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Dehlendorf C, Perry JC, Borrero S, Callegari L, Fuentes L, Perritt J. Meeting people's pregnancy prevention needs: Let's not force people to state an "Intention". Contraception 2024; 135:110400. [PMID: 38369272 DOI: 10.1016/j.contraception.2024.110400] [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: 08/02/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
Pregnancy intention screening does not identify need for pregnancy prevention and ignores the nuances of lived experiences while reinforcing white middle-class normative expectations. Asking about desire for contraception is a patient-centered approach to meeting people's needs.
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Affiliation(s)
- Christine Dehlendorf
- Person-Centered Reproductive Health Program, UCSF Departments of Family and Community Medicine, San Francisco, CA, United States.
| | | | - Sonya Borrero
- Center for Innovative Research on Gender Health Equity (CONVERGE), Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lisa Callegari
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | - Liza Fuentes
- Health Equity Accelerator, Boston Medical Center, Boston, MA, USA
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Kazmerski TM, Stransky OM, Wright CE, Albanowski M, Pilewski JM, Talabi MB, Callegari LS, Chang JC, Abebe KZ, Miller E, Deal A, O'Leary R, Borrero S. Feasibility Testing of a Web-Based Reproductive Decision Support Tool for Cystic Fibrosis. J Cyst Fibros 2024; 23:404-411. [PMID: 37833123 DOI: 10.1016/j.jcf.2023.10.003] [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: 05/18/2023] [Revised: 08/22/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND People with cystic fibrosis (CF) are increasingly considering their reproductive goals. We developed MyVoice:CF, a web-based patient-centered reproductive decision support tool and assessed its implementation in CF care. METHODS We conducted a feasibility trial among 18-44-year-old women with CF and multidisciplinary CF providers. Prior to CF clinic visit, patient participants completed a baseline survey, used MyVoice:CF, and assessed acceptability, appropriateness, and usability. After clinic, participants rated impact on reproductive health communication. At 3 months post-use, participants assessed impact on reproductive health outcomes. Provider participants completed a survey and focus group regarding MyVoice:CF feasibility/implementation. We assessed outcomes descriptively. We compared MyVoice:CF's impact on outcomes from baseline to follow-up using McNemar's and Wilcoxon signed rank tests as appropriate. RESULTS Forty-three patient participants completed baseline surveys and 40 rated MyVoice:CF's feasibility; 10 providers participated. Patient participants rated MyVoice:CF's acceptability as 4.48±0.50 out of 5, appropriateness as 4.61±0.48 out of 5, and usability as 82.25±11.02 ('A'/excellent). After MyVoice:CF use, participants reported improved reproductive health communication self-efficacy vs. baseline (3.54±1.17vs.3.95±0.93, p<0.001). At baseline, 36% of participants reported any discussion of reproductive goals/plans with their CF team in the past year compared to 59% after first visit post-MyVoice:CF use (p=0.049). Provider participants similarly rated MyVoice:CF as feasible and reported no negative impacts on clinic flow after implementation. CONCLUSIONS MyVoice:CF is acceptable, appropriate, and usable for those with CF. Preliminary effectiveness evaluation suggests that MyVoice:CF improves self-efficacy in and frequency of reproductive health communication. Future studies should further assess MyVoice:CF's impact on reproductive health communication and outcomes.
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Affiliation(s)
- Traci M Kazmerski
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA.
