Maariyah Sajid Desai¹, Andrew Kumwenda²*
¹ University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia
² Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia

Corresponding author: Andrew Kumwenda

DOI: https://doi.org/10.55320/mjz.53.3.1166

Keywords: Polycystic Ovary Syndrome; Qualitative Research; Health Services Accessibility; Mental Health; Zambia; Health Knowledge, Attitudes, Practice; Infertility; Resource-Limited Settings.

Background

Polyendocrine metabolic ovarian syndrome (PMOS), the name adopted in 2026 for polycystic ovary syndrome (PCOS), affects an estimated 8–13% of women of reproductive age worldwide and carries substantial reproductive, metabolic and psychological burden. Despite its prevalence, PMOS remains underdiagnosed and inconsistently managed in low- and middle-income countries, with limited published evidence on care experiences in Zambia.

Methods

We conducted a qualitative study using purposive sampling across three facilities in Lusaka between January and April 2026. Semi-structured in-depth interviews were completed with 24 participants: 12 patients with a prior clinical diagnosis of PCOS/PMOS and 12 specialist obstetrician-gynaecologists. Data were analysed using reflexive thematic analysis, and reporting followed the Consolidated Criteria for Reporting Qualitative Research.

Results

Three themes were identified: structural and financial fractures in the care pathway; a cycle of diagnostic uncertainty associated with provider knowledge gaps, symptom-focused treatment and communication deficits; and a substantial psychosocial burden involving stigma, psychological distress and infertility-related fear, often met by patient self-reliance.

Conclusion

Participants described PMOS care in Lusaka as fragmented and under-resourced, with barriers across diagnosis, treatment and psychosocial support. Locally adapted clinical guidance, improved access to indicated investigations, strengthened primary-care training and routine mental health screening may improve care. Further research should evaluate the impact of these interventions on patient outcomes in Zambia.

Polyendocrine metabolic ovarian syndrome (PMOS), renamed from polycystic ovary syndrome (PCOS) in 2026 to reflect its broader polyendocrine manifestations,^[1] is a complex disorder affecting an estimated 8–13% of women of reproductive age worldwide.^[2] Despite its prevalence, PMOS is frequently underdiagnosed and undertreated, particularly in low- and middle-income countries, where population-based prevalence estimates of 8–19% contrast with health-system records capturing only 0.2–5% of cases.^[3] PMOS is characterised by irregular menstrual cycles, hyperandrogenism and polycystic ovarian morphology, and is associated with infertility, insulin resistance, type 2 diabetes, cardiovascular disease and psychological distress.^{[2] [4] [5]} These diagnostic and management challenges contribute substantially to impaired health and quality of life.^[6]

Globally, care has shifted towards multidisciplinary management that recognises PMOS as a lifelong reproductive, metabolic and psychological condition.^{[7] [8]} Such models remain inconsistently implemented in low- and middle-income settings.^[9] A structured search of PubMed and Google Scholar (April 2025; repeated July 2026) using combinations of 'polycystic ovary syndrome', 'PCOS', 'Zambia', 'diagnosis' and 'management' identified no published studies specifically addressing PCOS care in Zambia. Grey literature was reviewed through selected local institutional and Ministry of Health protocols; institutional repositories and conference proceedings were not systematically searched. PMOS is not specifically addressed in the reviewed University Teaching Hospitals obstetrics and gynaecology protocol^[10] or Ministry of Health clinical guidance,^[11] and international guidance has not been locally adapted or consistently implemented. Women may therefore experience delayed diagnosis, poor provider communication and limited lifestyle or emotional support.^[12]

This study explored patient and obstetrician-gynaecologist experiences of PMOS diagnosis and management across public and private facilities in Lusaka, Zambia. To the authors' knowledge, no prior published qualitative study has examined these perspectives in the Zambian context. Because data collection preceded the May 2026 renaming, the term PCOS is retained in participant quotations and in references to guidance published under the earlier name.

This study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ).^[13] See Appendix 1.

Study Design and Setting

This qualitative study used reflexive thematic analysis as described by Braun and Clarke^[14] to explore patient and obstetrician-gynaecologist experiences of PMOS diagnosis and management in Lusaka. It was conducted at three facilities: two public tertiary referral centres (Women and Newborn Hospital, University Teaching Hospitals, and Levy Mwanawasa University Teaching Hospital) and one private facility (Viva Med Hospital), allowing comparison across healthcare contexts.

