We are pleased to introduce the collection Frontiers in Global Women's Health – Highlights in Quality of Life 2021/22. This collection will welcome and showcase a selection of high-impact articles authored by leaders in the field. The work presented here highlights the broad diversity of research performed across the Quality of Life section, and aims to put a spotlight on the main areas of interest. This collection aims to further support Frontiers’ strong community by shining a spotlight on our authors' highly impactful research.

Medical University of Gdansk

Department of Education Sciences, University of Catania

Leeds Beckett University

Explore broad research contributions to understand the impact on Quality of Life.

. This research topic focuses on the psychosocial factors that contribute to expecting mothers' mental health and well-being, as well as strategies for addressing cervical cancer disparities among sub-Saharan African communities. It also examines the impact of the coronavirus pandemic on gender inequality and domestic abuse, and the development of an endometriosis participant questionnaire to harmonize non-surgical clinical participant characteristic data. <ul> <li>Expecting mothers' sense of coherence, perceived social support, and maternal-fetal attachment are associated with mental health outcomes.</li> <li>Leveraging existing community networks and training community members through research efforts are promising methods for addressing cervical cancer disparities.</li> <li>The coronavirus pandemic has exacerbated gender inequality and led to an increase in domestic abuse and intimate partner violence.</li> <li>The World Endometriosis Research Foundation (WERF) Endometriosis Phenome and Biobanking Harmonization Project (EPHect) have developed an endometriosis participant questionnaire (EPQ) to harmonize non-surgical clinical participant characteristic data.</li> </ul>

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Frontiers in Global Women's Health