| | - Olivia M Stransky
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
| | - Catherine E Wright
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
| | | | | | - Mehret Birru Talabi
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
| | - Lisa S Callegari
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA; Univ of Washington, Seattle, WA
| | - Judy C Chang
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
| | - Kaleab Z Abebe
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
| | - Ashley Deal
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA; Carnegie Mellon University, Pittsburgh, PA
| | - Raelynn O'Leary
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA; Carnegie Mellon University, Pittsburgh, PA
| | - Sonya Borrero
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
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Meekers D, Elkins A, Obozekhai V. Tools for patient-centred family planning counselling: A scoping review. J Glob Health 2024; 14:04038. [PMID: 38303671 PMCID: PMC10846870 DOI: 10.7189/jogh.14.04038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background The focus of family planning counselling is gradually shifting from the tiered-effectiveness model to patient-centred counselling. Although tools exist that aim to make family planning counselling more patient-oriented without increasing the provider's workload, they are not widely used. This scoping review aims to address this by identifying key tools to make family planning care more patient-centred, reviewing the domains of patient-centred care they address, and identifying gaps in the evidence base. Methods We systematically searched PubMed and SCOPUS for documents on 'patient-centred family planning counselling or support' published between 2013 and 2022. Eligibility criteria included discussion of: 1) strategies for providing patient-centred care; 2) interventions using a patient-centred approach; or 3) the impact of patient-centred approaches. We identified tools for patient-centred care, and mapped them against an existing framework of the main domains of patient-centred care. We reported the available evidence of the impact on those tools. Results Our scoping review is based on 33 documents. We identified six tools for increasing the patient-centeredness of family planning counselling. None of the tools addressed all domains of patient-centred care. Evidence about the impact of these tools remains scarce. Although there is some evidence about the acceptability of the tools, key evidence gaps include the effect of the tools on quality of care and family planning outcomes. Conclusions Family planning implementers should be aware that existing tools differ in the extent to which they address key domains of patient-centred family planning counselling. There is a need for further research on factors that may deter providers from adopting these tools. A larger evidence base is needed to permit a future systematic review to determine the effect of these tools on family planning outcomes, such as method adoption and continuation.
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Affiliation(s)
- Dominique Meekers
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Aaron Elkins
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Vivian Obozekhai
- DKT International, A. G. Leventis Building, Iddo House, Lagos Mainland, Lagos, Nigeria
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McDonald CE, Voutier C, Govil D, D’Souza AN, Truong D, Abo S, Remedios LJ, Granger CL. Do health service waiting areas contribute to the health literacy of consumers? A scoping review. Health Promot Int 2023; 38:daad046. [PMID: 37440256 PMCID: PMC10340083 DOI: 10.1093/heapro/daad046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Health service waiting areas commonly provide health information, resources and supports for consumers; however, the effect on health literacy and related outcomes remains unclear. This scoping review of the literature aimed to explore the use of waiting areas as a place to contribute to the health literacy and related outcomes of consumers attending health appointments. Articles were included if they focussed on health literacy or health literacy responsiveness (concept) in outpatient or primary care health service waiting areas (context) for adult consumers (population) and were published after 2010. Ten bibliographic databases, one full-text archive, dissertation repositories and web sources were searched. The search yielded 5095 records. After duplicate removal, 3942 title/abstract records were screened and 360 full-text records assessed. Data were charted into a standardized data extraction tool. A total of 116 unique articles (published empirical and grey literature) were included. Most articles were set in primary and community care (49%) waiting areas. A diverse range of health topics and resource types were available, but results demonstrated they were not always used by consumers. Outcomes measured in intervention studies were health knowledge, intentions and other psychological factors, self-reported and observed behaviours, clinical outcomes and health service utilization. Intervention studies overall demonstrated positive trends in health literacy-related outcomes, although the benefit declined after 3-6 months. Research on using waiting areas for health literacy purposes is increasing globally. Future research investigating the needs of consumers to inform optimal intervention design is needed.
