2) Family planning; (3) Abortion; (4) Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (5) Promoting sexual health (asked in Wave 2 only); and (6) SRH information online and via mobile apps (asked in Wave 1 only). Across both waves of survey collection, for most self-care interventions for SRHR in this study, respondents reported a doctor or health clinic, and a pharmacy as the top two places where they go to access each one, and the internet and a doctor or health worker as the top two places where they access information on individual interventions. Next, in section 5.2, quantitative and qualitative data are presented from Wave 1 of the survey relating to engagement with health workers for self-care interventions for SRHR. Among survey respondents who had reported usage (or their partner’s usage) of any of the listed self-care interventions, the majority (in both types of respondents) had engaged with a health worker when using the intervention or as a result of using the intervention, and very few (approximately 5%) had ever felt pressured or coerced to use the intervention(s). The majority of both groups also felt it was (very or somewhat) important to be able to access self-care interventions for SRHR without going through a health worker. The vast majority also felt it was (very or somewhat) important to have access to a health worker after using such interventions. As to their preference for being able to access such an intervention with or without the involvement of a health worker, most said it would depend on the intervention, while about a quarter said they would prefer it to be with a health worker and less than 20% said they preferred to do it on their own. The full quantitative data as well as selected quotes from respondents are presented in the text. Finally, in section 5.3, an overall summary of ease of access to health care and online information is provided, with 94.7% of Wave 1 and 91.8% of Wave 2 health worker respondents and 96.6% of Wave 1 and 95.4% of Wave 2 layperson respondents reporting that they have access to a health worker when they need one. The majority of both health workers and laypersons across waves reported that it is “very easy” for them to access online information or a mobile phone confidentially. “I would want to rely on a health- care provider's intervention. It does not mean that I shouldn’t decide but I should know everything about the intervention before I give consent or not.” – A 24-year-old female respondent in Türkiye 90 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 TABLE 5.1: MEANS OF ACCESSING SRH SELF-CARE INTERVENTIONS FOR ANTENATAL, INTRAPARTUM AND POSTNATAL CARE, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) At-home pregnancy test Self-management of nutrition supplements (folic acid) during pregnancy planning Self-management of nutrition supplements (iron and folic acid) during pregnancy Self-management of nutrition supplements (iron and folic acid) postpartum Self-monitoring/ home-monitoring of blood glucose levels during pregnancy Self-monitoring/ home-monitoring of proteinuria during pregnancy Self-monitoring/ home-monitoring of blood pressure during pregnancy From a doctor or health clinic (%) From a pharmacy (%) Health workers Laypersons KEY 17.5 9.9 74.4 83.1 33.7 26.8 55.8 45.1 35.9 28.6 57.9 45.7 34.0 27.5 58.0 43.5 32.1 35.2 42.6 29.6 32.3 32.9 34.8 21.4 32.3 31.0 41.6 29.6 5.1 ACCESSING SELF-CARE INTERVENTIONS FOR SRHR AND SOURCES OF RELEVANT INFORMATION: QUANTITATIVE FINDINGS This section presents the quantitative findings for the survey questions: (i) Where/how did you/do you/would you access these interventions? (with reference to the list of different self- care interventions), and (ii) How do you access information on these interventions? Both questions included the option to choose all applicable responses listed. For each intervention, Wave 1 participants were presented with the following five options for the first question about accessing interventions: “doctor or health clinic”, “pharmacy”, “online”, “I do not know where to get it”, and “I do not need this”. Wave 2 respondents were presented with all of the same response options, in addition to a sixth option: “from a peer, outreach or community worker”. For the second question about sources of information, participants in both survey waves were presented with the following four options for each intervention: “doctor or health worker”, “online/internet”, “friends, family or community member”, and “I haven’t received any information on this intervention”. The findings are presented both in tables and summarized in narrative form (separate for health worker and layperson respondents), grouped under six subsections by type of intervention: (5.1.1) Antenatal, intrapartum and postnatal care; (5.1.2) Family planning; (5.1.3) Abortion; (5.1.4) Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (5.1.5) Promoting sexual health; and (5.1.6) SRH information online and via mobile applications (apps). 5.1.1 Antenatal, intrapartum and postnatal care Questions regarding the interventions in this subsection were only asked in Wave 2 of the survey. The findings are presented in Tables 5.1 and 5.2 – please refer to these tables as needed for details not included in the narrative summary. 91Chapter 5 At-home pregnancy test Self-management of nutrition supplements (folic acid) during pregnancy planning Self-management of nutrition supplements (iron and folic acid) during pregnancy Self-management of nutrition supplements (iron and folic acid) postpartum Self-monitoring/ home-monitoring of blood glucose levels during pregnancy Self-monitoring/ home-monitoring of proteinuria during pregnancy Self-monitoring/ home-monitoring of blood pressure during pregnancy Would buy it online (%) From a peer, outreach or community worker (%) I don’t know where to get it (%) I don’t need to use this (%) 13.1 11.3 8.8 7.0 2.5 0.0 20.0 9.9 11.0 11.3 9.2 4.2 6.1 18.3 28.8 29.6 10.7 12.9 8.2 4.3 6.3 14.3 27.7 31.4 9.9 11.6 8.0 4.4 5.6 17.4 29.0 29.0 9.3 8.5 9.3 5.6 11.7 19.7 31.5 28.2 8.1 8.6 9.9 4.3 18.0 25.7 32.9 32.9 11.8 9.9 8.7 7.0 9.9 22.5 31.1 32.4 Health workers Laypersons KEY 92 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 TABLE 5.2: SOURCES OF INFORMATION ABOUT SRH SELF-CARE INTERVENTIONS FOR ANTENATAL, INTRAPARTUM AND POSTNATAL CARE, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) At-home pregnancy test Self-management of nutrition supplements (folic acid) during pregnancy planning Self-management of nutrition supplements (iron and folic acid) during pregnancy Self-management of nutrition supplements (iron and folic acid) postpartum Self-monitoring/ home-monitoring of blood glucose levels during pregnancy Self-monitoring/ home-monitoring of proteinuria during pregnancy Self-monitoring/ home-monitoring of blood pressure during pregnancy I ask a doctor or health worker (%) I go online/ internet (%) I ask my friends, family or community (%) I haven’t received any information on this (%) Health workers Laypersons KEY 48.7 33.9 65.3 64.5 35.3 50.0 9.3 11.3 63.1 39.3 49.0 32.8 18.1 23.0 18.8 45.9 60.5 38.3 50.3 33.3 19.7 20.0 19.1 45.0 59.7 39.3 48.3 34.4 19.5 19.7 20.1 45.9 61.7 37.7 43.6 32.8 12.8 18.0 24.2 50.8 58.1 36.1 40.5 31.2 11.5 16.4 27.0 52.5 60.5 41.0 46.3 29.5 15.0 21.3 23.8 47.5 At-home pregnancy test Health workers: To access at-home pregnancy testing, about three quarters of health worker respondents reported going to a pharmacy (74.4%), while small numbers said they would go to a doctor or health clinic (17.5%), buy it online (13.1%) or get it from a peer, outreach or community worker (8.8%). A few health workers admitted not knowing where to access it (2.5%), and 20.0% reported having no need for it. To get information about this intervention, most health workers reported they would find it on the internet (65.3%), and almost half reported asking a doctor/ health worker (48.7%) while over one third would ask friends, family or their community (35.3%) and 9.3% said they had not received information on at-home pregnancy tests. Laypersons: The vast majority of laypersons reported they would access at-home pregnancy tests by going to the pharmacy (83.1%), while small numbers said they would buy it online (11.3%), go to a doctor or health clinic (9.9%), or get it from a peer, outreach or community worker (7.0%). No laypersons reported not knowing where to get it, but 9.9% said they had no need for it. To access information on at-home pregnancy tests, the majority said they would search online (64.5%), while half would ask their friends, family or community (50.0%) and a third of laypersons reported asking a doctor or health worker (33.9%). Few reported they had not received information on this intervention (11.3%). Self-management of nutrition supplements (folic acid) during pregnancy planning Health workers: About a third (33.7%) of health workers reported accessing folic acid for self-management during pregnancy planning at a doctor or health clinic while more than half reported accessing it at a pharmacy (55.8%). Additionally, 11.0% reported 93Chapter 5 they would buy it online and 9.2% reported through a peer, outreach or community worker. A small minority of health workers reported not knowing where to get it (6.1%) and over a quarter said they had no need for it (28.8%). In terms of accessing information on this intervention, health workers reported going online (49.0%), asking a doctor (63.1%), and asking friends, family or community (18.1%). Additionally, 18.8% reported not having received information on this self-care intervention. Laypersons: Among laypersons, almost half reported accessing folic acid for self-management during pregnancy planning from a pharmacy (45.1%), a quarter from a doctor (26.8%), and 11.3% said they would buy it online. Additionally, 18.3% reported not knowing where to get it and 29.6% reported not having a need for it. To access information on folic acid self-management during pregnancy planning, 32.8% reported going online, 39.3% reported asking a doctor or health care worker, and 23.0% reported asking friends, family or community. Almost half of laypersons reported they had not received information on this self-care intervention (45.9%). Self-management of nutrition supplements (iron and folic acid) during pregnancy Health workers: Among health workers, 57.9% reported they would access iron and folic acid for self-management during pregnancy at a pharmacy, 35.9% reported from a doctor or health clinic, 10.7% reported online, and 8.2% reported from a peer, outreach, or community worker. A small minority reported not knowing where to get it (6.3%), and about a quarter reported not having a need for it (27.7%). The majority of health worker respondents reported they would ask a doctor/health worker for information on this self-care intervention (60.5%), while half also reported finding information online (50.3%) and about a fifth each reported asking their friends/family/community (19.7%) and that they had not received any information on this intervention (19.1%). Laypersons: Among laypersons, close to half reported they would access iron and folic acid for self-management during pregnancy at a pharmacy (45.7%), while almost a third reported accessing it from a doctor or health clinic (28.6%). Small numbers said they buy them online (12.9%), access them from a peer, outreach or community worker (4.3%), or don’t know where to get them (14.3%) while a third reported not having a need for them (31.4%). For information on this self-care intervention, 38.3% of laypersons reported asking a doctor/ health worker, a third to online (33.3%), and a fifth ask their friends, family or community (20.0%). Almost half said they had not received information on this intervention (45.0%). Self-management of nutrition supplements (iron and folic acid) postpartum Health workers: The majority of health worker respondents (58.0%) reported accessing iron and folic acid for self- management during postpartum at a pharmacy and another third (34.0%) got it from a doctor or health clinic. Small numbers bought it online (9.9%), got it from a peer, outreach or community worker (8.0%), or reported not knowing where to get it (5.6%). Over a quarter said they had no need for this intervention (29.0%). The majority (59.7%) of health workers reported they access information on postpartum iron and folic acid self- management by asking a doctor or health worker, while almost half reported going online (48.3%), and a fifth reported asking friends, family or their community (19.5%) and another fifth said they had not received information on this intervention (20.1%). Laypersons: Laypersons reported accessing iron and folic acid for self-management during postpartum from a pharmacy (43.5%), from a doctor or health clinic (27.5%), online (11.6%), and a few said they got it from a peer, outreach or community worker (4.4%). Additionally, some reported not knowing where to get it (17.4%) or not having a need for it (29.0%). Laypersons reported accessing information on iron and folic acid for self- management during postpartum by asking a doctor/health worker (39.3%), going online (34.4%) and asking friends, family or their community (19.7%). However, nearly half reported they had not received information on this intervention (45.9%). Self-monitoring/home-monitoring of blood glucose levels during pregnancy Health workers: Among health workers, 32.1% reported accessing self-monitoring/home-monitoring of blood glucose levels during pregnancy at the doctor or health clinic, about a third reported getting online (9.3%), and small numbers reported they would go to the pharmacy (42.6%) or get it from from a peer, outreach or community worker (9.3%). A small minority reported not knowing where to get it (11.7%) and nearly a third reported not having a need for it (31.5%). Over a third (43.6%) of health workers reported they would go online for information about this intervention, and another third reported they would ask a doctor/health worker (61.7%) while half reported they would ask their friends, family or community (12.8%). More than half reported not having received information on this intervention (24.2%). Laypersons: About a third of laypersons reported accessing self-monitoring/home-monitoring of blood glucose levels during pregnancy from a doctor or health clinic (35.2%), a pharmacy (29.6%), or not needing this intervention (28.2%). Much smaller numbers mentioned they access it online (8.5%) or and from peers, outreach or community workers (5.6%), and a substantial number said they do not know where to get this intervention (19.7%). Laypersons reported accessing information on this intervention from a doctor or health worker (37.7%), online (32.8%) or from their friends, family or community (18.0%), while half of laypersons reported not having received information on this intervention (50.8%). Self-monitoring/home-monitoring of proteinuria during pregnancy Health workers: Health workers reported accessing self- monitoring/home-monitoring of proteinuria during pregnancy at the pharmacy (34.8%), from a doctor or health clinic (32.3%), from peers, outreach or community workers (9.9%) or online 94 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 TABLE 5.3: MEANS OF ACCESSING SRH SELF-CARE INTERVENTIONS FOR FAMILY PLANNING AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE Over-the-counter hormonal contraception Over-the-counter emergency contraception Contraceptive patch Contraceptive vaginal ring Self-administered injectable contraception Diaphragm or cervical cap From a doctor or health clinic (%) W av e 1 W av e 2 Health workers Laypersons KEY 52.9 60.6 53.5 55.4 28.5 29.5 32.3 22.2 44.7 44.2 - - 44.8 44.0 43.2 54.2 45.7 50.0 35.8 52.2 43.9 46.8 35.8 38.6 (8.1%). About a fifth did not know where to get this intervention (18.0%) while a third reported not having a need for it (32.9%). Over half of health workers reported asking a doctor or health worker for information on this intervention (58.1%), while 40.5% reported going online, and 11.5% reported asking friends, family or their community. Over a quarter of health workers reported not having received information on this intervention (27.0%). Laypersons: Among laypersons, a third reported accessing self- monitoring/home-monitoring of proteinuria through a doctor or health clinic (32.9%), a fifth reported accessing this at a pharmacy (21.4%), and a few said they got it online (8.6%) or through peers, outreach or community workers (4.3%). A quarter reported not knowing where to access this service (25.7%) while a third reported not having a need for it (32.9%). Laypersons reported accessing information on this intervention online (31.2%), from a doctor or health care worker (36.1%), and from friends, family or community (16.4%), but more than half of layperson respondents had not received information on this intervention (52.5%). Self-monitoring/home-monitoring of blood pressure during pregnancy Health workers: Among health workers, 41.6% reported accessing self-monitoring/home monitoring of blood pressure during pregnancy from a pharmacy, 32.3% reported accessing this from a doctor or health clinic, 8.7% reported getting it from peers, outreach or community workers, and 11.8% said they would buy it online. A small minority reported not knowing where to access the intervention (9.9%) and almost a third reported not having a need for it (31.1%). The majority of health workers reported accessing information on this intervention by asking a doctor or fellow health worker (60.5%), while another 46.3% reported using the internet, and 15.0% reported asking friends, family or community. Almost a quarter reported not receiving information on this intervention (23.8%). Laypersons: About a third of layperson respondents reported accessing self-monitoring/home monitoring of blood pressure during pregnancy from a doctor or health clinic (31.0%) or from a pharmacy (29.6%), or said they have no need for it (32.4%). Smaller numbers reported they would buy it online (9.9%) or through peers, outreach or community workers (7.0%), or that they didn’t know where to access this intervention (22.5%). Among laypersons, 41.0% reported accessing information about this intervention from a doctor or health worker, 29.5% reported searching online, and 21.3% reported asking friends, family or their community. Nearly half reported not receiving information on this intervention (47.5%). 5.1.2 Family planning Among the six interventions in this subsection, questions regarding one of them (contraceptive patch) were only asked in Wave 1. The findings are presented in Tables 5.3 and 5.4 – please refer to these tables as needed for details not included in the narrative summary. 95Chapter 5 Over-the-counter hormonal contraception Over-the-counter emergency contraception Contraceptive patch Contraceptive vaginal ring Self-administered injectable contraception Diaphragm or cervical cap From a pharmacy (%) W av e 1 W av e 2 Would buy it online (%) W av e 1 W av e 2 From a peer, outreach or community worker (%) W av e 1 W av e 2 I don’t know where to get it (%) W av e 1 W av e 2 I don’t need to use this (%) W av e 1 W av e 2 - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY 4.0 1.3 0.0 1.0 8.2 5.4 3.5 2.7 - - 16.5 21.5 7.1 5.4 20.6 9.5 3.6 1.3 1.5 3.6 8.5 5.6 0.6 1.4 - - 18.8 21.1 6.1 5.6 23.8 12.5 3.4 1.7 9.6 15.6 - - - - - - 29.8 29.6 - - - - 3.4 1.7 10.8 14.9 4.9 2.8 10.5 13.9 - - 30.6 30.1 4.3 5.6 31.5 22.2 2.2 1.0 11.8 13.7 6.8 1.5 23.5 20.3 - - 29.8 30.7 4.9 5.8 30.3 23.2 3.8 3.0 9.4 13.5 7.4 8.6 16.7 21.4 - - 30.4 32.3 3.1 4.3 33.3 21.4 49.4 41.0 60.6 71.6 62.4 57.8 68.9 80.6 27.3 22.9 - - 23.1 18.9 30.9 22.2 21.1 14.0 26.5 18.8 22.6 15.8 27.2 21.4 96 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 Over-the-counter hormonal contraception Over-the-counter emergency contraception Contraceptive patch Contraceptive vaginal ring Self-administered injectable contraception Diaphragm or cervical cap I ask a doctor or health worker (%) W av e 1 W av e 2 I go online/ internet (%) W av e 1 W av e 2 I ask my friends, family or community (%) W av e 1 W av e 2 I haven’t received any information on this (%) W av e 1 W av e 2 - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY 76.4 75.9 77.4 73.9 51.9 50.0 61.9 73.9 21.1 29.3 27.1 50.8 3.7 6.9 4.5 7.7 68.0 60.2 69.8 50.8 55.6 54.2 67.8 67.7 21.9 24.7 32.9 49.2 5.4 8.4 4.0 16.9 64.2 56.7 - - 45.7 42.7 - - 14.9 18.5 - - 16.3 21.0 - - 63.8 55.2 66.4 50.0 44.0 44.2 56.4 46.8 16.0 19.5 22.2 41.9 16.7 19.5 14.1 27.4 66.4 59.6 59.6 46.8 42.9 37.2 44.4 37.1 15.7 14.7 17.2 27.4 15.0 22.4 28.5 45.2 61.8 53.9 60.0 42.6 43.3 40.9 50.7 37.7 15.6 14.9 19.3 29.5 16.7 24.0 18.7 32.8 TABLE 5.4: SOURCES OF INFORMATION ABOUT SRH SELF-CARE INTERVENTIONS FOR FAMILY PLANNING, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE 97Chapter 5 Over-the-counter hormonal contraception (excluding emergency contraception – see next item) Health workers: About half of health worker respondents in in Wave 1 (49.4%) and 60.6% in Wave 2 reported accessing over-the-counter (OTC) hormonal contraception through a pharmacy, with an additional half of participants in both waves reporting access through a doctor or health clinic (Wave 1: 52.9%; Wave 2: 53.5%). Small numbers of health workers said they would buy it online (Wave 1: 4.0%; Wave 2: 8.2%), or access it through a peer, outreach or community worker (Wave 2 only: 7.1%) or that they did not know where to get it (Wave 1: 0.0%; Wave 2: 3.5%). Close to a fifth in each wave reported not having a need for OTC hormonal contraception (Wave 1: 16.5%; Wave 2: 20.6%). With respect to accessing information on this intervention, the majority of respondents reported they would ask a doctor or health worker (Wave 1: 76.4%; Wave 2: 77.4%) or go online (Wave 1: 51.9%; Wave 2: 61.9%) while around a quarter said they would ask friends, family or community members (Wave 1: 21.1%; Wave 2: 27.1%), and small numbers said they had not received information on OTC hormonal contraception (Wave 1: 3.7%; Wave 2: 4.5%). Laypersons: Among laypersons in each wave, it was also most common to access OTC hormonal contraception either through a pharmacy (Wave 1: 41.0%; Wave 2: 71.6%) or from a doctor or health clinic (Wave 1: 60.6%; Wave 2: 55.4%). Very small numbers of respondents in each wave reported buying it online (Wave 1: 1.3%; Wave 2: 5.4%), or through a peer, outreach or community worker (Wave 2 only: 5.4%) or said they did not know where to access it (Wave 1: 1.0%; Wave 2: 2.7%). About a fifth of laypersons in Wave 1 (21.5%) but far fewer in Wave 2 (9.5%) reported not needing to use this intervention. The majority of laypersons reported accessing information on OTC hormonal contraception from a doctor or health worker (Wave 1: 75.9%; Wave 2: 73.9%) or online (Wave 1: 50.0%; Wave 2: 73.9%) and substantial numbers also asked friends, family or their community (Wave 1: 29.3%; Wave 2: 50.8%). A small minority reported they had not received information on this intervention (Wave 1: 6.9%; Wave 2: 7.7%). Over-the-counter emergency contraception Health workers: The majority of health worker respondents in both waves reported going to the pharmacy to access OTC emergency contraception (Wave 1: 62.4%; Wave 2: 68.9%) while a substantial number also accessed it through a doctor or health clinic (Wave 1: 28.5%; Wave 2: 32.3%). Small numbers bought it online (Wave 1: 3.6%; Wave 2: 8.5%), through a peer, outreach or community worker (Wave 2 only: 6.1%) or did not know where to get it (Wave 1: 1.5%; Wave 2: 0.6%). A sizable minority reported not having a need for this intervention (Wave 1: 18.8%; Wave 2: 23.8%). To access information on OTC emergency contraception, most health workers reported they would ask a doctor or health worker (Wave 1: 68.0%; 12 Questions regarding the contraceptive patch were only asked in Wave 1. Wave 2: 69.8%) or go online (Wave 1: 55.6%; Wave 2: 67.8%). About a fifth of Wave 1 (21.9%) and a third of Wave 2 (32.9%) participants reported they would ask friends, family or community members, while a small number in each wave reported not receiving information on this intervention (Wave 1: 5.4%; Wave 2: 4.0%). Laypersons: Similarly, a majority of laypersons reported accessing OTC emergency contraception at the pharmacy (Wave 1: 57.8%; Wave 2: 80.6%), while some got it from a doctor or health clinic (Wave 1: 29.5%; Wave 2: 22.2%). Only small numbers bought it online (Wave 1: 1.3%; Wave 2: 5.6%) or from a peer, outreach or community worker (Wave 2 only: 5.6%) or reported not knowing where to get it (Wave 1: 3.6%; Wave 2: 1.4%). Some laypersons reported not having a need for OTC emergency contraception (Wave 1: 21.1%; Wave 2: 12.5%). In terms of accessing information on this intervention, most laypersons reported going online (Wave 1: 54.2%; Wave 2: 67.7%) or asking a doctor or health worker (Wave 1: 60.2%; Wave 2: 50.8%). A quarter of Wave 1 respondents reported asking their friends, family or community (24.7%), as did half of Wave 2 respondents (49.4%). A small minority in both waves reported they had not received information on this intervention (Wave 1: 8.4%; Wave 2: 16.9%). Contraceptive patch12 Health workers: Almost half of health worker respondents stated they would access the contraceptive patch through a doctor or health clinic (44.7%), while more than a quarter would go to the pharmacy (27.3%), and only 3.4% would buy it online. Another 9.6% reported not knowing where to get the patch but almost a third (29.8%) stated they have no need for it. To access information on the patch, almost two thirds of health workers reported they would ask a doctor (64.2%) and 45.7% would go online, while a small minority said they would ask friends, family or community (14.9%). A minority of health workers also reported not having received information on this intervention (16.3%). Laypersons: Similar proportions of laypersons also reported accessing the contraceptive patch at the doctor or health clinic (44.2%), the pharmacy (22.9%) or online (1.7%). About a sixth reported not knowing where to get it (15.6%) and nearly a third reported not having a need for it (29.6%). To access information on the patch, the majority (56.7%) would go to the doctor, 42.7% would go online and 18.5% would ask friends, family or community members. About a fifth reported not having received information on this (21.0%). Contraceptive vaginal ring Health workers: To access contraceptive vaginal rings (CVRs), just under half of health worker respondents in both waves reported going to a doctor or health clinic (Wave 1: 44.8%; Wave 2: 43.2%), while about a quarter to a third reported going to a pharmacy (Wave 1: 23.1%; Wave 2: 30.9%). Only a small minority reported buying it online (Wave 1: 3.4%; Wave 2: 4.9%) or from a peer, outreach or community worker 98 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 (Wave 2 only: 4.3%). About a third of health worker respondents said they did not need the CVR (Wave 1: 30.6%; Wave 2: 31.5%) and 10% reported not knowing where to access it (Wave 1: 10.8%; Wave 2: 10.5%). To access information on the CVR, almost two thirds of health worker respondents reported asking a doctor or health worker (Wave 1: 63.8%; Wave 2: 66.4%) and the next most common option was to go online (Wave 1: 44.0%; Wave 2: 56.4%). A minority reported asking friends, family or community members (Wave 1: 16.0%; Wave 2: 22.2%) or not having received information on this intervention (Wave 1: 16.7%; Wave 2: 14.1%). Laypersons: Among laypersons, about a fifth of Wave 1 respondents reported accessing CVRs from a pharmacy (18.9%) while this was not much higher in Wave 2, at 22.2%. Conversely, almost half of Wave 1 respondents (44.0%) and just a fifth of Wave 2 respondents (54.2%) reported accessing CVRs from a doctor or health clinic. Few respondents reported buying it online (Wave 1: 1.7%; Wave 2: 2.8%) or going to a peer, outreach or community worker (Wave 2 only: 5.6%). A minority of respondents reported not knowing where to get the CVR (Wave 1: 14.9%; Wave 2: 13.9%) or not having a need for it (Wave 1: 30.1%; Wave 2: 22.2%). To access information on this method, layperson respondents most often reported asking a doctor or health worker (Wave 1: 55.2%; Wave 2: 50.0%), going online (Wave 1: 44.2%; Wave 2: 46.8%) or asking their friends, family or community (Wave 1: 19.5%; Wave 2: 41.9%). A substantial number of laypersons reported not having received information on CVRs (Wave 1: 19.5%; Wave 2: 27.4%). Self-administered injectable contraception Health workers: Health worker respondents mainly reported accessing self-administered contraception from a doctor or health clinic (Wave 1: 45.7%; Wave 2: 35.8%) or a pharmacy (Wave 1: 21.1%; Wave 2: 26.5%), while small numbers bought it online (Wave 1: 2.2%; Wave 2: 6.8%) or from a peer, outreach or community worker (Wave 2 only: 4.9%). Across both waves, substantial numbers of health workers also reported not knowing where to access it (Wave 1: 11.8%; Wave 2: 23.5%) and not having a need for it (Wave 1: 29.8%; Wave 2: 30.3%). The most common ways for health workers to access information on self-administered contraceptives were to ask a doctor or health worker (Wave 1: 66.4%; Wave 2: 59.6%) or to go online (Wave 1: 42.9%; Wave 2: 44.4%), while a small minority would ask friends, family or their community (Wave 1: 15.7%; Wave 2: 17.2%). A considerable proportion of health workers reported not having received information on this intervention (Wave 1: 15.0%; Wave 2: 28.5%). Laypersons: Half of laypersons reported accessing self- administered contraception from a doctor or health clinic (Wave 1: 50.0%; Wave 2: 52.2%) while small minorities reported accessing it from pharmacy (Wave 1: 14.0%; Wave 2: 18.8%), from a peer, outreach or community worker (Wave 2 only: 5.8%) or buying it online (Wave 1: 1.0%; Wave 2: 1.5%). Some respondents also reported not knowing where to access it (Wave 1: 13.7%; Wave 2: 20.3%) and not having a need for it (Wave 1: 30.7%; Wave 2: 23.2%). Laypersons mainly reported accessing information on this intervention by asking a doctor or health worker (Wave 1: 59.6%; Wave 2: 46.8%) or by going online (Wave 1: 37.2%; Wave 2: 37.1%), while some also asked their friends, family or community (Wave 1: 14.7%; Wave 2: 27.4%). However, a fifth of Wave 1 respondents (22.4%) and almost half of Wave 2 respondents (45.2%) reported not having received information on self-administered contraception. Diaphragm or cervical cap Health workers: Health worker respondents mainly reported accessing the diaphragm or cervical cap from a doctor or health clinic (Wave 1: 43.9%; Wave 2: 35.8%) or a pharmacy (Wave 1: 22.6%; Wave 2: 27.2%). Small numbers bought it online (Wave 1: 3.8%; Wave 2: 7.4%) or accessed it from a peer, outreach or community worker (Wave 2 only: 3.1%). Some reported not knowing where to get it (Wave 1: 9.4%; Wave 2: 16.7%) and another third reported not having a need for it (Wave 1: 30.4%; Wave 2: 33.3%). Health workers reported accessing information on this method by asking a doctor or health worker (Wave 1: 61.8%; Wave 2: 60.0%), going online (Wave 1: 43.3%; Wave 2: 50.7%) and asking friends, family or community members (Wave 1: 15.6%; Wave 2: 19.3%). A considerable proportion reported not having received information on the diaphragm or cervical cap (Wave 1: 16.7%; Wave 2: 18.7%). Laypersons: Laypersons also mainly reported accessing the diaphragm or cervical cap from a doctor or health clinic (Wave 1: 46.8%; Wave 2: 38.6%) or from a pharmacy (Wave 1: 15.8%; Wave 2: 21.4%), while small numbers bought it online (Wave 1: 3.0%; Wave 2: 8.6%) or from a peer, outreach or community worker (Wave 2 only: 4.3%). Additionally, laypersons reported not knowing where to get this method (Wave 1: 13.5%; Wave 2: 21.4%) and/or not having a need for it (Wave 1: 32.3%; Wave 2: 21.4%). Laypersons reported accessing information on the diaphragm or cervical cap from a doctor or health worker (Wave 1: 53.9%; Wave 2: 42.6%), online (Wave 1: 40.9%; Wave 2: 37.7%), and from friends, family or community members (Wave 1: 14.9%; Wave 2: 29.5%). Across the waves, between a quarter and a third reported not having received information on this intervention (Wave 1: 24.0%; Wave 2: 32.8%). 99Chapter 5 5.1.3 Abortion Questions regarding self-management of medical abortion were asked in both waves of the survey. The findings are presented in Table 5.5 – please refer to the table as needed for details not included in the narrative summary. Self-management of medical abortion Health workers: Most health worker respondents reported accessing self-management of medical abortion from a doctor or health clinic (Wave 1: 43.2%; Wave 2: 38.4%) or at a pharmacy (Wave 1: 13.2%; Wave 2: 27.0%). Fewer reported accessing it online (Wave 1: 6.6%; Wave 2: 8.8%) or from a peer, outreach or community worker (Wave 2 only: 5.0%). Additionally, 12.0% of health workers in each wave reported not knowing where to access this self-care intervention and over a third reported not having a need for it (Wave 1: 36.3%; Wave 2: 38.4%). To access information on self-management of medical abortion, health workers mainly reported going online (Wave 1: 45.2%; Wave 2: 58.1%) or asking a doctor or health worker (Wave 1: 65.1%; Wave 2: 57.4%). Small numbers also reported asking friends, family or the community about this intervention (Wave 1: 15.3%; Wave 2: 18.9%) or not having received information on it (Wave 1: 16.4%; Wave 2: 18.9%). Laypersons: Laypersons also mainly reported accessing self-management of medical abortion from a doctor or health From a doctor or health clinic (%) From a pharmacy (%) Would buy it online (%) From a peer, outreach or community worker (%) I don’t know where to get it (%) I don’t need to use this (%) Means of accessing self- management of medical abortion W av e 1 W av e 2 I ask a doctor or health worker (%) I go online/internet (%) I ask my friends, family or community (%) I haven’t received any information on this (%) Sources of information about self- management of medical abortion W av e 1 W av e 2 - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY Health workers Laypersons KEY TABLE 5.5: MEANS OF ACCESSING AND SOURCES OF INFORMATION ABOUT SELF-MANAGEMENT OF MEDICAL ABORTION, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE 43.2 42.5 65.1 53.5 13.2 13.0 6.6 4.0 45.2 43.3 15.3 17.8 - - 16.4 23.6 12.0 17.9 36.3 31.6 38.4 55.7 57.4 43.6 27.0 22.9 8.8 4.3 58.1 48.4 18.9 35.5 5.0 5.7 18.9 30.7 12.0 20.0 38.4 17.1 100 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 clinic (Wave 1: 42.5%; Wave 2: 55.7%) or at a pharmacy (Wave 1: 13.0%; Wave 2: 22.9%). Small numbers reported accessing it from a peer, outreach or community worker (Wave 2 only: 5.7%) or online (Wave 1: 4.0%; Wave 2: 4.3%). Sizable minorities of laypersons in each wave reported not knowing where to access this self-care intervention (Wave 1: 17.9%; Wave 2: 20.0%) or not having a need for it (Wave 1: 31.6%; Wave 2: 17.1%). To access information on self-management of medical abortion, laypersons most commonly reported going online (Wave 1: 43.3%; Wave 2: 48.4%) or asking a doctor or health worker (Wave 1: 53.5%; Wave 2: 43.6%), while some also asked friends, family or community members (Wave 1: 17.8%; Wave 2: 35.5%). Additionally, almost a quarter of Wave 1 participants (23.6%) and almost a third of Wave 2 participants (30.7%) reported not receiving information on this intervention. 5.1.4 Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities Questions regarding four of the interventions in this subsection were asked in both waves of the survey, while questions about two of them (HIV and STI treatment) were only asked in Wave 1 and questions about self-sampling for HPV testing were only added later in Wave 2. The findings are presented in Tables 5.6 and 5.7 – please refer to these tables as needed for details not included in the narrative summary. TABLE 5.6: MEANS OF ACCESSING SRH SELF-CARE INTERVENTIONS FOR SEXUALLY TRANSMITTED INFECTIONS (INCLUDING HIV), REPRODUCTIVE TRACT INFECTIONS, CERVICAL CANCER AND OTHER GYNAECOLOGICAL MORBIDITIES, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE PrEP (pharmacy access) PEP (pharmacy access) HPV self-sampling STI self- sampling (not including HIV or HPV) HIV self-sampling HIV treatment STI treatment From a doctor or health clinic (%) W av e 1 W av e 2 From a pharmacy (%) W av e 1 W av e 2 Health workers Laypersons KEY 55.6 50.5 43.5 35.1 13.1 8.7 33.5 24.3 60.6 52.4 50.0 38.4 13.1 8.2 31.9 23.3 - - 35.4 37.1 - - 13.4 12.9 42.9 50.5 44.1 48.0 18.0 19.4 22.4 17.8 43.0 48.2 44.4 46.0 25.1 24.1 26.5 17.6 62.8 63.6 - - 8.5 8.6 - - 65.7 66.0 - - 17.3 15.6 - - 101Chapter 5 PrEP (pharmacy access) PEP (pharmacy access) HPV self-sampling STI self- sampling (not including HIV or HPV) HIV self-sampling HIV treatment STI treatment Would buy it online (%) W av e 1 W av e 2 From a peer, outreach or community worker (%) W av e 1 W av e 2 I don’t know where to get it (%) W av e 1 W av e 2 I don’t need to use this (%) W av e 1 W av e 2 HPV: human papillomavirus; PEP: post-exposure prophylaxis; PrEP: pre-exposure prohylaxis; STI: sexually transmitted infection - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY 2.5 1.7 11.9 21.8 5.0 5.4 18.6 32.4 30.3 24.6 7.5 4.1 26.1 20.3 2.2 1.7 9.4 21.4 5.0 5.5 16.9 32.9 28.1 23.1 5.6 2.7 23.8 17.8 - - - - 6.1 8.6 36.0 35.7 - - 6.7 5.7 20.7 14.3 7.8 4.7 18.0 22.7 7.5 6.9 29.8 35.6 24.5 16.4 8.1 8.2 18.6 13.7 8.7 4.0 14.6 21.7 9.3 10.8 28.4 33.8 - - 22.9 17.1 8.0 6.8 17.3 12.2 1.9 2.7 4.1 7.9 - - - - - - - -- -- -- - 32.8 25.1 - - - - 3.1 2.1 3.5 7.3 - - - - - - 26.1 20.1 - - - - 102 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 TABLE 5.7: SOURCES OF INFORMATION ABOUT SRH SELF-CARE INTERVENTIONS FOR SEXUALLY TRANSMITTED INFECTIONS (INCLUDING HIV), REPRODUCTIVE TRACT INFECTIONS, CERVICAL CANCER AND OTHER GYNAECOLOGICAL MORBIDITIES, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE PrEP (pharmacy access) PEP (pharmacy access) HPV self-sampling STI self- sampling (not including HIV or HPV) HIV self-sampling HIV treatment STI treatment I ask a doctor or health worker (%) W av e 1 W av e 2 I go online/ internet (%) W av e 1 W av e 2 I ask my friends, family or community (%) W av e 1 W av e 2 I haven’t received any information on this (%) W av e 1 W av e 2 HPV: human papillomavirus; PEP: post-exposure prophylaxis; PrEP: pre-exposure prohylaxis; STI: sexually transmitted infection - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY 66.3 49.0 61.1 38.1 43.4 37.7 12.9 10.6 14.7 33.8 50.3 33.3 13.4 30.2 23.5 42.9 70.3 52.6 60.7 40.6 42.7 37.5 10.4 9.2 14.3 33.6 50.7 32.8 14.0 28.1 22.7 45.3 - - - - - - - - - - - - - - - - - - - - - - - - 53.3 37.7 42.7 36.1 16.0 19.7 34.7 49.2 61.3 57.0 57.3 44.4 44.7 43.0 13.1 12.7 19.1 27.2 46.7 38.1 12.7 25.4 29.3 42.9 61.6 57.4 55.7 43.8 46.1 41.9 12.3 13.5 18.7 26.5 50.3 39.1 17.5 26.6 26.2 42.2 71.4 67.5 43.5 37.0 10.5 13.0 13.0 18.2 70.6 71.6 43.3 37.4 10.6 12.3 12.4 14.2 103Chapter 5 Pre-exposure prophylaxis (PrEP) Health workers: About half of health workers in each wave reported accessing PrEP from a doctor or health clinic (Wave 1: 55.6%; Wave 2: 43.5%). Fewer reported accessing PrEP from a pharmacy (Wave 1: 13.1%; Wave 2: 33.5%), buying it online (Wave 1: 2.5%; Wave 2: 5.0%) or getting it from a peer, outreach, or community worker (Wave 2 only: 7.5%). A substantial minority reported not knowing where to access PrEP (Wave 1: 11.9%; Wave 2: 18.6%) or not needing it (Wave 1: 30.3%; Wave 2: 26.1%). Health workers reported accessing information on PrEP from a doctor or health worker (Wave 1: 66.3%; Wave 2: 61.1%), online (Wave 1: 43.4%; Wave 2: 50.3%) or from friends, family or their community (Wave 1: 12.9%; Wave 2: 13.4%). Several respondents reported they had not received information on PrEP (Wave 1: 14.7%; Wave 2: 23.5%). Laypersons: Laypersons reported accessing PrEP mainly from a doctor or health clinic (Wave 1: 50.5%; Wave 2: 35.1%), with small numbers getting it from a pharmacy (Wave 1: 8.7%; Wave 2: 24.3%), from peers, outreach or community workers (Wave 2 only: 4.1%) or online (Wave 1: 1.7%; Wave 2: 5.4%). About a fifth of Wave 1 (21.8%) and a third of Wave 2 (32.4%) layperson respondents reported not knowing where to access PrEP, while some reported not having a need for it (Wave 1: 24.6%; Wave 2: 20.3%). Laypersons reported accessing information on PrEP from doctors or health workers (Wave 1: 49.0%; Wave 2: 38.1%), online (Wave 1: 37.7%; Wave 2: 33.3%) or from their friends, family or community (Wave 1: 10.6%; Wave 2: 30.2%). Over a third of respondents in each wave reported not receiving information on PrEP (Wave 1: 33.8%; Wave 2: 42.9%). Post-exposure prophylaxis (PEP) Health workers: The majority of health workers reported accessing PEP from a doctor or health clinic (Wave 1: 60.6%; Wave 2: 50.0%). Less than a third reported receiving it from a pharmacy (Wave 1: 13.1%; Wave 2: 31.9%), and small numbers got it from peers, outreach or community workers (Wave 2 only: 5.6%) or online (Wave 1: 2.2%; Wave 2: 5.0%). Several respondents reported not knowing where to access PEP (Wave 1: 9.4%; Wave 2: 16.9%) while close to a quarter in each wave reported not needing it (Wave 1: 28.1%; Wave 2: 23.8%). Most health workers reported accessing information on PEP from doctors or health workers (Wave 1: 70.3%; Wave 2: 60.7%) or online (Wave 1: 42.7%; Wave 2: 50.7%) while small numbers asked friends, family or their community (Wave 1: 10.4%; Wave 2: 14.0%). A considerable minority reported not receiving information on PEP (Wave 1: 14.3%; Wave 2: 22.7%). Laypersons: Laypersons mainly reported accessing PEP from a doctor or health clinic (Wave 1: 52.4%; Wave 2: 38.4%) while some got it from a pharmacy (Wave 1: 8.2%; Wave 2: 23.3%), online (Wave 1: 1.7%; Wave 2: 5.5%), or from a peer, outreach or community worker (Wave 2: 2.7%). Between a fifth and a third of participants reported not knowing where to receive PEP (Wave 1: 21.4%; Wave 2: 32.9%), and less than a quarter 13 Questions regarding HPV self-sampling were only asked in Wave 2. reported not needing it (Wave 1: 23.1%; Wave 2: 17.8%). Laypersons reported accessing information on PEP from a doctor or health worker (Wave 1: 52.6%; Wave 2: 40.6%), online (Wave 1: 37.5%; Wave 2: 32.8%), or from their friends, family or community (Wave 1: 9.2%; Wave 2: 28.1%). Over a third reported not receiving information on PEP (Wave 1: 33.6%; Wave 2: 45.3%). HPV self-sampling13 Health workers: Health workers reported mainly accessing HPV self-testing from a doctor or health clinic (35.4%), while small numbers got it at a pharmacy (13.4%), from a peer, outreach or community worker (6.7%) or online (6.1%). A third reported not knowing where to access HPV self-testing (36.0%), and a fifth reported having no need for it (20.7%). Most health workers reported accessing information on this intervention from a doctor or health worker (53.3%) or on the internet (42.7%), while 16.0% reported asking friends, family or their community. Nearly a third reported they had not received information on this intervention (34.7%). Laypersons: Laypersons reported mainly accessing HPV self-testing from a doctor or health clinic (37.1%), while small numbers got it at a pharmacy (12.9%), online (8.6%) or through a peer, outreach or community worker (5.7%). About a third reported not knowing where to access HPV self-testing (35.7%), and 14.3% reported not having a need for this intervention. Among laypersons, 37.7% reported going to the doctor or a health worker for information on HPV self-testing, 36.1% reported going online, and 19.7% reported asking their friends, family or community. About half reported not receiving information on this intervention (49.2%). STI self-sampling (not including HIV or HPV) Health workers: When accessing STI self-sampling, health workers reported using a doctor or health clinic (Wave 1: 42.9%; Wave 2: 44.1%), a pharmacy (Wave 1: 18.0%; Wave 2: 22.4%), a peer, outreach or community worker (Wave 2 only: 8.1%), or ordering it online (Wave 1: 7.8%; Wave 2: 7.5%). However, a sizeable proportion of health workers reported not knowing where to access STI self-sampling (Wave 1: 18.0%; Wave 2: 29.8%) or not having a need for it (Wave 1: 24.5%; Wave 2: 18.6%). Health workers reported getting information on STI self-sampling by asking a doctor or health worker (Wave 1: 61.3%; Wave 2: 57.3%), going online (Wave 1: 44.7%; Wave 2: 46.7%), or asking friends, family or their community (Wave 1: 13.1%; Wave 2: 12.7%). Several reported not receiving information on this intervention (Wave 1: 19.1%; Wave 2: 29.3%). Laypersons: Laypersons reported accessing STI self- sampling from a doctor (Wave 1: 50.5%; Wave 2: 48.0%), from a pharmacy (Wave 1: 19.4%; Wave 2: 17.8%), from a peer, outreach or community worker (Wave 2: 8.2%) or ordering it online (Wave 1: 4.7%; Wave 2: 6.9%). Between a fifth and a third reported not knowing where to access STI self-sampling 104 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 (Wave 1: 22.7%; Wave 2: 35.6%), and smaller numbers reported not having a need for this intervention (Wave 1: 16.4%; Wave 2: 13.7%). When accessing information on STI self- sampling, laypersons reported asking a doctor or health worker (Wave 1: 57.0%; Wave 2: 44.4%), going online (Wave 1: 43.0%; Wave 2: 38.1%), and asking their friends, family or community (Wave 1: 12.7%; Wave 2: 25.4%). A considerable number of respondents reported not receiving information on this intervention (Wave 1: 27.2%; Wave 2: 42.9%). HIV self-sampling Health workers: Health workers reported accessing HIV self- sampling at a doctor or health clinic (Wave 1: 43.0%; Wave 2: 44.4%), from a pharmacy (Wave 1: 25.1%; Wave 2: 26.5%), ordering it online (Wave 1: 8.7%; Wave 2: 9.3%), and getting the intervention from a peer, outreach or community worker (Wave 2: 8.0%). Several reported not knowing where to access HIV self-sampling (Wave 1: 14.6%; Wave 2: 28.4%), and around a fifth reported not needing it (Wave 1: 22.9%; Wave 2: 17.3%). Most health workers reported asking a doctor or health worker for information on HIV self-sampling (Wave 1: 61.6%; Wave 2: 55.7%) or searching the internet (Wave 1: 46.1%; Wave 2: 50.3%), while fewer reported asking friends, family or their community (Wave 1: 12.3%; Wave 2: 17.5%). Up to a quarter reported not receiving information on this intervention (Wave 1: 18.7%; Wave 2: 26.2%). Laypersons: Laypersons reported accessing HIV self-sampling from a doctor or health clinic (Wave 1: 48.2%; Wave 2: 46.0%), a pharmacy (Wave 1: 24.1%; Wave 2: 17.6%), online (Wave 1: 4.0%; Wave 2: 10.8%), or through a peer, outreach or community worker (Wave 2: 6.8%). Up to a third reported not knowing where to access HIV self-sampling (Wave 1: 21.7%; Wave 2: 33.8%), while a few participants reported not needing it (Wave 1: 17.1%; Wave 2: 12.2%). Laypersons reported asking a doctor or health worker for information on HIV self- sampling (Wave 1: 57.4%; Wave 2: 43.8%), searching online (Wave 1: 41.9%; Wave 2: 39.1%) and asking friends, family or community members (Wave 1: 13.5%; Wave 2: 26.6%). More than a quarter of respondents reported not having received information on this intervention (Wave 1: 26.5%; Wave 2: 42.2%). 14 Questions regarding HIV treatment were only asked in Wave 1. 15 Questions regarding this STI treatment were only asked in Wave 1. HIV treatment (antiretroviral therapy; ART)14 Health workers: The majority of health worker respondents reported they would access HIV treatment at the doctor or health clinic (62.8%), while 8.5% would get it at the pharmacy, and 1.9% would access it online. A small minority reported not knowing where to get ART (4.1%), and about a third reported not having a need for it (32.8%). For information about ART, the majority of health worker respondents would ask a doctor or health worker (71.4%), while some would also go online (43.5%), 10.5% would ask friends, family or community, and 13.0% had not received information on HIV treatment. Laypersons: The majority of laypersons accessing HIV treatment would get it at the doctor (63.6%), while 8.6% would go to the pharmacy, and 2.7% would get it online. Some reported not knowing where to get it (7.9%) and a quarter reported not having a need for it (25.1%). For information on ART, 67.5% of laypersons would ask a doctor or health worker, 37.0% would go online, and 13.0% would ask their friends, family or community. Nearly a fifth reported not having received information on this intervention (18.2%). Medical treatment for STIs15 Health workers: The majority of health worker respondents reported they would access STI treatment at the doctor or health clinic (65.7%), while 17.3% would access it at the pharmacy and 3.1% would buy it online. A small minority reported not knowing where to get it (3.5%), and about a quarter reported not having a need for it (26.1%). The majority of health worker respondents reported they would ask a doctor or health worker for information on STI treatment (70.6%), while many others would search online (43.3%) and 10.6% would ask friends, family or their community. A minority reported not having received information about medicines to treat STIs (12.4%). Laypersons: Most laypersons reported they would access STI treatment through a doctor or health clinic (66.0%), while 15.6% would access it at the pharmacy and 2.1% would buy it online. A minority reported not knowing where to get it (7.3%) and a fifth reported not having a need for it (20.1%). For information on STI treatment, 71.6% reported they would ask a doctor or health workers, 37.4% would search online, and 12.3% would ask their friends, family or community. A minority reported they had not received information on this intervention (14.2%). 105Chapter 5 5.1.5 Promoting sexual health Questions regarding the interventions in this subsection – lubricant and hormone therapy for gender affirmation – were only asked in Wave 2 of the survey. The findings are presented in Table 5.8 – please refer to the table as needed for details not included in the narrative summary. From a doctor or health clinic (%) From a pharmacy (%) Would buy it online (%) From a peer, outreach or community worker (%) I don’t know where to get it (%) I don’t need to use this (%) M ea ns o f a cc es si ng s el f- ca re in te rv en tio ns fo r… ? Lubricants for sexual health Hormone therapy for gender affirmation I ask a doctor or health worker (%) I go online/internet (%) I ask my friends, family or community (%) I haven’t received any information on this (%) S ou rc es o f i nf or m at io n ab ou t s el f- ca re in te rv en tio ns fo r… ? Lubricants for sexual health Hormone therapy for gender affirmation Health workers Laypersons KEY Health workers Laypersons KEY TABLE 5.8: MEANS OF ACCESSING AND SOURCES OF INFORMATION ABOUT SRH SELF-CARE INTERVENTIONS FOR PROMOTING SEXUAL HEALTH, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) 15.5 10.1 28.0 33.8 73.3 71.0 12.1 8.8 21.1 30.4 3.2 1.5 9.3 10.1 1.3 5.9 3.1 2.9 13.4 16.2 14.3 10.1 59.9 48.5 35.8 27.4 39.6 27.6 67.6 67.7 38.1 31.0 33.8 45.2 14.4 22.4 9.9 11.3 46.8 60.3 Lubricants for sexual health Health workers: Among health workers, almost three quarters (73.3%) reported accessing lubricant at the pharmacy, 21.1% buy it online, 15.5% get it from the doctor or health clinic, and 9.3% get it from a peer, outreach or community worker. A small minority reported not knowing where to access lubricant (3.1%) and 14.3% reported not needing it. Most health workers reported accessing information on lubricant from a doctor or health worker (35.8%) or online (67.6%), while 33.8% reported asking friends, family or their community. A quarter reported they had not received information on this intervention (9.9%). Laypersons: To access lubricant, laypersons reported going to the pharmacy (71.0%), buying it online (30.4%), getting it from a doctor or health clinic (10.1%) or from a peer, outreach or community worker (10.1%). A small minority reported not knowing where to access it (2.9%) or not needing it (10.1%). Laypersons reported accessing information on lubricant from a doctor or health worker (27.4%), online (67.7%) or from friends, family or community (45.2%), although 11.3% reported not having received this information. 106 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 Hormone therapy for gender affirmation Health workers: Health workers reported they would access hormone therapy for gender affirmation from a doctor or health clinic (28.0%), from a peer, outreach or community worker (1.3%), from a pharmacy (12.1%), or online (3.2%). A minority reported not knowing where to access this therapy for self-administration (13.4%), and over half reported not needing it (59.9%). Most health workers reported accessing information on this intervention from a doctor or health worker (39.6%), online (38.1%), and/or by asking friends, family or their community (14.4%). Nearly half reported they had not received information on this intervention (46.8%). Laypersons: Laypersons reported accessing hormone therapy for gender affirmation from a doctor or health clinic (33.8%), from a pharmacy (8.8%), from a peer, outreach or community worker (5.9%), or online (1.5%). About a fifth reported not knowing where to access this intervention (16.2%), and half reported not needing it (48.5%). Laypersons reported accessing information on self-administered therapy by searching online (31.0%), by asking a doctor or health worker (27.6%), or from friends, family or community members (22.4%). The majority said they have not received information on this intervention (60.3%). 5.1.6 SRH information online and via mobile applications Questions regarding the interventions in this subsection were only included in Wave 1 of the survey. The findings are presented in Tables 5.9 and 5.10 – please refer to these tables as needed for details not included in the narrative summary. TABLE 5.9: MEANS OF ACCESSING ONLINE SRH INFORMATION AND MOBILE APPLICATIONS (APPS), AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 1 ONLY, 2018) Online reproductive health information Mobile reproductive health apps Online sexual health information Mobile sexual health apps From a doctor or health clinic (%) From a pharmacy (%) Would buy it online (%) From a peer, outreach or community worker (%) Health workers Laypersons KEY 23.5 20.0 5.5 8.2 58.0 54.6 13.5 12.1 3.6 4.6 52.0 49.6 24.7 22.3 5.6 8.5 55.9 53.0 14.4 12.7 4.6 4.9 51.5 51.1 - -- -- -- - 107Chapter 5 TABLE 5.10: SOURCES OF INFORMATION ABOUT ONLINE SRH INFORMATION AND MOBILE APPLICATIONS (APPS), AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 1 ONLY, 2018) Online reproductive health information Mobile reproductive health apps Online sexual health information Mobile sexual health apps I ask a doctor or health worker (%) I go online/ internet (%) I ask my friends, family or community (%) I haven’t received any information on this (%) Online reproductive health information Mobile reproductive health apps Online sexual health information Mobile sexual health apps I don’t know where to get it (%) I don’t need to use this (%) - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY Health workers Laypersons KEY 43.3 27.8 70.2 74.7 14.9 16.5 6.0 9.5 33.0 20.4 70.3 66.2 17.0 17.2 11.2 22.3 42.8 29.0 68.6 73.5 15.5 16.1 6.7 10.3 34.8 20.1 68.5 66.0 16.5 16.4 11.8 22.0 4.2 8.2 16.9 16.4 10.5 16.7 25.0 21.3 3.9 10.2 18.8 15.2 10.5 17.3 24.6 19.4 108 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 Online reproductive health information Health workers: The health worker respondents reported they would access online reproductive health (RH) information through the internet (58.0%), from a doctor or health clinic (23.5%), and at the pharmacy (5.5%). A small minority did not know where to get it (4.2%), and 16.9% reported not having a need for it. For accessing information about these online resources, most health worker respondents reported they would go online (70.2%) while some would ask a doctor or health worker (43.3%) and 14.9% would ask friends, family or community. A small minority reported that they had not received information on this service (6.0%). Laypersons: For laypersons accessing online RH information, over half would get it online (54.6%), a fifth would ask a doctor or health clinic (20.0%), and 8.2% would ask at a pharmacy. A minority of respondents reported not knowing where to access this service (8.2%) and not having a need for it (16.4%). To access information on this service, 74.7% reported accessing it online, 27.8% would ask a doctor or health worker, and 16.5% would ask their friends, family or community. Only a few reported they had not received information on this service (9.5%). Mobile reproductive health apps Health workers: More than half of health worker respondents reported going online to access mobile RH apps (52.0%), while 13.5% would seek this from a doctor or health clinic, and 3.6% would go to the pharmacy. RH apps were unknown among 10.5% of health workers and a quarter reported not having a need for this (25.0%). The majority of health workers reported they would go online to access information about RH apps (70.3%), while a third would ask a doctor or health worker (33.0%), and 17.0% would ask friends, family or community. Some reported they had not received information on this service (11.2%). Laypersons: About half of layperson respondents reported they would access RH apps online (49.6%), while 12.1% would go to the doctor or health clinic, and 4.6% would go to the pharmacy. Additionally, 16.7% reported not knowing where to access RH apps, and 21.3% reported not having a need for this. To access information on RH apps, most laypersons 66.2% would go online, 20.4% would ask a doctor or health worker, and 17.2% would ask their friends, family or community. Over a fifth reported they had not received information on this (22.3%). Online sexual health information Health workers: The majority of health worker respondents would access online sexual health (SH) information on the internet (55.9%). A quarter would access it at the doctor or health clinic (24.7%), while only 5.6% reported they would go to the pharmacy for it. A small minority reported not knowing where to access this (3.9%), and nearly a fifth reported not having a need for it (18.8%). For information about this service, the majority of health worker respondents reported they would search online (68.6%), while 42.8% would ask a doctor and 15.5% would ask friends, family or community. A small minority reported not having received information on this (6.7%). Laypersons: Among laypersons accessing online SH information, over half would do this online (53.0%), while 22.3% would go to a doctor, and 8.5% would go to a pharmacy. About one in ten reported not knowing where to get it (10.2%), and 15.2% reported not having a use for this. For information about this service, the majority would search online (73.5%), while 29.0% would ask their doctor, and 16.1% would ask their friends, family or community. Some reported not having received information on this service (10.3%). Mobile sexual health apps Health workers: Most health worker respondents reported they would access mobile SH apps using the internet (51.5%), while 14.4% would access it at the doctor or health clinic and 4.6% would access it at the pharmacy. An additional 10.5% reported not knowing where to get it and about a quarter reported not having a need for it (24.6%). The majority of health worker respondents reported they would go online to access information about SH apps (68.5%), while about a third would ask a doctor or health worker (34.8%) and 16.5% would ask friends, family or community. Some had not received information on this (11.8%). Laypersons: Over half of laypersons would access mobile SH apps using the internet (51.1%), while 12.7% would access it through the doctor or health clinic and 4.9% would access it through the pharmacy. Another 17.3% reported not knowing where to access it, and 19.4% reported not having a need for this. To get information about mobile SH apps, 66.0% would go online, 20.1% would ask a doctor or health worker, and 16.4% would ask their friends, family or community. Over a fifth reported they had not received information on this service (22.0%). 