Quality of Life

Highlights in Quality of Life 2021/22

Editorial on the Research Topic <a href="https://www.frontiersin.org/research-topics/37232/highlights-in-quality-of-life-202122">Highlights in quality of life 2021/22</a>Quality of life (QoL) has long been a part of medical research, attracting a steadily increasing amount of attention from scholars around the world. However, recent years have seen an unprecedented rise in research about the topic. Once the terms [(patient-reported outcomes) or (quality of life)] are entered into the search strategy at <a href="www.pubmed.gov">www.pubmed.gov</a>, the growth immediately becomes apparent, with 2,038 papers published in 1992, 7,391 in 2002, but a staggering 40,740 in 2022 alone.Patient-Reported Outcome Measures (PROs) are used to assess QoL. A PRO has been defined as any report about patient health status which comes directly from the patient, without being interpreted by a physician or anyone else (<a href="#B1">1</a>). PROs are completed by patients to measure their perception of the functional well-being and health status (<a href="#B2">2</a>). The questionnaires which are used to assess quality of life may be categorized into “generic” and “disease-specific”. Generic questionnaires allow for a more general assessment of the problem and can be applied to both, general and patient populations. Disease-specific questionnaires cover the issues which are specific to a particular disease entity or a population. They are also typically more responsive to change or treatment (<a href="#B2">2</a>, <a href="#B3">3</a>). The use of any questionnaire in a given population and in a given language is only possible after a meticulously planned validation process. One of the first steps in the process of validation is translation and cultural adaptation of the instrument.The paper <a href="https://doi.org/10.3389/fgwh.2021.644609">Protocol for the Cultural Translation and Adaptation of the World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project Endometriosis Participant Questionnaire (EPHect)</a> presents the process in detail. Content and face validity of WERF EPHect EPQ-M were performed. The cross-cultural translation and adaptation of the questionnaire was carried out using the recommended guidelines and COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN standards) (<a href="#B4">4</a>). The process was completed as follows: (1) conceptual equivalence, (2) forward translation, (3) backward translation, (4) expert panel revision, (5) cognitive testing, and (6) proofreading. The six phases of the cross-cultural adaptation are detailed in Figure&nbsp;1 in the paper. The authors included the questionnaire in their Supplementary Material. According to the authors, endometriosis affects about 10% of the reproductive age women globally (190 million girls and women), remaining one of the most common causes of pelvic pain and infertility worldwide. Therefore, the development of tools for collecting non-surgical clinical and epidemiological data relevant to endometriosis research is critical to enable worldwide collaboration. According to the World Endometriosis Research Foundation, 54 institutions in 22 countries are registered as users of the tool (<a href="#B5">5</a>).International databases are becoming increasingly important, especially in the context of collecting data to conduct analyses on large groups of subjects in many conditions, e.g., in endometriosis, as presented in the paper. Research data registries contain shared datasets and facilitate collaborative research between various international centers. Surgical databases which collect information about the outcomes of the procedure and complications are of great importance.The following article, <a href="https://doi.org/10.3389/fgwh.2021.697607">Community-Engaged Approaches to Cervical Cancer Prevention and Control in Sub-Saharan Africa: A Scoping Review</a>, deals with the issues of cervical cancer prevention. Organized screening has decreased cervical cancer incidence in the developed countries. However, at the same time, cervical cancer remains to be the leading cause of cancer-related mortality among African women. The paper is a narrative review describing community-engaged approaches to cervical cancer prevention and control methods in Sub-Saharan Africa (SSA). The Covidence systematic review software was used and nine articles were selected for the final analysis. The objectives of the review were as follows: to describe community engagement activities in cervical cancer prevention and control in SSA, to identify the aspects of cervical cancer research which used community engagement, and to describe the best practices for community engagement in achieving the goal of cervical cancer prevention and control. The study presented a Community-Based Participatory Research (CBPR) framework and analyzed the research, in accordance with its eight principles.Cervical cancer is a global public health problem, with a particularly high burden in many low- and middle-income countries. The proven effectiveness of interventions such as vaccination against the most oncogenic human papillomavirus (HPV) types, and screening, particularly with HPV-based methods, makes cervical cancer a largely preventable disease (<a href="#B6">6</a>). Substantial geographical and socioeconomic inequalities in cervical cancer have been reported. Twenty percent of all cases of cervical cancer globally were reported in Africa (<a href="#B6">6</a>). Age-standardized incidence and morality rates in southern Africa were estimated at 36.4 (95% CI 35.8–37.1) and 20.6 (95% CI 20.1–21.1) per 100 000 woman-years, as compared to Western Europe 7.0 (95% CI 6.9–7.2) and 2.0 (95% CI 2.0–2.1), respectively (<a href="#B6">6</a>). Public awareness and education projects to increase knowledge and generate more favorable attitudes toward HPV vaccinations are two of the most crucial steps in cervical cancer prevention (<a href="#B7">7</a>). Little or no encouragement from the health providers results in low interest in preventive examinations. The situation might be improved by involving traditional and religious leaders, as well as the local media, to raise greater awareness among the population and to address public mistrust and concerns about HPV vaccination (<a href="#B8">8</a>).Both articles address the topic of research methodology. On the one hand, we have a paper on an international database covering a variety of patient medical data to improve our understanding of endometriosis. On the other hand, we have a paper evaluating the feasibility of community-based prevention of cervical cancer. The authors of these papers aim to reduce the morbidity of endometriosis and the incidence of cervical cancer. The WERF EPHect EPQ-M questionnaire, whose validation is presented by <a href="https://doi.org/10.3389/fgwh.2021.644609">Mis et al.</a>, is released under the auspices of the World Endometriosis Research Foundation. The organization aims to be a global charity facilitating research into endometriosis to improve knowledge and treatment. In turn, the authors of the narrative review highlight the role of tribal leaders, religious leaders, and community health workers in increasing knowledge about cervical cancer and screening. They highlight strategies to identify and engage target populations and improve awareness.The author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Editorial: Highlights in quality of life 2021/22

Retraction: “Crisis within the Walls”: Rise of Intimate Partner Violence (IPV) during the pandemic, Indian perspectives