Participants and Recruitment

Twenty-four participants were purposively recruited: 12 patients and 12 specialist obstetrician-gynaecologists with experience managing PCOS/PMOS. For eligibility, a prior diagnosis was defined as one assigned by a treating clinician; the research team did not independently verify Rotterdam or other diagnostic criteria. Six patients were identified through hospital records and six through clinic-based or online recruitment with self-reported prior clinical diagnoses. Formal documentation was not required from the latter group, but participants described the symptoms and investigations that led to their diagnoses during interview. Patients were aged 18 years or older and had accessed treatment within the preceding two years. Providers had completed obstetrics and gynaecology training and included junior and senior consultants. Patients were approached through clinics, WhatsApp and Instagram; providers were recruited through the Zambia Association of Gynaecologists and Obstetricians, private clinics and professional networks. Recruitment occurred from January to April 2026; interviews were conducted in March and April, before the global renaming of PCOS to PMOS in May 2026.^[1] Participants and interview guides therefore used PCOS throughout. All approached individuals consented and no refusals were recorded. Participants received K200 to reimburse time away from work and/or transport costs. Recruitment continued until analytic sufficiency was reached: no new codes emerged after approximately 8–9 provider and 10–12 patient interviews, assessed through ongoing comparison of codes. Provider recruitment continued slightly beyond this point to ensure private-sector representation.

Data Collection and Analysis

Semi-structured in-depth interviews were conducted using separate guides for patients and providers (Appendices 2–3). The guides were not formally piloted; the first interviews in each group served as a pretest of question clarity and flow. No changes were required, and these interviews were retained in the analysis.

The principal investigator (MD) conducted 11 interviews (5 patients and 6 providers). Two research assistants conducted the remainder: CL completed 7 interviews (4 patients and 3 providers) and MH completed 6 (3 patients and 3 providers). The research assistants were briefed on the interview guides, study objectives and consent procedures and had no role in transcription, coding or analysis. All interviews were conducted in English; no translation was required. Only the participant and interviewer were present, and no repeat interviews were conducted. Interviews lasted 11–32 minutes; 15 were conducted in person and 9 online. Data depth was comparable across modes, although online interviews limited the ability to offer in-person emotional support. Field notes were not taken because verbatim transcripts were the primary data source. Transcripts were not returned to participants, and member checking was not undertaken.

All interviews were audio-recorded with written and verbal consent. Verbatim transcripts were generated using Gemini Pro within a closed institutional Google Workspace environment and then reviewed and corrected against the original recordings by the principal investigator. Coding and thematic analysis were undertaken solely by the principal investigator.

Verified transcripts were imported into Dedoose and analysed using Braun and Clarke's six-phase reflexive thematic analysis: familiarisation, initial coding, development of candidate subthemes, review against the dataset, definition and naming of themes, and final write-up. Coding was primarily inductive and data-driven, although the interview guides were informed by existing literature and international guidelines. Both semantic and latent coding were used; latent interpretation was particularly relevant to cultural attribution and stigma. Three overarching themes were developed (Table 2). For example, the codes 'better perceived treatment/outcomes in private' and 'more investigations available in private' were grouped under the subtheme 'Public–Private Resource Disparities'. The supervisor reviewed the emerging thematic structure and agreed with the final organisation.

The principal investigator maintained reflexive awareness of her position as a female final-year medical student working within the same healthcare system. Several patients indicated that the interviews were the first time they had been asked directly about psychological and social dimensions of their condition; this may reflect the perceived safety of a non-treating, peer-adjacent interviewer. Providers were generally forthcoming, although visible hesitancy sometimes preceded responses about guideline awareness, potentially reflecting social desirability when discussing knowledge gaps with a medical trainee. These dynamics were considered throughout coding and interpretation.