109Chapter 5 Current state of SRHR self-care training for health professionals The training of health professionals needs to address the growing access to, and delivery and uptake of, self-care interventions for health care. Recognizing the importance of such training, the WHO Department of Reproductive Health and Research convened the first consultation of early-career health professionals from the fields of midwifery, nursing, pharmacy, public health and medicine. This case study summarizes key gaps and challenges of SRHR self-care training for these professionals, including: • Curricula focus on technical and scientific content rather than communication skills, decision-making and comprehensive problem-solving. • Biased training from biased teachers creates biased providers, institutionalizing stigmatization of present and future patients. • Lack of integrated approaches is due to lack of funding, as well as institutional and specialty siloes. • There is a lack of training to build trust and work with health professionals across sectors in interdisciplinary and inter-professional teams. • In the training, there is a lack of sensitivity to social, cultural and religious context. • Training on patient management and how to establish healthy client–provider relationships is insufficient, including retaining those young people, adolescents and vulnerable populations who may need longer-term care. • Training in gender equality, human rights and ethics is inadequate. • Institutional glass ceilings hinder women’s advancement to leadership positions in many health careers, although women now constitute the majority of the incoming health workforce. To address these issues, there is a need for more interactive ways of teaching, to help students integrate their knowledge, skills and attitudes for improved real- world patient care. Curricula should also be person- centred and emphasize specific training on SRHR issues and work to strengthen understanding of social, cultural and religious contexts that affect SRHR. Artwork from this workshop comm unity HIGHLIGHTS FROM HEALTH-CARE COMMUNITY CONSULTATIONS 110 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 5.2 ENGAGING WITH HEALTH WORKERS FOR SELF-CARE SRHR INTERVENTIONS: QUANTITATIVE AND QUALITATIVE FINDINGS (WAVE 1 ONLY) This section presents further information about engaging with health workers in relation to the use of self-care interventions, to add to the findings reported in section 5.1 above about where/from whom the survey respondents access the interventions and information about the interventions. In Wave 1, survey respondents who had reported usage (or their partner’s usage) of any of the listed self-care interventions (see Chapter 3, section 3.1) were asked follow-up questions about their experience of engaging with health workers when using a self- care intervention for SRHR or as a result of using the intervention, and whether they had ever felt forced or pressured to use the intervention. All respondents were also asked how important they thought it was to be able to access self-care interventions for SRHR without going through a health worker, and how important they thought it was to have access to a health worker after using one of these interventions, and finally their preference for being able to access these interventions on their own or with a health worker. Quantitative findings on these questions are presented in Figure 5.11, and they are also summarized in the text below along with the available qualitative responses related to these issues. Yes, engaged with a health worker when using the intervention or as a result of using the intervention Yes, ever felt forced or pressured to use a self-care intervention for SRHR 69.3 57.7 4.9 6.4 Health workers (%) Laypersons (%) Experience of engaging with health workers among respondents who had reported usage (or their partner’s usage) of any of the listed self-care interventions for SRHR Very Somewhat Neutral Not that important Not important at all Depends on the intervention 33.8 27.4 26.9 24.1 19.9 8.6 7.5 9.7 14.26.07.714.2 Health workers (%) Laypersons (%) Importance of accessing self-care interventions for SRHR without going through a health worker Very Somewhat Neutral Not that important Not important at all Depends on the intervention 60.6 58.0 28.2 23.7 8.3 2.2 2.2 4.9 1.1 1.1 3.16.6 Health workers (%) Laypersons (%) Importance of having access to a health worker after using a self-care intervention for SRHR FIGURE 5.11: EXPERIENCE OF AND VALUES AND PREFERENCES FOR ACCESSING SELF-CARE INTERVENTIONS FOR SRHR WITH OR WITHOUT THE INVOLVEMENT OF A HEALTH WORKER, AND FOR HAVING ACCESS TO A HEALTH WORKER AFTER THE USE OF AN INTERVENTION (WAVE 1 ONLY, 2018) 111Chapter 5 Prefer on my own Prefer with a health worker Depends on the intervention 19.1 11.7 24.0 24.5 64.2 56.4 Health workers (%) Laypersons (%) Preference for being able to access a self-care intervention for SRHR on their own or with a health worker 5.2.1 Experience of engagement with or pressure from health workers in relation to use of self-care SRHR interventions: quantitative findings As presented in Chapter 3, section 3.1, of this report, respondents indicated their personal, or their partner’s, usage of a range of self-care interventions for SRHR. In follow-up to that question, in Wave 1, if they had reported usage of any of the listed interventions (ever, or within the past 3 months), they were further asked whether they had engaged with health workers when using the intervention, or as a result of using it, and whether they had felt forced or pressured to use the intervention. For health worker respondents, as indicated in Figure 5.11 above, more than two thirds (69.3%) engaged with health workers when they used, or as a result of using, the self-care SRHR interventions while the remainder (30.7%) did not engage with health workers. Only a small minority of health worker respondents (4.9%) reported ever feeling forced or pressured to use the self-care SRHR interventions while the vast majority (95.1%) did not. For all other respondents (laypersons), well over half also reported engaging with health workers when using or as a result of using the interventions (57.7%), while 42.3% did not. And, similar to health workers, only a small minority of laypersons reported ever feeling forced or pressured to use the interventions (6.4%), while the majority did not (93.6%). 5.2.2 Importance of and preference for accessing self-care SRHR interventions with or without involvement of a health worker Health workers In response to the question “How important is it for you to be able to access self-care interventions for SRHR without going through a health worker?”, as shown in Figure 5.11 above, just over a third of health worker respondents rated this as “very important” (33.8%), while another quarter rated it as “somewhat” important (24.1%). The remaining respondents were neutral or considered this unimportant, although 50 health workers (14.2% ) said that it depends on the intervention. Some respondents offered explanations for saying that it depends on the interventions, such as needing more information, the controversial nature of SRHR interventions, and the complexity of and risks associated with certain interventions. Needing trusted information on interventions from a health- care professional was discussed by some health worker respondents. A 31-year-old female respondent in the United Kingdom explained: “For anything more complex, I'd like reassurance of a health professional as there is so much information available online, not always very credible.” Similarly, a 24-year-old female respondent in Türkiye discussed how seeing a health worker can ensure that a client makes independent, well informed decisions: Because the knowledge that I have may not be comprehensive, I would want to rely on a health-care provider's intervention. It does not mean that I shouldn’t decide but I should know everything about the intervention before I give consent or not. The stigma, judgement and controversy attached to specific interventions meant that for some, the health worker respondents said it is preferable to access them without seeing a health-care professional. A 59-year-old female respondent in the USA explained: “The more controversial (emergency contraception, HIV testing/treatment) the more I want access without going through a health-care provider.” A 23-year-old female respondent in Qatar explained how it depends on the societal view of that intervention: “If the intervention is normal and accepted by the society then it’s 112 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 fine, however, if it would lead to people making judgements then I would prefer to do it myself.” Other health worker respondents explained that the decision to use an intervention without a health worker depends on the complexity of using it and the risk for adverse reactions. A 27-year-old female respondent in the Republic of Moldova said: “In case of any complications or adverse reactions, unproper use of the intervention, if the risk is minimal and the supervision of the health-care provider is not required, then let it be.” Some respondents specified the interventions they viewed as having higher risks. An 18-year-old female respondent in North Macedonia discussed the importance of knowing the risks for those interventions in advance: Some interventions, for example the abortion pill, are somewhat dangerous in the sense that it's a lot of hormones so I feel that those types of interventions should be acquired after having an unbiased consultation just to know the side-effects. In response to the question “How important is it for you to have access to a health worker after using a self-care intervention for SRHR?”, as shown in Figure 5.11 above, most health worker respondents thought this was “very important” (60.6%), while about a quarter rated it as “somewhat important” (23.7%), and 6.6% felt neutral about the issue. At the other end of the scale, only very few rated it as “not that important” (3.1%) or “not important at all” (1.1%), and the remaining 4.9% reported that it depends on the intervention. Some explained that it depends on the result of the intervention and whether or not there are any adverse effects. A 38-year-old female health worker in the USA elaborated on her response: “Yes. For example, after HIV home testing, I would want to have counselling with a provider. On the other hand, after use of EC [emergency contraception], I wouldn't need to talk with anyone in the health profession unless I was experiencing complications.” Other health worker respondents elaborated that, while for some interventions accessing a health worker afterwards is important, this does not have to be an in-person visit. A 51-year-old woman in South Africa specified: “I need to be able to ask questions or go to someone in case of side- effects, etc. If this was telephonic that is fine, I would not need to see someone physically.” In response to the question “Do you prefer to be able to access a self-care intervention for SRHR on your own or with a health worker?”, as shown in Figure 5.11 above, most health worker respondents said it depends on the intervention (56.4%), while about a fifth stated a preference for accessing it on their own (19.1%), and a quarter preferred to do so with a health worker (24.5%). Layperson respondents In response to the question “How important is it for you to be able to access self-care interventions for SRHR without going through a health worker?”, as shown in Figure 5.11 above, about a quarter each of layperson respondents rated it as “very” and “somewhat” important (27.4% and 26.9%, respectively). About a fifth were neutral on the issue (19.9%), and only small numbers said that it was “not that important” (8.6%), “not important at all” (7.5%) or that it depends on the intervention (9.7%). Some respondents explained that it depends on the nature of the intervention, with complexity and urgency being major concerns. A 24-year-old woman in Venezuela specified: “For example, if I needed antiretroviral therapy I definitely would go to a health-care provider, or if I suffered a STI or if I required injectable medicines.” Another respondent, a 25-year-old woman in Croatia, noted the issue of time-sensitive matters relating to SRHR: If the intervention needs to be quick and convenient, where time is the matter of urgency, it is important to be able to access the health-care provider quickly or to bypass them if necessary. Otherwise, I prefer to have contact with a health-care provider. Some respondents noted that accessing interventions through a health worker may not always be reliable. A 34-year-old woman in Mexico explained: “It depends if I feel it's something I can get sufficient information on without seeing a doc. But so many are poorly informed on sexual health and, generally, access to the intervention. Plus access to information is enough.” Similarly, a 25-year-old female respondent in Australia noted the advantages of accessing trusted sources for information, particularly for individuals who are sexually diverse: “As long as wherever I am getting information is safe, ethical, accessible and queer friendly.” In response to the question “How important is it for you to have access to a health worker after using a self-care intervention for SRHR?”, as shown in Figure 5.11 above, the majority of layperson respondents rated this as as “very important” (58.0%) while another 28.2% rated it as “somewhat important”. The remaining small numbers of respondents felt neutral about the issue (8.3%) or rated it as “not that important” (2.2%) or “not important at all” (1.1%). Four respondents (2.2%) said that it depends on the intervention, and offered explanations highlighting the complexity of the intervention and risk for adverse reactions. A 48-year-old woman in Kenya specified: “For simple intervention not important, but for HIV, abortion, complicated STI very important.” In response to the question “Do you prefer to be able to access a self-care intervention for SRHR on your own or with a health worker?”, as shown in Figure 5.11 above, almost two thirds of laypersons reported that it depends on the intervention (64.2%), while about a quarter reported that they prefer to access self- care interventions with a health worker and just 11.7% stated that they prefer to access them on their own. 113Chapter 5 5.3 EASE OF ACCESS TO SELF-CARE INTERVENTIONS FOR SRHR: QUANTITATIVE FINDINGS This section presents the quantitative findings from both waves of the survey on respondents’ overall ease of access to health care when they need it and their ease of accessing the internet or a mobile phone confidentially. As shown in Figure 5.12, overall, respondents across both survey waves reported very high access to health care and confidential access to a mobile phone or the internet. Respondents in Wave 2 were also asked about their proximity to a variety of health-care facilities. On average, both health workers and laypersons reported living closest to a pharmacy, while health workers on average lived furthest from an SRH clinic, and laypersons lived furthest from a public hospital. FIGURE 5.12: ENGAGEMENT WITH HEALTH CARE AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE Very easy Yes Easy No Somewhat easy Not easy Very difficult 81.6 94.7 86.1 96.6 71.7 91.8 80.0 95.4 26.0 8.2 18.5 4.6 16.5 5.3 10.9 3.5 1.7 0.6 1.5 0.8 1.1 3.0 Health workers (%) Health workers (%) Laypersons (%) Laypersons (%) Wave 1 Wave 1 Wave 1 Wave 1 Wave 2 Wave 2 Wave 2 Wave 2 Ease of confidential mobile phone/internet access Able to access health care when required 114 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 Health workers: Most health workers reported that it was “very easy” (Wave 1: 81.6%; Wave 2: 71.7%) or “easy” (Wave 1: 16.5%; Wave 2: 26.0%) to access the internet or a mobile phone confidentially. Very small numbers reported that it was “somewhat easy” (Wave 2 only: 1.7%), “not easy” (Wave 1: 1.1%; Wave 2: 0.6%), or “very difficult” (Wave 1 only: 0.8%). In addition, the vast majority reported being able to access health care when they need it (Wave 1: 94.7%; Wave 2: 91.8%), while the rest said they could not. In Wave 2, responses regarding distance from their homes to a range of health-care facilities were also analysed. On average, health workers reported living closest to a pharmacy (mean: 2.0 km), a community clinic (mean: 3.5 km) and a private health clinic (mean: 4.6 km), and further away on average from other facilities – 5.6 km from a public health clinic, 5.9 km from a private hospital, 8.2 km from a public hospital and 8.7 km from an SRH clinic. Laypersons: The majority of layperson respondents reported it was “very easy” (Wave 1: 86.1%; Wave 2: 80.0%) or “easy” (Wave 1: 10.9%; Wave 2: 18.5%) to access the internet or mobile phone confidentially, and the remainder said it was “not easy” (Wave 1: 3.0%; Wave 2: 1.5%). The vast majority of laypersons reported being able to access health care when they need it (Wave 1: 96.6%; Wave 2: 95.4%), while the remaining few said they could not. In Wave 2, responses about distance for their homes to a range of health-care facilities were also analysed. On average, laypersons reported living closest to a pharmacy (mean: 1.5 km), a private health clinic (mean: 3.4 km) and a community clinic (mean: 3.4 km), and a bit further away from other facilities – 3.8 km from a public health clinic, 4.6 km from a private hospital, 5.4 km from an SRH clinic and 5.7 km from a public hospital. Mean distance (km) from home to Health workers Laypersons KEY Public hospital (SD) Public health clinic (SD) Private hospital (SD) Private health clinic (SD) SRH clinic (SD) Pharmacy (SD) Community clinic (SD) 8.2 (10.4) 5.7 (4.2) 5.6 (8.4) 3.8 (4.5) 5.9 (13.0) 4.6 (5.1) 4.6 (13.2) 3.4 (3.5) 8.7 (16.3) 5.4 (5.5) 2.0 (2.5) 1.5 (1.9) 3.5 (3.8)a 3.4 (3.5) SD: standard deviation a The data here have been calculated to exclude an “outlier” response from one health worker respondent who reported a distance of 700 km from their home to the community clinic. Chapter 4 1155 115 HIGHLIGHTS FROM COMMUNITY WORKSHOPS Truck drivers in India All the participants in this workshop were male truck drivers working in the Indian state of Tamil Nadu. Though their education levels varied from primary school through university level, many were illiterate. Body mapping was used as a tool to facilitate this workshop on general and sexual health care and self-care. The key issues raised by the participants included: 1. Participants typically have a family doctor in their hometown, whose advice they trust and follow. 2. When on long-distance truck routes, they carry previously issued prescriptions prepared by their family doctor and reuse them to buy medicines from pharmacies. 3. Under the state AIDS control programme, they are tested for STIs and HIV every six months and provided treatment if needed. 4. While the truck drivers found it convenient to access self-testing kits, many of them were anxious about using these products because they could not read or follow the directions for use. 5. Fellow drivers are an important source of health information. They also generally trust most health- related information received via social media. Not all drivers have mobile phones and they do not regularly watch television. 6. It is generally very difficult to access proper medical care while travelling long distances due to language barriers, so they rely on old prescriptions from pharmacies back home. STI and HIV self-testing and self-treatment products can be used at the individuals’ discretion while on the road. Self-care products would help overcome the stigma faced in clinics. There is fear of complications due to inappropriate use of self-care products. There is difficulty understanding which products or services to use and how, given low literacy levels. Artwork from this workshop co mmu nity “We are anxious about using self- testing products as we are illiterate and we cannot read the instructions. In some cases, it would be good if the instructions are written in our own language.” Benefits and barriers to self-care interventions 116 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 6 Impacts of COVID-19 on respondents’ use of self-care interventions and access to sexual and reproductive health services 6 117Chapter 6 Chapter summary Since the Wave 1 Global Values and Preferences Survey (GVPS) in 2018, the world has experienced unprecedented changes due to the COVID-19 pandemic. This pandemic has exerted broad and sustained impacts on multiple spheres of people’s lives, including their use of and access to self-care interventions and sexual and reproductive health (SRH) services. Non-pharmaceutical interventions, such as lockdowns, together with overwhelmed health care systems have resulted in delays to non-essential care, and COVID-19 has led to many changes in the ways people access and provide health care. Recognizing this, respondents participating in Wave 2 of the GVPS in 2020–2021 were asked a brief series of questions regarding the impact of the COVID-19 pandemic on their usage of self-care interventions and their access to SRH services. This chapter reports the findings, which indicate that by and large respondents reported no change in usage or access, but where there was change, there tended to be more of an increase in the use of self-care interventions and more of a decrease in access to both sexual health and reproductive health services. These results were very similar for both health worker respondents and layperson respondents. “Awareness is key to sexual and reproductive health. During the pandemic, there was no mobility, so you were not aware of what was wrong with you until it became a problem.” – 19-year-old female college student in Nigeria 118 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 6 Recognizing that COVID-19 has led to many changes in the ways people access and provide health care, in Wave 2 of the survey, health workers and layperson respondents were asked three additional questions: • Has your use of self-care interventions changed due to COVID-19? • Has your access to sexual health services changed due to COVID-19? • Has your access to reproductive health services changed due to COVID-19? Figure 6.1 presents the responses to these questions, and they are also summarized in the text below. Yes – increased use Yes – increased use Yes – increased use Yes – decreased use Yes – decreased use Yes – decreased use No change No change No change I don’t know I don’t know I don’t know 12.4 4.0 6.1 10.5 1.8 7.5 18.3 29.8 9.3 19.2 25.0 70.2 81.7 68.4 11.9 10.5 1.3 2.0 67.9 75.5 66.9 Health workers (%) Health workers (%) Health workers (%) Laypersons (%) Laypersons (%) Laypersons (%) Has your use of self-care interventions changed due to COVID-19? Has your access to reproductive health services changed due to COVID-19? Has your access to sexual health services changed due to COVID-19? FIGURE 6.1: IMPACTS OF COVID-19 ON USE OF SELF-CARE INTERVENTIONS AND ACCESS TO SEXUAL HEALTH AND REPRODUCTIVE HEALTH SERVICES, ACCORDING TO GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) Notes: Sexual health services refers to services such as HIV and STI testing and treatment. Reproductive health services include contraceptive services, pregnancy testing, antenatal supplements and self-management of medical abortion, among others. 119Chapter 6 Health workers: The majority of health worker respondents reported no change in their use of self-care interventions for SRHR due to the COVID-19 pandemic (67.9%), while the remainder were split fairly evenly between increased use of these interventions (12.4%), decreased use (9.3%) and not knowing if their use had changed (10.5%). Regarding access to sexual health services during the COVID-19 pandemic, again a two thirds majority of health workers reported no change (66.9%). An additional quarter of the health workers indicated that their access to sexual health services had decreased during the pandemic (25.0%), while 6.1% said their access had increased and 2.0% indicated that they did not know whether their access to sexual health services had changed or not due to the COVID-19 pandemic. With regard to access to reproductive health services, an even greater majority of three quarters of health workers reported no change due to the COVID-19 pandemic (75.5%), while almost a fifth indicated that their access to reproductive health services had decreased (19.2%) and the remaining few respondents indicated that their access had increased (4.0%) or that they did not know whether their access to reproductive health services had changed or not due to the COVID-19 pandemic (1.3%). Laypersons: Similar to health workers’ responses, the majority of layperson respondents reported that their use of self-care interventions for SRHR had not changed due to the COVID-19 pandemic (70.2%) and small minorities reported increased use (10.5%), decreased use (7.5%) and not knowing if their use had changed due to the pandemic (11.9%). While more than two thirds of the layperson respondents reported that their access to sexual health services did not change due to the pandemic (68.4%), almost a third reported decreased access (29.8%) and one respondent stated that their access had increased (1.8%). The vast majority of laypersons reported no change in their access to reproductive health services (81.7%) while the remaining fifth of the respondents indicated decreased access (18.3%). 120 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 6 Views on SRHR and self-care Qualitative research was undertaken in six countries using focus group discussions (FGDs) among adolescents and young people, including those from underserved populations. The goals were to stimulate the exchange of knowledge and ideas regarding the adoption and strategic implementation of self-care interventions for health, and to supplement the findings of the Global Values and Preferences Survey (GVPS) on self-care interventions, during the second wave of GVPS in 2020–2021. The research process also served to strengthen the roles of multiple stakeholders including, nongovernmental organizations (NGOs) and community-based organizations (CBOs) and members of underserved communities, who made valuable contributions to the research implementation and the dissemination and adoption of the research findings, especially during the COVID-19 pandemic. The research sought to understand the participants’ self- care practices, their motivations and perceptions, and the barriers and challenges they face in adopting self-care, including social, economic and mental barriers. It also investigated the accountability mechanisms they use when self-care does not work. In all six countries the FGDs included college graduates, while in three countries they also included high school students (Cameroon, Mexico, Nigeria) and in three they also included young married couples (Cameroon, India, Nigeria), and the FGDs in Nigeria also included commercial sex workers, drug users and members of the LGBQ+ community, and in India they also included members of the LGBQ+ community. Source and accessibility of information (data from FGDs in Egypt, India, Mexico, Nigeria and the United Arab Emirates with young college graduates, drug users, sex workers, people living with HIV and high school students). • High-risk communities of young people (including drug users, people living with HIV, and sex workers interviewed) report accessing credible and reliable health information from community health workers (CHWs) and from the CBOs/NGOs that they have been in contact with. • Three growing trends have been noticed across regions in most popular sources or methods of accessing online information: (i) through social media platforms like Instagram and Facebook; (ii) direct searches in search engines, like Google, comparing information across different websites or documents that appear in the search results; and (iii) preference for scholarly articles, specific trusted institutional websites and/or reputable blogs. • While participants acknowledged that the information they find online may not be entirely accurate or legitimate, the internet is the most immediately accessible source of information for them, and each person had their own way of checking the veracity of the information or relied on particular “go to” sources. • Almost all participants had access to online information via mobile phones. Knowledge (data from FGDs in Egypt, India, Mexico, Nigeria and the United Arab Emirates). • FGDs with adolescent girls and young women in urban slum areas in North India revealed that knowledge about SRH (e.g. menstruation) was limited and their knowledge of self-care products was limited to sanitary napkins/ cloth only. Furthermore, it was apparent that information received from their parents was focussed on policing the behaviour and limiting the freedom of girls after puberty. HIGHLIGHTS FROM FOCUS GROUP DISCUSSIONS WITH ADOLESCENTS AND YOUNG PEOPLE Artwork from this work sho p c om mu nit y Views on SRHR and self-care “We are not aware of reproductive health, but our family and especially, mothers told us we will come to know about it after we get married.” 22-year-old woman, resident of an urban slum setting in North India “Once puberty hit and there were changes in our bodies, we were instructed to stay away from boys and not allowed to play with them.” 20-year-old woman, resident of an urban slum setting in North India • Knowledge of SRH services and interventions among participants in Egypt, India, Mexico, Nigeria and the United Arab Emirates was reportedly limited to their personal experiences or hearsay. While they are aware that information on SRH is available through NGOs and CBOs, they are not inclined to access information that way unless they really had to. For instance, knowledge about PEP and PrEP, HIV self-testing, and HPV self- sampling was generally limited or non-existent, with the exception of some participants who were living with HIV and had been in contact with other people living with HIV or working with other high-risk communities. • Participants from New Delhi slums and from Egypt indicated that while the school curriculum included SRH information, most participants were not well informed about relevant products other than sanitary napkins and, in some cases, contraceptives. Use of information (data from FGDs in India, Mexico, Nigeria, Egypt and the United Arab Emirates among college graduates, people living with HIV and high school students). • Some participants shared that despite realizing that online SRH information was misleading, they hesitated to visit the doctor, for fear of being judged. Importance of SRH (data from FGDs with college graduates from India, Mexico and Nigeria) • Young college graduates in Nigeria were generally better informed about the important of safer sex practices (e.g. male/female condoms, lubricants, HIV testing kits) than were participants from the other five countries due to widespread public health programmes and campaigns on HIV prevention. “It is important, not just for me but for the youth because in today's society, most of our youth are not trustworthy, one person can have multiple relationships. Transmission of diseases will be taken from one person to another and pregnancy is another factor. In order to not destroy somebody’s future, I feel one should use sexual reproductive health to protect him or herself to avoid all these issues.” 21-year-old female college graduate in Nigeria • Bisexual college graduates in India and Mexico had good awareness of the importance of SRHR including the risks of disease transmission, but lacked specific knowledge about sexual health self-care practices for same-sex relationships, and their SRH-related self-care practices were either limited or guided by the partner. “Not all of my boyfriends thought SRH was important. For my girlfriends, this has been important. If something [self-care practice] is right, she will tell me.” 22-year-old bisexual college graduate in Mexico “Sex is a very intimate thing. If you contract an infection, it might be chronic so one needs to take proper precautions. I believe I have a certain amount of knowledge for SRH self-care.” 23-year-old bisexual female college graduate in India Risks and challenges (data from India and Nigeria). • Reports about their experience of and access to health- care facilities among participants from India and Nigeria indicated that some health workers may be unfriendly and the facilities poorly stocked and maintained – or completely closed due to the COVID-19 pandemic. “Some of the medical practitioners are very unfriendly to their patients or clients at the hospital. There is a lack of drugs, a test could be carried out but the drugs to be administered will not be there. Then, there will be unhealthy conditions for both the person and the staff. Some of them use dilapidated buildings. These are my own bitter challenges I have noticed.” 18-year-old male college student in Nigeria 121Chapter 6 122 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 6 Views on SRHR and self-care “Awareness is key to sexual and reproductive health. During the pandemic, there was no mobility, so you were not aware of what was wrong with you until it became a problem – like if you have gonorrhoea, you will not know because you have not tested until it affects you fully before you know. You cannot cure it immediately because hospitals have closed down so it was a big problem during the lockdown. 19-year-old female college student in Nigeria • Sociocultural challenges were reported by participants in Egypt, India and Nigeria. Due to prevalent religious and cultural notions, individuals feel stigmatized discussing anything related to SRH with their children, parents, peers, or sometimes even with health workers. Though SRH is part of the school curriculum, the subject tends to be either skipped or treated in a hushed manner. “People are not educated and from backward classes, so they are hardly bothered about COVID. It was a religious thing for them ‘agr hona hoga to bina mask ke bhi ho jayega’ [If we have to get COVID, we will get it with or without using a mask].” 17-year-old female college graduate, resident of an urban slum setting in North India “The first question that always comes up is regarding pregnancy. The doctor we went to when I was 19 or 20, part of her treatment plan was to advise my mother that marriage and pregnancy are like long-term plans. Marriage is a long-term solution to your pregnancy. They usually ask how old you are. They were worried about my education and I have to take my medication for a three- month period. I have to manage my weight. I have to maintain a certain lifestyle. I felt that the entire approach didn’t really suit me. I didn’t feel she was putting me first. You don’t need to go to a doctor if you are married. There is a heavy focus on getting married so that you are healthy.” 20-year-old bisexual female college graduate in India • With regard to human rights and decision-making, female college graduates in India revealed that regardless of their education, financial independence and empowered lifestyle in urban settings, decisions about finding a life partner, marriage, family planning, pregnancy and childbirth are influenced or made by some family members (e.g. husband or parents), often accompanied by a struggle for autonomy. Self-care products for family planning (data from India, Mexico, Nigeria and the United Arab Emirates from college graduates). • Participants across the six countries, with the exception of adolescent girls from urban slums in North India, were aware of and use oral contraceptive pills (OCPs). • College graduates were aware of OCPs but expressed hesitance about using them due to side-effects. Nevertheless, they were inclined to use them, often secretly, in emergency situations as emergency contraception to prevent unplanned pregnancy and/or to address hormonal issues. • College graduates in Nigeria mentioned that due to the high cost of OCPs, they prefer to use condoms, which are affordable or free. “I think it should be a task for both partners. They should take care of themselves. She should take birth control pills or hormones. It is not just a task of one person.” 22-year-old college student in Mexico “Compared to other products, I feel condoms are much better as they are used externally.” 24-year-old college graduate in Mexico “It can be availed at pharmacies only with medical prescription. I don’t think there is any discrimination regarding birth control pills; like my family they talk about it, they consult the doctor and they use it.” 23-year-old college graduate in Nigeria Appendices 123 APPENDIX A: COUNTRY OF RESIDENCE OF GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY “WAVE” REPORTED COUNTRY OF RESIDENCE Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) Afghanistan 1 (0.3) 1 (0.7) 1 (0.2) 0 (0.0) Albania 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Algeria 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Argentina 7 (1.9) 3 (2.1) 11 (2.4) 1 (1.3) Aruba 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Australia 0 (0.0) 2 (1.4) 4 (0.9) 1 (1.3) Azerbaijan 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Bangladesh 0 (0.0) 0 (0.0) 2 (0.4) 0 (0.0) Barbados 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Belarus 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Belgium 2 (0.6) 0 (0.0) 2 (0.4) 0 (0.0) Bhutan 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Bolivia (Plurinational State of) 0 (0.0) 3 (2.1) 0 (0.0) 1 (1.3) Bosnia and Herzegovina 0 (0.0) 0 (0.0) 1 (0.2) 1 (1.3) Botswana 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Brazil 8 (2.2) 1 (0.7) 2 (0.4) 0 (0.0) Bulgaria 2 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) Burkina Faso 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Burundi 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Cameroon 3 (0.8) 1 (0.7) 1 (0.2) 1 (1.3) Canada 6 (1.7) 16 (11.2) 6 (1.3) 21 (28.0) Chile 0 (0.0) 2 (1.4) 0 (0.0) 0 (0.0) China 4 (1.1) 2 (1.4) 6 (1.3) 0 (0.0) Colombia 34 (9.4) 5 (3.5) 14 (3.0) 0 (0.0) Congo 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Costa Rica 2 (0.6) 0 (0.0) 2 (0.4) 0 (0.0) Côte d’Ivoire 0 (0.0) 0 (0.0) 0 (0.0) 2 (2.7) Croatia 4 (1.1) 0 (0.0) 8 (1.7) 0 (0.0) Cuba 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Czech Republic 2 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) Democratic Republic of the Congo 0 (0.0) 0 (0.0) 2 (0.4) 1(1.3) Denmark 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) APPENDICES Appendices 124 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report REPORTED COUNTRY OF RESIDENCE Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) Dominica 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Dominican Republic 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) Ecuador 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) Egypt 2 (0.6) 1 (0.7) 1 (0.2) 0 (0.0) El Salvador 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Eswatini 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Ethiopia 3 (0.8) 2 (1.4) 2 (0.4) 0 (0.0) Finland 0 (0.0) 0 (0.0) 2 (0.4) 0 (0.0) France 3 (0.8) 0 (0.0) 1 (0.2) 2 (2.7) Gambia 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Germany 2 (0.6) 0 (0.0) 5 (1.1) 1(1.3) Ghana 1 (0.3) 0 (0.0) 2 (0.4) 0 (0.0) Greece 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Grenada 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Guatemala 3 (0.8) 0 (0.0) 3 (0.7) 0 (0.0) Guyana 2 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) Haiti 2 (0.6) 1 (0.7) 0 (0.0) 0 (0.0) Honduras 0 (0.0) 1 (0.7) 1 (0.2) 1 (1.3) Hungary 0 (0.0) 2 (1.4) 0 (0.0) 0 (0.0) India 8 (2.2) 4 (2.8) 11 (2.4) 1 (1.3) Indonesia 0 (0.0) 2 (1.4) 3 (0.7) 0 (0.0) Iran (Islamic Republic of) 3 (0.8) 0 (0.0) 2 (0.4) 0 (0.0) Italy 1 (0.3) 1 (0.7) 2 (0.4) 0 (0.0) Jamaica 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Japan 0 (0.0) 0 (0.0) 3 (0.7) 0 (0.0) Jordan 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Kenya 48 (13.3) 2 (1.4) 37 (8.0) 2 (2.7) Lebanon 2 (0.6) 2 (1.4) 2 (0.4) 0 (0.0) Liberia 2 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) Malawi 1 (0.3) 3 (2.1) 0 (0.0) 0 (0.0) Malaysia 1 (0.3) 0 (0.0) 2 (0.4) 0 (0.0) Mali 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) Malta 0 (0.0) 0 (0.0) 3 (0.7) 0 (0.0) Mauritius 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Mexico 2 (0.6) 1 (0.7) 2 (0.4) 0 (0.0) Morocco 0 (0.0) 2 (1.4) 2 (0.4) 1 (1.3) Mozambique 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Appendices 125 REPORTED COUNTRY OF RESIDENCE Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) Myanmar 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Namibia 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Nepal 3 (0.8) 1 (0.7) 0 (0.0) 2 (2.7) Netherlands 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) New Zealand 1 (0.3) 0 (0.0) 2 (0.4) 0 (0.0) Nicaragua 3 (0.8) 1 (0.7) 0 (0.0) 1 (1.3) Nigeria 16 (4.4) 14 (9.8) 19 (4.1) 2 (2.7) North Macedonia 2 (0.6) 0 (0.0) 9 (1.9) 0 (0.0) Norway 0 (0.0) 0 (0.0) 3 (0.7) 0 (0.0) Oman 0 (0.0) 0 (0.0) 2 (0.4) 0 (0.0) Pakistan 1 (0.3) 3 (2.1) 9 (1.9) 2 (2.7) Palestine 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Panama 0 (0.0) 0 (0.0) 4 (0.9) 0 (0.0) Paraguay 2 (0.6) 0 (0.0) 1 (0.2) 0 (0.0) Peru 5 (1.4) 2 (1.4) 2 (0.4) 1 (1.3) Philippines 3 (0.8) 2 (1.4) 2 (0.4) 0 (0.0) Poland 7 (1.9) 0 (0.0) 17 (3.7) 0 (0.0) Portugal 20 (5.6) 1 (0.7) 61 (13.1) 0 (0.0) Qatar 1 (0.3) 0 (0.0) 2 (0.4) 0 (0.0) Republic of Korea 0 (0.0) 2 (1.4) 2 (0.4) 0 (0.0) Republic of Moldova 2 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Romania 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Rwanda 1 (0.3) 1 (0.7) 0 (0.0) 0 (0.0) Saudi Arabia 1 (0.7) 0 (0.0) 0 (0.0) 0 (0.0) Senegal 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.3) Serbia 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Singapore 0 (0.0) 0 (0.0) 31 (6.7) 0 (0.0) Slovakia 0 (0.0) 1 (0.7) 1 (0.2) 0 (0.0) Slovenia 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Somalia 0 (0.0) 1 (0.7) 1 (0.2) 0 (0.0) South Africa 6 (1.7) 1 (0.7) 5 (1.1) 0 (0.0) Spain 2 (0.6) 2 (1.4) 2 (0.4) 1 (1.3) Sri Lanka 3 (0.8) 0 (0.0) 1 (0.2) 0 (0.0) Sudan 1 (0.3) 0 (0.0) 2 (0.4) 1 (1.2) Swaziland 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) Sweden 2 (0.6) 0 (0.0) 5 (1.1) 0 (0.0) Switzerland 5 (1.4) 1 (0.7) 3 (0.7) 0 (0.0) Appendices 126 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report REPORTED COUNTRY OF RESIDENCE Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) Syrian Arab Republic 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Thailand 6 (1.7) 1 (0.7) 3 (0.7) 0 (0.0) Trinidad and Tobago 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Tunisia 3 (0.8) 0 (0.0) 12 (2.6) 0 (0.0) Türkiye 8 (2.2) 1 (0.7) 7 (1.5) 1 (1.3) Turkmenistan 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Uganda 10 (2.8) 2 (1.4) 12 (2.6) 1 (1.3) United Kingdom 16 (4.4) 5 (3.5) 16 (3.4) 2 (2.7) United Republic of Tanzania 3 (0.8) 0 (0.0) 1 (0.2) 0 (0.0) United States of America 44 (12.2) 27 (18.9) 54 (11.6) 21 (28.0) Uruguay 2 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) Venezuela (Bolivarian Republic of) 0 (0.0) 2 (1.4) 2 (0.4) 0 (0.0) Viet Nam 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) Yemen 1 (0.3) 1 (0.7) 0 (0.0) 0 (0.0) Zambia 1 (0.3) 2 (1.4) 0 (0.0) 1 (1.3) Zimbabwe 1 (0.3) 2 (1.4) 1 (0.2) 1 (1.3) TOTAL 360 143 465 75 Appendices 127 APPENDIX B: AGES OF THE GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE AGE GROUP Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) 18–29 years 117 (32.7) 28 (16.7) 262 (56.5) 40 (48.8) 18 1 (0.3) 0 (0.0) 13 (2.8) 2 (2.4) 19 3 (0.8) 0 (0.0) 20 (4.3) 1 (1.2) 20 11 (3.0) 0 (0.0) 35 (7.5) 2 (2.4) 21 8 (2.2) 1 (0.6) 36 (7.8) 3 (3.7) 22 15 (4.2) 1 (0.6) 39 (8.4) 3 (3.7) 23 16 (4.5) 7 (4.2) 25 (5.4) 10 (12.2) 24 9 (2.5) 2 (1.2) 19 (4.1) 2 (2.4) 25 11 (3.1) 4 (2.4) 23 (5.0) 0 (0.0) 26 10 (2.8) 4 (2.4) 14 (3.0) 8 (9.8) 27 12 (3.4) 2 (1.2) 11 (2.4) 2 (2.4) 28 13 (3.6) 3 (1.8) 12 (2.6) 4 (4.9) 29 8 (2.2) 4 (2.4) 15 (3.2) 3 (3.7) 30–39 years 98 (27.4) 47 (28.0) 91 (19.6) 14 (17.1) 30 10 (2.8) 3 (1.8) 15 (3.2) 2 (2.4) 31 11 (3.1) 5 (3.0) 10 (2.2) 2 (2.4) 32 7 (2.0) 2 (1.2) 7 (1.5) 1 (1.2) 33 10 (2.8) 4 (2.4) 8 (1.7) 2 (2.4) 34 8 (2.2) 6 (3.6) 14 (3.0) 1 (1.2) 35 16 (4.5) 7 (4.2) 4 (0.9) 0 (0.0) 36 9 (2.5) 3 (1.8) 9 (1.9) 3 (3.7) 37 9 (2.5) 3 (1.8) 8 (1.7) 0 (0.0) 38 11 (3.1) 9 (5.4) 9 (1.9) 1 (1.2) 39 7 (2.0) 5 (3.0) 7 (1.5) 2 (2.4) 40–49 years 72 (20.1) 45 (26.8) 55 (11.9) 16 (19.5) 40 12 (3.4) 4 (2.4) 10 (2.2) 1 (1.2) 41 7 (2.0) 2 (1.2) 3 (0.7) 1 (1.2) 42 11 (3.1) 5 (3.0) 3 (0.7) 3 (3.7) 43 5 (1.4) 2 (1.2) 10 (2.2) 4 (4.9) 44 7 (2.0) 5 (3.0) 1 (0.2) 1 (1.2) 45 6 (1.7) 6 (3.6) 6 (1.3) 0 (0.0) 46 5 (1.4) 6 (3.6) 5 (1.1) 2 (2.4) 47 6 (1.7) 3 (1.8) 4 (0.9) 1 (1.2) 48 7 (2.0) 7 (4.2) 9 (1.9) 0 (0.0) 49 6 (1.7) 5 (3.0) 4 (0.9) 3 (3.7) Appendices 128 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report AGE GROUP Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) 50–59 years 44 (12.3) 32 (19.1) 33 (7.1) 6 (7.3) 50 2 (0.6) 5 (3.0) 8 (1.7) 1 (1.2) 51 6 (1.7) 0 (0.0) 0 (0.0) 0 (0.0) 52 4 (1.1) 1 (0.6) 8 (1.7) 2 (2.4) 53 3 (0.8) 4 (2.4) 1 (0.2) 0 (0.0) 54 8 (2.2) 4 (2.4) 4 (0.9) 1 (1.2) 55 3 (0.8) 2 (1.2) 1 (0.2) 1 (1.2) 56 6 (1.7) 3 (1.8) 0 (0.0) 0 (0.0) 57 3 (0.8) 7 (4.2) 3 (0.7) 1 (1.2) 58 3 (0.8) 2 (1.2) 3 (0.7) 0 (0.0) 59 6 (1.7) 4 (2.4) 5 (1.1) 0 (0.0) 60–69 years 17 (4.7) 14 (8.3) 18 (3.9) 5 (6.1) 60 2 (0.6) 4 (2.4) 4 (0.9) 0 (0.0) 61 2 (0.6) 0 (0.0) 1 (0.2) 0 (0.0) 62 0 (0.0) 1 (0.6) 4 (0.9) 1 (1.2) 63 2 (0.6) 2 (1.2) 2 (0.4) 2 (2.4) 64 3 (0.8) 0 (0.0) 2 (0.4) 1 (1.2) 65 3 (0.8) 0 (0.0) 2 (0.4) 0 (0.0) 66 1 (0.3) 1 (0.6) 1 (0.2) 0 (0.0) 67 2 (0.6) 2 (1.2) 1 (0.2) 0 (0.0) 68 1 (0.3) 3 (1.8) 1 (0.2) 0 (0.0) 69 1 (0.3) 1 (0.6) 0 (0.0) 1 (1.2) 70+ years 10 (2.8) 2 (1.2) 5 (1.1) 1 (1.2) 70 4 (1.1) 1 (0.6) 2 (0.4) 0 (0.0) 71 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) 72 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) 74 2 (0.6) 1 (0.6) 0 (0.0) 1 (1.2) 75 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) 83 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) 87 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) TOTAL 358 168 464 82

WHO Self-Care Interventions for health Global values and preferences survey results WHO guideli e on self-care interventions for health and w ll-being, 2022 revision Web Annex A. Global values and preferences survey report WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report ISBN 978-92-4-005221-5 (electronic version) © World Health Organization 2022 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. 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Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. This publication forms part of the WHO guideline entitled WHO guideline on self-care interventions for health and well- being, 2022 revision. It is being made publicly available for transparency purposes and information, in accordance with the WHO handbook for guideline development, 2nd edition (2014). iiiContents CONTENTS Acknowledgements vii Acronyms and abbreviations vii 1. About this document 1.1 About the GVPS and focus group discussions 2 1.2 Why is this GVPS report important? 2 1.3 Structure of the report 3 2. Sociodemographic characteristics, self-efficacy, autonomy, and sources of information relating to self-care interventions 2.1 Sociodemographic profile of participants 8 2.2 Sources of information about sexual and reproductive health services 14 2.3 New General Self-Efficacy (NGSE) Scale: respondents’ results (Wave 2) 17 2.4 Sexual and reproductive autonomy scales: respondents’ results (Wave 2) 19 3. Awareness and experience of, and values and preferences relating to self-care interventions for SRHR: quantitative findings 3.1 Survey respondents’ awareness about, usage of, and decision-making considerations on self-care interventions for SRHR 24 3.2 Health workers’ experience of and confidence about providing services related to self-care interventions for SRHR, and related concerns and benefits 51 4. Values and preferences relating to self-care interventions for SRHR: qualitative findings 4.1 Current concerns with self-care SRHR interventions: health workers and laypersons 74 4.2 Potential benefits of self-care SRHR interventions: health workers and laypersons 78 4.3 Preferred conditions for use of self-care interventions for SRHR: health workers and laypersons 81 4.4 Future issues for considerations with self-care SRHR interventions: health workers and laypersons 83 4.5 Perspectives on linkages to health care: health workers only 84 4.6 Perspectives regarding training and information needs: health workers only 86 4.7 Any additional comments: Wave 1 health worker respondents only 87 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey reportiv 5. Health-care engagement and self-care interventions for SRHR 5.1 Accessing self-care interventions for SRHR and sources of relevant information: quantitative findings 90 5.2 Engaging with health workers for self-care SRHR interventions: quantitative and qualitative findings (Wave 1 only) 110 5.3 Ease of access to self-care interventions for SRHR: quantitative findings 113 6. Impacts of COVID-19 on respondents’ use of self-care interventions and access to sexual and reproductive health services Appendices Appendix A: Country of residence of Global Values & Preferences Survey participants, by respondent type and survey “wave” 123 Appendix B: Ages of the Global Values & Preferences Survey participants, by respondent type and survey wave 127 vChapter 1 LIST OF TABLES AND FIGURES Figure 1: Topics and respondents included in GPVS Wave 1 and Wave 2 4 Table 2.1. Sociodemographic characteristics of Global Values & Preferences Survey participants, by respondent type and survey wave 8 Figure 2.1. Sources of information from which GVPS participants reported learning about SRH services, by respondent type (Wave 1 only, 2018) 14 Figure 2.2. Preferences for online information sources from which GVPS participants would like to learn more about SRHR, by respondent type (Wave 1 only, 2018) 15 Figure 2.3. New General Self-Efficacy (NGSE) Scale response frequencies and mean overall scores among all Global Values & Preferences Survey participants, and by respondent type (Wave 2 only, 2020–2021) 17 Figure 2.4. Sexual and reproductive autonomy scale response frequencies and mean overall scores among all Global Values and Preferences Survey participants, and by respondent type (Wave 2 only, 2020–2021) 19 Table 3.1. Awareness, usage and Decision-making considerations of SRH self-care interventions for antenatal, intrapartum and postnatal care by self or partner among Global Values & Preferences Survey participants, by type of respondent (Wave 2 only, 2020–2021) 25 Table 3.2. Awareness, Usage and Decision-making CONSIDERATIONS for use of SRH self-care interventions for family planning among Global Values & Preferences Survey participants, by type of respondent and survey wave 30 Table 3.3. Awareness and ever/recent use of, and decision-making considerations about self-management of medical abortion, among Global Values & Preferences Survey participants, by type of respondent and survey wave 35 Table 3.4. Awareness, uSAge and Decision-making of SRH self-care interventions for sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities, among Global Values & Preferences Survey participants, by type of respondent and survey wave 37 Table 3.5. Awareness, ever use, and decision-making factors for use of SRH self-care interventions for promoting sexual health, among Global Values & Preferences Survey participants, by type of respondent (Wave 2 only, 2020–2021) 44 Table 3.6. Awareness, ever use, and decision-making factors of SRH self-care interventions/information available online and via mobile applications (apps), among Global Values & Preferences Survey participants, by type of respondent (Wave 1 only, 2018) 46 Figure 3.1: Health-care provider responses regarding self-care srhr interventions 51 Figure 3.2: Health-care provider concerns per intervention 52 Figure 3.3: Perceived benefits by health-care providers per intervention 53 Figure 3.4: Health-care provider responses regarding self-care srhr interventions 56 Figure 3.5: Health-care provider concerns per intervention 57 Figure 3.6: Perceived benefits by health-care providers per intervention 58 Figure 3.7: Health-care provider responses regarding self-care srhr interventions 60 Figure 3.8: Health-care provider concerns per intervention 60 Figure 3.9: Perceived benefits by health-care providers per intervention 61 Figure 3.10: Health-care provider responses regarding self-care SRHR interventions 62 Figure 3.11: Health-care provider concerns per intervention 64 Figure 3.12: Perceived benefits by health-care providers per intervention 65 Figure 3.13: Health-care provider responses regarding self-care srhr interventions 67 Figure 3.14: Health-care provider concerns per intervention 67 Figure 3.15: Perceived benefits by health-care providers per intervention 67 Figure 3.16: Health-care provider responses regarding self-care srhr interventions 68 Figure 3.17: Health-care provider concerns per intervention 69 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey reportvi PHOTOGRAPHY AND ART WORK CREDITS Cover: ©Shutterstock/Mila Supinskaya Glashchenko, ©Jonathan Torgovnik/Reportage by Getty Images, ©WHO/Sergey Volkov, ©Getty Images/Images of Empowerment/Paula Bronstein, ©PATH/Gabe Bienczycki , ©WHO/Blink Media - Nikolay Doychi, ©UNICEF/Patricia Willocq, ©UNICEF/Njiokiktjien, ©AJR_photo/Shutterstock p. vii: ©Rawpixel/Shutterstock p. 1: ©Gajendra Bhati/Shutterstock p. 3: art work depicting a nurse by Kirti p. 6: ©krishna - stock.adobe.com p. 16: art work depicting women and an i-pill by Shivani p. 22: ©i_am_zews, Nigeria/Shutterstock p. 43: ©WHO/Anna Kari p. 49: art work depicting an HIV testing screen within a sunflower by Ran p. 50: art work depicting a transgender person browsing self-care products by Karan p. 55: ©WHO/Patrick Brown p. 71: art work depicting a woman by Ashu p. 72: ©Paula Bronstein/The Verbatim Agency/Getty Images p. 88: ©Jonathan Torgovnik/Getty Images/Images of Empowerment p. 109: art work depicting a self-care book in front of the sun by Ashu p. 114: ©Yerchak Uladzimir/Shutterstock p. 115: art work depicting a truck and truck driver by Karan p. 116: © WHO/Blink Media - Nadège Mazars p. 119: © WHO/Tom Pietrasik p. 120: art work depicting two young people by Ashu Figure 3.18: Perceived benefits by health-care providers per intervention 69 Table 5.1: Means of accessing SRH self-care interventions for antenatal, intrapartum and postnatal care, among Global Values & Preferences Survey participants, by respondent type (Wave 2 only, 2020–2021) 90 Table 5.2: Sources of information about SRH self-care interventions for antenatal, intrapartum and postnatal care, among Global Values & Preferences Survey participants, by respondent type (Wave 2 only, 2020–2021) 92 Table 5.3: Means of accessing SRH self-care interventions for family planning among Global Values & Preferences Survey participants, by respondent type and survey wave 94 Table 5.4: Sources of information about SRH self-care interventions for family planning, among Global Values & Preferences Survey participants, by respondent type and survey wave 96 Table 5.5: Means of accessing and sources of information about self-management of medical abortion, among Global Values & Preferences Survey participants, by respondent type and survey wave 99 Table 5.6: Means of accessing SRH self-care interventions for sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities, among Global Values & Preferences Survey participants, by respondent type and survey wave 100 Table 5.7: Sources of information about SRH self-care interventions for sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities, among Global Values & Preferences Survey participants, by respondent type and survey wave 102 Table 5.8: Means of accessing and sources of information about SRH self-care interventions for promoting sexual health, among Global Values & Preferences Survey participants, by respondent type (Wave 2 only, 2020–2021) 105 Table 5.9: Means of accessing online SRH information and mobile applications (apps), among Global Values & Preferences Survey participants, by respondent type (Wave 1 only, 2018) 106 Table 5.10: Sources of information about online SRH information and mobile applications (apps), among Global Values & Preferences Survey participants, by respondent type (Wave 1 only, 2018) 107 Figure 5.11: Experience of and values and preferences for accessing self-care interventions for SRHR with or without the involvement of a health worker, and for having access to a health worker after the use of an intervention (Wave 1 only, 2018) 110 Figure 5.12: Engagement with health care among Global Values & Preferences Survey participants, by respondent type and survey wave 113 Figure 6.1: Impacts of COVID-19 on use of self-care interventions and access to sexual health and reproductive health services, according to Global Values & Preferences Survey participants, by respondent type (Wave 2 only, 2020–2021) 118 vii ACKNOWLEDGEMENTS ACRONYMS AND ABBREVIATIONS COVID-19 Coronavirus disease GVPS Global Values and Preferences Survey HPV human papillomavirus LGBQ+ lesbian, gay, bisexual, queer or other sexual orientation PEP post-exposure prophylaxis PrEP pre-exposure prophylaxis SD standard deviation SRH sexual and reproductive health SRHR sexual and reproductive health and rights STI sexually transmitted infection UNAIDS United Nations Joint Programme on HIV/AIDS WHO World Health Organization This document is a web annex to the 2022 revision of the WHO guideline on self-care interventions for health and well-being. We acknowledge all those who supported work leading up to the development of the guideline and this web annex. Sincere thanks in particular to Carmen Logie, Isha Berry and Clara McNamee (Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada) for administering the online survey and analysing the results. We are also grateful to Ash Pachauri (Center for Human Progress, New Delhi, India) for managing the focus group discussions. We thank all the participants of the survey and focus group discussions for their time and valuable feedback. This document has been coordinated by Manjulaa Narasimhan of the Department of Sexual and Reproductive Health and Research, which includes the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) at the World Health Organization. viii WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report About this document 1 1Table of Contents Chapter summary This report presents the consolidated findings of two “waves” of the Global Values and Preferences Survey (GVPS) on self-care interventions, which were conducted in 2018 and in 2020–2021 among health workers and current or potential end-users of self-care interventions (i.e. laypersons). The survey responses to the first wave of the GVPS were taken into account in developing the new recommendations, as well as in assessing the strength of the recommendations to the 2019 WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights (1). The second wave of the GVPS used the same methods and was conducted to support the updating of the guidance, to create the 2022 revision of the WHO guideline on self-care interventions for health and well-being, to which this is a web annex. The results of the second wave are now being published for the first time in this report, combined with those of the first wave, which were first published in 2019 (2). A total of 1085 respondents from 194 Member States participated in the surveys. The full guideline is available at: https://www.who.int/publications/i/item/9789240030909. “Only if we keep ourselves healthy will we be able to live a better life. If we deal with issues in our daily life, it won’t be possible for us to fulfil our wishes and ultimately live the way we want to.” – Participant from self-care SRHR intervention workshop with men who have sex with men WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report2 Chapter 1 1.1 ABOUT THE GVPS AND FOCUS GROUP DISCUSSIONS 1 Available at: https://www.who.int/publications/i/item/9789240030909 The first GVPS (referred to in this report as “Wave 1”) was available online to respondents in English, French and Spanish and ran for seven weeks from mid-September to mid- November 2018. The second GVPS (“Wave 2”) was updated with an expanded scope and was available online in English, French and Spanish between November 2020 and June 2021. Both waves of the GVPS were self-administered online surveys. In each wave, the survey was open to adults ≥18 years of age; with the ability to complete the survey in English, French, or Spanish; and able to provide web-based informed consent. Participants were recruited through two complementary web-based strategies: (i) the survey was hosted on the WHO Department of Reproductive Health and Research website, and (ii) the survey was purposively shared with various (n=35) SRH listservs. The anonymous survey took approximately 20 minutes to complete and aimed to understand participants’ knowledge, uptake, and preferences on a range of self-care interventions. The study was approved by the University of Toronto Research Ethics Board (Protocol 36022). By beginning the survey, participants acknowledged that they were informed about the study purpose, risks and benefits and completed an online informed consent form before entering the survey. The survey questions included both general questions about health services and self-care interventions and also questions specific to a range of existing self-care interventions. Both versions of the survey provided both quantitative and qualitative data, since some open-ended questions and spaces for additional comments were included. Participant data were analysed separately by survey version (Wave 1 and Wave 2) and type of respondent (health workers and layperson respondents). Further details on the methods are available in related publications (3). There are limitations to this survey. For instance, we cannot infer causality from associations between variables, so a future longitudinal study to support the cross-sectional results may be warranted. The survey was only conducted in three languages (English, French, Spanish), and recruited via SRH listservs, suggesting a bias toward including persons who had prior knowledge on SRHR, self-care interventions and who had access. Internet surveys, while low cost and allowing participation from diverse global regions, may exclude persons without access to internet and mobile technology. This is one of the reasons focus group discussions (FGDs) were held in addition to the survey. Furthermore, Wave 2 of the GVPS was conducted during the COVID-19 pandemic and contributed to the response rates and decreased representativeness in the survey sample. However, despite these limitations, the outcomes noted here was always intended to be in addition to the evidence base presented to the guideline development group, that included systematic, literature, qualitative and costing reviews. Focus group discussions (FGDs) were also held during both waves of the GVPS to gather additional qualitative information to ensure in particular that the voices of underserved individuals and communities – who may not have had access to the online survey – were captured. In conjunction with Wave 1, participants in the FGDs were asked about their knowledge, use and uptake of self-care interventions, as well as any key issues that they experienced or expected in accessing or using the self-care interventions. In Wave 1, these workshops took place in several countries including Canada, India, Kenya, Mexico, Morocco and the United Kingdom of Great Britain and Northern Ireland. In Wave 2 the FGDs were held with in Cameroon, Egypt, India, Mexico, Nigeria and the United Arab Emirates. The FGDs in Wave 2 were held with adolescents and young people who were students or recent graduates, young married couples, drug users, sex workers, young people living with HIV and members of the LGBQ+ community – varying by country and location. During the FGDs in both waves, the groups also participated in creating artworks reflecting their perspectives on self-care in the context of their everyday lives and their communities. Summaries of key findings and selected drawings from these discussion sessions are presented in this document (see pages 16, 49, 50, 71, 109, 115, 120 and 121). 