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Affiliation(s)
- Cassie E McDonald
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
- Allied Health, Alfred Health, Melbourne, VIC 3004, Australia
| | - Catherine Voutier
- Health Sciences Library, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Dhruv Govil
- Department of Business Intelligence and Reporting, Bass Coast Health, Wonthaggi, VIC 3995, Australia
| | - Aruska N D’Souza
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Dominic Truong
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Shaza Abo
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Louisa J Remedios
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Department of Physiotherapy, Federation University, Churchill, VIC 3842, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
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Chao GF, Yang J, Peahl A, Thumma JR, Dimick JB, Arterburn DE, Telem DA. Births After Bariatric Surgery in the United States: Incidence, Obstetric Outcomes, and Reinterventions. Ann Surg 2023; 277:e801-e807. [PMID: 35762610 PMCID: PMC9794635 DOI: 10.1097/sla.0000000000005438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To characterize incidence and outcomes for bariatric surgery patients who give birth. BACKGROUND Patients of childbearing age comprise 65% of bariatric surgery patients in the United States, yet data on how often patients conceive and obstetric outcomes are limited. METHODS Using the IBM MarketScan database, we performed a retrospective cohort study of female patients ages 18 to 52 undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass from 2011 to 2017. We determined the incidence of births in the first 2 years after bariatric surgery using Kaplan-Meier estimates. We then restricted the cohort to those with a full 2-year follow-up to examine obstetric outcomes and bariatric-related reinterventions. We reported event rates of adverse obstetric outcomes and delivery type. Adverse obstetric outcomes include pregnancy complications, severe maternal morbidity, and delivery complications. We performed multivariable logistic regression to examine associations between birth and risk of reinterventions. RESULTS Of 69,503 patients who underwent bariatric surgery, 1464 gave birth. The incidence rate was 2.5 births per 100 patients in the 2 years after surgery. Overall, 85% of births occurred within 21 months after surgery. For 38,922 patients with full 2-year follow-up, adverse obstetric event rates were 4.5% for gestational diabetes and 14.2% for hypertensive disorders. In all, 48.5% were first-time cesarean deliveries. Almost all reinterventions during pregnancy were biliary. Multivariable logistic regression analysis showed no association between postbariatric birth and reintervention rate (odds ratio: 0.93, 95% confidence interval: 0.78-1.12). CONCLUSIONS In this first national US cohort, we find giving birth was common in the first 2 years after bariatric surgery and was not associated with an increased risk of reinterventions. Clinicians should consider shifting the dialogue surrounding pregnancy after surgery to shared decision-making with maternal safety as one component.
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Affiliation(s)
- Grace F. Chao
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Veterans Affairs Ann Arbor, Ann Arbor, MI
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Jie Yang
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Alex Peahl
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Jyothi R. Thumma
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Justin B. Dimick
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - David E. Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Dana A. Telem
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
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Marshall CJ, Parham L, Hubbard E, Irani RA. Experiences of Preconception Counseling among Pregnant Women with Preexisting Diabetes: Opportunities to Improve Patient-Centered Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2908. [PMID: 36833605 PMCID: PMC9956389 DOI: 10.3390/ijerph20042908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Available research suggests that patients with diabetes do not regularly receive preconception counseling, but information on patients' experiences of counseling is scant. We conducted a qualitative study involving semi-structured interviews with 22 patients between October 2020 and February 2021. Pregnant patients with preexisting diabetes were recruited from a specialty diabetes and pregnancy clinic at a large academic medical center in Northern California. Interviews were transcribed, coded, and analyzed using an inductive and deductive content analysis approach. A total of 27% reported they did not have any pregnancy-related discussions with a health care provider before pregnancy. Of those that did, many sought out counseling; this was often connected to how "planned" the pregnancy was. Few participants, nearly all with type 1 diabetes, reported having a formal preconception care visit. Participants described receiving information mostly about the risks associated with diabetes and pregnancy. While participants who sought out counseling generally reported their providers were supportive of their desire for pregnancy, there were a few exceptions, notably all among patients with type 2 diabetes. The varied experiences of participants indicate gaps in the delivery of pre-pregnancy counseling to patients with diabetes and suggest counseling may vary based on diabetes type. There are opportunities to improve the patient-centeredness of counseling.