Ethical Considerations

Ethical approval was granted by UNZASOMUREC (Ref. 75-12-2025) and the National Health Research Authority (Ref. NHRA11844/5/01/2026). Written and verbal informed consent was obtained from all participants. The participant information sheet stated that interviews would be transcribed verbatim and that voices would not be shared; it did not specify the transcription method because this operational decision was made after protocol approval. Transcription used Gemini Pro within a closed, non-training institutional Google Workspace environment. Audio files contained no participant names; incidental identifiers, including facility names, were removed during transcript verification. Access to audio and transcripts was restricted to the principal investigator, the environment administrator (JM) and the supervisor (AK). Audio recordings were permanently deleted after verification, administrative access was revoked once transcription support ended, and only coded, de-identified transcripts were retained for analysis. Patient and provider identifiers used PID and DID codes, respectively. Interviewers had foundational grounding in psychological first aid and patient-centred interviewing; on-site social worker and clinician support was available for hospital-based interviews if distress occurred, but no participant required escalation.

Participants comprised 12 obstetrician-gynaecologists with 1–37 years of experience and 12 patients aged 18–36 years. Three overarching themes and nine subthemes were identified.

Table 1: Participant characteristics

Table 2: Themes, subthemes and exemplar quotations

Theme 1: Structural and Financial Fractures in the Lusaka Care Pathway

1A. Public–Private Resource Disparities

Participants described differences in diagnostic and management capacity across sectors, although experiences were not uniformly negative. One patient attending a public facility with a dedicated weekly clinic day reported consistently feeling “helped” and “given the attention that I seek” (PID_008; patient, public facility, age 24–29).

More commonly, patients referred to private facilities for investigations described this as a barrier:

“They told me to get certain blood tests done which weren’t being offered at [public hospital]” (PID_004; patient, public facility, age 30–36).

Providers largely attributed these differences to resource availability rather than clinical judgement:

“The private sector may be better because they’re able to afford to investigate thoroughly...whilst for us we’ll use probably the clinical, the imaging” (DID_008; provider, public/private practice).

1B. Financial and Geographic Access Barriers

Cost and distance were distinct but compounding barriers. Investigations were often technically available but financially inaccessible:

“They are accessible, it’s just that they are expensive...most of the tests are usually not even funded by insurance” (PID_007; patient, public facility, age 18–23).

Providers described similar constraints in routine work-up:

“In the private sector there is no problem, but in the public sector, it can be a bit of a challenge because some of the tests are very expensive” (DID_006; provider, public/private practice).

Distance created an additional barrier:

“Distance was one of them because [public hospital] was quite far to where I am located” (PID_008; patient, public facility, age 24–29).

Providers suggested that geographic barriers extended beyond Lusaka:

“If you leave Lusaka right now and go to Eastern Province, from Chipata to the next specialist is almost 400 to 500 kilometers” (DID_012; provider, public/private practice).

1C. Workforce Limitations and Calls for System Reform

Limited specialist availability further constrained access:

“In terms of endocrinologists, if memory serves me correctly, I think we just have about two in Lusaka” (DID_011; provider, public facility).

Some patients described a prolonged search for clinicians who understood the condition:

“Not readily available because it took time for me to see one and these others mostly those that are general they would have their own assumptions but the gynae actually knew what he was talking about” (PID_007; patient, public facility, age 18–23).

Patients and providers converged on the need for more standardised care:

“We need to get to a place where we have national guidelines for PCOS. That way we will then be speaking the same language” (DID_007; provider, public/private practice).

“I don’t know if there is any specialist in our city or in our country who focuses only on PCOS or any hormonal issues...I want there to be at least a specialist in our country or in our city where people can go and atleast they can get the care that they deserve.” (PID_014; patient, public facility, age 24–29).

Together, these accounts suggest that resource constraints, cost and distance can fragment the care pathway, while workforce shortages and limited condition-specific expertise increase reliance on structural solutions such as national guidance and specialist referral pathways.

Theme 2: Clinical Practice Gaps and the Cycle of Diagnostic Uncertainty

2A. Diagnostic Delay and Provider Knowledge Gaps

Diagnostic delay was among the most consistently reported patient experiences:

“We just kept going until I went to a GP in Lusaka...he said, ‘Go for now, come back after two weeks. I need to do some research.’ He diagnosed me officially, I think five years after I got my first initial period” (PID_011; patient, private facility, age 30–36).

Providers independently identified limited recognition of the clinical presentation as a contributor:

“The biggest gap is maybe late diagnosis, which may be due to a lack of knowledge or not understanding the clinical presentation” (DID_016; provider, public facility).

