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The Freyja Study

A study about the role of fertility awareness technology “Natural Cycles” in users’ and their partners’ experience of planning a pregnancy.

The Study
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Freyja Study The Study
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Why are we doing this study?

There are a growing number of online and app-based fertility awareness methods available, for monitoring menstrual cycles and identifying the ‘fertile window’ (the time in the menstrual cycle when pregnancy is most likely). However, the way people use these methods, and how they feel about them, has received little research attention so far. We’re carrying out this study to explore the views and experiences of people who currently or have previously used the Natural Cycles app in ‘plan a pregnancy’ mode, and whose partners have done so.

What does the study involve?

We plan to carry out up to 30 in-depth interviews with people who – either themselves or their partners  – have experience of using Natural Cycles in ‘plan a pregnancy’ mode, and who are living in the UK. Interviews will be individual (users and their partners will be interviewed separately) and conversational, via Skype, with one of the researchers, Pippa, Nerissa, Rebecca or Jill. During interviews, the researchers will ask participants about their views and experiences of using Natural Cycles and other fertility awareness methods, and how they fit in with their everyday lives and plans. Interviews are anonymous and confidential. Interviews will only begin once the participant has had a chance to ask any questions about the study and given their consent to take part. Interview participants will receive a £40 voucher as a thank you. They will also be offered information on advice and support services that may be helpful to them (please see links here).

To read more about what your participation would involve, please read the information for participants:

Natural Cycles Users - Participant Information
Partners of Natural Cycles Users - Participant Information

View the consent form we ask interview participants to complete.

Who do we want to talk to?

To be eligible to take part in this study, you need to:

  • be aged 18 years old or above (and aged 18-44 if you are a Natural Cycles user; there is no upper age limit for partners of Natural Cycles users)
  • have ever used Natural Cycles in ‘plan a pregnancy’ mode (yourself or your current partner)
  • not have been advised to avoid pregnancy for health reasons (yourself if you are a Natural Cycles user, or your current partner)
  • currently live in the UK
What will we do these results?

We will write up the results of this study for ‘Open Access’ publication, in academic journals. We will also publish a summary of the results on this website. All outputs will be publicly and freely accessible, and will be listed and linked to here.

We will use the results to improve understanding of how people use technologies when trying to conceive. The results will be relevant to individuals and couples who are trying to conceive or who are thinking about doing so, including those who use Natural Cycles and other fertility awareness methods. They will also be relevant to health professionals, policy makers and app developers (including but not limited to Natural Cycles) in the fields of fertility, preconception and reproductive health. More broadly, the results will be of interest to people concerned with how we use technology in relation to our health and well-being.

Who are we funded by?

This study is funded by Natural Cycles. It is being conducted independently by researchers at the London School of Hygiene and Tropical Medicine (LSHTM) and the University of Plymouth, and steered by an independent advisory group (please click here for more details).

To read more about why we are doing this research and the methods we are using, please read the study abstract here.

Research Team & Advisory Group
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Rebecca French

Rebecca French

I am an Associate Professor in Sexual & Reproductive Health Research at the London School of Hygiene & Tropical Medicine. I have been involved research in this area for over 25 years. Particular research interests include contraceptive decision-making, teenage pregnancy and use of technologies in the delivery of sexual and reproductive health services. I am leading the Freyja Study, in collaboration with Jill, Pippa and Nerissa (see below).

Pippa Grenfell

Pippa Grenfell

I am an Assistant Professor in Public Health Sociology at the London School of Hygiene & Tropical Medicine. I’ve spent the last 11 years carrying out qualitative research - particularly in collaboration with marginalised and minority groups - about their sexual and reproductive health, health inequalities and social justice. On the Freyja Study, I’m leading on interviewing, analysing data and reporting the results, together with Nerissa, Jill and the project lead, Rebecca.

Nerissa Tilouche

Nerissa Tilouche

I am a Research Assistant at the London School of Hygiene & Tropical Medicine. I support different research projects in the Public Health, Environments and Society department with interviews, fieldwork, project coordination and financial management. On the Freyja Study, I’m working with Pippa, Rebecca and Jill to organise and conduct interviews, analyse data and report the results, as well as carrying our project coordination.

