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Algera E, Leusink P, Gerrits T, Pols J, Ravesloot JH. mHealth technologies for pregnancy prevention: A challenge for patient-centred contraceptive counselling in Dutch general practice. Eur J Gen Pract 2024; 30:2302435. [PMID: 38264977 PMCID: PMC10810654 DOI: 10.1080/13814788.2024.2302435] [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: 05/23/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND A general practitioner (GP) standardly provides contraceptive counselling and care in the Netherlands. Recent years have seen the rise of mobile health technologies that aim to prevent pregnancy based on fertility awareness-based methods (FABMs). We lack high-quality evidence of these methods' effectiveness and clarity on how healthcare professionals include them in contraceptive counselling. OBJECTIVES To analyse how Dutch healthcare professionals include pregnancy-prevention mobile health technologies (mHealth contraception) in contraceptive counselling and to propose practice recommendations based on our findings. METHODS We used ethnographic methods, including semi-structured interviews with nine professionals who were recruited using purposive sampling, 10 observations of contraceptive counselling by four professionals, six observations of teaching sessions in medical training on contraception and reproductive health, one national clinical guideline, and seven Dutch patient decision aids. Data were collected between 2018 and 2021 and analysed inductively using praxiographic and thematic analysis. RESULTS In contraceptive counselling and care, professionals tended to blend two approaches: 1) individual patient-tailored treatment and 2) risk minimisation. When interviewed about mHealth contraception, most professionals prioritised risk minimisation and forewent tailored treatment. Some did not consider mHealth contraception or FABMs as contraceptives or deemed them inferior methods. CONCLUSION To minimise risk of unintended pregnancy, professionals hesitated to include mHealth contraception or other FABMs in contraceptive consultations. This may hamper adequate patient-centred counselling for patients with preference for mHealth contraception.Based on these results, we proposed recommendations that foster a patient-tailored approach to mHealth contraceptives.
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Affiliation(s)
- Ellen Algera
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of Ethics, Law & Medical Humanities, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Biology, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, The Netherlands
- Institute for Interdisciplinary Studies, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Trudie Gerrits
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeannette Pols
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of Ethics, Law & Medical Humanities, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Hindrik Ravesloot
- Department of Medical Biology, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, The Netherlands
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2
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Newmark RL, Hodge CC, Shih G, Karlin J. Patient experiences switching from in-clinic to self-administration of injectable contraception in two Western US states. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024. [PMID: 38965382 DOI: 10.1111/psrh.12278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
OBJECTIVE We describe the experiences and preferences of women who switched from clinic-administered intramuscular depot medroxyprogesterone acetate (DMPA-IM) to self-administered subcutaneous DMPA (DMPA-SC) in the context of the COVID-19 pandemic. METHODS We conducted interviews with women in California and Washington about their experiences with self-administered DMPA-SC. We interviewed women after their first or second self-administered DMPA-SC injection and conducted follow-up interviews after their third or fourth injection. We performed both thematic and descriptive content analyses. RESULTS We completed 29 interviews with 15 women. Most participants (n = 10) were between the ages of 20 and 39 and the majority (n = 12) used DMPA primarily for contraception. Most (n = 13) described self-administered DMPA-SC as "very easy" or "somewhat easy" to use and reported greater convenience, decreased pain, fewer logistical and financial challenges, increased privacy, and improved comfort with injection compared to DMPA-IM. Participants identified difficulties obtaining DMPA-SC from pharmacies and safe needle disposal as barriers. Most (n = 13) would recommend DMPA-SC to a friend and desired to continue self-administration beyond the COVID-19 pandemic. Participants recommended counseling all patients about this option alongside other contraceptive methods, and offering clinician supervision, if desired. CONCLUSION Women who switched from in-clinic DMPA-IM to self-administered DMPA-SC during the COVID-19 pandemic preferred the latter and intended to continue self-administration. Self-administration of DMPA-SC should be routinely offered and easily accessible to patients.
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Affiliation(s)
- Rebecca L Newmark
- Department of Humanities and Social Sciences, University of California, San Francisco, California, USA
- School of Medicine, University of California, San Francisco, California, USA
| | - Caroline C Hodge
- School of Medicine, University of California, San Francisco, California, USA
- Department of Anthropology, University of Pennsylvania, Philadephia, Pennsylvania, USA
| | - Grace Shih
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Jennifer Karlin
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
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3
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Newton-Levinson A, Blake SC, Swartzendruber A, Kramer MR, Sales JM. "So that I can trust them with my body:" How people with low incomes who may become pregnant define and prioritize quality reproductive health care. Contraception 2024:110517. [PMID: 38885892 DOI: 10.1016/j.contraception.2024.110517] [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: 09/27/2023] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES As part of a larger mixed-methods study to better define equity in access to sexual and reproductive health (SRH) care in Georgia, this analysis sought to understand: (1) how individuals define quality care for their SRH services; and (2) how quality of care is salient in their SRH care-seeking. STUDY DESIGN From January 2019 to February 2020, we conducted life history interviews with individuals with the capacity to become pregnant in suburban areas in Georgia. We analyzed interviews using thematic analysis. RESULTS SRH care quality was shaped by experiences with health center environment, with providers, and with staff. Study participants emphasized elements associated with trusted SRH care such as showing compassion, respecting and non-judging, taking time, providing information, and assuring agency. Participants also voiced a desire for holistic care that addressed the lived experiences of the individual. Participants took quality of care into account when care-seeking but sometimes had to weigh out preferences for quality with issues of affordability. CONCLUSIONS Access to quality person-centered care is an essential component of realized access to SRH services. Measures of equitable access and quality should account for experiences of quality care that include both provider and staff interactions as well as the larger healthcare environment and ability to use quality care despite financial constraints. IMPLICATIONS Quality family planning care should involve both clinicians and staff to incorporate showing compassion, providing respectful and non-judgmental care, taking time with patients, providing information, assuring agency in decision-making, as well as addressing the lived experiences of individuals.
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Affiliation(s)
- Anna Newton-Levinson
- Department of Behavioral, Social and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Sarah C Blake
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Andrea Swartzendruber
- Department of Epidemiology and Biostatistics, College of Public Health, The University of Georgia, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jessica M Sales
- Department of Behavioral, Social and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Flores-Rodriguez A, Diaz Gonzalez-Colmenero F, Garcia-Leal M, Saenz-Flores M, Burciaga-Jimenez E, Zuñiga-Hernandez JA, Alvarez-Villalobos NA, Rodríguez-Guajardo R, Morales-Martinez FA, Sordia-Hernandez LH, Rodriguez-Gutierrez R. Harms of third- and fourth-generation combined oral contraceptives in premenopausal women: A systematic review and meta-analysis. J Investig Med 2023; 71:871-888. [PMID: 37415461 DOI: 10.1177/10815589231184227] [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] [Indexed: 07/08/2023]
Abstract
We assessed the available evidence regarding adverse effects on surrogate and patient-important health outcomes of third- and fourth-generation combined oral contraceptives among premenopausal women. We performed a systematic review and meta-analysis including randomized controlled trials and observational studies comparing third- and fourth-generation combined oral contraceptives with other generation contraceptives or placebo. Studies that enrolled women aged 15 to 50 years, with at least three cycles of intervention and 6 months of follow-up were included. A total of 33 studies comprising 629,783 women were included. Low-density lipoprotein cholesterol levels were significantly lower in fourth-generation oral contraceptives (mean differences (MD): -0.24 mmol/L; [95% CI -0.39 to -0.08]), while total cholesterol was significantly increased in levonorgestrel users when compared to third-generation oral contraceptives (MD: 0.27 mmol/L; [95% CI 0.04 to 0.50]). A decreased arterial thrombosis incidence was shown in fourth-generation oral contraceptive users, as compared to levonorgestrel (incidence rate ratio (IRR): 0.41; [95% CI 0.19 to 0.86]). No difference was found in the occurrence of deep venous thrombosis between fourth-generation oral contraceptives and levonorgestrel users (IRR: 0.91; [95% CI 0.66 to 1.27]; p = 0.60; I2 = 0%). Regarding the remaining outcomes, data were heterogeneous and showed no clear difference. In premenopausal women, the use of third- and fourth-generation oral contraceptives is associated with an improved lipid profile and lower risk of arterial thrombosis. Data were inconclusive regarding the rest of outcomes assessed. This review was registered in PROSPERO with CRD42020211133.
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Affiliation(s)
- Andrea Flores-Rodriguez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Fernando Diaz Gonzalez-Colmenero
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
- Research Unit, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mariana Garcia-Leal
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Melissa Saenz-Flores
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Erick Burciaga-Jimenez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge A Zuñiga-Hernandez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Neri A Alvarez-Villalobos
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
- Research Unit, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, México
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Rene Rodríguez-Guajardo
- Gynecology and Obstetrics Department, University Hospital "Dr. JosJosé E. González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Felipe A Morales-Martinez
- Gynecology and Obstetrics Department, University Hospital "Dr. JosJosé E. González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Luis H Sordia-Hernandez
- Gynecology and Obstetrics Department, University Hospital "Dr. JosJosé E. González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rene Rodriguez-Gutierrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
- Research Unit, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, México
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
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Congdon JL, Bardach NS, Franck LS, Brindis CD, Boscardin WJ, Carrasco Z, Cabana MD, Dehlendorf C. Postpartum Family Planning in Pediatrics: A Survey of Parental Contraceptive Needs and Health Services Preferences. Acad Pediatr 2023; 23:1417-1425. [PMID: 36958531 PMCID: PMC11166476 DOI: 10.1016/j.acap.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE Infant well-child visits are increasingly being explored as opportunities to address parental postpartum health needs, including those related to reproductive health. To inform potential pediatric clinic-based interventions, this study assessed postpartum contraceptive needs and health services preferences. METHODS We surveyed postpartum individuals attending 2 to 6-month well-child visits at three Northern California pediatric clinics (2019-20). We examined unmet contraceptive needs; the acceptability of contraceptive education, counseling, and provision at well-child visits; and sociodemographic and clinical correlates. We conducted univariate and multivariable regression modeling to assess associations between sociodemographic and clinical variables, the status of contraceptive needs, and acceptability measures. RESULTS Study participants (n = 263) were diverse in terms of race and ethnicity (13% Asian, 9% Black, 37% Latinx, 12% Multi-racial or Other, 29% White), and socioeconomic status. Overall, 25% had unmet contraceptive needs. Unmet need was more common among participants who had delivered more recently, were multiparous, or reported ≥ 1 barrier to obtaining contraception; postpartum visit attendance, education, race, and ethnicity were not associated with unmet need. Most participants deemed the following acceptable in the pediatric clinic: receiving contraceptive information (85%), discussing contraception (86%), and obtaining a contraceptive method (81%). Acceptability of these services was greater among participants with unmet contraceptive needs, better self-rated health, and private insurance (all P < .05). CONCLUSIONS A quarter of participants had unmet contraceptive needs beyond the early postpartum period. Most considered the pediatric clinic an acceptable place to address contraception, suggesting the pediatric clinic may be a suitable setting for interventions aiming to prevent undesired pregnancies and their sequelae.