Introduction: Pregnancy is associated with psychological, physiological and social shifts, and can be a vulnerable time in a woman's life. Despite a growing understanding of the importance of antenatal mental health, there is a paucity of research on psychosocial factors relevant to this phase, especially in developing countries. The aim of the present study was to investigate the associations of expecting mothers' sense of coherence, perceived social support, and maternal-fetal attachment with mental health outcomes.Method: Participants (N = 122) were nulliparous expectant mothers residing in urban India. Cross-sectional data was collected using an online questionnaire.Results: Participant reports of perceived social support and sense of coherence were negatively correlated with symptoms of antenatal depression, while reports of maternal-fetal attachment, sense of coherence, and social support were positively associated with antenatal well-being. In a multilinear regression model, perceived social support and sense of coherence uniquely contributed to symptoms of antenatal depression, while maternal-fetal attachment and sense of coherence uniquely contributed to antenatal well-being.Discussion: The findings of this study highlight the role of perceived social support, sense of coherence and maternal-fetal attachment in contributing to expecting mothers' mental health and well-being in urban India. These findings have implications for clinical practice and research, intending to the subjective experiences of pregnant women to improve antenatal mental health. Future research investigating these psychosocial factors using longitudinal designs is warranted and would help clinicians and practitioners identify women at risk for perinatal mental health concerns.

Introduction: Pregnancy is associated with psychological, physiological and social shifts, and can be a vulnerable time in a woman's life. Despite a growing understanding of the importance of antenatal mental health, there is a paucity of research on psychosocial factors relevant to this phase, especially in developing countries. The aim of the present study was to investigate the associations of expecting mothers' sense of coherence, perceived social support, and maternal-fetal attachment with mental health outcomes.Method: Participants (N = 122) were nulliparous expectant mothers residing in urban India. Cross-sectional data was collected using an online questionnaire.Results: Participant reports of perceived social support and sense of coherence were negatively correlated with symptoms of antenatal depression, while reports of maternal-fetal attachment, sense of coherence, and social support were positively associated with antenatal well-being. In a multilinear regression model, perceived social support and sense of coherence uniquely contributed to symptoms of antenatal depression, while maternal-fetal attachment and sense of coherence uniquely contributed to antenatal well-being.Discussion: The findings of this study highlight the role of perceived social support, sense of coherence and maternal-fetal attachment in contributing to expecting mothers' mental health and well-being in urban India. These findings have implications for clinical practice and research, intending to the subjective experiences of pregnant women to improve antenatal mental health. Future research investigating these psychosocial factors using longitudinal designs is warranted and would help clinicians and practitioners identify women at risk for perinatal mental health concerns.

Sense of Coherence, Social Support, Maternal-Fetal Attachment, and Antenatal Mental Health: A Survey of Expecting Mothers in Urban India

Background: Cervical cancer remains one of the top causes of cancer mortality among African women. Cervical cancer screening and early detection and treatment of precancer is one of the evidence-based interventions to reduce incidence and mortality. The application of community-based participatory research (CBPR) has been used in the United States to improve participation in screening and reduce cervical cancer disparities. However, it is unclear whether these engaged approaches have been used in sub-Saharan African to address disparities related to cervical cancer mortality.Objectives: Highlight community engagement in cervical cancer prevention and control in Sub-Saharan Africa (SSA), describe the community engagement efforts that are currently being used, and to describe the best practices for community engagement toward the end-goal of cervical cancer prevention and control.Methods: We searched PubMed, Embase, CINHAL, African Journals Online (AJOL), and African Index Medicus-WHO from inception until June 8, 2020. After screening 620 titles and abstracts, and reviewing 56 full-text articles according to inclusion and exclusion criteria, 9 articles met the selection criteria and were included. Relevant data variables were extracted from the included articles and a narrative synthesis was performed.Results: Between 2005 and 2019, 9 articles describing research in Ghana, Kenya, Zambia, Senegal, South Africa, and Nigeria were included. These articles described work that largely took place in rural settings predominantly among women age 15–65 years. Leveraging community networks such as community health workers, religious organizations, traditional leaders, and educational institutions increased awareness of cervical cancer. Working within existing social structures and training community members through the research effort were promising methods for addressing the disparities in cervical cancer incidence and mortality among communities.Discussion: The findings of this scoping review have contributed to the understanding of which novel approaches to community-based practices can be used to address cervical cancer disparities among SSA communities that carry a disproportionate disease burden. Community engagement in the research process, while effortful, has shown to be beneficial to researchers and to the communities that they serve, and provides valuable next steps in the effort to address cervical cancer disparities in SSA.

