INTRODUCTION: Polycystic Ovary Syndrome (PCOS) is a reproductive and endocrine disorder common among women of reproductive age. It is characterized by elevated androgen levels, menstrual irregularities, and several cysts ranging from 2 to 9 mm on one or both ovaries. PCOS is prevalent in approximately 10% of women typically between the ages of 18-44. It is significantly underdiagnosed due to variation in disease manifestation. Treatment for PCOS includes oral contraceptives, Metformin, and Spironolactone. However, supplements such as zinc and magnesium are increasingly promising additions to PCOS treatment regimens to manage symptoms and co-morbid chronic diseases. The objective of this thesis is to determine the prevalence of supplement use as a treatment for PCOS in the Ovulation and Menstruation Health Pilot Study (OM). The OM Pilot study is an epidemiological, online survey that aims to study the characteristics and determinants of female reproductive diseases in a diverse population. This thesis also explores the overall role of nutrition in PCOS management. METHODS: The goal of the OM Pilot Study is to determine women’s gynecological health outcomes in a multi-ethnic cohort and to characterize the lifestyle, health, and menstrual risks of reproductive diseases such as polycystic ovary syndrome, endometriosis, and uterine fibroids. The eligibility criteria included: being of reproductive age, having the ability to menstruate, being able to read in English, and having a working email address to receive the link to the survey. The survey and questions were designed by a board-certified reproductive endocrinology and infertility specialist at Boston Medical Center and was administered through REDCap, a cloud-based clinical software application for building and managing online surveys and databases. The questionnaire was comprised of each of the following sections: Demographics, Baseline Questionnaire, Anthropometrics, Menstrual Cycle, Contraceptive History, Health and Body, Polycystic Ovary Syndrome, Reproductive Health Questions, General Health Questions, Diet and Lifestyle, and Pregnancy and Birth History. Participants were recruited from multiple cities across the United States using in-person recruiting methods, online recruitment through a link, flyers, posters, word-of-mouth, and advertisements on Facebook and other social media websites such as Twitter and LinkedIn. Consenting participants were entered into a raffle to win a $200 gift card. Data analysis was conducted on SAS 9.4 and manually as needed. RESULTS: In terms of prevalence of PCOS: Of the 249 women who completed the survey, 60 women self-reported to having polycystic ovary syndrome (37 were diagnosed by a physician and 23 diagnosed by self). And of those 60 women who reported having PCOS, 24 reported taking medication for PCOS and out of these women, 10 women reported taking one, two, or three of the supplementary treatment options. Of the 60 women with PCOS, 4 women currently take a multivitamin for PCOS, 2 women currently take a dietary supplement, 2 women currently take herbal remedies, and 4 women reported drinking spearmint tea to help with PCOS management. Additionally, out of the 60 women who reported yes to having PCOS whether they were diagnosed by a physician and self-diagnosed, 11 women also reported yes to having an eating disorder. Of those 11 women, 7 women have anorexia, 7 women have bulimia, and 4 women have binge eating disorder. CONCLUSION: In this thesis, the prevalence rates of PCOS diagnoses, supplement use among PCOS patients, and eating disorders among PCOS patients were determined. Based on current literature on the effectiveness of supplements on PCOS symptoms, it seems advisable to study the effects of supplements further to incorporate them into treatment. With additional research, medical personnel such as physicians and registered dietitians should consider adding supplements to treatment regimen for PCOS. A personalized diet and exercise plan along with a plan to treat mental health to curb the prevalence of eating disorders may be beneficial to add to the treatment regimen for PCOS.

Mental illness affects more women than men in the United States. Poor mental health in reproductive-age women has negative implications on population health. The purpose of this quantitative, correlational study was to examine the relationship between household structure and frequency of mental distress, with consideration of the mediation social-emotional support provides for reproductive-age women. The social ecological model was the theoretical framework for this research, in which frequency of mental distress related to the individual-level of the human-environment interaction construct. Household structure and social-emotional support were examined at the relationship-level. Pearson's correlation coefficient and linear regression were used to conduct a cross-sectional analysis of the 2010 Behavioral Risk Factor Surveillance System data set with a total sample size of 65,269 women, 18-44 years old. The confounding variables, health care access, race, income, marital status, number of children in the household, and pregnancy status, were included in the analysis. Although social-emotional support significantly influenced both household structure and frequency of mental distress, significance was not found between household structure and frequency of mental distress indicating that mediation does not exist. This study provides researchers and practitioners information about household structure that should be considered when designing innovative, nonprofessional support programs at the community-level. Positive social change implications include an understanding of the relationship between complex variables associated with social-emotional support, which could improve community support programs focused on mental health wellness of reproductive-age women.