2B. Symptomatic Treatment and Neglect of Holistic/Mental Health Care

Providers linked limited condition-specific knowledge to narrow, symptom-focused management:

“It’s mainly knowledge with the physicians providing the management. We don’t have many people who have taken special interest in PCOS to be specific” (DID_011; provider, public facility).

Patients described the consequences when their presentation did not fit perceived standard patterns:

“I felt like they were gaslighting me into feeling like I have insulin resistance, but I didn’t have any symptoms of insulin resistance. I just wanted somebody to sit and actually hear what my experience is so they can give me management according to what my experience is, not according to what is in the textbooks” (PID_006; patient, private facility, age 24–29).

Mental health assessment was also described as largely reactive:

“I would be lying if I said I actively do it personally...I don’t go so much into the mental health of these patients” (DID_002; provider, public facility).

2C. Patient–Provider Communication and Satisfaction

Communication quality appeared closely related to patient satisfaction. One patient described feeling well guided:

“I’m very satisfied because they really guide you. They tell you what to do...they ask you questions before you take each step” (PID_002; patient, public facility, age 18–23).

Other patients described rushed or incomplete explanations:

“It was confusing. They just said that there are cysts and stuff on the ovaries...they didn’t explain further in-depth” (PID_012; patient, private facility, age 18–23).

Providers linked this to service pressure:

“Because of the patient load in our outpatient clinics, you tend to quickly review patients, so sometimes the balance is not so good” (DID_002; provider, public facility).

These accounts suggest a cycle in which delayed recognition and symptom-focused management may leave limited time for the explanations and shared decision-making patients described as important.

Theme 3: The Psychosocial Burden and the Emergence of Patient Resilience

3A. Cultural Context, Gender Norms and Stigma

Participants described stigma arising from moral or behavioural interpretations of symptoms, particularly weight gain:

“They view it as you’re not a healthy person, you eat junk all the time...it’s just we live a very unhealthy lifestyle” (PID_012; patient, private facility, age 18–23).

One patient linked this directly to family judgement:

“Mostly they think that it’s because of the eating habit...they just look down upon you a lot if you are not conceiving at the right time” (PID_014; patient, private facility, age 24–29).

Infertility and pregnancy loss could intensify stigma and intersect with traditional beliefs:

“By the time I was having my multiple miscarriages, they would say negative things...people will stop coming to your house” (PID_003; patient, public facility, age 30–36).

Provider views were mixed. Some rejected a meaningful cultural influence:

“Not really” (DID_003; provider, public facility).

Others recognised that cultural beliefs could shape symptom interpretation and clinical encounters:

“Cultural beliefs regarding management such as weight loss” (DID_016; provider, public facility).

3B. Psychological Burden and Illness Perception

Psychological distress was frequently linked to fears about fertility:

“It was traumatizing the first time because these symptoms might lead to infertility...I was crying and telling my dad and mom what the doctor said —that I’m not going to have kids.” (PID_015; patient, public facility, age 30–36).

Providers recognised this burden even when formal screening was not routine:

“Some of them do have some mental issues. I mean depression or low self-esteem because of obesity, infertility, and all this” (DID_014; provider, private facility).

3C. Patient Coping and Self-Management

In the absence of structured guidance, some patients described relying on their own knowledge:

“I wasn’t told that I need to do this or that diet or exercise. Everything came from my own knowledge” (PID_013; patient, private facility, age 18–23).

Providers suggested that access to self-directed information varied by setting:

“Patient awareness of the condition is high in the private sector. People Google and read...But in the public sector, especially rural places, people don’t have access to such information” (DID_012; provider, public/private practice).

These accounts suggest that stigma and psychological distress may drive some patients towards independent, often unguided self-management when formal support is limited.

This study explored patient and obstetrician-gynaecologist experiences of PMOS care across public and private facilities in Lusaka. Three themes were identified: structural and financial fractures in the care pathway, a cycle of diagnostic uncertainty associated with clinical knowledge gaps, and a substantial psychosocial burden often met by patient self-reliance. Providers also expressed support for structured training and locally adapted guidance.