1.2 WHY IS THIS GVPS REPORT IMPORTANT? This report presents in detail the data used to inform the values and preferences component of the 2021 WHO guideline on self-care interventions for health and well-being.1 It presents both the evidence and the people-centred approaches that were central to the development of the guideline. The results from the surveys showed that the values and preferences of the potential end-users were variable and were closely tied to the individuals’ circumstances, needs and desires across the life course, and the environment in which they live. This report aims to showcase this diversity and also reveals gaps in the knowledge and uptake of self-care interventions. 3Chapter 1 1.3 STRUCTURE OF THE REPORT Throughout this report, the results are reported for two separate respondent groups – the health worker respondents and all other respondents, who are referred to throughout as “laypersons” – and data are also reported separately for the two survey waves. For all quantitative data, findings are presented both in tables and summarized in narrative text. Following this introduction, Chapter 2 presents data on the survey respondents’ sociodemographic characteristics, followed by their reported sources of information for learning about sexual and reproductive health (SRH) services derived from questions included in Wave 1 of the GVPS, and finally the results of specific scales on self-efficacy and sexual and reproductive autonomy that were only included in Wave 2 of the GVPS. In Chapter 3, sections 3.1 and 3.2, and in Chapter 5, section 5.1, quantitative findings are grouped under six subsections by type of intervention: (1) Antenatal, intrapartum and postnatal care (asked in Wave 2 only); (2) Family planning; (3) Abortion; (4) Sexually transmitted infections (STIs, including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (5) Promoting sexual health (asked in Wave 2 only); and (6) SRH information online and via mobile apps (asked in Wave 1 only). • The self-care interventions for SRHR included in both survey waves are: over-the-counter hormonal contraception, over-the-counter emergency contraception, contraceptive vaginal ring, self-administered contraception, diaphragm, self-management of medical abortion, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), STI self-sampling and HIV self-sampling (i.e. self-collection of a sample to be submitted for analysis at a facility, whether for screening or diagnostic testing). • Interventions that were only asked about in Wave 1 were: the contraceptive patch, STI and HIV treatment, online information and mobile applications (apps) for reproductive health and for sexual health. • New interventions added to the questions for Wave 2 of the survey included all those relating to antepartum, intrapartum and postnatal care: at-home pregnancy test, self-management of nutrition supplements (folic acid) during pregnancy planning, self-management of nutrition supplements (iron and folic acid) during pregnancy, self- management of nutrition supplements (iron and folic acid) during postpartum, self-monitoring/home-monitoring of blood glucose levels during pregnancy, self-monitoring/ home-monitoring of proteinuria during pregnancy, and self-monitoring/home-monitoring of blood pressure during pregnancy. In addition, Wave 2 also included human papillomavirus (HPV) self-sampling (i.e. self-collection of a sample to be submitted for HPV testing at a facility for purposes of screening for prevention of cervical cancer) and the interventions for promotion of sexual health – lubricants and hormone therapy for gender affirmation. • The first section of Chapter 3 reports on questions relating to respondents’ awareness about self-care interventions for SRHR and where to access them, as well as their or their partners’ experience of using these interventions, and the considerations which underpin their decision-making regarding use of these interventions (e.g. privacy/confidentiality, feelings of non-judgement, empowerment, convenience and access). The second section reports on health workers’ experiences of providing related services (referrals, prescriptions, information), how confident and informed they felt about providing such services, if they had any concerns about providing these services, and what they perceive as the benefits of each self-care intervention. After the presentation of the quantitative data on the above issues, Chapter 4 follows up by summarizing the related qualitative data gathered from respondents through the use of open-ended questions, shedding light on their values and preferences, their concerns and their hopes regarding the use of self-care interventions for SRHR. Four main themes emerged for both respondent groups and another two main themes for health worker respondents specifically, and the chapter thus presents information in six sections: (1) current concerns with self-care SRHR interventions; (2) potential benefits of self-care SRHR interventions; (3) preferred conditions for self-care SRHR intervention implementation; (4) future issues for considerations with self-care SRHR interventions (5) linkages to health care (health workers only); and (6) health worker training and information needs (health workers only). Throughout this document are one-page highlights from discussions with health-care workers and vulnerable population groups. Accompanying these are artworks created by the respective communities, representing their perspectives on self-care interventions. WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report4 Chapter 1 FIGURE 1: TOPICS AND RESPONDENTS INCLUDED IN GPVS WAVE 1 AND WAVE 2 WAVE 1: 2018 – HW & LP WAVE 2: 2020–2021 – HW & LP GVPS sections Sociodemographic questions: CH2 Relationship status was NOT asked Engagement in sex work was asked Self-reported health status was NOT asked Sociodemographic questions: Relationship status was asked Engagement in sex work was NOT asked Self-reported health status was asked Self-efficacy and autonomy scales: CH2 NOT included Self-efficacy and autonomy scales: NGSE Scale included RH and SH autonomy scales included Other: CH2 Sources of info/learning about SRHR and SRH services Other: Sources NOT asked Quantitative questions per intervention CH3 1. Awareness about intervention NOT asked in Wave 1 for at-home pregn test, self-mgmt of nutrition supplements during preg planning, self- mgmt of nutrition supplements during preg, self-mgmt of nutn suppl postpartum, self-monitoring/home- monitoring of blood glucose levels during preg, self- monitoring/home-monitoring of proteinuria during preg, self-monitoring/home-monitoring of blood pressure during preg, lubricant, hormone therapy for gender affirmation, HPV self-sampling 2. Ever use (and recent use) of intervention by self or partner – same items as noted above 3. Decision-making considerations for use of interventions – same items as noted above. Also for each item included, cost and legal restrictions were NOT asked in Wave 1 (but accessibility was asked) 4. Means of accessing interventions – same items as noted above (but response options did NOT include From a peer, outreach or community worker) 5. Sources of information about interventions – same items as noted above 6. HW ONLY: Health workers’ experience of, confidence and concerns about providing self-care SRHR interventions and perceived benefits: quantitative findings – same items as noted above Quantitative questions per intervention 1. Awareness about intervention NOT asked in Wave 2 for contraceptive patch, HIV tx, STI tx, RH online info, RH mobile app, SH online info, SH mobile app. But many others were added (see list on left of items not asked Wave 1). 2. Ever use (recent use NOT asked in Wave 2) of intervention by self or partner – same items as noted above 3. Decision-making considerations for use of interventions – same items as noted above. Also for each item included, accessibility was NOT asked Wave 2 (but cost and legal restrictions were added) 4. Means of accessing interventions – same items as noted above (but response options DID include From a peer, outreach or community worker) 5. Sources of information about interventions – same items as noted above 6. HW ONLY Health workers’ experience of, confidence and concerns about providing self-care SRHR interventions and perceived benefits: quantitative findings – same items as noted above Engaging with HW for interventions CH4 1. Experience of and values and preferences for accessing self-care SRHR interventions with or without the involvement of a health worker, and for having access to a health worker after the use of an intervention: quantatitve data on 4 items - qualitative data (quotes) about the above also 2. Ease of access to interventions: quantitative data only – 2 items only (distance was NOT asked) Engaging with HW for interventions 1. NOT ASKED IN WAVE 2 2. Yes, 3 items, including addition in Wave 2 of distance from health-care facility Chapter 5 includes a combination of both quantitative and qualitative information, focusing on respondents’ experiences with and preferences for accessing self-care interventions for SRHR or information about these interventions, and for engagement with health workers in relation to these interventions. In section 5.1, quantitative findings report on where both types of respondents access self-care interventions for SRHR, as well as where they access information on these interventions, grouped by type of intervention as described above. In section 5.2, quantitative and qualitative data from Wave 1 of the survey are presented, relating to preferences for engaging or not engaging with health workers when using or after using self-care interventions for SRHR. Data providing an overall summary of ease of access to health care and online information are also presented. Chapter 6 provides information on reported changes in participants’ use of self-care interventions for SRHR, and in their access to both sexual health and reproductive health services, as a result of the COVID-19 pandemic. 5Chapter 1 WAVE 1: 2018 – HW & LP WAVE 2: 2020–2021 – HW & LP Qual/open-ended questions on: CH5 1. Current concerns with self-care SRHR interventions – HW and LP 2. Potential benefits of self-care SRHR interventions – HW and LP 3. Preferred conditions for self-care SRHR intervention implementation – HW and LP 4. Future issues for considerations with self-care SRHR interventions – HW and LP 5. Health worker perspectives on linkages to health care – HW ONLY 6. Health worker perspectives on training and information needs – HW ONLY WE HAVE WAVE 2 DATA FOR EACH, except for (4) Future issues for LP (we have it for HW only) COVID-19 CH6 - NA in 2018 COVID-19 Use of self-care interventions changed? Access to RH changed? Access to SH changed? Focus group discussions: underserved communities Focus group discussions: adolescents and young people in 6 countries Inclusivity All individuals have the right to equality and non-discrimination in accessing services. The right to be free from discrimination is stated in the Universal Declaration of Human Rights and in other universal human rights treaties and regional human rights instruments. It has been affirmed that the right to non-discrimination guaranteed by the International Covenant on Economic, Social and Cultural Rights (ICESCR) includes sexual orientation, gender identity and sex characteristics. As stated in the 2018 report of the Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity to the United Nations General Assembly, “the right to effective recognition of one’s gender identity is linked to the right to equal recognition before the law”.(4) Providers of health services must consider the needs of – and provide equal care to – all individuals; gender identity or its expression must not lead to discrimination. References for Chapter 1 1. WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights. Geneva: World Health Organization; 2019 (https://www.who.int/ reproductivehealth/publications/self-care-interventions/en/). 2. WHO Self-care interventions for health: sexual and reproductive health and rights. Web Annex A: Global Values and Preferences Survey report. Geneva: World Health Organization; 2019 (https://apps.who.int/iris/bitstream/ handle/10665/329989/WHO-RHR-19.24-eng.pdf). 3. Logie C, Okumu M, Abela H, Wilson D, Narasimhan M. Sexual and reproductive health mobile apps: results from a cross-sectional values and preferences survey to inform World Health Organization normative guidance on self-care interventions. Glob Health Action. 2020;13(1):1796346. doi: 10.1080/16549716.2020.1796346. 4. Report of the Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity, 12 July 2018. New York (NY): United Nations General Assembly; 2018 (A/73/152; https://undocs. org/A/73/152). 6 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Sociodemographic characteristics, self-efficacy, autonomy, and sources of information relating to self-care interventions 2 7Table of Contents Chapter summary This chapter presents data tables and a narrative summary of survey respondents’ sociodemographic characteristics for both Wave 1 and Wave 2 of the GVPS, followed by information on Wave 1 respondents’ sources of information for learning about sexual and reproductive health (SRH) services and about sexual and reproductive health and rights (SRHR). Finally, this chapter reports on the results of specific scales on self-efficacy and sexual and reproductive autonomy, which were only included within Wave 2 of the GVPS. For Waves 1 and 2, most of the health worker respondents were resident in the WHO Region of the Americas, the African Region and the European Region. Regarding gender, in Wave 1, about two thirds of health worker respondents reported identifying as women, about one third as men, and one respondent (0.3%) identified as transgender/two spirited/another gender identity. This was similar in Wave 2, when three quarters of health worker respondents identified as women, one fifth as men, and six respondents (3.5%) identified as transgender/two spirited/another gender identity. For both waves, the majority identified their sexual orientation as heterosexual, while a minority identified as sexually diverse (i.e. lesbian, gay, bisexual, queer, or other sexual orientation [LGBQ+]). The average age of health worker respondents was 38.0 years in Wave 1 and 42.8 years in Wave 2. Most health workers reported having a postgraduate degree and working in full-time paid employment in both waves. Among layperson respondents in both waves, most were from the Region of the Americas, the African Region and the European Region. In both waves, most of these respondents self-identified as women with a minority identifying as men, and just six and two people in Waves 1 and 2 respectively did not identify as either. Across waves, the majority of respondents reported their sexual orientation as heterosexual, with a minority identifying as sexually diverse. In Wave 1, the average age of these respondents was 31.9 years, while in Wave 2 it was 34.9. In Waves 1 and 2, most respondents reported having a bachelor’s (undergraduate) or a postgraduate degree, with the majority of each sample reporting their current employment status as full-time or as current students. Wave 1 respondents were asked about the sources of information from which they had received information about various SRH services, and online sources from which they would like to learn more about these services. The top three sources that both health worker and layperson respondents reported accessing information about SRH services from were the internet, school and doctors. The vast majority of health worker and layperson respondents indicated that they would prefer to learn about SRH services from trusted websites. Wave 2 participants were administered scales measuring general self-efficacy and sexual and reproductive autonomy. Altogether, respondents rated their overall self-efficacy highly (mean = 4.0 on a 5-point scale), and reported a high degree of sexual autonomy (mean = 3.2 on a 4-point scale) and reproductive autonomy (mean = 3.5 on a 4-point scale). There were few differences between health worker and layperson respondents. “I use condoms. My peers were the ones who told me to use it. When I first came here, they asked me to take an HIV test and I refused, but they made me understand that this was for my own benefit.” – Commercial sex worker Chapter 2 8 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report 2.1 SOCIODEMOGRAPHIC PROFILE OF PARTICIPANTS While Wave 1 received 837 responses originating from a total of 112 countries, Wave 2 received 260 responses from across 218 countries (see Appendix A for list of countries). Table 2.1 presents the background and sociodemographic characteristics of two respondent groups – health workers and laypersons – in each survey wave and totals for all respondents in each survey wave. Narrative summaries of this information are provided below. In order to define the two respondent groups for the purposes of analysis, all survey respondents were asked if they were “a health worker, educator or researcher”. Of those who responded to this question (Wave 1: n=528; Wave 2: n=260), about two thirds of participants in each wave said “Yes” – they self-identified as being in one of these three professions (Wave 1: 68.2%, n=360; Wave 2: 67.3%, n=175), and they are grouped and referred to in this document as “health workers”, while the remaining third of the respondents said “No”, they were not any of these professions (Wave 1: 31.8%, n=168; Wave 2: 32.7%, n=85), and they are referred to in this document as “laypersons”. Of note, about one third of Wave 1 respondents (36.9%, n=309) did not respond to this question, and were therefore included as laypersons by default for the purpose of further analyses for this report. In Wave 2, only 2 respondents did not indicate their status on this question, and were excluded from all the analyses. Overall, as shown in Table 2.1 below, in Wave 1, 43.0% of respondents were categorized as health workers and 57.0% (n=477) as laypersons, while in Wave 2, a majority of respondents identified as health workers (67.3%), while one third (32.7%) were laypersons. TABLE 2.1. SOCIODEMOGRAPHIC CHARACTERISTICS OF GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE Gender Men Women Transgender/two spirited/another gender identity Prefer not to say Health workersa Wave 1 n=360 30.8%, n=111 68.9%, n=248 0.3%, n=1 0.0%, n=0 Wave 2 n=173 20.8%, n=36 75.7%, n=131 3.5%, n=6 0.0%, n=0 Laypersonsb Wave 1 n=465 30.1%, n=140 68.0%, n=316 1.3%, n=6 0.6%, n=3 Wave 2 n=85 12.9%, n=11 83.5%, n=71 2.4%, n=2 1.2%, n=1 The solid dots represent 10 people The circle outlines represent less than 10 people Total health workers Wave 1 Wave 1Wave 2 Wave 2 360 175 477 85 Layperson respondents Chapter 2 9 Age 18–29 30–39 40–49 50–59 60–69 70+ Health workersa Wave 1 n=358 32.7%, n=117 27.4%, n=98 20.1%, n=72 12.3%, n=44 4.7%, n=17 2.8%, n=10 Wave 2 n=168 16.7%, n=28 28.0%, n=47 26.8%, n=45 19.1%, n=32 8.3%, n=14 1.2%, n=2 Laypersonsb Wave 1 n=464 56.5%, n=262 19.6%, n=91 11.9%, n=55 7.1%, n=33 3.9%, n=18 1.1%, n=5 Wave 2 n=82 48.8%, n=40 17.1%, n=14 19.5%, n=16 7.3%, n=6 6.1%, n=5 1.2%, n=1 WHO region African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region Health workersa Wave 1 n=360 28.3%, n=102 34.7%, n=125 6.1%, n=22 23.3%, n=84 4.7%, n=17 2.8%, n=10 Wave 2 n=143 23.1%, n=33 48.3%, n=69 5.6%, n=8 9.8%, n=14 7.7%, n=11 5.6%, n=8 Laypersonsb Wave 1 n=168 19.1%, n=89 23.4%, n=109 4.3%, n=20 33.8%, n=157 8.0%, n=37 11.4%, n=53 Wave 2 n=75 16.0%, n=12 62.7%, n=47 4.0%, n=3 10.7%, n=8 5.3%, n=4 1.3%, n=1 World Bank income group High income Upper middle income Lower middle income Low income Health workersa Wave 1 - - - - Wave 2 n=140 45.8%, n=65 14.8%, n=21 29.6%, n=42 8.5%, n=12 Laypersonsb Wave 1 - - - - Wave 2 n=73 67.1%, n=49 5.5%, n=4 23.3%, n=17 4.1%, n=3 Sexual orientation Heterosexual/straight Sexually diverse (LGBQ+) Prefer not to say Health workersa Wave 1 n=358 84.9%, n=304 13.4%, n=48 1.7%, n=6 Wave 2 n=172 77.3%, n=133 22.7%, n=39 - Laypersonsb Wave 1 n=464 75.6%, n=351 22.2%, n=103 2.2%, n=10 Wave 2 n=84 64.3%, n=54 35.7%, n=30 - Chapter 2 10 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Disability Yes No Health workersa Wave 1 n=360 2.5%, n=9 97.5%, n=351 Wave 2 n=170 19.4%, n=33 80.6%, n=137 Laypersonsb Wave 1 n=466 3.4%, n=16 96.6%, n=450 Wave 2 n=84 20.2%, n=17 79.8%, n=67 Engaged in sex work Yes No Health workersa Wave 1 n=359 5.0%, n=18 95.0%, n=341 Wave 2 - - Laypersonsb Wave 1 n=465 2.8%, n=13 97.2%, n=452 Wave 2 - - Relationship status No current partner One partner Multiple partners Health workersa Wave 1 - - - Wave 2 n=169 13.6%, n=23 79.9%, n=135 6.5%, n=11 Laypersonsb Wave 1 - - - Wave 2 n=67 22.4%, n=15 59.7%, n=40 17.9%, n=12 Self-reported health status Excellent Good Fair Poor Health workersa Wave 1 - - - - Wave 2 n=174 22.4%, n=39 68.4%, n=119 9.2%, n=16 0.0%, n=0 Laypersonsb Wave 1 - - - - Wave 2 n=83 20.5%, n=17 69.9%, n=58 9.6%, n=8 0.0%, n=0 Chapter 2 11 Size of city/town Big city (> 1 million inhabitants) Large city (300 000– 1 million inhabitants) Small city (100 000– 300 000 inhabitants) Large town (20 000–100 000 inhabitants) Medium town (1000–20 000 inhabitants) Small town or hamlet (< 1000 inhabitants) Health workersa Wave 1 n=357 49.6%, n=177 18.5%, n=66 10.9%, n=39 11.2%, n=40 7.0%, n=25 2.8%, n=10 Wave 2 n=173 49.7%, n=86 23.1%, n=40 11.6%, n=20 8.1%, n=14 4.6%, n=8 2.9%, n=5 Laypersonsb Wave 1 n=167 49.7%, n=83 19.2%, n=32 8.4%, n=14 9.0%, n=15 9.6%, n=16 4.2%, n=7 Wave 2 n=67 47.8%, n=32 16.4%, n=11 16.4%, n=11 14.9%, n=10 3.0%, n=2 1.5%, n=1 Highest level of education Completed high school Undergraduate degree Postgraduate degree Other Health workersa Wave 1 n=358 6.7%, n=24 27.1%, n=97 65.6%, n=235 0.6%, n=2 Wave 2 n=173 2.3%, n=4 15.6%, n=27 63.0%, n=109 19.1%, n=33 Laypersonsb Wave 1 n=178 27.5%, n=49 36.5%, n=65 35.4%, n=63 0.6%, n=1 Wave 2 n=65 13.9%, n=9 38.5%, n=25 40.0%, n=26 7.7%, n=5 Employment statusc Employed – full time Employed – part time Self-employed Casual labour Student Unemployed Health workersa Wave 1 n=357 62.7%, n=224 12.3%, n=44 8.1%, n=29 0.8%, n=3 18.2%, n=65 3.1%, n=11 Wave 2 n=172 67.4%, n=116 11.6%, n=20 13.4%, n=23 1.7%, n=3 9.3%, n=16 2.3%, n=4 Laypersonsb Wave 1 n=166 40.4%, n=67 6.6%, n=11 5.4%, n=9 1.2%, n=2 48.8%, n=81 3.0%, n=5 Wave 2 n=66 45.5%, n=30 13.6%, n=9 4.6%, n=3 0.0%, n=0 27.3%, n=18 13.6%, n=9 Type of health workerc Doctor Researcher Staff at clinic/ agency providing SRH information/ education Activist Health educator Health workersa Wave 1 n=355 27.6%, n=98 - 22.0%, n=78 18.6%, n=66 15.2%, n=54 Wave 2 n=175 18.9%, n=33 32.0%, n=56 10.9%, n=19 17.1%, n=30 17.7%, n=31 Chapter 2 12 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Type of health workerc (continued) Nurse or other health-care professional Community worker Pharmacist Midwife Other Health workersa Wave 1 n=355 11.8%, n=42 6.5%, n=23 22.5%, n=80 3.1%, n=11 19.7%, n=70 Wave 2 n=174 9.7%, n=17 4.6%, n=8 3.4%, n=6 6.9%, n=12 13.1%, n=23 SD: standard deviation. Note: Denominators (subtotals) vary across variables/rows because of non-response on some items. - Indicates that the question or response option was not asked in a given wave. a This group includes all respondents who said “Yes” to a question asking if they were “a health worker, educator or researcher”. b This group includes all respondents who said “No” to being “a health worker, educator or researcher”, and those in Wave 1 who failed to answer that question. c Selection of multiple response options was possible. 2.1.1 Health workers Health worker respondents were asked what kind of health worker they were, with the option to choose all that apply. In the second GVPS (Wave 2), the option of “Researcher” was added, and it was selected by almost a third of respondents, the highest proportion among the available options. Across survey waves, the other top responses for this question were doctor (Wave 1: 27.6%; Wave 2: 18.9%), followed by staff at a clinic/ agency providing SRH information or education (Wave 1: 22%; Wave 2: 10.9%), activist (Wave 1: 18.6%; Wave 2: 17.1%), health educator (Wave 1: 15.2%; Wave 2: 17.7%), and nurse or other health worker (Wave 1: 11.8%; Wave 2: 9.7%). In Wave 1, 22.5% of respondents reported being pharmacists, while in Wave 2 this was just 3.4%. Only a small proportion of health worker respondents reported being community workers or midwives in both waves. Up to a fifth of participants selected “other” without further specification (see Table 2.1). Among the health worker respondents who identified their country of residence, the largest proportion were from the WHO Region of the Americas (Wave 1: 34.6%; Wave 2: 48.3%), followed by the African Region (Wave 1: 28.3%; Wave 2: 23.1%) and the European Region (Wave 1: 23.3%; Wave 2: 9.8%). In both waves, less than 10% resided in the Eastern Mediterranean Region (Wave 1: 4.7%; Wave 2: 7.7%), the South-East Asia Region (Wave 1: 6.1%; Wave 2: 5.6%) and the Western Pacific Region (Wave 1: 2.8%; Wave 2: 5.6%). The countries with the highest numbers of health worker respondents in Wave 1 were Kenya (n=48), the United States of America (USA) (n=44) and Colombia (n=34), while in Wave 2 they were the USA (n=27), Canada (n=16) and Nigeria (n=14) (see Appendix A for details). In Wave 2, respondents were also analysed according to the World Bank income groups of their countries of residence. Almost half of health worker respondents lived in high-income countries (45.8%) and just 8.5% lived in low-income countries. Health worker respondents varied widely in age, ranging from 18 to 87 years in Wave 1, and from 21 to 74 years in Wave 2. In Wave 1, the age group with the greatest number of respondents was 18–29 years (32.7%), followed by 30–39 years (27.4%) and 40–49 years (20.1%). For Wave 2, the age group with the greatest number of respondents was 30–39 years (28.0%), followed by 40–49 years (26.8%) and 50–59 years (19.1%). The mean age of health worker respondents in Wave 1 was 38.0 years and in Wave 2 it was 42.8 years (see Appendix B for details). The majority of health worker respondents in both waves identified as women (Wave 1: 68.9%; Wave 2: 75.7%), while a sizable minority said they were men (Wave 1: 30.8%; Wave 2: 20.8%). A small minority of respondents identified as transgender, two spirited or another gender identity (1 respondent in Wave 1 and 6 in Wave 2). Regarding sexual orientation, the majority of health worker respondents in both waves identified as heterosexual or straight (Wave 1: 84.9%; Wave 2: 77.3%), while a minority identified as sexually diverse (LGBQ+): 13.4% in Wave 1 and 22.7% in Wave 2. In Wave 1, just 2.5% of health worker respondents identified as having a disability, while in Wave 2, it was as high as 19.4%. Data on having ever engaged in sex work were only collected in Wave 1, with 5.0% of health workers reporting this. Relationship status data were only collected in Wave 2, with the majority of health workers reporting having one partner (79.9%), while 13.6% reported having no current partner, and 6.5% reported having multiple partners. In Wave 2, respondents were asked to rate their perceived health. Over 90% rated their health as either “excellent” or “good”, with the remainder selecting “fair”. About half of health worker respondents in each wave reported living in a big city of more than a million inhabitants, while just under a quarter lived in large cities of 300 000 to 1 million. Approximately 1 in 10 health workers in each wave reported living in a city with a population of 100 000–300 000 inhabitants or in large towns of 20 000–100 000 inhabitants. Less than 10% lived in towns of 1000–20 000 inhabitants and approximately 3% in each wave lived in a small town or hamlet of less than 1000 inhabitants. Chapter 2 13 The majority of health workers in both waves reported high educational qualifications, with over 60% reporting having a postgraduate (master’s or higher) degree, about 15–30% having an undergraduate (bachelor’s) degree, and less than 10% reporting high school as their highest education level. Just a couple of Wave 1 respondents and 33 Wave 2 respondents (19.1%) selected “other” without further specification. Regarding current employment at the time of the survey, respondents could select multiple response options. Approximately two thirds of health workers in both survey waves reported full-time employment while around 10–20% of respondents in each wave reported being self-employed, holding part-time paid employment, and being a current student. Less than 5% in both waves were unemployed or were casual labourers. 2.1.2 Layperson respondents Among laypersons – those who did not report being health workers/researchers/educators – the most common WHO regions of residence were the Region of the Americas (Wave 1: 23.4%; Wave 2: 62.7%), the African Region (Wave 1: 19.1%; Wave 2: 16.0%) and the European Region (Wave 1: 33.8%; Wave 2: 10.7%). While 11.4% of Wave 1 laypersons reported residing in the Western Pacific Region, only 1 respondent (1.3%) in Wave 2 reported residing in this region. In both waves, less than 10% reported residing in countries in the Eastern Mediterranean Region (Wave 1: 8.0%; Wave 2: 5.3%) and the South-East Asia Region (Wave 1: 4.3%; Wave 2: 4.0%). In Wave 1, the countries with the most layperson respondents were Portugal (n=61), the USA (n=54), Kenya (n=37) and Singapore (n=31), while in Wave 2 more than half of layperson respondents were concentrated in the USA (n=21) and Canada (n=21) (see Appendix A for details). In Wave 2, respondents were also analysed according to the World Bank income groups of their countries of residence. Two thirds of the layperson respondents lived in a high-income country (67.1%) and just 4.1% were resident in low-income countries (see Table 2.1). Wave 1 participants ranged widely in age from 18 to 83 years, while in Wave 2 they ranged from 18 to 74 years. About half of respondents in both waves were in the 18–29 age group (Wave 1: 56.5%; Wave 2: 48.8%). The next most common age groups were 30–39 years (Wave 1: 19.6%; Wave 2: 17.1%) and 40–49 years (Wave 1: 11.9%; Wave 2: 19.5%). The mean age of Wave 1 layperson respondents was 31.9 years, and in Wave 2 it was 34.9 years (see Appendix B for details). The majority of layperson participants in both waves self- identified as women (Wave 1: 68.0%; Wave 2: 83.5%), while a minority identified as men (Wave 1: 30.1%; Wave 2: 12.9%) and a small number identified as transgender, two spirited or another gender identity (6 in Wave 1, and 2 in Wave 2). Additionally, a total of 4 laypersons preferred not to report their gender. Regarding sexual orientation, the majority of laypersons identified as heterosexual or straight (Wave 1: 75.6%; Wave 2: 64.3%), while in Wave 1 about a fifth identified as sexually diverse/LGBQ+ (22.2%), as did about a third in Wave 2 (35.7%). In Wave 1, just 3.4% of laypersons identified as having a disability, while this was as high as 20.2% in Wave 2 – similar to the data for health workers. Data on having ever engaged in sex work were only collected in Wave 1, with 2.8% of laypersons reporting this. Relationship status data were only collected in Wave 2, with the majority of laypersons reporting having one partner (59.7%), while 22.4% reported having no current partner and 17.9% reported having multiple partners. Wave 2 respondents were also asked to rate their health status. The vast majority of respondents rated their health as either “excellent” or “good” (90.4%), while the remained selected “fair”. Of those who reported the size of the city or town in which they lived, about half of layperson respondents in both waves reported living in a big city with a population of over 1 million, while just under a fifth reported living in a large city with a population between 300 000 and 1 million. Between 10% and 20% of participants in both waves reported living in a small city with a population of 100 000–300 000 or in a a large town with a population of 20 000–100 000. In both waves, under 10% lived in a medium town with 1000–20 000 inhabitants and under 5% lived in a small town or hamlet of less than 1000 inhabitants. Of those layperson participants who responded regarding their highest level of education in each wave, more than a third had a bachelor’s degree (Wave 1: 36.5%; Wave 2: 38.5%), and a similar amount had a postgraduate degree (Wave 1: 35.4%; Wave 2: 40.0%). Over a quarter of Wave 1 respondents reported high school as their highest educational attainment (27.5%), as did 13.9% in Wave 2. Just 1 respondent in Wave 1 and 5 in Wave 2 selected “other” without further specification. Regarding current employment status, participants were able to select multiple options. Similar proportions in both waves reported full-time paid employment (Wave 1: 40.4%; Wave 2: 45.5%). Almost half of Wave 1 participants reported being a current student (48.8%), while just over a quarter of Wave 2 participants (27.3%) said the same. Small numbers of laypersons in each sample reported holding part-time paid employment, being unemployed, self-employed, or holding casual employment. Chapter 2 14 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report 2.2 SOURCES OF INFORMATION ABOUT SEXUAL AND REPRODUCTIVE HEALTH SERVICES This section reports results based on questions in Wave 1 of the GVPS about sources of information on SRH services. The two questions were: (i) Where have you learned about SRH services? (14 options were listed, with instructions to choose all that apply; see Figure 2.1); and (ii) What types of online or social media resources would you like to use to learn more about SRHR? (12 options were listed, with instructions to choose all that apply; see Figure 2.2). FIGURE 2.1. SOURCES OF INFORMATION FROM WHICH GVPS PARTICIPANTS REPORTED LEARNING ABOUT SRH SERVICES, BY RESPONDENT TYPE (WAVE 1 ONLY, 2018) KEY Health workers (n=357) Layperson respondents (n=179) 21.6% 24.0% SOURCES OF INFORMATION ON SRHR SERVICES 66.7% 3.4% 6.2% 5.3% 2.5% 68.2% 1.7% 7.3% 6.7% 1.1% 66.7% 63.7% 45.4% 45.8% 42.9% 57.0% 32.2% 36.3% 22.4% 19.6% 10.1% 26.6% 27.4% INTERNET 70.3% 82.7% 23.2% Own work/profession – 9.5% University – 6.2% Nongovernmental organization or non-profit – 3.6% Own work/profession – 3.9% University – 3.4% Nongovernmental organization or non-profit – 1.7% SCHOOL BROTHER SISTEROTHER FAMILY MEMBERS PARENT SUPPORT GROUP DOCTORS BOOKS AND MAGAZINES FRIENDS TV/FILMS/ VIDEOS/ RADIO PARENT OTHER COMMUNITY OUTREACH OFFICER, WORKER OR NURSE PARTNER For this option, respondents could write in a response. Those responses were coded and the top options for other sources were: Chapter 2 15 2.2.1 Health workers Respondents were asked about the sources of their existing knowledge about SRH services. The majority of health worker respondents reported the internet (70.3%), school (66.7%) and/or doctors (66.7%) as being their sources for SRHR knowledge. Around a third or more also mentioned books/ magazines (45.4%), friends (42.9%) and/or TV/films/videos/ radio (32.2%), while around a quarter mentioned their partner (26.6%), a community outreach officer, worker or nurse (22.4%) and/or a parent (21.6%). Almost a quarter (23.2%) of health worker respondents also chose the “other” option and wrote in a different response. These “other” responses were coded, and the top sources mentioned in this way were work/occupation/ profession, university and nongovernmental (or non-profit) organizations. Respondents were also asked what types of online resources they would prefer to use to learn more about SRHR. Over half of the health worker respondents chose websites that they trust, such as the World Health Organization (WHO) and the United Nations Joint Programme on HIV/AIDS (UNAIDS) (82.0%) and online web search (57.7%). The next most highly preferred resources were mobile phone apps (38.3%), webinars (34.9%), getting emails with information (34.6%), television series (24.0%) and Facebook (20.9%). Less than 20% of respondents mentioned radio (17.1%), getting text messages with information (14.6%), WhatsApp (14.3%) or Twitter (12.9%) as preferred online resources. 2.2.2 Layperson respondents Among layperson survey participants, the top sources for information about SRH services – mentioned by more than half of the respondents – were the internet (82.7%), school (68.2%), doctors (63.7%) and friends (57.0%). Other sources mentioned by a substantial proportion of respondents were books/ magazines (45.8%), TV/films/videos/radio (36.3%), a partner (27.4%); a parent (24.0%); and a community outreach officer, worker or nurse (19.6%). Similar to the health worker respondents, the preferred online SRHR sources most commonly mentioned were trusted websites (e.g. WHO, UNAIDS) (86.0%) and online web searches (56.7%), followed by substantial numbers mentioning mobile phone apps (32.7%), emails with information (29.2%), television series (28.7%), webinars (24.0%), Facebook (17.5%), radio (14.0%) and text messages with information (12.9%). Twitter Other WhatsApp Text messages with information Radio Facebook Television series Emails with information Webinar Mobile phone apps Online searches Websites they trust (e.g. WHO, UNAIDS) 5.3% 5.3% 12.9% 7.1% 9.4%14.3% 12.9%14.6% 14.0%17.1% 17.5%20.9% 28.7%24.0% 29.2%34.6% 24.0%34.9% 32.7%38.3% 56.7%57.7% 86.0%82.0% FIGURE 2.2. PREFERENCES FOR ONLINE INFORMATION SOURCES FROM WHICH GVPS PARTICIPANTS WOULD LIKE TO LEARN MORE ABOUT SRHR, BY RESPONDENT TYPE (WAVE 1 ONLY, 2018) Chapter 2 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Drug-using juvenile girls in conflict with the law This workshop was held in New Delhi, India and involved female participants, the majority of whom were minors. The youngest was 10 years old. Education levels varied, but many were illiterate and came from poor backgrounds. All were accessed via a drug rehabilitation centre. Resource mapping and graffiti were used as tools to promote dialogue during the session. The key issues raised by the participants included: 1. The girls described numerous common physical ailments such as blurred vision, dizziness and sleeplessness, as well as complications resulting from gonorrhoea and the use of unclean needles. 2. Common ailments are often treated at home, after reaching out to family members. 3. The participants had used alcohol, marijuana, adhesive solutions, pain killers, cough syrups, heroin, cocaine and other drugs. 4. They reported frequently visiting pharmacists for medication, with or without prescriptions. Several have also visited “voodoo” practitioners. 5. Participants were largely uneducated about health issues and health care, including having no knowledge of HIV or HIV risk reduction strategies prior to enrolment in the rehabilitation centre. 6. At the centre, they obtained information, testing and treatment for drug- and HIV-related issues and accessed counsellors and doctors. 7. They also reported gathering information about health issues from TV, radio, billboards and newspaper ads and through books. There were two people living with HIV in this group. This group were at risk of HIV and hepatitis C, through shared use of infected needles and sexual transmission (several of the participants were sexually abused, raped or married as minors.) “We come from very poor, uneducated backgrounds and we cannot read or write. So we don’t practise self-care as we don’t know anything about it.” Ease of access was a perceived benefit, although the participants did not report use of many self-care products. Being unable to read or write restricts access to self-care products. Those from a poor, uneducated background do not have access to self-care products or even knowledge about health issues and how to address them. HIGHLIGHTS FROM COMMUNITY WORKSHOPS Benefits and barriers to self-care interventions Artwork from this workshop co mmu nity 16 Chapter 2 17 Drug-using juvenile girls in conflict with the law Artwork from this workshop co mmu nity FIGURE 2.3. NEW GENERAL SELF-EFFICACY (NGSE) SCALE RESPONSE FREQUENCIES AND MEAN OVERALL SCORES AMONG ALL GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, AND BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) Strongly agree Strongly agree Strongly agree Strongly agree Agree Agree Agree Agree Neither agree nor disagree Neither agree nor disagree Neither agree nor disagree Neither agree nor disagree Disagree Disagree Disagree Disagree Strongly disagree Strongly disagree Strongly disagree Strongly disagree Mean score (range 1–5) Mean score (range 1–5) Mean score (range 1–5) Mean score (range 1–5) 37.8 19.3 27.0 25.3 22.7 10.6 22.7 28.8 53.7 60.3 67.3 56.8 56.1 59.1 60.6 43.9 4.9 14.3 3.1 3.113.0 4.4 9.1 15.2 10.6 16.7 7.6 12.1 3.0 7.6 4.6 1.2 2.4 1.9 1.3 1.9 1.3 3.0 3.0 3.0 Health-care providers (%) Health-care providers (%) Health-care providers (%) Health-care providers (%) Laypersons (%) Laypersons (%) Laypersons (%) Laypersons (%) 4.2 3.9 4.2 4.0 3.8 3.6 4.0 3.9 I will be able to achieve most of the goals that I set for myself When facing difficult tasks, I am certain that I will accomplish them In general, I think that I can obtain outcomes that are important to me I believe I can succeed at most any endeavour I set my mind to 2.3 NEW GENERAL SELF-EFFICACY (NGSE) SCALE: RESPONDENTS’ RESULTS (WAVE 2) Wave 2 of the GVPS included the eight-item NGSE Scale (1) for all respondents. The NGSE scale measures general self-efficacy – that is, an individual’s belief that they can achieve their goals across a variety of situations. Participants rated each item on a five-point Likert scale from 1 – “Strongly disagree” to 5 – “Strongly agree”, with higher scores indicating a greater degree of self- efficacy. Response frequencies for individual items and overall mean scores are presented in Figure 2.3. Chapter 2 18 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Strongly agree Strongly agree Strongly agree Strongly agree Agree Agree Agree Agree Neither agree nor disagree Neither agree nor disagree Neither agree nor disagree Neither agree nor disagree Disagree Disagree Disagree Disagree Strongly disagree Strongly disagree Strongly disagree Strongly disagree Mean score (range 1–5) Mean score (range 1–5) Mean overall score (SD) Mean score (range 1–5) Mean score (range 1–5) 26.7 21.1 24.5 29.8 24.6 20.0 27.7 34.4 61.5 60.9 54.1 62.7 56.9 56.9 49.2 53.1 3.7 3.1 7.5 14.3 16.4 5.0 10.8 13.9 18.5 6.3 4.6 9.2 4.6 3.1 0.6 1.9 1.9 1.9 1.2 1.2 3.1 3.1 Health-care providers (%) Health-care providers (%) Health-care providers Health-care providers (%) Health-care providers (%) Laypersons (%) Laypersons (%) Laypersons Laypersons (%) Laypersons (%) 4.1 4.0 4.1 (0.6) 4.0 4.2 4.0 3.9 3.9 (0.7) 4.0 4.1 I will be able to successfully overcome many challenges Even when things are tough, I can perform quite well New General Self-Efficacy Scale scorea Compared to other people, I can do most tasks very well I am confident that I can perform effectively on many different tasks SD: standard deviation Notes: The response options for each question were “strongly disagree” (1), “disagree” (2), “neither agree nor disagree” (3), “agree” (4) and “strongly agree” (5), such that scores for each respondent (and mean scores across all respondents) ranged from 1 to 5 on each item. Denominators (subtotals) vary across variables/rows because of non-response on some items. a The scores of individual items were averaged to create an overall score for each participant who responded to all eight items (health worker [HW] n=156, non-HW n=64, total n=220), and the mean scores are presented here per respondent group and for all respondents combined. Source: The NGSE Scale was created by Chen et al. (2001) (1). Chapter 2 19 For participants who completed all scale items (220 in total), composite scores were created by averaging their scores for all eight items, with possible mean scores ranging between 1 and 5. Overall, participants reported high general self-efficacy (mean=4.0), and there was little difference in mean scores between the health workers (4.1) and the layperson respondents (3.9). 2.4 SEXUAL AND REPRODUCTIVE AUTONOMY SCALES: RESPONDENTS’ RESULTS (WAVE 2) All survey respondents in Wave 2 were also administered the sexual and reproductive autonomy scales. Sexual autonomy describes feeling that one’s sexual behaviours are self- determined and volitional (2). Sexual autonomy questions were derived from a three-item measure of sexual autonomy created by Sanchez et al. (2005) (2), with responses provided on a four-point Likert scale ranging from 1 – “Strongly disagree” to 4 “Strongly agree”. Reproductive autonomy refers to an individual’s control over family planning and contraceptive use within an intimate relationship. Survey respondents were administered the five-item “communication” subscale of the Reproductive Autonomy Scale (3), which specifically assesses an individual’s level of comfort with discussing reproductive health issues with their intimate partner. Respondents indicated their agreement with items on a four-point Likert scale ranging from 1 – “Strongly disagree” to 4 – “Strongly agree”, with higher scores indicating greater comfort with communication about reproductive health. Response frequencies for individual items and overall mean scores per scale are presented in Figure 2.4. FIGURE 2.4. SEXUAL AND REPRODUCTIVE AUTONOMY SCALE RESPONSE FREQUENCIES AND MEAN OVERALL SCORES AMONG ALL GLOBAL VALUES AND PREFERENCES SURVEY PARTICIPANTS, AND BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) Strongly agree Strongly agree Agree Agree Disagree Disagree Strongly disagree Strongly disagree Not applicable Not applicable Mean score (range 1–4) Mean score (range 1–4) 34.8 47.4 40.3 58.1 48.7 42.9 41.9 35.5 11.4 5.2 3.8 3.3 12.9 3.2 4.8 1.3 1.3 3.2 Health-care providers (%) Health-care providers (%) Laypersons (%) Laypersons (%) 3.2 3.4 3.2 3.5 During sex I feel free to be who I am During sex I have a say in what happens and I can voice my opinion SEXUAL AUTONOMY SCALE Chapter 2 20 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Strongly agree Strongly agree Agree Agree Disagree Disagree Strongly disagree Strongly disagree Not applicable Not applicable Mean score (range 1–4) Mean score (range 1–4) 8.7 59.4 11.7 78.6 18.1 24.1 20.0 16.1 40.3 31.5 5.3 26.741.7 1.3 9.8 1.8 1.8 1.81.5 Health-care providers (%) Health-care providers (%) Laypersons (%) Laypersons (%) 3.0 3.5 2.8 3.7 During sex I feel controlled and pressured to be certain waysa REPRODUCTIVE AUTONOMY – COMMUNICATION SUB-SCALE Mean overall score (SD) Health-care providers Laypersons3.2 (0.6) 3.2 (0.7) Scale scoreb My partner would support me if I wanted to use a method to prevent pregnancy Strongly agree Strongly agree Strongly agree Agree Agree Agree Disagree Disagree Disagree Strongly disagree Strongly disagree Strongly disagree Not applicable Not applicable Not applicable Mean score (range 1–4) Mean score (range 1–4) Mean score (range 1–4) 46.9 50.7 55.0 46.3 63.2 68.5 36.1 40.5 30.2 35.2 28.1 24.1 8.2 3.4 4.7 4.1 13.0 7.0 3.7 5.6 4.8 3.4 7.8 Health-care providers (%) Health-care providers (%) Health-care providers (%) Laypersons (%) Laypersons (%) Laypersons (%) 3.3 3.4 3.5 3.2 3.5 3.6 It is easy to talk about sex with my partner If I didn’t want to have sex I could tell my partner If I was worried about being pregnant or not being pregnant I could talk to my partner about it 1.8 1.9 1.9 2.0 2.3 Chapter 2 21 Mean overall score (SD) Health-care providers Laypersons3.4 (0.6) 3.5 (0.6) Sub-scale scorec Strongly agree Agree Disagree Strongly disagree Not applicable Mean score (range 1–4) 54.7 67.3 30.5 21.2 4.7 7.7 7.8 Health-care providers (%) Laypersons (%) 3.5 3.6 If I really did not want to become pregnant I could get my partner to agree with me 1.9 1.9 2.3 SD: standard deviation Notes: The response options for each question were “strongly disagree” (1), “disagree” (2), “agree” (3) and “strongly agree” (4), such that scores for each respondent (and mean scores across all respondents) ranged from 1 to 4 on each item. Denominators (subtotals) vary across variables/rows because of non-response on some items. a Item reverse-scored for scale scoring. b Adapted from Sanchez et al. (2005) (2). The scores of individual items were averaged to create an overall score for each participant who responded to all three items (health worker [HW] n=145, non-HW n=59, total n=204), and the average scores are presented here per respondent group and for all respondents combined. c Adapted from Upadhyay et al. (2014) (3). The scores of individual items were averaged to create an overall score for each participant who responded to all five items (HW n=107, non-HW n=48, total n=155), and the average scores are presented here per respondent group and for all respondents combined. For the sexual autonomy scale, after reverse-scoring the negatively worded items, overall scores per scale were calculated by averaging items for participants who responded to all questions (204 in total). Possible scores ranged from 1 to 4, with higher scores indicating a greater degree of sexual autonomy. The mean scores among the survey respondents indicated a high degree of sexual autonomy with a total mean score of 3.2 for each respondent group and for both groups combined. For participants who responded to all reproductive autonomy subscale items (155 in total), a composite score was derived by averaging the scores for the five scale items with the potential score ranging between 1 and 4. Overall, respondents demonstrated a high degree of comfort with communicating about reproductive health, with a total mean score of 3.5 for both respondent groups combined (3.4 for health workers and 3.5 for laypersons). References for Chapter 2 1. Chen G, Gully SM, Eden D. Validation of a New General Self-Efficacy Scale. Organizational Research Methods. 2001;4(1):62-83. doi:10.1177/109442810141004 2. Sanchez DT, Kiefer AK, Ybarra O. Sexual submissiveness in women: costs for sexual autonomy and arousal. Pers Soc Psychol Bull. 2006;32(4):512-24. doi:10.1177/0146167205282154 3. Upadhyay UD, Dworkin SL, Weitz TA, Foster DG. Development and validation of a reproductive autonomy scale. Stud Fam Plann. 2014;45(1):19-41. doi:10.1111/ j.1728-4465.2014.00374.x. 22 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 Awareness and experience of, and values and preferences relating to self- care interventions for SRHR: quantitative findings 3 23Chapter 3 Chapter summary This chapter presents quantitative findings based on survey respondents’ answers to several questions about a wide range of self-care interventions for SRHR. The findings in both sections of the chapter are grouped under six subsections by type of intervention: (1) Antenatal, intrapartum and postnatal care (asked in Wave 2 only); (2) Family planning; (3) Abortion; (4) Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (5) Promoting sexual health (asked in Wave 2 only); and (6) SRH information online and via mobile apps (asked in Wave 1 only). The first section (3.1) focuses on both groups of respondents’ awareness about self-care interventions for SRHR and where to access them, as well as their or their partners’ experience of using these interventions, and the considerations which underpin their decision- making regarding use of these interventions (e.g. privacy/ confidentiality, feelings of non-judgement, empowerment, convenience and access). Overall, the majority of respondents were generally aware about the interventions and where to access them, though this was somewhat higher for health worker respondents than for laypersons. Experience of using the interventions varied widely depending on the particular interventions, and there were substantial proportions of respondents who had no need for some of the interventions. Convenience and privacy/ confidentiality tended to be the most important factors in decision-making about using the interventions, although in some cases accessibility and cost also featured strongly. The second section (3.2) reports on health workers’ experiences of providing related services (referrals, prescriptions, information), how confident and informed they felt about providing such services, if they had any concerns about providing these services, and what they perceive as the benefits of each intervention. Quantitative data on these topics are reported in tabular form and summarized in narrative text, with separate data for health workers and layperson respondents and for each survey wave. “When home or Internet-based information regarding remedies are not an option, we heavily depend on pharmacies. It’s always paracetamol for basic conditions, if you ask for 20, they don’t refuse to give you 20. No prescriptions required. We go to doctors only when nothing else works out.” – A youth from the Dalit community, India 24 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 3.1 SURVEY RESPONDENTS’ AWARENESS ABOUT, USAGE OF, AND DECISION-MAKING CONSIDERATIONS ON SELF-CARE INTERVENTIONS FOR SRHR This section presents the quantitative findings on survey participants’ awareness about, usage of, and basis for decision-making on the use of self-care interventions for SRHR – both health workers and laypersons. The data are derived from questions asking participants (i) whether they knew of each intervention and where to access it; (ii) whether they or their partners have ever used the intervention (or recently used it in the past 3 months – asked in Wave 1 only); and (iii) what their considerations are for decision-making about using an intervention. The findings are both provided in tables and summarized in narrative form (separate for health worker and layperson respondents), grouped under six subsections by type of intervention: (3.1.1) Antenatal, intrapartum and postnatal care; (3.1.2) Family planning; (3.1.3) Abortion; (3.1.4) Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (3.1.5) Promoting sexual health; and (3.1.6) SRH information online and via mobile apps. 3.1.1 Antenatal, intrapartum and postnatal care Questions regarding all the interventions in this subsection were added in Wave 2 of the survey and not asked in Wave 1. The findings are presented in Table 3.1 – please refer to these tables as needed for details not included in the narrative summary. 