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Bhochhibhoya S, Maness SB, Allen JO, Cheney MK, Peck BM, Lu Y. Contraceptive Use and Its Associations With Social Determinants of Health Among Young Adults. FAMILY & COMMUNITY HEALTH 2024:00003727-990000000-00043. [PMID: 39422329 DOI: 10.1097/fch.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
BACKGROUND Nonuse and inconsistent use of contraception in young adults can result in undesired pregnancies. Prior research on contraceptive use has primarily focused on individual influences such as attitudes, beliefs, and skills related to contraceptive use, with little consideration of the social and economic determinants. OBJECTIVE This study explored domains from the Healthy People 2030 Social Determinants of Health (SDH) framework and examined their cross-sectional associations with young adults' self-reported contraceptive use (ie, any use in the past year and consistent use of contraception). METHODS Eleven measures related to 5 SDH domains were extracted from the Add Health dataset collected from 2001 to 2002 (Wave III). The final sample included 11,172 youth with a mean age of 21.88 years (SD: 1.84) and was 53.8% female. RESULTS Measures associated with the past year's use of contraceptives included non-poverty status, employment, housing instability, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, and access to primary care. For consistent use of contraception, associated measures were participants' non-poverty status, employment, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, incarceration, and access to health care. CONCLUSIONS Interventions that address social determinants of health can potentially promote contraceptive use.
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Affiliation(s)
- Shristi Bhochhibhoya
- Author Affiliations: Department of Health, Human Performance and Recreation (Dr Bhochhibhoya), University of Arkansas, Fayetteville, Arkansas; College of Health and Human Performance (Dr Maness), East Carolina University, Greenville, North Carolina; Department of Kinesiology (Dr Allen), University of Wisconsin, Madison, Wisconsin; and Department of Health and Exercise Science (Drs Cheney and Lu), Department of Sociology (Dr Peck), University of Oklahoma, Norman, Oklahoma
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Ujah OI, Salemi JL, Rapkin RB, Sappenfield WM, Daley EM, Kirby RS. Do women with a previous unintended birth subsequently experience missed opportunities for postpartum family planning counseling? A multilevel mixed effects analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002570. [PMID: 38838062 DOI: 10.1371/journal.pgph.0002570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
Client-provider communication about family planning (FP) remains an important strategy for preventing unintended pregnancy. Yet, the literature lacks empirical studies examining whether and how women's intendedness of a recent pregnancy may impact subsequent receipt of FP counseling. We investigated whether the intendedness of a recent pregnancy is associated with subsequent missed opportunities (MOs) for FP counseling, taking into account compositional and contextual factors. We performed a secondary analysis using pooled data from the 2016, 2017 and 2018 Performance Monitoring and Accountability 2020 cross-sectional surveys conducted in Nigeria, adjusting for complex design effects. Weighted multilevel logistic regression modeling was used to examine the relationships between pregnancy intention and MOs, overall and at the health facility, using two-level random intercept models. In the analytic sample of women within 24 months postpartum (N = 6479), nearly 60% experienced MOs for FP counseling overall and even 45% of those who visited a health facility visit in the past 12 months (N = 4194) experienced MOs. In the multivariable models adjusted for individual-/household- and community-level factors, women whose recent birth was either mistimed or unwanted were just as likely to have MOs for FP counseling as their counterparts whose pregnancy was intended (p > 0.05). Factors independently associated with a MOs include individual/household level factors such as level of education, exposure to FP media, household wealth index and contextual-level variables (geographic region). While evidence that pregnancy intendedness is associated with MOs for FP counseling remains inconclusive, efforts to mitigate these MOs requires prioritizing women's prior pregnancy intentions as well as equipping healthcare providers with the capacity need to provide high-quality client-centered FP counseling, particularly for women whose recent birth was unintended.
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Affiliation(s)
- Otobo I Ujah
- Department of Obstetrics and Gynaecology, Federal University of Health Sciences, Otukpo, Nigeria
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Jason L Salemi
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Rachel B Rapkin
- University of South Florida, Tampa, Florida, United States of America
| | - William M Sappenfield
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Elen M Daley
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Russell S Kirby
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
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Freeman E, Paul R, Dorsey M, Madden T. Comparison of interpersonal quality of contraceptive counseling delivered via telehealth versus in person. Contraception 2023; 128:110129. [PMID: 37499735 DOI: 10.1016/j.contraception.2023.110129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES This study aimed to compare the interpersonal quality of contraceptive counseling between telehealth and in-person visits. STUDY DESIGN Patients at a single Title X-funded clinic selected their preferred counseling modality (in person or telehealth via video or telephone) when scheduling an appointment for contraception. After counseling, we invited patients to complete a survey and recorded their desired contraceptive method. We assessed the quality of counseling using the Interpersonal Quality in Family Planning scale. We reviewed the electronic medical record to identify any subsequent clinician visit. We performed between-group comparisons using Mann-Whitney U, χ2, and Fisher exact tests. RESULTS From March 2021 to June 2022, 360 patients were eligible to participate, and 296 (82%) completed the survey and were included in the analysis; 150 (51%) completed counseling in person, and 146 (49%) completed counseling via telehealth. In the telehealth group, 102 (70%) chose telephone, and 44 (30%) chose video. Respondent characteristics were similar between groups. The majority of respondents in both groups reported high quality of counseling, defined as a top score on the Interpersonal Quality in Family Planning scale (75.0% telehealth respondents and 80.0% in person, p = 0.30). Compared to respondents completing in-person counseling, telehealth respondents were less likely to have a subsequent clinician visit (89.0% versus 100.0%, p < 0.001). CONCLUSIONS The majority of respondents reported high-quality contraceptive counseling without significant difference between the modalities. However, respondents choosing telehealth were less likely to have a subsequent clinician visit. Given the higher uptake of telephone compared to video, telehealth via telephone may be more accessible or acceptable to some patients. IMPLICATIONS Contraceptive counseling via telehealth has similar high interpersonal quality when compared to traditional, in-person visits. However, barriers may exist for patients who choose telehealth contraceptive counseling to access subsequent in-person care. Utilization of telehealth for contraceptive visits may provide opportunities for more equitable health care and to expand contraceptive access.
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Affiliation(s)
- Emily Freeman
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Rachel Paul
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Megan Dorsey
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Tessa Madden
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
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Schulte A, Biggs MA. Association Between Facility and Clinician Characteristics and Family Planning Services Provided During U.S. Outpatient Care Visits. Womens Health Issues 2023; 33:573-581. [PMID: 37543443 DOI: 10.1016/j.whi.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/17/2023] [Accepted: 06/29/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Recent guidelines from the Centers for Disease Control and Prevention emphasize the importance of access to comprehensive family planning services and recommend patient-centered contraceptive counseling be incorporated into routine primary care visits for reproductive-age individuals. This study aims to describe family planning service provision in outpatient care settings and assess differences by facility and clinician characteristics. METHODS Using National Ambulatory Medical Care Survey data, a nationally representative survey of outpatient care visits, we assessed family planning service provision by facility location, facility type, physician specialty, types of clinicians seen, and whether the patient was seen by their primary care provider. We used random intercept logistic regression with robust standard errors, adjusting for patient characteristics, and state and year fixed effects. RESULTS The analytic sample included 53,489 patient visits with reproductive-age (15-49 years) individuals between 2011 and 2019. Family planning services were provided at 8% of total sampled visits and were more likely to be provided in urban compared with rural areas (adjusted odds ratio, 1.45; p = .02) and at community health centers compared with private physician practices (adjusted odds ratio, 1.74; p = .00). Family planning services were also more likely to be provided when the patient saw a physician assistant or nurse compared with only a physician. After controlling for observed covariates, measures of between-clinician heterogeneity indicate wide variation in which clinicians provided family planning services. CONCLUSIONS Family planning services were more likely to be provided in urban areas, at community health centers, and when patients received team-based care. The wide variation between clinicians suggests a need to better incorporate family planning services into primary care and other outpatient settings to meet patient needs and preferences.
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Affiliation(s)
- Alex Schulte
- Department of Health Policy, School of Public Health, University of California, Berkeley, Berkeley, California.
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
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Gabler LS, Shankar M, Ketterer T, Molnar J, Adams A, Min J, Miller E, Barral RL, Akers A, Miller MK, Mollen C. Contraceptive counseling for adolescents in the emergency department: A novel curriculum for nurse practitioners and physician assistants. J Am Assoc Nurse Pract 2023; 35:540-549. [PMID: 36735568 PMCID: PMC10394106 DOI: 10.1097/jxx.0000000000000824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/09/2022] [Accepted: 11/18/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT Many adolescents use the emergency department (ED) as their primary source of health care. As a result, the ED serves as a unique opportunity to reach adolescents. Although many adolescent visits to the ED are related to reproductive health, ED providers report barriers to providing this care, including lack of training. Nurse practitioners (NPs) and physician assistants (PAs) serve a vital role in the provision of consistent care to adolescents in the ED. The purpose of this study was to create a curriculum to train NPs and PAs at two pediatric institutions to provide patient-centered contraceptive counseling to adolescents in the pediatric ED regardless of their chief complaint. To do this, we created a four-part webinar followed by an in-person training session. Participants completed training and then conducted counseling sessions with adolescents in the ED. Counseling sessions were recorded and reviewed for fidelity to delineated counseling principles, and data from post-counseling surveys were collected. 27 NPs and PAs completed the training and conducted 99 counseling sessions. Nearly all sessions incorporated essential content and communication principles such as shared decision making (90%) and teach-back methods (75%). All NPs and PAs who participated reported satisfaction and subjective improvement in knowledge and competence from the training. This curriculum offers a novel and feasible approach to train NPs and PAs to deliver patient-centered contraception counseling to adolescents in the ED setting, and it can serve as a model for how to educate different providers to incorporate reproductive health education into the busy ED visit.