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Affiliation(s)
- Cassondra J. Marshall
- School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA 94720, USA
| | - Lindsay Parham
- Wallace Center for Maternal, Child & Adolescent Health, University of California, 2121 Berkeley Way, Berkeley, CA 94720, USA
| | - Erin Hubbard
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, 490 Illinois St., San Francisco, CA 94143, USA
| | - Roxanna A. Irani
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, 490 Illinois St., San Francisco, CA 94143, USA
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Gawron LM, Young J, Yang S, Galyean P, Callegari LS, Gero A, Simmons RG, Millar MM, Zickmund SL. Women's Health Provider Perspectives on Reproductive Services Provision in the Veterans Health Administration. South Med J 2023; 116:181-187. [PMID: 36724533 PMCID: PMC9906969 DOI: 10.14423/smj.0000000000001513] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Women veterans are a fast-growing population in the Veterans Health Administration (VHA), and ensuring reproductive service availability is a VHA priority. As such, we sought to explore barriers and facilitators to VHA reproductive service provision across a catchment area from women's health providers' perspectives. METHODS We performed a mixed-methods study, including semistructured, qualitative provider interviews with a quantitative survey on training, comfort, and knowledge of reproductive services. All women's health providers and their support staff from the Salt Lake City Veterans Affairs Medical Center and nine VHA community-based outpatient clinics were asked to participate. We conducted qualitative interviews and knowledge surveys with providers and staff to explore training, care processes, and improvement opportunities in reproductive service provision. We completed descriptive analyses of all of the quantitative data and used an open, iterative process to analyze provider interviews for emergent themes. RESULTS We interviewed 15 providers (7 advanced practice nurses, 4 registered nurses, and 4 physicians) across nine sites (50% response rate). The commonly identified barriers included provider training and staffing, scheduling/referral processes, inconsistent services/supplies, and lack of veteran awareness of reproductive services. Facilitators included prior non-VHA reproductive health experience among providers, invested support staff, and the integrated VHA health system. CONCLUSIONS Addressing barriers to VHA reproductive healthcare provision may overcome reproductive service variations related to clinic location and improve reproductive health outcomes for women veterans.
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Affiliation(s)
| | | | | | | | | | - Alexandra Gero
- From the Department of Obstetrics and Gynecology, Division of Family Planning, University of Utah, Salt Lake City
| | - Rebecca G Simmons
- From the Department of Obstetrics and Gynecology, Division of Family Planning, University of Utah, Salt Lake City
| | - Morgan M Millar
- the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City
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Katon JG, Rodriguez A, Yano EM, Johnson AM, Frayne SM, Hamilton AB, Miller LJ, Williams K, Zephyrin L, Patton EW. Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System. Womens Health Issues 2023; 33:215-221. [PMID: 36702724 DOI: 10.1016/j.whi.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Jodie G Katon
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Adriana Rodriguez
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Health Policy and Management, Jonathan and Karen Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Amanda M Johnson
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California; Stanford University School of Medicine, Stanford, California
| | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Laura J Miller
- Office of Mental Health and Suicide Prevention, Women's Mental Health, U.S. Department of Veterans Affairs, Washington, District of Columbia; Loyola Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | | | | | - Elizabeth W Patton
- Division of Gynecology, Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts; Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts.