Background: Cervical cancer remains one of the top causes of cancer mortality among African women. Cervical cancer screening and early detection and treatment of precancer is one of the evidence-based interventions to reduce incidence and mortality. The application of community-based participatory research (CBPR) has been used in the United States to improve participation in screening and reduce cervical cancer disparities. However, it is unclear whether these engaged approaches have been used in sub-Saharan African to address disparities related to cervical cancer mortality.Objectives: Highlight community engagement in cervical cancer prevention and control in Sub-Saharan Africa (SSA), describe the community engagement efforts that are currently being used, and to describe the best practices for community engagement toward the end-goal of cervical cancer prevention and control.Methods: We searched PubMed, Embase, CINHAL, African Journals Online (AJOL), and African Index Medicus-WHO from inception until June 8, 2020. After screening 620 titles and abstracts, and reviewing 56 full-text articles according to inclusion and exclusion criteria, 9 articles met the selection criteria and were included. Relevant data variables were extracted from the included articles and a narrative synthesis was performed.Results: Between 2005 and 2019, 9 articles describing research in Ghana, Kenya, Zambia, Senegal, South Africa, and Nigeria were included. These articles described work that largely took place in rural settings predominantly among women age 15–65 years. Leveraging community networks such as community health workers, religious organizations, traditional leaders, and educational institutions increased awareness of cervical cancer. Working within existing social structures and training community members through the research effort were promising methods for addressing the disparities in cervical cancer incidence and mortality among communities.Discussion: The findings of this scoping review have contributed to the understanding of which novel approaches to community-based practices can be used to address cervical cancer disparities among SSA communities that carry a disproportionate disease burden. Community engagement in the research process, while effortful, has shown to be beneficial to researchers and to the communities that they serve, and provides valuable next steps in the effort to address cervical cancer disparities in SSA.

Community-Engaged Approaches to Cervical Cancer Prevention and Control in Sub-Saharan Africa: A Scoping Review

The ongoing coronavirus disease 2019 pandemic has been a social “un-equalizer,” besides being a global health threat. Gender inequality has been globally prominent during the outbreak and the consequent lockdown. Although domestic abuse and intimate partner violence have increased due to chronic entrapment, overcrowding in families, enhanced substance use, distorted relationship dynamics, travel restrictions, and reduced healthcare access, coercive sexual practices have also been on the rise. In low- and middle-income countries, the lack of awareness, societal pressure, administrative apathy, fear of legal hassles, and inadequate knowledge–attitude–practice related to help-seeking lead to underreporting and mismanagement of domestic abuse, which can perpetuate its vicious cycle during the ongoing crisis. India, with its socio-culturally diverse population, has been one of the nations worst hit by the pandemic. With the rise in reports of gender-based violence on the premise of preexisting gender inequality and minority stress, concerns behind “closed doors” are as threatening as the infection itself. With this background, the authors highlight the backdrop of domestic violence as a “hidden pandemic” during the coronavirus disease 2019 crisis, drawing on perspectives from India and briefly reviewing the data from other nations. The role of mental health education and digital literacy as mitigating strategies is subsequently discussed.

The ongoing coronavirus disease 2019 pandemic has been a social &#x201c;un-equalizer,&#x201d; besides being a global health threat. Gender inequality has been globally prominent during the outbreak and the consequent lockdown. Although domestic abuse and intimate partner violence have increased due to chronic entrapment, overcrowding in families, enhanced substance use, distorted relationship dynamics, travel restrictions, and reduced healthcare access, coercive sexual practices have also been on the rise. In low- and middle-income countries, the lack of awareness, societal pressure, administrative apathy, fear of legal hassles, and inadequate knowledge&#x2013;attitude&#x2013;practice related to help-seeking lead to underreporting and mismanagement of domestic abuse, which can perpetuate its vicious cycle during the ongoing crisis. India, with its socio-culturally diverse population, has been one of the nations worst hit by the pandemic. With the rise in reports of gender-based violence on the premise of preexisting gender inequality and minority stress, concerns behind &#x201c;closed doors&#x201d; are as threatening as the infection itself. With this background, the authors highlight the backdrop of domestic violence as a &#x201c;hidden pandemic&#x201d; during the coronavirus disease 2019 crisis, drawing on perspectives from India and briefly reviewing the data from other nations. The role of mental health education and digital literacy as mitigating strategies is subsequently discussed.