25Chapter 3 TABLE 3.1. AWARENESS, USAGE AND DECISION-MAKING CONSIDERATIONS OF SRH SELF-CARE INTERVENTIONS FOR ANTENATAL, INTRAPARTUM AND POSTNATAL CARE BY SELF OR PARTNER AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT (WAVE 2 ONLY, 2020–2021) AT-HOME PREGNANCY TEST SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (FOLIC ACID) DURING PREGNANCY PLANNING SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (IRON AND FOLIC ACID) DURING PREGNANCY AWARENESS n=168 n=77 n=169 n=77 n=169 n=77 Aware of intervention and where to access it (%) 88.7 90.9 79.3 59.7 81.7 55.8 Aware of intervention but not where to access it (%) 7.7 7.8 13.6 29.9 12.4 31.2 Not aware of intervention (%) 3.6 1.3 7.1 10.4 5.9 13.0 USAGE n=166 n=74 n=165 n=74 n=167 n=74 I/my partner have used intervention (%) 57.8 54.1 37.0 16.2 40.7 20.3 I and my partner have not used intervention (%) 19.9 27.0 29.7 39.2 25.2 33.8 I don’t need to use this (%) 22.3 18.9 33.3 44.6 34.1 46.0 DECISION-MAKING CONSIDERATIONS n=145 n=57 n=142 n=47 n=140 n=46 Privacy and confidentiality (%) 56.6 57.9 24.7 21.3 25.0 17.4 Lack of judgement (%) 27.6 40.4 14.1 10.6 13.6 13.0 Empowerment (%) 28.3 24.6 31.0 25.5 29.3 28.3 Convenience (%) 59.3 56.1 61.3 59.6 62.9 63.0 Cost (%) 45.5 45.6 52.8 36.2 51.4 37.0 Legal restrictions (%) 6.2 7.0 7.0 2.1 6.4 0.0 % respondents Health workers Layperson respondents KEY 26 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (IRON AND FOLIC ACID) POSTPARTUM SELF-MONITORING/HOME- MONITORING OF BLOOD GLUCOSE LEVELS DURING PREGNANCY SELF-MONITORING/ HOME-MONITORING OF PROTEINURIA DURING PREGNANCY AWARENESS n=167 n=77 n=170 n=79 n=167 n=77 Aware of intervention and where to access it (%) 79.6 57.1 59.4 29.1 37.1 14.3 Aware of intervention but not where to access it (%) 12.6 28.6 25.3 44.3 26.4 31.2 Not aware of intervention (%) 7.8 14.3 15.3 26.6 36.5 54.6 USAGE n=165 n=74 n=167 n=75 n=165 n=74 I/my partner have used intervention (%) 35.8 17.6 18.6 4.0 12.7 2.7 I and my partner have not used intervention (%) 28.5 37.8 49.1 48.0 52.7 50.0 I don’t need to use this (%) 35.8 44.6 32.3 48.0 34.6 47.3 DECISION-MAKING CONSIDERATIONS n=139 n=47 n=141 n=46 n=141 n=47 Privacy and confidentiality (%) 24.5 19.2 27.0 23.9 27.7 21.3 Lack of judgement (%) 14.4 10.6 12.1 17.4 12.8 12.8 Empowerment (%) 29.5 25.5 30.5 23.9 29.8 27.7 Convenience (%) 61.2 61.7 59.6 58.7 59.6 59.6 Cost (%) 54.0 40.4 53.2 41.3 52.5 42.6 Legal restrictions (%) 5.0 2.1 6.4 2.2 6.4 0.0 % respondents Health workers Layperson respondents KEY 27Chapter 3 SELF-MONITORING/ HOME-MONITORING OF BLOOD PRESSURE DURING PREGNANCY AWARENESS n=169 n=77 Aware of intervention and where to access it (%) 71.6 39.0 Aware of intervention but not where to access it (%) 18.9 37.7 Not aware of intervention (%) 9.5 23.4 USAGE n=164 n=74 I/my partner have used intervention (%) 28.1 10.8 I and my partner have not used intervention (%) 38.4 43.2 I don’t need to use this (%) 33.5 46.0 DECISION-MAKING CONSIDERATIONS n=141 n=47 Privacy and confidentiality (%) 27.7 17.0 Lack of judgement (%) 13.5 14.9 Empowerment (%) 30.5 23.4 Convenience (%) 63.8 61.7 Cost (%) 51.1 38.3 Legal restrictions (%) 6.4 2.1 % respondents Note: Denominators (subtotals) vary across variables/rows because of non-response on some items. - Indicates that question or response option was not asked in a given wave. 28 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 At-home pregnancy test Health workers: The vast majority of health worker respondents reported being aware of at-home pregnancy testing and knowing how to access it (88.7%). However, some reported knowing what it is but not how to access it (7.7%) and a few were unaware of it (3.6%). Over half of the health worker respondents reported that they themselves and/or their partner had ever used an at- home pregnancy test (57.8%), while a about a fifth each reported not having used it before (19.9%) and not having a need for it (22.3%). For health workers, the most important considerations when deciding to use at-home pregnancy testing were convenience (selected by 59.3%), privacy and confidentiality (56.6%) and cost (45.5%). Other reasons included to feel empowered (28.3%) and so as not to feel judged (27.6%) and nine mentioned legal restrictions (6.2%). Laypersons: Among laypersons, almost all participants reported being aware of at-home pregnancy testing and how to access it (90.9%), while a few respondents reported knowing what it is but not how to access it (7.8%) or not knowing what it is (1.3%). With respect to usage, 54.1% reported they themselves and/or their partner had ever used at-home pregnancy testing. Additionally, about a quarter reported not having used it (27.0%) and the remaining participants reported not having a need for it (18.9%). For layperson respondents, the most important considerations when deciding to use at-home pregnancy testing were privacy and confidentiality (57.9%), convenience (56.1%) and cost (45.6%). Participants also mentioned not feeling judged (40.4%) and feeling more empowered (24.6%) and four mentioned legal restrictions (7.0%). Self-management of nutrition supplement (folic acid) during pregnancy planning Health workers: The majority of health worker respondents reported knowing about self-management of folic acid supplementation during pregnancy planning and where to access it (79.3%), while some reported knowing about it but not how to access it (13.6%) or not knowing what it is (7.1%). Regarding usage, 37.0% reported having used folic acid supplements during pregnancy planning, with about another third each reporting not having used it (29.7%) or that it is not relevant to them (33.3%). The most important factors for self-management of folic acid during pregnancy planning were convenience (61.3%) and cost (52.8%). Other factors were empowerment (31.0%), privacy and confidentiality (24.7%), not feeling judged (14.1%) and legal restrictions (7.0%). Laypersons: Over half of layperson respondents reported knowing about self-management of folic acid during pregnancy planning and how to access it (59.7%), while almost a third reported knowing about it but not how to access it (29.9%) and 10.4% reported not knowing what it is. In terms of self-reported usage, almost half of layperson respondents (44.6%) reported not having a need for this, while just 16.2% reported having used folic acid during pregnancy planning and just over another third reported not having used this intervention (39.2%). The most important factors for respondents when deciding to use folic acid during pregnancy planning were convenience (59.6%) and cost (36.2%). Smaller proportions of respondents also reported that empowerment (25.5%), privacy and confidentiality (21.3%), not feeling judged (10.6%) and legal restrictions (2.1%) were important in decision-making. Self-management of nutrition supplements (iron and folic acid) during pregnancy Health workers: The majority of health worker respondents reported knowing about self-management of iron and folic acid supplements during pregnancy and where to access them (81.7%), but a small proportion reported knowing about them but not how to access them (12.4%) or not knowing what they are (5.9%). In terms of usage, 40.7% reported that they or their partner had used iron and folic acid during pregnancy, while a quarter reported not having used them during pregnancy (25.2%) and a third indicated that this intervention is not relevant to them (34.1%). The most important factors for deciding to use these supplements during pregnancy were convenience (62.9%) and cost (51.4%). Smaller numbers of respondents also noted the importance of empowerment (29.3%), privacy and confidentiality (25.0%), not feeling judged (13.6%) and legal restrictions (6.4%). Laypersons: Over half of layperson respondents reported knowing about self-management of iron and folic acid during pregnancy and how to access these supplements (55.8%), while almost a third of respondents reported knowing about them but not how to access them (31.2%) and 13.0% reported not knowing what they are. Almost half of laypersons reported not having a need for this intervention (46.0%), but about a fifth (20.3%) reported they or their partner have used iron and folic acid during pregnancy; the remaining third reported not having used this intervention (33.8%). Respondents indicated that the most important factors when deciding to use iron and folic acid during pregnancy were convenience (63.0%), cost (37.0%) and empowerment (28.3%). A small number of respondents also mentioned the importance of privacy and confidentiality (17.4%) and not feeling judged (13.0%). No respondents mentioned legal restrictions as a deciding factor. Self-management of nutrition supplements (iron and folic acid) postpartum Health workers: The majority of health worker respondents reported knowing about self-management of iron and folic acid supplementation during the postpartum period, and where to access them (79.6%), while 12.6% reported knowing about them but not how to access them and 7.8% reported not knowing what they are. About a third of respondents each reported that they themselves and/or their partner had ever used postpartum iron and folic acid supplements (35.8%), that they have not used them (28.5%) or that they had no need for them (35.8%). The most commonly reported factors considered important when deciding to engage with these supplements postpartum were convenience (61.2%) and cost (54.0 %), while substantial 29Chapter 3 numbers also mentioned empowerment (29.5%), privacy and confidentiality (24.5%) and not feeling judged (14.4%), and a few reported legal restrictions (5.0%) as deciding factors. Laypersons: Over half of layperson respondents reported knowing about self-management of iron and folic acid during postpartum and how to access these supplements (57.1%), while over a quarter reported knowing about them but not how to access them (28.6%) and 14.3% reported not knowing what they are. In terms of usage, 17.6% reported having used iron and folic acid during postpartum and 37.8% reported not having used this intervention; nearly half (44.6%) indicated having no need for these supplements. Among laypersons, the most important factors when deciding to use iron and folic acid during the postpartum period were convenience (61.7%) and cost (40.4%), while some also mentioned empowerment (25.5%), privacy and confidentiality (19.2%) and not feeling judged (10.6%) and one person mentioned legal restrictions. Self-monitoring/home-monitoring of blood glucose levels during pregnancy Health workers: Over half of health worker respondents reported knowing about self-monitoring/home-monitoring of blood glucose levels during pregnancy and where to access it (59.4%) and another quarter reported knowing about it but not how to access it (25.3%). However, 15.3% reported not knowing what it is. In terms of usage, 18.6% reported that they and/or their partner had ever used this intervention during pregnancy. However, half of the health worker respondents had not used it (49.1%), and another third said that it was not relevant for them (32.3%). The most important factors for deciding to engage in self-monitoring/home-monitoring of blood glucose levels during pregnancy were convenience (59.6%) and cost (53.2%). Some respondents also mentioned empowerment (30.5%), privacy and confidentiality (27.0%) and not feeling judged (12.1%), and a few reported legal restrictions (6.4%) as being important in their decision-making. Laypersons: Just under a third of laypersons reported knowing about this intervention and how to access it (29.1%), while 44.3% reported that while they know about it, they did not know how to access it and a quarter said they do not know what it is (26.6%). About half of the layperson respondents reported not having used this intervention (48.0%) or not having a need for it (48.0%), and just a few (4.0%) reported having engaged with self-monitoring/home-monitoring blood glucose levels during pregnancy. The most important factors when deciding to use this intervention were convenience (58.7%) and cost (41.3%), but empowerment (23.9%), privacy and confidentiality (23.9%) and not feeling judged (17.4%) were also important, and one respondent mentioned legal restrictions. Self-monitoring/home-monitoring of proteinuria during pregnancy Health workers: Over a third of health worker respondents reported knowing about self-monitoring/home-monitoring of proteinuria during pregnancy and where to access it (37.1%), while a quarter reported knowing about it but not how to access it (26.4%) and 36.5% reported not knowing what it is. Among health workers, 12.7% reported that they and/or their partner have used this intervention during pregnancy, but the majority reported not having used it (52.7%), and a third said it is not relevant to them (34.6%). The most important factors in deciding to use this intervention were convenience (59.6%) and cost (52.5%), and additional factors mentioned by fewer respondents were empowerment (29.8%), privacy and confidentiality (27.7%), not feeling judged (12.8%) and legal restrictions (6.4%). Laypersons: Among laypersons, only 14.3% of respondents reported knowing about this intervention and how to access it while a third (31.2%) reported knowing about it but not how to access it; the majority of respondents (54.6%) were unaware of this intervention. Half of the laypersons reported not having used this intervention (50.0%) or not having a need for it (47.3%), and only two reported that they and/or their partner had used self-monitoring/home-monitoring of proteinuria during pregnancy. Among laypersons, the factors most often mentioned as being important when deciding to use this intervention were convenience (59.6%) and cost (42.6%). Some almost mentioned empowerment (27.7%), privacy and confidentiality (21.3%) and not feeling judged (12.8%). No participants reported legal restrictions as a deciding factor for using this intervention. Self-monitoring/home-monitoring of blood pressure during pregnancy Health workers: The majority of health worker respondents reported knowing about self-monitoring/home-monitoring of blood pressure during pregnancy and where to access it (71.6%), while 18.9% reported knowing about it but not how to access it and 9.5% reported not knowing what it is. About a third each of health worker respondents reported that they themselves and/or their partner have used this intervention (28.1%), have not used it (38.4%), or that it is not relevant for them (33.5%). The most important factors for deciding to self-monitor/home- monitor blood pressure during pregnancy were convenience (63.8%) and cost (51.1%). A substantial number also mentioned empowerment (30.5%) and privacy and confidentiality (27.7%), and a small number felt that not feeling judged (13.5%) and legal restrictions (6.4%) were also important factors. Laypersons: Over a third of layperson respondents reported knowing about this intervention and how to access it (39.0%), and a similar number reported being aware of it but not how to access it (37.7%) and a quarter reported not knowing what it is (23.4%). Among layperson respondents, 10.8% reported they and/or their partner have used this intervention during pregnancy, but the vast majority have either opted not to use it (43.2%) or not had a need for it (46.0%). The most important factors for deciding to self-monitor/home-monitor blood pressure during pregnancy were convenience (61.7%), cost (38.3%) and empowerment (23.4%). Small number of laypersons also mentioned privacy and confidentiality (17.0%) and not feeling judged (14.9%) and one mentioned legal restrictions (2.1%). 30 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 3.1.2 Family planning Among the six interventions in this subsection, questions about one of them (the contraceptive patch) were only asked in Wave 1 of the survey. The findings are presented in Table 3.2 – please refer to these tables as needed for details not included in the narrative summary. TABLE 3.2. AWARENESS, USAGE AND DECISION-MAKING CONSIDERATIONS FOR USE OF SRH SELF-CARE INTERVENTIONS FOR FAMILY PLANNING AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT AND SURVEY WAVE OVER-THE-COUNTER HORMONAL CONTRACEPTION (EXCLUDING EC) OVER-THE-COUNTER EMERGENCY CONTRACEPTION (EC) WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS n=360 n=423 n=174 n=79 n=359 n=421 n=172 n=79 Aware of intervention and where to access it (%) 98.1 93.4 90.8 87.3 92.8 85.3 90.1 84.8 Aware of intervention but not where to access it (%) 1.1 5.7 6.9 11.4 4.7 8.8 7.6 11.4 Not aware of intervention (%) 0.8 0.9 2.3 1.3 2.5 5.9 2.3 3.8 USAGE n=354 n= 366 n=172 n=75 n=346 n=361 n=168 n=75 I/my partner have used intervention (%) 48.6 38.8 61.6 58.7 36.4 29.6 39.3 52.0 I/my partner used in past 3 months (%) 6.2 7.4 - - 4.0 3.6 - - I and my partner have not used intervention (%) 26.6 26.5 19.2 21.3 35.0 31.0 36.9 25.3 I don’t need to use this (%) 18.6 27.3 19.2 20.0 24.6 35.7 23.8 22.7 DECISION-MAKING CONSIDERATIONS n=320 n=193 n=154 n=66 n=292 n=175 n=150 n=64 Privacy and confidentiality (%) 48.4 43.0 56.5 42.4 55.8 51.4 64.7 56.3 Lack of judgement (%) 25.3 22.3 37.7 30.3 32.9 28.6 40.7 50.0 Empowerment (%) 31.3 24.9 35.1 42.4 27.1 20.6 29.3 31.3 Convenience (%) 56.6 56.0 65.6 59.1 49.3 41.7 56.7 53.1 Cost (%) - - 47.4 59.1 - - 44.0 50.0 Legal restrictions (%) - - 15.6 9.1 - - 20.0 12.5 Accessibility (%) 52.8 64.2 - - 51.7 52.6 - - % respondents Health workers Layperson respondents KEY 31Chapter 3 CONTRACEPTIVE PATCH CONTRACEPTIVE VAGINAL RING WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS n=356 n=420 - - n=357 n=420 n=171 n=79 Aware of intervention and where to access it (%) 74.4 66.0 - - 69.2 61.0 60.8 63.3 Aware of intervention but not where to access it (%) 16.6 17.9 - - 24.4 26.9 32.2 31.7 Not aware of intervention (%) 9.0 16.2 - - 6.4 12.1 7.0 5.1 USAGE n=346 n=361 - - n=343 n=362 n=165 n=75 I/my partner have used intervention (%) 5.5 5.0 - - 4.1 5.8 9.1 14.7 I/my partner used in past 3 months (%) 0.0 0.8 - - 0.9 0.8 - - I and my partner have not used intervention (%) 71.7 60.4 - - 70.3 57.7 65.5 56.0 I don’t need to use this (%) 22.8 33.8 - - 24.8 35.6 25.5 29.3 DECISION-MAKING CONSIDERATIONS n=267 n=155 - - n=264 n=156 n=144 n=58 Privacy and confidentiality (%) 41.2 36.1 - - 43.9 36.5 46.5 29.3 Lack of judgement (%) 23.6 20.0 - - 23.9 23.1 28.5 20.7 Empowerment (%) 27.3 25.2 - - 24.2 23.7 29.2 24.1 Convenience (%) 53.6 45.8 - - 50.4 46.8 58.3 58.6 Cost (%) - - - - - - 47.2 53.5 Legal restrictions (%) - - - - - - 10.4 6.9 Accessibility (%) 44.9 54.2 - - 44.3 51.9 - - % respondents 32 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 SELF-ADMINISTERED INJECTABLE CONTRACEPTION2 DIAPHRAGM OR CERVICAL CAP WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS n=356 n=418 n=169 n=78 n=353 n=417 n=170 n=78 Aware of intervention and where to access it (%) 69.1 57.4 47.3 37.2 73.4 63.3 57.1 46.2 Aware of intervention but not where to access it (%) 16.6 21.1 36.7 34.6 21.0 24.7 34.7 32.1 Not aware of intervention (%) 14.3 21.5 16.0 28.2 5.7 12.0 8.2 21.8 USAGE n=345 n=360 n=164 n=75 n=344 n=363 n=166 n=73 I/my partner have used intervention (%) 4.3 4.4 9.2 6.7 6.1 5.0 9.6 6.9 I/my partner used in past 3 months (%) 0.6 0.8 - - 0.0 0.8 - - I and my partner have not used intervention (%) 71.0 58.9 67.1 62.7 70.6 59.2 64.5 65.8 I don’t need to use this (%) 24.1 35.8 23.8 30.7 23.3 35.0 25.9 27.4 DECISION-MAKING CONSIDERATIONS n=268 n=152 n=144 n=55 n=254 n=148 n=139 n=52 Privacy and confidentiality (%) 41.0 39.5 49.3 32.7 42.1 34.5 46.8 26.9 Lack of judgement (%) 23.9 23.0 30.6 20.0 22.4 23.0 29.5 21.2 Empowerment (%) 23.5 27.0 34.0 25.5 22.8 24.3 32.4 21.2 Convenience (%) 55.2 46.1 54.2 50.9 49.2 45.3 48.9 53.9 Cost (%) - - 47.2 58.2 - - 44.6 51.9 Legal restrictions (%) - - 16.0 9.1 - - 16.0 9.6 Accessibility (%) 44.4 53.3 - - 44.9 54.1 - - Notes: Denominators (subtotals) vary across variables because of non-response on some items. In Wave 1, the “have used intervention” data do not include those who reported use “in past 3 months”, whereas in Wave 2, these data are combined in “have used intervention” since the separate response option on recent use was not available. - Indicates that question or response option was not asked in a given wave. 2 In Wave 1, the response option was “Self-injectable long-acting contraceptive” and in Wave 2 it was revised to “Self-administered contraception (e.g. self-injectable contraception)”. % respondents Health workers Layperson respondents KEY 33Chapter 3 Over-the-counter hormonal contraception (excluding emergency contraception – see next item) Health workers: The vast majority of health worker respondents in both waves reported having heard of over-the-counter (OTC) hormonal contraception and knowing where to access it (Wave 1: 98.1%; Wave 2: 90.8%), while a very small minority reported knowing of it but not know how to access it (Wave 1: 1.1%; Wave 2: 6.9%) or not being aware of this intervention (Wave 1: 0.8%; Wave 2: 2.3%). A majority of health workers reported that they themselves or their partner had ever used OTC hormonal contraception (in Wave 1, 6.2% had used it in the past 3 months and another 48.6% had used it previously; in Wave 2, 61.6% had ever used it), while the remainder reported not having used it (Wave 1: 26.6%; Wave 2: 19.2%) or that they did not have a need for it (Wave 1: 18.6%; Wave 2: 19.2%). The most important factors for deciding to use OTC hormonal contraception – mentioned by half or more health workers across both waves – were convenience (Wave 1: 56.6%; Wave 2: 65.6%), accessibility (Wave 1 only: 52.8%), privacy and confidentiality (Wave 1: 48.4%; Wave 2: 56.5%) and cost (Wave 2 only: 47.4%). A quarter to a third of health workers also reported not feeling judged (Wave 1: 25.3%; Wave 2: 37.7%) and feeling empowered (Wave 1: 31.3%; Wave 2: 35.1%), while a small number mentioned legal restrictions (Wave 2 only: 15.6%). Laypersons: Among laypersons, the vast majority reported knowing about OTC hormonal contraception and where to access it (Wave 1: 93.4%; Wave 2: 87.3%), while a only small numbers reported knowing about it but not where to access it (Wave 1: 5.7%; Wave 2: 11.4%) and a few respondents were not aware of this intervention (Wave 1: 0.9%; Wave 2: 1.3%). Almost half of laypersons in Wave 1 (7.4% in the past 3 months and another 38.8% previously) and over half in Wave 2 (58.7%) reported having ever used OTC hormonal contraception. About a fifth to a quarter of the respondents in each wave reported not having used this intervention (Wave 1: 26.5%; Wave 2: 21.3%) or not needing it (Wave 1: 27.3%; Wave 2: 20.0%). In terms of factors in their decision-making about using this intervention, the majority of laypersons across both waves mentioned accessibility (Wave 1 asked: 64.2%), convenience (Wave 1: 56.0%; Wave 2: 59.1%) and cost (Wave 2 only: 59.1). Substantial numbers also mentioned privacy and confidentiality (Wave 1: 43.0%; Wave 2: 42.4%) and empowerment (Wave 1: 24.9%; Wave 2: 42.4%) and not feeling judged (Wave 1: 22.3%; Wave 2: 30.3%), while only a few mentioned legal restrictions (Wave 2: 9.1%). Over-the-counter emergency contraception Health workers: The vast majority of health worker respondents reported being aware of and knowing where to access OTC emergency contraception (Wave 1: 92.8%; Wave 2: 90.1%). Less than 10% reported knowing what it is but not how to get it (Wave 1: 4.7%; Wave 2: 7.6%) or not knowing what it is (Wave 1: 2.5%; Wave 2: 2.3%). About 40% of health workers 3 Questions regarding the contraceptive patch were only asked in Wave 1. reported they and/or their partner had ever used OTC emergency contraception (in Wave 1, 4.0% had used it in the past 3 months and another 36.4% had used it previously; in Wave 2, 39.3% had ever used it). Another third reported not having used it (Wave 1: 35.0%; Wave 2: 36.9%) and about a quarter reported not having a need for it (Wave 1: 24.6%; Wave 2: 23.8%). The most important factors for deciding to use OTC emergency contraception for health workers were privacy and confidentiality (Wave 1: 55.8%; Wave 2: 64.7%), accessibility (Wave 1 only: 51.7%), convenience (Wave 1: 49.3%; Wave 2: 56.7%), cost (Wave 2 only: 44.0%) and not feeling judged (Wave 1: 32.9%; Wave 2: 40.7%). Smaller numbers also mentioned feeling empowered (Wave 1: 27.1%; Wave 2: 29.3%) and legal restrictions (Wave 2: 20.0%) as important considerations. Laypersons: The large majority of laypersons reported being aware of OTC emergency contraception and knowing where to access it (Wave 1: 85.3%; Wave 2: 84.8%), while small numbers reported having heard of it but not knowing where to access it (Wave 1: 8.8%; Wave 2: 11.4%) or not knowing what it is (Wave 1: 5.9%; Wave 2: 3.8%). In Wave 1, approximately equal numbers of participants reported having ever used OTC emergency contraceptives (3.6% in the past 3 months plus another 29.6% ever previously), not having used them (31.0%) and having no need for them (35.7%). However, in Wave 2 over half of laypersons reported having used this intervention (52.0%), while about a quarter each reported not having used it (25.3%) or not having a need for it (22.7%). The most important factors when deciding to use emergency contraception were accessibility (Wave 1 only: 52.6%), privacy and confidentiality (Wave 1: 51.4%; Wave 2: 56.3%), convenience (Wave 1: 41.7%; Wave 2: 53.1%) and cost (Wave 2 only: 50.0%). In Wave 1 not feeling judged was less commonly cited (28.6%), while this was an important deciding factor for more participants in Wave 2 (50.0%). Some laypersons also mentioned feeling empowered (Wave 1: 20.6%; Wave 2: 31.3%) and legal restrictions (Wave 2: 12.5%). Contraceptive patch3 Health workers: Three quarters of health worker respondents reported knowing what the contraceptive patch is and where to access it (74.4%), while the remainder reported knowing what it is but not how to access it (16.6%) or not knowing what it is (9.0%). A small minority of health workers reported that they or their partner had ever used the contraceptive patch (5.5% – none in the past 3 months), while most had not used it (71.7%) and less than a quarter reported not having a need for this intervention (22.8%). More than half of respondents mentioned convenience as an important consideration when deciding to use the patch (53.6%), which smaller numbers mentioned accessibility (44.9%), privacy and confidentiality (41.2%), feeling of empowerment (27.3%) and not feeling judged (23.6%). Laypersons: Two thirds of layperson respondents reported knowing about the contraceptive patch and where to access it (66.0%), while the remaining respondents reported knowing what it is but not knowing how to access it (17.9%), or not knowing what it is (16.2%). A minority of these respondents (or their partners) had ever used this intervention (only 0.8% 34 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 in the past 3 months, and another 5.0% previously), while the majority had not opted to use it (60.4%) and a third had no need for it (33.8%). The most commonly selected considerations for deciding to use the contraceptive patch among laypersons were its accessibility (54.2%) and convenience (45.8%), while smaller numbers mentioned privacy and confidentiality (36.1%), feeling empowered (25.2%) and not feeling judged (20.0%). Contraceptive vaginal ring Health workers: Over half of health worker respondents in both waves reported knowing what the contraceptive vaginal ring is and where to access it (Wave 1: 69.2%; Wave 2: 60.8%). A considerable minority reported knowing what it is but not how to access it (Wave 1: 24.4%; Wave 2: 32.2%) and less than 10% reported not knowing what it is (Wave 1: 6.4%; Wave 2: 7.0%). A small minority of health workers reported that they or their partner had ever used this method (in Wave 1, 0.9% had used it in the past 3 months and another 4.1% had used it previously; in Wave 2, 9.1% had ever used it), while the majority had not (Wave 1: 70.3%; Wave 2: 65.5%) and a quarter reported not having a need for it (Wave 1: 24.8%; Wave 2: 25.5%). When deciding to use the contraceptive vaginal ring, important considerations included convenience in both waves (Wave 1: 50.4%; Wave 2: 58.3%), cost (Wave 2 only: 47.2%), accessibility (Wave 1 only: 44.3%), and privacy and confidentiality (Wave 1: 43.9%; Wave 2: 46.5%). Some health workers also mentioned feeling empowered (Wave 1: 24.2%; Wave 2: 29.2%), not feeling judged (Wave 1: 23.9%; Wave 2: 28.5%) and legal restrictions (Wave 2: 10.4%) as key considerations. Laypersons: Among laypersons in each wave, almost two thirds reported knowing about the contraceptive vaginal ring and where to get it (Wave 1: 61.0%; Wave 2: 63.3%), while the remaining participants reported knowing what it is but not how to access it (Wave 1: 26.9%; Wave 2: 31.7%), or not knowing what it is (Wave 1: 12.1%; Wave 2: 5.1%). A minority of layperson respondents reported having ever used this intervention (in Wave 1, 0.8% had used it in the past 3 months and another 5.8% had used it previously; in Wave 2, 14.7% had ever used it). Most laypersons had never used it (Wave 1: 57.7%; Wave 2: 56.0%) and about a third had no need for it (Wave 1: 35.6%; Wave 2: 29.3%). The most important factors for deciding to use the contraceptive vaginal ring were accessibility (Wave 1 only: 51.9%), convenience (Wave 1: 46.8%; Wave 2: 58.6%) and cost (Wave 2: 53.5%). Some respondents also mentioned privacy and confidentiality (Wave 1: 36.5%; Wave 2: 29.3%), feeling of empowerment (Wave 1: 23.7%; Wave 2: 24.1%), not feeling judged (Wave 1: 23.1%; Wave 2: 20.7%) and legal restrictions (Wave 2: 6.9%). Self-administered injectable contraception Health workers: A majority of Wave 1 health worker respondents reported knowing about self-administered contraception and where to access it (69.1%), compared with just under half of those in Wave 2 (47.3%). A smaller proportion of respondents in both waves reported knowing what it is but now how to access it (Wave 1: 16.6%; Wave 2: 36.7%) or not knowing what it is (Wave 1: 14.3%; Wave 2: 16.0%). Only a few health workers reported having ever used self-administered contraception (in Wave 1, 0.6% had used it in the past 3 months and another 4.3% had used it previously; in Wave 2, 9.2% had ever used it). The majority reported not having used it (Wave 1: 71.0%; Wave 2: 67.1%), and about a quarter in each wave said they have no need for it (Wave 1: 24.1%; Wave 2: 23.8%). When deciding to use this intervention, convenience was the most important consideration in both waves (Wave 1: 55.2%; Wave 2: 54.2%), followed by accessibility (Wave 1 only: 44.4%), privacy and confidentiality (Wave 1: 41.0%; Wave 2: 49.3%) and cost (Wave 2 only: 47.2%). Smaller numbers of health workers mentioned empowerment (Wave 1: 23.5%; Wave 2: 34.0%), not feeling judged (Wave 1: 23.9%; Wave 2: 30.6%) and legal restrictions (Wave 2 only: 16.0%) as important considerations. Laypersons: Over half of Wave 1 layperson respondents reported having heard of self-administered contraception and knowing where to access it (57.4%), compared with about a third of Wave 2 respondents (37.2%). The remaining participants in each wave reported knowing about it but not knowing where to access it (Wave 1: 21.1%; Wave 2: 34.6%), or not knowing what it is (Wave 1: 21.5%; Wave 2: 28.2%). A small minority of respondents reported that they or their partner had ever used self-administered contraceptives (in Wave 1, 0.8% had used it in the past 3 months and another 4.4% had used it previously; in Wave 2, 6.7% had ever used it). The majority reported not having used this intervention (Wave 1: 58.9%; Wave 2: 62.7%) and about a third reported not having a need for it (Wave 1: 35.8%; Wave 2: 30.7%). Regarding important considerations when deciding to use self- administered contraception, laypersons most often mentioned cost (Wave 2 only: 58.2%), accessibility (Wave 1 only: 53.3%) and convenience (Wave 1: 46.1%; Wave 2: 50.9%). Other considerations included privacy and confidentiality (Wave 1: 39.5%; Wave 2: 32.7%), feeling empowered (Wave 1: 27.0%; Wave 2: 25.5%), not feeling judged (Wave 1: 23.0%; Wave 2: 20.0%) and legal restrictions (Wave 2 only: 9.1%). Diaphragm or cervical cap Health workers: The majority of health worker respondents reported knowing about the diaphragm or cervical cap and where to access it (Wave 1: 73.4%; Wave 2: 57.1%), while a sizable minority reported knowing about it, but not how to access it (Wave 1: 21.0%; Wave 2: 34.7%), and the remainder reported not knowing what it is (Wave 1: 5.7%; Wave 2: 8.2%). Only a small proportion had ever used this contraceptive method (Wave 1: 6.1% [none in the past 3 months]; Wave 2: 9.6%), while the majority reported not having used it (Wave 1: 70.6%; Wave 2: 64.5%), and just under a quarter of health workers in each wave reported not having a need for it (Wave 1: 23.3%; Wave 2: 25.9%). The most important factors when deciding to use the diaphragm or cervical cap were convenience (Wave 1: 49.2%; Wave 2: 48.9%), privacy and confidentiality (Wave 1: 42.1%; Wave 2: 46.8%), cost (Wave 2 only: 44.6%) and accessibility (Wave 1 only: 44.9%). Smaller 35Chapter 3 numbers also mentioned empowerment (Wave 1: 22.8%; Wave 2: 32.4%), not feeling judged (Wave 1: 22.4; Wave 2: 25.9%) and legal restrictions (Wave 2: 16.0%). Laypersons: Among laypersons, just under two thirds of Wave 1 participants reported knowing what the diaphragm or cervical cap is and how to access it (Wave 1: 63.3%), compared with just under half of Wave 2 participants (Wave 2: 46.2%). The remaining participants reported knowing what it is but not how to access it (Wave 1: 24.7%; Wave 2: 32.1%), or not knowing what it is (Wave 1: 12.0%; Wave 2: 21.8%). A small minority of respondents reported that they themselves and/or their partner had ever used this method (in Wave 1, 0.8% had used it in the past 3 months and another 5.0% had used it previously; in Wave 2, 6.9% had ever used it). The majority reported not having used it (Wave 1: 59.2%; Wave 2: 65.8%) and about a quarter to a third reported not having a need for it (Wave 1: 35.0%; Wave 2: 27.4%). The most important factors when deciding to use a diaphragm or cervical cap were accessibility (Wave 1 only: 54.1%), convenience (Wave 1: 45.3%; Wave 2: 53.9%) and cost (Wave 2: 51.9%). Smaller numbers of laypersons also reported privacy and confidentiality (Wave 1: 34.5%; Wave 2: 26.9%), feeling empowered (Wave 1: 24.3%; Wave 2: 21.2%), not feeling judged (Wave 1: 23.0%; Wave 2: 21.2%) and legal restrictions (Wave 2: 9.6%) as important considerations. 3.1.3 Abortion Questions regarding self-management of medical abortion were asked in both waves of the survey. The findings are presented in Table 3.3 – please refer to the table as needed for details not included in the narrative summary. TABLE 3.3. AWARENESS AND EVER/RECENT USE OF, AND DECISION-MAKING CONSIDERATIONS ABOUT SELF-MANAGEMENT OF MEDICAL ABORTION, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT AND SURVEY WAVE SELF-MANAGEMENT OF MEDICAL ABORTION WAVE 1 WAVE 2 AWARENESS n=357 n=420 n=171 n=78 Aware of intervention and where to access it (%) 65.3 57.1 56.1 35.9 Aware of intervention but not where to access it (%) 28.0 33.6 33.9 51.3 Not aware of intervention (%) 6.7 9.3 9.9 12.8 USAGE n=345 n=361 n=166 n=74 I/my partner have used intervention (%) 5.5 6.9 10.2 8.1 I/my partner used in past 3 months (%) 0.6 0.6 - - I and my partner have not used intervention (%) 67.5 53.2 53.6 62.2 I don’t need to use this (%) 26.4 39.3 36.1 29.7 % respondents Health workers Layperson respondents KEY 36 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 SELF-MANAGEMENT OF MEDICAL ABORTION WAVE 1 WAVE 2 DECISION-MAKING CONSIDERATIONS n=261 n=144 n=141 n=59 Privacy and confidentiality (%) 65.6 59.0 61.0 61.0 Lack of judgement (%) 38.3 41.0 43.3 44.1 Empowerment (%) 31.8 27.8 29.8 37.3 Convenience (%) 43.7 32.6 39.0 39.0 Cost (%) - - 33.3 42.4 Legal restrictions (%) - - 42.6 30.5 Accessibility (%) 43.3 47.2 - - Note: Denominators (subtotals) vary across variables/rows because of non-response on some items. - Indicates that question or response option was not asked in a given wave. Self-management of medical abortion Health workers: Over half of health worker respondents reported knowing what self-management of medical abortion is and where to get it (Wave 1: 65.3%; Wave 2: 56.1%), while about a third reported knowing what it is but not how to access it (Wave 1: 28.0%; Wave 2: 33.9%) and small numbers were not aware of this self-care intervention (Wave 1: 6.7%; Wave 2: 9.9%). Few health workers reported having ever used this intervention (in Wave 1, 0.6% had used it in the past 3 months and another 5.5% had used it previously; in Wave 2, 10.2% had ever used it). Over half reported not having used it (Wave 1: 67.5%; Wave 2: 53.6%) and the remaining health workers reported not having a need for it (Wave 1: 26.4%; Wave 2: 36.1%). A sizable majority of health worker respondents in each wave reported privacy and confidentiality (Wave 1: 65.6%; Wave 2: 61.0%) as the most important consideration when deciding to use self-management of medical abortion. Large proportions of the respondents in both waves also mentioned other important considerations: accessibility (Wave 1 only: 43.3%), not feeling judged (Wave 1: 38.3%; Wave 2: 43.3%), legal restrictions (Wave 2 only: 42.6%), convenience (Wave 1: 43.7%; Wave 2: 39.0%), cost (Wave 2 only: 33.3%) and to feel empowered (Wave 1: 31.8%; Wave 2: 29.8%). Laypersons: Among laypersons in Wave 1, more than half reported having heard of self-management of medical abortion and knowing how to access it (57.1%), with an additional third reporting knowing what it is but not how to get it (33.6%). This was reversed among laypersons in Wave 2, with about a third knowing what it is and how to access it (35.9%) and another half knowing what it is but not how to access it (51.3%). Around 10% of participants in each wave reported not knowing what it is (Wave 1: 9.3%; Wave 2: 12.8%). Less than 10% of laypersons in each survey wave reported that they and/or their partner have ever used self-management of medical abortion (in Wave 1, 0.6% had used it in the past 3 months and another 6.9% had used it previously; in Wave 2, 8.1% had ever used it). Over half of laypersons reported not having used this intervention (Wave 1: 53.2%; Wave 2: 62.2%) and the remainder had no need for it (Wave 1: 39.3%; Wave 2: 29.7%). Laypersons most frequently mentioned privacy and confidentiality (Wave 1: 59.0%; Wave 2: 61.0%) as an important consideration when deciding to use self-management of medical abortion. Substantial numbers all mentioned accessability (Wave 1 only: 47.2%), not feeling judged (Wave 1: 41.0%; Wave 2: 44.1%), cost (Wave 2 only: 42.4%), convenience (Wave 1: 32.6%; Wave 2: 39.0%), feeling empowered (Wave 1: 27.8%; Wave 2: 37.3%) and legal restrictions (Wave 2: 30.5%). 3.1.4 Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities Questions regarding four of the interventions in this subsection were asked in both waves of the survey, while questions about two of them (HIV and STI treatment) were only asked in Wave 1 and questions about HPV self-sampling (for cervical cancer screening) were only asked in Wave 2. The findings are presented in Table 3.4 – please refer to these tables as needed for details not included in the narrative summary. 37Chapter 3 TABLE 3.4. AWARENESS, USAGE AND DECISION-MAKING OF SRH SELF-CARE INTERVENTIONS FOR SEXUALLY TRANSMITTED INFECTIONS (INCLUDING HIV), REPRODUCTIVE TRACT INFECTIONS, CERVICAL CANCER AND OTHER GYNAECOLOGICAL MORBIDITIES, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT AND SURVEY WAVE PrEP (PHARMACY ACCESS) PEP (PHARMACY ACCESS) WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS n=355 n=412 n=171 n=79 n=356 n=416 n=169 n=79 Aware of intervention and where to access it (%) 64.5 48.5 38.6 30.4 69.7 51.7 44.4 31.7 Aware of intervention but not where to access it (%) 25.4 25.5 44.4 25.3 21.1 23.6 38.5 26.6 Not aware of intervention (%) 10.1 26.0 17.0 44.3 9.3 24.8 17.2 41.8 USAGE n=343 n=361 n=166 n=77 n=344 n=359 n=167 n=77 I/my partner have used intervention (%) 2.0 1.7 3.6 6.5 3.8 2.5 7.8 7.8 I/my partner used in past 3 months (%) 1.7 1.4 - - 0.6 0.6 - - I and my partner have not used intervention (%) 66.2 64.8 64.5 61.0 66.3 64.3 61.7 59.7 I don’t need to use this (%) 30.0 32.1 31.9 32.5 29.4 32.6 30.5 32.5 DECISION-MAKING CONSIDERATIONS n=262 n=148 n=141 n=49 n=266 n=149 n=144 n=51 Privacy and confidentiality (%) 56.5 54.1 68.8 53.1 57.9 57.7 70.8 56.9 Lack of judgement (%) 33.6 30.4 39.0 42.9 32.0 29.5 38.9 37.3 Empowerment (%) 26.3 28.4 29.8 22.5 24.8 26.8 28.5 25.5 Convenience (%) 41.2 36.5 42.6 42.9 42.5 36.2 43.1 47.1 Cost (%) - - 40.4 44.9 - - 38.9 45.1 Legal restrictions (%) - - 14.9 10.2 - - 13.9 9.8 Accessibility (%) 43.1 48.6 - - 45.5 49.0 - - % respondents Health workers Layperson respondents KEY 38 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 HPV SELF-SAMPLING STI SELF-SAMPLING (NOT INCLUDING HIV OR HPV) WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS - - n=171 n=77 n=356 n=419 n=167 n=79 Aware of intervention and where to access it (%) - - 28.1 20.8 48.9 44.4 34.7 24.1 Aware of intervention but not where to access it (%) - - 46.2 35.1 36.2 36.0 44.9 51.9 Not aware of intervention (%) - - 25.7 44.2 14.9 19.6 20.4 24.1 USAGE - - n=168 n=75 n=346 n=362 n=167 n=77 I/my partner have used intervention (%) - - 7.7 4.0 9.2 7.2 11.4 7.8 I/my partner used in past 3 months (%) - - - - 3.2 2.8 - - I and my partner have not used intervention (%) - - 69.6 66.7 69.7 63.8 62.9 66.2 I don’t need to use this (%) - - 22.6 29.3 17.9 26.2 25.8 26.0 DECISION-MAKING CONSIDERATIONS - - n=148 n=36 n=280 n=157 n=146 n=56 Privacy and confidentiality (%) - - 63.5 60.7 61.4 65.6 67.8 64.3 Lack of judgement (%) - - 32.4 30.4 34.6 38.9 42.5 39.3 Empowerment (%) - - 22.3 25.0 26.1 30.6 32.2 23.2 Convenience (%) - - 50.7 44.6 47.9 40.8 45.9 55.4 Cost (%) - - 42.6 44.6 - - 32.9 46.4 Legal restrictions (%) - - 13.5 7.1 - - 13.7 10.7 Accessibility (%) - - - - 43.2 49.0 - - % respondents Health workers Layperson respondents KEY 39Chapter 3 HIV SELF-SAMPLING HIV TREATMENT WAVE 1 WAVE 2 WAVE 1 WAVE 2 AWARENESS n=357 n=417 n=171 n=79 n=356 n=419 - - Aware of intervention and where to access it (%) 56.9 48.9 42.1 31.7 89.9 72.8 - - Aware of intervention but not where to access it (%) 33.9 34.8 43.9 46.8 7.3 20.0 - - Not aware of intervention (%) 9.2 16.3 14.0 21.5 2.8 7.2 - - USAGE n=346 n=360 n=167 n=77 n=338 n=361 - - I/my partner have used intervention (%) 13.3 7.5 14.4 10.4 4.7 3.9 - - I/my partner used in past 3 months (%) 2.3 3.6 - - 0.6 1.1 - - I and my partner have not used intervention (%) 65.3 65.0 67.1 67.5 56.5 55.4 - - I don’t need to use this (%) 19.1 23.9 18.6 22.1 38.2 39.6 - - DECISION-MAKING CONSIDERATIONS n=278 n=156 n=144 n=58 n=262 n=150 - - Privacy and confidentiality (%) 64.4 64.1 73.6 63.8 59.2 57.3 - - Lack of judgement (%) 35.3 39.1 41.7 46.6 29.0 34.0 - - Empowerment (%) 24.8 27.6 32.6 24.1 23.7 26.0 - - Convenience (%) 46.8 39.7 46.5 55.2 40.5 36.7 - - Cost (%) - - 34.0 41.4 - - - - Legal restrictions (%) - - 13.9 8.6 - - - - Accessibility (%) 41.7 50.0 - - 42.0 51.3 - - % respondents 40 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 STI TREATMENT WAVE 1 WAVE 2 AWARENESS n=353 n=415 - - Aware of intervention and where to access it (%) 87.3 71.6 - - Aware of intervention but not where to access it (%) 7.9 16.4 - - Not aware of intervention (%) 4.8 12.0 - - USAGE n=345 n=356 - - I/my partner have used intervention (%) 15.4 11.2 - - I/my partner used in past 3 months (%) 1.2 2.5 - - I and my partner have not used intervention (%) 52.5 50.0 - - I don’t need to use this (%) 31.0 36.2 - - DECISION-MAKING CONSIDERATIONS n=268 n=156 - - Privacy and confidentiality (%) 60.1 60.3 - - Lack of judgement (%) 32.1 35.3 - - Empowerment (%) 22.8 23.1 - - Convenience (%) 41.0 39.1 - - Cost (%) - - - - Legal restrictions (%) - - - - Accessibility (%) 43.3 54.5 - - HPV: human papillomavirus; PEP: post-exposure prophylaxis; PrEP: pre-exposure prohylaxis; STI: sexually transmitted infection Note: Denominators (subtotals) vary across variables/rows because of non-response of some items. - Indicates that question or response option was not asked in a given wave. % respondents Health workers Layperson respondents KEY 41Chapter 3 Pre-exposure prophylaxis (PrEP) Health workers: Among health worker respondents in Wave 1, almost two thirds reported having heard of PrEP and knowing where to get it (64.5%), while this was reported by only about a third of Wave 2 respondents (38.6%). The remaining health workers reported knowing what it is but not how to access it (Wave 1: 25.4%; Wave 2: 44.4%), or not knowing what it is (Wave 1: 10.1%; Wave 2: 17.0%). Very few health workers reported that they and/or their partner had ever used PrEP (Wave 1: 1.7% in the past 3 months and another 2.0% previously; Wave 2: 3.6%). Instead, most reported they had not used it (Wave 1: 66.2%; Wave 2: 64.5%) or that it was not relevant for them (Wave 1: 30.0%; Wave 2: 31.9%). The most important factors for deciding to use PrEP were privacy and confidentiality (Wave 1: 56.5%; Wave 2: 68.8%), accessibility (Wave 1 only: 43.1%), convenience (Wave 1: 41.2%; Wave 2: 42.6%) and cost (Wave 2 only: 40.4%). Smaller numbers also mentioned not feeling judged (Wave 1: 33.6%; Wave 2: 39.0%), feeling empowered (Wave 1: 26.3%; Wave 2: 29.8%) and legal restrictions (Wave 2: 14.9%) as important considerations. Laypersons: A third to half of layperson respondents reported knowing about PrEP and how to access it (Wave 1: 48.5%; Wave 2: 30.4%), with an additional quarter reporting knowing what it is but not how to access it (Wave 1: 25.5%; Wave 2: 25.3%). Additionally, 26.0% of Wave 1 laypersons did not know what PrEP is, while this was 44.3% among Wave 2 respondents. A small minority of respondents reported that they themselves and/or their partner had ever used PrEP (Wave 1: 1.4% in the past 3 months and another 1.7% previously; Wave 2: 6.5%), but over 60% had never used this intervention (Wave 1: 64.8%; Wave 2: 61.0%) and a third had no need for it (Wave 1: 32.1%; Wave 2: 32.5%). The most important factors for deciding to use PrEP were privacy and confidentiality (Wave 1: 54.1%; Wave 2: 53.1%), accessibility (Wave 1 only: 48.6%), cost (Wave 2 cost: 44.9%), convenience (Wave 1: 36.5%; Wave 2: 42.9%) and not feeling judged (Wave 1: 30.4%; Wave 2: 42.9%). Smaller numbers of laypersons also reported feeling empowered (Wave 1: 28.4%; Wave 2: 22.5%) and legal restrictions (Wave 2: 10.2%) as key considerations. Post-exposure prophylaxis (PEP) Health workers: Over two thirds of Wave 1 health worker respondents reported knowing about PEP and where to access it (69.7%), compared with less than half of those in Wave 2 (44.4%). A sizable minority in both waves reported knowing about PEP but did not know where to access it (Wave 1: 21.1%; Wave 2: 38.5%), with the remaining respondents reporting not knowing what it is (Wave 1: 9.3%; Wave 2: 17.2%). Few participants reported that they and/or their partner have ever used PEP (Wave 1: 0.6% in the past 3 months and another 3.8% previously; Wave 2: 7.8%), while the majority reported not having used PEP (Wave 1: 66.3%; Wave 2: 61.7%), or not having a need for it (Wave 1: 29.4%; 4 Questions regarding HPV self-sampling were only asked in Wave 2. Wave 2: 30.5%). For health workers, the most important factors when deciding to use PEP were privacy and confidentiality (Wave 1: 57.9%; Wave 2: 70.8%), accessibility (Wave 1 only: 45.5%) and convenience (Wave 1: 42.5%; Wave 2: 43.1%). Substantial numbers also mentioned cost (Wave 2 only: 38.9%), not feeling judged (Wave 1: 32.0%; Wave 2: 38.9%), and feeling empowered (Wave 1: 24.8%; Wave 2: 28.5%), while a few mentioned legal restrictions (Wave 2 only: 13.9%). Laypersons: Among laypersons, about half of Wave 1 participants reported knowing what PEP is and how to access it (51.7%), compared with about a third of Wave 2 participants (31.7%). About a quarter of respondents in each wave reported knowing what PEP is but not how to access it (Wave 1: 23.6%; Wave 2: 26.6%) and another quarter of Wave 1 respondents reported not knowing what it is (24.8%), compared with 41.8% in Wave 2. Few layperson respondents reported that they and/ or their partner had ever used PEP (Wave 1: 0.6% in the past 3 months and another 2.5% previously; Wave 2: 7.8%), while the majority of respondents reported not having used this intervention (Wave 1: 64.3%; Wave 2: 59.7%), or not having a need for it (Wave 1: 32.6%; Wave 2: 32.5%). The most important factors when deciding to use PEP were privacy and confidentiality (Wave 1: 57.7%; Wave 2: 56.9%), accessibility (Wave 1 only: 49.0%), convenience (Wave 1: 36.2%; Wave 2: 47.1%) and cost (Wave 2 only: 45.1%). Some participants also reported that not feeling judged (Wave 1: 29.5%; Wave 2: 37.3%), feeling empowered (Wave 1: 26.8%; Wave 2: 25.5%) and legal restrictions (Wave 2 only: 9.8%) influenced their decisions. HPV self-sampling4 Health workers: Among health worker respondents, just over a quarter reported awareness of HPV self-sampling and how to access it (28.1%), almost half reported knowing what it is but not how to access it (46.2%) and another quarter reported not knowing what it is (25.7%). Very few health workers reported that they themselves and/or their partner had ever used HPV self-sampling (7.7%), while more than two thirds had never used it (69.6%) and 22.6% reported not having a need for it. The factors most commonly reported as being important when deciding to use HPV self-sampling were privacy and confidentiality (63.5%), convenience (50.7%) and cost (42.6%). Smaller numbers of health workers also mentioned not feeling judged (32.4%), feeling empowered (22.3%) and legal restrictions (13.5%). Laypersons: Among layperson respondents, 20.8% reported knowing about HPV self-sampling and how to access it, 35.1% reported knowing what it is but not how to access it and 44.2% reported not know what it is. Only three laypersons reported that they and/or their partner had ever used HPV self-sampling (4.0%), while two thirds reported not having used it (66.7%) and almost a third reported not having a need for it (29.3%). Factors influencing decisions about using HPV self-sampling were privacy and confidentiality (60.7% of respondents), convenience (44.6%), cost (44.6%), not feeling judged (30.4%), feeling empowered (25.0%) and legal restrictions (7.1%). 42 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 STI self-sampling (not including HIV or HPV) Health workers: In Waves 1 and 2, between a third to half of health worker respondents reported being aware of STI self-sampling and where to access it (Wave 1: 48.9%; Wave 2: 34.7%), with similar proportions reporting awareness of it but not how to access it (Wave 1: 36.2%; Wave 2: 44.9%), while the remaining respondents were unaware of this self-care intervention (Wave 1: 14.9%; Wave 2: 20.4%). Just over 10% of health workers in each wave reported that they and/or their partner had ever used STI self-sampling (Wave 1: 3.2% in the past 3 months and another 9.2% previously; Wave 2: 11.4%), while around two thirds reported not having used it (Wave 1: 69.7%; Wave 2: 62.9%), and some said they had no need for it (Wave 1: 17.9%; Wave 2: 25.8%). Factors mentioned as important when deciding to use STI self-sampling were privacy and confidentiality (Wave 1: 61.4%; Wave 2: 67.8%), convenience (Wave 1: 47.9 %; Wave 2: 45.9%), accessibility (Wave 1 only: 43.2%) and not feeling judged (Wave 1: 34.6%; Wave 2: 42.5%). Some health workers also mentioned cost (Wave 2 only: 32.9%), feeling empowered (Wave 1: 26.1%; Wave 2: 32.2%) and legal restrictions (Wave 2: 13.7%). Laypersons: Among laypersons, almost half in Wave 1 (44.4%) and a quarter in Wave 2 (Wave 2: 24.1%) reported knowing about STI self-sampling and where to get it, while about a third of respondents in Wave 1 (36.0%) and half in Wave 2 (51.9%) reported knowing about it but not where to access it, and the remainder reported not knowing about this intervention (Wave 1: 19.6%; Wave 2: 24.1%). A small proportion reported that they or their partner had ever used STI self-sampling (Wave 1: 2.8% in the past 3 months and another 7.2% previously; Wave 2: 7.8%), while two thirds reported not having used it (Wave 1: 63.8%; Wave 2: 66.2%) and the remainder reported not needing it (Wave 1: 26.2%; Wave 2: 26.0%). Factors mentioned as important considerations when deciding to use STI self-sampling included privacy and confidentiality (Wave 1: 65.6%; Wave 2: 64.3%), convenience (Wave 1: 40.8%; Wave 2: 55.4%), accessibility (Wave 1 only: 49.0%), cost (Wave 2 only: 46.4%). Some also mentioned not feeling judged (Wave 1: 38.9%; Wave 2: 39.3%), empowerment (Wave 1: 30.6%; Wave 2: 23.2%) and legal restrictions (Wave 2 only: 10.7%). HIV self-sampling Health workers: Around half of health workers in each wave reported knowing about HIV self-sampling and where to access it (Wave 1: 56.9%; Wave 2: 42.1%), while a sizable proportion reported knowing about it but not how to access it (Wave 1: 33.9%; Wave 2: 43.9%) and a smaller minority reported not knowing what it is (Wave 1: 9.2%; Wave 2: 14.0%). In terms of usage, about 15% of health workers in each wave reported that they and/or their partner had ever used HIV self-sampling (Wave 1: 2.3% in the past 3 months and another 13.3% previously; Wave 2: 14.4%), while about two thirds reported not having used it (Wave 1: 65.3%; Wave 2: 67.1%) and just under a fifth had not need for it 5 Questions regarding HIV treatment were only asked in Wave 1. (Wave 1: 19.1%; Wave 2: 18.6%). The most important factors when deciding to use HIV self-sampling were privacy and confidentiality (Wave 1: 64.4%; Wave 2: 73.6%), convenience (Wave 1: 46.8%; Wave 2: 46.5%), accessibility (Wave 1 only: 41.7%) and not feeling judged (Wave 1: 35.3%; Wave 2: 41.7%). Smaller numbers also mentioned cost (Wave 2 only: 34.0%), empowerment (Wave 1: 24.8%; Wave 2: 32.6%) and legal restrictions (Wave 2 only: 13.9%). Laypersons: Half of Wave 1 and a third of Wave 2 laypersons reported knowing what HIV self-sampling is and how to access it (Wave 1: 48.9%; Wave 2: 31.7%), while about a third of those in Wave 1 and half in Wave 2 reported knowing what it is but not how to access it (Wave 1: 34.8%; Wave 2: 46.8%) and the remainder reported not knowing what it is (Wave 1: 16.3%; Wave 2: 21.5%). About 10% of laypersons reported they and/ or their partner have ever used HIV self-sampling (Wave 1: 3.6% in the past 3 months and another 7.5% previously; Wave 2: 10.4%). Two thirds reported not having used it (Wave 1: 65.0%; Wave 2: 67.5%) and just under a quarter had no need for it (Wave 1: 23.9%; Wave 2: 22.1%). The most important factors influencing decisions for using HIV self-sampling were privacy and confidentiality (Wave 1: 64.1%; Wave 2: 63.8%), accessibility (Wave 1 only: 50.0%), convenience (Wave 1: 39.7%; Wave 2: 55.2%) and not feeling judged (Wave 1: 39.1%; Wave 2: 46.6%). Smaller numbers also mentioned the importance of cost (Wave 2 only: 41.4%), feeling empowered (Wave 1: 27.6%; Wave 2: 24.1%) and legal restrictions (Wave 2: 8.6%). HIV treatment (i.e. antiretroviral therapy; ART)5 Health workers: The vast majority of health worker respondents reported knowing about ART and where to get it (89.9%), while less than 10% of respondents knew about it but not how to access it (7.3%), and just 2.8% did not know what it is. Few health worker respondents reported that they and/or their partner had ever used ART (0.6% in the past 3 months and another 4.7% had used it previously), while over half reported not having used it (56.5%) and over a third reported not having a need for it (38.2%). For health workers, the most important factors when deciding to use ART were privacy and confidentiality (59.2%), accessibility (42.0%) and convenience (40.5%). Some also mentioned not feeling judged (29.0%) and feeling empowered (23.7%). Laypersons: Almost three quarters of layperson respondents reported knowing about ART and how to access it (72.8%), while a fifth reported knowing about it but not how to access it (20.0%), and the remaining participants reported not knowing what it is (7.2%). A small minority of respondents and/or their partners had ever used ART (1.1% in the past 3 months and another 3.9% had used it previously) while just over half had not used it (55.4%), and over a third reported not having a need for it (39.6%). For laypersons’ decisions to use HIV treatment, the most endorsed factors were privacy and confidentiality (57.3%), accessibility (51.3%) and convenience (36.7%). Additional factors were not feeling judged was (34.0%) and feeling empowered (26.0%). 43Chapter 3 Medical treatment for STIs6 Health workers: The vast majority of health worker respondents reported knowing about STI medical treatment and where to access it (87.3%), while a small minority reported knowing about it but not where to get it (7.9%), or not knowing what it is (4.8%). A minority of health workers and/or their partners had ever used STI treatment (1.2% had used it in the past 3 months and another 15.4% had used it previously), while over half had never used it (52.5%) and nearly a third reported not having a need for it (31.0%). The most important factors when deciding to use STI treatment were privacy and confidentiality (60.1%), accessibility (43.3%) and convenience (41.0%). Some participants also mentioned the importance of not feeling judged (32.1%) and feeling empowered (22.8%). 6 Questions regarding STI medical treatment were only asked in Wave 1. Laypersons: Just under three quarters of laypersons reported knowing about STI treatment and how to access it (71.6%), while the remainder reported knowing about it but not how to access it (16.4%), or not knowing what it is (12.0%). A minority of laypersons reported that they and/ or their partners had ever used STI treatment (2.5% in the past 3 months and another 11.2% previously) while half had not used it (50.0%) and just over a third reported not having a need for it (36.2%). The factors most commonly mentioned as important when deciding to use STI treatment were privacy and confidentiality (60.3%) and accessibility (54.5%), while substantial numbers also mentioned convenience (39.1%), not feeling judged (35.3%) and feeling empowered (23.1%). 44 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 TABLE 3.5. AWARENESS, EVER USE, AND DECISION-MAKING FACTORS FOR USE OF SRH SELF-CARE INTERVENTIONS FOR PROMOTING SEXUAL HEALTH, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT (WAVE 2 ONLY, 2020–2021) LUBRICANTS FOR SEXUAL HEALTH HORMONE THERAPY FOR GENDER AFFIRMATION WAVE 2 ONLY WAVE 2 ONLY AWARENESS n=168 n=76 n=166 n=77 Aware of intervention and where to access it (%) 84.5 85.5 32.5 29.9 Aware of intervention but not where to access it (%) 9.5 10.5 46.4 41.6 Not aware of intervention (%) 6.0 4.0 21.1 28.6 USAGE n=164 n=74 n=165 n=73 I/my partner have used intervention (%) 63.4 59.5 3.6 2.7 I and my partner have not used intervention (%) 22.0 27.0 34.6 37.0 I don’t need to use this (%) 14.6 13.5 61.8 60.3 DECISION-MAKING CONSIDERATIONS n=146 n=57 n=119 n=44 Privacy and confidentiality (%) 52.7 36.8 56.3 52.3 Lack of judgement (%) 29.5 26.3 42.9 40.9 Empowerment (%) 33.6 31.6 35.3 29.6 Convenience (%) 54.8 47.4 30.3 36.4 Cost (%) 40.4 52.6 32.8 45.5 Legal restrictions (%) 5.5 7.0 33.6 36.4 Note: Denominators (subtotals) vary across variables/rows because of non-response on some items. - Indicates that question or response option was not asked in a given wave. % respondents Health workers Layperson respondents KEY 3.1.5 Promoting sexual health Questions regarding the interventions in this subsection – lubricant and hormone therapy for gender affirmation – were only asked in Wave 2 of the survey and were not asked in Wave 1. The findings are presented in Table 3.5 – please refer to the table as needed for details not included in the narrative summary. 45Chapter 3 Lubricants for sexual health Health workers: Almost all health worker respondents reported having heard of lubricant and knowing where to access it (84.5%), although small numbers reported knowing what it is but not how to access it (9.5%) or not knowing what it is (6.0%). Over half of the health workers reported that they themselves and/or their partner have used lubricant (63.4%), while a minority reported not having used lubricant (22.0%) or not needing it (14.6%). The most important factors when deciding to use lubricant were convenience (54.8%), privacy and confidentiality (52.7%) and cost (40.4%). Smaller numbers mentioned the importance of empowerment (33.6%) and not feeling judged (29.5%) and several mentioned legal restrictions (5.5%). Laypersons: Almost all layperson respondents were aware of lubricant and how to access it (85.5%), with another 10.5% reporting knowing what it is but not how to access it while a few were not aware of it (4.0%). Over half of laypersons and/ or their partners had used lubricant (59.5%), while 27.0% reported not having used this intervention and 13.5% reported not having a need for it. The main factors mentioned as important when deciding to use lubricant were cost (52.6%) and convenience (47.4%), while substantial numbers also mentioned privacy and confidentiality (36.8%), empowerment (31.6%) and not feeling judged (26.3%), and just a few mentioned legal restrictions (7.0%). Hormone therapy for gender affirmation Health workers: A third of health worker respondents reported knowledge of hormone therapy for gender affirmation and how to access it (32.5%), while almost half reported knowing what it is but not how to access it (46.4%) and about a fifth reported not knowing what it is (21.1%). A very small number of health workers reported that they and/or their partner have used this intervention (3.6%), while a third reported not having used it (34.6%) and the majority indicated having no need for it (61.8%). The most important considerations when deciding to use hormone therapy for gender affirmation were privacy and confidentiality (56.3%) and lack of judgement (42.9%), but substantial numbers also mentioned empowerment (35.3%), legal restrictions (33.6%), cost (32.8%) and convenience (30.3%). Laypersons: Just under a third of layperson respondents reported knowing what hormone therapy for gender affirmation is and how to access it (29.9%) and about the same number don’t know what it is (28.6%), but the largest proportion reported knowing what it is but not how to access it (41.6%). Just a couple of laypersons reported that they themselves and/or their partner had used this intervention (2.7%), while over a third reported they had not used it (37.0%) and most said they had no need for it (60.3%). Laypersons reported that important factors for deciding to use hormone therapy for gender affirmation were privacy and confidentiality (52.3%), cost (45.5%) and not feeling judged (40.9%). Smaller numbers of respondents mentioned the importance of legal restrictions (36.4%), convenience (36.4%) and empowerment (29.6%). 