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Affiliation(s)
- Laurel S. Gabler
- Pediatric Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Michelle Shankar
- Department of Pediatrics, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
| | | | | | - Amber Adams
- Churches United for Justice, Saint Louis, Missouri A. Adams was a research associate at Children's Mercy Hospital, Kansas City, Missouri
| | - Jungwon Min
- Department of Biomedical and Health Informatics, CHOP, Philadelphia, Pennsylvania
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh; Professor of Pediatrics, Public Health and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania
| | - Romina L. Barral
- Division of Adolescent Medicine, Children's Mercy Hospital and Clinics, Kansas City, Missouri; Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Research Assistant Professor of Pediatrics, University of Kansas School of Medicine, Kansas City, Missouri
| | - Aletha Akers
- The Guttmacher Institute, Philadelphia, Pennsylvania
| | - Melissa K. Miller
- University of Missouri-Kansas City; Attending Physician, Children's Mercy Hospital, Kansas City, Missouri
| | - Cynthia Mollen
- Attending Physician, Emergency Medicine, CHOP, Philadelphia, Pennsylvania; Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; Distinguished Chair, Department of Pediatrics, Philadelphia, Pennsylvania
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Bansal A, Kullu A, Dixit P. Understanding the healthcare provider role on post abortion contraception adoption in India using National Family Household Survey-5. Reprod Health 2023; 20:123. [PMID: 37612745 PMCID: PMC10463293 DOI: 10.1186/s12978-023-01667-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Post abortion contraceptive use is an important area in provisioning of services associated with child birth planning. This study examines the factors related to the type and timing of initiation of contraception adoption among women who had undergone induced abortion. Study also tries to identify the role of personnel who provided the abortion service on decision of family planning adoption using complementary log-log model in India. METHODOLOGY The study uses the secondary data from the fifth round of the National Family Household Survey conducted during 2019-21. For, the analysis, we have used five-year women's reproductive calendar to extract information on contraceptive use, post last induced abortion among women. We used complementary log-log regression models, to estimate relative risk ratios and its 95% Confidence intervals (CI). RESULTS According to NFHS-5, out of all the last pregnancies (2,55,549), about three percent resulted in abortion. Most of the abortion occurred in private facilities (55%), with the help of health professionals (71%). From the women's reproductive calendar, it was found that around 40% of the women adopted modern methods of contraception, with maximum adopting spacing method (33%), and only handful adopted permanent method (7%). It was also found that the likelihood of early adoption of permanent method increased to two times when the abortion is done by health professional compared to others [95% CI (1.25-3.30)]. CONCLUSION This emphasises a need for quality counselling related to timing and types of family planning as an essential part of the family planning program ensuring client centric approach suited to their needs and contexts that helps in alleviating any apprehensions associated with adverse effects of modern contraceptive methods.
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Affiliation(s)
- Anjali Bansal
- Research Scholar, International Institute for Population Sciences, Govandi Station Road, Deonar, 400088, Mumbai, India.
| | - Arpana Kullu
- Research Scholar, Tata Institute of Social Sciences, V. N. Purav Marg, Deonar, 400088, Mumbai, India
| | - Priyanka Dixit
- Assistant Professor, School of Health Systems Studies (SHSS), Tata Institute of Social Sciences, V. N. Purav Marg, Deonar, 400088, Mumbai, India
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Samuel B, Tsegaye B, Dulla D, Aynalem A, Israel E, Gebrie M. Informed choice and its associated factors among women received immediate postpartum long-acting reversible contraceptives at public hospitals in Sidama Regional State, Ethiopia, 2022. Contracept Reprod Med 2023; 8:32. [PMID: 37165449 PMCID: PMC10170022 DOI: 10.1186/s40834-023-00229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/28/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION It is crucial to ensure the quality of family planning (FP) services through women's informed choice during the provision of long-acting reversible contraceptives. In Ethiopia, previous studies have focused on the quality of family planning services. However, much emphasis was not given to the informed choice of immediate postpartum long-acting reversible contraceptives (LARCs), particularly in the study area. This study determines the mangnitude of informed choice and associated factors among immediate postpartum women who received long-acting reversible contraceptives. METHOD An institution-based cross-sectional study was conducted from July 1 - August 31, 2022, among 373 immediate postpartum women who received long-acting reversible contraceptives at public hospitals in the Sidama regional state, Ethiopia. Women were selected and interviewed using a systematic random sampling technique and via a structured interviewer-administered questionnaire respectively. Data was collected using Kobo Toolbox software and then exported to the Statistical Package for Social science (SPSS) version 25 for analysis. A logistic regression model was used to identify the predictor variables. RESULTS The magnitude of informed choice of long-acting reversible contraceptives was 23.5% (95% CI (19.6%-27.7%)). The messages through posters about long-acting reversible contraceptives at the facility (AOR 3.6, 95% CI (1.92-6.79), postpartum family planning counseling during antenatal care (AOR 2.8, 95% CI (1.2-6.4), previous contraceptive use (AOR 3.23, 95% CI (1.12-9.33), and being secondary and higher educated (AOR 2.92, 95%CI (1.27-6.73) and (AOR 5.7, 95% CI (2.267-14.669) respectively were factors significantly associated with informed choice during immediate postpartum family planning service. CONCLUSION AND RECOMMENDATION In the current study, nearly one-fourth of women were informed about LARCs. Socio-demographic factors, prior use of contraception, exposure to posters that have messages about long-acting reversible contraceptives, and postpartum family planning counselling during antenatal care are factors that affect the woman's ability to make an informed choice. There should be immediate PPFP counselling that focuses on a full range of contraceptive method choices to facilitate postpartum women's ability to make informed choices.
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Affiliation(s)
- Beniyam Samuel
- Department of Midwifery, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Berhan Tsegaye
- School of Midwifery, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Dubale Dulla
- School of Midwifery, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Amdehiwot Aynalem
- School of Nursing, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Eskinder Israel
- Department of Reproductive Health, School of Public health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Meless Gebrie
- School of Nursing, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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MacLachlan E, Agali BI, Maytan-Joneydi A, Chaibou S, Garba SA, Halidou IC, Speizer IS, Nouhou AM. Qualitative assessment of providers' experiences with a segmentation counseling tool for family planning in Niger. Reprod Health 2023; 20:71. [PMID: 37161472 PMCID: PMC10170744 DOI: 10.1186/s12978-023-01617-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION This study examines experiences with a family planning segmentation counseling tool that is used during the provision of family planning services. Based on answers to a series of questions, women are segmented into one of five categories of family planning users and counseled based on their identified segment. This study aimed to qualitatively assess provider perspectives on implementation of the tool. METHODS Semi-structured in-depth interviews took place in the Dosso region of Niger among 16 family planning providers who had been trained in segmentation and were currently using the segmentation tool. The facilities chosen for interviews were part of a larger mixed methods study assessing the impact of using the segmentation approach. Interview questions focused on training, supervision, how segmentation occurs at the health facility, how segmentation changes provider-client interactions, and any difficulties faced with implementation. Interviews were translated and transcribed into French and data were coded and thematically analyzed. RESULTS All providers in the study reported positive outcomes associated with segmentation. While providers acknowledged that the segmentation approach added time to the clinic visit, they did see the benefit of this extra time in providing more meaningful interactions between clients and providers, leaving clients with a deeper understanding of family planning and of the different methods available. The implementation of the tool did not change other aspects of service delivery, except that a segmentation sheet was required to be filled in and kept in each patient's file. Difficulties reported included translating the segmentation tool questions into local languages, training enough health care providers and avoiding stock outs of the segmentation sheets. CONCLUSION The segmentation process is of benefit to family planning clients in Niger and the scale-up of the strategy could bring higher quality services to women. If this approach is brought to scale the implementation challenges uncovered need to be addressed, especially adequate training. Further research is needed to determine if segmentation leads to changes in family planning use outcomes.
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Affiliation(s)
| | | | - Amelia Maytan-Joneydi
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Ilene S Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hall B, Atrio J, Moore S, Lorvick J, Cropsey K, Ramaswamy M. Perceived healthcare quality and contraception utilization among persons recently incarcerated. JOURNAL OF CRIMINAL JUSTICE 2022; 83:101974. [PMID: 37663234 PMCID: PMC10473011 DOI: 10.1016/j.jcrimjus.2022.101974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Purpose Previously incarcerated women have specific gender and physiologic needs that are poorly addressed on community re-entry. The objective of this study is to evaluate the relationship between contraception use and perceived healthcare quality post-incarceration. Additionally, we examine the association between social determinants of health and contraception use post-incarceration. Methods A secondary analysis of a cross-sectional study of reproductive-aged women with a history of criminal-justice involvement in three cities (n = 383) was performed. Questions related to demographics, social determinants of health, sexual and reproductive health practices, health services use, and healthcare quality were analyzed. Bivariate analysis and logistic regression examined associations between these variables and contraception utilization among persons recently incarcerated. Results 35% of the participants used a method to prevent pregnancy. There were no significant differences noted between contraceptive users and non-users in perceived healthcare quality. Participants who were not using a contraceptive method were more likely to lack health insurance and experience food insecurity when compared to contraceptive users. Conclusions Although there was no difference in perceived healthcare quality between contraceptive users and non-users, significant barriers to contraceptive access on community re-entry exist. More studies are warranted to explore the sexual and reproductive health of previously incarcerated women.
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Affiliation(s)
- Bianca Hall
- Department of Obstetrics, Gynecology and Women’s Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, NY, USA
| | - Jessica Atrio
- Department of Obstetrics, Gynecology and Women’s Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, NY, USA
| | - Shawana Moore
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer Lorvick
- RTI International Community Health and Implementation Research Program, Berkeley, CA, USA
| | - Karen Cropsey
- Department of Psychiatry, University of Alabama, Birmingham, AL, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas, Kansas City, KS, USA
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Ghomeshi A, Diaz P, Henry V, Ramasamy R, Masterson TA. The Interest in Permanent Contraception Peaked Following the Leaked Supreme Court Majority Opinion of Roe vs. Wade: A Cross-Sectional Google Trends Analysis. Cureus 2022; 14:e30582. [PMID: 36420253 PMCID: PMC9678014 DOI: 10.7759/cureus.30582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023] Open
Abstract
Introduction With the leaked Supreme Court draft regarding Roe vs. Wade, substantial public reactions followed as the horizon of abortion laws within the United States of America have been changing. We sought to compare internet searches for vasectomy and tubal ligation seven days following the leaked draft on May 2, 2022. Methods We used public data provided by Google Trends to investigate the interest and geographic distribution of searches for the two forms of permanent contraception: Vasectomy and tubal ligation. We calculated the mean Search Volume Index (SVI) of these terms. Data analysis was performed with Microsoft Excel Version 16.60 (Redmond, USA), and comparisons between groups were performed using paired t-tests. Results The term 'vasectomy' saw a 121% increase (p=0.0063), and 'tubal ligation' had a 70% (p=0.029) increase compared to the week prior. 49/50 states had increased search inquiries for each term. However, the North and Southwestern regions of the U.S. had increased relative surge for vasectomy and the Midwest region for tubal ligation procedures, respectively. South Dakota and Idaho, with trigger laws that banned abortion immediately following the overturn of Roe vs. Wade, had the greatest surge in SVI for tubal ligation and vasectomy, respectively. Conclusion Our study indicates that with the potential overturn of Roe vs. Wade, there was a significantly increased interest in these two forms of permanent contraception. Future studies should investigate specific concerns and questions patients may have when it comes to the different options of contraception.