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Affiliation(s)
- Jayme L Congdon
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies (JL Congdon and NS Bardach), University of California San Francisco.
| | - Naomi S Bardach
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies (JL Congdon and NS Bardach), University of California San Francisco.
| | - Linda S Franck
- Department of Family Health Care Nursing (LS Franck), University of California San Francisco, School of Nursing.
| | - Claire D Brindis
- Adolescent and Young Adult Health National Resource Center and Philip R. Lee Institute for Health Policy Studies (CD Brindis), University of California, San Francisco.
| | - W J Boscardin
- Departments of Medicine and Epidemiology and Biostatistics (WJ Boscardin), University of California San Francisco.
| | - Zoe Carrasco
- School of Nursing (Z Carrasco), University of California San Francisco.
| | - Michael D Cabana
- Department of Pediatrics (MD Cabana), Albert Einstein College of Medicine and the Children's Hospital at Montefiore (CHAM), Bronx, NY.
| | - Christine Dehlendorf
- Department of Family and Community Medicine (C Dehlendorf), University of California San Francisco.
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Boydell V, Smith RD. Hidden in plain sight: A systematic review of coercion and Long-Acting Reversible Contraceptive methods (LARC). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002131. [PMID: 37594941 PMCID: PMC10437997 DOI: 10.1371/journal.pgph.0002131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/12/2023] [Indexed: 08/20/2023]
Abstract
In recent years there has been extensive promotion of long-acting reversible contraceptives (LARC) globally to increase access to what is widely considered a highly effective contraceptive method. Yet, despite these efforts, evidence points towards the worrying propensity for LARCS to be associated with coercion. Hence, we undertook a meta-narrative review across nine databases to draw together the heterogeneous and complex evidence on the coercive practices associated with LARC programs. A total of 92 papers were grouped into three metanarratives: (1) law, (2) public health and medicine, and (3) the social sciences. Across disciplines, the evidence supports the conclusion that coercive practices surrounding LARC programs always target marginalized, disadvantaged and excluded population(s). Looking at coercion across disciplines reveals its many forms, and we present a continuum of coercive practices associated with LARC programming. We found that each discipline provides only a partial picture of coercion, and this fragmentation is a knowledge practice that prevents us from collecting accurate information on this subject and may contribute to the perpetuation of these suspect practices. We present this review to address longstanding silences around coercion and LARCs, and to encourage the development of clinical and programmatic guidance to actively safeguard against coercion and uphold reproductive rights and justice.
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Affiliation(s)
- Victoria Boydell
- School of Health and Social Care, University of Essex, Colchester Campus, Colchester, United Kingdom
| | - Robert Dean Smith
- Department of Anthropology and Sociology, Geneva Graduate Institute, Geneva, Switzerland
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Stevenson TB, Rumbold A, Callander E, Buckingham P, Assifi A, Mazza D, Grzeskowiak LE. Online platforms for prescription and supply of hormonal contraception in Australia: a mapping review. Sex Health 2023; 20:273-281. [PMID: 37012210 DOI: 10.1071/sh22138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023]
Abstract
Online platforms have emerged as a convenient way for individuals to access contraception. However, the extent to which such services exist in Australia and how they operate is currently unknown. We aimed to identify Australian online contraception platforms and evaluate the services they provide to determine the degree to which they may facilitate equitable access to contraception. We conducted an internet search to identify online contraception platforms operating in Australia. Data were extracted from each of the platforms relating to operating policies, services provided and associated payment processes, as well as prescribing and screening processes for assessing user suitability. As of July 2022, eight online contraception platforms operating within Australia were identified. All platforms offered oral contraception, with two also offering the vaginal ring, and one emergency oral contraception. None of the platforms provided access to long-acting reversible contraception. Significant variability existed in product and membership costs across platforms, with only one platform providing access to subsidised medicines. Five platforms restricted services to those already using oral contraception. Overall, online questionnaires were deemed to be adequately screening for important contraindications to using oral contraception. While online contraception platforms may be a valuable option for some individuals who face access barriers and are willing to pay out-of-pocket for to have their contraception sent straight to their home, they do not necessarily ensure that individuals can access their contraceptive method of choice or address recognised financial and structural barriers to contraceptive care.
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Affiliation(s)
- Tahlee B Stevenson
- Faculty of Health and Medical Sciences, School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Alice Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; and Adelaide Medical School and the Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; and Women's and Babies Division, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Emily Callander
- School of Public Health and Preventative Medicine, Monash University, Clayton, Vic., Australia
| | - Pip Buckingham
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Vic., Australia
| | - Anisa Assifi
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Vic., Australia
| | - Danielle Mazza
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Vic., Australia
| | - Luke E Grzeskowiak
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; and Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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Shea M, Decker E, LeRoy L, Winter M. Testing the validity and reliability of the Person-Centered Contraceptive Counseling (PCCC) Performance Measure in a Real-World Contraceptive Access Program. Contraception 2023; 123:110039. [PMID: 37030339 DOI: 10.1016/j.contraception.2023.110039] [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: 01/11/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVES To validate the Person-Centered Contraceptive Counseling (PCCC) patient-reported outcome performance measure and assess for differences by sociodemographic attributes using survey data from a multistate contraceptive access program. STUDY DESIGN This analysis explored internal reliability and construct validity of the PCCC using survey data from 1413 patients who visited 15 health centers in Washington state and Massachusetts that had partnered with Upstream USA. RESULTS Multiple psychometric indicators provided evidence of reliability and validity. Significant associations between the highest PCCC rating and conceptually-related survey questions (i.e., experience with bias/coercion and shared decision-making) provided further evidence of construct validity. CONCLUSIONS Our findings demonstrate that the PCCC is valid and reliable. The results also highlight differences in experience of care by patient-reported race and ethnicity, income level, and language.
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Affiliation(s)
- Margaret Shea
- Boston University School of Public Health-Biostatistics and Epidemiology Data Analytics Center, Boston, MA, United States.
| | - Emily Decker
- Monitoring, Evaluation, and Learning Department, Upstream USA, Boston, MA, United States.
| | - Lisa LeRoy
- Monitoring, Evaluation, and Learning Department, Upstream USA, Boston, MA, United States.
| | - Michael Winter
- Boston University School of Public Health-Biostatistics and Epidemiology Data Analytics Center, Boston, MA, United States.
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9
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Trope LA, Congdon JL, Bruce JS, Chung PJ, Dehlendorf C, Chamberlain LJ. Meeting the Needs of Postpartum Women: Provider Perspectives on Maternal Contraceptive Care in Pediatric Settings. Acad Pediatr 2023; 23:821-828. [PMID: 36067921 PMCID: PMC11189802 DOI: 10.1016/j.acap.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Closely spaced, mistimed, and unwanted pregnancies are common among postpartum women and can lead to adverse maternal and perinatal outcomes. Women inconsistently attend postpartum obstetric visits, though they reliably interface with pediatric providers during the postpartum months, presenting novel opportunities to identify and address unmet family planning needs. METHODS We conducted a qualitative study to explore pediatric provider perspectives on addressing maternal family planning in three settings: a neonatal intensive care unit, a primary care clinic, and a high-risk infant follow-up clinic. RESULTS Pediatric providers were generally open to incorporating postpartum family planning screening and counseling into a pediatric encounter, if given appropriate training and implementation support. Providers largely agreed that contraceptive provision to women was not feasible in their practices, and they shared ideas for utilizing the pediatric encounter to connect women with comprehensive contraceptive care. CONCLUSION Pediatric providers perceived postpartum family planning screening and counseling, and not contraceptive provision, as potentially acceptable and feasible in their practice settings. These exploratory findings justify further investigation to assess their generalizability and to develop postpartum family planning interventions for pediatrics.
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Affiliation(s)
- Lee A Trope
- Department of Pediatrics, Santa Clara Valley Medical Center (LA Trope), San Jose, Calif.
| | - Jayme L Congdon
- Department of Pediatrics, University of California, San Francisco (JL Congdon)
| | - Janine S Bruce
- Department of Pediatrics, Stanford University (JS Bruce), Palo Alto, Calif
| | - Paul J Chung
- Health Systems Science, Kaiser Permanente School of Medicine (PJ Chung), Pasadena, Calif
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California, San Francisco (C Dehlendorf)
| | - Lisa J Chamberlain
- Department of Pediatrics, Stanford University (LJ Chamberlain), Palo Alto, Calif
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10
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McColl R, Gifford K, McDuffie MJ, Boudreaux M. Same-day long-acting reversible contraceptive utilization after a statewide contraceptive access initiative. Am J Obstet Gynecol 2023; 228:451.e1-451.e8. [PMID: 36565901 PMCID: PMC10065916 DOI: 10.1016/j.ajog.2022.12.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Same-day placement of long-acting reversible contraceptives, occurring when the device is requested and placed within a single visit, reduces barriers to the patient and reduces unintended pregnancies. Despite the safety and efficacy of same-day placement, access to same-day services remains low. OBJECTIVE This study aimed to evaluate the effects of the Delaware Contraceptive Access Now initiative, a statewide initiative in Delaware focused on increasing same-day access to effective contraception on same-day receipt of long-acting reversible contraceptives. STUDY DESIGN We used Medicaid claims and encounter data to identify instances of same-day and multivisit receipts of long-acting reversible contraceptives among Medicaid-enrolled individuals in Delaware and Maryland aged 15-44 years who were covered in a full-benefits or family planning Medicaid aid category during the month of the placement and the 2 previous months. We used a difference-in-differences design that compared changes in the outcome from before to after implementation of the initiative among placements at agencies that participated in the initiative (n=6676) vs 2 alternative comparison groups: placements at Delaware agencies that did not participate (n=688) and placements in Maryland (n=35,847). RESULTS We found that the intervention was associated with a 13.3 percentage point increase (95% confidence interval, 1.9%-24.7%) in receipt of same-day long-acting reversible contraceptives using a nonparticipating Delaware comparison group, a 21.1 percentage point increase (95% confidence interval, 13.7%-28.6%) using a Maryland comparison group, and a 21.0 percentage point increase (95% confidence interval, 14.1%-27.9%) using a pooled comparison group. The effects were larger for implants than intrauterine devices. CONCLUSION The Delaware Contraceptive Access Now initiative substantially increased the number of patients receiving long-acting reversible contraceptives through a single-visit encounter. Our findings suggested that coordinated interventions involving provider and staff training and capital investments that seed device stocking can increase the number of patients receiving same-day long-acting reversible contraceptives.