46 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 3.1.6 SRH information online and via mobile applications Questions regarding the interventions in this subsection were only asked in Wave 1 of the survey. The findings are presented in Table 3.6 – please refer to these tables as needed for details not included in the narrative summary. TABLE 3.6. AWARENESS, EVER USE, AND DECISION-MAKING FACTORS OF SRH SELF-CARE INTERVENTIONS/INFORMATION AVAILABLE ONLINE AND VIA MOBILE APPLICATIONS (APPS), AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY TYPE OF RESPONDENT (WAVE 1 ONLY, 2018) ONLINE REPRODUCTIVE HEALTH (RH) INFORMATION MOBILE REPRODUCTIVE HEALTH (RH) APPS WAVE 1 ONLY WAVE 1 ONLY AWARENESS n=356 n=420 n=355 n=420 Aware of intervention and where to access it (%) 91.0 87.9 56.1 53.8 Aware of intervention but not where to access it (%) 5.6 7.4 26.8 22.9 Not aware of intervention (%) 3.4 4.8 17.2 23.3 USAGE n=347 n=365 n=341 n=362 I/my partner have used intervention (%) 54.8 45.5 17.6 20.4 I/my partner used it in the past 3 months (%) 11.2 10.1 7.0 2.8 I and my partner have not used online RH information (%) 22.2 24.1 57.2 51.1 I don’t need to use this (%) 11.8 20.3 18.2 25.7 DECISION-MAKING CONSIDERATIONS n=276 n=156 n=267 n=153 Privacy and confidentiality (%) 44.2 41.0 40.8 42.5 Lack of judgement (%) 24.6 24.4 21.7 19.0 Empowerment (%) 31.2 24.4 31.1 24.8 Convenience (%) 47.5 45.5 50.6 45.8 Accessibility (%) 54.7 58.3 50.2 54.2 % respondents Health workers Layperson respondents KEY 47Chapter 3 ONLINE SEXUAL HEALTH (SH) INFORMATION MOBILE SEXUAL HEALTH (SH) APPS WAVE 1 ONLY WAVE 1 ONLY AWARENESS n=355 n=420 n=357 n=422 Aware of intervention and where to access it (%) 89.6 87.1 47.3 41.7 Aware of intervention but not where to access it (%) 6.5 8.3 29.4 27.7 Not aware of intervention (%) 3.9 4.5 23.2 30.6 USAGE n=347 n=364 n=344 n=363 I/my partner have used intervention (%) 53.3 46.4 12.2 12.7 I/my partner used it in the past 3 months (%) 10.7 10.2 3.5 2.8 I and my partner have not used online RH information (%) 24.8 25.5 66.0 60.3 I don’t need to use this (%) 11.2 17.9 18.3 24.2 DECISION-MAKING CONSIDERATIONS n=276 n=155 n=268 n=154 Privacy and confidentiality (%) 46.4 40.6 41.0 42.2 Lack of judgement (%) 25.0 24.5 22.8 19.5 Empowerment (%) 31.5 23.9 29.1 24.0 Convenience (%) 46.4 45.8 50.0 46.1 Accessibility (%) 54.3 58.7 50.0 53.9 Note: Denominators (subtotals) vary across variables/rows because of non-response on some items. - Indicates that question or response option was not asked in a given wave. % respondents Health workers Layperson respondents KEY Online reproductive health information Health workers: The vast majority of health worker respondents reported knowing about online reproductive health (RH) information and how to access it (91.0%), while the remainder reported knowing what it is but not know how to access it (5.6%), or not knowing what it is (3.4%). Over half of health workers reported that they and/or their partner had ever accessed online RH information (11.2% in the past 3 months and another 54.8% previously), while the remainder either had not used it (22.2%) or had no need for it (11.8%). Health workers mentioned the following important considerations when deciding to use online RH information: accessibility (54.7%), convenience (47.5%), privacy and confidentiality (44.2%), empowerment (31.2%) and not feeling judged (24.6%). Laypersons: The vast majority of laypersons also reported knowing about online RH information and how to access it (87.9%), while 7.4% reported knowing what it is but not how to access it and 4.8% did not know what it is. Over half of respondents reported that they and/or their partner had ever 48 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 used online RH information (10.1% in the past 3 months and another 45.5% previously). About a quarter reported not having used it (24.1%), while another fifth reporting not having a need for it (20.3%). Important considerations when deciding to use online RH information were being able to access it (58.3%), convenience (45.5%), privacy and confidentiality (41.0%), not feeling judged (24.4%) and to feel empowered (24.4%). Mobile reproductive health apps Health workers: More than half of health worker respondents reported knowing about mobile RH apps and where to access them (56.1%). Over a quarter reported knowing what they are but not how to access them (26.8%), while the remainder did not know what they are (17.2%). About a quarter of health worker respondents and/or their partners had ever used a mobile RH app (7.0% in the past 3 months and another 17.6% previously). Over half had not used this type of app (57.2%) and 18.2% reported not having a need for this. The top considerations when deciding to use a mobile RH phone app among health worker respondents were convenience (50.0%), being able to access it (50.2%), and privacy and confidentiality (40.8%). Smaller numbers also mentioned that using mobile RH apps was important to feel empowered (31.1%) and not to feel judged (21.7%). Laypersons: Over half of layperson respondents reported knowing what mobile RH apps are and how to access them (53.8%), while about a fifth of respondents reported knowing what they are but not how to access them (22.9%) or not knowing what they are (23.3%). Over a fifth of respondents reported that they and/or their partners had ever used a mobile RH app (2.8% in the past 3 months and another 20.4% previously). Over half of respondents had not used them (51.1%), while about a quarter reported not having a need for them (25.7%). The most commonly mentioned factors considered important when deciding to use a mobile RH app were being able to access them (54.2%), convenience (45.8%) and privacy and confidentiality (42.5%). Some also mentioned to feel empowered (24.8%) and not to feel judged (19.0%). Online sexual health information Health workers: The vast majority of health worker respondents reporting knowing about online sexual health (SH) information and where to access it (89.6%), while about 10% were aware of it but not how to access it (6.5%) or were unaware of it (3.9%). Almost two thirds of health workers had used online SH information (10.7% in the past 3 months and another 53.3% previously), while a quarter had not used it (24.8%) and 11.2% reported not needing it. Among health workers, the most important considerations when deciding to use online SH information were accessibility (54.3%), convenience (46.4%) and privacy and confidentiality (46.4%), while some also mentioned empowerment (31.5%) and not feeling judged (25.0%). Laypersons: The vast majority of laypersons reported knowing about online SH information and how to access it (87.1%), while a minority knew what it was but not how to access it (8.3%) or were unaware of it (4.5%). Over half of respondents reported having used online SH information (10.2% in the past 3 months and another 46.4% previously). About a quarter had not used this service (25.5%) and 17.9% reported not having a need for it. The most common considerations reported by laypersons when deciding to use online SH information were being able to access it (58.7%), convenience (45.8%) and privacy and confidentiality (40.6%). About a quarter also felt that not feeling judged (24.5%) and feeling empowered (23.9%) were important factors. Mobile sexual health apps Health workers: Just under half of health worker respondents had heard of mobile SH apps and knew where to access them (47.3%), while almost a third reported knowing about them but not how to access them (29.4%), and almost a quarter reported not knowing what they are (23.2%). About 15% of health workers had used a mobile SH app (3.5% in the past 3 months and another 12.2% previously), while two thirds had not used one (66.0%) and the remainder reported not having a need for it (18.3%). The most important considerations for using a mobile SH app were convenience (50.0%), accessibility (50.0%) and privacy and confidentiality (41.0%). Some respondents also mentioned empowerment (29.1%) and not feeling judged (22.8%). Laypersons: Among layperson respondents, 41.7% reported knowing about mobile SH apps and how to access them, while a quarter were aware of them but not how to access them (27.7%) and nearly a third reported not knowing what they are (30.6%). A minority of respondents reported ever using a mobile SH app (2.8% in the past 3 months and another 12.7% previously), while almost two thirds had not used them (60.3%) and an additional quarter reporting not needing them (24.2%). For laypersons, the top considerations when deciding to use a mobile SH app were accessibility (53.9%), convenience (46.1%) and privacy and confidentiality (42.2%). Some participants also mentioned the importance of feeling empowered (24.0%) and not feeling judged (19.5%). Artwork fro m th is w ork sho p c om m un ity 49Chapter 3 Artwork fro m th is w ork sho p c om m un ity African and Caribbean women service providers The participants at this workshop were young women of African or Caribbean descent living in Toronto, Canada. All of the participants work in the community or public health sector and have at least a high school education. Two thirds of the group actively shared and participated in the discussion. The key issues that emerged include: 1. In Canada, African and Caribbean Black women face high levels of stigma, racism and judgement that deter them from accessing health care and services. 2. Health-care centres are not easily accessible to these communities because distance and clinic hours are inconvenient. 3. Community Health Ambassadors can potentially overcome many of the cultural barriers to health care by speaking the same language and being present in the communities they serve. 4. The community lacks trust in doctors and the health- care system. This lack of trust is embedded in their culture with roots in the exploitative history lived by African communities. 5. Women feel they are expected to uphold the image of a “strong Black female” – always putting their family’s needs before their own. While they value self-reliance, which could serve as a springboard for self-care, it is uncommon in their cultures to talk openly about health or mental health. 6. Intimate partner violence is prevalent but many women do not realize that their relationship is violent and lack positive examples of healthy relationships. HIGHLIGHTS FROM COMMUNITY WORKSHOPS Benefits and barriers to self-care interventions People can avoid judgement and stigma through the more confidential and anonymous nature of self-care products and services. Access is needed to wide community networks and peers who speak their language. Literacy poses a barrier to reading and following directions for medication. Lack of knowledge and awareness about self-care products and services poses a barrier. 49 50 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 Transgender people, male and transgender sex workers, and men who have sex with men Resource mapping and graffiti tools were used to support dialogue and gather information at this workshop in India, which had 15 participants. The key issues raised by the participants included: 1. The community often visits unqualified practitioners and gurus (i.e. community leaders) for treatment, health- care advice and sex reassignment surgery (SRS). Those who are literate rely on social media and the Internet for information. 2. They also self-medicate, re-use and exchange prescriptions for treatment of STIs and common ailments. 3. This community is largely faceless, voiceless and highly marginalized by society. 4. Debt is ubiquitous among the participants because of the high cost of care and SRS, forcing them into sex work and putting them at greater risk of HIV and STIs. 5. Outward beauty and appearance is often emphasized over health. 6. The community strongly feels the need for reliable transgender resources (health, legal and others) and the need to sensitize health-care providers. 7. The community wants access to safe HIV and STI testing facilities. 8. The government health system is not trusted due to stigma, discrimination and the fear of breach of confidentiality. Government hospitals are often the last resort for help. 9. The National AIDS Control Organization and the governmental AIDS programmes do not encourage self-testing as they are concerned that the community may not access treatment if needed. Therefore, the community is not aware that HIV self-testing and other self-testing kits exist. A rtw ork from this w orkshop com m unity HIGHLIGHTS FROM COMMUNITY WORKSHOPS Educated men who have sex with men, male sex workers and transgender people access health-care information online, allowing them to manage interventions on their own and guide their peers. There is no stigma or fear of disclosure in accessing self-care products. There is no support system to guide the community in case of failure or complications as a result of using self-care products. Since many of the services the community accesses are illegal, there is no recourse or remedial measure available when self-care products fail. Benefits and barriers to self-care interventions Global Values a d Prefe nces Survey report 51Chapter 3 20.7% 36.3% 38.5% 4.4% A rtw ork from this w orkshop com m unity SELF-MONITORING/HOME- MONITORING OF BLOOD GLUCOSE LEVELS DURING PREGNANCY SELF-MONITORING/HOME- MONITORING OF PROTEINURIA DURING PREGNANCY FIGURE 3.1: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS AT-HOME PREGNANCY TEST SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (FOLIC ACID) DURING PREGNANCY PLANNING QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 50.9%82.8% 58.6% 31.0% 36.5% 41.7% 23.3% 27.0% 11.2% 25.0% 10.3% 19.8% Feel confident and informed Need more information Need training 3.2 HEALTH WORKERS’ EXPERIENCE OF AND CONFIDENCE ABOUT PROVIDING SERVICES RELATED TO SELF-CARE INTERVENTIONS FOR SRHR, AND RELATED CONCERNS AND BENEFITS In this section, collated quantitative findings are presented for survey questions that were asked exclusively to health worker respondents about their experiences with, their knowledge levels about and their perspectives on a range of self-care interventions for SRHR. The data are derived from questions asking the health workers (i) if they had ever provided services (i.e. referrals, prescriptions, information) for any of the listed interventions; (ii) how confident and informed they felt about providing such services for the listed interventions; (iii) if they had any concerns about providing these services for each intervention; and (iv) what they perceive as the benefits of each intervention. For the questions about concerns and benefits, participants could select all the answers that applied. As in section 3.1, the findings are both provided in tables and summarized in narrative form, grouped under six subsections by type of intervention: (3.2.1) Antenatal, intrapartum and postnatal care; (3.2.2) Family planning; (3.2.3) Abortion; (3.2.4) Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (3.2.5) Promoting sexual health; and (3.2.6) SRH information online and via mobile apps. 3.2.1 Antenatal, intrapartum and postnatal care Questions regarding all seven of the interventions in this subsection were added in Wave 2 of the survey and not asked in Wave 1. The findings are presented in Figure 3.1, 3.2 and 3.3 – please refer to these figures as needed for details not included in the narrative summary. 11.9% 53.7% 32.8% 1.5% 17.8% 43.7% 38.5% 0.0% 26.1% 26.9% 39.6% 7.5% KEY YesNoIt is not related to my jobIt is not available where I live 52 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 18.7% 41.0% 38.8% 1.5% 12.6% 48.2% 37.8% 1.5% SELF-MONITORING/HOME- MONITORING OF BLOOD PRESSURE DURING PREGNANCY SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (IRON AND FOLIC ACID) POSTPARTUM I feel confident and informed I need more information I need training to provide this service/referral KEY Yes No It is not related to my job It is not available where I live 56.9%61.4% 62.1% 27.6% 19.8% 23.7% 21.6% 19.3% 19.8% SELF-MANAGEMENT OF NUTRITION SUPPLEMENTS (IRON AND FOLIC ACID) DURING PREGNANCY FIGURE 3.2: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety Quality of product Incorrect use Reducing health care access At-home pregnancy test 21.4% 32.9% 47.1% 38.6% Self-management of nutrition supplements (folic acid) during pregnancy planning 31.9% 29.2% 40.3% 36.1% Self-management of nutrition supplements (iron and folic acid) during pregnancy 31.4% 31.4% 41.4% 37.1% Self-management of nutrition supplements (iron and folic acid) postpartum 31.4% 28.6% 42.9% 40.0% Self-monitoring/ home-monitoring of blood glucose levels during pregnancy 25.6% 18.0% 57.7% 39.7% Self-monitoring/ home-monitoring of proteinuria during pregnancy 23.5% 18.5% 50.6% 44.4% Self-monitoring/ home-monitoring of blood pressure during pregnancy 24.4% 25.6% 53.9% 42.3% 17.8% 43.0% 38.5% 0.7% 53Chapter 3 FIGURE 3.3: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions Convenient for client Reduces barriers for client Reduces health worker workload Empowering for client Less expensive for client At-home pregnancy test 75.9% 39.1% 59.8% 50.6% 37.9% Self-management of nutrition supplements (folic acid) during pregnancy planning 73.1% 23.1% 51.3% 44.9% 32.1% Self-management of nutrition supplements (iron and folic acid) during pregnancy 72.2% 21.5% 54.4% 43.0% 35.4% Self-management of nutrition supplements (iron and folic acid) postpartum 70.9% 21.5% 55.7% 41.8% 34.2% Self-monitoring/ home-monitoring of blood glucose levels during pregnancy 69.3% 29.3% 52.0% 48.0% 33.3% Self-monitoring/ home-monitoring of proteinuria during pregnancy 66.2% 28.2% 53.5% 49.3% 26.8% Self-monitoring/ home-monitoring of blood pressure during pregnancy 71.4% 22.1% 53.3% 45.5% 33.8% At-home pregnancy test About half (53.7%) of health worker respondents reported they have provided services7 for at-home pregnancy testing, while 11.9% have not. Only two participants reported it was not available where they live (1.5%) and one third of them reported it was not related to their job (32.8%). The vast majority of respondents reported feeling confident and informed about at-home pregnancy testing (82.8%), while 11.2% reported needing more information and 10.3% reported needing more training to enable them to provide relevant services. Concerns regarding this intervention were that people would not use it correctly (47.1%), or would not access health care if needed (38.6%), and concerns about the quality (32.9%) and 7 Here and in the rest of this section, “services” encompasses referrals, prescriptions and/or information. safety (21.4%) of the product. The perceived benefits of this intervention were convenience for the user (75.9%), reduced health worker workload (59.8%), empowerment (50.6%), reduced barriers (39.1%) and affordability for the user (37.9%). Self-management of nutrition supplements (folic acid) during pregnancy planning Less than half of health workers reported having provided services for the self-management of folic acid during pregnancy planning (43.7%), while 17.8% had not. No health workers reported that this intervention was unavailable where they live and 38.5% reported that this was not related to their job. Over half of health workers felt confident and informed about this self-care intervention (58.6%), while a quarter needed more 54 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 information (25.0%) and a fifth reported needing more training before they could provide relevant services (19.8%). Concerns surrounding the self-management of folic acid during pregnancy planning included that people would do it incorrectly (40.3%), or they may not access health care when needed (36.1%), and concerns about safety (31.9%) and the quality of the product (29.2%). The perceived benefits of this intervention were convenience for the user (73.1%), reduced health worker workload (51.3%), and better empowerment (44.9%), affordability (32.1%) and reduced barriers (23.1%) for the user. Self-management of nutrition supplements (iron and folic acid) during pregnancy About half of the health workers had provided services for the self-management of iron and folic acid during pregnancy (48.2%), while 12.6% had not. A couple of health workers noted that this intervention is unavailable where they live (1.5%) and 37.8% reported that this was not related to their job. The majority of health workers felt confident and informed about this self-care intervention (61.4%), while almost a quarter felt they needed more information (23.7%) and almost a fifth reported needing more training to provide relevant services (19.3%). Concerns surrounding the self-management of iron and folic acid during pregnancy included that people would do it incorrectly (41.4%), or may not access health care when needed (37.1%), and concerns about safety (31.4%) and product quality (31.4%). The reported benefits of this intervention were convenience for the user (72.2%), reduced health worker workload (54.4%), and better empowerment (43.0%), affordability (35.4%) and reduced barriers (21.5%) for the user. Self-management of nutrition supplements (iron and folic acid) postpartum Less than half of health workers reported having provided services for the self-management of iron and folic during the postpartum period (43.0%), while 17.8% had not. One participant (0.7%) reported that this intervention was unavailable where they live and 38.5% reported that this was not related to their job. Over half of health workers felt confident and sufficiently informed to provide services relevant to this self-care intervention (62.1%), while about a fifth needed more information (21.6%) and another fifth reported needing more training (19.8%). Concerns surrounding postpartum self-management of iron and folic acid included that people would do it incorrectly (42.9%), or may not access health care when needed (40.0%), and concerns about safety (31.4%) and product quality (28.6%). Most health workers felt that the benefits of this intervention were convenience for the user (70.9%) and reduced health worker workload (55.7%), while some also mentioned better empowerment (41.8%), affordability (34.2%) and reduced barriers (21.5%) for the user. Self-monitoring/home-monitoring of blood glucose levels during pregnancy Over a third of health workers reported having provided services for self-monitoring/home-monitoring of blood glucose levels during pregnancy (36.3%), while 20.7% had not. A small minority of respondents indicated that this intervention was unavailable where they live (4.4%), while 38.5% reported that this was not related to their job. About half of health workers felt confident and informed about this self-care intervention (50.9%), while 31.0% needed more information and 23.3% reported needing more training before they could provide relevant services. Concerns surrounding the self-monitoring/home-monitoring of blood glucose levels during pregnancy included incorrect use (57.7%), clients not accessing health care when needed (39.7%), and concerns about safety (25.6%) and product quality (18.0%). Most health workers viewed the benefits of this intervention as being convenience for users (69.3%) and reduced health worker workload (52.0%), while substantial numbers also mentioned better empowerment (48.0%), affordability (33.3%) and reduced barriers (29.3%) for users of the intervention. Self-monitoring/home-monitoring of proteinuria during pregnancy About a quarter of health workers had provided services for the self-monitoring/home-monitoring of proteinuria during pregnancy (26.9%), while another quarter (26.1%) had not. Additionally, 7.5% providers reported that this intervention was unavailable where they live and 39.6% said it was not related to their job. Less than half of health workers felt sufficiently confident and informed about the intervention to provide relevant services (41.7%), with 36.5% reporting needing more information and 27.0% reporting needing more training. Health workers’ main concerns about this intervention were the risk of incorrect use (50.6%) and clients not accessing health care when needed (44.4%), while some had concerns about safety (23.5%) and the quality of the product (18.5%). The main perceived benefits of this intervention were convenience for the user (66.2%) and reduced health worker workload (53.5%), while substantial numbers also mentioned more empowerment (49.3%), reduced barriers (28.2%) and better affordability (26.8%) for users. 55Chapter 3 Self-monitoring/home-monitoring of blood pressure during pregnancy Less than half health workers had ever provided services related to self-monitoring/home-monitoring of blood pressure during pregnancy (41.0%) and an additional 18.7% had not. A couple of health workers (1.5%) reported that this intervention was unavailable where they live and 38.8% reported that this was not related to their job. Over half of health workers felt sufficiently confident and informed about this intervention to provide related services (56.9%), while 27.6% needed more information and 19.8% reported needing more training. Health workers reported concerns that the intervention would be used incorrectly (53.9%), that clients may not access health care when needed (42.3%), and concerns about the quality of the product (25.6%) and about safety (24.4%). Most health workers viewed the benefits of the intervention as convenience for the client (71.4%) and reduced health worker workload (53.3%), while substantial number also mentioned increased empowering (45.5%), better affordability (33.8%) and reduced barriers (22.1%) for the user. 56 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 25.9% 25.2% 34.1% 14.8% 3.2.2 Family planning Among the six interventions in this subsection, questions about one of them (the contraceptive patch) were only asked in Wave 1 of the survey. The findings are presented in Figures 3.4, 3.5 and 3.6 – please refer to these tables as needed for details not included in the narrative summary. FIGURE 3.4: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 78.7% 53.0% 75.4% 82.3% 49.0% 80.7% 50.8% 14.8% 25.6% 17.0% 13.1% 23.9% 11.9% 11.4% 35.8% 13.0% 35.9% Question or response option was not asked in a given wave. Question or response option was not asked in a given wave. 9.2% 20.3% 8.3% 16.6% Feel confident and informed Need more information Need training Wave 1 Wave 1 Wave 1 Wave 1 Wave 2 Wave 2 Wave 2 Wave 2 OVER-THE-COUNTER HORMONAL CONTRACEPTION (EXCLUDING EC) CONTRACEPTIVE VAGINAL RING OVER-THE-COUNTER EMERGENCY CONTRACEPTION (EC) CONTRACEPTIVE PATCH KEY YesNoIt is not related to my jobIt is not available where I live 6.8% 74.8% 18.5% 0.3% 10.9% 52.9% 32.6% 3.6% 12.6% 67.9% 18.6% 1.3% 15.6% 48.9% 32.6% 3.0% 29.0% 40.6% 20.6% 10.3% 33.0% 37.3% 20.8% 10.9% 57Chapter 3 27.4% 28.2% 34.1% 10.4% 53.0% 52.4% 51.5% 35.0% 37.6% 27.0% 29.9% 24.4% 33.1% 33.3% 21.3% 19.6% Feel confident and informed Need more information Need training Wave 1 Wave 1 Wave 2 Wave 2 SELF-ADMINISTERED INJECTABLE CONTRACEPTION DIAPHRAGM OR CERVICAL CAP KEY YesNoIt is not related to my jobIt is not available where I live - Question or response option was not asked in a given wave. FIGURE 3.5: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety Quality of product Incorrect use Reducing health care access Over-the-counter hormonal contraception (excluding EC) 53.6% 27.8% 58.6% 31.6% 58.3% 28.1% 56.3% 38.5% Over-the-counter emergency contraception (EC) 45.7% 26.3% 59.9% 39.3% 46.7% 24.4% 57.8% 40.0% Contraceptive patch 28.4% 15.5% 38.9% 37.2% - - - - Contraceptive vaginal ring 37.7% 23.3% 59.6% 35.0% 40.0% 21.3% 62.5% 26.3% Self-administered injectable contraception 52.0% 21.0% 47.2% 40.2% 41.8% 22.0% 70.3% 26.4% Diaphragm or cervical cap 35.2% 22.7% 63.9% 36.1% 30.5% 26.8% 61.0% 29.3% Wave 2 Wave 1 28.2% 41.2% 20.8% 11.0% 18.5% 29.6% 31.9% 20.0% 33.2% 36.5% 20.5% 11.7% 58 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 FIGURE 3.6: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions Convenient for client Reduces barriers for client Reduces health worker workload Empowering for client Less expensive for client Over-the-counter hormonal contraception (excluding EC) 75.7% 44.2% 40.4% 49.8% 40.1% 76.3% 37.1% 37.1% 52.6% 48.5% Over-the-counter emergency contraception (EC) 73.1% 47.9% 34.3% 49.2% 35.5% 76.7% 56.7% 42.2% 54.4% 36.7% Contraceptive patch 69.6% 35.5% 40.1% 46.5% 27.6% - - - - - Contraceptive vaginal ring 65.0% 36.0% 37.9% 46.7% 25.7% 56.0% 41.3% 38.7% 49.3% 18.7% Self-administered injectable contraception 68.8% 35.5% 44.6% 48.2% 30.8% 65.8% 50.0% 55.3% 48.7% 25.0% Diaphragm or cervical cap 67.2% 31.4% 37.3% 44.6% 25.5% 57.1% 35.7% 40.0% 47.1% 21.4% - Question or response option was not asked in a given wave. Wave 2 Wave 1 Over-the-counter hormonal contraceptives (excluding emergency contraception – see next item) Among health workers, almost three quarters of Wave 1 respondents (74.8%) and over half of Wave 2 respondents (52.9%) reported that they have provided services for OTC hormonal contraceptives while a small minority had not (Wave 1: 6.8%; Wave 2: 10.9%). Very few health workers said this intervention is not available where they live (Wave 1: 0.3%; Wave 2: 3.6%), but a substantial number reported that it is not related to their job (Wave 1: 18.5%; Wave 2: 32.6%). Across survey waves, most respondents reported feeling confident and sufficiently informed to provide relevant services (Wave 1: 82.3%; Wave 2: 78.7%), although small numbers of health workers reported that they needed more information (Wave 1: 11.4%; Wave 2: 14.8%) or more training (Wave 1: 9.2%; Wave 2: 13.1%). Health workers’ main concerns about OTC hormonal contraceptives were safety (Wave 1: 53.6%; Wave 2: 58.3%) and incorrect usage (Wave 1: 58.6%; Wave 2: 56.3%), while some were also concerned about the user not accessing health care when needed (Wave 1: 31.6%; Wave 2: 38.5%) and the quality of product (Wave 1: 27.8%; Wave 2: 28.1%). The main perceived benefits of this intervention were convenience (Wave 1: 75.7%; Wave 2: 76.3%), user empowerment (Wave 1: 49.8%; Wave 2: 52.6%) and cost (Wave 1: 40.1%; Wave 2: 48.5%), and substantial numbers also mentioned reduced barriers for users (Wave 1: 44.2%; Wave 2: 37.1%) and reduced health worker workload (Wave 1: 40.4%; Wave 2: 37.1%). Over-the-counter emergency contraception Most health workers in each wave reported they have provided services for OTC emergency contraception (Wave 1: 67.9%; Wave 2: 48.9%), while a small proportion had not (Wave 1: 12.6%; Wave 2: 15.6%). Just a few health workers said this intervention was not available where they live (Wave 1: 1.3%; Wave 2: 3.0%) and some reported that it is not related to their job (Wave 1: 18.6%; Wave 2: 32.6%). Most health workers reported feeling confident and sufficiently informed to provide services related to this intervention (Wave 1: 80.7%; Wave 2: 75.4%), but small numbers reported needing more information 59Chapter 3 (Wave 1: 13.0%; Wave 2: 17.0%) or more training (Wave 1: 8.3%; Wave 2: 11.9%). Health workers reported concerns about incorrect use of OTC emergency contraception (Wave 1: 59.9%; Wave 2: 57.8%), concerns about safety (Wave 1: 45.7%; Wave 2: 46.7%), concerns that users would not access health care if needed (Wave 1: 39.3%; Wave 2: 40.0%) and concerns about the quality of the product (Wave 1: 26.3%; Wave 2: 24.4%). But they also perceived major benefits of this intervention: convenience (Wave 1: 73.1%; Wave 2: 76.7%), reduced barriers for users (Wave 1: 47.9%; Wave 2: 56.7%), empowerment (Wave 1: 49.2%; Wave 2: 54.4%), reduced health worker workload (Wave 1: 34.3%; Wave 2: 42.2%) and affordability (Wave 1: 35.5%; Wave 2: 36.7%). Contraceptive patch8 Fewer than half of health worker respondents reported having provided services for the contraceptive patch (40.6%), while 29.0% said they had not. For 10.3% of respondents, the intervention was not available where they live, and a fifth said it was unrelated to their job (20.6%). About half of respondents reported feeling confident and sufficiently informed to provide services related to this intervention (50.8%), while more than a third reported needing more information (35.9%) and 16.6% stated they would need training. Health worker concerns were most commonly about incorrect use (38.9%), that users may not access health care if needed (37.2%), concerns about safety (28.4%) and about the quality of the product (15.5%). The most commonly cited benefits were convenience (69.6%) and empowerment (46.5%) for the user, and substantial numbers also mentioned reduction in health worker workload (40.1%), removal of barriers for users (35.5%) and more affordable (27.6%). Contraceptive vaginal ring Over a third of Wave 1 health worker respondents (37.3%) and about a quarter of those in Wave 2 (25.2%) reported having provided services for the vaginal ring, with similar proportions also reporting that they had not (Wave 1: 33.0%; Wave 2: 25.9%). A minority of health workers said this contraceptive was not available where they live (Wave 1: 10.9%; Wave 2: 14.8%), and for between a fifth and a third it was unrelated to their job (Wave 1: 20.8%; Wave 2: 34.1%). About half of respondents in each survey wave reported feeling confident and sufficiently informed about this intervention to provide relevant services (Wave 1: 49.0%; Wave 2: 53.0%), while more than a quarter reported needing more information (Wave 1: 35.8%; Wave 2: 25.6%) and more than a fifth stated they need training (Wave 1: 20.3%; Wave 2: 23.9%). The main health worker concerns regarding the vaginal ring were incorrect use (Wave 1: 59.6%; Wave 2: 62.5%), concerns about safety (Wave 1: 37.7%; Wave 2: 40.0%), concerns that clients would not access health care if needed (Wave 1: 35.0%; 8 Questions regarding the contraceptive patch were only asked in Wave 1. Wave 2: 26.3%) and concerns about the quality of the product (Wave 1: 23.3%; Wave 2: 21.3%). In terms of benefits, the majority of health workers stated that the vaginal ring was convenient (Wave 1: 65.0%; Wave 2: 56.0%) and empowering (Wave 1: 46.7%; Wave 2: 49.3%) for users. Many also mentioned reduced barriers for users (Wave 1: 36.0%; Wave 2: 41.3%), reduced health worker workload (Wave 1: 37.9%; Wave 2: 38.7%) and cheaper for the client (Wave 1: 25.7%; Wave 2: 18.7%). Self-administered injectable contraception Less than half of health workers in each survey wave reported they have provided services for self-administered contraceptives (Wave 1: 41.2%; Wave 2: 29.6%), while a smaller minority had not (Wave 1: 28.2%; Wave 2: 18.5%). Some health workers reported it was not available where they live (Wave 1: 11.0%; Wave 2: 20.0%) and between a fifth and a third reported it was not related to their job (Wave 1: 20.8%; Wave 2: 31.9%). Less than half of health workers reported feeling confident and sufficiently informed about self-administered contraception to provide relevant services (Wave 1: 52.4%; Wave 2: 37.6%), while more than a third reported they need more information (Wave 1: 33.1%; Wave 2: 35.0%) and a smaller number reported that they would need training to provide relevant services (Wave 1: 21.3%; Wave 2: 29.9%). Key concerns among health worker respondents about self- administered contraceptives were regarding incorrect use (Wave 1: 47.2%; Wave 2: 70.3%), safety (Wave 1: 52.0%; Wave 2: 41.8%), clients not accessing health care if needed (Wave 1: 40.2%; Wave 2: 26.4%) and the quality of the product (Wave 1: 21.0%; Wave 2: 22.0%). The main perceived benefits of this self-care intervention were convenience for users (Wave 1: 68.8%; Wave 2: 65.8%), reduced health worker workload (Wave 1: 44.6%; Wave 2: 55.3%), reduced barriers (Wave 1: 35.5%; Wave 2: 50.0%), empowerment (Wave 1: 48.2%; Wave 2: 48.7%) and lower cost for users (Wave 1: 30.8%; Wave 2: 25.0%). Diaphragm or cervical cap Over a third of health workers in Wave 1 (36.5%) and a quarter in Wave 2 (28.2%) reported they have provided services for the diaphragm or cervical cap, while around a third in each wave had not (Wave 1: 33.2%; Wave 2: 27.4%). About 10% of health workers said it was not available where they live (Wave 1: 11.7%; Wave 2: 10.4%) and the remainder reported it was unrelated to their job (Wave 1: 20.5%; Wave 2: 34.1%). Approximately half of respondents in each survey wave reported feeling confident and sufficiently informed about the diaphragm or cervical cap to provide relevant services (Wave 1: 51.5%; Wave 2: 53.0%), while around a third reported needing more information (Wave 1: 33.3%; Wave 2: 27.0%) and almost a quarter would need training (Wave 1: 19.6%; Wave 2: 24.4%). Among health worker respondents, by far the main concern relating to diaphragms or cervical caps was the risk of incorrect use (Wave 1: 63.9%; Wave 2: 61.0%). Much smaller 60 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 25.4% 21.6% 30.6% 22.4% numbers were also concerned about safety (Wave 1: 35.2%; Wave 2: 30.5%), about clients not accessing health care if needed (Wave 1: 36.1%; Wave 2: 29.3%), and about product quality (Wave 1: 22.7%; Wave 2: 26.8%). Also by far the main perceived benefit of the diaphragm or cervical cap was convenience (Wave 1: 67.2%; Wave 2: 57.1%), while a minority of health workers also mentioned empowerment (Wave 1: 44.6%; Wave 2: 47.1%), reduced health worker workload (Wave 1: 37.3%; Wave 2: 40.0%), and reduced barriers (Wave 1: 31.4%; Wave 2: 35.7%) and increased affordability (Wave 1: 25.5%; Wave 2: 21.4%) for users. 3.2.3 Abortion Questions regarding self-management of medical abortion were asked in both waves of the survey. The findings are presented in Figures 3.7, 3.8 and 3.9 – please refer to the figures as needed for details not included in the narrative summary. FIGURE 3.7: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 48.8% 33.0% 40.2% 32.1% 33.6% 22.7% Feel confident and informed Need more information Need training Wave 1 Wave 2 EXPERIENCE PROVIDING SERVICES FOR SELF-MANAGEMENT OF MEDICAL ABORTION KEY YesNoIt is not related to my jobIt is not available where I live FIGURE 3.8: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety Quality of product Incorrect use Reducing health care access Concerns about providing services for self-management of medical abortion 54.0% 24.9% 51.9% 53.6% 46.7% 21.7% 54.4% 54.4% Wave 2 Wave 1 30.6% 37.1% 22.5% 12.1% 61Chapter 3 FIGURE 3.9: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions Convenient for client Reduces barriers for client Reduces health worker workload Empowering for client Less expensive for client Perceived benefits of self-management of medical abortion 59.4% 62.2% 41.5% 52.5% 33.2% 57.5% 62.5% 45.0% 51.3% 26.3% Wave 2 Wave 1 Self-management of medical abortion Substantial numbers of health worker respondents reported having provided services for self-management of medical abortion (Wave 1: 37.1%; Wave 2: 21.6%), while many also had not done so (Wave 1: 30.6%; Wave 2: 25.4%). Other health workers said it was not available where they live (Wave 1: 12.1%; Wave 2: 22.4%) or that it was not related to their job (Wave 1: 22.5%; Wave 2: 30.6%). Less than half of respondents in each survey wave reported feeling confident and sufficiently informed to provide services relevant to self-management of medical abortion (Wave 1: 48.8%; Wave 2: 40.2%), while a third reported needing more information (Wave 1: 33.6%; Wave 2: 33.0%) and slightly smaller numbers reported needing training (Wave 1: 22.7%; Wave 2: 32.1%). The main reported concerns regarding self-management of medical abortion were that clients would not implement the procedures correctly (Wave 1: 51.9%; Wave 2: 54.4%), clients would not access health care if needed (Wave 1: 53.6%; Wave 2: 54.4%), and concerns about safety (Wave 1: 54.0%; Wave 2: 46.7%), while smaller numbers of health workers were also concerned about product quality (Wave 1: 24.9%; Wave 2: 21.7%). Health workers viewed the main benefits of this self- care intervention as reduced barriers (Wave 1: 62.2%; Wave 2: 62.5%), improved convenience (Wave 1: 59.4%; Wave 2: 57.5%) and increased empowerment (Wave 1: 52.5%; Wave 2: 51.3%) for abortion seekers. Smaller numbers also mentioned reduced health worker workload (Wave 1: 41.5%; Wave 2: 45.0%) and reduced cost for abortion seekers (Wave 1: 33.2%; Wave 2: 26.3%). 62 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 3.2.4 Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities Questions regarding four of the interventions in this subsection were asked in both waves of the survey, while questions about two of them (HIV and STI treatment) were only asked in Wave 1 and questions about HPV self-sampling were only added later in Wave 2. The findings are presented in Figures 3.10, 3.11 and 3.12 – please refer to these figures as needed for details not included in the narrative summary. FIGURE 3.10: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 49.5% 32.2% 35.0% 41.0% 32.2% 40.0% 29.1% 40.0% 45.8% 37.6% 19.7% 18.3% Feel confident and informed Need more information Need training Wave 1 Wave 1 Wave 2 Wave 2 PRE-EXPOSURE PROPHYLAXIS (PREP) – PHARMACY ACCESS POST-EXPOSURE PROPHYLAXIS (PEP) – PHARMACY ACCESS KEY YesNoIt is not related to my jobIt is not available where I live 41.7% 25.2% 35.7% Wave 1 Wave 2HPV SELF-SAMPLING Question or response option was not asked in a given wave. Question or response option was not asked in a given wave. 31.6% 41.2% 21.6% 8.3% 29.4% 22.8% 35.3% 12.5% 26.4% 48.9% 22.1% 4.2% 23.5% 32.4% 32.4% 11.8% 27.0% 14.6% 31.4% 27.0% 63Chapter 3 54.4% 55.3% 33.6% 39.7% 37.1% 32.8% 31.9% 34.5% 43.1% 42.8% 32.8% 34.6% 49.2% 34.2% 19.9% 18.9% 15.6% 21.7% Wave 1 Wave 1 Wave 1 Wave 1 Wave 2 Wave 2 Wave 2 Wave 2 HIV SELF-SAMPLING HIV TREATMENT STI TREATMENT STI SELF-SAMPLING (NOT INCLUDING HIV OR HPV) KEY YesNoIt is not related to my jobIt is not available where I live Question or response option was not asked in a given wave. Question or response option was not asked in a given wave. Question or response option was not asked in a given wave. Question or response option was not asked in a given wave. HPV: human papillomavirus; STI: sexually transmitted infection. Feel confident and informed Need more information Need training 35.8% 32.6% 19.5% 15.6% 25.0% 18.4% 32.4% 24.3% 30.9% 40.2% 19.0% 14.1% 21.2% 26.3% 29.9% 22.6% 20.7% 56.9% 21.7% 1.0% 17.8% 61.2% 20.1% 1.3% 64 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 - Question or response option was not asked in a given wave. FIGURE 3.11: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety Quality of product Incorrect use Reducing health care access Pre-exposure prophylaxis (PrEP) – pharmacy access 40.9% 17.8% 52.9% 54.2% 27.4% 16.7% 53.6% 56.0% Post-exposure prophylaxis (PEP) – pharmacy access 42.4% 17.9% 52.7% 53.6% 30.1% 18.1% 49.4% 61.5% HPV self-sampling - - - - 23.1% 22.0% 55.0% 52.8% STI self-sampling (not including HIV or HPV) 25.7% 24.3% 53.6% 57.2% 20.0% 24.4% 61.1% 52.2% HIV self-sampling 24.4% 20.0% 53.3% 58.2% 19.8% 24.2% 55.0% 62.6% HIV treatment 49.1% 22.6% 52.7% 53.1% - - - - STI treatment 42.6% 23.8% 54.7% 54.3% - - - - HPV: human papillomavirus; STI: sexually transmitted infection. Wave 2 Wave 1 Pre-exposure prophylaxis (PrEP) Among health workers, a greater proportion of Wave 1 respondents (41.2%) than Wave 2 respondents (22.8%) reported having provided services for PrEP, while just under a third in both survey waves reported they had not (Wave 1: 31.6%; Wave 2: 29.4%). Additionally, a minority reported it was not available where they live (Wave 1: 8.3%; Wave 2: 12.5%) and a substantial proportion said it was unrelated to their job (Wave 1: 21.6%; Wave 2: 35.3%). Less than half of respondents reported feeling confident and informed enough to provide services related to PrEP (Wave 1: 45.8%; Wave 2: 32.2%), while 40.0% reported needing more information (Wave 1: 40.0%; Wave 2: 40.0%) and others reported needing training (Wave 1: 19.7%; Wave 2: 32.2%). The main health worker concerns were that PrEP users would not access health care if needed (Wave 1: 54.2%; Wave 2: 56.0%) and that they would not use it correctly (Wave 1: 52.9%; Wave 2: 53.6%). Smaller numbers were concerned about safety (Wave 1: 40.9%; Wave 2: 27.4%) and product quality (Wave 1: 17.8%; Wave 2: 16.7%). The majority of health workers perceived the benefits of PrEP as being convenience for clients (Wave 1: 65.4%; Wave 2: 59.2%) and reduced barriers (Wave 1: 58.9%; Wave 2: 52.6%). Substantial numbers also mentioned empowerment (Wave 1: 50.0%; Wave 2: 48.7%), reduced health worker workload (Wave 1: 42.1%; Wave 2: 48.7%) and better affordability for the user (Wave 1: 27.1%; Wave 2: 22.4%). Post-exposure prophylaxis (PEP) Between a third and half of health workers reported they have provided services for PEP (Wave 1: 48.9%; Wave 2: 32.4%), while a quarter said they have not (Wave 1: 26.4%; Wave 2: 23.5%). Additionally, a minority of health workers reported PEP was not available where they live (Wave 1: 4.2%; Wave 2: 11.8%) and the remainder reported it was unrelated 65Chapter 3 FIGURE 3.12: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions Convenient for client Reduces barriers for client Reduces health worker workload Empowering for client Less expensive for client Pre-exposure prophylaxis (PrEP) – pharmacy access 65.4% 58.9% 42.1% 50.0% 27.1% 59.2% 52.6% 48.7% 48.7% 22.4% Post-exposure prophylaxis (PEP) – pharmacy access 66.7% 62.0% 37.5% 45.8% 25.9% 58.1% 59.5% 47.3% 46.0% 21.6% HPV self-sampling - - - - - 51.4% 47.3% 43.2% 46.0% 20.3% STI self-sampling (not including HIV or HPV) 64.1% 61.5% 44.6% 48.5% 30.3% 49.3% 57.5% 46.6% 45.2% 23.3% HIV self-sampling 64.4% 63.9% 43.8% 50.6% 29.2% 57.7% 59.0% 50.0% 43.6% 25.6% HIV treatment 62.3% 58.5% 40.1% 50.2% 24.2% - - - - - STI treatment 66.5% 60.4% 39.6% 47.2% 25.5% - - - - - HPV: human papillomavirus; STI: sexually transmitted infection. - Question or response option was not asked in a given wave. Wave 2 Wave 1 to their job (Wave 1: 22.1%; Wave 2: 32.4%). Less than half of health workers in each wave reported feeling sufficiently confident and informed to provide services related to PEP (Wave 1: 49.5%; Wave 2: 41.0%), with over a third needing more information (Wave 1: 37.6%; Wave 2: 35.0%), and smaller numbers needing training (Wave 1: 18.3%; Wave 2: 29.1%). Health workers’ main concerns about PEP were that clients would not access health care if needed (Wave 1: 53.6%; Wave 2: 61.5%) and that they would use PEP incorrectly (Wave 1: 52.7%; Wave 2: 49.4%). Substantial numbers were also concerned about safety (Wave 1: 42.4%; Wave 2: 30.1%) and product quality (Wave 1: 17.9%; Wave 2: 18.1%). By far the main perceived benefits of PEP were that it removes barriers for users (Wave 1: 62.0%; Wave 2: 59.5%) and it is convenient (Wave 1: 66.7%; Wave 2: 58.1%). Substantial numbers also noted that it reduces health worker workload (Wave 1: 37.5%; Wave 2: 47.3%), and 9 Questions regarding HPV self-sampling were only asked in Wave 2. improves empowerment (Wave 1: 45.8%; Wave 2: 46.0%) and affordability (Wave 1: 25.9%; Wave 2: 21.6%) for users. HPV self-sampling9 A minority of health worker respondents reported that they have provided services for HPV self-sampling (14.6%), while over a quarter reported not having done so (27.0%) and the same number said that HPV self-sampling is not available where they live (27.0%). The remaining 31.4% of health workers said this intervention was unrelated to their job (31.4%). A quarter of health workers reported feeling confident and informed enough to provide services related to HPV self-sampling (25.2%), while a greater proportion reported needing more information (41.7%) or needing more training (35.7%). 66 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 Health workers’ main concerns regarding HPV self-sampling were incorrect use (55.0%) and that clients may not access health care if needed (52.8%), while some were also concerned about safety (23.1%) and product quality (22.0%). Health workers identified the main benefits of HPV self-sampling as convenience for the user (51.4%), reduced barriers (47.3%), client empowerment (46.0%) and reduced health worker workload (43.2%), while some also mentioned reduced cost for the user (20.3%). STI self-sampling (not including HIV or HPV) About a third of health workers in Wave 1 (32.6%) and a fifth in Wave 2 (18.4%) reported they have provided services related to STI self-sampling, while between a quarter and a third (Wave 1: 35.8%; Wave 2: 25.0%) had not. Additional respondents reported that it was not available where they live (Wave 1: 15.6%; Wave 2: 24.3%) or that it was unrelated to their job (Wave 1: 19.5%; Wave 2: 32.4%). Less than half of health workers reported feeling sufficiently confident and informed about STI self-sampling to provide relevant services (Wave 1: 34.2%; Wave 2: 32.8%), while most said they would either need more information (Wave 1: 49.2%; Wave 2: 37.1%) or more training (Wave 1: 21.7%; Wave 2: 34.5%). Health workers’ main concerns about this intervention related to incorrect usage (Wave 1: 53.6%; Wave 2: 61.1%) and clients not accessing health care if needed (Wave 1: 57.2%; Wave 2: 52.2%). Substantial number were also concerned about product quality (Wave 1: 24.3%; Wave 2: 24.4%) and safety (Wave 1: 25.7%; Wave 2: 20.0%). The main perceived benefits were reduced barriers (Wave 1: 61.5%; Wave 2: 57.5%) and improved convenience for users (Wave 1: 64.1%; Wave 2: 49.3%), reduced health worker workload (Wave 1: 44.6%; Wave 2: 46.6%) and client empowerment (Wave 1: 48.5%; Wave 2: 45.2%), while some also mentioned improved affordability for the client (Wave 1: 30.3%; Wave 2: 23.3%). HIV self-sampling In Wave 1, 40.2% of health workers reported having provided services related to HIV self-sampling, while this was just 26.3% in Wave 2. The remaining health workers reported that they had not provided services related to this intervention (Wave 1: 30.9%; Wave 2: 21.2%), that it was not available where they live (Wave 1: 14.1%; Wave 2: 22.6%) or that it was not related to their job (Wave 1: 19.0%; Wave 2: 29.9%). Less than half of respondents reported feeling sufficiently confident and informed to provide services related to HIV self-sampling (Wave 1: 42.8%; Wave 2: 39.7%), with others saying they would need more information (Wave 1: 43.1%; Wave 2: 33.6%) or training (Wave 1: 19.9%; Wave 2: 31.9%). Health workers’ main concerns regarding HIV self-sampling were that clients would not access health care if needed 10 Questions regarding HIV treatment were only asked in Wave 1. 11 Questions regarding STI treatment were only asked in Wave 1. (Wave 1: 58.2%; Wave 2: 62.6%) and that they would not use it correctly (Wave 1: 53.3%; Wave 2: 55.0%). Smaller numbers were also concerned about product quality (Wave 1: 20.0%; Wave 2: 24.2%) and safety (Wave 1: 24.4%; Wave 2: 19.8%). The main perceived benefits were reduced barriers (Wave 1: 63.9%; Wave 2: 59.0%) and convenience (Wave 1: 64.4%; Wave 2: 57.7%) for clients, while substantial numbers also mentioned reduced health worker workload (Wave 1: 43.8%; Wave 2: 50.0%), client empowerment (Wave 1: 50.6%; Wave 2: 43.6%) and affordability for the client (Wave 1: 29.2%; Wave 2: 25.6%). HIV treatment (i.e. antiretroviral therapy; ART)10 The majority of health workers reported that they have provided services for ART (56.9%), while 20.7% have not. For three respondents (1.0%), ART is not available where they live, and 21.7% said it is not related to their job. More than half of respondents reported feeling sufficiently confident and informed to provide services related to HIV treatment (54.4%), while 32.8% reported needing more information, and 18.9% reported needing training before they could provide these services. Health workers’ main concerns regarding ART were that the client would not access health care if needed after/while using ART (53.1%) and that the client would not use the treatment correctly (52.7%). Many were also concerned about safety (49.1%) and product quality (22.6%). The key benefits identified by health workers were convenience (62.3%) and reduced barriers (58.5%), while many also mentioned client empowerment (50.2%), reduction of health worker workload (40.1%) and reduced cost to the client (24.2%). Medical treatment of STIs11 The majority of health worker respondents reported that they have provided services for STI treatment (61.2%), while 17.8% had not. For four respondents (1.3%), it was not available where they live, and 20.1% said it was not related to their job. Over half of respondents reported feeling sufficiently confident and informed about STI treatment to provide relevant services (55.3%), while 34.6% reported needing more information, and 15.6% reported needing training. The top concerns identified by health worker respondents were that clients would not take the treatment correctly (54.7%) and that they would not access health care if needed (54.3%), and some were also concerned about safety (42.6%) and product quality (23.8%). The main benefits selected were convenience (66.5%) and reduced barriers (60.4%) for the client. Substantial numbers also mentioned empowerment (47.2%), reduction of health worker workload (39.6%) and reduced costs to the client (25.5%). 67Chapter 3 3.2.5 Promoting sexual healths Questions regarding the interventions in this subsection – lubricant and hormone therapy for gender affirmation – were only asked in Wave 2 of the survey. The findings are presented in Figures 3.13, 3.14 and 3.15 – please refer to the figure as needed for details not included in the narrative summary. FIGURE 3.13: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 72.4% 46.9% 18.0% 44.1% 19.0% 13.8% Feel confident and informed Need more information Need training FIGURE 3.14: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety Quality of product Incorrect use Reducing health care access Lubricants for sexual health 28.6% 36.5% 52.4% 28.6% Hormone therapy for gender affirmation 33.8% 27.0% 56.8% 56.8% FIGURE 3.15: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions Convenient for client Reduces barriers for client Reduces health worker workload Empowering for client Less expensive for client Lubricants for sexual health 71.8% 42.3% 32.1% 53.9% 26.9% Hormone therapy for gender affirmation 42.7% 52.9% 42.7% 55.9% 22.1% HORMONE THERAPY FOR GENDER AFFIRMATIONLUBRICANTS FOR SEXUAL HEALTH 20.7% 46.7% 30.4% 2.2% 28.0% 17.4% 46.2% 8.3% KEY YesNoIt is not related to my jobIt is not available where I live 68 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 Lubricants for sexual health About half of health worker respondents reported that they have provided services for lubricant (46.7%), while 20.7% had not. A few participants reported it was not available where they live (2.2%) and an additional 30.4% reported it was unrelated to their job. The majority of health workers reported feeling confident and informed enough to provide services related to personal lubricant (72.4%), while 19.0% said they would need more information and 13.8% would need training. Health workers’ main concern regarding lubricant was that clients would not use it correctly (52.4%), while some were also concerned about product quality (36.5%), safety (28.6%) and that clients would not access health care if needed (28.6%). The perceived benefits of lubricant were convenience for the client (71.8%), empowerment (53.9%), reduced barriers for clients (42.3%), reduced health worker workload (32.1%) and reduced cost for clients (26.9%). Hormone therapy for gender affirmation A minority of health worker respondents reported they had provided services for hormone therapy for gender affirmation (17.4%), while 28.0% had not. Additionally, 8.3% reported that this intervention is not available where they live and 46.2% said it was unrelated to their job. Less than a fifth of health workers reported feeling sufficiently confident and informed to provide services related to hormone therapy for gender affirmation (18.0%), while 46.9% said they would need more information and 44.1% would need training. Among the health workers, the main concerns about this intervention were that clients would not access health care if needed (56.8%) and that clients would not use it correctly (56.8%), while smaller numbers were concerned about product quality (27.0%), and safety (33.8%). A majority identified client empowerment (55.9%) and reduced barriers (52.9%) as the benefits of hormone therapy for gender affirmation, while some also mentioned reduced health worker workload (42.7%), convenience for the client (42.7%) and affordability for the client (22.1%). 3.2.6 SRH information online and via mobile applications Questions regarding the interventions in this subsection were only included in Wave 1 of the survey. The findings are presented in Tables 3.16, 3.17 and 3.18 – please refer to these tables as needed for details not included in the narrative summary. ONLINE SEXUAL HEALTH INFORMATION MOBILE SEXUAL HEALTH APPS FIGURE 3.16: HEALTH-CARE PROVIDER RESPONSES REGARDING SELF-CARE SRHR INTERVENTIONS ONLINE REPRODUCTIVE HEALTH INFORMATION MOBILE REPRODUCTIVE HEALTH APPS QUESTION 2: How confident and informed do you feel about these interventions? QUESTION 1: Have you provided a referral, prescription, or information about the interventions to patients or clients? 39.9% 35.2% 19.9% 5.6% 66.6%68.5% 29.3% 47.4% 40.8% 7.6% 15.6% 27.1% 45.7% 42.6% 7.2% 15.1% Feel confident and informed Need more information Need training KEY YesNoIt is not related to my jobIt is not available where I live 20.5% 63.0% 15.9% 1.0% 19.4% 63.8% 15.8% 1.0% 41.0% 34.3% 20.0% 5.3% 69Chapter 3 FIGURE 3.17: HEALTH-CARE PROVIDER CONCERNS PER INTERVENTION QUESTION 3: What are your concerns regarding these self-care interventions? Interventions Safety (e.g. side-effects) Quality of product Incorrect use Access to health care if needed Reproductive health information found online 19.9% 30.3% 46.0% 48.3% Reproductive health mobile phone app 15.1% 29.8% 44.9% 46.8% Sexual health information found online 19.1% 30.1% 45.5% 48.8% Sexual health mobile phone app 16.0% 29.1% 44.2% 48.1% FIGURE 3.18: PERCEIVED BENEFITS BY HEALTH-CARE PROVIDERS PER INTERVENTION QUESTION 4: What are the benefits of these self-care interventions? Interventions It is more convenient for patient/client It will remove barriers such as stigma It reduces health-care provider workload It is empowering It is cheaper for the client Reproductive health information found online 67.8% 50.2% 44.1% 57.3% 37.9% Reproductive health mobile phone app 66.4% 44.4% 38.1% 58.3% 36.8% Sexual health information found online 68.4% 51.1% 43.6% 58.7% 36.9% Sexual health mobile phone app 68.4% 45.3% 37.3% 56.9% 35.1% Online reproductive health information The majority of health workers reported that they have referred people to online reproductive health (RH) information (63.8%), while 19.4% had not. For three respondents, it was not available where they live (1.0%), and for 15.8%, it was not related to their job. The majority of health workers reported feeling confident and informed enough about RH information that is available online (68.5%), while 27.1% reported needing more information, and 7.2% reported needing training before they could assist people with this. Health workers’ main concerns were that clients would not access health care if needed (48.3%) and that they would not use these online resources correctly (46.0%), and there were also concerns about the quality of the RH information (30.3%), and safety (19.9%). The top benefits identified were convenience for the client (67.8%), empowerment (57.3%), reduced barriers (50.2%), reduced health worker workload (44.1%), and affordability (37.9%). 70 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 3 Mobile reproductive health apps Over a third of health workers reported they have provided a referral to or information about mobile RH apps (35.2%), while 39.9% have not. For 5.6%, it was not available where they live, and for 19.9%, it was unrelated to their job. Less than half of health workers reported feeling confident and informed about RH apps (42.6%), while 45.7% reported that they would need more information, and 15.1% reported needing training before they could provide a relevant referral to an RH app. The top concerns identified by health workers were that clients would not access health care if needed (46.8%) and that they would not use the RH app correctly (44.9%), and some were also concerned about the quality of the product (29.8%), and safety (15.1%). The key perceived benefits were convenience (66.4%) and empowerment (58.3%), while substantial numbers also mentioned reduced barriers (44.4%), reduced health worker workload (38.1%), and affordability (36.8%). Online sexual health information The majority of health worker respondents reported they have referred people to sexual health (SH) information online (63.0%), while 20.5% have not. For three respondents, it was not available where they live (1.0%), and for 15.9%, it was not related to their job. Two thirds of respondents reported feeling confident and informed about online SH information (66.6%), while 29.3% reported needing more information, and 7.6% reported needing training before they would be able to refer people to appropriate online resources. The top concerns identified by health worker respondents were that clients would not access health care if needed (48.8%) and they may not use the SH information correctly (45.5%), and there were also concerns about the quality of the resources (30.1%), and safety (19.1%). The main perceived benefits reported were convenience for the client (68.4%), empowerment (58.7%), reduced barriers (51.1%), reduced health worker workload (43.6%), and affordability (36.9%). Mobile sexual health apps About a third of health workers reported having provided a referral to or information about mobile SH apps (34.3%), while 41.0% had not. For 5.3%, such apps were not available where they lived, and 20.0% said this was unrelated to their job. Fewer than half of respondents reported feeling confident and informed about SH apps (40.8%), while 47.4% reported needing more information, and 15.6% reported needing training before they could provide a referral to an appropriate SH app. Health workers’ top concerns were that the client would not access health care if needed (48.1%) and that they would not use the app correctly (44.2%), in addition to concerns about product quality (29.1%), and safety (16.0%). The main perceived benefits were convenience for the client (68.4%) and empowerment (56.9%), while substantial numbers also mentioned reduced barriers (45.3%), reduced health worker workload (37.3%), and affordability (35.1%). 