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Affiliation(s)
- Armin Ghomeshi
- Urology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | | | - Valencia Henry
- Urology, Edward Via College of Osteopathic Medicine, Spartanburg, USA
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López García-Franco A, Baeyens Fernández JA, Iglesias Piñeiro MJ, Alonso Coello P, Ruiz Cabello C, Pereira Iglesias A, Landa Goñi J. [Preventive activities in women. PAPPS update 2022]. Aten Primaria 2022; 54 Suppl 1:102471. [PMID: 36435585 PMCID: PMC9705224 DOI: 10.1016/j.aprim.2022.102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022] Open
Abstract
In the 2022 PAPPS update we present those specific preventive activities for women's health, except those related to cancer prevention (which are included in another document) and those aspects related to differential gender morbidity, a cross-cutting aspect for all working groups. Contraception is an essential preventive activity, considering basic the right to decide both the number of children and the time to have them. We must inform about the possible contraceptive methods, guaranteeing the monitoring of their safety, efficacy and effectiveness (tables are included on changing from one method to another to preserve contraceptive protection). We must inform about emergency contraception and propose it in the event of unprotected intercourse. All this will be done through opportunistic screening without requiring screening for thrombophilia or dyslipidemia, but for arterial hypertension. Pregnancy is an important life experience and the family doctor should not remain oblivious. We must be competent both in the preconception consultation (recommending the intake of folic acid, avoiding exposure to occupational and environmental risks, screening for certain pathologies and assessing the intake of drugs not indicated during pregnancy) and in the monitoring of pregnancy. Whether or not we monitor the pregnancy, we must not disregard its control, taking advantage of this period to promote healthy lifestyles and participating in the intercurrent processes that may occur. Menopause in general and osteoporosis in particular exemplify the strategy of medicalization of vital processes that has been followed from different instances and organizations. In our update we address the prevention and treatment of symptoms secondary to estrogen deprivation. We also propose the prevention of osteoporosis, including carrying out densitometry based on the risk of fracture in the next 10 years, and therefore densitometric screening is not recommended in women under 60 years of age. In risk assessment we recommend the use of the frax tool or better, the calibration of the risk of hip fracture with prevalence data from our setting. We linked the indication for treatment with the Z-Score (bone mineral density compared with women of the same age), as it is a condition associated with aging.
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Affiliation(s)
| | | | | | - Pablo Alonso Coello
- Medicina Familiar y Comunitaria, Centro Cochrane Iberoamericano (CIBERESP-IIB Sant Pau), Barcelona, España
| | - Cristina Ruiz Cabello
- Medicina Familiar y Comunitaria, Consultorio Castilléjar, zona básica de Benamaurel, Granada, España
| | - Ana Pereira Iglesias
- Medicina Familiar y Comunitaria, Centro de Salud Dr. Mendiguchía Carriche, Leganés, Madrid, España
| | - Jacinta Landa Goñi
- Medicina Familiar y Comunitaria, Centro de Salud Emisora, Pozuelo de Alarcón, Madrid, España
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Mann AK, Khoury A, McCartt P, Smith MG, Hale N, Beatty K, Johnson L. Multilevel Influences on Providers' Delivery of Contraceptive Services: A Qualitative Thematic Analysis. WOMEN'S HEALTH REPORTS 2022; 3:491-499. [PMID: 35651999 PMCID: PMC9148650 DOI: 10.1089/whr.2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/12/2022]
Abstract
Introduction: Access to a full range of contraceptive services is essential for quality health care. Contraceptive provision practices of primary care providers play an important role in patients' decision-making about their reproductive health care. Understanding the multilevel factors influencing contraceptive care delivery in primary care settings is critical for advancing quality care. This study offers an in-depth examination of influences on providers' delivery of contraceptive services across multiple primary care specialties and practice settings to identify issues and strategies to improve care. Materials and Methods: Twenty-four in-depth face-to-face interviews were conducted in 2017 with primary care providers, including family physicians, gynecologists, pediatricians, and nurse practitioners from academic settings, private practices, and health centers. Interviews were transcribed and analyzed thematically. Results: Providers described a complex set of influences on their provision of contraception across multiple ecological contexts. Seven major themes emerged from the qualitative analysis, including six types of influence on provision of contraception: organizational, individual provider-related, structural and policy, individual patient-related, community, and the lack of influences or barriers. Providers also discussed the sources they access for information about evidence-based contraception counseling. Conclusions: A diverse set of providers described a complex system in which multiple concentric ecological contexts both positively and negatively influence the ways in which they provide contraceptive services to their patients. To close the gaps in contraceptive service delivery, it is important to recognize that both barriers and facilitators to patient-centered contraceptive counseling exist simultaneously across multiple ecological contexts.
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Affiliation(s)
- Abbey K. Mann
- Department of Family Medicine, Quillen College of Medicine, and College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal Khoury
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Paezha McCartt
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Michael G. Smith
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nathan Hale
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kate Beatty
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Leigh Johnson
- Department of Family Medicine, Quillen College of Medicine, and College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
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Ontiri S, Kabue M, Biesma R, Stekelenburg J, Gichangi P. Assessing quality of family planning counseling and its determinants in Kenya: Analysis of health facility exit interviews. PLoS One 2021; 16:e0256295. [PMID: 34506509 PMCID: PMC8432739 DOI: 10.1371/journal.pone.0256295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background Available evidence suggests that provision of quality of care in family planning services is crucial to increasing uptake and continuation of use of contraception. Kenya achieved a modern contraceptive prevalence rate of 60% in 2018, surpassing its 2020 target of 58%. With the high prevalence, focus is geared towards improved quality of family planning services. The objective of this study is to examine the quality of family planning counseling and its associated factors in health facilities in Kenya. Methods We conducted a secondary analysis of the 2019 Kenya Performance Monitoring and Action, client exit data of women who had received family planning services. Quality of counseling was assessed using the Method Information Index Plus. We conducted a multivariable ordinal logistic regression analysis of data from 3,731 women to establish determinants of receiving quality family planning services. Results The Method Information Index Plus score for higher-quality counseling was 56.7%, lower-quality counseling 32.4%, and no counseling 10.9%. Women aged 15–24 years (aOR = 0.69, 95% CI = 0.56–0.86, p = 0.001) had lower odds of receiving better counseling compared to women aged 35 years and above. Those with no education (aOR = 0.52, 95% CI = 0.33–0.82, p = 0.005), primary (aOR = 0.56, 95% CI = 0.44–0.71, p<0.001) and secondary (aOR = 0.79, 95% CI = 0.65–0.98, p = 0.028) were less likely to receive better counseling compared to those with tertiary education. Women who received long acting and reversible contraception methods (aOR = 1.75, 95% CI = 1.42–2.17, p<0.001), and those who were method switchers (aOR = 1.24, 95% CI = 1.03–1.50, p = 0.027), had a higher likelihood of receiving better quality of counseling as compared to those on short-term methods and those who were continuers, respectively. Conclusion The quality of family planning counseling in Kenya is still sub-optimal considering that some women receive no form of counseling at service delivery point. There is need to review the existing FP guidelines and training packages to increase focus on the quality of counseling services offered by health providers. Social accountability strategies that empower women to demand quality services should be included in community-level family planning interventions.
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Affiliation(s)
- Susan Ontiri
- Department of Health Sciences/Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Mark Kabue
- Department of Monitoring Evaluation and Research, Jhpiego, Johns Hopkins University Affiliate, Nairobi, Kenya
| | - Regien Biesma
- Department of Health Sciences/Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences/Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Peter Gichangi
- Department of Research, Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- International Centre for Reproductive Health Kenya (ICRH-K), Mombasa, Kenya
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Amour C, Manongi RN, Mahande MJ, Elewonibi B, Farah A, Msuya SE, Shah I. Missed opportunity for family planning counselling along the continuum of care in Arusha region, Tanzania. PLoS One 2021; 16:e0250988. [PMID: 34260605 PMCID: PMC8279341 DOI: 10.1371/journal.pone.0250988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/18/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Adequate sexual and reproductive health information is vital to women of reproductive age (WRA) 15 to 49 years, for making informed choices on their reproductive health including family planning (FP). However, many women who interact with the health system continue to miss out this vital service. The study aimed to identify the extent of provision of FP counselling at service delivery points and associated behavioral factors among women of reproductive age in two districts of Arusha region. It also determined the association between receipt of FP counselling and contraceptive usage. METHODS Data were drawn from a cross-sectional survey of 5,208 WRA residing in two districts of Arusha region in Tanzania; conducted between January and May 2018. Multistage sampling technique was employed to select the WRA for the face-to-face interviews. FP counseling was defined as receipt of FP information by a woman during any visit at the health facility for antenatal care (ANC), or for post-natal care (PNC). Analyses on receipt of FP counseling were done on 3,116 WRA, aged 16-44 years who were in contact with health facilities in the past two years. A modified Poisson regression model was used to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counseling and current use of modern contraception, controlling for potential confounders. RESULTS Among the women that visited the health facility for any health-related visit in the past two years, 1,256 (40%) reported that they received FP counselling. Among the women who had had births in the last 30 months; 1,389 and 1,409 women had contact with the service delivery points for ANC and PNC visits respectively. Of these 31% and 26% had a missed FP counseling at ANC and PNC visit respectively. Women who were not formally employed were more likely to receive FP counselling during facility visit than others. WRA who received any FP counseling at PNC were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.28; 95% Confidence Interval [CI]: 1.09, 1.49). CONCLUSION Overall, only 40% women reported that they received any form of FP counseling when they interfaced with the healthcare system in the past two years. Informally employed women were more likely to receive FP counselling, and women who received FP counselling during PNC visits were significantly more likely to use contraceptive in comparison to the women who did not receive FP counselling. This presents a missed opportunity for prevention of unintended pregnancies and suggests a need for further integration of FP counseling into the ANC and PNC visits.
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Affiliation(s)
- Caroline Amour
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rachel N. Manongi
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Michael J. Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Bilikisu Elewonibi
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Amina Farah
- Department of Community Health, KCMC Hospital, Moshi, Tanzania
| | - Sia Emmanuel Msuya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Community Health, KCMC Hospital, Moshi, Tanzania
| | - Iqbal Shah
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Gawron LM, Simonsen S, Millar MM, Lewis-Caporal J, Patel S, Simmons RG. Pregnancy Risk Screening and Counseling for Women Veterans: Piloting the One Key Question in the Veterans Healthcare Administration. South Med J 2021; 114:150-155. [PMID: 33655308 DOI: 10.14423/smj.0000000000001218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Women veterans have a high prevalence of comorbidities that increase the risk of adverse pregnancy outcomes. Screening for pregnancy desires in primary care provider (PCP) visits offers an opportunity to optimize preconception health. This pilot quality improvement initiative sought to assess Veterans Healthcare Administration provider preferences on One Key Question (OKQ) implementation, identification of veterans' reproductive needs, and the effect of training on documentation in a women's primary care clinic in Salt Lake City, Utah. METHODS We hosted OKQ training sessions for providers and staff, audio recorded group discussions on implementation barriers, and explored themes. Women veterans presenting for a PCP visit in July 2018 self-completed a paper OKQ screening tool. We calculated summary statistics on responses. We conducted a pre-post analysis, with respect to training sessions, to measure for changes in family planning documentation during PCP visits. RESULTS Nineteen providers and staff completed the training. They acknowledged the importance, but believed that the screening tool should be completed by veterans and not be provider prompted. Forty-two women veterans completed the screening tool: 21% desired pregnancy in the next year and 26% desired contraceptive information. Chart reviews found a nonsignificant increase in current contraceptive method documentation between periods (20% vs 37%; P = 0.08), a decline in documentation of reproductive goals (22% vs 3%; P = 0.02), and no significant change in counseling. CONCLUSIONS Veterans identify reproductive needs via the OKQ screening tool, but provider documentation did not reflect changes in care following training. Further study is necessary to develop an optimal, patient-centered tool and implementation plan to support women veterans in their reproductive goals.
