Shannon Leung’s research while affiliated with University of Toronto and other places

Objective To assess the awareness, knowledge, and misconceptions of young people regarding long-acting reversible contraceptives (LARCs). Design We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of MEDLINE-Ovid, Embase, and Cumulative Index to Nursing and Allied Health Literature. A random-effects meta-analysis was performed with formal tests for heterogeneity and publication bias. Additional outcomes were summarized using thematic analysis. Setting Not applicable. Patient(s) Adolescents and young adults (aged 12–25 years) with a uterus. Intervention(s) Not applicable. Main Outcome Measure(s) Patient-reported outcomes related to awareness, knowledge, and misconceptions of LARCs (including intrauterine devices, subdermal implants, and injections) were analyzed. Result(s) Of the 4,077 database citations, we included 40 studies encompassing 10,470 adolescents and young people. Twenty studies were eligible for meta-analysis. The pooled prevalence described that only 65.0% (95% confidence interval [CI], 51–78) of participants were aware of at least 1 type of LARC (I² = 100). The meta-regression noted that the region, risk of bias, gravidity, sexual history, previous LARC experience, and postsecondary education were not associated with awareness. There were numerous misconceptions regarding eligibility, safety, and usage. Notably, 62% (95% CI, 20–91) did not understand that LARCs could be used in nulliparous individuals, and 37% (95% CI, 21–56) believed that LARCs could cause infertility. Conclusion(s) There are notable knowledge gaps among adolescents and young people regarding LARCs, such as eligibility criteria, the reversibility of long-acting options, and misconceptions regarding infertility. Clinicians should specifically counsel regarding the suitability for LARCs in nulliparous populations and that LARCs do not cause infertility.

Background: Incarcerated individuals that experience pregnancy or childbirth in correctional facilities face unique considerations for obstetrical care and consequently are at greater risk of adverse maternal and fetal outcomes. Objectives: To characterize patient experiences regarding pregnancy and childbirth during incarceration via qualitative synthesis. Search strategy: Medline-OVID, EMBASE, CINAHL, Sociological Abstracts, Social Work Abstracts, Web of Science, Scopus, and PsycInfo were systematically searched from inception to December 24, 2020. Supplementary searches were done using the Scopus database. Selection criteria: Only original, peer-reviewed literature was examined. Eligible studies were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Results: After screening 4173 original database citations, 24 studies that met inclusion criteria were included and analyzed via thematic analysis. The 24 studies included perspectives from 645 female patients who had experienced incarceration, 69 healthcare providers, and 70 prison staff. Key patient-reported concerns for the well-being of pregnant individuals during incarceration included mental health challenges, dehumanization of prenatal care and delivery, lack of privacy, stigma, lack of emotional support, and shackle usage during pregnancy and labour. The studies reported a lack of support for patients to access female correctional officers or guards, timely medical care, and support for breastfeeding. Above all, the trauma of separation from one's newborn after birth was of utmost devastation for pregnant individuals during incarceration. Conclusions: Our systematic review highlights the dire need for accountability and interventions in order to improve pregnancy and childbirth care for incarcerated individuals.

Background: There is concern regarding the psychological impact of the perinatal period on LGBTQ2S+ childbearing individuals. Objectives: To characterize and synthesize the experiences of LGBTQ2S+ childbearing individuals regarding perinatal mental health, including symptomatology, access to care, and care-seeking. Search strategy: We conducted and reported a systematic review following PRISMA guidelines of eight databases (EMBASE, Medline-OVID, CINAHL, Scopus, Web of Science: Core Collection, Sociological Abstracts, Social Work Abstract, and PsycINFO) from inception to March 1st, 2021. Selection criteria: Original, peer-reviewed research related to LGBTQ2S+ mental health was eligible for inclusion if the study was specific to the perinatal period (defined as pregnancy planning, conception, pregnancy, childbirth, and first year postpartum; includes miscarriages, fertility treatments, and surrogacy). Data collection and analysis: Findings were synthesized qualitatively via meta-aggregation using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI), and the ConQual approach. Main results: Our systematic search included 26 eligible studies encompassing 1199 LGBTQ2S+ childbearing participants. Using the JBI SUMARI approach, we reported 65 results, which we synthesized as six key findings. The studies described unique considerations for LGBTQ2S+ individuals' perinatal mental health, including heteronormativity, cisnormativity, isolation, and distressing situations from the gendered nature of pregnancy. LGBTQ2S+ childbearing individuals described barriers to accessing mental healthcare, and gaps in health systems. Strategies to improve care include avoidance of gendered language, documentation of correct pronouns, cultural humility training, and tailored care. Conclusions: There are unique considerations for LGBTQ2S+ childbearing individuals during the perinatal period and providers should implement the identified strategies to improve perinatal care.

Background Though cervical cancer is one of the leading causes of cancer-related death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening as this population has historically been under-screened. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines. The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening (CCS) among adolescents and young people globally. Methods We conducted a systematic review following PRISMA guidelines of three key databases: Medline-OVID, EMBASE, and CINAHL. Supplementary searches were done through ClinicialTrials.Gov and Scopus. Databases were examined from 1946 until the date of our literature searches on March 12th 2020. We only examined original, peer-reviewed literature. Articles were excluded if they did not specifically discuss CCS, were not specific to individuals under the age of 35, or did not report outcomes or evaluation. All screening, extraction, and synthesis was completed in duplicate with two independent reviewers. Outcomes were summarized descriptively. Risk of bias for individual studies was graded using an adapted rating scale based on the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Results Of the 2177 original database citations, we included 36 studies that met inclusion criteria. The 36 studies included a total of 14,362 participants, and around half (17/36, 47.2%) of studies specifically targeted students. The majority of studies (31/36, 86.1%) discussed barriers and facilitators to Pap testing specifically, while one study analyzed self-sampling (1/36, 2.8%), one study targeted HPV DNA testing (1/36, 2.8%), and the remainder (4/36, 11.1%) were not specified. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and systemic barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. Conclusion There are unique barriers and facilitators that affect CCS rates in adolescents and young people. Health systems and healthcare providers worldwide should address the challenges for this unique population.