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Callegari LS, Benson SK, Mahorter SS, Nelson KM, Arterburn DE, Hamilton AB, Taylor L, Hunter-Merrill R, Gawron LM, Dehlendorf C, Borrero S. Evaluating the MyPath web-based reproductive decision support tool in VA primary care: Protocol for a pragmatic cluster randomized trial. Contemp Clin Trials 2022; 122:106940. [PMID: 36179982 DOI: 10.1016/j.cct.2022.106940] [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: 04/13/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Counseling to identify and support individuals' desires for family formation is a key component of preventive health care that is often absent in primary care visits. This study evaluates a novel, web-based, person-centered intervention to increase the frequency and quality of communication about reproductive goals and healthcare needs in Veterans Health Administration (VA) primary care. METHODS We describe a hybrid type 1 effectiveness-implementation cluster randomized controlled trial in seven VA healthcare systems testing a web-based reproductive health decision support tool (MyPath). VA primary care providers are enrolled and randomized to intervention or usual care arms. Veterans scheduled to see intervention-arm providers receive a text message inviting them to use MyPath ahead of their appointment; Veterans scheduled to see control-arm providers receive usual care. Target enrollment is 36 providers and 456 Veterans. Outcomes are assessed by Veteran self-report after the visit and at 3- and 6-months follow-up. The primary outcome is occurrence of reproductive health discussions involving shared decision making; secondary outcomes include measures of communication, knowledge, decision conflict, contraceptive utilization, and receipt of services related to prepregnancy health. Data on implementation barriers, facilitators and cost are collected. RESULTS The trial is ongoing with no results to report. We have enrolled 36 primary care providers across 7 VA healthcare systems and recruitment of Veterans is ongoing. CONCLUSIONS Results will inform efforts to increase the quality and person-centeredness of reproductive healthcare delivery in primary care and to operationalize and scale up use of digital decision support tools in clinical settings. TRIAL REGISTRATION http://ClinicalTrials.gov Identifier: NCT04584294 Trial Status: Recruiting.
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Affiliation(s)
- Lisa S Callegari
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA; Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA.
| | - Samantha K Benson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Siobhan S Mahorter
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Karin M Nelson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA; Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Alison B Hamilton
- Health Services Research and Development, VA Greater Los Angeles Healthcare System, Los Angeles, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, USA
| | - Leslie Taylor
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Rachel Hunter-Merrill
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Lori M Gawron
- Health Services Research and Development, VA Salt Lake City Health Care System, Salt Lake City, USA; Department of Obstetrics & Gynecology, University of Utah School of Medicine, Salt Lake City, USA
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, USA
| | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, USA; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Callegari LS, Mahorter SS, Benson SK, Zhao X, Schwarz EB, Borrero S. Perceived Contraceptive Counseling Quality Among Veterans Using VA Primary Care: Data from the ECUUN Study. J Gen Intern Med 2022; 37:698-705. [PMID: 36042079 PMCID: PMC9481768 DOI: 10.1007/s11606-022-07586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND High-quality contraceptive counseling is critical to support Veterans' reproductive autonomy and promote healthy outcomes. OBJECTIVE To describe perceived quality of contraceptive counseling in Veterans Health Administration (VA) primary care and assess factors associated with perceived high- and low-quality contraceptive counseling. DESIGN Cross-sectional study using data from the Examining Contraceptive Use and Unmet Need in women Veterans (ECUUN) national telephone survey. PARTICIPANTS Veterans aged 18-44 who received contraceptive services from a VA primary care clinic in the past year (N=506). MAIN MEASURES Perceived quality of contraceptive counseling was captured by assessing Veterans' agreement with 6 statements regarding provider counseling adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. High-quality counseling was defined as a top score of strongly agreeing on all 6 items; low-quality counseling was defined as not agreeing (neutral, disagreeing, or strongly disagreeing) with >3 items. We constructed two multivariable models to assess associations between patient-, provider-, and system-level factors and perceived high-quality (Model 1) and perceived low-quality counseling (Model 2). KEY RESULTS Most participants strongly agreed that their providers listened carefully (74%), explained things clearly (77%), and spent enough time discussing things (71%). Lower proportions strongly agreed that their provider discussed more than one option (54%), discussed pros/cons of various methods (44%), or asked which choice they thought was best for them (62%). In Model 1, Veterans who received care in a Women's Health Clinic (WHC) had twice the odds of perceiving high-quality counseling (aOR=1.99; 95%CI=1.24-3.22). In Model 2, Veterans who received care in a WHC (aOR=0.49; 95%CI=0.25-0.97) or from clinicians who provide cervical cancer screening (aOR=0.49; 95%CI=0.26-0.95) had half the odds of perceiving low-quality counseling. CONCLUSIONS Opportunities exist to improve the quality of contraceptive counseling within VA primary care settings, including more consistent efforts to seek patients' perspectives with respect to contraceptive decisions.