Jill Shawe

Jill Shawe

I am a Registered Nurse and Midwife and Professor in Women’s Health at The University of Plymouth.  I have 30 years’ experience in the field of sexual health care and I am an advanced practitioner in Fertility Awareness with a particular interest in preconception care.  My programme of research and education in peri-conception care aims to improve the health of women and their partners before and between pregnancies.

 

Advisory group

The Freyja Study is steered by an independent advisory group that advises on how the research team designs, conducts, analyses and disseminates the results of the study. The advisory group includes a community representative (someone with experience of using Natural Cycles, recruited independently of the company), a social scientist and a medical professional with expertise in fertility (both of whom have no link to Natural Cycles).

Get Involved
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Thank you for your interest in the Freyja Study.

We are inviting up to 30 people who – either themselves or their partners – have ever used Natural Cycles in ‘plan a pregnancy’ mode, to take part in an interview on Skype about their views and experiences (we will be interviewing Natural Cycles users and partners separately).

To be eligible to take part, Natural Cycles users need to:

  • be aged between 18 and 44,
  • have some experience of using Natural Cycles in ‘plan a pregnancy’ mode (now or previously)
  • currently live in the UK

Current partners of Natural Cycles users meeting the above eligibility criteria will also be eligible to take part.

If you are interested in taking part, please click on the button below that applies to you. This will take you to a short series of questions about yourself, your (main) partner if you have one, your use of Natural Cycles, pregnancy and parenting. These questions will help us to work out if you are eligible to take part in the study, and to make sure that we talk to a diverse range of Natural Cycles users and their partners.

Any information you share with us will remain strictly confidential and you do not have to share any information you do not wish to (most questions have a ‘prefer not to say’ option). If you do not go on to participate in an interview, the information you provide here will be deleted. If you do participate in an interview, this information will be included in the study if you later agree to this.

Natural Cycles User    Partner of Natural Cycles User

To find out more about the study, please click here.

To find out more about the research team, please click here.

To read more about what your participation would involve, please read the information for participants:

Natural Cycles Users - Participant Information
Partners of Natural Cycles Users - Participant Information

View the consent form we ask interview participants to complete.

Resources
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Freyja Study Publications
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Links to information, advice and support

Below is information that we offer to interview participants about organisations that may be able to help with any issues that they, or someone they know, might be going through:

NHS website: Provides information for planning a pregnancy (https://www.nhs.uk/conditions/pregnancy-and-baby/planning-pregnancy/) and a contraception guide (https://www.nhs.uk/conditions/contraception/). Provides information and advice on getting help and support for domestic violence (https://www.nhs.uk/live-well/healthy-body/getting-help-for-domestic-violence/#getting-help-and-support-for-domestic-violence).

The Family Planning Association (FPA): A sexual and reproductive health charity providing advice on contraception, sexually transmitted infections, pregnancy choices, abortion and planning a pregnancy. Visit: https://www.fpa.org.uk/.

Human Fertilisation and Embryology Authority: Offering impartial information to all affected by fertility treatment. The UK Government's independent regulator overseeing fertility treatment and research. Call 020 7291 8200 or visit: www.hfea.gov.uk

National Sexual Health Helpline: Sexual Health Advice Service provided by Public Health England. Call 0300 123 7123, Monday–Friday, 9am to 8pm

Switchboard LGBT+ Helpline: Providing information, support and referral services for lesbians, gay men and bisexual and trans people, and anyone considering issues around their sexuality or gender identity. Call 0300 330 0630 or visit: http://switchboard.lgbt/help/   

The Samaritans: Someone to talk to, available 24 hours a day for confidential, non-judgmental support. Call 116 123 or visit: www.samaritans.org   

Mind: Offering advice and support for anyone experiencing a mental health problem. Call 0300 123 3393 or visit: www.mind.org.uk   

Rape Crisis: Provides information on nearest services for people who have experienced sexual violence. Call 0808 802 9999 or visit: www.rapecrisis.org.uk

Glossary

Below are some terms we use on this website and in Freyja Study documents.