71Chapter 3 Chapter 4 Transformative training for health professionals on self-care SRHR interventions New approaches and changes in training and education of health-care providers are needed in order to institutionalize sensitive and effective use of self-care interventions. It is crucial for a revised curriculum to be embedded in principles of human rights, gender equality, and increased user autonomy and health literacy to improve empowerment and support confident decision-making. Recognizing the importance of such training, the WHO Department of Reproductive Health and Research convened the first consultation of early-career health professionals from the fields of midwifery, nursing, pharmacy, public health and medicine. For this session of the meeting, panelists were invited from different WHO departments and United Nations agencies to talk about their experiences and approaches to health education and ending stigma and discrimination in health care. After the discussion, recommendations for the new types of training and transformation to accommodate self-care interventions were made by participants and are listed here. Participant recommendations for transformative training: • Focus on competency-based curricula, with a special emphasis on communication, compassion and a person-centred approach to care. • Integrate self-care interventions into the curricula for health professional education and training. • Support students and young health professionals to take active roles in university governing bodies, societies and academic communities to advocate for appropriate advances and innovations in curricula. • Provide early training on holistic and integrated health care and sensitization, to institutionalize empathetic attitudes among health professionals that take into account the broader social, psychological, spiritual and religious context of people’s lives. • Emphasize and operationalize inter-professional collaborations and build teamwork skills for more effective integrated service delivery, including mobility and access to opportunities for skills exchange at global, regional and national levels. • Address issues of power and vulnerability to support increased user autonomy and empowerment. • Integrate the use of innovative research, technologies, digital and online resources, interactive learning and other innovative forms of training to reinforce comprehensive learning of information and practical skills. • Facilitate continuous quality improvement through implementation of appropriate accountability and feedback mechanisms. HIGHLIGHTS FROM HEALTH-CARE COMMUNITY CONSULTATIONS Chapter 4 72 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Values and preferences relating to self-care interventions for SRHR: qualitative findings 4 Chapter 4 73 Chapter summary This chapter presents the qualitative data gathered from respondents through the use of open-ended questions, shedding light on their values and preferences, their concerns and their hopes regarding the use of self-care interventions for SRHR. Four main themes emerged for both respondent groups (health workers and laypersons) and another two main themes for health worker respondents specifically: • current concerns with self-care interventions for SRHR • potential benefits of self-care interventions for SRHR • preferred conditions for use of self-care interventions for SRHR • future issues for consideration with self-care interventions for SRHR • linkages to health care (health workers only) • health worker training and information needs (health workers only). In Wave 1, 172 health worker respondents provided qualitative feedback. In Wave 1, the most prominent issues mentioned by health workers were accessibility, stigma and discrimination, cost, information and knowledge, misuse, expertise, culture and beliefs, confidentiality and legitimacy. In Wave 2, 76 health workers provided qualitative feedback and the most prominent issues mentioned fell within those same themes as well as the issues of availability and linkage to care. In Wave 1, 74 laypersons provided qualitative feedback, as did 20 laypersons in Wave 2. In both waves, the most prominent issues mentioned by laypersons in relation to the first four themes listed above were accessibility, stigma and discrimination, information and knowledge, cost, expertise, misuse, culture and beliefs, confidentiality and legitimacy. “Only men have easy access to condoms in the pharmacy. Women like us are given judgemental looks and sometimes asked what we need it for! This is the same problem when we try to access self-testing pregnancy kits.” – A female college student Chapter 4 74 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Survey respondents in both waves were asked to share their thoughts reflecting their values and preferences about self-care interventions for SRHR by providing written responses to the open-ended questions provided in the box below. Open-ended survey questions In Wave 1 and 2: • Is there anything you would like to share with us about self-initiated interventions? This could include thoughts about access, cost, stigma and discrimination. We are interested in what you like or don’t like about these and other relevant interventions, or any concerns you have about them. • Are there any other benefits you can see regarding self-initiated interventions? (Note: in Wave 2, the end of this question was modified with the following addition: particularly for marginalized or vulnerable clients) • How do you think we can help to link patients/clients to health care if needed after using a self-initiated intervention (e.g. after a positive result from an HIV self- test?) (only asked to health workers) • What specific training, information or skills would you like regarding self-initiated interventions? (only asked to health workers) • Any other comments? • Additional question added in Wave 2 only: • Is there anything you would like to share about your experience within health facilities, and/or of stigma and discrimination, when you were accessing these products? All of the qualitative responses were collated and coded thematically based on the topics mentioned or discussed in respondents’ comments. The findings are presented here, including selected quotes, grouped according to several main themes that emerged from this analysis for both health workers and layperson respondents for each wave of the GVPS. Four main themes emerged for both respondent groups and another two main themes for health worker respondents specifically, within their responses to the questions listed above: • current concerns with self-care interventions for SRHR • potential benefits of self-care interventions for SRHR • preferred conditions for use of self-care intervention for SRHR • future issues for consideration with self-care interventions for SRHR • linkages to health care (health workers only) • health worker training and information needs (health workers only). 4.1.1 HEALTH WORKERS Wave 1 Health worker respondents were asked “What other concerns do you have about self-initiated interventions?” and presented with the list of response options as shown below, from which they could select all that apply. A total of 316 health workers responded to this question in Wave 1 with the results as shown below. • age restrictions (54.1%, n=171) • spousal consent laws (31.6%, n=100) • the patient/client may not use it correctly (64.6%, n=204) • concerns about where the patient/client would go if they used it incorrectly (56.6%, n=179) • no concerns (9.5%, n=30). The health worker respondents also had the option to express and elaborate on their concerns through a qualitative written response, and 66 health workers did so, providing valuable qualitative data, as presented below. The most common themes in these written responses were sociocultural issues (especially stigma and discrimination), the importance of knowledge and information, lack of accessibility, side-effects and potential complications. Sociocultural issues, especially stigma, were mentioned in the written responses of 18 health workers. These issues were described as a concern present at the individual level through shame; at the community level through stigmatizing norms; and at the state level through lack of supportive policies. A 21-year-old female respondent in Poland who identifies as bisexual described this issue as: “Shame accompanying using them, e.g. because of social stereotypes.” A 32-year-old male health worker in Nigeria noted that there could be challenges in accessing self-care interventions due to low community acceptance and stigma, highlighting the need for: “Accessibility to self-interventions without prejudice.” A 33-year-old female 4.1 CURRENT CONCERNS WITH SELF-CARE SRHR INTERVENTIONS: HEALTH WORKERS AND LAYPERSONS Chapter 4 75 health worker in Cameroon described how sociocultural issues may exist on the macro level, through “traditional and discriminatory state policy”. A 27-year-old male respondent in Thailand explained the impact of stigma and discrimination: “Stigma and discrimination in traditional communities by health-care providers and pharmacy employees creates barrier to access any of STI self-treatment methods.” Similarly, facing negative judgement when accessing health care was a concern expressed by some participants. A 30-year-old male respondent in the Philippines explained the importance of this issue: “Non-judgemental and quality care and service is the paramount consideration.” Those concerns of facing stigma and poor treatment when accessing services were connected to culture and beliefs. A 22-year-old male respondent in Türkiye explained the phenomenon in the local context: Especially in Türkiye, people are very strict about sexual relationships. They have some rules, like two young people cannot have sex before the marriage… When they go to the doctor they come face to face with unacceptable behaviours. Young people are exposed to ill treatment by the doctor. This issue was identified as a barrier to accessing SRH services. A 45-year-old female respondent in Colombia wrote of the consequences of health workers’ beliefs: “In health centres, many times they do not give information with what they do not agree with, or they are not within the pos.” Seventeen health workers also expressed concerns about knowledge and information. A 39-year-old female health worker in the USA explained this issue: “I think there is a lot of false information out there, and it can be hard to distinguish the credible sources from the ones that aren't.” The lack of appropriate information can have consequences for people’s health-care decisions. A 43-year-old female health worker in Spain expanded on this concern: “Incomplete information to make a really informed choice.” Lack of accessibility was also a major concern expressed by 10 health workers. A 60-year-old male respondent in Brazil wrote: “High costs and difficulty of access are issues important for some methods.” This issue was connected to health workers controlling access to self-care interventions for SRHR. A 47-year-old female respondent in the USA explained: “Doctors, pharmacists or any other health-care staff should not be gatekeepers.” Overreliance on health workers was identified as a barrier to self-care interventions. A 31-year-old female respondent in the USA elaborated: “The field is too medicalized. Patients have been taught to go to the doctor for everything. It will take time and effort for people to fight for and access some of these interventions without the use of a health-care provider.” A 56-year-old female respondent in Italy described this lack of accessibility: “Lack of access to health services when needed even if they exist, due to many barriers.” This was mentioned as particularly an issue for certain underserved populations. A 42-year-old female respondent in Portugal notes the issue of “lack of access by disabled people”. Concerns about side-effects and potential complications were also raised by nine health worker respondents in Wave 1. They expressed concern about what the user of an intervention would do in the event that they experience side- effects. A 54-year-old male respondent in Kenya noted the concern of “handling of complications”. Some respondents expressed concerns about potentially harmful consequences. A 27-year-old female health worker in the Republic of Moldova explained her view of the impact this could have: “Side- effects [are a concern] and as result decision to quit and refuse the self-initiated interventions in the potential future.” A 54-year-old female respondent in Switzerland also discussed the importance of linking people to health care as needed following use of self-care interventions: “Access to and support provided by health services if the patient has used something incorrectly and needs treatment/support to correct that.” Wave 2 A total of 54 health workers in Wave 2 expressed current concerns with self-care interventions for SRHR through their written responses. The main themes that emerged from their responses were accessibility, stigma and discrimination, lack of community awareness and product quality. Accessibility was the most common theme to emerge among the concerns expressed by 24 health worker respondents. Within this theme, three broad categories could be distinguished: cost, availability and insurance coverage. The respondents expressed concern about the high cost of self-care interventions for SRHR. A 34-year-old female health worker in Zambia explained that “affordability of these interventions for ordinary people is a major issue”. The high cost of some products impacted individuals’ ability to access them. A 22-year-old respondent from Canada (gender not specified) found that the “accessibility to sexual health services/products is largely influenced by whether you can afford these products”. Lack of availability impacted access and was a concern for many. In some countries, respondents reported that self- care intervention products were not only hard to find but not available at all. A 63-year-old female respondent from Zimbabwe explained that while “some of the products like lubricants are not readily available” some were not sold in Zimbabwe as “there is no over-the-counter abortion pill in our country”. Health workers noted a difference in availability based on location, a 49-year-old male respondent in Morocco said that “there is an unavailability of certain products, particularly in rural and in isolated areas”. Finally, health worker respondents highlighted that certain products were continually unavailable. A 57 year-old female respondent from Nigeria said that “pre/ post prophylaxis is not easily accessible with high rate of nonavailability”, and a 34-year-old female health worker from Zambia said “services including syphilis tests are not readily available at public health centres”. Additionally, there were also concerns about youths’ ability to access self-care interventions for SRHR. A 30-year-old female health worker in Australia felt that: “It’s important that legal restrictions related to age don’t impede access; younger Chapter 4 76 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report people who might be among those most able to benefit from self-administered interventions are barred from accessing them.” Additionally, a 49-year-old male health worker from Rwanda felt that for “youth is not easy to get services without accompaniment with parents”. The final concern related to accessibility of self-care interventions for SRHR was that many of the interventions were not covered by health insurance, which therefore rendered them unaffordable and inaccessible. As a 59-year-old female health worker from the USA wrote, “Access within a reasonable amount of time is difficult for people like me with poor insurance coverage. The products that are available in my area are expensive.” The lack of insurance coverage for self-care interventions for SRHR make them unaffordable to many, as explained by a 59-year-old female health worker from Zimbabwe: Access to basic services such as these is a privilege of a few and beyond the reach of many. Public institutions that are supposed to provide the services hardly have them or enough of the resources. The next most common theme, expressed by 21 health worker respondents in Wave 2, was stigma and discrimination. A 35-year-old queer respondent (country non-specified) summarized the concerns surrounding stigma expressed by numerous respondents by saying, “Stigma is the biggest barrier to accessing these self-care interventions.” Stigma was said to impact access to both products and information on products. A 57-year-old female respondent from India said: There is stigma and discrimination related to purchase, getting information on and use of medicines and products related to contraception, STI (including HIV) and abortion. There is also stigma related to use of pregnancy-related products and services for unmarried women or young girls, such as use of the pregnancy test. Highlighting how stigma impacted women accessing self- care interventions for SRHR was common in health worker responses. A 38-year-old woman from Bolivia wrote, “Unfortunately, it is difficult to access public health services, it is not given due importance, there is still discrimination for being a woman and looking for condoms.” Stigma was particularly felt by single/unmarried women. A 49-year-old male respondent from Morocco shared that access to self-care interventions for SRHR was difficult for “single women who are not considered as the target population in the national programme”. In Wave 2, multiple health workers specifically highlighted concerns about stigma surrounding gender identity. A 59-year-old female respondent from the USA explained, “People of certain gender identities, races and religions encounter prejudice in health-care settings and therefore do not like to go. Direct access to these items could be important for them.” Further, a 30-year-old transgender respondent from Chile said: It is very difficult to access hormone replacement therapy, since trans identities are pathologized despite the fact that the Gender Identity Law prohibits it. It is required to go through a highly bureaucratic process that ends up being a barrier to access, in addition to other people requesting psychological and psychiatric certificates to access. Another concern about self-care interventions for SRHR expressed by six health workers was the lack of public/ community awareness about these interventions and their usage. A 48-year-old female health worker explained that “information is required for safe self-care and what to do or where to go in case of side-effects”. Further, a 59-year-old female health worker from the USA said that: Most people are not well educated regarding which contraceptives are most reliable, how to use them properly, and when STI testing is needed. Direct access needs to come with a lot of consumer education. Finally, four health workers expressed concern about the quality of products, noting possible counterfeit self-care interventions. For instance, a 38-year-old female health worker from Zimbabwe stressed that “standards and quality for self- care test kits on the market need to be checked frequently by regulatory authorities” and that the “supply chain for contraceptives need to be strengthened to prevent shortages and street trading of these commodities”. Chapter 4 77 4.1.2 LAYPERSON RESPONDENTS Wave 1 In their written responses, layperson respondents in Wave 1 described concerns that fell within the following major themes: poor accessibility, stigma and discrimination, and culture and beliefs. Respondents mentioned barriers that exist in accessing self- care interventions for SRHR. A 45-year-old female respondent in Canada expressed how the lack of affordable interventions leads to poor access: “Cost is indeed a big barrier to some.” Other factors, such as lack of availability and provider unwillingness, also make it difficult to access specific self-care interventions for SRHR. A 21-year-old woman in Poland explained the barriers in a local context: “In Poland, to get an emergency contraception you first have to go to the doctor and not all of them want to prescribe it. Some pharmacies also do not want to sell it.” Stigma and discrimination were recognized by respondents as being a major concern relevant to self-care interventions for SRHR. A 25-year-old female respondent in Colombia stated: “The principal concern is stigma related to the use of sexual and reproductive health products.” This was specifically expressed as a problem for certain populations. A 27-year-old female respondent from the Republic of Korea elaborated on the circumstances in which stigma becomes a barrier: When teenagers and young women visit to the hospital in obstetrics and gynaecology for many reasons, consulting on ovulation pain, unregular ovulation, STI test, etc., there is a social stigma from older women and relevant people and regarded as not moral person. This social stigma blocks many young women to access and take care of their health. Lastly, culture and beliefs, particularly traditional or conservative beliefs, were perceived by layperson respondents as being a significant concern relevant to self-care interventions for SRHR. A 26-year-old female respondent in Panama explained how this manifests in regard to accessing abortion: “Voluntary abortion is illegal in my country and there is a lot of religious (Christian) stigma when expressing wanting it.” The impact of religion on access to SRH services was also mentioned by other respondents. A 29-year-old female respondent in Croatia explained: “I would like religion groups stay away from affecting laws and directives about contraception. They mess up a lot of things.” Wave 2 Some layperson respondents in Wave 2 also wrote down their concerns regarding self-care interventions for SRHR. The major themes were limited availability, high cost, and stigma and discrimination. Poor availability and accessibility was related to the location of self-care interventions for SRHR. A 39-year-old female respondent from Côte d’Ivoire described that “emergency contraception is incredibly expensive and often locked away/ behind the counter.” Further, the high cost was also seen as a barrier to access for self-care interventions for SRHR. A 39-year-old woman from Australia explained: I’ve also struggled to access the morning-after pill/ emergency contraception – I acquired it from the local chemist, but was shocked by the price, which left my partner and I without money as we’re both on welfare and thus below the poverty line. Stigma and discrimination was another theme among layperson respondents’ written contributions. A 31-year- old female respondent from Spain shared, “I have felt some judgement about my sexual activity when using contraception services.” Similarly, a 40-year-old woman from Nigeria explained, “The process and procedure of accessing some of the above listed are cumbersome and quite discriminatory.” Stigma was said to be associated with certain products. For example, a 31-year-old from Kenya said, “There still exists a lot of stigma accessing HIV-related and abortion-related products.” Stigma was tied to local cultural beliefs, as explained by a 28-year-old respondent from Pakistan: “There is cultural, social and religious barrier to access these products.” For self-care interventions that required a prescription, a 23-year-old female respondent from Canada said she “had to go to multiple doctors at a clinic to find someone who would prescribe it, severe stigma associated with it leading to decline in mental health”. Chapter 4 78 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report 4.2.1 HEALTH WORKERS Wave 1 A total of 112 health workers provided written responses in Wave 1 about the benefits of self-care interventions for SRHR. The most common theme expressed was that there are no benefits, but many others also wrote about intrapersonal benefits, reduced exposure to stigma and discrimination, and increased usage, convenience, knowledge and confidentiality (1). The most common sentiment, mentioned by 31 health workers, was that there are no benefits to self-initiated interventions. For instance, a 34-year-old male health worker in Lebanon explains: “[No benefits] at all! People should go see a doctor, otherwise all self-initiated interventions are a failure.” Twenty-five other respondents recognized the intrapersonal benefits of these interventions. Many noted how their use promotes empowerment, self-confidence and better-informed decision-making. A 54-year-old female health worker in Switzerland noted that these interventions provide “increased power to people”. Similarly, a 33-year-old female health worker in Ecuador observed the benefit of providing “people with autonomy”. Some described the personal benefits that self-care interventions would provide to higher risk populations. A 25-year-old female health worker in Kenya explained how self-care interventions “enable [young women] to make informed decisions without being pressured by anyone”. Fifteen respondents noted that the self-initiated aspect of these products could lead to increased use of the interventions in the population. A 59-year-old female health worker in the USA noted: “There is greater uptake and adherence of interventions if self-initiated.” This was identified as especially beneficial for populations who may not engage in SRH services as often as needed. A 56-year-old female provider in Italy described the benefits of these interventions for young people: “Many of them are excellent for increasing access by youth to RH [reproductive health] services, as they are often deprived.” Increased convenience was also mentioned by 15 respondents, explained in terms of ease of access and time saved. A 56-year-old female health worker in New Zealand noted that this type of intervention “removes gatekeepers”. A 31-year-old female health worker in Serbia explained this benefit as: “Faster treatment if patient don't have time to wait in health clinics and hospitals.” This was specified as being particularly beneficial for certain interventions. A 28-year-old female health worker in France wrote: “Better accessibility and quicker process (abortion/self-diagnosis STI/HIV).” Fourteen health workers identified the benefit of increased knowledge. Self-care interventions for SRHR were described as having the potential to increase the population’s knowledge and information on SRHR, which benefits their health and well-being in multiple ways. A 65-year-old male health worker in Kenya noted this benefit: “This can lead to improvement of knowledge and confidence.” A 58-year-old female health worker in Peru explained how this can benefit a patient’s interactions with the health system: “It helps to know better the functioning of your body. It will have better elements for dialogue with health personnel.” Eleven health worker respondents noted the benefit of increased confidentiality with self-care interventions for SRHR. A 40-year-old female health worker in Canada described how this would help those who are marginalized, such as women in abusive relationships: “Privacy [is a benefit], especially for women in abusive situations where husbands may control medical care.” A 32-year-old male health worker in Nigeria wrote that “confidentiality will be maintained” with these interventions. A 32-year-old male health worker in Argentina wrote of “greater respect and privacy” as being benefits to self- care interventions. The benefit of greater confidentiality was supported by a 26-year-old female health worker in Kenya: “… needless to say, my confidentiality will be better safeguarded”. Nine health worker respondents identified improved health as an advantage of self-care interventions for SRHR. A 30-year- old male health worker in the Philippines explained how these interventions will “encourage health seeking behaviour of the public”. A number of health workers mentioned that self-care interventions for SRHR help to address issues related to stigma and discrimination. A 21-year-old female health worker in Poland explained: “I think that having these interventions easily accessible and without stigmatization or shame would make these interventions easier, more pleasant and safer.” A 26-year-old female health worker in Uganda elaborated on its potential in certain regions: “I believe self- initiated interventions can play a huge role in reducing barriers to accessing services due to stigma associated around it, especially in sub-Saharan Africa.” A 38-year-old male health worker in Thailand discussed how the risk of discrimination against sexual and gender minorities can be a barrier to access that could be addressed by self-care interventions: Access would be the most important. While I don’t have concerns visiting a doctor or health centre as I am out and comfortable with my sexuality, those who are not out would be unlikely to access a health service and disclose their sexuality to a doctor. Health worker respondents discussed how the affordable cost of self-care interventions is a potential benefit. A 38-year- 4.2 POTENTIAL BENEFITS OF SELF-CARE SRHR INTERVENTIONS: HEALTH WORKERS AND LAYPERSONS Chapter 4 79 old male respondent in Malawi explained how there is “less cost because there is no service fee for the health provider”. A 70-year-old male health worker in the United Kingdom supported the affordability of self-care interventions: “Good idea, will save cost and time.” Increased confidentiality and reduced stigma and cost all act to improve accessibility to the interventions. Wave 2 A total of 33 health worker respondents shared written responses in Wave 2 about the benefits of self-care interventions for SRHR. The most common themes in their responses were increasing access to care, addressing stigma and discrimination, improving confidentiality and linkage to care, reducing costs and addressing concerns surrounding gender-based violence. The most common theme, mentioned by 10 health workers, was that self-care interventions for SRHR increased access to care. A 37-year-old woman from Nigeria articulated a commonly held sentiment among health workers, that self-care interventions “increase access to effective SRHR services”. By increasing access to care, self-care interventions for SRHR were understood to in turn improve health. The subsequent reduction in health inequities was mentioned by a 45-year-old female respondent in Canada: “Self-care reduces inequality between those who can afford to go to health care centre and those who cannot.” Others discussed reduced mortality, as expressed by a female health worker in Cameroon: “They will easily access sexual and reproductive health services which will reduce mortality and morbidity rate among these groups of persons.” One avenue through which self-care interventions for SRHR were understood to increase access was by reducing costs when compared with interventions that require an appointment or extensive interactions with health-care personnel or facilities. For instance, a 69-year-old female health worker (country non-specified) said that self-care interventions for SRHR were beneficial because they are “cost-effective and minimizes encounters with health providers”. Additionally, a 43-year-old Kenyan female health worker said that when these interventions are low cost, this increases access to care because they “could be cheaper and then more accessible”. The lower cost of these interventions helped individuals in “avoiding financial strain”, as mentioned by a 25-year-old female health worker from the Philippines. Addressing stigma and discrimination was mentioned as a benefit by eight health worker respondents in Wave 2. A 60-year-old male health worker (country non-specified) explained they were considering providing self-care options to some of their patients as it helped address patient experiences of stigma and discrimination. He elaborated as follows: I was thinking of providing a self-care test kit for example injectables (contraceptives), HCG test kit, and HIV test kit. Most of them hardly visit any health clinics as they are sometimes discriminated against by other people. Related to increased access to care, four health worker respondents noted that self-care interventions for SRHR could lead to more timely diagnoses and pathways to care. One respondent (no socio-demographic information provided) wrote that self-care interventions for SRHR facilitated “the timely detection of diseases such as HPV infection, HIV, as well as the diagnosis of pregnancy”. Further, a 48-year-old female health worker (country non-specified) felt that these interventions “increase access, timeliness to care, limits complications due to delayed care.” A few health worker respondents also noted that self-care interventions for SRHR had the potential to address concerns around confidentiality and privacy. A 39-year-old female health worker from the USA summarized this point by saying, “Discretion and privacy is the major benefit of self-care.” More specifically, being able to use self-care interventions at home was highlighted as a major potential benefit. A 50-year-old male bisexual health worker (country non-specified) said that one of the “numerous benefits” of self-care interventions for SRHR for individuals who might experience stigma is “the capability to manage themselves privately, away from stigmatizers.” A few health worker respondents also mentioned another benefit of self-care interventions for SRHR: their ability to address some concerns surrounding gender-based violence. A 45-year-old female health worker (country non-specified) shared that one of the benefits of self-care interventions for SRHR was their potential to “reduce intimate partner violence”. A 31-year-old female health worker from the United States elaborated on this benefit, explaining, “Some of these methods also reduce gender-based violence – particularly products that allow women to prevent pregnancy and HIV acquisition in ways that are discreet.” Chapter 4 80 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report 4.2.2 LAYPERSON RESPONDENTS Wave 1 A number of laypersons in Wave 1 mentioned the potential benefits associated with self-care interventions for SRHR. The most common themes were decreased barriers to access and reduced stigma and discrimination. Respondents expressed how self-care interventions for SRHR have the potential to increase access to SRHR interventions by reducing barriers to access. A 29-year-old female respondent in the USA described the existing barriers that these interventions could help to reduce as well as the benefits for women in particular: I think it's really important to have self-initiated interventions available over the counter at pharmacies at a low cost so that people can access them without having to visit a health-care provider, which adds an additional cost in both monetary value and lost time. Oftentimes going to a health- care provider to access some of these self-initiated options makes women feel shameful and some health-care providers don’t do a great job of making it a safe, empowering space for women to choose the method that is right for them. It would be amazing to have more options available, more easily accessible to women in the United States. A 31-year-old female respondent in the USA elaborated on the potential for improved access to SRHR interventions for women: “Going to a health-care provider can be a major barrier for women to access RH [reproductive health] services. Putting care directly into the hands of women to manage is an important way to overcome this barrier.” Another potential benefit recognized by layperson respondents was how self-care options could reduce the stigma and discrimination often associated with SRHR interventions. A 41-year-old man in Uganda explained: “I think an option for self-initiated interventions is good to reduce stigma and discrimination.” Some respondents specified that online sources for SRHR information would be particularly helpful for youth. A 25-year-old female respondent in Croatia explained how this would address stigma: “A majority of the public are not informed well enough about them, due to stigma surrounding these interventions. A reliable, up-to-date and simple-to-use online, mobile source of information would be highly beneficial, especially to the younger population.” Wave 2 Most layperson respondents in Wave 2 discussed the potential benefits associated with self-care SRHR interventions. The most common theme was that self-care strategies held the potential to reduce stigma and discrimination. Respondents noticed that when they had accessed self-care interventions for SRHR in the past, they did not feel stigmatized. As a 36-year-old woman from the USA described, “I used emergency contraception twice in my early 20s. Went to Planned Parenthood to obtain the EC [emergency contraception] – they were supportive and nonjudgemental.” As seen in this response, the respondents highlighted specific locations where they did not feel judged. A similar sentiment was expressed by a 22-year-old woman from Canada: When accessing birth control on university campus I felt a sense of comfort and non-judgement, but going to a pharmacy I felt the judgement from the pharmacist behind the counter when seeking out Plan B. The difference in care was a little scary for me and so I wouldn’t want to go back to a pharmacy for that particular concern again because I have a young face and I think I would receive that treatment again. Chapter 4 81 4.3.1 HEALTH WORKERS Wave 1 The major themes that emerged when health worker respondents provided their qualitative answers about their preferred conditions for use of self-care interventions for SRHR were: ease of access and availability; information, knowledge and education; and confidentiality and privacy. Respondents indicated a preference for self-care interventions that are easily accessible and available. A 30-year-old male health worker in Kenya explained: “The interventions should be readily available and at minimal cost.” A 37-year-old female health worker in the USA discussed what that would look like: “Access and cost should be minimized for these [interventions] – ideally non- prescription, over the counter, with an ability to seek additional guidance.” Health worker respondents recognized the need for better information, increased knowledge and more education about self-care interventions. A 70-year-old male health worker in India mentioned the need for widespread knowledge on these interventions: “Self-initiated interventions require awareness, good educational background and community participation.” Similarly, a 40-year-old male health worker in Uganda described how this is important for use of the self-care interventions: “Availability of information for users is important and also how to interface with health system after use.” Better confidentiality and privacy were also mentioned by health workers as important conditions for successful use of self-care SRHR interventions. A 40-year-old female health worker in the USA emphasized this issue: “Privacy and confidentiality are key for self-initiated SRH interventions.” A 25-year-old female health worker in Nigeria explained the significance of this issue in her local context: “Stigma in Nigeria is still a huge issue. I’d like for more discreet means of accessing SIIs [self-initiated interventions] in such countries.” Wave 2 A number of health worker respondents expressed their preferred conditions for use of self-care interventions for SRHR in the written responses. The major themes of these responses were cost, and knowledge and information. A 54-year-old male health worker from the United Kingdom summarized these themes saying: “I would support the range of self-care interventions being made as widely available but would also want access to be as simple, discrete and cost effective as possible.” Health workers highlighted that it was important to provide information and education when giving out self-care interventions for SRHR. This included general information on the availability of self-care interventions. A female health worker in Cameroon (age not specified) asked that there be “community awareness on the concept and products of self- care”. Health workers felt that greater general knowledge about self-care interventions for SRHR would lead to more people accessing these interventions. A 54-year-old male health worker in the United Kingdom said, “I would also like to see greater promotion of and education about the range of self-care commodities available to increase uptake.” Health workers also felt it was important for information on side-effects to be widely known. A 31-year-old female respondent in Venezuela expressed concerned over the lack of information on side-effects: I do not like that health providers do not inform women well about complications, side-effects or warning signs about contraceptive methods, they offer them as innocuous and 100% safe or effective, which is not as true. Participants recommended that information on side-effects should be provided at the point of care or point of purchase. Health worker respondents felt that information would also help link individuals to care. As a 48-year-old female health worker (country not specified) wrote, “information is required for safe self- care and what to do or where to go in case of side-effects”. 4.3.2 LAYPERSON RESPONDENTS Wave 1 Layperson respondents described their preferred conditions for use of self-care interventions for SRHR in their qualitative responses, and the major themes of their answers were: accessibility and availability; information and knowledge; cost; and privacy and confidentiality. These respondents viewed it as ideal for self-care interventions to be accessible and available as an option for SRH services. A 32-year-old female respondent in the USA explained: “Self- initiated interventions are somewhat rare in the USA – I wish they were more common.” This was noted as being especially important for certain marginalized or higher-risk populations and in particular 4.3 PREFERRED CONDITIONS FOR USE OF SELF-CARE INTERVENTIONS FOR SRHR: HEALTH WORKERS AND LAYPERSONS Chapter 4 82 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report contexts. A 33-year-old male respondent in North Macedonia highlighted the need for access to self-care interventions among sexual and gender minorities: “As a gay man who has regular safe sex with other men, I would like to have PrEP and PEP accessible and affordable in my country.” Access for rural communities was suggested as a priority. A 20-year-old female respondent in Kenya wrote: “Access to birth control pills should be made available even in the remote areas.” Similarly, easy access was mentioned as ideal for youth, with some respondents providing suggestions on how that would work. A 37-year-old respondent in Uganda explained: “Mobile application on SRH is very important currently for young people, since every one at least has a smartphone.” Being better informed and educated was described as essential for making informed decisions on SRHR. A 23-year- old female respondent in Portugal explained: “I just want to be well informed of the interventions and choices I have, and then I want to choose by myself without needing a doctor.” Another participant in Portugal, a 20-year-old female respondent, supported widespread education about these interventions: “People must be more informed about all of these self-initiated interventions.” This was also discussed as being particularly important in certain regional contexts. A 21-year-old female respondent in Argentina wrote: “I would like that in Argentina there would be more sexual education.” Costs and affordability of self-care interventions were viewed as important by layerson respondents, who provided some suggestions on how that would work. A 58-year-old female respondent in the USA explained: “Cost is an issue. I would want interventions to be covered by insurance or provided for free or on a sliding scale based on income.” This was supported by other respondents. A 21-year-old female respondent in Panama wrote: “It would be useful if they were presented in a variety of pharmacies with different price ranges.” Affordable self-care interventions were seen as important for reducing STI rates in the population. A 20-year-old male respondent in Portugal explained, “I think that the cost of any sexual health product needs to be the lowest or free. That could help decrease the amount of people infected with any kind of sexual disease.” Among these respondents, the final major theme that emerged relating to preferred conditions for self-care interventions for SRHR was the protection of privacy and confidentiality for the user when accessing the intervention. A 34-year-old female respondent in Mexico explained how anonymity can be improved and why it is important: “Stocking them not behind the counter, [so they are available] without an ID is important – there can be just as much judgement from a pharmacist, especially in conservative places.” A 26-year-old female respondent in Sweden elaborated on the consequences when there is a lack of privacy and confidentiality: “I think anonymity is still very important for SRH, and often it is forgotten in services and that’s why many people don't access care through health-care providers.” Wave 2 A number of layperson respondents also shared their preferred conditions for use of self-care interventions for SRHR in Wave 2. The major themes that emerged were that open discussion, widely available information, and reduced costs all help to increase access and availability. Creating public dialogue and having widely available information about self-care interventions for SRHR was seen as beneficial to wider use and access. A 36-year-old woman from the USA explained, “I think that self-care will become more socialized and normalized if it is a topic that is discussed and advocated upon in peer groups, such as women’s groups or youth groups.” Some respondents shared that access to information facilitated access to care. A 43-year-old woman in the USA shared: I myself was well into my own sexual experience/activity before I had access to education on how to access contraception, methods and differences, largely due to education curricula and norms in safe conversations within family. Respondents felt information on self-care interventions for SRHR was not readily available. To illustrate, a 31-year-old woman from Kenya wrote that “Family planning education on use of FP products is not freely accessible in the public sphere (one needs to actively seek through doctor consultations or internet searches).” In another example, a 28-year-old woman from Spain described that, “Where I live, it is not that easy to find out where to get tested or to find out further information. Everything is 'hush hush' and there are no easy websites to access where to get help or find a clinic that can help you.” Ultimately for wider implementation and use of self-care interventions for SRHR, the same participant from Kenya explained, “There needs to be more awareness-raising and deeper understanding of self-care interventions.” Another emergent theme surrounding the preferred conditions for use of self-care interventions for SRHR was the importance of reducing costs to increase access. The high cost of some of the products and interventions was mentioned. A 28-year-old from Spain said, “The cost of the pill here in Valencia (Spain) is quite expensive and contributed to my decision to come off it.” A 26-year-old in Germany felt that high cost should not present access barriers to these interventions, particularly among young and/or economically insecure persons. They explained: I think all the interventions stated here are extremely expensive for a student or young individuals who are unemployed. But this shouldn't be a hindrance to get access to health products. For example, I use birth control solely for my period since it is a life-stopping pain. And I need to pay ~20 euros per package, which is basically my grocery cost per week. So when I buy birth control I need to decide what to eat and not to eat for that week. Finally, participants noted simply that increased and easier access would help with the wider use of self-care interventions for SRHR. For example, a 36-year-old respondent from the USA shared that their “ob-gyn offers a 1-year prescription and then I do mail order restocking every 3 months – very convenient.” Chapter 4 83 4.4 FUTURE ISSUES FOR CONSIDERATIONS WITH SELF-CARE SRHR INTERVENTIONS: HEALTH WORKERS AND LAYPERSONS 4.4.1 HEALTH WORKERS Wave 1 Health worker respondents identified and discussed potential issues with self-care SRHR interventions that may arise in the future, and which should thus be considered at early stages of roll-out. The major topics discussed were: the importance of expertise, the legitimacy (authenticity and quality) of interventions, and the potential for incorrect use. Many health worker respondents raised the issue of lack of expertise among the average user of self-care interventions, and the importance of accessing health workers for any SRHR interventions. A 65-year-old male health worker in India warned: “Self-initiated interventions need to be avoided as far as possible. Always consult doctor when there arises problem.” Similarly, a 58-year-old female health worker in Congo emphasized the need for medical professionals: “There should be very strong counselling communication on the need to consult a doctor or other health-care worker should the patient not be happy with results or if they should develop complications.” The risks of illegitimate self-care interventions were also raised for consideration by a number of health workers. A 46-year- old male health worker in Uganda explained why this issue should be considered: “Private drug shops, clinics need to be well regulated and could be sources of more burden and challenges.” A 35-year-old female health worker in the USA explained how this is particularly an issue with online sources, “I would want to make sure they are trusted, not counterfeit, if I buy them online.” Another potential issue that emerged in the responses was about the misuse or incorrect use of the interventions, which can have serious consequences. A 56-year-old woman in Italy described how this can be a result of poor knowledge among the population: “There is a risk for the general public of abuse or misuse due to lack of knowledge. There is a lot of misinformation out there so there must be safeguards and some control.” Those risks can impact one’s health, and some health workers expressed a preference for consulting with a medical professional as a result of such risks. The opinion of a 63-year- old female health worker in Pakistan was that: “An intervention led by a doctor or health-care provider is safer and maintains safer reproductive health.” Wave 2 Health worker respondents in Wave 2 discussed future issues to consider for self-care interventions for SRHR. The main theme that emerged in the written qualitative responses was the need for more training related to these interventions for health workers. Health worker respondents wanted training to learn more about where self-care interventions for SRHR could be accessed about how users could be linked to care. A 45-year- old female health worker (country not specified) said there was a need for: Communication through service providers in shops/ pharmacies where self-care products are mostly accessed. These service providers need to emphasize the need to seek medical attention where needed. Health worker respondents also expressed the need for additional training about the self-care interventions themselves. A 50-year-old male health worker (country not specified) mentioned this, describing: At times we do not know how to administer some of the products ourselves. I at times make mistakes. So there is need for some (group) trainings. At present, training was described as not widely available for many participants. For instance, a 57-year-old female health worker from Bolivia stated: Sexual and reproductive health is not a prioritized programme in the health system. This weakness also translates into the lack of trained personnel in the services. 4.4.2 LAYPERSON RESPONDENTS Wave 1 (not collected in Wave 2) Among non-health-worker respondents, with regard to potential future issues to consider for self-care SRHR interventions, the relevant themes that emerged in the qualitative responses were the same as among health workers: the risk of incorrect use, the importance of expertise, and concerns about product legitimacy. Chapter 4 84 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report The potential for incorrect use of self-initiated interventions for SRHR with negative consequences was clearly an area of concern. A 20-year-old female respondent in Indonesia wrote: “Just make sure there’s a risk management.” In particular, this was noted as more of an issue for some interventions than for others. A 48-year-old female respondent in Kenya elaborated on the interventions for which this would be a problem: Simple interventions can be feeling self-initiated like birth control or morning-after pills or self-testing. But abortion pills, HIV medication pre- and post-exposure, STI medication should be through a health provider because of complications arising from the condition or from the medication taken. This was also discussed as being a particularly important issue for individuals with lower educational attainment. A 32-year-old male respondent in Uganda wrote: “Self-initiated interventions are only good for literates – health, reading, writing, digital, etc. I feel they might be misused by illiterates.” Many respondents emphasized the importance of medical expertise when it came to SRHR interventions. A 67-year- old male respondent in Mexico expressed this concern and cautioned against using self-care interventions for SRHR: “Warning: only your medical team had the knowledge, avoid self-treatment, and [health] conditions and drug response are very personal.” A 22-year-old female respondent in Kenya explained the need for medical experts: “I just hope they don’t eliminate the need of a health-care provider because really, anything could go wrong really.” This was discussed as being particularly important for specific services. A 44-year-old female respondent in Uganda elaborated on this need: “Some interventions need counselling before they are used, how will that happen in self-initiated interventions?” Respondents also commented on the importance of the legitimacy and quality of the intervention products and services. A 40-year-old male respondent in Pakistan explained that important issues include “availability of full information and quality of the products.” This was noted as a particular concern for online sources for self-care interventions. A 26-year-old female respondent in Sweden emphasized the need for ways of obtaining self-care interventions without purchasing them online: “Simple STI tests, pregnancy tests and the like should be more readily available because going online also puts people at risk for illegal medication/tests and the like.” It was also mentioned that certain populations are especially vulnerable to SRHR products that lack legitimacy or are low quality. A 19-year-old male respondent in China explained: “Some girls may need emergency contraception after unprotected sex, but they may buy it online due to other's attitudes and the drugs online are not really safe.” 4.5 PERSPECTIVES ON LINKAGES TO HEALTH CARE: HEALTH WORKERS ONLY Wave 1 Health workers were asked open-ended questions about how they thought patients/clients could be linked to any health services they may need following use of self-care interventions for SRHR. A total of 212 health workers provided written responses on this question in Wave 1. The most common themes that emerged here were: provide contact information, set up a referral system, increase education, use mobile applications (apps), provide support and include instructions on the next steps. Sixty seven health workers suggested providing contact information (telephone number, website, QR code, etc.) with the intervention to enable users to seek further care if needed. It was suggested by several respondents that the phone number provided should also include anonymous and confidential text messaging (SMS) services. Having a referral directory or other referral system in place was the next most common suggestion (mentioned by 56 health workers). Respondents explained different ways referrals could work for users of self-care interventions. A 49-year-old female health worker in Nigeria recommended to “involve health workers before commencement to ensure linkages”. A 24-year- old gender non-binary provider in Türkiye discussed the ideal qualities of a referral system: There needs to be a directory of clinics/doctors/health- care providers that are sensitive and not prejudiced against people who need health-care services for SRH problems. Patients/clients could be matched to the nearest doctor/clinic through a web application. The next most common suggestion was to increase education (mentioned by 47 health workers) to better facilitate linkages to care. As described by respondents, this could be done through raising awareness/knowledge levels and health literacy among the population. Some suggested the use of the media and prominent public figures, while others thought increasing education on the community level would be most effective. A 26-year-old female health worker in Nepal suggested: “More awareness and more media coverage could help.” Similarly, a 21-year-old female health worker in Poland supported “spreading information about that in the community”. This was explained in further detail by a 36-year-old male health worker in Paraguay: “By educating people, letting them know that if something is not right and they need more information or an intervention from health personnel, they should go – for the good of their health.” Increasing education was identified as helpful for reducing the impact of negative community beliefs on self-care SRHR interventions. A 71-year-old male health worker in the USA described the need for “education for community leaders to mitigate sociological, cultural, religious factors”. Chapter 4 85 Thirty six health workers wrote about the use of mobile applications (apps) as being helpful for enabling linkages to care, by involving interactive features that encourage linkage to health care. A 30-year-old female health worker in Kenya suggested, “In the app, there is a constant reminder for the patient to visit a health-care provider and log the details in the app with follow-ups.” Mobile apps were noted as being especially useful in certain regions of the world. A 30-year-old male provider in the United Republic of Tanzania explained the potential for “online services, especially considering the growing internet coverage in African countries”. Provision of support was described by 25 health workers as an option to ensure linkages to care. The types of support mentioned included counselling, psychological care and guidance. A 24-year-old female health worker in Uganda explained how this could work: “A toll-free number that provides quality counselling services should be put on the products used in the interventions so that people can easily talk to someone who will guide them on what to do.” Some respondents gave their views on who would best be able to provide support and guidance. A 32-year-old female health worker in Cameroon explained how community health workers would be well equipped for this: “Patients need assurance of confidentiality and trust in the personnel. Thus, through the use of professional and empathetic community health workers.” The next most common response about how to ensure linkages to care was to include instructions on next steps along with the self-care SRHR intervention, clearly outlining how to proceed following the use of the intervention (mentioned by 23 respondents). A 56-year-old female health worker in Italy explained: “This should be an integral part of all interventions with clear guidance provided on all platforms of how to access services if needed.” A 32-year-old female health worker in Nigeria explained that for self-testing kits, this would work “by outlining steps to follow after each test result, either negative or positive”. Wave 2 Health workers were asked how they thought patients/clients could be linked to any health services they may need following use of self-care interventions for SRHR, and 66 of them provided written responses to this question in Wave 2. The most commonly suggested strategies to link users of these interventions to health care were to use eHealth solutions, accessible education and information, and working with peer navigators and existing community support organizations. The most common response to facilitate linkages to care, mentioned by 24 health worker respondents, was eHealth solutions. Health worker respondents recommended using hotlines, social media, web pages and other telemedicine interventions to link users of self-care interventions for SRHR to care. The most commonly suggested eHealth solution suggestion was a hotline/helpline. For example, a 45-year- old health worker from Swaziland (gender not specified) suggested “a toll-free number that patients can call and be advised on what to do next after getting a positive HIV result”. Similarly, health workers felt that hotlines could be used to direct individuals to care appointments or locations. As a 36-year-old female health worker in Mexico suggested “to have a hotline or Telecomunicaciones Indigenas Comunitarius (TIC) service to find attention”. Similarly, a 59-year-old female health worker from the USA noted the benefits of a “hotline call number to talk with a nurse or counsellor who can tell them to get care and give ideas of how to access that care”. For those who could not immediately access care, virtual appointments were suggested as an option. A 48-year-old female health worker in Canada suggested that linkage to care could be facilitated by “providing access to health professionals through virtual means (telephone, video- conference, text)”. A 57-year-old female health worker from Bolivia described “virtual office, counselling and follow-up to help with adherence to treatment”. On a different theme, 16 health worker respondents stressed the importance of linking individuals to care at the point of purchase or prescription, including through providing referrals and/or education and information. A 46-year-old man from Malawi suggested to “provide referral contacts at the counter”. Similarly, a 38-year-old female from Zimbabwe suggested that linkage to care could be facilitated through the point of purchase of a self-test kit as follows: At point of purchase, advise client on options if they test positive or advise them to return. Alternatively offer a follow-up option to the client so that you can find out outcome and have opportunity to provide further guidance. Health worker respondents also suggested that clear information be provided on the packaging of self-care interventions for SRHR, to link users to health-care resources. A 43-year-old female health worker from Kenya suggested a combination of providing verbal information at the point of purchase as well as on the package, stating: “The vendor could provide some basic information explaining the importance of health care. The package can also contain similar information.” A 46-year-old female health worker from Hungary suggested that information be “clearly printed in big red letters on the product itself, not just the accompanying small printed paper”. Finally, nine health workers wrote positively about engaging with peer navigators and existing community support organizations to connect users to health care. For instance, a 59-year-old male health worker suggested, “We can work with trained peer educators who can reach out, help test and help in linking them.” Some respondents suggested that peer navigators would be one component in linking individuals to care. As a female health worker respondent from Cameroon (age not specified) envisioned specifically for HIV self-testing interventions: A mobile network (e.g. WhatsApp) should be created in every community linking clients, peer educators and counsellors, community relay agents and the health facility service provider. Positive tests results are communicated to the community relay agent by the peer educator/counsellor who in turn identifies and links the patient to the community relay agent. Chapter 4 86 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report A non-binary 35-year-old health worker (country not specified) similarly described ways to link people to care: Having trained community members check in with folks whenever possible after distributing the self-care item, having peer supporters available to help with making calls and appointments, having health care options that are more convenient than typical med services (e.g. a community nurse van, docs on call at community orgs, etc.). 