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Affiliation(s)
- Rebecca McColl
- Biden School of Public Policy and Administration, University of Delaware, Newark, DE.
| | - Katie Gifford
- Biden School of Public Policy and Administration, University of Delaware, Newark, DE
| | - Mary Joan McDuffie
- Biden School of Public Policy and Administration, University of Delaware, Newark, DE
| | - Michel Boudreaux
- University of Maryland School of Public Health, College Park, MD
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11
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Rahayuwati L, Nurhidayah I, Ekawati R, Agustina HS, Suhenda D, Rosmawati D, Amelia V. Determinant Factors of Post-Partum Contraception among Women during COVID-19 in West Java Province, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2303. [PMID: 36767669 PMCID: PMC9915049 DOI: 10.3390/ijerph20032303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND One of the manifestations of family development is pregnancy planning, where this method is applied 0-42 days after childbirth. Post-partum contraception is an effort to avoid pregnancy by using contraceptive medicine from 42 days to 84 days after childbirth. PURPOSE This research aims to analyze the attitudes of fertile couples who use contraceptive devices after childbirth during the COVID-19 pandemic and the factors that influence it. METHOD This research uses a quantitative method approach. The sampling technique was random sampling with proportional sampling so that 280 respondents were obtained from 3 regencies/cities in West Java with high fertility rates and low post-partum contraceptive participation rates. Quantitative data analysis used univariate, bivariate, and multivariate methods. RESULT The results showed that the final model of the analysis of the most determining factors for post-partum contraception during a pandemic were family support, healthcare staff support, counselling with healthcare staff, attitudes, and age at first marriage. CONCLUSION Fertile couples with the highest amount of family support are more likely to use post-partum contraceptive devices during COVID-19. The results of this study can be used as material for consideration in making decisions about post-partum contraception, especially during the COVID-19 pandemic.
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Affiliation(s)
- Laili Rahayuwati
- Department of Community Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Ikeu Nurhidayah
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Rindang Ekawati
- National Population and Family Planning Board, Jakarta 13650, Indonesia
| | - Habsyah Saparidah Agustina
- Department of Mental Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Dadang Suhenda
- National Population and Family Planning Board, Jakarta 13650, Indonesia
| | - Dean Rosmawati
- National Population and Family Planning Board, Jakarta 13650, Indonesia
| | - Vira Amelia
- Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
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Moore AL, Hasselbacher L, Tyler CP, Rodriguez-Ortiz AE, Gilliam M. Are Illinois Contraceptive Providers Comfortable Providing Care to Adolescents? Results From a Statewide Provider Needs Assessment. Womens Health Issues 2023; 33:36-44. [PMID: 35961851 DOI: 10.1016/j.whi.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/24/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Legislation allows adolescents to access comprehensive contraceptive care; however, provider practices remain unclear. We examined predictors of provider knowledge and comfort surrounding the provision of contraceptive care to adolescents. METHODS We mailed a survey to Illinois contraceptive providers (n = 251). Study outcomes include 1) knowledge of adolescent consent laws, 2) comfort asking for time alone with adolescents, 3) comfort providing contraception to adolescents without parental consent, and 4) comfort providing long-acting reversible contraception (LARC) to adolescents without parental consent. Using multivariable logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS Most providers are knowledgeable of consent laws (90%) and report being comfortable asking for time alone with adolescents (94%) and comfortable providing contraception to adolescents without parental consent (88%). Having a large proportion of patients who are eligible for family planning services was associated with increased comfort asking for time alone with adolescents (aOR, 7.03; 95% CI, 1.58-31.3) and providing contraception to adolescents (aOR, 4.0; 95% CI, 1.4-11.1). Only one-half (54%) were comfortable providing LARC methods to adolescents, with higher comfort among providers who: received more than 2 days of formal family planning training (aOR, 2.77; 95% CI, 1.2-6.2), specialized in obstetrics-gynecology (aOR, 5.64; 95% CI, 2.1-15.1), and had a patient population with more than 50% patients from minoritized racial/ethnic groups (aOR, 2.9; 95% CI, 1.2-6.6). CONCLUSIONS Although knowledge of consent laws was high, gaps remain. Only one-half of our sample indicated comfort with the provision of LARC methods without parental consent. Additional efforts to increase provider comfort with all contraceptive methods and training on adolescent-centered practices may be required to meet the needs of adolescent patients.
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Affiliation(s)
- Amy L Moore
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Lee Hasselbacher
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois.
| | - Crystal P Tyler
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | | | - Melissa Gilliam
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
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Goueth RC, Maki KG, Babatunde A, Eden KB, Darney BG. Effects of technology-based contraceptive decision aids: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 227:705-713.e9. [PMID: 35779590 PMCID: PMC9800645 DOI: 10.1016/j.ajog.2022.06.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/22/2022] [Accepted: 06/16/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to conduct a systematic review and meta-analysis of the effects of technology-based decision aids on contraceptive use, continuation, and patient-reported and decision-making outcomes. DATA SOURCES A systematic search was conducted in OVID MEDLINE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, Embase, PsycINFO, and SocINDEX databases from January 2005 to April 2022. Eligible references from a concurrent systematic review evaluating contraceptive care were also included for review. STUDY ELIGIBILITY CRITERIA Studies were included if a contraceptive decision aid was technology-based (ie, mobile/tablet application, web, or computer-based) and assessed contraceptive use and/or continuation or patient-reported outcomes (knowledge, self-efficacy, feasibility/acceptability/usability, decisional conflict). The protocol was registered under the International Prospective Register of Systematic Reviews (CRD42021240755). METHODS Three reviewers independently performed data abstraction and quality appraisal. Dichotomous outcomes (use and continuation) were evaluated with an odds ratio, whereas continuous outcomes (knowledge and self-efficacy) were evaluated with the mean difference. Subgroup analyses were performed for the mode of delivery (mobile and tablet applications vs web and computer-based) and follow-up time (immediate vs >1 month). RESULTS This review included 18 studies evaluating 21 decision aids. Overall, there were higher odds of contraceptive use and/or continuation among decision aid users compared with controls (odds ratio, 1.27; 95% confidence interval, [1.05-1.55]). Use of computer and web-based decision aids was associated with higher odds of contraceptive use and/or continuation (odds ratio, 1.36; 95% confidence interval, [1.08-1.72]) than mobile and tablet decision aids (odds ratio, 1.27; 95% confidence interval, [0.83-1.94]). Decision aid users also had statistically significant higher self-efficacy scores (mean difference, 0.09; 95% confidence interval, [0.05-0.13]), and knowledge scores (mean difference, 0.04; 95% confidence interval, [0.01-0.07]), with immediate measurement of knowledge having higher retention than measurement after 1 month. Other outcomes were evaluated descriptively (eg, feasibility, applicability, decisional conflict) but had little evidence to support a definite conclusion. Overall, the review provided moderate-level evidence for contraceptive use and continuation, knowledge, and self-efficacy. CONCLUSION The use of technology-based contraceptive decision aids to support contraceptive decision-making has positive effects on contraceptive use and continuation, knowledge, and self-efficacy. There was insufficient evidence to support a conclusion about effects on other decision-making outcomes.
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Affiliation(s)
- Rose C Goueth
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.
| | - Kristin G Maki
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ayo Babatunde
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
| | - Karen B Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR; Pacific Northwest Evidence-based Practice Center, Portland, OR
| | - Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; School of Public Health, Oregon Health & Science University -Portland State University, Portland, OR; Instituto Nacional de Salud Publica, Center for Population Health Research, Cuernavaca, Mexico
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14
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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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15
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Palmeira-de-Oliveira R, Oliveira AS, Rolo J, Tomás M, Palmeira-de-Oliveira A, Simões S, Martinez-de-Oliveira J. Women's preferences and acceptance for different drug delivery routes and products. Adv Drug Deliv Rev 2022; 182:114133. [PMID: 35104506 DOI: 10.1016/j.addr.2022.114133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
To use or not to use, that is the first decision to take regarding a drug product. This mandatory step for adherence dictates product efficacy. The determinants for such decision do not only rely on the priority of the therapeutic or preventive strategy, but are related to a complex network of perceptions, preferences, personal and cultural backgrounds, and results from previous experiences. Women's preferences for dosage forms and even for drug delivery routes have been mainly studied in the fields of contraception and HIV prevention (and their related multipurpose approaches). Much less attention has been devoted to other therapeutic or preventive strategies. In a time when patient-centred approaches and shared decisions are increasingly valued, considering women's preferences and their main determinants is essential for product development and selection. Such products will be more likely to be chosen and used as intended, increasing efficacy, and reducing the overall costs related with these treatments. This knowledge shall be integrated in early stages of product development. This article reviews the state of the art related with women's preferences and acceptance for different dosage forms and drug delivery routes involved in women's health. The methodologies used for collecting these data and their major drawbacks are discussed. Results obtained from acceptability studies and the main determinants for selection of preventive and treatment drug products are discussed as tools for new developments in the field.
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Affiliation(s)
- Rita Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal.
| | - Ana Sofia Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Joana Rolo
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
| | - Mariana Tomás
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Ana Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Sérgio Simões
- CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - José Martinez-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
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16
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Romero L, Sappenfield OR, Uesugi K, Howland JF, Kroelinger CD, Okoroh EM, Erondu C, Cox S. Review of Publicly Available State Policies for Long-Acting Reversible Contraception Device Reimbursement. J Womens Health (Larchmt) 2022; 31:1048-1056. [PMID: 35041489 DOI: 10.1089/jwh.2021.0361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Provider challenges to accessing long-acting reversible contraception (LARC) include level of reimbursement for LARC device acquisition and cost to stock. State-level LARC device reimbursement policies that cover a greater proportion of the cost of the LARC device and enable providers to purchase LARC upfront may improve contraceptive access. Materials and Methods: To summarize state-level policies that include language on LARC device reimbursement in the outpatient setting, we conducted a systematic, web-based review among all 50 states of publicly available LARC device reimbursement policies that include coverage of LARC devices as a medical or pharmacy benefit, the use of the 340B Drug Pricing Program to purchase LARC devices, and separate payment for LARC devices outside of the Medicaid Prospective Payment System (PPS) payment rate for Federally Qualified Health Centers or Rural Health Clinics. Results: Forty-two percent (21/50) of states with publicly available state-level policies included language on LARC device reimbursement. Among the states, 24% (5/21) had coverage policies as a medical benefit, 33% (7/21) as a pharmacy benefit, and 19% (4/21) as both a medical benefit and pharmacy benefit; 38% (8/21) used the 340B Program to purchase LARC devices; and 62% (13/21) indicated separate payment for LARC devices outside of the Medicaid PPS payment rate. Conclusion: State-level policies for LARC device reimbursement vary, highlighting differences in reimbursement strategies across the U.S. Future research could explore how the implementation of these payment methods may impact LARC device reimbursement and whether increased reimbursement may improve access to the full range of contraceptive methods.