Basal Body Temperature: the lowest body temperature that our bodies reach after having rested for at least three hours.
Conception: the onset of pregnancy.
Dissemination: making the results and recommendations of the study available, beyond the project team, partners and advisory group meetings.
In-depth interview: an informal, conversational-style interview during which the interviewer asks the research participant open-ended questions about their experiences and their views, and the participant tells their story in their own words.
Inductive: an inductive approach to analysing research data means looking for themes, patterns and theories that emerge from the data gathered, so that generalisations can be developed based on specific observations and experiences (rather than testing pre-determined ideas and theories by collecting data, which would be a deductive approach).
Insemination: sperm is inserted directly into the cervix, fallopian tube or uterus (womb) to facilitate fertilisation.
Iterative: an iterative approach to analysing research data means repeatedly going back to the original data to make sure that the researchers’ interpretations are coming from the data. This involves a repeated cycle of collecting data, analysing it and using this to guide the next phase of interviewing (for example, by identifying who to interview next (see ‘sampling’ below), and additional relevant questions to ask).
Open-ended questions: the person is asked answers in their own words (e.g. in response to “What do you think about this idea?”), rather than choosing from two or more answers (e.g. “Do you think this is a good idea?” Yes/No or “Which of these ideas do you agree with?” A, B, C).
Pre-conception: the period during which an individual or a couple plan pregnancy.
Progesterone: a steroid hormone within the body that stimulates the uterus to prepare for pregnancy.
Qualitative research explores people’s views and experiences by listening to what they have to say. It asks questions about how and why. It collects information in the form of words, and sometimes images, but not usually in numbers. Qualitative researchers use methods like in-depth interviews (see above).

Sampling: the process of selecting participants to take part in the research. Participants are selected because their experiences and views are relevant to the study.

  • Purposive sampling: selecting participants who have specific knowledge or experience that is relevant to the research. For example, in this study, we are purposively selecting participants who have ever used Natural Cycles in ‘plan a pregnancy’ mode.

  • Theoretical sampling: selecting participants based on existing research evidence and the ideas that are emerging from the data analysis. For example, in this study we aim to interview Natural Cycles users who are both under and over 30 years old, because experiences of conception can differ by age. There may also be additional sampling criteria that we develop as we learn new information during data collection.

Saturation: ‘data saturation’ or ‘theoretical saturation’ means that no new themes are generated when data from more participants are included in the analysis. This is the time at which sampling can be considered complete, although in practice other considerations may also affect how much data can be gathered (e.g. available funds and time, participants’ willingness to take part in the research).
Topic guide: a list of questions or topics used during qualitative interviews. The questions do not need to be asked in the same way or the same order during each interview. Some questions may not be asked at all, and some questions not in the topic guide might be asked - depending on the direction of the conversation, and what the participant feels is important, and is comfortable, to talk about.
Conferences and publications

We will post details of all publications and conference presentations resulting from this study here.

We are due to start data collection in January 2019 and will report on the findings in the summer of 2019.

FAQs
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Why are you conducting this study?

There are a growing number of online and app-based fertility awareness methods available, for monitoring menstrual cycles and identifying the ‘fertile window’ (the time in the menstrual cycle when pregnancy is most likely). However, the way people use these methods, and how they feel about them, has received little research attention so far. We’re carrying out this study to explore the views and experiences of people who currently or have previously used the Natural Cycles app in ‘plan a pregnancy’ mode, and whose partners have done so.

What do you hope to find answers to?

We will be asking interview participants how they use Natural Cycles and other methods when trying to conceive, how they feel about these methods, and how they fit in with their everyday lives and plans. We will be interviewing people who use ‘Natural Cycles’ themselves and the partners of those who do so, to understand these issues from each of their perspectives.

What impact could the study have and on whom?