4.6 PERSPECTIVES REGARDING TRAINING AND INFORMATION NEEDS: HEALTH WORKERS ONLY Wave 1 Health workers had the option to provide a written response on what specific training they would like to receive, and what information or skills they would like to learn relating to self- care SRHR interventions. Among the 181 health workers who provided written responses, the main themes were more information on specific interventions, instructions and next steps after use, related linkages to care and relevant counselling skills, safety-related information, evidence about the interventions, and information on digital technology. The most common response, expressed by 54 health workers, was a desire for more information on new, common or specific interventions. Specific interventions mentioned include HIV self-testing, contraceptives and self-management of medical abortion. Respondents mentioned wanting to know about the currently available interventions. A 44-year-old female health worker in Mozambique explained that she wants “information about the range of self-initiated interventions currently available and their status (i.e. which have been tested in which settings; as well as information about new technologies in the pipeline)”. The next most common response was about the need for instructions and next steps on how to proceed after using a self- care intervention (mentioned by 39 health workers). Respondents described the need for guidelines and specific details on how to implement the interventions, how the interventions are used, and how to provide follow-up care. A 29-year-old female health worker in China suggested there was a need for information on “correct usage of these interventions; also standard protocol in following steps.” A 25-year-old male health worker in Kenya asked for more information on “rolling it out”. Specific training for health workers was the next most common request in response to this item, mentioned by 34 health workers. This training would need to include how to administer the interventions, provide appropriate linkages to care and offer relevant counselling to patients/clients. A 25-year-old female health worker in Egypt described wanting training on “the power of trust and contact between the health- care provider and the patients”. The need for specifics on who will facilitate the training was mentioned by some respondents. A 32-year-old female health worker in Cameroon suggested: “Creating women health educators’ groups within communities who will train trainers.” Others offered further details on how the training could be disseminated. A 29-year-old female health worker in the USA explained: Maybe a webinar or some sort of online course, but that could be a barrier for some. I think that empowering pharmacists or those dispensing self-initiated interventions (if they are not bought online) should be trained to give training on them. The next most common response was about the need for safety-related information (mentioned by 22 health workers), particularly regarding side-effects, adverse reactions, contraindications and risks associated with the self-care SRHR interventions. A 33-year-old female health worker in the USA explained what information is needed: “How to identify bad side-effects, and where to go to seek medical help.” The need for complete training and information was the next most common response (11%, n=20). Many respondents described wanting extensive knowledge on all aspects of self- care interventions. A 52-year-old female health worker in Nigeria explained: “All the necessary knowledge and skills regarding self-initiated interventions.” Another respondent, a 20-year-old male health worker in Tunisia, described wanting “all that is possible at my level of knowledge. This concerns me strongly.” Seventeen health worker respondents expressed a need for evidence on these interventions. Preferred sources of evidence mentioned by respondents included reliable online sources that provide accurate and up-to-date information on self-care SRHR interventions. A 63-year-old female health worker in Pakistan described wanting “SRHR information on [web]sites that are authentic and registered for the work”. A few respondents make specific references to sources like the World Health Organization (WHO), while others describe seeking additional updated evidence more generally. A 27-year-old female health worker in the Republic of Moldova expressed a desire for additional accessible evidence: “More research on this field made public and translated in a couple of international languages.” Other respondents mentioned the importance of accurate evidence on specific interventions. A 21-year- old female health worker in Poland explained wanting “more information about contraceptives that can be 100% trusted – information about safe abortion and information about access to abortion”. Finally, 15 respondents also wrote about wanting information and training on digital technology, including mobile phone apps, webinars and online sources. A 50-year-old female health worker in Kenya explained that she wanted more information and training on “all matters digital. Mobile phone apps, online access confirmation”. A 44-year-old male health worker in the United Chapter 4 87 Kingdom described wanting to access “online tutorials by health- care providers” for information and training. Wave 2 Health workers in Wave 2 also had the option to provide a written response on what specific training, information or skills they would like regarding self-care interventions for SRHR, and 61 provided written responses. The primary themes included information on risks and complications, training on specific interventions/products, and training for working with specific populations. In their responses, seven health workers expressed the desire to learn more about the risks and complications associated with self-care interventions for SRHR. For instance, a 69-year- old female health worker wanted to know “more on risks and benefits of self-care”. A 55-year-old woman from Colombia wanted to know more about “how to respond on time if an adverse condition develops. Who will be responsible if something goes wrong?” Another common theme was the desire to be trained on specific self-care interventions for SRHR, mentioned by 14 health workers. This was especially true among health workers who did not have any previous experience working with an intervention. To illustrate, a 45-year-old from Eswatini (gender not specified) wanted training on “HPV self-testing and the hormonal therapy for gender affirmation, since these services not available in our country.” Similarly, health workers were interested in information and training on the services that were most pertinent to their role. A 33-year-old female health worker from Argentina described: As I work with families and babies, I would like to have specific information about family planning and detection of difficulties or obstacles when accessing all self-care [interventions] for a better quality of sexual life. The final common theme from the responses was the desire to learn more about working with self-care interventions for SRHR among specific populations, mentioned by six health workers. For instance, a 23-year-old female health worker (country not specified) wanted training to work with self-care interventions that would be most useful to sexually and gender diverse individuals, because she was “an outreach worker, mainly working with the LGBQ+ population, for over a year at a low-income clinic.” The need to feel prepared for working with specific populations extended to self-care SRHR resources in multiple languages. To illustrate, a 54-year-old woman from India wrote that she needed “communications materials that are publicly accessible in local language.” 4.7 ANY ADDITIONAL COMMENTS: WAVE 1 HEALTH WORKER RESPONDENTS ONLY In the final question of the health worker portion of the survey in Wave 1, respondents were asked to provide any additional comments in the form of written responses, and 48 health workers provided comments. The responses were most commonly regarding specific issues and perspectives on what is needed for self-care interventions for SRHR. A 28-year-old female health worker in South Africa, for example, described the potential for these interventions and what is needed for their success: Self-testing could revolutionize disease detection within the public health sphere. With the right amount of support channels this could empower people to take ownership of their health. There has been a lot of negative flack around self-testing, but I feel that to empower people is the rationale of thought leadership practices, which could be successful for public health initiatives. Some health workers mentioned the need for community-level empowerment and awareness. A 58-year-old male provider in Kenya explained: “It is important to empower the community with information about their sexual and reproductive health.” A 42-year-old female provider in Nigeria expanded further: “Community-based patient education rather than health facility-based health talks will drive uptake of the self- initiated care better, because oftentimes non-utilization is often due to lack of or inadequate awareness or knowledge about them.” Respondents brought up additional issues relevant to the topic of these interventions. A 32-year-old female provider in Nigeria explained the impact of social factors: “Family planning services are still not widely accepted in many parts of Africa, especially Nigeria. This is as a result of cultural and religious beliefs. There is a lot of emphasis on continuous education of the reproductive age group.” References for Chapter 4 1. Narasimhan M, Logie CH, Gauntley A, Gomez Ponce de Leon R, Gholbzouri K, Siegfried N, et al. Self-care interventions for sexual and reproductive health and rights for advancing universal health coverage. Sexual and Reproductive Health Matters. 2020;28(2):1778610. doi:10.10 80/26410397.2020.1778610. 88 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 Health-care engagement and self-care interventions for SRHR 5 89Chapter 5 Chapter summary This chapter focuses on respondents’ experiences with and preferences for accessing self-care interventions for SRHR or information about these interventions, and for engagement with health workers in relation to these interventions. First, in section 5.1, we present the quantitative findings on where both types of respondents access self-care interventions for SRHR, as well as where they access information on these interventions. The data are reported in tabular form and summarized in narrative text, with separate data for health workers and layperson respondents and for each survey wave. As in Chapter 3, the findings are grouped under six subsections by type of intervention: (1) Antenatal, intrapartum and postnatal care (asked in Wave 2 only); (2) Family planning; (3) Abortion; (4) Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (5) Promoting sexual health (asked in Wave 2 only); and (6) SRH information online and via mobile apps (asked in Wave 1 only). Across both waves of survey collection, for most self-care interventions for SRHR in this study, respondents reported a doctor or health clinic, and a pharmacy as the top two places where they go to access each one, and the internet and a doctor or health worker as the top two places where they access information on individual interventions. Next, in section 5.2, quantitative and qualitative data are presented from Wave 1 of the survey relating to engagement with health workers for self-care interventions for SRHR. Among survey respondents who had reported usage (or their partner’s usage) of any of the listed self-care interventions, the majority (in both types of respondents) had engaged with a health worker when using the intervention or as a result of using the intervention, and very few (approximately 5%) had ever felt pressured or coerced to use the intervention(s). The majority of both groups also felt it was (very or somewhat) important to be able to access self-care interventions for SRHR without going through a health worker. The vast majority also felt it was (very or somewhat) important to have access to a health worker after using such interventions. As to their preference for being able to access such an intervention with or without the involvement of a health worker, most said it would depend on the intervention, while about a quarter said they would prefer it to be with a health worker and less than 20% said they preferred to do it on their own. The full quantitative data as well as selected quotes from respondents are presented in the text. Finally, in section 5.3, an overall summary of ease of access to health care and online information is provided, with 94.7% of Wave 1 and 91.8% of Wave 2 health worker respondents and 96.6% of Wave 1 and 95.4% of Wave 2 layperson respondents reporting that they have access to a health worker when they need one. The majority of both health workers and laypersons across waves reported that it is “very easy” for them to access online information or a mobile phone confidentially. “I would want to rely on a health- care provider's intervention. It does not mean that I shouldn’t decide but I should know everything about the intervention before I give consent or not.” – A 24-year-old female respondent in Türkiye 90 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 TABLE 5.1: MEANS OF ACCESSING SRH SELF-CARE INTERVENTIONS FOR ANTENATAL, INTRAPARTUM AND POSTNATAL CARE, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) At-home pregnancy test Self-management of nutrition supplements (folic acid) during pregnancy planning Self-management of nutrition supplements (iron and folic acid) during pregnancy Self-management of nutrition supplements (iron and folic acid) postpartum Self-monitoring/ home-monitoring of blood glucose levels during pregnancy Self-monitoring/ home-monitoring of proteinuria during pregnancy Self-monitoring/ home-monitoring of blood pressure during pregnancy From a doctor or health clinic (%) From a pharmacy (%) Health workers Laypersons KEY 17.5 9.9 74.4 83.1 33.7 26.8 55.8 45.1 35.9 28.6 57.9 45.7 34.0 27.5 58.0 43.5 32.1 35.2 42.6 29.6 32.3 32.9 34.8 21.4 32.3 31.0 41.6 29.6 5.1 ACCESSING SELF-CARE INTERVENTIONS FOR SRHR AND SOURCES OF RELEVANT INFORMATION: QUANTITATIVE FINDINGS This section presents the quantitative findings for the survey questions: (i) Where/how did you/do you/would you access these interventions? (with reference to the list of different self- care interventions), and (ii) How do you access information on these interventions? Both questions included the option to choose all applicable responses listed. For each intervention, Wave 1 participants were presented with the following five options for the first question about accessing interventions: “doctor or health clinic”, “pharmacy”, “online”, “I do not know where to get it”, and “I do not need this”. Wave 2 respondents were presented with all of the same response options, in addition to a sixth option: “from a peer, outreach or community worker”. For the second question about sources of information, participants in both survey waves were presented with the following four options for each intervention: “doctor or health worker”, “online/internet”, “friends, family or community member”, and “I haven’t received any information on this intervention”. The findings are presented both in tables and summarized in narrative form (separate for health worker and layperson respondents), grouped under six subsections by type of intervention: (5.1.1) Antenatal, intrapartum and postnatal care; (5.1.2) Family planning; (5.1.3) Abortion; (5.1.4) Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities; (5.1.5) Promoting sexual health; and (5.1.6) SRH information online and via mobile applications (apps). 5.1.1 Antenatal, intrapartum and postnatal care Questions regarding the interventions in this subsection were only asked in Wave 2 of the survey. The findings are presented in Tables 5.1 and 5.2 – please refer to these tables as needed for details not included in the narrative summary. 91Chapter 5 At-home pregnancy test Self-management of nutrition supplements (folic acid) during pregnancy planning Self-management of nutrition supplements (iron and folic acid) during pregnancy Self-management of nutrition supplements (iron and folic acid) postpartum Self-monitoring/ home-monitoring of blood glucose levels during pregnancy Self-monitoring/ home-monitoring of proteinuria during pregnancy Self-monitoring/ home-monitoring of blood pressure during pregnancy Would buy it online (%) From a peer, outreach or community worker (%) I don’t know where to get it (%) I don’t need to use this (%) 13.1 11.3 8.8 7.0 2.5 0.0 20.0 9.9 11.0 11.3 9.2 4.2 6.1 18.3 28.8 29.6 10.7 12.9 8.2 4.3 6.3 14.3 27.7 31.4 9.9 11.6 8.0 4.4 5.6 17.4 29.0 29.0 9.3 8.5 9.3 5.6 11.7 19.7 31.5 28.2 8.1 8.6 9.9 4.3 18.0 25.7 32.9 32.9 11.8 9.9 8.7 7.0 9.9 22.5 31.1 32.4 Health workers Laypersons KEY 92 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 TABLE 5.2: SOURCES OF INFORMATION ABOUT SRH SELF-CARE INTERVENTIONS FOR ANTENATAL, INTRAPARTUM AND POSTNATAL CARE, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) At-home pregnancy test Self-management of nutrition supplements (folic acid) during pregnancy planning Self-management of nutrition supplements (iron and folic acid) during pregnancy Self-management of nutrition supplements (iron and folic acid) postpartum Self-monitoring/ home-monitoring of blood glucose levels during pregnancy Self-monitoring/ home-monitoring of proteinuria during pregnancy Self-monitoring/ home-monitoring of blood pressure during pregnancy I ask a doctor or health worker (%) I go online/ internet (%) I ask my friends, family or community (%) I haven’t received any information on this (%) Health workers Laypersons KEY 48.7 33.9 65.3 64.5 35.3 50.0 9.3 11.3 63.1 39.3 49.0 32.8 18.1 23.0 18.8 45.9 60.5 38.3 50.3 33.3 19.7 20.0 19.1 45.0 59.7 39.3 48.3 34.4 19.5 19.7 20.1 45.9 61.7 37.7 43.6 32.8 12.8 18.0 24.2 50.8 58.1 36.1 40.5 31.2 11.5 16.4 27.0 52.5 60.5 41.0 46.3 29.5 15.0 21.3 23.8 47.5 At-home pregnancy test Health workers: To access at-home pregnancy testing, about three quarters of health worker respondents reported going to a pharmacy (74.4%), while small numbers said they would go to a doctor or health clinic (17.5%), buy it online (13.1%) or get it from a peer, outreach or community worker (8.8%). A few health workers admitted not knowing where to access it (2.5%), and 20.0% reported having no need for it. To get information about this intervention, most health workers reported they would find it on the internet (65.3%), and almost half reported asking a doctor/ health worker (48.7%) while over one third would ask friends, family or their community (35.3%) and 9.3% said they had not received information on at-home pregnancy tests. Laypersons: The vast majority of laypersons reported they would access at-home pregnancy tests by going to the pharmacy (83.1%), while small numbers said they would buy it online (11.3%), go to a doctor or health clinic (9.9%), or get it from a peer, outreach or community worker (7.0%). No laypersons reported not knowing where to get it, but 9.9% said they had no need for it. To access information on at-home pregnancy tests, the majority said they would search online (64.5%), while half would ask their friends, family or community (50.0%) and a third of laypersons reported asking a doctor or health worker (33.9%). Few reported they had not received information on this intervention (11.3%). Self-management of nutrition supplements (folic acid) during pregnancy planning Health workers: About a third (33.7%) of health workers reported accessing folic acid for self-management during pregnancy planning at a doctor or health clinic while more than half reported accessing it at a pharmacy (55.8%). Additionally, 11.0% reported 93Chapter 5 they would buy it online and 9.2% reported through a peer, outreach or community worker. A small minority of health workers reported not knowing where to get it (6.1%) and over a quarter said they had no need for it (28.8%). In terms of accessing information on this intervention, health workers reported going online (49.0%), asking a doctor (63.1%), and asking friends, family or community (18.1%). Additionally, 18.8% reported not having received information on this self-care intervention. Laypersons: Among laypersons, almost half reported accessing folic acid for self-management during pregnancy planning from a pharmacy (45.1%), a quarter from a doctor (26.8%), and 11.3% said they would buy it online. Additionally, 18.3% reported not knowing where to get it and 29.6% reported not having a need for it. To access information on folic acid self-management during pregnancy planning, 32.8% reported going online, 39.3% reported asking a doctor or health care worker, and 23.0% reported asking friends, family or community. Almost half of laypersons reported they had not received information on this self-care intervention (45.9%). Self-management of nutrition supplements (iron and folic acid) during pregnancy Health workers: Among health workers, 57.9% reported they would access iron and folic acid for self-management during pregnancy at a pharmacy, 35.9% reported from a doctor or health clinic, 10.7% reported online, and 8.2% reported from a peer, outreach, or community worker. A small minority reported not knowing where to get it (6.3%), and about a quarter reported not having a need for it (27.7%). The majority of health worker respondents reported they would ask a doctor/health worker for information on this self-care intervention (60.5%), while half also reported finding information online (50.3%) and about a fifth each reported asking their friends/family/community (19.7%) and that they had not received any information on this intervention (19.1%). Laypersons: Among laypersons, close to half reported they would access iron and folic acid for self-management during pregnancy at a pharmacy (45.7%), while almost a third reported accessing it from a doctor or health clinic (28.6%). Small numbers said they buy them online (12.9%), access them from a peer, outreach or community worker (4.3%), or don’t know where to get them (14.3%) while a third reported not having a need for them (31.4%). For information on this self-care intervention, 38.3% of laypersons reported asking a doctor/ health worker, a third to online (33.3%), and a fifth ask their friends, family or community (20.0%). Almost half said they had not received information on this intervention (45.0%). Self-management of nutrition supplements (iron and folic acid) postpartum Health workers: The majority of health worker respondents (58.0%) reported accessing iron and folic acid for self- management during postpartum at a pharmacy and another third (34.0%) got it from a doctor or health clinic. Small numbers bought it online (9.9%), got it from a peer, outreach or community worker (8.0%), or reported not knowing where to get it (5.6%). Over a quarter said they had no need for this intervention (29.0%). The majority (59.7%) of health workers reported they access information on postpartum iron and folic acid self- management by asking a doctor or health worker, while almost half reported going online (48.3%), and a fifth reported asking friends, family or their community (19.5%) and another fifth said they had not received information on this intervention (20.1%). Laypersons: Laypersons reported accessing iron and folic acid for self-management during postpartum from a pharmacy (43.5%), from a doctor or health clinic (27.5%), online (11.6%), and a few said they got it from a peer, outreach or community worker (4.4%). Additionally, some reported not knowing where to get it (17.4%) or not having a need for it (29.0%). Laypersons reported accessing information on iron and folic acid for self- management during postpartum by asking a doctor/health worker (39.3%), going online (34.4%) and asking friends, family or their community (19.7%). However, nearly half reported they had not received information on this intervention (45.9%). Self-monitoring/home-monitoring of blood glucose levels during pregnancy Health workers: Among health workers, 32.1% reported accessing self-monitoring/home-monitoring of blood glucose levels during pregnancy at the doctor or health clinic, about a third reported getting online (9.3%), and small numbers reported they would go to the pharmacy (42.6%) or get it from from a peer, outreach or community worker (9.3%). A small minority reported not knowing where to get it (11.7%) and nearly a third reported not having a need for it (31.5%). Over a third (43.6%) of health workers reported they would go online for information about this intervention, and another third reported they would ask a doctor/health worker (61.7%) while half reported they would ask their friends, family or community (12.8%). More than half reported not having received information on this intervention (24.2%). Laypersons: About a third of laypersons reported accessing self-monitoring/home-monitoring of blood glucose levels during pregnancy from a doctor or health clinic (35.2%), a pharmacy (29.6%), or not needing this intervention (28.2%). Much smaller numbers mentioned they access it online (8.5%) or and from peers, outreach or community workers (5.6%), and a substantial number said they do not know where to get this intervention (19.7%). Laypersons reported accessing information on this intervention from a doctor or health worker (37.7%), online (32.8%) or from their friends, family or community (18.0%), while half of laypersons reported not having received information on this intervention (50.8%). Self-monitoring/home-monitoring of proteinuria during pregnancy Health workers: Health workers reported accessing self- monitoring/home-monitoring of proteinuria during pregnancy at the pharmacy (34.8%), from a doctor or health clinic (32.3%), from peers, outreach or community workers (9.9%) or online 94 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 TABLE 5.3: MEANS OF ACCESSING SRH SELF-CARE INTERVENTIONS FOR FAMILY PLANNING AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE Over-the-counter hormonal contraception Over-the-counter emergency contraception Contraceptive patch Contraceptive vaginal ring Self-administered injectable contraception Diaphragm or cervical cap From a doctor or health clinic (%) W av e 1 W av e 2 Health workers Laypersons KEY 52.9 60.6 53.5 55.4 28.5 29.5 32.3 22.2 44.7 44.2 - - 44.8 44.0 43.2 54.2 45.7 50.0 35.8 52.2 43.9 46.8 35.8 38.6 (8.1%). About a fifth did not know where to get this intervention (18.0%) while a third reported not having a need for it (32.9%). Over half of health workers reported asking a doctor or health worker for information on this intervention (58.1%), while 40.5% reported going online, and 11.5% reported asking friends, family or their community. Over a quarter of health workers reported not having received information on this intervention (27.0%). Laypersons: Among laypersons, a third reported accessing self- monitoring/home-monitoring of proteinuria through a doctor or health clinic (32.9%), a fifth reported accessing this at a pharmacy (21.4%), and a few said they got it online (8.6%) or through peers, outreach or community workers (4.3%). A quarter reported not knowing where to access this service (25.7%) while a third reported not having a need for it (32.9%). Laypersons reported accessing information on this intervention online (31.2%), from a doctor or health care worker (36.1%), and from friends, family or community (16.4%), but more than half of layperson respondents had not received information on this intervention (52.5%). Self-monitoring/home-monitoring of blood pressure during pregnancy Health workers: Among health workers, 41.6% reported accessing self-monitoring/home monitoring of blood pressure during pregnancy from a pharmacy, 32.3% reported accessing this from a doctor or health clinic, 8.7% reported getting it from peers, outreach or community workers, and 11.8% said they would buy it online. A small minority reported not knowing where to access the intervention (9.9%) and almost a third reported not having a need for it (31.1%). The majority of health workers reported accessing information on this intervention by asking a doctor or fellow health worker (60.5%), while another 46.3% reported using the internet, and 15.0% reported asking friends, family or community. Almost a quarter reported not receiving information on this intervention (23.8%). Laypersons: About a third of layperson respondents reported accessing self-monitoring/home monitoring of blood pressure during pregnancy from a doctor or health clinic (31.0%) or from a pharmacy (29.6%), or said they have no need for it (32.4%). Smaller numbers reported they would buy it online (9.9%) or through peers, outreach or community workers (7.0%), or that they didn’t know where to access this intervention (22.5%). Among laypersons, 41.0% reported accessing information about this intervention from a doctor or health worker, 29.5% reported searching online, and 21.3% reported asking friends, family or their community. Nearly half reported not receiving information on this intervention (47.5%). 5.1.2 Family planning Among the six interventions in this subsection, questions regarding one of them (contraceptive patch) were only asked in Wave 1. The findings are presented in Tables 5.3 and 5.4 – please refer to these tables as needed for details not included in the narrative summary. 95Chapter 5 Over-the-counter hormonal contraception Over-the-counter emergency contraception Contraceptive patch Contraceptive vaginal ring Self-administered injectable contraception Diaphragm or cervical cap From a pharmacy (%) W av e 1 W av e 2 Would buy it online (%) W av e 1 W av e 2 From a peer, outreach or community worker (%) W av e 1 W av e 2 I don’t know where to get it (%) W av e 1 W av e 2 I don’t need to use this (%) W av e 1 W av e 2 - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY 4.0 1.3 0.0 1.0 8.2 5.4 3.5 2.7 - - 16.5 21.5 7.1 5.4 20.6 9.5 3.6 1.3 1.5 3.6 8.5 5.6 0.6 1.4 - - 18.8 21.1 6.1 5.6 23.8 12.5 3.4 1.7 9.6 15.6 - - - - - - 29.8 29.6 - - - - 3.4 1.7 10.8 14.9 4.9 2.8 10.5 13.9 - - 30.6 30.1 4.3 5.6 31.5 22.2 2.2 1.0 11.8 13.7 6.8 1.5 23.5 20.3 - - 29.8 30.7 4.9 5.8 30.3 23.2 3.8 3.0 9.4 13.5 7.4 8.6 16.7 21.4 - - 30.4 32.3 3.1 4.3 33.3 21.4 49.4 41.0 60.6 71.6 62.4 57.8 68.9 80.6 27.3 22.9 - - 23.1 18.9 30.9 22.2 21.1 14.0 26.5 18.8 22.6 15.8 27.2 21.4 96 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 Over-the-counter hormonal contraception Over-the-counter emergency contraception Contraceptive patch Contraceptive vaginal ring Self-administered injectable contraception Diaphragm or cervical cap I ask a doctor or health worker (%) W av e 1 W av e 2 I go online/ internet (%) W av e 1 W av e 2 I ask my friends, family or community (%) W av e 1 W av e 2 I haven’t received any information on this (%) W av e 1 W av e 2 - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY 76.4 75.9 77.4 73.9 51.9 50.0 61.9 73.9 21.1 29.3 27.1 50.8 3.7 6.9 4.5 7.7 68.0 60.2 69.8 50.8 55.6 54.2 67.8 67.7 21.9 24.7 32.9 49.2 5.4 8.4 4.0 16.9 64.2 56.7 - - 45.7 42.7 - - 14.9 18.5 - - 16.3 21.0 - - 63.8 55.2 66.4 50.0 44.0 44.2 56.4 46.8 16.0 19.5 22.2 41.9 16.7 19.5 14.1 27.4 66.4 59.6 59.6 46.8 42.9 37.2 44.4 37.1 15.7 14.7 17.2 27.4 15.0 22.4 28.5 45.2 61.8 53.9 60.0 42.6 43.3 40.9 50.7 37.7 15.6 14.9 19.3 29.5 16.7 24.0 18.7 32.8 TABLE 5.4: SOURCES OF INFORMATION ABOUT SRH SELF-CARE INTERVENTIONS FOR FAMILY PLANNING, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE 97Chapter 5 Over-the-counter hormonal contraception (excluding emergency contraception – see next item) Health workers: About half of health worker respondents in in Wave 1 (49.4%) and 60.6% in Wave 2 reported accessing over-the-counter (OTC) hormonal contraception through a pharmacy, with an additional half of participants in both waves reporting access through a doctor or health clinic (Wave 1: 52.9%; Wave 2: 53.5%). Small numbers of health workers said they would buy it online (Wave 1: 4.0%; Wave 2: 8.2%), or access it through a peer, outreach or community worker (Wave 2 only: 7.1%) or that they did not know where to get it (Wave 1: 0.0%; Wave 2: 3.5%). Close to a fifth in each wave reported not having a need for OTC hormonal contraception (Wave 1: 16.5%; Wave 2: 20.6%). With respect to accessing information on this intervention, the majority of respondents reported they would ask a doctor or health worker (Wave 1: 76.4%; Wave 2: 77.4%) or go online (Wave 1: 51.9%; Wave 2: 61.9%) while around a quarter said they would ask friends, family or community members (Wave 1: 21.1%; Wave 2: 27.1%), and small numbers said they had not received information on OTC hormonal contraception (Wave 1: 3.7%; Wave 2: 4.5%). Laypersons: Among laypersons in each wave, it was also most common to access OTC hormonal contraception either through a pharmacy (Wave 1: 41.0%; Wave 2: 71.6%) or from a doctor or health clinic (Wave 1: 60.6%; Wave 2: 55.4%). Very small numbers of respondents in each wave reported buying it online (Wave 1: 1.3%; Wave 2: 5.4%), or through a peer, outreach or community worker (Wave 2 only: 5.4%) or said they did not know where to access it (Wave 1: 1.0%; Wave 2: 2.7%). About a fifth of laypersons in Wave 1 (21.5%) but far fewer in Wave 2 (9.5%) reported not needing to use this intervention. The majority of laypersons reported accessing information on OTC hormonal contraception from a doctor or health worker (Wave 1: 75.9%; Wave 2: 73.9%) or online (Wave 1: 50.0%; Wave 2: 73.9%) and substantial numbers also asked friends, family or their community (Wave 1: 29.3%; Wave 2: 50.8%). A small minority reported they had not received information on this intervention (Wave 1: 6.9%; Wave 2: 7.7%). Over-the-counter emergency contraception Health workers: The majority of health worker respondents in both waves reported going to the pharmacy to access OTC emergency contraception (Wave 1: 62.4%; Wave 2: 68.9%) while a substantial number also accessed it through a doctor or health clinic (Wave 1: 28.5%; Wave 2: 32.3%). Small numbers bought it online (Wave 1: 3.6%; Wave 2: 8.5%), through a peer, outreach or community worker (Wave 2 only: 6.1%) or did not know where to get it (Wave 1: 1.5%; Wave 2: 0.6%). A sizable minority reported not having a need for this intervention (Wave 1: 18.8%; Wave 2: 23.8%). To access information on OTC emergency contraception, most health workers reported they would ask a doctor or health worker (Wave 1: 68.0%; 12 Questions regarding the contraceptive patch were only asked in Wave 1. Wave 2: 69.8%) or go online (Wave 1: 55.6%; Wave 2: 67.8%). About a fifth of Wave 1 (21.9%) and a third of Wave 2 (32.9%) participants reported they would ask friends, family or community members, while a small number in each wave reported not receiving information on this intervention (Wave 1: 5.4%; Wave 2: 4.0%). Laypersons: Similarly, a majority of laypersons reported accessing OTC emergency contraception at the pharmacy (Wave 1: 57.8%; Wave 2: 80.6%), while some got it from a doctor or health clinic (Wave 1: 29.5%; Wave 2: 22.2%). Only small numbers bought it online (Wave 1: 1.3%; Wave 2: 5.6%) or from a peer, outreach or community worker (Wave 2 only: 5.6%) or reported not knowing where to get it (Wave 1: 3.6%; Wave 2: 1.4%). Some laypersons reported not having a need for OTC emergency contraception (Wave 1: 21.1%; Wave 2: 12.5%). In terms of accessing information on this intervention, most laypersons reported going online (Wave 1: 54.2%; Wave 2: 67.7%) or asking a doctor or health worker (Wave 1: 60.2%; Wave 2: 50.8%). A quarter of Wave 1 respondents reported asking their friends, family or community (24.7%), as did half of Wave 2 respondents (49.4%). A small minority in both waves reported they had not received information on this intervention (Wave 1: 8.4%; Wave 2: 16.9%). Contraceptive patch12 Health workers: Almost half of health worker respondents stated they would access the contraceptive patch through a doctor or health clinic (44.7%), while more than a quarter would go to the pharmacy (27.3%), and only 3.4% would buy it online. Another 9.6% reported not knowing where to get the patch but almost a third (29.8%) stated they have no need for it. To access information on the patch, almost two thirds of health workers reported they would ask a doctor (64.2%) and 45.7% would go online, while a small minority said they would ask friends, family or community (14.9%). A minority of health workers also reported not having received information on this intervention (16.3%). Laypersons: Similar proportions of laypersons also reported accessing the contraceptive patch at the doctor or health clinic (44.2%), the pharmacy (22.9%) or online (1.7%). About a sixth reported not knowing where to get it (15.6%) and nearly a third reported not having a need for it (29.6%). To access information on the patch, the majority (56.7%) would go to the doctor, 42.7% would go online and 18.5% would ask friends, family or community members. About a fifth reported not having received information on this (21.0%). Contraceptive vaginal ring Health workers: To access contraceptive vaginal rings (CVRs), just under half of health worker respondents in both waves reported going to a doctor or health clinic (Wave 1: 44.8%; Wave 2: 43.2%), while about a quarter to a third reported going to a pharmacy (Wave 1: 23.1%; Wave 2: 30.9%). Only a small minority reported buying it online (Wave 1: 3.4%; Wave 2: 4.9%) or from a peer, outreach or community worker 98 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 (Wave 2 only: 4.3%). About a third of health worker respondents said they did not need the CVR (Wave 1: 30.6%; Wave 2: 31.5%) and 10% reported not knowing where to access it (Wave 1: 10.8%; Wave 2: 10.5%). To access information on the CVR, almost two thirds of health worker respondents reported asking a doctor or health worker (Wave 1: 63.8%; Wave 2: 66.4%) and the next most common option was to go online (Wave 1: 44.0%; Wave 2: 56.4%). A minority reported asking friends, family or community members (Wave 1: 16.0%; Wave 2: 22.2%) or not having received information on this intervention (Wave 1: 16.7%; Wave 2: 14.1%). Laypersons: Among laypersons, about a fifth of Wave 1 respondents reported accessing CVRs from a pharmacy (18.9%) while this was not much higher in Wave 2, at 22.2%. Conversely, almost half of Wave 1 respondents (44.0%) and just a fifth of Wave 2 respondents (54.2%) reported accessing CVRs from a doctor or health clinic. Few respondents reported buying it online (Wave 1: 1.7%; Wave 2: 2.8%) or going to a peer, outreach or community worker (Wave 2 only: 5.6%). A minority of respondents reported not knowing where to get the CVR (Wave 1: 14.9%; Wave 2: 13.9%) or not having a need for it (Wave 1: 30.1%; Wave 2: 22.2%). To access information on this method, layperson respondents most often reported asking a doctor or health worker (Wave 1: 55.2%; Wave 2: 50.0%), going online (Wave 1: 44.2%; Wave 2: 46.8%) or asking their friends, family or community (Wave 1: 19.5%; Wave 2: 41.9%). A substantial number of laypersons reported not having received information on CVRs (Wave 1: 19.5%; Wave 2: 27.4%). Self-administered injectable contraception Health workers: Health worker respondents mainly reported accessing self-administered contraception from a doctor or health clinic (Wave 1: 45.7%; Wave 2: 35.8%) or a pharmacy (Wave 1: 21.1%; Wave 2: 26.5%), while small numbers bought it online (Wave 1: 2.2%; Wave 2: 6.8%) or from a peer, outreach or community worker (Wave 2 only: 4.9%). Across both waves, substantial numbers of health workers also reported not knowing where to access it (Wave 1: 11.8%; Wave 2: 23.5%) and not having a need for it (Wave 1: 29.8%; Wave 2: 30.3%). The most common ways for health workers to access information on self-administered contraceptives were to ask a doctor or health worker (Wave 1: 66.4%; Wave 2: 59.6%) or to go online (Wave 1: 42.9%; Wave 2: 44.4%), while a small minority would ask friends, family or their community (Wave 1: 15.7%; Wave 2: 17.2%). A considerable proportion of health workers reported not having received information on this intervention (Wave 1: 15.0%; Wave 2: 28.5%). Laypersons: Half of laypersons reported accessing self- administered contraception from a doctor or health clinic (Wave 1: 50.0%; Wave 2: 52.2%) while small minorities reported accessing it from pharmacy (Wave 1: 14.0%; Wave 2: 18.8%), from a peer, outreach or community worker (Wave 2 only: 5.8%) or buying it online (Wave 1: 1.0%; Wave 2: 1.5%). Some respondents also reported not knowing where to access it (Wave 1: 13.7%; Wave 2: 20.3%) and not having a need for it (Wave 1: 30.7%; Wave 2: 23.2%). Laypersons mainly reported accessing information on this intervention by asking a doctor or health worker (Wave 1: 59.6%; Wave 2: 46.8%) or by going online (Wave 1: 37.2%; Wave 2: 37.1%), while some also asked their friends, family or community (Wave 1: 14.7%; Wave 2: 27.4%). However, a fifth of Wave 1 respondents (22.4%) and almost half of Wave 2 respondents (45.2%) reported not having received information on self-administered contraception. Diaphragm or cervical cap Health workers: Health worker respondents mainly reported accessing the diaphragm or cervical cap from a doctor or health clinic (Wave 1: 43.9%; Wave 2: 35.8%) or a pharmacy (Wave 1: 22.6%; Wave 2: 27.2%). Small numbers bought it online (Wave 1: 3.8%; Wave 2: 7.4%) or accessed it from a peer, outreach or community worker (Wave 2 only: 3.1%). Some reported not knowing where to get it (Wave 1: 9.4%; Wave 2: 16.7%) and another third reported not having a need for it (Wave 1: 30.4%; Wave 2: 33.3%). Health workers reported accessing information on this method by asking a doctor or health worker (Wave 1: 61.8%; Wave 2: 60.0%), going online (Wave 1: 43.3%; Wave 2: 50.7%) and asking friends, family or community members (Wave 1: 15.6%; Wave 2: 19.3%). A considerable proportion reported not having received information on the diaphragm or cervical cap (Wave 1: 16.7%; Wave 2: 18.7%). Laypersons: Laypersons also mainly reported accessing the diaphragm or cervical cap from a doctor or health clinic (Wave 1: 46.8%; Wave 2: 38.6%) or from a pharmacy (Wave 1: 15.8%; Wave 2: 21.4%), while small numbers bought it online (Wave 1: 3.0%; Wave 2: 8.6%) or from a peer, outreach or community worker (Wave 2 only: 4.3%). Additionally, laypersons reported not knowing where to get this method (Wave 1: 13.5%; Wave 2: 21.4%) and/or not having a need for it (Wave 1: 32.3%; Wave 2: 21.4%). Laypersons reported accessing information on the diaphragm or cervical cap from a doctor or health worker (Wave 1: 53.9%; Wave 2: 42.6%), online (Wave 1: 40.9%; Wave 2: 37.7%), and from friends, family or community members (Wave 1: 14.9%; Wave 2: 29.5%). Across the waves, between a quarter and a third reported not having received information on this intervention (Wave 1: 24.0%; Wave 2: 32.8%). 99Chapter 5 5.1.3 Abortion Questions regarding self-management of medical abortion were asked in both waves of the survey. The findings are presented in Table 5.5 – please refer to the table as needed for details not included in the narrative summary. Self-management of medical abortion Health workers: Most health worker respondents reported accessing self-management of medical abortion from a doctor or health clinic (Wave 1: 43.2%; Wave 2: 38.4%) or at a pharmacy (Wave 1: 13.2%; Wave 2: 27.0%). Fewer reported accessing it online (Wave 1: 6.6%; Wave 2: 8.8%) or from a peer, outreach or community worker (Wave 2 only: 5.0%). Additionally, 12.0% of health workers in each wave reported not knowing where to access this self-care intervention and over a third reported not having a need for it (Wave 1: 36.3%; Wave 2: 38.4%). To access information on self-management of medical abortion, health workers mainly reported going online (Wave 1: 45.2%; Wave 2: 58.1%) or asking a doctor or health worker (Wave 1: 65.1%; Wave 2: 57.4%). Small numbers also reported asking friends, family or the community about this intervention (Wave 1: 15.3%; Wave 2: 18.9%) or not having received information on it (Wave 1: 16.4%; Wave 2: 18.9%). Laypersons: Laypersons also mainly reported accessing self-management of medical abortion from a doctor or health From a doctor or health clinic (%) From a pharmacy (%) Would buy it online (%) From a peer, outreach or community worker (%) I don’t know where to get it (%) I don’t need to use this (%) Means of accessing self- management of medical abortion W av e 1 W av e 2 I ask a doctor or health worker (%) I go online/internet (%) I ask my friends, family or community (%) I haven’t received any information on this (%) Sources of information about self- management of medical abortion W av e 1 W av e 2 - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY Health workers Laypersons KEY TABLE 5.5: MEANS OF ACCESSING AND SOURCES OF INFORMATION ABOUT SELF-MANAGEMENT OF MEDICAL ABORTION, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE 43.2 42.5 65.1 53.5 13.2 13.0 6.6 4.0 45.2 43.3 15.3 17.8 - - 16.4 23.6 12.0 17.9 36.3 31.6 38.4 55.7 57.4 43.6 27.0 22.9 8.8 4.3 58.1 48.4 18.9 35.5 5.0 5.7 18.9 30.7 12.0 20.0 38.4 17.1 100 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 clinic (Wave 1: 42.5%; Wave 2: 55.7%) or at a pharmacy (Wave 1: 13.0%; Wave 2: 22.9%). Small numbers reported accessing it from a peer, outreach or community worker (Wave 2 only: 5.7%) or online (Wave 1: 4.0%; Wave 2: 4.3%). Sizable minorities of laypersons in each wave reported not knowing where to access this self-care intervention (Wave 1: 17.9%; Wave 2: 20.0%) or not having a need for it (Wave 1: 31.6%; Wave 2: 17.1%). To access information on self-management of medical abortion, laypersons most commonly reported going online (Wave 1: 43.3%; Wave 2: 48.4%) or asking a doctor or health worker (Wave 1: 53.5%; Wave 2: 43.6%), while some also asked friends, family or community members (Wave 1: 17.8%; Wave 2: 35.5%). Additionally, almost a quarter of Wave 1 participants (23.6%) and almost a third of Wave 2 participants (30.7%) reported not receiving information on this intervention. 5.1.4 Sexually transmitted infections (including HIV), reproductive tract infections, cervical cancer and other gynaecological morbidities Questions regarding four of the interventions in this subsection were asked in both waves of the survey, while questions about two of them (HIV and STI treatment) were only asked in Wave 1 and questions about self-sampling for HPV testing were only added later in Wave 2. The findings are presented in Tables 5.6 and 5.7 – please refer to these tables as needed for details not included in the narrative summary. TABLE 5.6: MEANS OF ACCESSING SRH SELF-CARE INTERVENTIONS FOR SEXUALLY TRANSMITTED INFECTIONS (INCLUDING HIV), REPRODUCTIVE TRACT INFECTIONS, CERVICAL CANCER AND OTHER GYNAECOLOGICAL MORBIDITIES, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE PrEP (pharmacy access) PEP (pharmacy access) HPV self-sampling STI self- sampling (not including HIV or HPV) HIV self-sampling HIV treatment STI treatment From a doctor or health clinic (%) W av e 1 W av e 2 From a pharmacy (%) W av e 1 W av e 2 Health workers Laypersons KEY 55.6 50.5 43.5 35.1 13.1 8.7 33.5 24.3 60.6 52.4 50.0 38.4 13.1 8.2 31.9 23.3 - - 35.4 37.1 - - 13.4 12.9 42.9 50.5 44.1 48.0 18.0 19.4 22.4 17.8 43.0 48.2 44.4 46.0 25.1 24.1 26.5 17.6 62.8 63.6 - - 8.5 8.6 - - 65.7 66.0 - - 17.3 15.6 - - 101Chapter 5 PrEP (pharmacy access) PEP (pharmacy access) HPV self-sampling STI self- sampling (not including HIV or HPV) HIV self-sampling HIV treatment STI treatment Would buy it online (%) W av e 1 W av e 2 From a peer, outreach or community worker (%) W av e 1 W av e 2 I don’t know where to get it (%) W av e 1 W av e 2 I don’t need to use this (%) W av e 1 W av e 2 HPV: human papillomavirus; PEP: post-exposure prophylaxis; PrEP: pre-exposure prohylaxis; STI: sexually transmitted infection - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY 2.5 1.7 11.9 21.8 5.0 5.4 18.6 32.4 30.3 24.6 7.5 4.1 26.1 20.3 2.2 1.7 9.4 21.4 5.0 5.5 16.9 32.9 28.1 23.1 5.6 2.7 23.8 17.8 - - - - 6.1 8.6 36.0 35.7 - - 6.7 5.7 20.7 14.3 7.8 4.7 18.0 22.7 7.5 6.9 29.8 35.6 24.5 16.4 8.1 8.2 18.6 13.7 8.7 4.0 14.6 21.7 9.3 10.8 28.4 33.8 - - 22.9 17.1 8.0 6.8 17.3 12.2 1.9 2.7 4.1 7.9 - - - - - - - -- -- -- - 32.8 25.1 - - - - 3.1 2.1 3.5 7.3 - - - - - - 26.1 20.1 - - - - 102 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 TABLE 5.7: SOURCES OF INFORMATION ABOUT SRH SELF-CARE INTERVENTIONS FOR SEXUALLY TRANSMITTED INFECTIONS (INCLUDING HIV), REPRODUCTIVE TRACT INFECTIONS, CERVICAL CANCER AND OTHER GYNAECOLOGICAL MORBIDITIES, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE PrEP (pharmacy access) PEP (pharmacy access) HPV self-sampling STI self- sampling (not including HIV or HPV) HIV self-sampling HIV treatment STI treatment I ask a doctor or health worker (%) W av e 1 W av e 2 I go online/ internet (%) W av e 1 W av e 2 I ask my friends, family or community (%) W av e 1 W av e 2 I haven’t received any information on this (%) W av e 1 W av e 2 HPV: human papillomavirus; PEP: post-exposure prophylaxis; PrEP: pre-exposure prohylaxis; STI: sexually transmitted infection - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY 66.3 49.0 61.1 38.1 43.4 37.7 12.9 10.6 14.7 33.8 50.3 33.3 13.4 30.2 23.5 42.9 70.3 52.6 60.7 40.6 42.7 37.5 10.4 9.2 14.3 33.6 50.7 32.8 14.0 28.1 22.7 45.3 - - - - - - - - - - - - - - - - - - - - - - - - 53.3 37.7 42.7 36.1 16.0 19.7 34.7 49.2 61.3 57.0 57.3 44.4 44.7 43.0 13.1 12.7 19.1 27.2 46.7 38.1 12.7 25.4 29.3 42.9 61.6 57.4 55.7 43.8 46.1 41.9 12.3 13.5 18.7 26.5 50.3 39.1 17.5 26.6 26.2 42.2 71.4 67.5 43.5 37.0 10.5 13.0 13.0 18.2 70.6 71.6 43.3 37.4 10.6 12.3 12.4 14.2 103Chapter 5 Pre-exposure prophylaxis (PrEP) Health workers: About half of health workers in each wave reported accessing PrEP from a doctor or health clinic (Wave 1: 55.6%; Wave 2: 43.5%). Fewer reported accessing PrEP from a pharmacy (Wave 1: 13.1%; Wave 2: 33.5%), buying it online (Wave 1: 2.5%; Wave 2: 5.0%) or getting it from a peer, outreach, or community worker (Wave 2 only: 7.5%). A substantial minority reported not knowing where to access PrEP (Wave 1: 11.9%; Wave 2: 18.6%) or not needing it (Wave 1: 30.3%; Wave 2: 26.1%). Health workers reported accessing information on PrEP from a doctor or health worker (Wave 1: 66.3%; Wave 2: 61.1%), online (Wave 1: 43.4%; Wave 2: 50.3%) or from friends, family or their community (Wave 1: 12.9%; Wave 2: 13.4%). Several respondents reported they had not received information on PrEP (Wave 1: 14.7%; Wave 2: 23.5%). Laypersons: Laypersons reported accessing PrEP mainly from a doctor or health clinic (Wave 1: 50.5%; Wave 2: 35.1%), with small numbers getting it from a pharmacy (Wave 1: 8.7%; Wave 2: 24.3%), from peers, outreach or community workers (Wave 2 only: 4.1%) or online (Wave 1: 1.7%; Wave 2: 5.4%). About a fifth of Wave 1 (21.8%) and a third of Wave 2 (32.4%) layperson respondents reported not knowing where to access PrEP, while some reported not having a need for it (Wave 1: 24.6%; Wave 2: 20.3%). Laypersons reported accessing information on PrEP from doctors or health workers (Wave 1: 49.0%; Wave 2: 38.1%), online (Wave 1: 37.7%; Wave 2: 33.3%) or from their friends, family or community (Wave 1: 10.6%; Wave 2: 30.2%). Over a third of respondents in each wave reported not receiving information on PrEP (Wave 1: 33.8%; Wave 2: 42.9%). Post-exposure prophylaxis (PEP) Health workers: The majority of health workers reported accessing PEP from a doctor or health clinic (Wave 1: 60.6%; Wave 2: 50.0%). Less than a third reported receiving it from a pharmacy (Wave 1: 13.1%; Wave 2: 31.9%), and small numbers got it from peers, outreach or community workers (Wave 2 only: 5.6%) or online (Wave 1: 2.2%; Wave 2: 5.0%). Several respondents reported not knowing where to access PEP (Wave 1: 9.4%; Wave 2: 16.9%) while close to a quarter in each wave reported not needing it (Wave 1: 28.1%; Wave 2: 23.8%). Most health workers reported accessing information on PEP from doctors or health workers (Wave 1: 70.3%; Wave 2: 60.7%) or online (Wave 1: 42.7%; Wave 2: 50.7%) while small numbers asked friends, family or their community (Wave 1: 10.4%; Wave 2: 14.0%). A considerable minority reported not receiving information on PEP (Wave 1: 14.3%; Wave 2: 22.7%). Laypersons: Laypersons mainly reported accessing PEP from a doctor or health clinic (Wave 1: 52.4%; Wave 2: 38.4%) while some got it from a pharmacy (Wave 1: 8.2%; Wave 2: 23.3%), online (Wave 1: 1.7%; Wave 2: 5.5%), or from a peer, outreach or community worker (Wave 2: 2.7%). Between a fifth and a third of participants reported not knowing where to receive PEP (Wave 1: 21.4%; Wave 2: 32.9%), and less than a quarter 13 Questions regarding HPV self-sampling were only asked in Wave 2. reported not needing it (Wave 1: 23.1%; Wave 2: 17.8%). Laypersons reported accessing information on PEP from a doctor or health worker (Wave 1: 52.6%; Wave 2: 40.6%), online (Wave 1: 37.5%; Wave 2: 32.8%), or from their friends, family or community (Wave 1: 9.2%; Wave 2: 28.1%). Over a third reported not receiving information on PEP (Wave 1: 33.6%; Wave 2: 45.3%). HPV self-sampling13 Health workers: Health workers reported mainly accessing HPV self-testing from a doctor or health clinic (35.4%), while small numbers got it at a pharmacy (13.4%), from a peer, outreach or community worker (6.7%) or online (6.1%). A third reported not knowing where to access HPV self-testing (36.0%), and a fifth reported having no need for it (20.7%). Most health workers reported accessing information on this intervention from a doctor or health worker (53.3%) or on the internet (42.7%), while 16.0% reported asking friends, family or their community. Nearly a third reported they had not received information on this intervention (34.7%). Laypersons: Laypersons reported mainly accessing HPV self-testing from a doctor or health clinic (37.1%), while small numbers got it at a pharmacy (12.9%), online (8.6%) or through a peer, outreach or community worker (5.7%). About a third reported not knowing where to access HPV self-testing (35.7%), and 14.3% reported not having a need for this intervention. Among laypersons, 37.7% reported going to the doctor or a health worker for information on HPV self-testing, 36.1% reported going online, and 19.7% reported asking their friends, family or community. About half reported not receiving information on this intervention (49.2%). STI self-sampling (not including HIV or HPV) Health workers: When accessing STI self-sampling, health workers reported using a doctor or health clinic (Wave 1: 42.9%; Wave 2: 44.1%), a pharmacy (Wave 1: 18.0%; Wave 2: 22.4%), a peer, outreach or community worker (Wave 2 only: 8.1%), or ordering it online (Wave 1: 7.8%; Wave 2: 7.5%). However, a sizeable proportion of health workers reported not knowing where to access STI self-sampling (Wave 1: 18.0%; Wave 2: 29.8%) or not having a need for it (Wave 1: 24.5%; Wave 2: 18.6%). Health workers reported getting information on STI self-sampling by asking a doctor or health worker (Wave 1: 61.3%; Wave 2: 57.3%), going online (Wave 1: 44.7%; Wave 2: 46.7%), or asking friends, family or their community (Wave 1: 13.1%; Wave 2: 12.7%). Several reported not receiving information on this intervention (Wave 1: 19.1%; Wave 2: 29.3%). Laypersons: Laypersons reported accessing STI self- sampling from a doctor (Wave 1: 50.5%; Wave 2: 48.0%), from a pharmacy (Wave 1: 19.4%; Wave 2: 17.8%), from a peer, outreach or community worker (Wave 2: 8.2%) or ordering it online (Wave 1: 4.7%; Wave 2: 6.9%). Between a fifth and a third reported not knowing where to access STI self-sampling 104 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 (Wave 1: 22.7%; Wave 2: 35.6%), and smaller numbers reported not having a need for this intervention (Wave 1: 16.4%; Wave 2: 13.7%). When accessing information on STI self- sampling, laypersons reported asking a doctor or health worker (Wave 1: 57.0%; Wave 2: 44.4%), going online (Wave 1: 43.0%; Wave 2: 38.1%), and asking their friends, family or community (Wave 1: 12.7%; Wave 2: 25.4%). A considerable number of respondents reported not receiving information on this intervention (Wave 1: 27.2%; Wave 2: 42.9%). HIV self-sampling Health workers: Health workers reported accessing HIV self- sampling at a doctor or health clinic (Wave 1: 43.0%; Wave 2: 44.4%), from a pharmacy (Wave 1: 25.1%; Wave 2: 26.5%), ordering it online (Wave 1: 8.7%; Wave 2: 9.3%), and getting the intervention from a peer, outreach or community worker (Wave 2: 8.0%). Several reported not knowing where to access HIV self-sampling (Wave 1: 14.6%; Wave 2: 28.4%), and around a fifth reported not needing it (Wave 1: 22.9%; Wave 2: 17.3%). Most health workers reported asking a doctor or health worker for information on HIV self-sampling (Wave 1: 61.6%; Wave 2: 55.7%) or searching the internet (Wave 1: 46.1%; Wave 2: 50.3%), while fewer reported asking friends, family or their community (Wave 1: 12.3%; Wave 2: 17.5%). Up to a quarter reported not receiving information on this intervention (Wave 1: 18.7%; Wave 2: 26.2%). Laypersons: Laypersons reported accessing HIV self-sampling from a doctor or health clinic (Wave 1: 48.2%; Wave 2: 46.0%), a pharmacy (Wave 1: 24.1%; Wave 2: 17.6%), online (Wave 1: 4.0%; Wave 2: 10.8%), or through a peer, outreach or community worker (Wave 2: 6.8%). Up to a third reported not knowing where to access HIV self-sampling (Wave 1: 21.7%; Wave 2: 33.8%), while a few participants reported not needing it (Wave 1: 17.1%; Wave 2: 12.2%). Laypersons reported asking a doctor or health worker for information on HIV self- sampling (Wave 1: 57.4%; Wave 2: 43.8%), searching online (Wave 1: 41.9%; Wave 2: 39.1%) and asking friends, family or community members (Wave 1: 13.5%; Wave 2: 26.6%). More than a quarter of respondents reported not having received information on this intervention (Wave 1: 26.5%; Wave 2: 42.2%). 