The findings broadly align with reports from sub-Saharan Africa. Diagnostic delay and provider knowledge gaps mirror findings from Uganda and Ethiopia.^{[15] [16]} Financial barriers to investigation and treatment are also reported in resource-limited settings.^{[15] [17] [18]} The public–private disparities described here are consistent with wider inequalities in Zambian healthcare delivery.^[19] Delayed diagnosis, insufficient information and feeling dismissed have been associated with dissatisfaction among women with PCOS.^{[12] [20]} The psychosocial burden of anxiety, low mood and infertility-related stigma is consistent with African infertility literature,^[21] while reliance on internet-based self-management reflects evidence that many women with PCOS obtain lifestyle information outside clinical services.^[22]

Notable differences also emerged. Positive experiences within a structured public clinic suggest that organisation of care, not sector alone, may influence patient experience.^[19] Patient and provider accounts independently converged on similar barriers, strengthening the credibility of the thematic interpretation. The apparent absence of locally adapted PMOS guidance in the reviewed Zambian protocols is therefore an actionable finding, although broader document review would be needed to establish this nationally.^[17]

The convergence of perspectives suggests that the observed gaps may reflect broader system-level problems rather than isolated experiences. International guidance distinguishes tests used to assess biochemical hyperandrogenism or exclude mimicking conditions, such as thyroid disease and hyperprolactinaemia, from metabolic risk assessment after diagnosis, including a 75-g oral glucose tolerance test, lipid profile and blood pressure. Ultrasound and hormonal testing are not required for diagnosis when irregular cycles and clinical hyperandrogenism are both present. Expansion of National Health Insurance Management Authority (NHIMA) coverage should therefore prioritise guideline-defined diagnostic and risk-assessment tests rather than indiscriminate hormonal profiling.

These findings also map onto the 2023 international evidence-based guideline, which frames PCOS/PMOS management across reproductive, metabolic, cardiovascular, dermatological, sleep-related and psychological domains and recommends routine screening for depression and anxiety with appropriate psychological support.^[8] Against this standard, limited mental health screening represents an important evidence–practice gap. The guideline's emphasis on culturally responsive education, equitable primary-care access with defined escalation pathways, and shared decision-making provides a useful framework for local service improvement.

Potential actions include incorporating PMOS into the Zambia Standard Treatment Guidelines and relevant institutional obstetrics and gynaecology protocols; developing simple primary-care algorithms for irregular cycles, hyperandrogenism and infertility with clear referral pathways to gynaecology, endocrinology, nutrition and mental health services; improving affordable access to oral glucose tolerance testing, lipid profiling, targeted androgen testing and ultrasound where indicated; embedding brief mental health screening tools such as PHQ-9²³ and GAD-7²⁴ in gynaecology and infertility services; developing patient education materials in English and local languages; and using the Zambia Association of Gynaecologists and Obstetricians and continuing professional development channels to address provider knowledge gaps.

Strengths include the inclusion of both patient and provider perspectives and a multicentre design spanning public and private facilities. Convergence across participant groups enhanced the credibility of the findings.

Because the study was confined to Lusaka, future research should examine rural and peri-urban settings, where barriers may differ. Quantitative studies and intervention research should evaluate the effects of primary-care training, structured screening and context-specific guideline implementation on diagnostic timeliness and patient outcomes.

Participants described a fragmented, resource-constrained PMOS care pathway in Lusaka, characterised by diagnostic delay, knowledge gaps, financial barriers and limited psychosocial support. Convergence between patient and provider accounts supports the interpretation that these challenges may reflect broader system-level factors. The findings support consideration of locally adapted clinical guidance, improved access to guideline-defined investigations, targeted primary-care training and routine mental health screening. The 2026 renaming of PCOS to PMOS provides a timely opportunity to strengthen recognition of the condition’s reproductive, metabolic and psychological dimensions. Further research should evaluate whether these interventions improve diagnostic timeliness and patient outcomes in Zambia.

Limitations

The qualitative design does not permit statistical generalisation or causal inference. The purposive sample comprised 24 participants from three Lusaka facilities, limiting transferability to rural and peri-urban settings. Social desirability bias is possible; the interview guides were not formally piloted, field notes were not taken and member checking was not undertaken. Coding and thematic analysis were conducted by the principal investigator; although compatible with reflexive thematic analysis, this places particular importance on transparent reflexivity and may have shaped theme development. Six patient diagnoses were identified through hospital records and six were based on self-report of a prior clinical diagnosis; none was independently verified against Rotterdam or other diagnostic criteria, introducing potential diagnostic heterogeneity. No formal subgroup comparison between record-identified and self-reported participants was undertaken.