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Affiliation(s)
- Lisa S Callegari
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA, 98108, USA. .,Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, USA. .,Department of Health Services, University of Washington School of Public Health, Seattle, USA.
| | - Siobhan S Mahorter
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA, 98108, USA
| | - Sam K Benson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA, 98108, USA
| | - Xinhua Zhao
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, USA
| | | | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Chernick LS, Konja A, Gonzalez A, Stockwell MS, Ehrhardt A, Bakken S, Westhoff CL, Dayan PS, Santelli J. Designing illustrative social media stories to promote adolescent peer support and healthy sexual behaviors. Digit Health 2022; 8:20552076221104660. [PMID: 35707267 PMCID: PMC9189520 DOI: 10.1177/20552076221104660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/14/2022] [Indexed: 12/31/2022] Open
Abstract
Objective Adolescent females in the United States continue to have unmet sexual and reproductive healthcare needs. Research shows that interventions incorporating peer support can augment perceived self-efficacy and reinforce healthy behaviors. Yet, few user-centered digital sexual health interventions incorporate peer support, and aim to change perceptions of peer norms and model social skills. The objective of this study was to design and demonstrate the receptivity of adolescent females to illustrated digital social media stories that promote healthy sexual behaviors and peer social support. Methods We conducted a three-phase study approved by our Institutional Review Board. In Phase 1, we presented sexually active adolescent female emergency department patients aged 14-19 with eight sexual health scenarios via a survey study. Participants wrote three text messages addressed to the protagonist of each scenario which motivated and encouraged her to consider the use of contraceptives. Messages were scored based on the construct of peer support (emotional, tangible, informational, and belonging). In Phase 2, we worked with a professional artist and screenwriter to design digital sexual health comics using the gathered messages. In Phase 3, we gathered feedback on the comics from adolescent female emergency department patients. Results Females (n = 22) provided 352 messages. Using top rated messages, we designed five digital visualizations in a running story called Mari tells it like it is. Each story incorporated 5-12 peer-authored quotes. We inserted the final images into Instagram®. Additional females (n = 39) found the images "relatable," "super-realistic," and "educational." Conclusion Collecting peer-authored texts from our local adolescent community led to the creation of well-received sexual health visualizations. This novel method of design incorporated adolescent voices to promote peer support and healthy behaviors.
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Affiliation(s)
- Lauren S Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA,Lauren S Chernick, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, 3959 Broadway, CHN 1-116, New York, NY, USA.
| | - Alexis Konja
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Ariana Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - Melissa S Stockwell
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Child and Adolescent Health, Columbia University Medical Center, New York, NY, USA
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center, New York, NY, USA
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center, New York, NY, USA
| | - Carolyn L Westhoff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Peter S Dayan
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - John Santelli
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Child and Adolescent Health, Columbia University Medical Center, New York, NY, USA
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12
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Gerchow L, Squires A. Dimensional Analysis of Shared Decision Making in Contraceptive Counseling. J Obstet Gynecol Neonatal Nurs 2022; 51:388-401. [PMID: 35605641 DOI: 10.1016/j.jogn.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To conduct a dimensional analysis to identify conceptual gaps around shared decision making (SDM) in reproductive health care and to refine the conceptual definition of SDM as related to contraceptive counseling. DATA SOURCES We identified source data through systematic searches of the CINAHL and PubMed databases. STUDY SELECTION We included peer-reviewed research and nonresearch articles that addressed contraceptive counseling for pregnancy prevention in the United States. We did not consider date of publication as an inclusion criterion. We included 35 articles in the final review. DATA EXTRACTION Using dimensional analysis, we extracted data to clarify the definition of SDM as a socially constructed concept that varies by perspective and context. DATA SYNTHESIS Data synthesis enabled us to compare SDM from patient and provider perspectives and to identify four primary dimensions of SDM that varied by context: Patient Preferences, Relationship, Provider Bias, and Clinical Suitability. CONCLUSION The four dimensions we identified illustrate the complexity and depth of SDM in contraceptive counseling encounters and broaden the definition of SDM to more than an encounter in which decision making incorporates clinician expertise and patient participation. We identified several assumptions that indicate the need for improved understanding that SDM is not a universal concept across perspectives and contexts. Most researchers in the included articles addressed the Patient Preferences dimension. Fewer considered the patient-provider relationship, the effect of provider bias, and the effect of specific clinical circumstances on SDM. We propose a conceptual map and model that can be used to refine the concepts that inform SDM and guide providers and researchers. Future research is needed to address the remaining gaps.