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Affiliation(s)
- Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Olivia R Sappenfield
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Keriann Uesugi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Julia F Howland
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Charlan D Kroelinger
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ekwutosi M Okoroh
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chioma Erondu
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Yates L, Birken S, Thompson TA, Stuart GS, Greene S, Hassmiller Lich K, Weinberger M. A qualitative analysis of Medicaid beneficiaries perceptions of prenatal and immediate postpartum contraception counseling. WOMEN'S HEALTH 2022. [PMCID: PMC9486062 DOI: 10.1177/17455057221124079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: In the United States, about four out of every ten births are financed by
Medicaid, making it a program that is key in addressing racial disparities
in maternal health. Many women covered by Medicaid have access to prenatal
and immediate postpartum contraception counseling that can aid them in their
postpartum contraception decision-making. However, existing inequities
within Medicaid and a history of reproductive harms targeting Black women
and women with low incomes may contribute to women with Medicaid having
different experiences of contraception counseling. This qualitative study
explores how Black women and White women insured by Medicaid perceive
prenatal and immediate postpartum contraception counseling and identifies
additional factors that shape their contraception decision-making. Methods: We conducted semi-structured interviews with 15 Medicaid beneficiaries who
delivered at a public teaching hospital in North Carolina. Interviews
focused on women’s beliefs about planning for pregnancy, experiences with
prenatal and immediate postpartum contraception counseling, and perceived
need for postpartum contraception. We used a priori and emergent codes to
analyze interviews. Results: Seven Black women and eight White women completed interviews 14–60 days
postpartum. All women reported receiving prenatal and immediate postpartum
counseling. Several women described receiving prenatal counseling,
reflective of patient-centered contraception counseling, that helped in
their postpartum contraception decision-making; one woman described
receiving immediate postpartum counseling that helped in her
decision-making. Some Black women reported receiving unsupportive/coercive
contraception counseling. In addition to contraception counseling, past
reproductive health experiences and future pregnancy intentions were salient
to women’s contraception decision-making. Conclusions: Prenatal and immediate postpartum contraception counseling can help some
Medicaid beneficiaries with their postpartum contraception decision, but
past reproductive health experiences and future pregnancy intentions are
also relevant. Counseling that does not consider these experiences may be
harmful, particularly to Black women, further contributing to racial
disparities in maternal postpartum health outcomes.
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Affiliation(s)
- Lindsey Yates
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah Birken
- Department of Implementation Science, Bowman Gray Center for Medical Education, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Gretchen S Stuart
- Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandra Greene
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Charron E, Tahsin F, Balto R, Eichelberger KY, Dickes L, Simonsen SE, Mayo RM. Provider Perspectives of Barriers to Contraceptive Access and Use among Women with Substance Use Disorders. Womens Health Issues 2021; 32:165-172. [PMID: 34930641 DOI: 10.1016/j.whi.2021.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/17/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Previous studies conducted from the patient perspective indicate that women with substance use disorders (SUDs) experience extensive barriers to contraceptive access and use (CAU), but there is limited research investigating this topic from the provider perspective. We explored provider perspectives on the barriers to CAU for women with SUDs. As a secondary objective, we highlighted provider contraceptive counseling strategies to address patient CAU barriers. METHODS We conducted 24 qualitative interviews with a purposeful sample of women's health providers, including medical doctors, nurse practitioners, and certified nurse-midwives. We used thematic analysis to code the interviews with inductive codes and organized findings according to levels of influence within the Dahlgren and Whitehead rainbow model, a socioecological model of health. RESULTS Provider-reported barriers to CAU were identified at four levels of socioecological influence and included reproductive misconceptions; active substance use; trauma, interpersonal violence, and reproductive coercion; limited social support; lack of housing, employment, health insurance, and transportation; stigma; discrimination; and punitive prenatal substance use policies and child welfare reporting requirements. Strategies for addressing CAU barriers mainly focused on patient-centered communication, including open information exchange, shared decision-making, and relationship building. However, providers described disproportionately highlighting the benefits of long-acting reversible contraception (LARC) and directing conversations toward LARC when they perceived that such methods would help patients to overcome adherence and other challenges related to active substance use or logistical barriers. Notably, there was no mention of CAU facilitators during the interviews. CONCLUSIONS Providers perceived that women with SUDs experience a range of CAU barriers, which they addressed within the clinical setting through use of both patient-centered communication and highlighting the benefits of LARC when they perceived that such methods would help clients to overcome barriers. Improving CAU for women with SUDs will require multidisciplinary, multipronged strategies that prioritize reproductive autonomy and are implemented across clinical, community, and policy settings.
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Affiliation(s)
- Elizabeth Charron
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Farah Tahsin
- Department of Political Science, Clemson University, Clemson, South Carolina
| | - Rwina Balto
- University of Utah College of Nursing, Salt Lake City, Utah
| | | | - Lori Dickes
- Department of Political Science, Clemson University, Clemson, South Carolina
| | | | - Rachel M Mayo
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
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Embregts PJCM, Ahaus K, Minkman M, Nies H, Meurs P. A sector-wide response to national policy on client-centred care and support: a document analysis of the development of a range of instruments to assess clients' experiences in the care and support for people with (intellectual) disabilities. BMC Health Serv Res 2021; 21:1307. [PMID: 34863165 PMCID: PMC8645069 DOI: 10.1186/s12913-021-07341-z] [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: 11/09/2020] [Accepted: 11/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background Client-centred care serves as the foundation for healthcare policy. Indeed, various instruments for assessing clients’ experiences of care and support are increasingly used to provide insights into the quality, and client-centred nature, of the care and support provided, which, in turn, aids the development of subsequent improvements. The unique characteristics of care and support for people with intellectual disabilities (ID), such as the need for both lifelong and life-wide care and support across all aspects of clients’ lives, led to an initiative within Dutch ID care to jointly develop a range of instruments to assess the experiences of clients receiving ID care and support. Individual clients’ experiences and suggestions for improvement, which are embedded in clients’ care plan cycles, constitute the foundation of this Range of Instruments. This paper provides a unique, bottom-up, exhaustive account of the process of developing the Range of instruments used to assess the experiences of clients in the field of Dutch ID care. Methods Relevant documents at three levels (i.e. 1) national documents, such as policy papers and governmental reports, 2) documents and reports from the Dutch Association of Healthcare Providers for People with Disabilities (VGN) along with minutes from the meetings of the expert Committee who assessed the instruments, and 3) correspondence between the Committee and developers as well as the forms used in the assessment process for each instrument) were qualitatively analysed by two researchers who had no affiliation with the development of the Range of instruments used to assess clients’ experiences in ID care and support. All of the documents were inductively coded using a thematic analytical approach. Informants who were either currently or previously involved in the development of these instruments were asked to provide clarification over the documents themselves and to explain the context in which they were produced. Results The development of the range of instruments can be classified into four phases, namely: 1) supporting the bottom-up development of initiatives to assess clients’ experiences, 2) focusing on learning and further development, 3) stimulating exchange between the developers and users of the instruments and the Committee responsible for assessing them, and 4) further development in response to the changing times and new landscape. Conclusions The range of instruments were found to be appropriate for a variety of clients in ID care and support, specifically in terms of assessing their individual experiences and gaining insight into their suggestions for improvement, and effective in terms of collaboratively improving the quality of ID care and support. In so doing, these instruments potentially provide an avenue through which clients’ experiences can be embedded in the process of ID care and support. Other specific features in the development of these instruments, namely their incremental adoption, ongoing evaluation and strong practice orientation, were also found to be suitable for other care contexts’ attempts to respond to the top-down policy objectives of client-centeredness and translating outcomes into direct care practice.
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Affiliation(s)
- Petri J C M Embregts
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000, LE, Tilburg, The Netherlands.
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mirella Minkman
- Tilburg University/TIAS Business school, Tilburg, The Netherlands.,Vilans, national Center of Expertise for Long term Care in The Netherlands, Utrecht, The Netherlands
| | - Henk Nies
- Vilans, national Center of Expertise for Long term Care in The Netherlands, Utrecht, The Netherlands.,Vrije Universiteit, Department of Organization Sciences, Amsterdam, The Netherlands
| | - Pauline Meurs
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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20
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21
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Kroelinger CD, Okoroh EM, Uesugi K, Romero L, Sappenfield OR, Howland JF, Cox S. Immediate Postpartum Long-Acting Reversible Contraception: Review of Insertion and Device Reimbursement Policies. Womens Health Issues 2021; 31:523-531. [PMID: 34602326 DOI: 10.1016/j.whi.2021.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous assessment of statewide policies on long-acting reversible contraception (LARC) indicate that an increasing number of states are implementing policies specifically for provision immediately postpartum, supported by current clinical guidelines. Less is known about how state policies describe payment methodologies for the insertion procedure and device costs. METHODS We conducted a systematic, web-based review of publicly available statewide policy language on immediate postpartum LARC among all 50 states. We examined the payor/s identified in the policy and policy type, if the policy included language on the global obstetric fee, whether providers and/or facilities were authorized to bill for procedure or device costs, and if the billing mechanism was identified as inpatient and/or outpatient services. RESULTS Three-fourths of states (76%; n = 38) had statewide policies on immediate postpartum LARC. All policies identified Medicaid as the payor, although two also included non-Medicaid plans. Language allowing for reimbursement separate from the global obstetric fee for insertion procedures was present in 76% of states; 23 states permit it and 6 do not. Device cost reimbursement separate from the fee was identified in more state policies (92%); 31 states allow it and 4 do not. More policies included inpatient or outpatient billing mechanisms for device costs (82%; n = 31) than insertion procedures (50%; n = 19). CONCLUSIONS Medicaid reimbursement policies for immediate postpartum LARC services vary by state reimbursement process, type, and mechanism. Observed differences indicate payment methodologies more often include the cost of the device than provider reimbursement (31 states vs. 23 states). Fewer than one-half of states offer reimbursement for provider insertion fees, a significant systems barrier to contraceptive access for women who choose LARC immediately postpartum.