What is already known on this topic

• PMOS (formerly PCOS) affects approximately 1 in 8 women of reproductive age worldwide and carries reproductive, metabolic and psychological burden across the lifespan.

• Underdiagnosis, limited specialist availability and fragmented care are reported in resource-limited settings.

• PMOS is not specifically addressed in the reviewed University Teaching Hospitals and Ministry of Health clinical protocols.

What this study adds

• This study provides locally grounded qualitative evidence on PMOS/PCOS care experiences from both patients and obstetrician-gynaecologists in Lusaka, Zambia.

• Patients and providers independently described convergent barriers—including diagnostic delay, cost-related gaps in testing and limited mental health screening—suggesting that these may reflect structural rather than isolated problems.

• The findings identify actionable priorities for locally adapted guidance, provider training, improved diagnostic access and psychosocial support.

Acknowledgements

The authors thank all study participants for their time and willingness to share their experiences. OneDay Africa and YES Zambia provided financial support for the study; no further role of the funders was reported in the submitted materials. The authors thank Dr Mwansa Lubeya for support through the grant committee. Champo Luswili and Mainza Hanene assisted with data collection, and John Mwiinga provided technical support for the interview-transcription infrastructure. The authors also thank their families, friends and colleagues for their support.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

MD conceptualised and designed the study, obtained ethical approvals, verified transcripts, conducted coding and thematic analysis, interpreted the findings and drafted the manuscript. AK supervised the study and critically revised the manuscript for important intellectual content. Both authors read and approved the final manuscript.

Purpose: To explore patient experiences with PCOS diagnosis, treatment, lifestyle advice, and challenges, including satisfaction and cultural barriers.

Target: 10–15 women aged 18+ diagnosed with PCOS, until thematic saturation reached.

Duration: 30–45 minutes per interview, conducted in-person or via phone, preferably in a private, comfortable setting.

Format: Semi-structured with open-ended questions and probes to encourage detailed narratives.

Cultural Considerations: Questions address stigma (e.g., infertility, hirsutism) sensitively, with translations into Bemba or Nyanja if needed. Offer psychosocial support referrals for distress.

Instructions for Interviewer

• Build rapport by explaining the study’s purpose and ensuring confidentiality.

• Use a conversational tone, allowing participants to share freely.

• Record interviews (with consent) and take notes for accuracy.

• Be sensitive to emotional topics (e.g., infertility stigma) and provide referral options if distress arises.

• Use probes (e.g., “Can you tell me more?”) to deepen responses.

Interview Questions

1. Diagnosis Experience

○ Can you describe your journey to getting a PCOS diagnosis? What symptoms first led you to seek help?

Probe: How did your healthcare provider explain PCOS to you? What was helpful or confusing?

○ How long did it take to get diagnosed, and what challenges did you face during this process?

Probe: Were tests like blood work or ultrasound used? Were they easy to access?

2. Treatment and Lifestyle Advice

○ What treatments or advice (e.g., diet, exercise, medications) were you given for PCOS?

Probe: How practical or affordable was this advice for you?

○ Were you referred to specialists like dietitians or counselors? If not, would that have helped?

Probe: What barriers (e.g., cost, distance, availability) affected your ability to follow treatment?

3. Satisfaction with Care

○ How satisfied are you with the care you’ve received for PCOS? Why? Probe: Did you feel listened to or supported by your healthcare provider?

○ How does care differ between public and private hospitals or clinics you’ve visited?

Probe: Were there differences in communication, resources, or wait times?

4. Emotional and Social Impact

○ How has PCOS affected your emotional well-being or social life?

Probe: Have you experienced feelings of anxiety, depression, or low self-esteem?

○ Have you faced stigma or judgment in your community because of PCOS symptoms (e.g., infertility, excess hair)?

Probe: Can you share an example? How did it make you feel?

5 . Cultural and Systemic Barriers

○ What cultural beliefs or community attitudes in Zambia have influenced your experience with PCOS?

Probe: For example, how do people view infertility or weight gain in your community?

○ What challenges have you faced in accessing PCOS care in Lusaka? Probe: Think about costs, specialist availability, or transportation.

6. Suggestions for Improvement

○ What changes would improve PCOS care for women in Zambia?

Probe: For example, better education, more specialists, or support groups?