“Crisis Within the Walls”: Rise of Intimate Partner Violence During the Pandemic, Indian Perspectives

Endometriosis affects 10% of women worldwide and is one of the most common causes of chronic pelvic pain and infertility. However, causal mechanisms of this disease remain unknown due to its heterogeneous presentation. In order to successfully study its phenotypic variation, large sample sizes are needed. Pooling of data across sites is not always feasible given the large variation in the complexity and quality of the data collected. The World Endometriosis Research Foundation (WERF) Endometriosis Phenome and Biobanking Harmonization Project (EPHect) have developed an endometriosis participant questionnaire (EPQ) to harmonize non-surgical clinical participant characteristic data relevant to endometriosis research, allowing for large-scale collaborations in English-speaking populations. Although the WERF EPHect EPQs have been translated into different languages, no study has examined the cross-cultural translation and adaptation for content and face validity. In order to investigate this, we followed the standard guidelines for cross-cultural adaptation and translation of the minimum version of the EPQ (EPQ-M) using 40 patients who underwent laparoscopic surgery in Turkey and 40 women in Northern Cyprus, aged between 18 and 55. We assessed the consistency by using cognitive testing and found the EPHect EPQ-M to be comprehensive, informative, and feasible in these two Turkish-speaking populations. The translated and adapted questionnaire was found to be epidemiologically robust, taking around 30–60 min to complete; furthermore, participants reported a similar understanding of the questions, showing that common perspectives were explored. Results from the cognitive testing process led to minor additions to some items such as further descriptive and/or visuals in order to clarify medical terminology. This paper illustrates the first successful cross-cultural translation and adaptation of the EPHect EPQ-M and should act as a tool to allow for further studies that wish to use this questionnaire in different languages. Standardized tools like this should be adopted by researchers worldwide to facilitate collaboration and aid in the design and conduction of global studies to ultimately help those affected by endometriosis and its associated symptoms.

Endometriosis affects 10% of women worldwide and is one of the most common causes of chronic pelvic pain and infertility. However, causal mechanisms of this disease remain unknown due to its heterogeneous presentation. In order to successfully study its phenotypic variation, large sample sizes are needed. Pooling of data across sites is not always feasible given the large variation in the complexity and quality of the data collected. The World Endometriosis Research Foundation (WERF) Endometriosis Phenome and Biobanking Harmonization Project (EPHect) have developed an endometriosis participant questionnaire (EPQ) to harmonize non-surgical clinical participant characteristic data relevant to endometriosis research, allowing for large-scale collaborations in English-speaking populations. Although the WERF EPHect EPQs have been translated into different languages, no study has examined the cross-cultural translation and adaptation for content and face validity. In order to investigate this, we followed the standard guidelines for cross-cultural adaptation and translation of the minimum version of the EPQ (EPQ-M) using 40 patients who underwent laparoscopic surgery in Turkey and 40 women in Northern Cyprus, aged between 18 and 55. We assessed the consistency by using cognitive testing and found the EPHect EPQ-M to be comprehensive, informative, and feasible in these two Turkish-speaking populations. The translated and adapted questionnaire was found to be epidemiologically robust, taking around 30&#x2013;60 min to complete; furthermore, participants reported a similar understanding of the questions, showing that common perspectives were explored. Results from the cognitive testing process led to minor additions to some items such as further descriptive and/or visuals in order to clarify medical terminology. This paper illustrates the first successful cross-cultural translation and adaptation of the EPHect EPQ-M and should act as a tool to allow for further studies that wish to use this questionnaire in different languages. Standardized tools like this should be adopted by researchers worldwide to facilitate collaboration and aid in the design and conduction of global studies to ultimately help those affected by endometriosis and its associated symptoms.

Protocol for the Cultural Translation and Adaptation of the World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project Endometriosis Participant Questionnaire (EPHect)