14 Questions regarding HIV treatment were only asked in Wave 1. 15 Questions regarding this STI treatment were only asked in Wave 1. HIV treatment (antiretroviral therapy; ART)14 Health workers: The majority of health worker respondents reported they would access HIV treatment at the doctor or health clinic (62.8%), while 8.5% would get it at the pharmacy, and 1.9% would access it online. A small minority reported not knowing where to get ART (4.1%), and about a third reported not having a need for it (32.8%). For information about ART, the majority of health worker respondents would ask a doctor or health worker (71.4%), while some would also go online (43.5%), 10.5% would ask friends, family or community, and 13.0% had not received information on HIV treatment. Laypersons: The majority of laypersons accessing HIV treatment would get it at the doctor (63.6%), while 8.6% would go to the pharmacy, and 2.7% would get it online. Some reported not knowing where to get it (7.9%) and a quarter reported not having a need for it (25.1%). For information on ART, 67.5% of laypersons would ask a doctor or health worker, 37.0% would go online, and 13.0% would ask their friends, family or community. Nearly a fifth reported not having received information on this intervention (18.2%). Medical treatment for STIs15 Health workers: The majority of health worker respondents reported they would access STI treatment at the doctor or health clinic (65.7%), while 17.3% would access it at the pharmacy and 3.1% would buy it online. A small minority reported not knowing where to get it (3.5%), and about a quarter reported not having a need for it (26.1%). The majority of health worker respondents reported they would ask a doctor or health worker for information on STI treatment (70.6%), while many others would search online (43.3%) and 10.6% would ask friends, family or their community. A minority reported not having received information about medicines to treat STIs (12.4%). Laypersons: Most laypersons reported they would access STI treatment through a doctor or health clinic (66.0%), while 15.6% would access it at the pharmacy and 2.1% would buy it online. A minority reported not knowing where to get it (7.3%) and a fifth reported not having a need for it (20.1%). For information on STI treatment, 71.6% reported they would ask a doctor or health workers, 37.4% would search online, and 12.3% would ask their friends, family or community. A minority reported they had not received information on this intervention (14.2%). 105Chapter 5 5.1.5 Promoting sexual health Questions regarding the interventions in this subsection – lubricant and hormone therapy for gender affirmation – were only asked in Wave 2 of the survey. The findings are presented in Table 5.8 – please refer to the table as needed for details not included in the narrative summary. From a doctor or health clinic (%) From a pharmacy (%) Would buy it online (%) From a peer, outreach or community worker (%) I don’t know where to get it (%) I don’t need to use this (%) M ea ns o f a cc es si ng s el f- ca re in te rv en tio ns fo r… ? Lubricants for sexual health Hormone therapy for gender affirmation I ask a doctor or health worker (%) I go online/internet (%) I ask my friends, family or community (%) I haven’t received any information on this (%) S ou rc es o f i nf or m at io n ab ou t s el f- ca re in te rv en tio ns fo r… ? Lubricants for sexual health Hormone therapy for gender affirmation Health workers Laypersons KEY Health workers Laypersons KEY TABLE 5.8: MEANS OF ACCESSING AND SOURCES OF INFORMATION ABOUT SRH SELF-CARE INTERVENTIONS FOR PROMOTING SEXUAL HEALTH, AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) 15.5 10.1 28.0 33.8 73.3 71.0 12.1 8.8 21.1 30.4 3.2 1.5 9.3 10.1 1.3 5.9 3.1 2.9 13.4 16.2 14.3 10.1 59.9 48.5 35.8 27.4 39.6 27.6 67.6 67.7 38.1 31.0 33.8 45.2 14.4 22.4 9.9 11.3 46.8 60.3 Lubricants for sexual health Health workers: Among health workers, almost three quarters (73.3%) reported accessing lubricant at the pharmacy, 21.1% buy it online, 15.5% get it from the doctor or health clinic, and 9.3% get it from a peer, outreach or community worker. A small minority reported not knowing where to access lubricant (3.1%) and 14.3% reported not needing it. Most health workers reported accessing information on lubricant from a doctor or health worker (35.8%) or online (67.6%), while 33.8% reported asking friends, family or their community. A quarter reported they had not received information on this intervention (9.9%). Laypersons: To access lubricant, laypersons reported going to the pharmacy (71.0%), buying it online (30.4%), getting it from a doctor or health clinic (10.1%) or from a peer, outreach or community worker (10.1%). A small minority reported not knowing where to access it (2.9%) or not needing it (10.1%). Laypersons reported accessing information on lubricant from a doctor or health worker (27.4%), online (67.7%) or from friends, family or community (45.2%), although 11.3% reported not having received this information. 106 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 Hormone therapy for gender affirmation Health workers: Health workers reported they would access hormone therapy for gender affirmation from a doctor or health clinic (28.0%), from a peer, outreach or community worker (1.3%), from a pharmacy (12.1%), or online (3.2%). A minority reported not knowing where to access this therapy for self-administration (13.4%), and over half reported not needing it (59.9%). Most health workers reported accessing information on this intervention from a doctor or health worker (39.6%), online (38.1%), and/or by asking friends, family or their community (14.4%). Nearly half reported they had not received information on this intervention (46.8%). Laypersons: Laypersons reported accessing hormone therapy for gender affirmation from a doctor or health clinic (33.8%), from a pharmacy (8.8%), from a peer, outreach or community worker (5.9%), or online (1.5%). About a fifth reported not knowing where to access this intervention (16.2%), and half reported not needing it (48.5%). Laypersons reported accessing information on self-administered therapy by searching online (31.0%), by asking a doctor or health worker (27.6%), or from friends, family or community members (22.4%). The majority said they have not received information on this intervention (60.3%). 5.1.6 SRH information online and via mobile applications Questions regarding the interventions in this subsection were only included in Wave 1 of the survey. The findings are presented in Tables 5.9 and 5.10 – please refer to these tables as needed for details not included in the narrative summary. TABLE 5.9: MEANS OF ACCESSING ONLINE SRH INFORMATION AND MOBILE APPLICATIONS (APPS), AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 1 ONLY, 2018) Online reproductive health information Mobile reproductive health apps Online sexual health information Mobile sexual health apps From a doctor or health clinic (%) From a pharmacy (%) Would buy it online (%) From a peer, outreach or community worker (%) Health workers Laypersons KEY 23.5 20.0 5.5 8.2 58.0 54.6 13.5 12.1 3.6 4.6 52.0 49.6 24.7 22.3 5.6 8.5 55.9 53.0 14.4 12.7 4.6 4.9 51.5 51.1 - -- -- -- - 107Chapter 5 TABLE 5.10: SOURCES OF INFORMATION ABOUT ONLINE SRH INFORMATION AND MOBILE APPLICATIONS (APPS), AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 1 ONLY, 2018) Online reproductive health information Mobile reproductive health apps Online sexual health information Mobile sexual health apps I ask a doctor or health worker (%) I go online/ internet (%) I ask my friends, family or community (%) I haven’t received any information on this (%) Online reproductive health information Mobile reproductive health apps Online sexual health information Mobile sexual health apps I don’t know where to get it (%) I don’t need to use this (%) - Indicates that question or response option was not asked in a given wave. Health workers Laypersons KEY Health workers Laypersons KEY 43.3 27.8 70.2 74.7 14.9 16.5 6.0 9.5 33.0 20.4 70.3 66.2 17.0 17.2 11.2 22.3 42.8 29.0 68.6 73.5 15.5 16.1 6.7 10.3 34.8 20.1 68.5 66.0 16.5 16.4 11.8 22.0 4.2 8.2 16.9 16.4 10.5 16.7 25.0 21.3 3.9 10.2 18.8 15.2 10.5 17.3 24.6 19.4 108 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 Online reproductive health information Health workers: The health worker respondents reported they would access online reproductive health (RH) information through the internet (58.0%), from a doctor or health clinic (23.5%), and at the pharmacy (5.5%). A small minority did not know where to get it (4.2%), and 16.9% reported not having a need for it. For accessing information about these online resources, most health worker respondents reported they would go online (70.2%) while some would ask a doctor or health worker (43.3%) and 14.9% would ask friends, family or community. A small minority reported that they had not received information on this service (6.0%). Laypersons: For laypersons accessing online RH information, over half would get it online (54.6%), a fifth would ask a doctor or health clinic (20.0%), and 8.2% would ask at a pharmacy. A minority of respondents reported not knowing where to access this service (8.2%) and not having a need for it (16.4%). To access information on this service, 74.7% reported accessing it online, 27.8% would ask a doctor or health worker, and 16.5% would ask their friends, family or community. Only a few reported they had not received information on this service (9.5%). Mobile reproductive health apps Health workers: More than half of health worker respondents reported going online to access mobile RH apps (52.0%), while 13.5% would seek this from a doctor or health clinic, and 3.6% would go to the pharmacy. RH apps were unknown among 10.5% of health workers and a quarter reported not having a need for this (25.0%). The majority of health workers reported they would go online to access information about RH apps (70.3%), while a third would ask a doctor or health worker (33.0%), and 17.0% would ask friends, family or community. Some reported they had not received information on this service (11.2%). Laypersons: About half of layperson respondents reported they would access RH apps online (49.6%), while 12.1% would go to the doctor or health clinic, and 4.6% would go to the pharmacy. Additionally, 16.7% reported not knowing where to access RH apps, and 21.3% reported not having a need for this. To access information on RH apps, most laypersons 66.2% would go online, 20.4% would ask a doctor or health worker, and 17.2% would ask their friends, family or community. Over a fifth reported they had not received information on this (22.3%). Online sexual health information Health workers: The majority of health worker respondents would access online sexual health (SH) information on the internet (55.9%). A quarter would access it at the doctor or health clinic (24.7%), while only 5.6% reported they would go to the pharmacy for it. A small minority reported not knowing where to access this (3.9%), and nearly a fifth reported not having a need for it (18.8%). For information about this service, the majority of health worker respondents reported they would search online (68.6%), while 42.8% would ask a doctor and 15.5% would ask friends, family or community. A small minority reported not having received information on this (6.7%). Laypersons: Among laypersons accessing online SH information, over half would do this online (53.0%), while 22.3% would go to a doctor, and 8.5% would go to a pharmacy. About one in ten reported not knowing where to get it (10.2%), and 15.2% reported not having a use for this. For information about this service, the majority would search online (73.5%), while 29.0% would ask their doctor, and 16.1% would ask their friends, family or community. Some reported not having received information on this service (10.3%). Mobile sexual health apps Health workers: Most health worker respondents reported they would access mobile SH apps using the internet (51.5%), while 14.4% would access it at the doctor or health clinic and 4.6% would access it at the pharmacy. An additional 10.5% reported not knowing where to get it and about a quarter reported not having a need for it (24.6%). The majority of health worker respondents reported they would go online to access information about SH apps (68.5%), while about a third would ask a doctor or health worker (34.8%) and 16.5% would ask friends, family or community. Some had not received information on this (11.8%). Laypersons: Over half of laypersons would access mobile SH apps using the internet (51.1%), while 12.7% would access it through the doctor or health clinic and 4.9% would access it through the pharmacy. Another 17.3% reported not knowing where to access it, and 19.4% reported not having a need for this. To get information about mobile SH apps, 66.0% would go online, 20.1% would ask a doctor or health worker, and 16.4% would ask their friends, family or community. Over a fifth reported they had not received information on this service (22.0%). 109Chapter 5 Current state of SRHR self-care training for health professionals The training of health professionals needs to address the growing access to, and delivery and uptake of, self-care interventions for health care. Recognizing the importance of such training, the WHO Department of Reproductive Health and Research convened the first consultation of early-career health professionals from the fields of midwifery, nursing, pharmacy, public health and medicine. This case study summarizes key gaps and challenges of SRHR self-care training for these professionals, including: • Curricula focus on technical and scientific content rather than communication skills, decision-making and comprehensive problem-solving. • Biased training from biased teachers creates biased providers, institutionalizing stigmatization of present and future patients. • Lack of integrated approaches is due to lack of funding, as well as institutional and specialty siloes. • There is a lack of training to build trust and work with health professionals across sectors in interdisciplinary and inter-professional teams. • In the training, there is a lack of sensitivity to social, cultural and religious context. • Training on patient management and how to establish healthy client–provider relationships is insufficient, including retaining those young people, adolescents and vulnerable populations who may need longer-term care. • Training in gender equality, human rights and ethics is inadequate. • Institutional glass ceilings hinder women’s advancement to leadership positions in many health careers, although women now constitute the majority of the incoming health workforce. To address these issues, there is a need for more interactive ways of teaching, to help students integrate their knowledge, skills and attitudes for improved real- world patient care. Curricula should also be person- centred and emphasize specific training on SRHR issues and work to strengthen understanding of social, cultural and religious contexts that affect SRHR. Artwork from this workshop comm unity HIGHLIGHTS FROM HEALTH-CARE COMMUNITY CONSULTATIONS 110 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 5.2 ENGAGING WITH HEALTH WORKERS FOR SELF-CARE SRHR INTERVENTIONS: QUANTITATIVE AND QUALITATIVE FINDINGS (WAVE 1 ONLY) This section presents further information about engaging with health workers in relation to the use of self-care interventions, to add to the findings reported in section 5.1 above about where/from whom the survey respondents access the interventions and information about the interventions. In Wave 1, survey respondents who had reported usage (or their partner’s usage) of any of the listed self-care interventions (see Chapter 3, section 3.1) were asked follow-up questions about their experience of engaging with health workers when using a self- care intervention for SRHR or as a result of using the intervention, and whether they had ever felt forced or pressured to use the intervention. All respondents were also asked how important they thought it was to be able to access self-care interventions for SRHR without going through a health worker, and how important they thought it was to have access to a health worker after using one of these interventions, and finally their preference for being able to access these interventions on their own or with a health worker. Quantitative findings on these questions are presented in Figure 5.11, and they are also summarized in the text below along with the available qualitative responses related to these issues. Yes, engaged with a health worker when using the intervention or as a result of using the intervention Yes, ever felt forced or pressured to use a self-care intervention for SRHR 69.3 57.7 4.9 6.4 Health workers (%) Laypersons (%) Experience of engaging with health workers among respondents who had reported usage (or their partner’s usage) of any of the listed self-care interventions for SRHR Very Somewhat Neutral Not that important Not important at all Depends on the intervention 33.8 27.4 26.9 24.1 19.9 8.6 7.5 9.7 14.26.07.714.2 Health workers (%) Laypersons (%) Importance of accessing self-care interventions for SRHR without going through a health worker Very Somewhat Neutral Not that important Not important at all Depends on the intervention 60.6 58.0 28.2 23.7 8.3 2.2 2.2 4.9 1.1 1.1 3.16.6 Health workers (%) Laypersons (%) Importance of having access to a health worker after using a self-care intervention for SRHR FIGURE 5.11: EXPERIENCE OF AND VALUES AND PREFERENCES FOR ACCESSING SELF-CARE INTERVENTIONS FOR SRHR WITH OR WITHOUT THE INVOLVEMENT OF A HEALTH WORKER, AND FOR HAVING ACCESS TO A HEALTH WORKER AFTER THE USE OF AN INTERVENTION (WAVE 1 ONLY, 2018) 111Chapter 5 Prefer on my own Prefer with a health worker Depends on the intervention 19.1 11.7 24.0 24.5 64.2 56.4 Health workers (%) Laypersons (%) Preference for being able to access a self-care intervention for SRHR on their own or with a health worker 5.2.1 Experience of engagement with or pressure from health workers in relation to use of self-care SRHR interventions: quantitative findings As presented in Chapter 3, section 3.1, of this report, respondents indicated their personal, or their partner’s, usage of a range of self-care interventions for SRHR. In follow-up to that question, in Wave 1, if they had reported usage of any of the listed interventions (ever, or within the past 3 months), they were further asked whether they had engaged with health workers when using the intervention, or as a result of using it, and whether they had felt forced or pressured to use the intervention. For health worker respondents, as indicated in Figure 5.11 above, more than two thirds (69.3%) engaged with health workers when they used, or as a result of using, the self-care SRHR interventions while the remainder (30.7%) did not engage with health workers. Only a small minority of health worker respondents (4.9%) reported ever feeling forced or pressured to use the self-care SRHR interventions while the vast majority (95.1%) did not. For all other respondents (laypersons), well over half also reported engaging with health workers when using or as a result of using the interventions (57.7%), while 42.3% did not. And, similar to health workers, only a small minority of laypersons reported ever feeling forced or pressured to use the interventions (6.4%), while the majority did not (93.6%). 5.2.2 Importance of and preference for accessing self-care SRHR interventions with or without involvement of a health worker Health workers In response to the question “How important is it for you to be able to access self-care interventions for SRHR without going through a health worker?”, as shown in Figure 5.11 above, just over a third of health worker respondents rated this as “very important” (33.8%), while another quarter rated it as “somewhat” important (24.1%). The remaining respondents were neutral or considered this unimportant, although 50 health workers (14.2% ) said that it depends on the intervention. Some respondents offered explanations for saying that it depends on the interventions, such as needing more information, the controversial nature of SRHR interventions, and the complexity of and risks associated with certain interventions. Needing trusted information on interventions from a health- care professional was discussed by some health worker respondents. A 31-year-old female respondent in the United Kingdom explained: “For anything more complex, I'd like reassurance of a health professional as there is so much information available online, not always very credible.” Similarly, a 24-year-old female respondent in Türkiye discussed how seeing a health worker can ensure that a client makes independent, well informed decisions: Because the knowledge that I have may not be comprehensive, I would want to rely on a health-care provider's intervention. It does not mean that I shouldn’t decide but I should know everything about the intervention before I give consent or not. The stigma, judgement and controversy attached to specific interventions meant that for some, the health worker respondents said it is preferable to access them without seeing a health-care professional. A 59-year-old female respondent in the USA explained: “The more controversial (emergency contraception, HIV testing/treatment) the more I want access without going through a health-care provider.” A 23-year-old female respondent in Qatar explained how it depends on the societal view of that intervention: “If the intervention is normal and accepted by the society then it’s 112 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 fine, however, if it would lead to people making judgements then I would prefer to do it myself.” Other health worker respondents explained that the decision to use an intervention without a health worker depends on the complexity of using it and the risk for adverse reactions. A 27-year-old female respondent in the Republic of Moldova said: “In case of any complications or adverse reactions, unproper use of the intervention, if the risk is minimal and the supervision of the health-care provider is not required, then let it be.” Some respondents specified the interventions they viewed as having higher risks. An 18-year-old female respondent in North Macedonia discussed the importance of knowing the risks for those interventions in advance: Some interventions, for example the abortion pill, are somewhat dangerous in the sense that it's a lot of hormones so I feel that those types of interventions should be acquired after having an unbiased consultation just to know the side-effects. In response to the question “How important is it for you to have access to a health worker after using a self-care intervention for SRHR?”, as shown in Figure 5.11 above, most health worker respondents thought this was “very important” (60.6%), while about a quarter rated it as “somewhat important” (23.7%), and 6.6% felt neutral about the issue. At the other end of the scale, only very few rated it as “not that important” (3.1%) or “not important at all” (1.1%), and the remaining 4.9% reported that it depends on the intervention. Some explained that it depends on the result of the intervention and whether or not there are any adverse effects. A 38-year-old female health worker in the USA elaborated on her response: “Yes. For example, after HIV home testing, I would want to have counselling with a provider. On the other hand, after use of EC [emergency contraception], I wouldn't need to talk with anyone in the health profession unless I was experiencing complications.” Other health worker respondents elaborated that, while for some interventions accessing a health worker afterwards is important, this does not have to be an in-person visit. A 51-year-old woman in South Africa specified: “I need to be able to ask questions or go to someone in case of side- effects, etc. If this was telephonic that is fine, I would not need to see someone physically.” In response to the question “Do you prefer to be able to access a self-care intervention for SRHR on your own or with a health worker?”, as shown in Figure 5.11 above, most health worker respondents said it depends on the intervention (56.4%), while about a fifth stated a preference for accessing it on their own (19.1%), and a quarter preferred to do so with a health worker (24.5%). Layperson respondents In response to the question “How important is it for you to be able to access self-care interventions for SRHR without going through a health worker?”, as shown in Figure 5.11 above, about a quarter each of layperson respondents rated it as “very” and “somewhat” important (27.4% and 26.9%, respectively). About a fifth were neutral on the issue (19.9%), and only small numbers said that it was “not that important” (8.6%), “not important at all” (7.5%) or that it depends on the intervention (9.7%). Some respondents explained that it depends on the nature of the intervention, with complexity and urgency being major concerns. A 24-year-old woman in Venezuela specified: “For example, if I needed antiretroviral therapy I definitely would go to a health-care provider, or if I suffered a STI or if I required injectable medicines.” Another respondent, a 25-year-old woman in Croatia, noted the issue of time-sensitive matters relating to SRHR: If the intervention needs to be quick and convenient, where time is the matter of urgency, it is important to be able to access the health-care provider quickly or to bypass them if necessary. Otherwise, I prefer to have contact with a health-care provider. Some respondents noted that accessing interventions through a health worker may not always be reliable. A 34-year-old woman in Mexico explained: “It depends if I feel it's something I can get sufficient information on without seeing a doc. But so many are poorly informed on sexual health and, generally, access to the intervention. Plus access to information is enough.” Similarly, a 25-year-old female respondent in Australia noted the advantages of accessing trusted sources for information, particularly for individuals who are sexually diverse: “As long as wherever I am getting information is safe, ethical, accessible and queer friendly.” In response to the question “How important is it for you to have access to a health worker after using a self-care intervention for SRHR?”, as shown in Figure 5.11 above, the majority of layperson respondents rated this as as “very important” (58.0%) while another 28.2% rated it as “somewhat important”. The remaining small numbers of respondents felt neutral about the issue (8.3%) or rated it as “not that important” (2.2%) or “not important at all” (1.1%). Four respondents (2.2%) said that it depends on the intervention, and offered explanations highlighting the complexity of the intervention and risk for adverse reactions. A 48-year-old woman in Kenya specified: “For simple intervention not important, but for HIV, abortion, complicated STI very important.” In response to the question “Do you prefer to be able to access a self-care intervention for SRHR on your own or with a health worker?”, as shown in Figure 5.11 above, almost two thirds of laypersons reported that it depends on the intervention (64.2%), while about a quarter reported that they prefer to access self- care interventions with a health worker and just 11.7% stated that they prefer to access them on their own. 113Chapter 5 5.3 EASE OF ACCESS TO SELF-CARE INTERVENTIONS FOR SRHR: QUANTITATIVE FINDINGS This section presents the quantitative findings from both waves of the survey on respondents’ overall ease of access to health care when they need it and their ease of accessing the internet or a mobile phone confidentially. As shown in Figure 5.12, overall, respondents across both survey waves reported very high access to health care and confidential access to a mobile phone or the internet. Respondents in Wave 2 were also asked about their proximity to a variety of health-care facilities. On average, both health workers and laypersons reported living closest to a pharmacy, while health workers on average lived furthest from an SRH clinic, and laypersons lived furthest from a public hospital. FIGURE 5.12: ENGAGEMENT WITH HEALTH CARE AMONG GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE Very easy Yes Easy No Somewhat easy Not easy Very difficult 81.6 94.7 86.1 96.6 71.7 91.8 80.0 95.4 26.0 8.2 18.5 4.6 16.5 5.3 10.9 3.5 1.7 0.6 1.5 0.8 1.1 3.0 Health workers (%) Health workers (%) Laypersons (%) Laypersons (%) Wave 1 Wave 1 Wave 1 Wave 1 Wave 2 Wave 2 Wave 2 Wave 2 Ease of confidential mobile phone/internet access Able to access health care when required 114 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 5 Health workers: Most health workers reported that it was “very easy” (Wave 1: 81.6%; Wave 2: 71.7%) or “easy” (Wave 1: 16.5%; Wave 2: 26.0%) to access the internet or a mobile phone confidentially. Very small numbers reported that it was “somewhat easy” (Wave 2 only: 1.7%), “not easy” (Wave 1: 1.1%; Wave 2: 0.6%), or “very difficult” (Wave 1 only: 0.8%). In addition, the vast majority reported being able to access health care when they need it (Wave 1: 94.7%; Wave 2: 91.8%), while the rest said they could not. In Wave 2, responses regarding distance from their homes to a range of health-care facilities were also analysed. On average, health workers reported living closest to a pharmacy (mean: 2.0 km), a community clinic (mean: 3.5 km) and a private health clinic (mean: 4.6 km), and further away on average from other facilities – 5.6 km from a public health clinic, 5.9 km from a private hospital, 8.2 km from a public hospital and 8.7 km from an SRH clinic. Laypersons: The majority of layperson respondents reported it was “very easy” (Wave 1: 86.1%; Wave 2: 80.0%) or “easy” (Wave 1: 10.9%; Wave 2: 18.5%) to access the internet or mobile phone confidentially, and the remainder said it was “not easy” (Wave 1: 3.0%; Wave 2: 1.5%). The vast majority of laypersons reported being able to access health care when they need it (Wave 1: 96.6%; Wave 2: 95.4%), while the remaining few said they could not. In Wave 2, responses about distance for their homes to a range of health-care facilities were also analysed. On average, laypersons reported living closest to a pharmacy (mean: 1.5 km), a private health clinic (mean: 3.4 km) and a community clinic (mean: 3.4 km), and a bit further away from other facilities – 3.8 km from a public health clinic, 4.6 km from a private hospital, 5.4 km from an SRH clinic and 5.7 km from a public hospital. Mean distance (km) from home to Health workers Laypersons KEY Public hospital (SD) Public health clinic (SD) Private hospital (SD) Private health clinic (SD) SRH clinic (SD) Pharmacy (SD) Community clinic (SD) 8.2 (10.4) 5.7 (4.2) 5.6 (8.4) 3.8 (4.5) 5.9 (13.0) 4.6 (5.1) 4.6 (13.2) 3.4 (3.5) 8.7 (16.3) 5.4 (5.5) 2.0 (2.5) 1.5 (1.9) 3.5 (3.8)a 3.4 (3.5) SD: standard deviation a The data here have been calculated to exclude an “outlier” response from one health worker respondent who reported a distance of 700 km from their home to the community clinic. Chapter 4 1155 115 HIGHLIGHTS FROM COMMUNITY WORKSHOPS Truck drivers in India All the participants in this workshop were male truck drivers working in the Indian state of Tamil Nadu. Though their education levels varied from primary school through university level, many were illiterate. Body mapping was used as a tool to facilitate this workshop on general and sexual health care and self-care. The key issues raised by the participants included: 1. Participants typically have a family doctor in their hometown, whose advice they trust and follow. 2. When on long-distance truck routes, they carry previously issued prescriptions prepared by their family doctor and reuse them to buy medicines from pharmacies. 3. Under the state AIDS control programme, they are tested for STIs and HIV every six months and provided treatment if needed. 4. While the truck drivers found it convenient to access self-testing kits, many of them were anxious about using these products because they could not read or follow the directions for use. 5. Fellow drivers are an important source of health information. They also generally trust most health- related information received via social media. Not all drivers have mobile phones and they do not regularly watch television. 6. It is generally very difficult to access proper medical care while travelling long distances due to language barriers, so they rely on old prescriptions from pharmacies back home. STI and HIV self-testing and self-treatment products can be used at the individuals’ discretion while on the road. Self-care products would help overcome the stigma faced in clinics. There is fear of complications due to inappropriate use of self-care products. There is difficulty understanding which products or services to use and how, given low literacy levels. Artwork from this workshop co mmu nity “We are anxious about using self- testing products as we are illiterate and we cannot read the instructions. In some cases, it would be good if the instructions are written in our own language.” Benefits and barriers to self-care interventions 116 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 6 Impacts of COVID-19 on respondents’ use of self-care interventions and access to sexual and reproductive health services 6 117Chapter 6 Chapter summary Since the Wave 1 Global Values and Preferences Survey (GVPS) in 2018, the world has experienced unprecedented changes due to the COVID-19 pandemic. This pandemic has exerted broad and sustained impacts on multiple spheres of people’s lives, including their use of and access to self-care interventions and sexual and reproductive health (SRH) services. Non-pharmaceutical interventions, such as lockdowns, together with overwhelmed health care systems have resulted in delays to non-essential care, and COVID-19 has led to many changes in the ways people access and provide health care. Recognizing this, respondents participating in Wave 2 of the GVPS in 2020–2021 were asked a brief series of questions regarding the impact of the COVID-19 pandemic on their usage of self-care interventions and their access to SRH services. This chapter reports the findings, which indicate that by and large respondents reported no change in usage or access, but where there was change, there tended to be more of an increase in the use of self-care interventions and more of a decrease in access to both sexual health and reproductive health services. These results were very similar for both health worker respondents and layperson respondents. “Awareness is key to sexual and reproductive health. During the pandemic, there was no mobility, so you were not aware of what was wrong with you until it became a problem.” – 19-year-old female college student in Nigeria 118 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 6 Recognizing that COVID-19 has led to many changes in the ways people access and provide health care, in Wave 2 of the survey, health workers and layperson respondents were asked three additional questions: • Has your use of self-care interventions changed due to COVID-19? • Has your access to sexual health services changed due to COVID-19? • Has your access to reproductive health services changed due to COVID-19? Figure 6.1 presents the responses to these questions, and they are also summarized in the text below. Yes – increased use Yes – increased use Yes – increased use Yes – decreased use Yes – decreased use Yes – decreased use No change No change No change I don’t know I don’t know I don’t know 12.4 4.0 6.1 10.5 1.8 7.5 18.3 29.8 9.3 19.2 25.0 70.2 81.7 68.4 11.9 10.5 1.3 2.0 67.9 75.5 66.9 Health workers (%) Health workers (%) Health workers (%) Laypersons (%) Laypersons (%) Laypersons (%) Has your use of self-care interventions changed due to COVID-19? Has your access to reproductive health services changed due to COVID-19? Has your access to sexual health services changed due to COVID-19? FIGURE 6.1: IMPACTS OF COVID-19 ON USE OF SELF-CARE INTERVENTIONS AND ACCESS TO SEXUAL HEALTH AND REPRODUCTIVE HEALTH SERVICES, ACCORDING TO GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE (WAVE 2 ONLY, 2020–2021) Notes: Sexual health services refers to services such as HIV and STI testing and treatment. Reproductive health services include contraceptive services, pregnancy testing, antenatal supplements and self-management of medical abortion, among others. 119Chapter 6 Health workers: The majority of health worker respondents reported no change in their use of self-care interventions for SRHR due to the COVID-19 pandemic (67.9%), while the remainder were split fairly evenly between increased use of these interventions (12.4%), decreased use (9.3%) and not knowing if their use had changed (10.5%). Regarding access to sexual health services during the COVID-19 pandemic, again a two thirds majority of health workers reported no change (66.9%). An additional quarter of the health workers indicated that their access to sexual health services had decreased during the pandemic (25.0%), while 6.1% said their access had increased and 2.0% indicated that they did not know whether their access to sexual health services had changed or not due to the COVID-19 pandemic. With regard to access to reproductive health services, an even greater majority of three quarters of health workers reported no change due to the COVID-19 pandemic (75.5%), while almost a fifth indicated that their access to reproductive health services had decreased (19.2%) and the remaining few respondents indicated that their access had increased (4.0%) or that they did not know whether their access to reproductive health services had changed or not due to the COVID-19 pandemic (1.3%). Laypersons: Similar to health workers’ responses, the majority of layperson respondents reported that their use of self-care interventions for SRHR had not changed due to the COVID-19 pandemic (70.2%) and small minorities reported increased use (10.5%), decreased use (7.5%) and not knowing if their use had changed due to the pandemic (11.9%). While more than two thirds of the layperson respondents reported that their access to sexual health services did not change due to the pandemic (68.4%), almost a third reported decreased access (29.8%) and one respondent stated that their access had increased (1.8%). The vast majority of laypersons reported no change in their access to reproductive health services (81.7%) while the remaining fifth of the respondents indicated decreased access (18.3%). 120 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 6 Views on SRHR and self-care Qualitative research was undertaken in six countries using focus group discussions (FGDs) among adolescents and young people, including those from underserved populations. The goals were to stimulate the exchange of knowledge and ideas regarding the adoption and strategic implementation of self-care interventions for health, and to supplement the findings of the Global Values and Preferences Survey (GVPS) on self-care interventions, during the second wave of GVPS in 2020–2021. The research process also served to strengthen the roles of multiple stakeholders including, nongovernmental organizations (NGOs) and community-based organizations (CBOs) and members of underserved communities, who made valuable contributions to the research implementation and the dissemination and adoption of the research findings, especially during the COVID-19 pandemic. The research sought to understand the participants’ self- care practices, their motivations and perceptions, and the barriers and challenges they face in adopting self-care, including social, economic and mental barriers. It also investigated the accountability mechanisms they use when self-care does not work. In all six countries the FGDs included college graduates, while in three countries they also included high school students (Cameroon, Mexico, Nigeria) and in three they also included young married couples (Cameroon, India, Nigeria), and the FGDs in Nigeria also included commercial sex workers, drug users and members of the LGBQ+ community, and in India they also included members of the LGBQ+ community. Source and accessibility of information (data from FGDs in Egypt, India, Mexico, Nigeria and the United Arab Emirates with young college graduates, drug users, sex workers, people living with HIV and high school students). • High-risk communities of young people (including drug users, people living with HIV, and sex workers interviewed) report accessing credible and reliable health information from community health workers (CHWs) and from the CBOs/NGOs that they have been in contact with. • Three growing trends have been noticed across regions in most popular sources or methods of accessing online information: (i) through social media platforms like Instagram and Facebook; (ii) direct searches in search engines, like Google, comparing information across different websites or documents that appear in the search results; and (iii) preference for scholarly articles, specific trusted institutional websites and/or reputable blogs. • While participants acknowledged that the information they find online may not be entirely accurate or legitimate, the internet is the most immediately accessible source of information for them, and each person had their own way of checking the veracity of the information or relied on particular “go to” sources. • Almost all participants had access to online information via mobile phones. Knowledge (data from FGDs in Egypt, India, Mexico, Nigeria and the United Arab Emirates). • FGDs with adolescent girls and young women in urban slum areas in North India revealed that knowledge about SRH (e.g. menstruation) was limited and their knowledge of self-care products was limited to sanitary napkins/ cloth only. Furthermore, it was apparent that information received from their parents was focussed on policing the behaviour and limiting the freedom of girls after puberty. HIGHLIGHTS FROM FOCUS GROUP DISCUSSIONS WITH ADOLESCENTS AND YOUNG PEOPLE Artwork from this work sho p c om mu nit y Views on SRHR and self-care “We are not aware of reproductive health, but our family and especially, mothers told us we will come to know about it after we get married.” 22-year-old woman, resident of an urban slum setting in North India “Once puberty hit and there were changes in our bodies, we were instructed to stay away from boys and not allowed to play with them.” 20-year-old woman, resident of an urban slum setting in North India • Knowledge of SRH services and interventions among participants in Egypt, India, Mexico, Nigeria and the United Arab Emirates was reportedly limited to their personal experiences or hearsay. While they are aware that information on SRH is available through NGOs and CBOs, they are not inclined to access information that way unless they really had to. For instance, knowledge about PEP and PrEP, HIV self-testing, and HPV self- sampling was generally limited or non-existent, with the exception of some participants who were living with HIV and had been in contact with other people living with HIV or working with other high-risk communities. • Participants from New Delhi slums and from Egypt indicated that while the school curriculum included SRH information, most participants were not well informed about relevant products other than sanitary napkins and, in some cases, contraceptives. Use of information (data from FGDs in India, Mexico, Nigeria, Egypt and the United Arab Emirates among college graduates, people living with HIV and high school students). • Some participants shared that despite realizing that online SRH information was misleading, they hesitated to visit the doctor, for fear of being judged. Importance of SRH (data from FGDs with college graduates from India, Mexico and Nigeria) • Young college graduates in Nigeria were generally better informed about the important of safer sex practices (e.g. male/female condoms, lubricants, HIV testing kits) than were participants from the other five countries due to widespread public health programmes and campaigns on HIV prevention. “It is important, not just for me but for the youth because in today's society, most of our youth are not trustworthy, one person can have multiple relationships. Transmission of diseases will be taken from one person to another and pregnancy is another factor. In order to not destroy somebody’s future, I feel one should use sexual reproductive health to protect him or herself to avoid all these issues.” 21-year-old female college graduate in Nigeria • Bisexual college graduates in India and Mexico had good awareness of the importance of SRHR including the risks of disease transmission, but lacked specific knowledge about sexual health self-care practices for same-sex relationships, and their SRH-related self-care practices were either limited or guided by the partner. “Not all of my boyfriends thought SRH was important. For my girlfriends, this has been important. If something [self-care practice] is right, she will tell me.” 22-year-old bisexual college graduate in Mexico “Sex is a very intimate thing. If you contract an infection, it might be chronic so one needs to take proper precautions. I believe I have a certain amount of knowledge for SRH self-care.” 23-year-old bisexual female college graduate in India Risks and challenges (data from India and Nigeria). • Reports about their experience of and access to health- care facilities among participants from India and Nigeria indicated that some health workers may be unfriendly and the facilities poorly stocked and maintained – or completely closed due to the COVID-19 pandemic. “Some of the medical practitioners are very unfriendly to their patients or clients at the hospital. There is a lack of drugs, a test could be carried out but the drugs to be administered will not be there. Then, there will be unhealthy conditions for both the person and the staff. Some of them use dilapidated buildings. These are my own bitter challenges I have noticed.” 18-year-old male college student in Nigeria 121Chapter 6 122 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report Chapter 6 Views on SRHR and self-care “Awareness is key to sexual and reproductive health. During the pandemic, there was no mobility, so you were not aware of what was wrong with you until it became a problem – like if you have gonorrhoea, you will not know because you have not tested until it affects you fully before you know. You cannot cure it immediately because hospitals have closed down so it was a big problem during the lockdown. 19-year-old female college student in Nigeria • Sociocultural challenges were reported by participants in Egypt, India and Nigeria. Due to prevalent religious and cultural notions, individuals feel stigmatized discussing anything related to SRH with their children, parents, peers, or sometimes even with health workers. Though SRH is part of the school curriculum, the subject tends to be either skipped or treated in a hushed manner. “People are not educated and from backward classes, so they are hardly bothered about COVID. It was a religious thing for them ‘agr hona hoga to bina mask ke bhi ho jayega’ [If we have to get COVID, we will get it with or without using a mask].” 17-year-old female college graduate, resident of an urban slum setting in North India “The first question that always comes up is regarding pregnancy. The doctor we went to when I was 19 or 20, part of her treatment plan was to advise my mother that marriage and pregnancy are like long-term plans. Marriage is a long-term solution to your pregnancy. They usually ask how old you are. They were worried about my education and I have to take my medication for a three- month period. I have to manage my weight. I have to maintain a certain lifestyle. I felt that the entire approach didn’t really suit me. I didn’t feel she was putting me first. You don’t need to go to a doctor if you are married. There is a heavy focus on getting married so that you are healthy.” 20-year-old bisexual female college graduate in India • With regard to human rights and decision-making, female college graduates in India revealed that regardless of their education, financial independence and empowered lifestyle in urban settings, decisions about finding a life partner, marriage, family planning, pregnancy and childbirth are influenced or made by some family members (e.g. husband or parents), often accompanied by a struggle for autonomy. Self-care products for family planning (data from India, Mexico, Nigeria and the United Arab Emirates from college graduates). • Participants across the six countries, with the exception of adolescent girls from urban slums in North India, were aware of and use oral contraceptive pills (OCPs). • College graduates were aware of OCPs but expressed hesitance about using them due to side-effects. Nevertheless, they were inclined to use them, often secretly, in emergency situations as emergency contraception to prevent unplanned pregnancy and/or to address hormonal issues. • College graduates in Nigeria mentioned that due to the high cost of OCPs, they prefer to use condoms, which are affordable or free. “I think it should be a task for both partners. They should take care of themselves. She should take birth control pills or hormones. It is not just a task of one person.” 22-year-old college student in Mexico “Compared to other products, I feel condoms are much better as they are used externally.” 24-year-old college graduate in Mexico “It can be availed at pharmacies only with medical prescription. I don’t think there is any discrimination regarding birth control pills; like my family they talk about it, they consult the doctor and they use it.” 23-year-old college graduate in Nigeria Appendices 123 APPENDIX A: COUNTRY OF RESIDENCE OF GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY “WAVE” REPORTED COUNTRY OF RESIDENCE Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) Afghanistan 1 (0.3) 1 (0.7) 1 (0.2) 0 (0.0) Albania 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Algeria 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Argentina 7 (1.9) 3 (2.1) 11 (2.4) 1 (1.3) Aruba 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Australia 0 (0.0) 2 (1.4) 4 (0.9) 1 (1.3) Azerbaijan 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Bangladesh 0 (0.0) 0 (0.0) 2 (0.4) 0 (0.0) Barbados 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Belarus 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Belgium 2 (0.6) 0 (0.0) 2 (0.4) 0 (0.0) Bhutan 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Bolivia (Plurinational State of) 0 (0.0) 3 (2.1) 0 (0.0) 1 (1.3) Bosnia and Herzegovina 0 (0.0) 0 (0.0) 1 (0.2) 1 (1.3) Botswana 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Brazil 8 (2.2) 1 (0.7) 2 (0.4) 0 (0.0) Bulgaria 2 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) Burkina Faso 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Burundi 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Cameroon 3 (0.8) 1 (0.7) 1 (0.2) 1 (1.3) Canada 6 (1.7) 16 (11.2) 6 (1.3) 21 (28.0) Chile 0 (0.0) 2 (1.4) 0 (0.0) 0 (0.0) China 4 (1.1) 2 (1.4) 6 (1.3) 0 (0.0) Colombia 34 (9.4) 5 (3.5) 14 (3.0) 0 (0.0) Congo 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Costa Rica 2 (0.6) 0 (0.0) 2 (0.4) 0 (0.0) Côte d’Ivoire 0 (0.0) 0 (0.0) 0 (0.0) 2 (2.7) Croatia 4 (1.1) 0 (0.0) 8 (1.7) 0 (0.0) Cuba 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Czech Republic 2 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) Democratic Republic of the Congo 0 (0.0) 0 (0.0) 2 (0.4) 1(1.3) Denmark 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) APPENDICES Appendices 124 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report REPORTED COUNTRY OF RESIDENCE Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) Dominica 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Dominican Republic 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) Ecuador 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) Egypt 2 (0.6) 1 (0.7) 1 (0.2) 0 (0.0) El Salvador 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Eswatini 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Ethiopia 3 (0.8) 2 (1.4) 2 (0.4) 0 (0.0) Finland 0 (0.0) 0 (0.0) 2 (0.4) 0 (0.0) France 3 (0.8) 0 (0.0) 1 (0.2) 2 (2.7) Gambia 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Germany 2 (0.6) 0 (0.0) 5 (1.1) 1(1.3) Ghana 1 (0.3) 0 (0.0) 2 (0.4) 0 (0.0) Greece 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Grenada 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Guatemala 3 (0.8) 0 (0.0) 3 (0.7) 0 (0.0) Guyana 2 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) Haiti 2 (0.6) 1 (0.7) 0 (0.0) 0 (0.0) Honduras 0 (0.0) 1 (0.7) 1 (0.2) 1 (1.3) Hungary 0 (0.0) 2 (1.4) 0 (0.0) 0 (0.0) India 8 (2.2) 4 (2.8) 11 (2.4) 1 (1.3) Indonesia 0 (0.0) 2 (1.4) 3 (0.7) 0 (0.0) Iran (Islamic Republic of) 3 (0.8) 0 (0.0) 2 (0.4) 0 (0.0) Italy 1 (0.3) 1 (0.7) 2 (0.4) 0 (0.0) Jamaica 0 (0.0) 1 (0.7) 0 (0.0) 0 (0.0) Japan 0 (0.0) 0 (0.0) 3 (0.7) 0 (0.0) Jordan 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Kenya 48 (13.3) 2 (1.4) 37 (8.0) 2 (2.7) Lebanon 2 (0.6) 2 (1.4) 2 (0.4) 0 (0.0) Liberia 2 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) Malawi 1 (0.3) 3 (2.1) 0 (0.0) 0 (0.0) Malaysia 1 (0.3) 0 (0.0) 2 (0.4) 0 (0.0) Mali 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) Malta 0 (0.0) 0 (0.0) 3 (0.7) 0 (0.0) Mauritius 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Mexico 2 (0.6) 1 (0.7) 2 (0.4) 0 (0.0) Morocco 0 (0.0) 2 (1.4) 2 (0.4) 1 (1.3) Mozambique 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Appendices 125 REPORTED COUNTRY OF RESIDENCE Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) Myanmar 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Namibia 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Nepal 3 (0.8) 1 (0.7) 0 (0.0) 2 (2.7) Netherlands 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) New Zealand 1 (0.3) 0 (0.0) 2 (0.4) 0 (0.0) Nicaragua 3 (0.8) 1 (0.7) 0 (0.0) 1 (1.3) Nigeria 16 (4.4) 14 (9.8) 19 (4.1) 2 (2.7) North Macedonia 2 (0.6) 0 (0.0) 9 (1.9) 0 (0.0) Norway 0 (0.0) 0 (0.0) 3 (0.7) 0 (0.0) Oman 0 (0.0) 0 (0.0) 2 (0.4) 0 (0.0) Pakistan 1 (0.3) 3 (2.1) 9 (1.9) 2 (2.7) Palestine 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Panama 0 (0.0) 0 (0.0) 4 (0.9) 0 (0.0) Paraguay 2 (0.6) 0 (0.0) 1 (0.2) 0 (0.0) Peru 5 (1.4) 2 (1.4) 2 (0.4) 1 (1.3) Philippines 3 (0.8) 2 (1.4) 2 (0.4) 0 (0.0) Poland 7 (1.9) 0 (0.0) 17 (3.7) 0 (0.0) Portugal 20 (5.6) 1 (0.7) 61 (13.1) 0 (0.0) Qatar 1 (0.3) 0 (0.0) 2 (0.4) 0 (0.0) Republic of Korea 0 (0.0) 2 (1.4) 2 (0.4) 0 (0.0) Republic of Moldova 2 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Romania 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Rwanda 1 (0.3) 1 (0.7) 0 (0.0) 0 (0.0) Saudi Arabia 1 (0.7) 0 (0.0) 0 (0.0) 0 (0.0) Senegal 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.3) Serbia 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) Singapore 0 (0.0) 0 (0.0) 31 (6.7) 0 (0.0) Slovakia 0 (0.0) 1 (0.7) 1 (0.2) 0 (0.0) Slovenia 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Somalia 0 (0.0) 1 (0.7) 1 (0.2) 0 (0.0) South Africa 6 (1.7) 1 (0.7) 5 (1.1) 0 (0.0) Spain 2 (0.6) 2 (1.4) 2 (0.4) 1 (1.3) Sri Lanka 3 (0.8) 0 (0.0) 1 (0.2) 0 (0.0) Sudan 1 (0.3) 0 (0.0) 2 (0.4) 1 (1.2) Swaziland 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) Sweden 2 (0.6) 0 (0.0) 5 (1.1) 0 (0.0) Switzerland 5 (1.4) 1 (0.7) 3 (0.7) 0 (0.0) Appendices 126 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report REPORTED COUNTRY OF RESIDENCE Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) Syrian Arab Republic 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Thailand 6 (1.7) 1 (0.7) 3 (0.7) 0 (0.0) Trinidad and Tobago 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Tunisia 3 (0.8) 0 (0.0) 12 (2.6) 0 (0.0) Türkiye 8 (2.2) 1 (0.7) 7 (1.5) 1 (1.3) Turkmenistan 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) Uganda 10 (2.8) 2 (1.4) 12 (2.6) 1 (1.3) United Kingdom 16 (4.4) 5 (3.5) 16 (3.4) 2 (2.7) United Republic of Tanzania 3 (0.8) 0 (0.0) 1 (0.2) 0 (0.0) United States of America 44 (12.2) 27 (18.9) 54 (11.6) 21 (28.0) Uruguay 2 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) Venezuela (Bolivarian Republic of) 0 (0.0) 2 (1.4) 2 (0.4) 0 (0.0) Viet Nam 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) Yemen 1 (0.3) 1 (0.7) 0 (0.0) 0 (0.0) Zambia 1 (0.3) 2 (1.4) 0 (0.0) 1 (1.3) Zimbabwe 1 (0.3) 2 (1.4) 1 (0.2) 1 (1.3) TOTAL 360 143 465 75 Appendices 127 APPENDIX B: AGES OF THE GLOBAL VALUES & PREFERENCES SURVEY PARTICIPANTS, BY RESPONDENT TYPE AND SURVEY WAVE AGE GROUP Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) 18–29 years 117 (32.7) 28 (16.7) 262 (56.5) 40 (48.8) 18 1 (0.3) 0 (0.0) 13 (2.8) 2 (2.4) 19 3 (0.8) 0 (0.0) 20 (4.3) 1 (1.2) 20 11 (3.0) 0 (0.0) 35 (7.5) 2 (2.4) 21 8 (2.2) 1 (0.6) 36 (7.8) 3 (3.7) 22 15 (4.2) 1 (0.6) 39 (8.4) 3 (3.7) 23 16 (4.5) 7 (4.2) 25 (5.4) 10 (12.2) 24 9 (2.5) 2 (1.2) 19 (4.1) 2 (2.4) 25 11 (3.1) 4 (2.4) 23 (5.0) 0 (0.0) 26 10 (2.8) 4 (2.4) 14 (3.0) 8 (9.8) 27 12 (3.4) 2 (1.2) 11 (2.4) 2 (2.4) 28 13 (3.6) 3 (1.8) 12 (2.6) 4 (4.9) 29 8 (2.2) 4 (2.4) 15 (3.2) 3 (3.7) 30–39 years 98 (27.4) 47 (28.0) 91 (19.6) 14 (17.1) 30 10 (2.8) 3 (1.8) 15 (3.2) 2 (2.4) 31 11 (3.1) 5 (3.0) 10 (2.2) 2 (2.4) 32 7 (2.0) 2 (1.2) 7 (1.5) 1 (1.2) 33 10 (2.8) 4 (2.4) 8 (1.7) 2 (2.4) 34 8 (2.2) 6 (3.6) 14 (3.0) 1 (1.2) 35 16 (4.5) 7 (4.2) 4 (0.9) 0 (0.0) 36 9 (2.5) 3 (1.8) 9 (1.9) 3 (3.7) 37 9 (2.5) 3 (1.8) 8 (1.7) 0 (0.0) 38 11 (3.1) 9 (5.4) 9 (1.9) 1 (1.2) 39 7 (2.0) 5 (3.0) 7 (1.5) 2 (2.4) 40–49 years 72 (20.1) 45 (26.8) 55 (11.9) 16 (19.5) 40 12 (3.4) 4 (2.4) 10 (2.2) 1 (1.2) 41 7 (2.0) 2 (1.2) 3 (0.7) 1 (1.2) 42 11 (3.1) 5 (3.0) 3 (0.7) 3 (3.7) 43 5 (1.4) 2 (1.2) 10 (2.2) 4 (4.9) 44 7 (2.0) 5 (3.0) 1 (0.2) 1 (1.2) 45 6 (1.7) 6 (3.6) 6 (1.3) 0 (0.0) 46 5 (1.4) 6 (3.6) 5 (1.1) 2 (2.4) 47 6 (1.7) 3 (1.8) 4 (0.9) 1 (1.2) 48 7 (2.0) 7 (4.2) 9 (1.9) 0 (0.0) 49 6 (1.7) 5 (3.0) 4 (0.9) 3 (3.7) Appendices 128 WHO guideline on self-care interventions for health and well-being, 2022 revision. Web Annex A. Global values and preferences survey report AGE GROUP Health workers Laypersons Wave 1 N (%) Wave 2 N (%) Wave 1 N (%) Wave 2 N (%) 50–59 years 44 (12.3) 32 (19.1) 33 (7.1) 6 (7.3) 50 2 (0.6) 5 (3.0) 8 (1.7) 1 (1.2) 51 6 (1.7) 0 (0.0) 0 (0.0) 0 (0.0) 52 4 (1.1) 1 (0.6) 8 (1.7) 2 (2.4) 53 3 (0.8) 4 (2.4) 1 (0.2) 0 (0.0) 54 8 (2.2) 4 (2.4) 4 (0.9) 1 (1.2) 55 3 (0.8) 2 (1.2) 1 (0.2) 1 (1.2) 56 6 (1.7) 3 (1.8) 0 (0.0) 0 (0.0) 57 3 (0.8) 7 (4.2) 3 (0.7) 1 (1.2) 58 3 (0.8) 2 (1.2) 3 (0.7) 0 (0.0) 59 6 (1.7) 4 (2.4) 5 (1.1) 0 (0.0) 60–69 years 17 (4.7) 14 (8.3) 18 (3.9) 5 (6.1) 60 2 (0.6) 4 (2.4) 4 (0.9) 0 (0.0) 61 2 (0.6) 0 (0.0) 1 (0.2) 0 (0.0) 62 0 (0.0) 1 (0.6) 4 (0.9) 1 (1.2) 63 2 (0.6) 2 (1.2) 2 (0.4) 2 (2.4) 64 3 (0.8) 0 (0.0) 2 (0.4) 1 (1.2) 65 3 (0.8) 0 (0.0) 2 (0.4) 0 (0.0) 66 1 (0.3) 1 (0.6) 1 (0.2) 0 (0.0) 67 2 (0.6) 2 (1.2) 1 (0.2) 0 (0.0) 68 1 (0.3) 3 (1.8) 1 (0.2) 0 (0.0) 69 1 (0.3) 1 (0.6) 0 (0.0) 1 (1.2) 70+ years 10 (2.8) 2 (1.2) 5 (1.1) 1 (1.2) 70 4 (1.1) 1 (0.6) 2 (0.4) 0 (0.0) 71 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) 72 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) 74 2 (0.6) 1 (0.6) 0 (0.0) 1 (1.2) 75 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) 83 1 (0.3) 0 (0.0) 1 (0.2) 0 (0.0) 87 1 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) TOTAL 358 168 464 82