This study was informed by the biopsychosocial model developed by George L. Engel, which indicates that the cause, manifestation and outcome of wellness are determined by interactions between biological, psychological and social factors (Pereboom et al. 2023). Bolton and Gillert (2019) recommend that health care professionals should be cognisant of these three factors as they align with the rationale of multi-disciplinary teams and increasing recognition of the value of women’s views in providing good and effective health care. An inductive approach was used to describe the psychosocial needs of women undergoing intimate examinations (Ravi et al. 2024). The purpose of this model is to make midwives and health care professionals understand that in a pregnant woman, not only the biological factors but also the psychological and social factors should be considered, as they can influence the execution of intimate examinations (Shabot 2021) (see Figure 1).

The study was qualitative, exploratory and contextual in nature. An exploratory design was used to explore the psychosocial needs of women who underwent perinatal intimate examinations. The researcher explored a phenomenon using qualitative research methodology, as it is an approach for exploring and understanding the meaning that individuals or groups assign to a social or human problem. Furthermore, the study aimed to explore the phenomena from the viewpoint of the participants as they have experienced intimate examinations during their perinatal period. The exploratory nature of this study facilitated the researchers’ attainment of comprehensive insights and a profound understanding of the psychosocial needs of women. The design utilised the biopsychosocial model, which was proposed by George L. Engel, to explore the psychosocial needs of women during perinatal intimate examinations. The model indicates that the cause, manifestation and outcome of wellness are determined by interactions between biological, psychological and social factors (Pereboom et al. 2023). The purpose of this model is to make midwives and health care professionals understand that in a pregnant woman, not only the biological factors but also the psychological and social factors should be considered, as they can influence the execution of intimate examinations.

The researcher engaged potential participants directly in person to invite their voluntary involvement in the study. The researcher also asked the midwives to assist with the recruitment by inviting women who met the inclusion criteria to participate in the study before they were discharged. An information leaflet and consent form were provided to explain the purpose of the study, and permission was requested to obtain a telephone number so the researcher could contact them in the following week. The participants were asked to sign the information leaflet and consent form, and they received a written copy containing details of the study, as well as the researcher’s contact information. Recruitment and data collection were initiated after permission was obtained from the facilities’ management and the Research Ethics Committee of the Faculty of Health Sciences, University of Pretoria.

During recruitment, the participants had an opportunity to indicate their preference for a standard phone call, WhatsApp call, WhatsApp video call or another format, such as Google Meet and Zoom. Permission was obtained from the participants to audio record the telephonic interviews during the initial recruitment when they signed informed consent and were confirmed again at the beginning of the call.

To obtain relevant and meaningful information that would generate rich data, effectively address the study’s objective and enhance trustworthiness, the researcher employed purposive sampling to recruit 30 postnatal women who had delivered vaginally at the time of the study in the selected district hospitals and Midwife Obstetric Units (MOUs) in a selected community health care centre. These participants took part in individual semi-structured telephonic interviews. The inclusion criteria were postnatal patients aged 18 years or older, who had given birth vaginally at the selected district hospitals and MOUs in the Tshwane District, Gauteng province, had no obstetric complications or emergencies and were willing to participate in the study. All women who did not meet the inclusion criteria were excluded from the study.

Data were collected in postnatal wards and MOUs of level 1/district hospitals in the Tshwane District in Gauteng province. Tshwane District is the metropolitan municipality that forms the local government of the northern Gauteng province in South Africa and is centred in the city of Pretoria, with surrounding towns and localities included in the local government area. The catchment population is 2 921 488. Tshwane District has four district hospitals, namely, Tshwane District Hospital, Pretoria West Hospital, ODI District Hospital and Jubilee District Hospital, as well as five MOUs situated in Eersterus, Dagga, Laudium, Soshanguve and Phedisong 4. The maternity wards in district hospitals provide 24 h services to low-risk pregnant women in labour and post-delivery care and are managed by obstetricians, midwives and midwife specialists (National Department of Health [NDOH] 2024). The selected district hospitals have, on average, a 24-bed capacity and manage 10 vaginal deliveries per day. The maternity staff work in shifts to have on average two medical officers, one specialist obstetrician, two midwife specialists and three midwives available at a time in a district hospital. All perinatal complications and emergencies are transferred to a tertiary hospital for further management.

In this study, data were collected through a semi-structured telephonic interview guide, which included central and probing questions to direct the interviews. The interviews were conducted in English or in Northern Sotho, Southern Sotho, Zulu or Xhosa – languages in which the researcher was fluent. Data collection commenced after permission had been obtained from the facilities’ management and the Research Ethics Committee of the Faculty of Health Sciences, University of Pretoria. The researcher contacted the participants during the daytime, after the so-called blues on day 3, but before the memories of the intimate examinations became too vague – therefore, between day 4 and day 7 post-delivery. If a participant did not answer, the researcher attempted to call again after a few hours or the following day, but discontinued efforts after four unsuccessful attempts. Each telephonic interview was allocated approximately 30 min. Field notes were taken to keep track of the discussion. The interview guide was pilot-tested at a district hospital and the MOU on two voluntary postnatal women. The data were not included in the main study.