<p><b>Background:</b> Shared decision-making (SDM) increases patients’ involvement in their healthcare, extending the goal of patient-centered care provision. However, SDM is underexplored in women’s reproductive health, where choices about contraception and pregnancy are frequently value and lifestyle-dependent. Furthermore, limited research exists on SDM outside of the patient-physician dyad, preventing insight into how non-physician community-based healthcare professionals (HCPs) engage women in practice. Finally, little research takes a social-ecological approach to SDM, despite interaction of multiple levels of influence in women’s reproductive healthcare decision-making. Therefore, the purpose of this study was to explore women’s and HCPs’ experiences with SDM, including the various factors associated with how women make their reproductive healthcare choices.</p><p> </p><p><b>Methods: </b>This study consisted of three distinct, but interconnected phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18-45 living in Indiana who sought community-based or private healthcare for women’s reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician HCPs (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women’s reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using an expanded grounded theory framework. Constant comparative analysis identified emergent themes in both phases. Phase 3 consisted of an online survey. Women (18-45 years) living in Indiana who sought reproductive healthcare completed the survey (N=432). Multiple linear regression, chi-square analyses, and structural equation modeling were utilized to identify ecological factors associated with pregnancy and contraceptive shared decision-making.</p><p> </p><p><b>Results:</b><i> Phase 1)</i> Participants (n=22) wanted to be invited into healthcare discussions. Additionally, they wanted conversations to proceed organically, where HCPs listened to their needs, and supported and validated their choices. Though these behaviors did not always occur, they provided recommendations to enhance these experiences. Additionally, participants described quality of time was more important than quantity of time during appointments. Prior negative healthcare experiences specifically tied to HCP-interactions decreased women’s healthcare engagement. Additionally, social support system experiences were influential on women’s choices. Race also emerged as impactful toward decision-making, including Black women feeling less respected in care and making choices about their reproductive healthcare to ensure their voices were heard, such as enlisting Black doulas. <i>Phase 2)</i> HCPs noted patient-centered care was important to community-based care. They also noted the importance of contextualized decision-making approaches to ensure they could meet women’s varied needs. Results identified that outcome-oriented SDM concepts, including patient buy-in and investigative listening, were important for increasing SDM. HCPs suggested SDM improved healthcare experience beyond one visit. <i>Phase 3) </i>Structural equation modeling revealed access, social support, and patient-HCP relationship had significant relationships with contraceptive and pregnancy SDM. These models demonstrated good global and component fit, suggesting the importance of context in women’s health choices. Further, regression results demonstrated SDM was associated with higher reproductive healthcare quality. Additionally, utilizing community-based healthcare for reproductive health was associated with decreased contraceptive SDM scores.</p><p> </p><p><b>Conclusion: </b>Findings from this study provide practical considerations for extending SDM work in women’s reproductive health. In particular, results supported shifting SDM beyond the patient-physician dyad to include non-physician HCPs and HCPs in community-based healthcare settings. Women frequently access these services when seeking reproductive healthcare; thus, findings improve our understanding of the practical considerations researchers, policy-makers, and HCPs must make when promoting SDM in these settings. Furthermore, results revealed SDM use across multiple touchpoints, including community-based services, is imperative for women to achieve partnership in their healthcare. Thus, SDM provides a broader opportunity to enhance patient involvement across the spectrum of women’s reproductive healthcare. Incorporating women’s contextual needs and preferences improves HCPs’ insight into women’s experiences to further personalize care. Findings emphasize the importance of decisional space that include the various factors, agents, healthcare settings, and options that exist in reproductive health decision-making as these can shape women’s choices, and, subsequently, their SDM experiences. This mixed methods study allowed thorough insight into multiple stakeholder groups engaged in healthcare decision-making; thus, the results offer guidance on the verbiage, resources, and strategies to engage in SDM and strengthen patient involvement reflective of women’s lifestyle needs and HCPs’ existing workflow. Findings drive SDM practice into community-based healthcare and position it as the standard of care across healthcare settings.</p><br>