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13
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Eysenbach G, Leung T, Callegari LS, Kazmerski TM, Borrero S. A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States. J Med Internet Res 2022; 24:e36338. [PMID: 35482371 PMCID: PMC9100540 DOI: 10.2196/36338] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/14/2022] [Accepted: 04/01/2022] [Indexed: 01/21/2023] Open
Abstract
The United States has abysmal reproductive health indices that, in part, reflect stark inequities experienced by people of color and those with preexisting medical conditions. The growth of "femtech," or technology-based solutions to women's health issues, in the public and private sectors is promising, yet these solutions are often geared toward health-literate, socioeconomically privileged, and/or relatively healthy white cis-women. In this viewpoint, we propose a set of guiding principles for building technologies that proactively identify and address these critical gaps in health care for people from socially and economically marginalized populations that are capable of pregnancy, as well as people with serious chronic medical conditions. These guiding principles require that such technologies: (1) include community stakeholders in the design, development, and deployment of the technology; (2) are grounded in person-centered frameworks; and (3) address health disparities as a strategy to advance health equity and improve health outcomes.
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Affiliation(s)
| | | | - Lisa S Callegari
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States.,Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Traci M Kazmerski
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Health Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, United States
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14
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Stransky OM, Pam M, Ladores SL, Birru Talabi M, Borrero S, Godfrey EM, Roe AH, Sawicki GS, Zuckerwise LC, Mody S, Mentch L, Deal A, O’Leary R, Taylor-Cousar JL, Jain R, Kazmerski TM. Engaging Stakeholders in the Development of a Reproductive Goals Decision AID for Women with Cystic Fibrosis. J Patient Exp 2022; 9:23743735221077527. [PMID: 35128042 PMCID: PMC8814976 DOI: 10.1177/23743735221077527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: More people with cystic fibrosis (pwCF) are reaching adulthood and considering their reproductive futures. Unfortunately, many pwCF report gaps in their reproductive healthcare. We describe measures of stakeholder engagement in developing a reproductive goals decision aid for women with CF called MyVoice:CF. Methods: Stakeholders reviewed the content, design, and usability of the tool, which was informed by prior research related to CF family planning experiences and preferences as well as a conceptual understanding of reproductive decision making. We evaluated stakeholder engagement via process measures and outcomes of stakeholder involvement. We collected data via recorded stakeholder recommendations and surveys. Results: Fourteen stakeholders participated and the majority described their role on the project as "collaborator", "advisor", or "expert." Most felt their expectations for the project were met or exceeded, that they had contributed significantly, and that they received sufficient and frequent information about the process. All stakeholders provided recommen-dations and clarified aims for a CF-specific family planning tool, including its content and focus on facilitating shared decision making. Discussion: Utilizing meaningful stakeholder contributions, we developed MyVoice:CF, a novel web-based decision aid to help women with CF engage in shared decision-making regarding their reproductive goals. Practical Value: Our findings from working with stakeholders for MyVoice:CF indicate that disease-specific reproductive health resources can and should be designed with input from individuals in the relevant communities.
