Chapter 8 198 Results From the explorative survey conducted before the current study25, we identified a knowledge gap. Mental health problems impacted domains of reproductive health and fertility desires (reproductive history, decision making, parenting and sexuality) amongst the respondents, but insight in if, why, how and by whom discussions about family planning and desire for children should be held was lacking. As a next step in this mixed methods design, focus groups were held to initiate this exploration. From the thematic analysis from four focus groups, we derived the six most important aspects related to a conversation about family planning and desire for children: (1) experiences of patients and close ones, (2) obstacles and catalysts, (3) timing, (4) need and responsibility, (5) personalized content and (6) competencies of MHPs. Questions for the surveys for MHPs and patients were based on these six aspects of a conversation about family planning/desire for children with the purpose to test the perspectives from the focus group participants in a larger sample (see Supplementary Files 8.1 and 8.2 for all specific items). Paragraphs 3.1 -3.6 integrate the qualitative findings from the focus group data with quantitative survey outcomes. As some survey questions included open questions, the answers to these questions were used to explain the reasons behind the numbers. Table 8.1 demonstrates demographic features of focus group participants, Table 8.2 presents features of MHPs (n = 139), (former) patients (n=268) and close ones (n=26) who participated in the surveys. Table S9.1 demonstrates professional characteristics of MHPs. Table S8.2 shows all quantitative survey data. Amongst patients, 36.6% expressed a need to discuss family planning with an MHP. A considerable group of MHPs (64.0%), patients (40.9%) and close ones (50.0%) found that family planning should be discussed by a psychiatrist. Table S8.3 shows disaggregated survey responses for patients ≤45 years (n=125) and patients >45 years (n=141). There were differences between age groups. Younger patients more often (48.8%) reported a need to discuss family planning (48.8% vs. 24.8%) and contraceptive care (12.8% vs. 5.7%) with a health professional. There was no difference between younger and older patients with regards to having regular discussions in mental healthcare about the desire to have children or that a psychiatrist should discuss family planning and the wish to have children with every patient in the reproductive age.
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