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Affiliation(s)
- Charlan D Kroelinger
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Ekwutosi M Okoroh
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Keriann Uesugi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Olivia R Sappenfield
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Julia F Howland
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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22
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Okwori G, Smith MG, Beatty K, Khoury A, Ventura L, Hale N. Geographic differences in contraception provision and utilization among federally funded family planning clinics in South Carolina and Alabama. J Rural Health 2021; 38:639-649. [PMID: 34355426 DOI: 10.1111/jrh.12612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Access to the full range of contraceptive options is essential to providing patient-centered reproductive health care. Women living in rural areas often experience more barriers to contraceptive care than women living in urban areas. Therefore, federally funded family planning clinics are important for ensuring women have access to contraceptive care, especially in rural areas. This study examines contraceptive provision, factors supporting contraceptive provision, and contraceptive utilization among federally funded family planning clinics in 2 Southern states. METHODS All health department and Federally Qualified Health Center clinics in Alabama and South Carolina that offer contraceptive services were surveyed in 2017-2018. Based on these surveys, we examined differences between rural and urban clinics in the following areas: clinic characteristics, services offered, staffing, staff training, policies, patient characteristics, contraceptive provision, and contraceptive utilization. Differences were assessed using Chi-square tests of independence for categorical variables and independent t-tests for continuous variables. FINDINGS Urban clinics had more staff on average than rural clinics, but rural clinics reported greater ease in recruiting and retaining family planning providers. Patient characteristics did not significantly vary between rural and urban clinics. While no significant differences were observed in the provision of long-acting reversible contraceptives (LARCs) overall, a greater proportion of patients in urban clinics utilized LARCs. CONCLUSIONS While provision of most contraceptives is similar between rural and urban federally funded family planning clinics, important differences in other factors continue to result in women who receive care in rural clinics being less likely to choose LARC methods.
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Affiliation(s)
- Glory Okwori
- 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
| | - Kate Beatty
- Department of Health Services Management and Policy, 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
| | - Liane Ventura
- 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
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23
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Le Guen M, Schantz C, Régnier-Loilier A, de La Rochebrochard E. Reasons for rejecting hormonal contraception in Western countries: A systematic review. Soc Sci Med 2021; 284:114247. [PMID: 34339927 DOI: 10.1016/j.socscimed.2021.114247] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Over the past decade, women in Western countries have taken to various social media platforms to share their dissatisfactory experiences with hormonal contraception, which may be pills, patches, rings, injectables, implants or hormonal intrauterine devices (IUDs). These online testimonials have been denounced as spreading "hormonophobia", i.e. an excessive fear of hormones based on irrational causes such as an overestimation of health risks associated with their use, that was already aroused by the recurring media controversies over hormonal contraception. In order to move toward a reproductive justice framework, we propose to study the arguments that women and men (as partners of female users) recently put forward against hormonal contraception to see whether they are related to hormonophobia. The aim of this article is to conduct a systematic review of the recent scientific literature in order to construct an evidence-based typology of reasons for rejecting hormonal contraception, in a continuum perspective from complaints to choosing not to use it, cited by women and men in Western countries in a recent time. The published literature was systematically searched using PubMed and the database from the French National Institute for Demographic Studies (Ined). A total of 42 articles were included for full-text analysis. Eight main categories emerged as reasons for rejecting hormonal contraception: problems related to physical side effects; altered mental health; negative impact on sexuality; concerns about future fertility; invocation of nature; concerns about menstruation; fears and anxiety; and the delegitimization of the side effects of hormonal contraceptives. Thus, arguments against hormonal contraception appeared complex and multifactorial. Future research should examine the provider-patient relationship, the gender bias of hormonal contraception and demands for naturalness in order to understand how birth control could better meet the needs and expectations of women and men in Western countries today.
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Affiliation(s)
- Mireille Le Guen
- Centre for Demographic Research, Université catholique de Louvain, Place Montesquieu 1, L2.08.03, B-1348, Louvain-la-Neuve, Belgium; Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France.
| | - Clémence Schantz
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France; Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD) and Université de Paris, Inserm ERL 1244, 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Arnaud Régnier-Loilier
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France.
| | - Elise de La Rochebrochard
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France; Univ. Paris-Saclay, UVSQ, Inserm, CESP, F-94807, Villejuif, France.
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24
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Agénor M, Pérez AE, Wilhoit A, Almeda F, Charlton BM, Evans ML, Borrero S, Austin SB. Contraceptive Care Disparities Among Sexual Orientation Identity and Racial/Ethnic Subgroups of U.S. Women: A National Probability Sample Study. J Womens Health (Larchmt) 2021; 30:1406-1415. [PMID: 34129406 DOI: 10.1089/jwh.2020.8992] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Sexual minority women may use contraception for various reasons but face notable barriers to contraceptive care, including stigma and discrimination. However, studies examining sexual orientation disparities in contraceptive care have largely relied on nonprobability samples of predominately White women and may thus not be generalizable to U.S. women overall or Black and Latina women in particular. Materials and Methods: Using data from the 2006 to 2017 National Survey of Family Growth, a large national probability sample of U.S. women 15-44 years of age (N = 25,473), we used multivariable logistic regression to estimate adjusted odds ratios for receiving a contraceptive method or prescription and contraceptive counseling from a health care provider in the past year among sexual orientation identity and racial/ethnic subgroups of heterosexual, bisexual, and lesbian White, Black, and Latina women relative to White heterosexual women. Results: Among women overall, 33.9% had received contraception and 18.3% had obtained contraceptive counseling. Black (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.65-0.82) and Latina (OR = 0.73, 95% CI: 0.64-0.82) heterosexual women, White (OR = 0.80, 95% CI: 0.65-0.99) and Black (OR = 0.43, 95% CI: 0.32-0.58) bisexual women, and White (OR = 0.23, 95% CI: 0.13-0.43), Black (OR = 0.19, 95% CI: 0.09-0.40), and Latina (OR = 0.08, 95% CI: 0.03-0.22) lesbian women had significantly lower adjusted odds of receiving contraception compared with White heterosexual women. White (OR = 0.36, 95% CI: 0.15-0.85), Black (OR = 0.42, 95% CI: 0.18-0.98), and Latina (OR = 0.22, 95% CI: 0.09-0.53) lesbian women also had significantly lower adjusted odds of obtaining contraceptive counseling relative to White heterosexual women. Conclusions: Policies, programs, and practices that facilitate access to person-centered contraceptive care among marginalized sexual orientation identity and racial/ethnic subgroups of U.S. women are needed to promote reproductive health equity.
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Affiliation(s)
- Madina Agénor
- Department of Community Health, Tufts University, Medford, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ashley E Pérez
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Amanda Wilhoit
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Florence Almeda
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Brittany M Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Megan L Evans
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Health Equity Research Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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25
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Sobel L, Lee YW, White KO, Woodhams E, Patton E. Contraceptive decision making among pregnancy-capable individuals with opioid use disorder at a tertiary care center in Massachusetts. Contraception 2021; 104:355-360. [PMID: 34118268 DOI: 10.1016/j.contraception.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To explore contraceptive decision making among recently pregnant patients with a history of opioid use disorder. STUDY DESIGN We conducted semi-structured qualitative interviews, based on principles of the Ottawa Decision Support Framework, with 20 recently pregnant individuals diagnosed with opioid use disorder at a tertiary care medical center in Massachusetts. We audio-recorded the interviews and they were transcribed verbatim. We analyzed our interview data using inductive and deductive coding. RESULTS Participants value the availability of barrier methods as a means of preventing both sexually transmitted infections and pregnancy. For some participants, housing instability makes storing contraceptive methods and managing personal hygiene related to bleeding patterns difficult. For others, housing instability impacts their overall fertility goals. Side effects including weight gain, interactions with mood stabilizing medications, concern regarding post-operative opioids, or intrinsic aspects of a method that serve as reminders of opioid use may be unacceptable given the risk of relapse. The relapsing and remitting arc of recovery make remembering important aspects of both short- and long-acting contraceptive method use difficult, yet participants offer strategies to aid in doing so. CONCLUSION When choosing a contraceptive method participants in our study exhibit similarities to individuals with other chronic medical conditions as well as motivations specific to opioid use disorder. Their contraceptive decisions are grounded in integrating a method into a chaotic life, preventing relapse, and protecting future fertility. IMPLICATIONS Our data highlight how lived experiences at the intersection of active opioid use disorder and recovery fundamentally shape the lens through which pregnancy-capable individuals with opioid use disorder view their contraceptive decisions.
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Affiliation(s)
- Lauren Sobel
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA.
| | - Yeon Woo Lee
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA
| | | | | | - Elizabeth Patton
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA
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26
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Berglas NF, Kimport K, Mays A, Kaller S, Biggs MA. "It's Worked Well for Me": Young Women's Reasons for Choosing Lower-Efficacy Contraceptive Methods. J Pediatr Adolesc Gynecol 2021; 34:341-347. [PMID: 33359316 PMCID: PMC8096642 DOI: 10.1016/j.jpag.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To understand the diverse reasons why some young women choose contraceptive methods that are less effective at preventing pregnancy, including condoms, withdrawal, and emergency contraception pills, even when more effective contraceptive methods are made available to them. DESIGN In-depth interviews with young women at family planning clinics in July-November 2016. Interview data were thematically coded and analyzed using an iterative approach. SETTING Two youth-serving family planning clinics serving predominantly Latinx and African American communities in the San Francisco Bay Area, California. PARTICIPANTS Twenty-two young women ages 15-25 years who recently accessed emergency contraception to prevent pregnancy. INTERVENTIONS None. MAIN OUTCOME MEASURES Young women's experiences using different methods of contraception, with specific attention to methods that are less effective at preventing pregnancy. RESULTS Young women reported having previously used a range of higher- and lower-efficacy contraceptive methods. In interviews, they described affirmative values that drive their decision to use lower-efficacy methods, including: a preference for flexibility and spontaneity over continual contraceptive use, an emphasis on protecting one's body, and satisfaction with the method's effectiveness at preventing pregnancy. Some young women described using a combination of lower-efficacy methods to reduce their pregnancy risk. CONCLUSION Young women make contraceptive decisions on the basis of preferences and values that include, but are not limited to, effectiveness at preventing pregnancy. These reasons are salient in their lives and need to be recognized as valid by sexual health care providers to ensure that young women receive ongoing high-quality care.