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Affiliation(s)
- Olivia M. Stransky
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
| | - Molly Pam
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, USA
| | - Sigrid L. Ladores
- University of Alabama at Birmingham, School of Nursing, 1701 University Blvd, THT 422, Birmingham, AL 35294, USA
| | - Mehret Birru Talabi
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Sonya Borrero
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA
| | - Emily M. Godfrey
- Department of Family Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Andrea H. Roe
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | | | - Lisa C. Zuckerwise
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1161 21 Avenue South, B-1100 Medical Center North, Nashville, TN 37232, USA
| | - Sheila Mody
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego
| | - Laura Mentch
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, USA
| | - Ashley Deal
- School of Design, Carnegie Mellon University, 5130 Margaret Morrison St, Pittsburgh, PA 15213, USA
| | - Raelynn O’Leary
- School of Design, Carnegie Mellon University, 5130 Margaret Morrison St, Pittsburgh, PA 15213, USA
| | - Jennifer L. Taylor-Cousar
- Divisions of Pulmonary, Critical Care and Sleep Medicine and Pediatric Pulmonary Medicine, National Jewish Health, 1400 Jackson Street, Denver, Colorado 80206, USA
| | - Raksha Jain
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Traci M. Kazmerski
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University Center, 120 Lytton Ave., Mezzanine Floor Suite M060, Pittsburgh, PA, 15213, USA
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15
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Boyle JA, Yimer NB, Hall J, Walker R, Jack B, Black K. Reproductive Life Planning in Adolescents. Semin Reprod Med 2021; 40:124-130. [PMID: 34687031 DOI: 10.1055/s-0041-1735210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Unplanned pregnancy in adolescents contributes to the burden of disease, mortality, and health and educational disparities experienced by young people during this vulnerable period between childhood and adulthood. Reproductive life planning (RLP) is an approach that has been endorsed and adopted internationally, which prompts individuals and couples to set personal goals regarding if and when to have children based on their own personal priorities. This review discusses RLP tools, their acceptability, effectiveness, and issues in implementation across different contexts, with a specific focus on how RLP has been applied for adolescents. While a range of RLP tools are available and considered acceptable in adult populations, there is minimal evidence of their potential benefits for adolescent populations. Online platforms and information technology are likely to promote reach and implementation of RLP interventions in adolescents. Consideration of the socioecological contexts where adolescent pregnancies are more common should be integral to much needed future work that explores RLP interventions in adolescents.
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Affiliation(s)
- Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia.,Obstetrics, Gynaecology and Neonatology, The University of Sydney Central Clinical School, University of Sydney, Australia
| | - Nigus Bililigin Yimer
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jennifer Hall
- College of Health Sciences, Woldia University, Ethiopia
| | - Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Brian Jack
- EGA Institute for Women's Health, University College London, United Kingdom
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16
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Zeal C, Paul R, Dorsey M, Politi MC, Madden T. Young women's preferences for contraceptive education: The importance of the clinician. Contraception 2021; 104:553-555. [PMID: 34139152 DOI: 10.1016/j.contraception.2021.06.005] [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: 02/26/2021] [Revised: 05/28/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We explored women's preferences for contraceptive education and assess the role of the clinician in delivering this education. STUDY DESIGN We recruited women ages 16 to 29 presenting for gynecologic care at 3 clinical sites. Respondents completed a survey about preferences for receipt of contraceptive information and trustworthiness of information sources. RESULTS We included 270 respondents' surveys (77.6% of approached). Clinicians were the most preferred (87.0%) and trusted (83.5%) source of contraceptive information, and 69.0% said a clinician's recommendation made a source more trustworthy. CONCLUSIONS Clinicians are a trusted source of contraceptive information; their recommendations of other educational resources may improve acceptance by patients.
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Affiliation(s)
- Carley Zeal
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Obstetrics and Gynecology, Mercyhealth - Beloit. 2825 Prairie Ave Beloit, WI 53511, United States
| | - Rachel Paul
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Megan Dorsey
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Tessa Madden
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States.
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