We will use the results to improve understanding of how people use technologies when trying to conceive. The results will be relevant to individuals and couples who are trying to conceive or who are thinking about doing so, including those who use Natural Cycles and other fertility awareness methods. They will also be relevant to health professionals, policy makers and app developers (including but not limited to Natural Cycles) in the fields of fertility, preconception and reproductive health. More broadly, the results will be of interest to people concerned with how we use technology in relation to our health and well-being.

What does the study involve?

We plan to carry out up to 30 in-depth interviews with people who – either themselves or their partners  – have experience of using Natural Cycles in ‘plan a pregnancy’ mode, and who are living in the UK. Interviews will be individual (users and their partners will be interviewed separately) and conversational, via Skype, with one of the researchers, Pippa, Nerissa, Rebecca or Jill. During interviews, the researchers will ask participants about their views and experiences of using Natural Cycles and other fertility awareness methods, and how they fit in with their everyday lives and plans. Interviews are anonymous and confidential. Interviews will only begin once the participant has had a chance to ask any questions about the study and given their consent to take part. Interview participants will receive a £40 voucher as a thank you. They will also be offered information on advice and support services that may be helpful to them (please see links here).

To read more about what your participation would involve, please read the information for participants:

Natural Cycles Users - Participant Information
Partners of Natural Cycles Users - Participant Information

View the consent form we ask interview participants to complete.

Who is conducting this research?

This study is being conducted by researchers from the London School of Hygiene and Tropical Medicine (LSHTM) and the University of Plymouth. The research is led Dr Rebecca French (Associate Professor, LSHTM) in collaboration with Professor Jill Shawe (University of Plymouth). The interviews, analysis, write-up and dissemination are led by Dr Pippa Grenfell (Assistant Professor, LSHTM) with support from Nerissa Tilouche (Research Assistant, LSHTM). The research team have extensive experience in sexual and reproductive health research. You can read more about them here.

Who is funding this research?

This study is funded by Natural Cycles. It is being conducted independently by researchers at the London School of Hygiene and Tropical Medicine (LSHTM) and the University of Plymouth (please see here for more details).

How are you ensuring that this study is conducted independently?

This study is being conducted by researchers from the London School of Hygiene and Tropical Medicine (LSHTM) and the University of Plymouth.

The study is led by Dr Rebecca French (LSHTM), working in collaboration with Dr Pippa Grenfell, Nerissa Tilouche (LSHTM) and Professor Jill Shawe (University of Plymouth). The team has extensive experience of sexual and reproductive health research. The study is steered by an independent advisory group that advises on how the research team designs, conducts, analyses and disseminates the results of the study (you can read more about the research team and advisory group here).

This study was proposed and designed by the research team. Natural Cycles are not involved in making any decisions about how the study is conducted, including the decision to publish. They will not know who takes part in the research and they will not have access to the study data or any information shared by participants with the researchers. Natural Cycles will only see study data that are in the public domain (i.e. anonymised data included in any publicly available publications and presentations).

Do the researchers have any conflict of interest?

The researchers have no involvement in Natural Cycles and they are not receiving any financial or other incentive to conduct this research other than their usual university salaries. Before developing the Freyja Study proposal, Dr Rebecca French and Professor Jill Shawe received an honorarium from Natural Cycles to participate in an expert workshop aimed at identifying research gaps in relation to fertility awareness methods.

I’m interested in taking part. How can I get involved?

You might see an advert about the study within the Natural Cycles app and website, or on social media, but you can also go directly to the Get Involved section of this website. If you (or your partner, if you have one) are interested in taking part, we ask you to answer a short series of questions to help us work out if you’re eligible to participate in the study, and to make sure we talk to a diverse range of people. We also ask you to provide your contact details. If you’re selected to take part, one of the researchers will get in touch to invite you to a one-to-one Skype interview.

Am I eligible to take part?

To be eligible to take part in this study, you need to:

  • be aged 18 years old or above (and aged 18-44 if you are a Natural Cycles user; there is no upper age limit for partners of Natural Cycles users)
  • have ever used Natural Cycles in ‘plan a pregnancy’ mode (yourself or your current partner)
  • not have been advised to avoid pregnancy for health reasons (yourself if you are a Natural Cycles user, or your current partner)
  • currently live in the UK
I’ve used Natural Cycles in ‘plan a pregnancy’ mode (now or in the past) and I currently have a partner. Can I take part in an interview even if my partner doesn’t want to be interviewed?