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Affiliation(s)
- Nancy F Berglas
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California.
| | - Katrina Kimport
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
| | - Aisha Mays
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California
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27
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McCarthy M. Contraceptive counseling following in-clinic pregnancy test among women not expecting pregnancy in the next two years: Disparities by service delivery setting and sociodemographic characteristics. Contraception 2021; 104:188-193. [PMID: 33667484 DOI: 10.1016/j.contraception.2021.02.014] [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: 10/20/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the frequency of the provision of contraceptive counseling at the time of clinical pregnancy test at family planning clinics to other clinical settings among women who wish to avoid pregnancy for the next 2 years or longer. STUDY DESIGN This was a secondary data analysis of the 2011-2017 National Survey of Family Growth. It used logistic regression to estimate the relationship between receiving contraceptive counseling with source of care, age, educational attainment, race/ethnicity, poverty status, marital status, insurance status, and pregnancy history among 1790 women aged 15-44 who received in-clinic pregnancy tests and sought to avoid pregnancy for the next two years or longer. RESULTS Most clinical pregnancy tests were performed by private practices (52%), community health clinics (20%), and other clinical settings (19%); 8% were performed by family planning clinics. Family planning clinics more frequently provided contraceptive counseling with pregnancy tests than other clinical settings (78% at family planning clinics versus 62% at private doctor's offices and 49% at other settings; aOR = 0.45 [0.25, 0.82], and aOR = 0.26 [0.13, 0.52]). Regardless of clinical setting, age, marital status, income, and pregnancy history, women were more likely to receive contraceptive counseling along with in-clinic pregnancy testing if they were Black (aOR = 1.84 [1.17, 2.90]); they were less likely to receive contraceptive counseling following in-clinic pregnancy test if they had educational attainment higher than a high school education (aOR = 0.53 [0.34, 0.82] and aOR = 0.57 [0.33, 0.99]). CONCLUSION Contraceptive counseling at the time of clinical pregnancy testing for women who wish to avoid pregnancy is more common at family planning clinics, but it varies by education and race. IMPLICATIONS Efforts are needed to ensure that women who wish to avoid pregnancy consistently receive contraceptive counseling when seeking clinical pregnancy testing.
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Affiliation(s)
- Molly McCarthy
- University of Nebraska Medical Center, College of Public Health, Department of Health Promotion, Omaha, NE, USA.
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28
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Giessler K, Seefeld A, Montagu D, Phillips B, Mwangi J, Munson M, Green C, Opot J, Golub G. Perspectives on implementing a quality improvement collaborative to improve person-centered care for maternal and reproductive health in Kenya. Int J Qual Health Care 2020; 32:671-676. [PMID: 33057658 PMCID: PMC7737155 DOI: 10.1093/intqhc/mzaa130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/18/2020] [Accepted: 10/13/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To understand perspectives and experiences related to participation in a quality improvement collaborative (QIC) to improve person-centered care (PCC) for maternal health and family planning (FP) in Kenya. DESIGN AND SETTING Semi-structured qualitative interviews were conducted with members of the QIC in four public health facilities in Kenya. PARTICIPANTS Clinical and nonclinical public health facility staff who had participated in the QIC were purposively sampled to participate in the semi-structured interviews. INTERVENTION A QIC was implemented across four public health facilities in Nairobi and Kiambu Counties in Kenya to improve PCC experiences for women seeking maternity or FP services. MAIN OUTCOME MEASURE Semi-structured interviews with participants of the QIC to understand perspectives and experiences associated with sensitization to and implementation of PCC behaviors in maternity and FP services. RESULTS Respondents reported that sensitization to PCC principles resulted in multiple perceived benefits for staff and patients alike, including improved interactions with patients and clients, deeper awareness of patient and client preferences, and improved interpersonal skills and greater job satisfaction. Respondents also highlighted system-level challenges that impeded their ability to consistently provide high-quality PCC to women, namely staff shortages and frequent turnover, high patient volumes and lack of space in their respective health facilities. CONCLUSION Respondents were easily able to articulate perceived benefits derived from participation in this QIC, although they were equally able to identify challenges that hindered their ability to consistently provide high-quality PCC to women seeking maternity or FP services.
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Affiliation(s)
- Katie Giessler
- Institute for Global Health Sciences, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
| | - Avery Seefeld
- Institute for Global Health Sciences, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
| | - Dominic Montagu
- Institute for Global Health Sciences, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
| | - Beth Phillips
- Institute for Global Health Sciences, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
| | - James Mwangi
- Jacaranda Health, Nairobi, Kenya, Diani Close, Nairobi, Kenya
| | - Meghan Munson
- Jacaranda Health, Nairobi, Kenya, Diani Close, Nairobi, Kenya
| | - Cathy Green
- Jacaranda Health, Nairobi, Kenya, Diani Close, Nairobi, Kenya
| | - James Opot
- Innovations for Poverty Action, Sandalwood Lane, Nairobi, Kenya
| | - Ginger Golub
- Innovations for Poverty Action, Sandalwood Lane, Nairobi, Kenya
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29
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Biggs MA, Tome L, Mays A, Kaller S, Harper CC, Freedman L. The Fine Line Between Informing and Coercing: Community Health Center Clinicians' Approaches to Counseling Young People About IUDs. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:245-252. [PMID: 33289277 DOI: 10.1363/psrh.12161] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/10/2020] [Accepted: 08/24/2020] [Indexed: 06/12/2023]
Abstract
CONTEXT While community health centers (CHCs) are meeting increased demand for contraceptives, little is known about contraceptive counseling in these settings. Understanding how clinicians counsel about IUDs in CHCs, including whether they address or disregard young people's preferences and concerns during counseling, could improve contraceptive care. METHODS As part of a training program, 20 clinicians from 11 San Francisco Bay Area CHC sites who counsel young people about contraception were interviewed by telephone in 2015 regarding their IUD counseling approaches. An iterative grounded theory approach was used to analyze interview transcripts and identify salient themes related to clinicians' contraceptive counseling, IUD removal practices and efforts to address patient concerns regarding side effects. RESULTS Most clinicians offered comprehensive contraceptive counseling and method choice. While several clinicians viewed counseling as an opportunity to empower their patients to make contraceptive decisions without pressure, they also described a tension between guiding young people toward higher-efficacy methods and respecting patients' choices. Many clinicians engaged in what could be considered coercive practices by trying to dissuade patients from removals within a year of placement and offering to treat or downplay side effects. CONCLUSIONS Providers try to promote their young patients' autonomous decision making, but their support for high-efficacy methods can result in coercive practices. More training is needed to ensure that providers employ patient-centered counseling approaches, including honoring patient requests for removals.
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Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Lucia Tome
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Aisha Mays
- Department of Family and Community Medicine, University of California, San Francisco
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Cynthia C Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco
| | - Lori Freedman
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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30
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Charron E, Mayo RM, Heavner-Sullivan SF, Eichelberger KY, Dickes L, Truong KD, Rennert L. “It’s a very nuanced discussion with every woman”: Health care providers’ communication practices during contraceptive counseling for patients with substance use disorders. Contraception 2020; 102:349-355. [DOI: 10.1016/j.contraception.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 09/01/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
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31
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Hochberg I, Orshalimy S, Yom-Tov E. Real-World Evidence on the Effect of Missing an Oral Contraceptive Dose: Analysis of Internet Search Engine Queries. J Med Internet Res 2020; 22:e20632. [PMID: 32930672 PMCID: PMC7525397 DOI: 10.2196/20632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/30/2020] [Accepted: 07/26/2020] [Indexed: 01/16/2023] Open
Abstract
Background Oral contraceptives (OCs) are a unique chronic medication with which a memory slip may result in a threat that could change a person’s life course. Subjective concerns of missed OC doses among women have been addressed infrequently. Anonymized queries to internet search engines provide unique access to concerns and information gaps faced by a large number of internet users. Objective We aimed to quantitate the frequency of queries by women seeking information in an internet search engine, after missing one or more doses of an OC; their further queries on emergency contraception, abortion, and miscarriage; and their rate of reporting a pregnancy timed to the cycle of missing an OC. Methods We extracted all English-language queries submitted to Bing in the United States during 2018, which mentioned a missed OC and subsequent queries of the same users on miscarriage, abortion, emergency contraceptives, and week of pregnancy. Results We identified 26,395 Bing users in the United States who queried about missing OC pills and the fraction that further queried about miscarriage, abortion, emergency contraceptive, and week of pregnancy. Users under the age of 30 years who asked about forgetting an OC dose were more likely to ask about abortion (1.5 times) and emergency contraception (1.7 times) (P<.001 for both), while users at ages of 30-34 years were more likely to query about pregnancy (2.1 times) and miscarriage (5.4 times) (P<.001 for both). Conclusions Our data indicate that many women missing a dose of OC might not have received sufficient information from their health care providers or chose to obtain it online. Queries about abortion and miscarriage peaking in the subsequent days indicate a common worry of possible pregnancy. These results reinforce the importance of providing comprehensive written information on missed pills when prescribing an OC.
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Affiliation(s)
- Irit Hochberg
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sharon Orshalimy
- School of Public Health, Ben Gurion University, Beer Sheva, Israel
| | - Elad Yom-Tov
- Microsoft Research, Herzeliya, Israel.,Faculty of Industrial Engineering and Management, Technion - Israel Institute of Technology, Haifa, Israel
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Walker S, Piercy H, Shearn K, Acton F. What consultation resources are available to support delivery of integrated sexual and reproductive health services? A scoping review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:88-99. [PMID: 31678969 DOI: 10.1136/bmjsrh-2019-200414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Contraceptive and sexual healthcare is increasingly delivered in an integrated setting in the UK and worldwide, requiring staff to be competent in differing styles of delivery, and to have a wide knowledge base. OBJECTIVES We did a scoping review of the literature for evidence of the resources that exist for healthcare professionals to guide or structure the process of conducting an integrated sexual and reproductive health (SRH) consultation. ELIGIBILITY CRITERIA Articles were included in the review if (1) their primary focus was a consultation resource related to one or more aspects of an SRH consultation and (2) they provided details of the resource and/or its application including evaluation of use. SOURCES OF EVIDENCE Peer-reviewed articles published in English, published non-peer-reviewed guides, and web-based guidelines addressing the conduct of a contraception or sexual health consultation were included. Date range: 1998-December 2018. Searches were carried out in the databases AMED (Ovid), ASSIA (ProQuest), CINAHL Complete (EBSCO), Cochrane Library (Wiley), HMIC (NHS Evidence), Medline (EBSCO), PsycINFO (Proquest) and Scopus (Elsevier) on 10 February 2017, and incremental searching performed until December 2018. RESULTS A total of 12 peer-reviewed journal articles, two web-published guidelines from the Faculty of Sexual & Reproductive Healthcare and three published, non-peer-reviewed resources were included. CONCLUSION Many resources exist to guide either the contraceptive or sexual health consultations, but there is a lack of a comprehensive consultation resource to guide the conduct of an integrated consultation.
