Enabling Self-Care for Pessary Users in Rural Setting

Patient reported Visual Analogue Score for (0-100mm) for satisfaction of prolapse management.

modified Patient Experience with Treatment and Self-Management Questionnaire. This is a 41-item questionnaire that is validated for patient experience with treatment and self-management of diseases as a measure of treatment burden. The questionnaire has been shortened from the original 48-item questionnaire in the original study by Eton et al and it has been slightly modified to address how prolapse and pessary care impacts treatment burden. Minimum value = 41, Maximum value = 205. Higher PETS scores are associated with greater treatment burden, with more distress, less satisfaction with medications, lower self-efficacy, worse physical and mental health, and lower convenience of healthcare.

Patient Experience with Pessary Treatment and Self-Management Questionnaire. This is a non-validated 11-item questionnaire that is focused on factual information regarding patient's care of their prolapse, including how long they have used a pessary, if they have cared for it themselves, how far they travel for care, how often they have their pessary checked by a practitioner. There are a few individual scaled questions with Likert responses, regarding discomfort of pessary removal and reinsertion (0-4, with the highest score being the worst outcome, "very uncomfortable"); bother of care for the pessary (0-5, the highest score being the worst outcome, "very bothersome"); interest in taking care of the pessary (0-5, the highest score being the worst outcome, "not interested at all". There is one visual analogue score (minimum 0, maximum 10) on how bothersome it is to have to travel for office care several times per year.

Pelvic Floor Impact Questionnaire - 7. This is a validated 7-item questionnaire that assesses treatment on pelvic floor impact for urinary symptoms, prolapse symptoms and colorectal symptoms. Each of the seven questions for each symptom category (bladder, prolapse, rectal) has a scale of 0-3, with higher scores being worse. The total PFIQ-7 score range is 0-300, with the higher score being worse. It has been used in many studies on prolapse, including preliminary studies on the Reia pessary.

This is a non-validated 8-item questionnaire on sexual activity for subjects and whether the pessary impacts ability to be sexually active. Most questions are informational yes/no responses. The last question is a Likert scale [0-3] regarding how much the current pessary interferes with being able to be sexually active, with 3 being worse, "interferes a lot".

Patient Global Impression of Improvement: Validated one-item questionnaire (Likert scale, 1-7); The highest score is a worse outcome.

Patient Global Impression of Severity: Validated one-item assessment of severity of prolapse condition (Likert scale, 1-4). The highest score is a worse outcome.

Patient Global Symptoms Rating Scale (PGSC): Non-validated one-item questionnaire of treatment and adequacy of control of symptoms (Likert scale, 1-5); The highest score is a better outcome.

Adverse events will be collected, including discharge, bleeding, pain during the course of the study in both the intervention group and the continued office-based care group. There is not a maximum number of adverse events but a The highest number is a worse outcome.

Patients who decide to learn self-management of their pessary will record the number of times they remove and reinsert the pessary.