○ Is there anything else you’d like to share about your experience with PCOS or healthcare in Zambia?

Post-Interview

• Thank the participant and confirm how they prefer to receive study updates (if applicable).

• Offer a referral to psychosocial support if distress was observed.

• Note any non-verbal cues (e.g., discomfort) for analysis.

Purpose: To explore obstetrician-gynaecologists’ knowledge, guideline adherence, challenges, openness to updates, and public/private differences, with specific focus on patient-centred versus symptom-focused care, weight-loss advice, specialist referrals, and mental health awareness.

Target: 10–15 obstetrician-gynaecologists, until thematic saturation was reached.

Duration: 20–30 minutes per interview, conducted in-person or via phone in a professional setting.

Format: Semi-structured with open-ended questions and probes for detailed insights.

Cultural Considerations: Questions account for Zambia’s resource constraints and training gaps, avoiding judgment about practices.

Instructions for Interviewer

• Explain the study’s purpose and assure confidentiality to encourage honest responses.

• Use a neutral, conversational tone and avoid leading questions.

• Record interviews (with consent) and take notes for accuracy.

• Be mindful of time constraints due to doctors’ schedules.

Interview Questions

1. Knowledge of PCOS and Mental Health

○ How would you describe your understanding of PCOS and its complications, including mental health issues like anxiety or depression?

Probe: How common are mental health concerns among your PCOS patients? Do you actively screen for them?

○ Are you familiar with the Rotterdam criteria for diagnosing PCOS? How do you apply them in your practice?

Probe: Are there challenges in using these criteria in Zambia?

2 . Guideline Adherence and Treatment Approach

○ Are you aware of the 2018 or 2023 International Evidence-Based PCOS Guidelines? How do they influence your practice?

Probe: Which aspects (e.g., diagnosis, mental health management) are hardest to implement?

○ Do you focus more on treating specific PCOS symptoms (e.g., irregular periods, hirsutism) or the patient’s overall health (e.g., metabolic, psychological)? Why? Probe: How do you balance symptom management with holistic care in your setting?

3 . Weight Loss Advice

○ What specific weight loss advice do you give to PCOS patients?

Probe: Do you recommend particular diets (e.g., low-carb) or exercise plans? How do you tailor this to patients’ resources or lifestyles?

○ How effective do you think your weight loss advice is for PCOS patients? Probe: What challenges do patients face in following this advice in Zambia?

4 . Specialist Referrals

○ How often do you refer PCOS patients to specialists like nutritionists, endocrinologists, or psychologists?

Probe: What factors influence your decision to refer or not (e.g., availability, cost)?

○ Are there enough nutritionists, endocrinologists, or psychologists in Lusaka to support PCOS care?

Probe: How does this differ between public and private settings?

5. Challenges in PCOS Care

○ What challenges do you face in diagnosing PCOS in Lusaka?

Probe: Are diagnostic tools like ultrasound or hormonal assays readily available?

○ What barriers do you encounter in managing PCOS, particularly for mental health or lifestyle interventions?

Probe: How do patient adherence, cultural beliefs, or resource constraints play a role?

6. Public vs. Private Sector

○ How does PCOS care differ between public and private healthcare settings in your experience?

Probe: Are there differences in resources, patient outcomes, or time for holistic care?

○ What systemic factors in Zambia’s healthcare system impact PCOS care? Probe: For example, training, funding, or patient awareness.

7. Openness to Updated Guidelines

○ How open are you to adopting new PCOS management guidelines, especially for mental health or multidisciplinary care?

Probe: What would make it easier to implement these guidelines?

○ Would you be interested in training on PCOS, including mental health management or lifestyle interventions? If so, what kind?

Probe: For example, workshops, online courses, or specialist collaboration.

8. General Reflections

○ What do you think are the biggest gaps in PCOS care in Zambia, especially for patient-centered care or mental health?

Probe: How could these gaps be addressed in public and private settings?

○ Is there anything else you’d like to share about your experience managing PCOS?

Post-Interview

• Thank the provider and confirm how they prefer to receive study updates (if applicable).
• Note any contextual factors (e.g., interruptions, time constraints) for analysis.

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Medical Journal of Zambia, Vol 53, 3

The Medical Journal of Zambia, ISSN 0047-651X, is published by the Zambia Medical Association.
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