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Affiliation(s)
- Susan Walker
- Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Chelmsford, UK
| | - Hilary Piercy
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Katie Shearn
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Faye Acton
- Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Chelmsford, UK
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Brandi K, Fuentes L. The history of tiered-effectiveness contraceptive counseling and the importance of patient-centered family planning care. Am J Obstet Gynecol 2020; 222:S873-S877. [PMID: 31794724 DOI: 10.1016/j.ajog.2019.11.1271] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 11/19/2022]
Abstract
Public health workers, clinicians, and researchers have tried to increase long-acting reversible contraceptive (LARC) use by changing contraceptive counseling between patients and providers. Several major health organizations now recommend tiered-effectiveness counseling, in which the most effective methods are explained first so that patients can use information about the relative efficacy of contraceptive methods to make an informed choice. Some scholars and practitioners have raised concerns that, given histories of inequitable treatment and coercion in reproductive health care, tiered-effectiveness counseling may undermine patient autonomy and choice. This Clinical Opinion examines the development of tiered-effectiveness contraceptive counseling, how its rise mirrored the focus on promoting LARC to decrease the unintended pregnancy rate, and key considerations and the potential conflicts of a LARC-first model with patient-centered care. Finally, we discuss how reproductive justice and shared decision making can guide efforts to provide patient-centered contraceptive care.
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Affiliation(s)
- Kristyn Brandi
- Department of Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark, NJ.
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Agénor M. A Reproductive Justice Approach to Patient-Centered, Structurally Competent Contraceptive Care Among Diverse Sexual Minority US Women. Am J Public Health 2020; 109:1626-1627. [PMID: 31693413 DOI: 10.2105/ajph.2019.305382] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Madina Agénor
- Madina Agénor is Gerald R. Gill Assistant Professor of Race, Culture, and Society in the Department of Community Health at Tufts University, Medford, MA
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Schafer R, Phillippi JC. Group B Streptococcal Bacteriuria in Pregnancy: An Evidence-Based, Patient-Centered Approach to Care. J Midwifery Womens Health 2020; 65:376-381. [PMID: 32096338 DOI: 10.1111/jmwh.13085] [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: 09/19/2017] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 11/29/2022]
Abstract
Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS-related neonatal morbidity and mortality. Universal screening and management of GBS bacteriuria in pregnancy are standards of care in the United States; however, some women may decline guideline-based recommendations for screening, treatment, or intrapartum antibiotic prophylaxis. This article uses a case study approach to discuss evidence-based, patient-centered care for GBS bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.
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Affiliation(s)
- Robyn Schafer
- Rutgers University School of Nursing, Newark, New Jersey
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"If You Don't Ask, I'm Not Going to Tell You": Using Community-Based Participatory Research to Inform Pregnancy Intention Screening Processes for Black and Latina Women in Primary Care. Womens Health Issues 2019; 30:25-34. [PMID: 31562052 DOI: 10.1016/j.whi.2019.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/22/2019] [Accepted: 08/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Public health and medical professional organizations recommend screening women of reproductive age for pregnancy intention (PI) routinely in primary care. Existing PI screening tools may not address the complexity of intentions for women of color or lower socioeconomic status or be well-suited to primary care settings. This study sought to inform recommendations for carrying out PI screening meaningfully in primary care settings. METHODS This community-based participatory research project united staff from a research institution, community health organization, and federally qualified health center in a predominantly Latina community in New York City. The Community Advisory Board members designed the research question, developed qualitative interview guides, and conducted in-depth interviews with 30 English- and Spanish-speaking female federally qualified health center patients ages 15 to 49. Community Advisory Board members developed an initial codebook using an inductive approach and refined themes throughout the coding process. After coding, Community Advisory Board members created a conceptual map representing relationships between key themes, and generated data-informed recommendations for PI screening practices that are relevant and feasible in the community context. RESULTS Participants expressed a range of experiences with PI screening processes, depending on medical histories, attitudes, norms, and perceived benefits of screening. Three central themes emerged through frequency of occurrence, consistency in content, and relevance as reflected in concept mapping: agency, judgment and shame, and expertise versus authority. Recommendations included specific strategies and wording providers could use to explain the rationale and context for discussing PI. CONCLUSIONS Future work should examine the experience and effectiveness of implementing these community-based participatory research-derived recommendations in primary care.
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Affiliation(s)
- Rachel Peragallo Urrutia
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
- Reply OB/Gyn & Fertility, Cary, NC, USA
| | - Chelsea B Polis
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Guttmacher Institute, New York, USA
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Cluster randomized trial of a patient-centered contraceptive decision support tool, My Birth Control. Am J Obstet Gynecol 2019; 220:565.e1-565.e12. [PMID: 30763545 DOI: 10.1016/j.ajog.2019.02.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research suggests the need for improvement in the patient-centeredness and comprehensiveness of contraceptive counseling. My Birth Control is a tablet-based decision support tool designed to improve women's experience of contraceptive counseling and to help them select contraceptive methods that are consistent with their values and preferences. OBJECTIVE The objective of this study was to evaluate the effect of My Birth Control on contraceptive continuation, experience of contraceptive care, and decision quality. STUDY DESIGN Using a cluster randomized design, randomized at the provider level, patient participants interested in starting or changing contraception interacted with My Birth Control before their family planning visit (intervention) or received usual care (control). A postvisit survey assessed experience of care method satisfaction, decision quality, and contraceptive knowledge. Surveys at 4 and 7 months assessed the primary outcome of contraceptive continuation, along with method use, satisfaction, and unintended pregnancy. Mixed-effects logistic regression models with multiple imputation for missing data were used to examine the effect of treatment assignment. RESULTS Twenty-eight providers participated and 758 patients enrolled between December 5, 2014, and February 5, 2016. Participants were racially/ethnically diverse; less than a quarter self-identified as white. No effect was found on 7-month continuation (56.6% and 59.6% for intervention and control group respectively, odds ratio, 0.89; 95% confidence interval, 0.65-1.22). However, assignment to the intervention group increased reporting of the greatest Interpersonal Quality of Family Planning score (66.0% vs 57.4%, odds ratio, 1.45; 95% confidence interval, 1.03-2.05), the greatest scores on the informed decision and uncertainty subscales of the Decisional Conflict Scale (50.5% vs 43.2%, odds ratio, 1.34; 95% confidence interval, 1.0-1.80 and 41.6% vs 33.3%, odds ratio, 1.45; 95% confidence interval, 1.03-2.05), and greater knowledge. CONCLUSION My Birth Control had no effect on contraceptive continuation. The intervention did enhance the experience of contraceptive counseling and informed decision making, as well as contraceptive knowledge., The intervention's effect on patient experience is important, particularly given the personal nature of contraceptive decision making and the social and historical context of family planning care.
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Mody SK, Gorman JR, Oakley LP, Layton T, Parker BA, Panelli D. Contraceptive utilization and counseling among breast cancer survivors. J Cancer Surviv 2019; 13:438-446. [PMID: 31065953 PMCID: PMC6561485 DOI: 10.1007/s11764-019-00765-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/26/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To explore contraceptive counseling and utilization among breast cancer survivors. METHODS We enrolled reproductive-aged women with a history of breast cancer for a cross-sectional study. Participants were recruited via the Athena Breast Health Network and via the Young Survival Coalition's social media postings. Descriptive statistics were calculated to understand utilization of and feelings about contraceptive methods before, during, and after breast cancer treatment. RESULTS Data presented here are from an online survey of 150 breast cancer survivors who completed the survey. Seventy-one percent (n = 105) of respondents reported being sexually active and not pregnant during their primary cancer treatment (surgery, chemotherapy, and/or radiation). Of these, 90% (n = 94) reported using any form of contraceptive, and the most common method was condoms (n = 55, 52%). Respondents reported that safety concerns had the biggest influence on their contraception method choice. Sixty-one percent (n = 92) reported receiving contraceptive counseling by their oncologist either before or after treatment; however, 49% (n = 45) of those did not receive a specific recommendation for a contraceptive method. Of respondents who reported receiving contraceptive counseling from their gynecologist, 44% (n = 35) reported that their gynecologist specifically recommended a copper intrauterine device (IUD). The majority of respondents (n = 76, 52%) wanted their oncologist to discuss contraceptive options with them and preferred to receive this counseling at the time of diagnosis (n = 81, 57%). CONCLUSIONS Breast cancer survivors in this study remained sexually active across the cancer care continuum and predominantly used condoms as their contraceptive method during treatment. Breast cancer patients would prefer contraceptive counseling from their oncologist at the time of their cancer diagnosis. IMPLICATION FOR CANCER SURVIVORS Education efforts in the future should focus on initiatives to improve comprehensive contraceptive counseling at the time of diagnosis by an oncologist.
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Affiliation(s)
- Sheila Krishnan Mody
- Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 9300 Campus Point Dr, MC 7433, La Jolla, San Diego, CA, 92037, USA.
| | - Jessica R Gorman
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Lisa P Oakley
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Tracy Layton
- Moores Cancer Center, University of California, San Diego, OR, USA
| | - Barbara A Parker
- Moores Cancer Center, University of California, San Diego, OR, USA
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, OR, USA
| | - Danielle Panelli
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Stanford, CA, USA
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Callegari LS, Tartaglione EV, Magnusson SL, Nelson KM, Arteburn DE, Szarka J, Zephyrin L, Borrero S. Understanding Women Veterans' Family Planning Counseling Experiences and Preferences to Inform Patient-Centered Care. Womens Health Issues 2019; 29:283-289. [PMID: 30981559 DOI: 10.1016/j.whi.2019.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women veterans' unique experiences in the military and burden of health comorbidities increase their risk of adverse pregnancy outcomes and may influence their counseling needs related to planning or preventing pregnancy. We investigated women veterans' experiences of family planning counseling in the military and Veterans Affairs (VA) health care systems as well as their counseling preferences. METHODS We conducted 32 qualitative interviews among women veterans ages 18-44 years receiving primary care at the VA Puget Sound or VA Pittsburgh health care systems between March and June 2016 to explore their experiences and preferences related to counseling about pregnancy goals and planning and contraception. Transcripts were analyzed using inductive and deductive content analysis, and key themes were identified. RESULTS Nearly all participants described negative experiences in family planning counseling encounters in the military and/or VA, including perceptions of gender-based discrimination and pressure to choose certain contraceptive methods, perceived judgment of their reproductive choices, and a lack of continuity with providers. Some women also reported positive experiences in family planning encounters in the VA, including feeling respected, receiving comprehensive information about options, and having their perspectives and concerns elicited. Counseling preferences that emerged included that providers initiate and validate family planning discussions, establish trust and avoid judgment, elicit women's individual preferences, and engage them as equal partners in decision making. CONCLUSIONS Women veterans reported a spectrum of negative and positive experiences in family planning encounters in the military and VA that, in conjunction with their preferences, provide key insights for patient-centered reproductive health care in VA.