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Affiliation(s)
- Lori M Gawron
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Sara Simonsen
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Morgan M Millar
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Jessica Lewis-Caporal
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Shardool Patel
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Rebecca G Simmons
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
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Worthington RO, Oyler J, Pincavage A, Baker NA, Saathoff M, Rusiecki J. A Novel Contraception Counseling and Shared Decision-Making Curriculum for Internal Medicine Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11046. [PMID: 33324751 PMCID: PMC7727611 DOI: 10.15766/mep_2374-8265.11046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/11/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Many women of reproductive age with complex medical conditions receive primary care through an internal medicine (IM) physician rather than an obstetrician/gynecologist. Long-acting reversible contraception methods are the most effective form of contraception; however, IM residents are not routinely trained in them. Infrequent training in, inadequate knowledge of, and discomfort with contraception counseling limit the counseling performed by IM residents. Shared decision-making (SDM) is a method of patient-centered communication that can improve communication about patient preferences and increase patient satisfaction with and adherence to contraception. We developed a curriculum to teach contraception counseling under the framework of SDM for IM residents. METHODS The curriculum focused on contraception counseling through the lens of SDM designed for IM and medicine/pediatrics residents (PGY 2-PGY 4). We adapted an existing seven-step model of SDM to fit elements of contraception counseling. The curriculum consisted of a didactic teaching session with integration of an instructional video and structured interactive discussion. The session lasted 60 minutes. RESULTS Fifty-eight residents participated in the curriculum. On pre- and postcurriculum surveys, residents reported improvement in contraception knowledge (overall mean precurriculum = 57%, postcurriculum = 70%, p < .001) and comfort with contraception counseling (overall mean precurriculum = 3.2, postcurriculum = 3.6, p < .01). Residents expressed strong support for SDM before and after the curriculum. DISCUSSION Based on the survey results, the curriculum successfully addressed gaps in residents' comfort with contraception counseling and knowledge of contraception side effects and efficacy.
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Affiliation(s)
| | - Julie Oyler
- Associate Professor, Department of Medicine, University of Chicago Medicine; Associate Program Director, Internal Medicine Residency Program, University of Chicago Medicine; Associate Medical Director, Resident Clinic, Primary Care Group, University of Chicago Medicine
| | - Amber Pincavage
- Associate Professor, Department of Medicine, University of Chicago Medicine; Clerkship Director, Department of Medicine, University of Chicago Medicine
| | - Nabil Abou Baker
- Assistant Professor, Departments of Internal Medicine and Pediatrics, University of Chicago Medicine
| | - Mark Saathoff
- Director of Educational Technology and Learning for Clinical Skills Education, University of Chicago Pritzker School of Medicine
| | - Jennifer Rusiecki
- Assistant Professor, Department of Medicine, University of Chicago Medicine; Women's Health Track Director, Internal Medicine Residency Program, University of Chicago Medicine
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Huysman BC, Paul R, Nigaglioni Rivera A, Tal E, Maddipati R, Madden T. Patient and counselor satisfaction with structured contraceptive counseling by health center staff in federally qualified health centers. Contraception 2020; 103:97-102. [PMID: 33160909 DOI: 10.1016/j.contraception.2020.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To characterize patient and counselor satisfaction with structured, tier-based contraceptive counseling provided by a nonclinician. STUDY DESIGN We conducted a planned secondary analysis of patient and counselor surveys from a study that enrolled women in 2 contraceptive care programs. All participants received structured contraceptive counseling from trained staff members. Women and counselors completed a confidential post-visit survey regarding satisfaction with counseling and medical mistrust. We used univariate and multivariable regressions to examine differences in high satisfaction with counseling (top score), perceived counselor influence, and perceived counselor judgment by participant characteristics. RESULTS Nine hundred forty-two participants completed surveys; most reported they felt respected (100.0%), trusted the counseling information (99.5%), and that counseling helped them choose a contraceptive method (83.8%). Black race, high school education, public insurance, an income below the federal poverty level, and enrollment site were associated with high medical mistrust. Participants with high medical mistrust were less likely to be highly satisfied with counseling (adjusted relative risk (RR) 0.72; 95% confidence interval [CI] 0.63-0.82), more likely to perceive influence (RR 1.77; 95% CI 1.37-2.28), and more likely to perceive judgment (adjusted odds ratio 8.91; 95% CI 3.61-22.01). Mostly, counselors felt they were able to answer participant questions (98.8%), establish good rapport (95.9%), and that participants understood the information presented (98.0%). CONCLUSIONS Overall, participants were satisfied with tier-based contraceptive counseling delivered by nonclinician staff members. Those with high levels of medical mistrust were less likely to be satisfied. The majority of women found the information beneficial in contraceptive decision making. IMPLICATIONS Overall, women reported high satisfaction with tier-based contraceptive counseling delivered by a nonclinician in 3 federally qualified health centers. However, women with high medical mistrust were less likely to report high levels of satisfaction and more likely to report perceived influence or judgment from the counselor.
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Affiliation(s)
- Bridget C Huysman
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Rachel Paul
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Adriana Nigaglioni Rivera
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Elana Tal
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ragini Maddipati
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Tessa Madden
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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López García-Franco A, Baeyens Fernández JA, Bailón Muñoz E, Iglesias Piñeiro MJ, Ortega Del Moral A, Coello PA, Ruiz Cabello C, Landa Goñi J, Arribas Mir L. [Preventive activities in women's care]. Aten Primaria 2020; 52 Suppl 2:125-148. [PMID: 33388112 PMCID: PMC7801221 DOI: 10.1016/j.aprim.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 12/17/2022] Open
Abstract
A review is presented of the scientific evidence on preventive activities in women's care in relation to pregnancy follow-up, preventive activities in the planning and follow-up of contraceptive methods, preventive activities in menopause, and the prevention of osteoporotic fractures.
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Affiliation(s)
| | | | - Emilia Bailón Muñoz
- Medicina Familiar y Comunitaria, Centro de Salud Universitario de Albaycín, Granada, España
| | | | | | - Pablo Alonso Coello
- Medicina Familiar y Comunitaria, Centro Cochrane Iberoamericano (CIBERESP-IIB Sant Pau), Barcelona, España
| | - Cristina Ruiz Cabello
- Medicina Familiar y Comunitaria, Consultorio Castilléjar, zona básica de Benamaurel, Granada, España
| | - Jacinta Landa Goñi
- Medicina Familiar y Comunitaria, Centro de Salud Emisora, Pozuelo de Alarcón, Madrid, España
| | - Lorenzo Arribas Mir
- Medicina Familiar y Comunitaria, Centro de Salud Universitario La Chana, Granada, España
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Song B, White VanGompel E, Wang C, Guzman S, Carlock F, Schueler K, Stulberg DB. Effects of clinic-level implementation of One Key Question® on reproductive health counseling and patient satisfaction. Contraception 2020; 103:6-12. [PMID: 33130107 DOI: 10.1016/j.contraception.2020.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We evaluated the effect of clinic level implementation of the One Key Question (OKQ) intervention, including physician and staff training and workflow adjustments, on reproductive counseling and patient satisfaction in primary care and ob/gyn. STUDY DESIGN We implemented the OKQ intervention in one primary care and one ob/gyn practice, while observing another primary care and ob/gyn practice that each provided usual care (control practices). We surveyed separate patient cohorts at two time points: 26 before and 33 after the primary care practice implemented OKQ, 38 before and 36 after the ob/gyn practice implemented OKQ, 26 and 37 at the primary care control practice, and 31 and 37 at the ob/gyn control practice. We used chi square tests to assess OKQ's effects on counseling rates and patient satisfaction, comparing intervention to control practices across time points. RESULTS In primary care, from before to after implementation, the intervention practice did not significantly increase reproductive counseling (69-76%, p = 0.58), but increased patient satisfaction (81-97%, p = 0.04) while the control practice demonstrated a decrease in patient satisfaction over the same time periods. In the ob/gyn clinics, no significant change in reproductive counseling or patient satisfaction was seen in the intervention practice, while the control practice demonstrated a decrease in patient satisfaction. CONCLUSIONS Implementing OKQ appears to increase patient satisfaction. Larger studies are needed to assess whether this clinic-level intervention may increase reproductive counseling. IMPLICATIONS Further studies of the impact of clinic-level implementation of OKQ are needed.
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Affiliation(s)
- Bonnie Song
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Emily White VanGompel
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA; Department of Family Medicine, University of Chicago, 5841 S Maryland Ave., MC 7110, Chicago, IL 60637, USA; NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Chi Wang
- NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Suzette Guzman
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Francesca Carlock
- NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Kellie Schueler
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Debra B Stulberg
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA; Department of Family Medicine, University of Chicago, 5841 S Maryland Ave., MC 7110, Chicago, IL 60637, USA.
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Abstract
INTRODUCTION Unplanned pregnancies lead to adverse health outcomes and contribute to economic burdens. A lack of continuity and consistency in immediate postpartum care may be a contributor. The most frequent postpartum medical encounters occur with the child's pediatric health care provider, which represents an opportunity to discuss postpartum contraception. Therefore, our objective was to evaluate postpartum family planning knowledge and behavior in women, and to assess the potential acceptability of a pediatrician-delivered intervention to improve knowledge of and convenient access to contraception among postpartum women. METHODS This was a non-interventional pilot study that employed survey and interview methodology. RESULTS Women attending pediatric visits for their newborn or infant (N = 346) were surveyed; 35 were interviewed. On average, respondents were 27 years old (SD = 6), 6 months postpartum (SD = 5), and resumed sex 8 weeks after delivery (SD = 6). Of those who had resumed sex, 68% were not using contraception at the time. However, only 18% of survey respondents wanted to have another child. Few exhibited accurate knowledge of birth spacing or long acting reversible contraception. Most interviewees (86%) supported the idea of pediatricians providing contraceptive counseling. Concerns identified included whether it was "allowable" and pediatrician's lack of knowledge of complex maternal health histories. DISCUSSION This study highlights a gap between contraceptive need and provision in postpartum women. However, the findings suggest women's willingness to engage in conversations with their child's pediatrician about family planning. Future research should assess the feasibility and impact of integrating postpartum counseling into pediatric visits.
