Access to and utilisation of sexual and reproductive healthcare for women and girls with cerebral palsy: a scoping review

Figures & data

Table 1. Thematic chart.

Individual	Micro-system (Family, School and Friends)	Exo-system (Services)	Macro-system (Social processes, Attitudes and Culture)
Physical	Physical	Physical	Physical
Type of CP and its physical impacts Accelerated ageing effects (decline in mobility and functionality)	Managing transitions (menarche, pregnancy and menopause) Contraception and menstruation management	Reasonable adjustments to equipment and physical environment Transitions in care (between paediatric and adult healthcare) Availability of specialist information and services for women with CP	Structural barriers
Psychosocial	Psychosocial	Psychosocial	Psychosocial
Own knowledge and awareness of CP effects in adulthood Changes in identity, psychosocial impacts of ageing with CP	Limited discussion about sexual and reproductive health between teenage girls and parents	Attitudes of HCPs HCP knowledge of CP in adulthood Limited sexual and reproductive health education (in school or home), encompassing: a) Methods of birth control; b) Sexual transmitted diseases; c) Sexual violence Communication barriers between HCPs and patients with CP and speech impairment Training for healthcare staff on communicating with patients with speech impairments	Cultural attitudes and perceptions of being a-sexual

Figure 1. Preferred reporting items for systematic reviews and metaanalyses (PRISMA) flow diagram.

Figure 2. The socio-ecological model used for the review.

Table 2. Patterning chart.

Authors		Balandin et al. (2007)	Flavin et al. (2019)	Fowler ret al (2015)	Gray et al. (2017)	Hammar et al. (2009)	Hayward et al. (2017)	Morgan, Pogrebnoy, and McDonald (2014)	Mudge et al. (2016)	Nandam et al. (2018)	Sundelin et al. (2020)	Turk et al. (2001)	Zacharin, Savasi, and Grover (2010)
Individual Physical	Type of CP and its physical impacts			X									X
	Accelerated ageing							X	X			X
Individual Psychosocial	Own knowledge and awareness of CP effects in adulthood								X
	Changes in identity/ psychosocial effects of ageing							X	X
Micro-physical	Managing transitions (menarche, pregnancy and menopause)						X
	Knowledge of CP in adulthood							X	X	X
	HCP knowledge and understanding of CP effects vs SRH		X				X				X		X
	Limited SRH education (in school or home)		X
	Communication barriers between HCPs and patients with CP	X
	Training for nurses and healthcare staff	X
Macro-physical	Structural barriers									X
Macro-psychosocial	Cultural attitudes -perceptions of being a-sexual				X		X

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