In this study, data were analysed according to a method described by Busetto, Wick and Gumbinger (2020). The researcher listened to each audio tape and transcribed the data verbatim and labelled the field notes. Then, she read through all the data to obtain a general sense of information and reflect on its overall meaning, wrote notes in the margin as well as general thoughts about the data, read several participants’ transcripts and made a list of all topics that came to mind. The topics were typed into columns and labelled as codes, which were grouped into categories based on similarities and differences. Themes were developed from the categories to create headings in the report, and quotations were used to supplement the sub-themes. Six themes and 24 sub-themes emerged. This was followed up with a literature review to confirm or disconfirm the findings.

An application for full ethical approval was made to the University of Pretoria, Faculty of Health Sciences Research Ethics Committee, and ethics consent was received on 11 April 2024. The ethics approval number is 149/2022, and it was obtained from the facility managers of the MOU and the Chief Executive Officers (CEOs) of the district hospitals in the selected District of Gauteng province, before data collection. In this study, the following will be applied:

Participants were protected through several ethical principles. They were assured of their right to protection from exploitation, meaning their participation would not expose them to harm, and any information they shared would be used solely for the study and never against them. The right to self-determination was upheld by obtaining voluntary informed consent, with participants made aware that they could withdraw at any time without consequences. The right to full disclosure was also respected, and participants were thoroughly informed about the study’s purpose, risks and benefits. They were not deceived, and the researcher explained that participation might evoke emotional discomfort, allowing sufficient time for questions and decision-making.

Furthermore, the right to fair treatment was observed by treating all participants, including those who declined or withdrew, with equal respect and without penalty. Participants were selected based on clear inclusion criteria, and no one was forced or required to justify their decision to opt out. Privacy was maintained by avoiding intrusive questions that could cause embarrassment or loss of dignity. Confidentiality and anonymity were ensured by not revealing participant identities at any stage of the research. Voice recordings and interview materials were securely stored, accessible only to the researcher and her supervisors, and personal data were kept separate from interview content using coded identifiers.

Thirty postnatal mothers who underwent vaginal delivery were interviewed through telephonic semi-structured interviews. Women were recruited in postnatal wards and MOUs of level 1/district hospitals in the Tshwane District in Gauteng province. All Participants resided in different regions of the Tshwane District. The participants’ ages ranged between 18 years and 38 years; two participants were below 20, 16 were between 20 years and 30 years old, and 12 were between 30 and 38 years old. The educational levels of the participants ranged from primary to tertiary; however, five participants had not attended school at all. Their occupational categories were grouped into two categories, government and private; eight of the participants were government workers, and 10 were self-employed. Six were working in the private sector, four were unemployed and two were scholars. Concerning marital status: 12 were married, 8 were cohabiting, 6 were separated from their partners and 4 were single in a relationship with their partners. Parity: 9 were primigravida and 21 were multigravida. Table 1 shows the demographic profile of the participants.

The data were analysed, revealing one theme and four sub-themes, which are outlined in Table 2. These themes and sub-themes describe the psycho-social needs of women undergoing intimate examinations. The findings are further explored and supported by direct quotes in italics. To maintain anonymity, participants’ identities have been replaced with symbols as shown in brackets (e.g. P1). The findings are then followed by relevant discussions in literature.

This theme describes the psychosocial needs of women who underwent intimate examinations and has four sub-themes, namely, Sufficient and competent health care providers, Limited intimate examinations by health care providers, Alternative Assessment Methods, and Social Support from others.

Conducting the study in the hospitals and midwives’ obstetric units in one District of Gauteng province was a limitation, as maternal and neonatal care is provided in the hospitals and midwives’ obstetric units in other districts in Gauteng province. As such, it would be beneficial to conduct this study in more than one district, as many women will be able to be reached. Furthermore, the implementation of these guidelines should be taken into consideration.

To address the psychosocial needs of women during perinatal intimate examinations, it is recommended that midwives receive ongoing training in respectful communication, emotional support and consent-based care to enhance women’s psychological well-being. The Department of Health should urgently address staff shortages as adequate staffing allows midwives to provide more compassionate, patient-centred care during these sensitive procedures. Emotional support systems, such as allowing trusted companions or peer supporters to be present, should be integrated into routine care to reduce anxiety and promote dignity. Additionally, midwives must practice consistent infection prevention and minimise unnecessary vaginal examinations to protect both the physical and emotional safety of women during labour.