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Tahaineh L, Alkyam MM, Al‐Sawalha NA, Jaber D, Albsoul‐Younes AM. Evaluation of the clinical pharmacist's role in educating women about the benefits and risks of combined oral contraceptive pills in Jordan. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Linda Tahaineh
- Department of Clinical PharmacyCollege of Pharmacy, Jordan University of Science and Technology (JUST) Irbid Jordan
| | - Mayssam M. Alkyam
- Department of Clinical PharmacyCollege of Pharmacy, Jordan University of Science and Technology (JUST) Irbid Jordan
| | - Nour A. Al‐Sawalha
- Department of Clinical PharmacyCollege of Pharmacy, Jordan University of Science and Technology (JUST) Irbid Jordan
| | - Deema Jaber
- Department of Clinical PharmacySchool of PharmacyZarqa University Zarqa Jordan
| | - Abla M. Albsoul‐Younes
- Department of Biopharmaceutics and Clinical PharmacyFaculty of PharmacyThe University of Jordan (JU) Amman Jordan
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Hrusa G, Spigt M, Dejene T, Shiferaw S. Quality of Family Planning Counseling in Ethiopia: Trends and determinants of information received by female modern contraceptive users, evidence from national survey data, (2014- 2018). PLoS One 2020; 15:e0228714. [PMID: 32040485 PMCID: PMC7010283 DOI: 10.1371/journal.pone.0228714] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Family planning counseling is critical for women to make informed reproductive and sexual health decisions. Despite Ethiopia's success in expanding access to family planning services, information on the quality of family planning counseling is limited. The objectives of this study were to assess whether the quality of counseling from the female client´s perspective has changed over time (2014 to 2018) and to investigate determinants associated with the quality of counseling to provide a more nuanced understanding of disparities in sexual and reproductive health outcomes in Ethiopia. METHODS Data were obtained from five rounds of the Ethiopian Performance Monitoring and Accountability 2020 female survey questionnaire. Quality of counseling was categorized into four levels based on the responses of the questions that compose the Method Information Index, a core Family Planning 2020 indicator that serves as a proxy for quality of counseling and reflects the extent to which women are informed about side effects and alternate methods. The proportion of female contraceptive users that received good counseling were examined over time by each region, demographic characteristics, and contraception method type and source. Ordinal logistic regression was applied to the last survey round (2018) to investigate determinants associated with counseling quality. RESULTS The proportion of female contraception users that reported receiving information on all three questions did not significantly change over the period 2014 to 2018. Overall quality of counseling on family planning was low, with only 30% of women reporting receiving sufficient information during counseling. The likelihood of good quality counseling was the least among those who had no formal schooling when compared to those who had higher educational attainment (OR = 0.70, 95% CI: 0.50, 0.97). Women from the wealthiest quintile were 1.72 times more likely (95% CI: 1.10, 2.69) to receive good quality counseling when compared to women in the lower wealth quintile. Women from rural areas were 1.51 times more likely to have received good counseling when compared to those in urban areas (95% CI: 1.04, 2.18). Amhara residents were less likely to receive good counseling when compared to the SNNPR (OR: 0.51, 95% CI: 0.32, 0.81). Women who acquired their method from the private sector had worse counseling (OR: 0.31, 95% CI: 0.23, 0.41) when compared to the public sector. Those using short-acting methods were more at risk of receiving lesser quality counseling when compared to users of long-acting methods (OR: 0.58, 95% CI: 0.46, 0.72). CONCLUSION The results of this analysis indicated that Ethiopia's overall progress in modern contraceptive use has not been accompanied by a corresponding increase in the quality of family planning counseling. Improving the quality of contraception counseling for women across all demographics, including wealth quintiles and education, is a crucial strategy to support positive reproductive health outcomes with a rights-based focus. Based on the findings of this study, it is essential to emphasize the need to do proper counseling for all methods including short-acting methods especially for those working the private sector and some of the regions which have lower prevalence of good counseling. Further community-based participatory and qualitative research should focus on understanding the root causes and barriers to the delivery of high-quality counseling in Ethiopia.
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Affiliation(s)
- Gili Hrusa
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Mark Spigt
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Community Medicine, General Practice Research Unit, the Arctic University of Norway, Tromsø, Norway
| | - Tariku Dejene
- Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Caldwell MT, Hambrick N, Vallee P, Thomas CSD, Sutton A, Daniels G, Goyal N, Manteuffel J, Joseph CLM, Guetterman TC. "They're Doing Their Job": Women's Acceptance of Emergency Department Contraception Counseling. Ann Emerg Med 2020; 76:515-526. [PMID: 31959536 DOI: 10.1016/j.annemergmed.2019.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE We explore reproductive-aged women's acceptance of contraception counseling in the emergency department (ED). METHODS This study is phase 1 of an exploratory sequential mixed methods study. We purposively interviewed 31 participants with the following criteria: black, white, or Latina race/ethnicity; nonpregnant; aged 15 to 44 years; receiving nonemergency care; not using highly effective contraception; and did not intend to become pregnant. We conducted semistructured interviews with a piloted interview guide until reaching thematic saturation. We coded transcripts with an iteratively developed codebook, maintaining intercoder agreement greater than 80%. Qualitative acceptance of ED contraception counseling was grouped into 3 categories: acceptable, unacceptable, and equivocal. We conducted a thematic text analysis to assess themes expressing support and concern for ED contraception counseling. Qualitative findings were stratified by age, race, and frequency of ED use. Using components of grounded theory, we developed a conceptual model. RESULTS Most participants (81%) accepted ED contraception counseling. Themes expressing support and concern for ED contraception counseling included opportunity to address women's unmet contraception needs, contraception is within the scope of ED practice, the ED is a convenient setting with competent providers, contraception is a sensitive topic, and the ED may be an inappropriate setting for some women. Latina participants had lower acceptance of ED contraception counseling. Dominant subthemes varied slightly by race, age, and frequency of ED use. CONCLUSION Diverse women had high acceptance of contraception counseling in the ED. Perspectives expressing both support and concern in regard to ED contraception counseling were explored in detail.
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Affiliation(s)
| | - Nanci Hambrick
- Center for Behavioral Health and Justice, Wayne State University School of Social Work, Detroit, MI
| | - Phyllis Vallee
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI
| | | | | | | | - Nikhil Goyal
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; Department of Internal Medicine, Henry Ford Hospital, Detroit, MI
| | - Jacob Manteuffel
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI
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Moore CL, Edie AH, Johnson JL, Stevenson EL. Long-acting reversible contraception: Assessment of knowledge and interest among college females. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:615-619. [PMID: 30239327 DOI: 10.1080/07448481.2018.1500473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/24/2018] [Accepted: 05/29/2018] [Indexed: 06/08/2023]
Abstract
Objective: To implement the Long-Acting Reversible Contraception Quality Improvement (LARC QI) project using evidence-based contraceptive counseling techniques to improve knowledge and intent to use among college females. Participants: The project, conducted from April through September 2017, involved 41 female students, from a 4-year public college in North Carolina. Methods: Students participated in group educational sessions on all methods of birth control with an emphasis on LARC. Surveys were administered to group participants and descriptive statistics were used to determine the difference in knowledge scores and intent to use. Descriptive and qualitative analysis described usage of LARC methods. Results: LARC knowledge scores significantly improved. Intention to use also increased compared to reported actual use. The final chart review demonstrated an increase usage of the subdermal implant, but no change for intrauterine device. Conclusions: The college setting offers a unique opportunity to use evidence-based contraceptive counseling techniques to guide use of LARC.
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Affiliation(s)
| | - Alison H Edie
- School of Nursing, Duke University , Durham , NC , USA
| | - Jennifer L Johnson
- School of Nursing, Fayetteville State University , Fayetteville , NC , USA
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Mahendra IGAA, Wilopo SA, Putra IGNE. The role of decision-making pattern on the use of long-acting and permanent contraceptive methods among married women in Indonesia. EUR J CONTRACEP REPR 2019; 24:480-486. [PMID: 31566414 DOI: 10.1080/13625187.2019.1670345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: This study aimed to analyse the association between the decision-making pattern and the use of long-acting and permanent methods of contraception (LAPMs) among married and cohabiting women in Indonesia, by controlling for variables at the individual and community or regional level, and geographical area (province).Methods: A cross-sectional survey was conducted using secondary data from Performance Monitoring and Accountability 2020 (PMA2020) which involved 4724 married or cohabitating women aged 15-49 years. Data were analysed using bivariate and multivariate analysis. Multilevel logistic regression was performed to investigate the determinants by taking geographical area into account.Results: The majority of women (63.8%) had made their own decision on current contraceptive use, 30.1% had made a joint decision with their partner or health care provider, and 6.1% had not been involved in the decision-making process. Multilevel analysis showed that the decision-making pattern and individual level factors were significantly associated with LAPM use, and variables at community or regional level were not significant predictors. Compared with women who had made their own decision on contraceptive use, LAPM use was 2.3 times higher in women who had made a joint decision with their partner or health care provider (odds ratio [OR] 2.3; 95% confidence interval [CI] 2.0, 2.7; p < .001) and more than three times higher in women not involved in the decision-making process (OR 3.1; 95% CI 2.3, 4.1; p < .001).Conclusion: Coercion potentially occurs in the contraceptive decision-making process. Our findings suggest that LAPM use may be increased by encouraging joint contraceptive decision making. Increasing women's participation in the decision-making process is an integral part of respecting women's reproductive autonomy.
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Affiliation(s)
| | - Siswanto Agus Wilopo
- Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - I Gusti Ngurah Edi Putra
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia
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Tyson NA. Reproductive Health: Options, Strategies, and Empowerment of Women. Obstet Gynecol Clin North Am 2019; 46:409-430. [PMID: 31378285 DOI: 10.1016/j.ogc.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Contraception is paramount to the overall health and longevity of women. Most women in the United States use birth control in their reproductive lifetimes. All options should be available and easily accessible to permit individualization and optimization of chosen methods. Current contraceptive methods available in the United States are reviewed. Emergency contraception, contraception in the postpartum period, and strategies to tailor methods to those affected by partner violence are also addressed. Tables and flow charts help providers and patients compare various contraceptive methods, optimize the start of a method, and identify resources for addressing safety in those with underlying medical conditions.
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Affiliation(s)
- Nichole A Tyson
- Department of Obstetrics and Gynecology, The Permanente Medical Group, 1600 Eureka Road, Medical Office Building C, 3rd Floor, Roseville, CA 95661, USA; UC Davis Medical Center, Sacramento, CA, USA.
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Effective patient education techniques for preventing unintended pregnancies. JAAPA 2019; 32:19-23. [PMID: 31094870 DOI: 10.1097/01.jaa.0000558233.14498.d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ample resources exist detailing the variety of contraceptive options for patients who want to prevent an unintended pregnancy; however, few resources provide tools to guide clinicians in best practices for history taking and patient education about contraceptive use. This article attempts to fill this gap by reviewing current recommendations on timing of patient education, techniques to open a discussion, and common patient misunderstandings about pregnancy and contraception.