Yes. Your partner doesn’t have to participate in the study for you to take part. Similarly, if you don’t want to take part but your partner would like to, that’s fine. Interviews with users and partners will take place separately.

My partner has used Natural Cycles in ‘plan a pregnancy’ mode (now or in the past). Can I take part in an interview even if my partner doesn’t want to be interviewed?

Yes. Your partner doesn’t have to participate in the study for you to take part. Similarly, if you don’t want to take part but your partner would like to, that’s fine. Interviews with users and partners will take place separately.

I’ve used Natural Cycles in ‘plan a pregnancy’ mode (now or in the past) but I don’t currently have a partner. Am I eligible to take part?

Yes. To be eligible to participate in this study, you need to: have used Natural Cycles in ‘plan a pregnancy’ mode (currently or in the past), be aged 18-44, not have been advised to avoid pregnancy for health reasons, and currently live in the UK. You do not need to be in a relationship to take part.

Why does this research focus on using Natural Cycles in ‘plan a pregnancy’ mode rather than ‘prevent a pregnancy’ mode?

Natural Cycles has three modes that users can select from: ‘prevent a pregnancy’, ‘plan a pregnancy’ and ‘follow a pregnancy’.

So far the app has been promoted most widely as a method of contraception, and the company has previously undertaken its own, in-house research on this topic (you can read more about this here). As far as we know, no research has yet looked at users’ and their partners’ experiences of using Natural Cycles in ‘plan a pregnancy’ mode. In the Freyja Study, we are focusing mainly on participants’ views and experiences of using Natural Cycles (and other methods) when trying to conceive. We will also ask participants about any experiences they’ve had using Natural Cycles in other modes, including ‘prevent a pregnancy’.

Why are you only interviewing up to 30 people?

In the Freyja Study, we’re aiming to find out about the views and experiences of up to 30 people (Natural Cycles users and their partners). ‘Qualitative’ research like this — which explores what people have to say about their experiences, and what they mean to them — usually involves interviewing fewer people in-depth (compared with ‘quantitative’ research which involves asking less in-depth questions to more people). Qualitative research is suitable for topics that haven’t been researched in much detail before, or about which little is known. So far, there hasn’t been much research about the views and experiences of people using app-based fertility awareness methods when trying to conceive, so qualitative methods are appropriate for this study.

Why are you only interviewing people who currently live in the UK?

In this exploratory research, we’re aiming to find out about the views and experiences of up to 30 people (Natural Cycles users and their partners). Studies like this often focus on one setting to get an in-depth understanding of participants’ views and experiences. This is because views and experiences may be affected by issues that differ between countries (for example, health systems, social norms about fertility and planning pregnancy). There are a large number of people who use Natural Cycles in the UK. This research will also be able to inform future studies in other countries.

Why are you interviewing Natural Cycles users up to the age of 44?

We plan to interview Natural Cycles users aged between 18 and 44 years. Studies about fertility often set a younger upper age limit (for example, 35, because fertility declines after this age), but we feel that it is important to hear from a wider range of users, given that we know that women above this age are increasingly conceiving. We have set an upper age limit of 44 because the chances of conceiving without fertility treatment are small after this age. There is no upper age limit for partners of Natural Cycles users.

Why are you also interviewing partners of Natural Cycles users?

We plan to interview up to 25 people who have personal experience of using Natural Cycles in ‘plan a pregnancy’ mode (currently or previously). We’re also aiming to interview at least five people whose current partners have this experience. This is because we know from previous research that using fertility awareness methods can have implications both for those using the method and for their partners. So although the Freyja Study focuses mainly on the views and experiences of people who’ve used Natural Cycles themselves, we also want to include the perspectives of their partners.

How can I find out the results of the research?

We will write up the results of this study for ‘Open Access’ publication, in academic journals. We will also publish a summary of the results on this website. All outputs will be publicly and freely accessible, and will be listed and linked to here.