Background Though cervical cancer is one of the leading causes of death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines and in many countries, screening rates for this age-group have even dropped. Objectives The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening among young people globally. Search Strategy We conducted a systematic review following PRISMA guidelines of four databases: Medline-OVID, EMBASE, CINAHL, and ClinicalTrials.Gov. Selection Criteria We only examined original, peer-reviewed literature. Databases were examined from inception until the date of our literature searches (12/03/2020). Articles were excluded if they did not specifically discuss cervical cancer screening, were not specific to young people, or did not report outcomes or evaluation. Data Collection and Analysis All screening and extraction was completed in duplicate with two independent reviewers. Main Results Of the 2177 original database citations, we included 36 studies that met inclusion criteria. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and practical barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. Conclusions Health systems worldwide should address the barriers and facilitators to increase cervical cancer screening rates in young people. Further research is required to understand this age group.

Objective To characterize the patient and provider perspectives on cultural competence in lesbian, gay, bisexual, transgender, and queer (LGBTQ+) fertility care. Design Systematic review. Setting Not applicable. Patient(s) LGBTQ+ patients and their partners treated for fertility-related care; fertility providers who treat LGBTQ+ patients. Intervention(s) We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines of six databases: Medline-OVID, EMBASE, CINAHL, Cochrane Library, ClinicalTrials.Gov, and PsycInfo. Citations of full-text articles were hand-searched using the Scopus database. Eligible studies were assessed using the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices, as well as the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. All screening, extraction, and appraisal were completed in duplicate with two independent reviewers. Main Outcome Measure(s) Patient-reported or provider-reported views on LGBTQ+ cultural competence in fertility care, including barriers and facilitators to inclusive care. Result(s) Of the 1,747 original database citations, we included 25 studies that met the inclusion criteria. Of the 21 studies that evaluated patient perspectives, 13 studies targeted same-sex cisgender couples while the remainder targeted transgender and gender-nonconforming participants (n = 6) or any individual who identified as a sexual or gender minority (n = 2). Key barriers for LGBTQ+ participants included gender dysphoria, heteronormativity, stigmatization, and psychological distress. The lack of tailored information for LGBTQ+ populations was repeatedly highlighted as a concern. Promising solutions included tailored information, psychosocial interventions, gender-neutral language, and inclusive intake processes. Conclusion(s) LGBTQ+ individuals face unique barriers in fertility care, as described by both patients and providers. This review describes a number of implementable solutions for equitable care, which should be given priority for both research and hospital interventions.

Objective To characterize the patient-reported barriers to equitable fertility care for racial/ethnic minority groups Evidence Review We conducted a systematic review following PRISMA guidelines of six databases: Medline-OVID, EMBASE, CINAHL, Cochrane Library, ClinicalTrials.Gov, and PsycInfo. Citations of full-text articles were also hand-searched using the Scopus database. Original research was eligible for inclusion if the study reported patient-reported outcomes regarding racial equity or cultural competence in fertility care. All racial and ethnic minority groups, including Black, Hispanic, South/East Asian, Pacific Islander, and Indigenous groups were eligible for inclusion. All screening, extraction, and appraisal was completed in duplicate with two independent reviewers. The Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices, as well as the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, were used to risk of bias and methodological quality. Results Of the 2921 original database citations, we included 17 studies that encompassed 3743 patients from racial/ethnic minority as well as immigrant/refugee groups. Key patient-reported barriers included stigmatizing cultural beliefs, low fertility knowledge, language barriers, discrimination, and lack of institutional trust. Options for culturally competent care included multilingual services, physicians of diverse backgrounds, incorporation of traditional healers, awareness of religious beliefs, and screening for psychosocial services. Conclusions This review describes a number of implementable solutions for equitable fertility care, which should be given priority for both research and hospital interventions.

Background Though cervical cancer is one of the leading causes of death globally, its incidence is nearly entirely preventable. Young women have been an international priority for screening. However, in both high-income and low-income countries, young women have not been screened appropriately according to country-specific guidelines. The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening among young women globally. Methods We conducted a systematic review following PRISMA guidelines of four databases: Medline-OVID, EMBASE, CINAHL, and ClinicalTrials.Gov. Databases were examined from inception until the date of our literature searches (12/03/2020). We only examined original, peer-reviewed literature. Articles were excluded if they did not specifically discuss cervical cancer screening, were not specific to young women, or did not report outcomes or evaluation. All screening, extraction, and synthesis was completed in duplicate with two independent reviewers. Outcomes were summarized descriptively. Risk of bias for individual studies was graded using an adapted rating scale based on the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Results Of the 2177 original database citations, we included 36 studies that met inclusion criteria. Our systematic review found that there are three large categories of barriers for young women: lack of knowledge/awareness, negative perceptions of the test, and practical barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. Conclusions There are unique barriers and facilitators that affect cervical cancer screening rates in young women. Health systems worldwide should address the challenges for this population.