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Barr AC, Badell ML, Vettese TE. Contraception Counseling in Patients With SLE and Other Chronic Medical Conditions Requiring Potentially Teratogenic Medications: A Teachable Moment. JAMA Intern Med 2019; 179:562-563. [PMID: 30688978 DOI: 10.1001/jamainternmed.2018.7990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Martina L Badell
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Theresa E Vettese
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Assaf S, Davis LM. Women’s modern contraceptive use in sub-Saharan Africa: does men’s involvement matter? JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Maciuba JM, Chen JM. A New Contraception Curriculum in the Internal Medicine Residency Primary Care Clinic. Mil Med 2019; 184:e61-e64. [PMID: 30053194 DOI: 10.1093/milmed/usy174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/27/2018] [Indexed: 11/12/2022] Open
Abstract
Introduction Nearly half of all pregnancies in the USA are unintended with a relatively higher proportion occurring in military populations, which can have a large impact on military readiness. Military and civilian internal medicine residency programs do not place an emphasis on contraception in the primary care setting. This intervention sought to elucidate the perceptions of contraception in an internal medicine primary care setting in a military residency and improve confidence in contraceptive counseling and prescribing. Material and Methods Residents at a military internal residency program were given an hour-long didactic presentation on contraception that was followed 5 weeks later by the implementation of a pocket card for point of care use with key information from the presentation. Residents became certified in the placement and removal of the etonogestrel implant. Pre- and post-intervention surveys were administered to assess for changes in attitudes and confidence in prescribing and counseling. This project was determined to be a quality improvement project by the IRB board of the home institution. Results Forty-two of 75 (56%) residents responded initially and 40 of 75 (53%) responded after the intervention. There was a significant improvement in resident attitudes towards the applicability of contraception training in internal medicine (p = 0.03) as well as acquiring the skill of etonogestrel implant placement (p = 0.001). There was a trend towards significance in confidence in prescribing oral contraception (p = 0.053). There was no change in residents' confidence in counseling on oral contraception (p = 0.45). Conclusion A change in the contraception curriculum led to improved residents' skills in etonogestrel placement, and attitudes regarding the applicability of training in contraception to internal medicine, but did not significantly improve confidence in contraceptive counseling. These results suggest that internal medicine residencies should focus on teaching contraception to improve the attitudes in future internists who will need to address contraception in the military population. Future studies could include assessing physician preparedness for addressing contraception during general medical officer tours.
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Affiliation(s)
- Joseph M Maciuba
- Department of Internal Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD
| | - Julie M Chen
- Department of Internal Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD
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Santibenchakul S, Tschann M, Carlson ADP, L Hurwitz E, Salcedo J. Promotion of Long-Acting Reversible Contraception Among Adolescents and Young Adults. J Midwifery Womens Health 2018; 64:194-200. [PMID: 30570219 DOI: 10.1111/jmwh.12934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Intrauterine devices and contraceptive implants are recommended as first-line contraceptives by health care professional societies. However, uptake among US women lags substantially behind other developed countries. Little information is available on the extent to which clinicians document discussion about long-acting reversible contraception (LARC) in this patient population. We sought to determine the frequency with which clinicians document LARC discussion with eligible women aged 14 to 25 years in a training clinic and evaluate factors associated with LARC discussion and uptake. METHODS We conducted a retrospective chart review of all visits of nonpregnant women aged 14 to 25 years seen at an obstetrics and gynecology resident physician clinic during a calendar year. A logistic regression model was used to assess demographic factors associated with LARC education and uptake. RESULTS Among 450 visits by eligible patients, LARC discussion was documented during 47.8% (215/450) of visits. Among visits with documentation of LARC counseling, 45.6% (98/215) had documentation of a LARC placement plan. Among patients who decided to initiate LARC, 40.8% (40/98) had a device placed at the same visit. LARC placement was documented during 8.9% (40/450) of visits. Clinicians documented LARC counseling for women aged 14 to 19 years more frequently than for women aged 20 to 25 years. Compared with women who did not use any method of contraception, clinicians documented LARC counseling less frequently for women who used short-term hormonal contraception. DISCUSSION Clinicians in a training clinic did not document LARC counseling for more than half of eligible patients. Every clinical visit is an opportunity to assess risk of unintended pregnancy and ensure that contraceptive needs are addressed.
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Berardi MC, Mendes-Rodrigues C, Paro HBMDS. Contraceptive counseling lectures do not influence decision making in family planning services. CIENCIA & SAUDE COLETIVA 2018; 25:2369-2376. [PMID: 32520281 DOI: 10.1590/1413-81232020256.26472018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/07/2018] [Indexed: 11/22/2022] Open
Abstract
Family planning services should provide women and men with information on contraceptive methods. This study aimed to evaluate the impact of multidisciplinary contraceptive counseling lectures related to the efficacy and individual choices of contraceptive methods. Sociodemographic variables, preferred methods and opinion about the efficacy of contraceptive methods of 101 participants were analyzed. After the lecture, a lower percentage of men declared that they did not know which contraceptive method was more efficacious (24.3% versus 0.0%; p=0.006). Also, a lower percentage of women (12.7% versus 1.8%; p=0.020) and men (25.5% versus 7.7%; p=0.003) reported that they did not know which contraceptive method was less efficacious. Number of children increased the likelihood of choosing an irreversible method in a 30.87-fold (95%CI, 5.503 to 173.168, p<0.001). The choice of irreversible methods did not change after the counseling lecture (p>0.05). The lecture impacted on participants' opinions about the efficacy of contraceptive methods, making them have more informed choices. However, it did not influence their choice of contraception. Number of children was the most determining factor in choosing irreversible methods.
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Affiliation(s)
- Marília Cristina Berardi
- Diagnosis Department, Postgraduate Program in Health Science, Medical School, Federal University of Uberlandia (UFU). Av. Pará 1357/1358, Umuarama. 38405-320, Uberlândia, MG, Brazil.
| | - Clesnan Mendes-Rodrigues
- Department of Surgical Clinical Nursing, Nursing School, Medical School, UFU. Uberlândia, MG, Brazil
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Jadhav A, Vala-Haynes E. INFORMED CHOICE AND FEMALE STERILIZATION IN SOUTH ASIA AND LATIN AMERICA. J Biosoc Sci 2018; 50:823-839. [PMID: 29343307 DOI: 10.1017/s0021932017000621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Globally, female sterilization is one of the most popular contraceptive methods despite concerns about quality of care for women who report being sterilized. In this study, informed choice among sterilized women was quantified using Demographic and Health Survey (DHS) data from 2000 to 2012 for countries in South Asia and Latin America. Three responses measured informed choice and knowledge about whether women were informed by a health worker or provider: that sterilization is permanent, the potential side-effects of sterilization and other methods of contraception. An ascending composite Method Information Index with scores ranging from 0 (women received no information) to 3 (women received information across all three indicators) was used. Using ordinal logistic regression analysis, the results indicated that women younger than 25 and older than 35 at the time of sterilization, and those at high parities, had lower odds of a high score on the index, while the opposite was true for women sterilized in the private sector in Latin America. Educated women in India had higher odds of a high score on the index, while the same was true for educated and wealthy women in Colombia. These findings indicate that not enough health care providers spend time informing women in South Asia and Latin America about different aspects of sterilization, and that there are specific groups of women that are more affected. There is an urgent need to improve quality of care within health systems providing sterilization for this very important and effective type of contraception.
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Affiliation(s)
- Apoorva Jadhav
- *Population Studies Center,University of Michigan,Ann Arbor,MI,USA
| | - Emily Vala-Haynes
- †Division of Health and Exercise Science,Western Oregon University,Monmouth,OR,USA
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Mandiwa C, Namondwe B, Makwinja A, Zamawe C. Factors associated with contraceptive use among young women in Malawi: analysis of the 2015-16 Malawi demographic and health survey data. Contracept Reprod Med 2018; 3:12. [PMID: 30250748 PMCID: PMC6146597 DOI: 10.1186/s40834-018-0065-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Although Malawi is one of the countries with highest Contraceptive Prevalence Rate (CPR) in Sub-Saharan Africa, pregnancies and fertility among young women remain high. This suggests low up take of contraceptives by young women. The aim of this study was to investigate the factors associated with contraceptive use among young women in Malawi. Methods This is a secondary analysis of household data for 10,422 young women aged 15-24 years collected during the 2015-16 Malawi Demographic and Health Survey (MDHS). The sample was weighted to ensure representativeness. Descriptive statistics, bivariate and multivariate logistic regressions were performed to assess the demographic, social - economic and other factors that influence contraceptive use among young women. Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) with their corresponding 95% confidence intervals (95% CI) were computed using the Statistical Package for the Social Sciences version 22.0. Results Of the 10,422 young women, 3219 used contraception representing a prevalence of 30.9%. The findings indicate that age, region of residence, marital status, education, religion, work status, a visit to health facility, and knowledge of the ovulatory cycle are significant predictors of contraceptive use among young women in Malawi. Women who were in the age group 20-24 years (AOR = 1.93; 95% CI = 1.73-2.16), working (AOR = 1.26; 95% CI = 1.14-1.39), currently married (AOR = 6.26; 95% CI = 5.46-7.18), knowledgeable about their ovulatory cycle (AOR = 1.75; 95% CI = 1.50-2.05), and those with primary education (AOR = 1.47; 95% CI = 1.18-1.83) were more likely to use contraceptives than their counterparts. Conclusion This study has demonstrated that several social demographic and economic factors are associated with contraceptive use among young women in Malawi. These findings should be considered and reflected in public health policies to address issues that could be barriers to the use of contraception by young women. Strengthening access to family planning information and services for young women is highly recommended to reduce pregnancies among young women in Malawi.
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Affiliation(s)
- Chrispin Mandiwa
- Ministry of Health, South-West Zone Health Support Office, P.O. Box 3, Blantyre, Malawi.,Malawi Health Sector Programme (DFID Project), Lilongwe, Malawi
| | | | - Andrew Makwinja
- 3University of Malawi, College of Medicine, Blantyre, Malawi
| | - Collins Zamawe
- University College London, Institute for Global Health, London, UK
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Pill, patch or ring? A mixed methods analysis of provider counseling about combined hormonal contraception. Contraception 2018; 99:104-110. [PMID: 30227121 DOI: 10.1016/j.contraception.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 08/23/2018] [Accepted: 09/06/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study we aimed to investigate the content and process of contraceptive counseling surrounding combined hormonal contraceptive (CHC) methods (combined oral contraceptives, the ring, and the patch). STUDY DESIGN We performed a mixed methods analysis of data collected as part of the Patient-Provider Communication about Contraception study, in which reproductive age women and their providers were recruited at several San Francisco Bay Area clinics from 2009-2012. Participants completed pre- and post-visit surveys, and had their visits audio recorded and transcribed. We performed descriptive and bivariate analyses of the entire cohort to examine associations between demographic characteristics and pre-existing method preferences with method selection and counseling content, and coded transcripts of a subset of the sample for salient themes related to content and process of counseling about combined hormonal contraceptive methods using a directed content analysis approach. RESULTS The overall sample included 342 women, with 152 women (44%) having a preference for a specific CHC prior to their visit, 127 women (37%) had a preference for a non-CHC method, and 63 (18%) having no existing method preference. Of the women who reported preferring a CHC in their pre-visit survey, the majority (72%) chose that method. We found that women were inconsistently counseled about the range of CHC methods. For example, women who had no pre-visit method preference (52%) or who preferred the ring (54%) or the patch (73%) were more likely to receive comprehensive counseling about the three CHC methods than were women who preferred combined oral contraceptives (35%) or non-CHC methods (33%). Providers mentioned the patch the least often, and in qualitative analysis indicated discomfort with prescribing this method. Side effects and benefits of methods, as well as strategies to enhance successful use of the chosen method, were inconsistently discussed. In only 73% of visits in which a woman chose a CHC did the provider assess the patient's ability to use the chosen method correctly, and in 66% of all visits in which women chose a CHC method, providers discussed what to do if she was dissatisfied with the method. CONCLUSIONS Counseling about combined hormonal contraceptive methods often does not include information about all available methods, or comprehensive information about side effects, benefits, or logistics of use. As this counseling can impact patient's satisfaction with and continuation of their chosen method of contraception, future work should focus on designing interventions to improve providers' ability to meet patients' needs. IMPLICATIONS Short acting hormonal contraception is widely used, but counseling for these methods often neglects key features. Comprehensive counseling about all methods and their individual features can improve contraceptive selection and use.
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Grubb LK, Beyda RM, Eissa MA, Benjamins LJ. A Contraception Quality Improvement Initiative with Detained Young Women: Counseling, Initiation, and Utilization. J Pediatr Adolesc Gynecol 2018; 31:405-410. [PMID: 29382540 DOI: 10.1016/j.jpag.2018.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 01/09/2018] [Accepted: 01/13/2018] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To assess the effect of providing standardized counseling to improve the rates of contraception initiation and utilization among detained young women. This was a quality improvement (QI) project conducted at a large urban juvenile short-term detention center. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The intervention included educating all staff and care providers, counseling detained young women on various contraceptive options, and offering contraception initiation with oral contraceptive pills or depot medroxyprogesterone acetate injection. Retrospective chart review before February 2012 established baseline contraception initiation and utilization rates. The QI intervention began in February 2012 and continued for 6 months followed by chart review. Outcomes measured included number of patients counseled about contraception, started contraception, and overall contraception utilization. RESULTS We reviewed 120 and 186 charts before and after intervention, respectively. Compared with baseline data, the intervention group had statistically significant (P < .05) higher proportions of patients counseled (10% [10/120] baseline vs 84% [156/186] intervention) and who started contraception (7% [8/120] baseline vs 52% [97/186] intervention). CONCLUSION This contraception QI intervention showed significant improvement in the rates of contraception counseling, contraception initiation, and utilization among detained young women. Most of youths' guardians were supportive and approved contraception initiation. This project showed it is feasible for health care providers to include contraception services for all intake assessments at juvenile detention facilities.
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Affiliation(s)
- Laura K Grubb
- McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, Texas; Tufts Medical Center, Boston, Massachusetts.
| | - Rebecca M Beyda
- McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Mona A Eissa
- McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Laura J Benjamins
- McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, Texas
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Pregnancy scares and change in contraceptive use. Contraception 2018; 98:260-265. [PMID: 30056159 DOI: 10.1016/j.contraception.2018.07.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We examined whether the experience of a "pregnancy scare" is related to subsequent changes in contraceptive use that increase the risk of unintended pregnancy. METHODS We used data from the Relationship Dynamics and Social Life (RDSL) study, which interviewed a random, population-based sample of 1003 young women weekly for 2.5 years. We used multivariate regression models to predict the effect of experiencing a pregnancy scare on change in contraceptive use. RESULTS We found pregnancy scares are associated with changes in contraceptive use that increase the risk of pregnancy. Experiencing a pregnancy scare is related to discontinued contraceptive use, change from consistent to inconsistent use of contraception, and change from a more effective to a less effective method of contraception. We also found pregnancy scares are associated with continued inconsistent use of contraception. CONCLUSIONS Our findings suggest that the experience of a pregnancy scare does not serve as a "wake-up call" to start using contraception, to start using it consistently, or to switch to a more effective method to reduce the risk of unintended pregnancy. Instead, contraceptive use after a pregnancy scare typically remains the same or worsens. IMPLICATIONS Clinicians should be aware that young women who have experienced pregnancy scares may be at increased risk of unintended pregnancy, relative to young women who did not experience a pregnancy scare.
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Vakilian K, Molavi S, Zamani AR, Goodarzi M. Effect of Motivational Interviewing on Using Intrauterine Device in Women at High Risk for Pregnancy. Open Access Maced J Med Sci 2018; 6:1306-1309. [PMID: 30087742 PMCID: PMC6062271 DOI: 10.3889/oamjms.2018.166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 06/09/2018] [Accepted: 06/10/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Reproductive health programs help women live healthier. Family planning consultation is an important component of reproductive health. A good family planning consultation can increase the use of effective birth control methods and improve the life quality of people, specifically of those at high risk. One of the most effective birth control techniques is an intrauterine device (IUD). AIM This study was done to investigate the effect of motivational interviewing (MI) on the use of IUD in women at high risk for pregnancy. METHODS This random educational trial was conducted in Isfahan on 44 women at high risk for pregnancy in 2015. Subjects were selected through random sampling. First, written informed consent of all samples was gathered, and then the intervention was made in five 45-minute motivational interviewing sessions by the researcher. For this study, a questionnaire was created to measure knowledge, attitude, acceptance, and performance. All the subjects filled this instrument prior and one month after the intervention. Data were then analysed using SPSS 20. The employed statistical tests included dependent t-test, independent t-test, Mann-Whitney, Fischer's exact test, and McNemar's test. RESULTS Results suggested that MI significantly improved the use of IUD in the intervention group (p < 0.001). Also, the mean knowledge (p < 0.001) and attitude (p < 0.001) scores significantly increased in the intervention group. CONCLUSION Due to the role of MI in increasing the use of IUD, embedding this type of consultation in specific programs for changing health behaviours during pregnancy can be beneficial.
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Affiliation(s)
- Katayoon Vakilian
- Arak University of Medical Sciences, Arak School of Nursing and Midwifery, Arak, Iran
| | - Sajedeh Molavi
- Arak University of Medical Sciences, Arak School of Nursing and Midwifery, Arak, Iran
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García-Franco AL, Baeyens Fernández JA, Bailón Muñoz E, Iglesias Piñeiro MJ, Cura González ID, Del Moral AO, Landa Goñi J, Alonso Coello P, Arribas Mir L. Actividades preventivas en la mujer. Actualización PAPPS 2018. Aten Primaria 2018; 50 Suppl 1:125-146. [PMID: 29866353 PMCID: PMC6836928 DOI: 10.1016/s0212-6567(18)30366-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
| | | | - Emilia Bailón Muñoz
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Universitario de Albaycín, Granada
| | | | - Isabel Del Cura González
- Especialista en Medicina Familiar y Comunitaria, Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Madrid
| | | | - Jacinta Landa Goñi
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Emisora, Pozuelo de Alarcón, Madrid
| | - Pablo Alonso Coello
- Especialista en Medicina Familiar y Comunitaria, Centro Cochrane Iberoamericano (CIBERESP-IIB Sant Pau), Barcelona
| | - Lorenzo Arribas Mir
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Universitario La Chana, Granada
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40
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Burgess CK, Henning PA, Norman WV, Manze MG, Jones HE. A systematic review of the effect of reproductive intention screening in primary care settings on reproductive health outcomes. Fam Pract 2018; 35:122-131. [PMID: 28973668 PMCID: PMC5892170 DOI: 10.1093/fampra/cmx086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE No recommendations exist for routine reproductive intention screening in primary care. The objective of this systematic review is to assess the effect of reproductive intention screening in primary care on reproductive health outcomes (PROSPERO CRD42015019726). METHODS We performed a systematic search in Ovid Medline, PubMed, CINAHL, Embase, CDR/DARE databases, Web of Science, ISRCTN registry, Clinicaltrials.gov and Cochrane Library. Studies published in English between 2000 and 2017 and whose population was patients of reproductive age (15-49) were included. Studies without a comparison group were excluded. Two independent reviewers assessed eligibility, study quality and abstracted data. RESULTS Of 24 780 titles and/or abstracts reviewed, nine studies met inclusion criteria: four randomized controlled trials (RCTs) and five observational studies. Two RCTs and one quasi-experimental cohort study showed a statistically significant increase in knowledge related to healthier pregnancy, such as the benefits of folic acid supplementation, and increased risk profiles for those with chronic conditions. Among studies measuring contraceptive use, only one cohort study showed any increase while the RCT and retrospective cohort did not show a statistically significant effect. Neither of the two RCTs that assessed the provision of contraception by primary care providers for those not desiring pregnancy found increased access to contraception, although one found increased documentation of contraception in electronic medical records. Acceptability of reproductive intention screening was measured in seven studies, and participant satisfaction was high in all seven studies. CONCLUSIONS More research is needed to determine whether routine inclusion of reproductive intention screening in primary care is warranted.
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Affiliation(s)
- Carolyne K Burgess
- Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, USA
| | - Paul A Henning
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Canada.,Department of Family Practice, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Department of Family Practice, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meredith G Manze
- Department of Community Health and Social Sciences, City University of New York School of Public Health, New York, NY, USA
| | - Heidi E Jones
- Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, USA
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41
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El-Khoury M, Thornton R, Chatterji M, Kamhawi S, Sloane P, Halassa M. Counseling Women and Couples on Family Planning: A Randomized Study in Jordan. Stud Fam Plann 2018; 47:222-38. [PMID: 27611319 DOI: 10.1111/sifp.69] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article evaluates the effects of involving men in family planning counseling in Jordan using a randomized experiment. We randomly assigned a sample of 1,247 married women to receive women-only counseling, couples counseling, or no counseling. We measured the effects of each type of counseling on family planning use, knowledge, attitudes, and spousal communication about family planning. Compared to no counseling, couples counseling led to a 54 percent increase in uptake of modern methods. This effect is not significantly different from the 46 percent increase in modern method uptake as a result of women-only counseling. This outcome may be due, in part, to lower rates of compliance with the intervention among those assigned to couples counseling compared to women-only counseling. To realize the possible added benefits of involving men, more tailored approaches may be needed to increase men's participation.
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Affiliation(s)
| | | | - Minki Chatterji
- Abt Associates, 4550 Montgomery Ave. #800N, Bethesda, MD 20814
| | - Sarah Kamhawi
- Monitoring, Evaluation and ResearchOfficer,Abt Associates-led SHOPS project, Amman, Jordan
| | - Phoebe Sloane
- Abt Associates, 4550 Montgomery Ave. #800N, Bethesda, MD 20814
| | - Mays Halassa
- Technical Specialist, Abt Associates, Amman, Jordan
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Liddon N, Steiner RJ, Martinez GM. Provider communication with adolescent and young females during sexual and reproductive health visits: findings from the 2011–2015 National Survey of Family Growth. Contraception 2018; 97:22-28. [DOI: 10.1016/j.contraception.2017.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 12/01/2022]
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Dehlendorf C, Henderson JT, Vittinghoff E, Steinauer J, Hessler D. Development of a patient-reported measure of the interpersonal quality of family planning care. Contraception 2018; 97:34-40. [DOI: 10.1016/j.contraception.2017.09.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 01/17/2023]
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44
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Johns MM, Liddon N, Jayne PE, Beltran O, Steiner RJ, Morris E. Systematic Mapping of Relationship-Level Protective Factors and Sexual Health Outcomes Among Sexual Minority Youth: The Role of Peers, Parents, Partners, and Providers. LGBT Health 2017; 5:6-32. [PMID: 29271692 DOI: 10.1089/lgbt.2017.0053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sexual minority youth (SMY) experience elevated rates of adverse sexual health outcomes. Although risk factors driving these outcomes are well studied, less attention has been paid to protective factors that potentially promote health and/or reduce negative effects of risk. Many factors within interpersonal relationships have been identified as protective for the sexual health of adolescents generally. We sought to systematically map the current evidence base of relationship-level protective factors specifically for the sexual health of SMY through a systematic mapping of peer-reviewed observational research. Articles examining at least one association between a relationship-level protective factor and a sexual health outcome in a sample or subsample of SMY were eligible for inclusion. A total of 36 articles reporting findings from 27 data sources met inclusion criteria. Included articles examined characteristics of relationships with peers, parents, romantic/sexual partners, and medical providers. Peer norms about safer sex and behaviorally specific communication with regular romantic/sexual partners were repeatedly protective in cross-sectional analyses, suggesting that these factors may be promising intervention targets. Generally, we found some limits to this literature: few types of relationship-level factors were tested, most articles focused on young sexual minority men, and the bulk of the data was cross-sectional. Future work should expand the types of relationship-level factors investigated, strengthen the measurement of relationship-level factors, include young sexual minority women in samples, and use longitudinal designs. Doing so will move the field toward development of empirically sound interventions for SMY that promote protective factors and improve sexual health.
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Affiliation(s)
- Michelle M Johns
- 1 Division of Adolescent and School Health (DASH), Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Nicole Liddon
- 1 Division of Adolescent and School Health (DASH), Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Paula E Jayne
- 1 Division of Adolescent and School Health (DASH), Centers for Disease Control and Prevention , Atlanta, Georgia
| | | | - Riley J Steiner
- 1 Division of Adolescent and School Health (DASH), Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Elana Morris
- 3 Division of HIV/AIDS Prevention (DHAP), Centers for Disease Control and Prevention , Atlanta, Georgia
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Smith AJB, Harney KF, Singh T, Hurwitz AG. Provider and Health System Factors Associated with Usage of Long-Acting Reversible Contraception in Adolescents. J Pediatr Adolesc Gynecol 2017; 30:609-614. [PMID: 28502827 DOI: 10.1016/j.jpag.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE Long-acting reversible contraception (LARC) is recommended as first-line contraception for adolescents. Surveys of primary care providers suggest that physician and clinic factors might influence LARC counseling, but their effect on usage is unknown. Our objective was to explore provider and clinic characteristics associated with LARC usage in adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional study of 5363 women ages 15-21 years receiving primary care within a large health system in Massachusetts in 2015. We used data abstracted from electronic medical records to characterize rates of LARC usage. We analyzed the association of provider (specialty, degree, gender, resident status, LARC credentialing) and clinic (Title X funding, onsite LARC provision, onsite obstetrician-gynecologist) factors with adolescents' LARC usage using multivariate logistic regression. RESULTS Overall, 3.4% (95% confidence interval [CI], 2.9-3.9) of adolescents were documented as currently using a LARC method. Older adolescents were significantly more likely to use a LARC method (adjusted odds ratio, 2.41; 95% CI, 1.62-3.58 for women ages 20-21 years compared with ages 15-17 years). Adolescents whose primary care provider was a resident were significantly more likely to use a LARC method (adjusted odds ratio, 1.65; 95% CI, 1.02-2.68). Provider specialty, degree, gender, onsite LARC provision, and onsite obstetrician-gynecologist were not significantly associated with LARC usage in adolescents. CONCLUSION Being older and having a primary care provider early in their training increased the odds of LARC usage among adolescents in a large Massachusetts health system. Across primary care specialties, educating providers about the appropriate uses of LARC methods in nulliparous adolescents might facilitate LARC usage.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Kathleen F Harney
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Tara Singh
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Anita Gupta Hurwitz
- Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Cambridge Health Alliance, Cambridge, Massachusetts
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Kaewkiattikun K. Effects of immediate postpartum contraceptive counseling on long-acting reversible contraceptive use in adolescents. Adolesc Health Med Ther 2017; 8:115-123. [PMID: 29133985 PMCID: PMC5669788 DOI: 10.2147/ahmt.s148434] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adolescent pregnancy is a global public health problem, particularly repeated pregnancy. The best strategy to lower prevalence of adolescent pregnancy and repeated pregnancy is promoting highly effective long-acting contraceptive methods along with special counseling programs. Long-acting reversible contraception (LARC) is the ideal contraceptive of choice for adolescents. It is not known whether immediate postpartum contraceptive counseling increases postpartum LARC use in adolescents. OBJECTIVE To compare LARC use between immediate and conventional postpartum contraceptive counseling and discover predictive factors of postpartum LARC use. MATERIALS AND METHODS This prospective, randomized controlled trial was conducted among postpartum adolescents at Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, from 1 July 2016 to 31 March 2017. The participants were assigned to receive immediate postpartum contraceptive counseling or conventional postpartum contraceptive counseling. The primary outcome was postpartum LARC use. The secondary outcome was predictive factors for LARC use in postpartum adolescents. RESULTS Of the 233 postpartum adolescents, postpartum LARC use was 87 of 118 (73.7%) in the immediate postpartum counseling group and 49 of 115 (42.6%) in the conventional postpartum counseling group (odds ratio 3.780, 95% CI 2.18-6.57, p<0.001). A significant predictive factor for LARC use in postpartum adolescents was immediate postpartum counseling (odds ratio 3.67, 95% CI 2.10-6.41, p<0.001). CONCLUSION Immediate postpartum contraceptive counseling led to a significant increase in postpartum use of LARC in adolescents, when compared with conventional (4-6 weeks) postpartum contraceptive counseling. Adolescent mothers who received immediate postpartum counseling were 3.67 times more likely to use LARC than those who received conventional postpartum counseling.
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Affiliation(s)
- Kasemsis Kaewkiattikun
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Bangkok, Thailand
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47
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How can Primary Care Physicians Best Support Contraceptive Decision Making? A Qualitative Study Exploring the Perspectives of Baltimore Latinas. Womens Health Issues 2017; 27:158-166. [DOI: 10.1016/j.whi.2016.09.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 11/19/2022]
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48
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Patient Experiences with Pregnancy Planning and Perspectives on Reproductive Care in Community Health Centers: A Qualitative Study of African American Women in Chicago. Womens Health Issues 2016; 27:322-328. [PMID: 27931733 DOI: 10.1016/j.whi.2016.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 10/15/2016] [Accepted: 10/27/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Given the potential benefits of preventive reproductive health care for both women and children, it is important that clinicians routinely offer preconception and contraceptive counseling in ways that are responsive to patients' wishes. The goal of this study is to gain knowledge about the components of preventive reproductive health care that patients at Federally Qualified Health Centers value, and to elicit patient perspectives on how best to deliver this care. METHODS We conducted three focus groups with African American women (n = 21) at two Federally Qualified Health Centers in Chicago. The groups were facilitated using an open-ended, semistructured interview guide. We asked women to reflect on past experiences, advice they would give their teenage daughters, and how to design an ideal clinic. All groups were recorded and transcribed verbatim. Transcripts were coded and analyzed using an inductive approach with ATLAS.ti software. RESULTS Although participants wanted comprehensive information about sex and pregnancy, they reported receiving no information at all, or many negative messages. The idea of timing and spacing pregnancies was generally embraced by participants. They described an ideal clinic as having a patient population diverse in income, trusting relationships with providers, comprehensive services, and educational opportunities. CONCLUSIONS The women in our study expressed a desire for more information and comprehensive care in the setting of an equitable clinic where they feel respected as individuals. Our findings support the idea behind the patient-centered medical home and challenge prior literature, which suggests the concept of pregnancy planning does not resonate with low-income African American women.
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Rubin SE, Coy LN, Yu Q, Muncie HL. Louisiana and Mississippi Family Physicians' Contraception Counseling for Adolescents with a Focus on Intrauterine Contraception. J Pediatr Adolesc Gynecol 2016; 29:458-463. [PMID: 26872714 PMCID: PMC5125944 DOI: 10.1016/j.jpag.2016.01.126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE The adolescent pregnancy rate in Louisiana (LA) and Mississippi (MS) is one of the highest in the United States. One approach to decrease that rate is to increase contraceptive use. We sought to characterize LA and MS family physicians' (FPs) contraception counseling for adolescents with a focus on the intrauterine contraceptive device (IUD). DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Online survey of resident and practicing physician members of the LA and MS Academy of FPs. RESULTS Three hundred ninety-eight of 1616 invited FPs responded; 244 were included in our analysis. When counseling adolescents about contraception, respondents "frequently discussed" oral contraceptives and condoms 87.5% (210/240) and 83.8% (202/241) of the time, respectively. Newer and more highly effective contraceptives such as the ring, patch, IUD, and implant were "frequently discussed" only 34.6% (82/237)-39.3% (92/234) of the time. In the previous 6 months, 56% (136/243) of respondents ever discussed an IUD with an adolescent. Respondents were more likely to have discussed IUDs if they learned IUD insertion during residency, had on-site access to IUD inserters, believed they were competent and/or comfortable with IUD counseling. In 5 clinical scenarios asking whether the respondent would recommend an IUD to a 17- or a 27-year-old patient (in all scenarios patients were eligible for an IUD), respondents were restrictive overall and significantly fewer would recommend an IUD for the adolescent. CONCLUSION Our results suggest that there are missed opportunities for full-scope contraception counseling by LA and MS FPs. When these FPs counsel adolescents about contraception they less frequently discuss newer methods and more highly effective methods. Additionally many LA and MS FPs use overly restrictive eligibility criteria when considering IUDs.
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Affiliation(s)
- Susan E Rubin
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
| | - Lauren N Coy
- Columbia University, Mailman School of Public Health, New York, New York
| | - Qingzhao Yu
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | - Herbert L Muncie
- Louisiana State University School of Medicine, New Orleans, Louisiana
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50
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Kumar N, Brown JD. Access Barriers to Long-Acting Reversible Contraceptives for Adolescents. J Adolesc Health 2016; 59:248-253. [PMID: 27247239 DOI: 10.1016/j.jadohealth.2016.03.039] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/28/2016] [Accepted: 03/28/2016] [Indexed: 01/08/2023]
Abstract
The United States continues to have the highest adolescent birth rate of any industrialized country. Recently published guidelines by the American Academy of Pediatrics create a new consensus among professional organizations around the suitability of long-acting reversible contraceptives as first-line contraception for adolescents. Through a narrative review of U.S. studies published after 2000, this study seeks to summarize existing access barriers to long-acting reversible contraceptives for adolescents and highlight areas that warrant further intervention so that the recommendations of these professional organizations can be effectively integrated into clinical practice. Existing barriers include costs for institutions providing contraceptive care and for recipients; consent and confidentiality for adolescent patients; providers' attitudes, misconceptions and limited training; and patients' lack of awareness or misconceptions. Systemic policy interventions are required to address cost and confidentiality, such as the Affordable Care Act's mandate that contraceptive coverage be a part of essential health benefits for all insurance providers. Individual-level access barriers such as providers' misconceptions and gaps in technical training as well as patients' lack of awareness can be addressed directly by professional medical organizations, health care training programs, and other interventions.
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Affiliation(s)
- Natasha Kumar
- Warren Alpert Medical School of Brown University, Providence Rhode Island.
| | - Joanna D Brown
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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