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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, Washington; Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
| | - Erica V Tartaglione
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
| | - Sara L Magnusson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
| | - Karin M Nelson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - David E Arteburn
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jackie Szarka
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
| | | | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Hooiveld T, Molenaar JM, van der Heijde CM, Meijman FJ, Groen TP, Vonk P. End-user involvement in developing and field testing an online contraceptive decision aid. SAGE Open Med 2018; 6:2050312118809462. [PMID: 30455946 PMCID: PMC6236861 DOI: 10.1177/2050312118809462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/26/2018] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Decision aids in the field of healthcare contribute to informed decision making. To increase the usefulness and effectiveness of decision aids, it is important to involve end-users in the development of these tools. This article reports on the development of an online contraceptive decision aid. METHODS An exploratory, qualitative study was conducted in the Netherlands between 2014 and 2016. The development process of the decision aid consisted of six steps and included a needs assessment and field test. Interviews were conducted with 17 female students. RESULTS The needs assessment provided information on the preferred content and structure of a contraceptive decision aid and guided the development of the online contraceptive decision aid prototype. Participants had an overall positive impression of the decision aid prototype during the field test. Minor revisions were made based on participants' feedback. Participants expected that the decision aid would positively contribute to decision making by increasing knowledge and awareness regarding the available contraceptive methods and their features and attributes, and by opening up to other options than the known methods. CONCLUSION The developed contraceptive decision aid can contribute to better informed decision making and consultation preparation. Involving end-users in development seems valuable to adapt decision aids to specific needs and to identify in what way a decision aid influences decision making.
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Affiliation(s)
- Truus Hooiveld
- Department of Research, Development and
Prevention, Student Health Service, University of Amsterdam, Amsterdam, The
Netherlands
| | - Joyce M Molenaar
- Department of Research, Development and
Prevention, Student Health Service, University of Amsterdam, Amsterdam, The
Netherlands
| | - Claudia M van der Heijde
- Department of Research, Development and
Prevention, Student Health Service, University of Amsterdam, Amsterdam, The
Netherlands
| | - Frans J Meijman
- Department of General Practice &
Elderly Care Medicine, VUmc School of Medical Sciences, Amsterdam, The
Netherlands
| | - Theo P Groen
- Section of Biology and Society, VU
University, Amsterdam, The Netherlands
| | - Peter Vonk
- Department of General Practice, Student
Health Service, University of Amsterdam, Amsterdam, The Netherlands
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Fox E, Reyna A, Malcolm NM, Rosmarin RB, Zapata LB, Frederiksen BN, Moskosky SB, Dehlendorf C. Client Preferences for Contraceptive Counseling: A Systematic Review. Am J Prev Med 2018; 55:691-702. [PMID: 30342632 PMCID: PMC6655529 DOI: 10.1016/j.amepre.2018.06.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/27/2018] [Accepted: 06/04/2018] [Indexed: 12/15/2022]
Abstract
CONTEXT Providers can help clients achieve their personal reproductive goals by providing high-quality, client-centered contraceptive counseling. Given the individualized nature of contraceptive decision making, provider attention to clients' preferences for counseling interactions can enhance client centeredness. The objective of this systematic review was to summarize the evidence on what preferences clients have for the contraceptive counseling they receive. EVIDENCE ACQUISITION This systematic review is part of an update to a prior review series to inform contraceptive counseling in clinical settings. Sixteen electronic bibliographic databases were searched for studies related to client preferences for contraceptive counseling published in the U.S. or similar settings from March 2011 through November 2016. Because studies on client preferences were not included in the prior review series, a limited search was conducted for earlier research published from October 1992 through February 2011. EVIDENCE SYNTHESIS In total, 26 articles met inclusion criteria, including 17 from the search of literature published March 2011 or later and nine from the search of literature from October 1992 through February 2011. Nineteen articles included results about client preferences for information received during counseling, 13 articles included results about preferences for the decision-making process, 13 articles included results about preferences for the relationship between providers and clients, and 11 articles included results about preferences for the context in which contraceptive counseling is delivered. CONCLUSIONS Evidence from the mostly small, qualitative studies included in this review describes preferences for the contraceptive counseling interaction. Provider attention to these preferences may improve the quality of family planning care; future research is needed to explore interventions designed to meet preferences. THEME INFORMATION This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.
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Affiliation(s)
- Edith Fox
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California.
| | - Arlene Reyna
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | | | | | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Susan B Moskosky
- Office of Population Affairs, HHS, Washington, District of Columbia
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California,San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
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Kroelinger CD, Romero L, Lathrop E, Cox S, Morgan I, Frey MT, Warner L, Curtis KM, Pazol K, Barfield WD, Meaney-Delman D, Jamieson DJ. Meeting Summary: State and Local Implementation Strategies for Increasing Access to Contraception During Zika Preparedness and Response - United States, September 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:1230-1235. [PMID: 29121000 PMCID: PMC5679579 DOI: 10.15585/mmwr.mm6644a6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Zika virus infection during pregnancy is a cause of microcephaly and other serious brain abnormalities (1). To support state and territory response to the threat of Zika, CDC's Interim Zika Response Plan outlined activities for vector control; clinical management of exposed pregnant women and infants; targeted communication about Zika virus transmission among women and men of reproductive age; and primary prevention of Zika-related adverse pregnancy and birth outcomes by prevention of unintended pregnancies through increased access to contraception.* The most highly effective,† reversible contraception includes intrauterine devices and implants, known as long-acting reversible contraception (LARC). On September 28, 2016, the Association of Maternal and Child Health Programs (AMCHP) and CDC facilitated a meeting in Atlanta, Georgia, of representatives from 15 states to identify state-led efforts to implement seven CDC-published strategies aimed at increasing access to contraception in the context of Zika virus (2). Qualitative data were collected from participating jurisdictions. The number of states reporting implementation of each strategy ranged from four to 11. Participants identified numerous challenges, particularly for strategies implemented less frequently. Examples of barriers were discussed and presented with corresponding approaches to address each barrier. Addressing these barriers could facilitate increased access to contraception, which might decrease the number of unintended pregnancies affected by Zika virus.
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Provider Attitudes and Practices toward Sexual and Reproductive Health Care for Young Women with Cystic Fibrosis. J Pediatr Adolesc Gynecol 2017; 30:546-552. [PMID: 28163120 DOI: 10.1016/j.jpag.2017.01.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To investigate the attitudes and practices of cystic fibrosis (CF) providers toward sexual and reproductive health (SRH) care in young women with CF. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS Adult and pediatric US CF providers were sent an online survey exploring their attitudes toward SRH importance, SRH care practices, and barriers/facilitators to SRH care in adolescent and/or young adult women. Descriptive statistics and logistic regression were used to analyze results. MAIN OUTCOME MEASURES Attitudes toward the importance of SRH care in patients with CF and self-report of practice patterns of SRH discussion. RESULTS Respondents (n = 196) were 57% pediatric (111/196) and 24% adult physicians (48/196) and 19% nurse practitioners (NPs)/physician assistants (PAs) (37/196). Ninety-four percent of respondents believed SRH was important for female patients with CF (184/196). More than 75% believed SRH care should be standardized within the CF care model (147/196) and 41% believed the CF team should have the primary role in SRH discussion and care (80/196). For many CF-specific SRH topics, discrepancies emerged between how important respondents believed these were to address and how often they reported discussing these topics in practice. Significant differences in SRH attitudes and practices were present between adult and pediatric physicians. The most significant barriers to SRH care identified were lack of time (70%, 137/196) and the presence of family in clinic room (54%, 106/196). Potential facilitators included training materials for providers (68%, 133/196) and written (71%, 139/196) or online (76%, 149/196) educational resources for patients. CONCLUSION CF providers perceive SRH topics as important to discuss, but identify barriers to routine discussion in current practice. Providers endorsed provider training and patient educational resources as means to improve SRH delivery.
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More Than a Destination: Contraceptive Decision Making as a Journey. Womens Health Issues 2017; 27:539-545. [DOI: 10.1016/j.whi.2017.03.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 01/07/2017] [Accepted: 03/08/2017] [Indexed: 11/24/2022]
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Gomez AM, Mann ES, Torres V. ‘It would have control over me instead of me having control’: intrauterine devices and the meaning of reproductive freedom. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1343935] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Emily S. Mann
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Vanessa Torres
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
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Holt K, Dehlendorf C, Langer A. Defining quality in contraceptive counseling to improve measurement of individuals' experiences and enable service delivery improvement. Contraception 2017. [PMID: 28645786 DOI: 10.1016/j.contraception.2017.06.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Kelsey Holt
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, Boston, MA 02115, USA.
| | - Christine Dehlendorf
- Departments of Family & Community Medicine, Obstetrics, Gynecology & Reproductive Sciences, and Epidemiology & Biostatistics, University of California San Francisco, 500 Parnassus Avenue, MUE3, San Francisco, CA 94143, USA.
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, Boston, MA 02115, USA.
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Gomez AM, Freihart B. Motivations for Interest, Disinterest and Uncertainty in Intrauterine Device Use Among Young Women. Matern Child Health J 2017. [DOI: 10.1007/s10995-017-2297-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rosenfeld E, Callegari LS, Sileanu FE, Zhao X, Schwarz EB, Mor MK, Borrero S. Racial and ethnic disparities in contraceptive knowledge among women veterans in the ECUUN study. Contraception 2017; 96:54-61. [PMID: 28322769 DOI: 10.1016/j.contraception.2017.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 02/17/2017] [Accepted: 03/12/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess whether racial/ethnic disparities in contraceptive knowledge observed in the general US population are also seen among women Veterans served by the Veterans Affairs (VA) healthcare system. STUDY DESIGN We analyzed data from a national telephone survey of 2302 women Veterans aged 18-44 who had received care within VA in the prior 12 months. Twenty survey items assessed women's knowledge about various contraceptive methods. Multivariable logistic regression was used to examine racial/ethnic variation in contraceptive knowledge items, adjusting for age, marital status, education, income, parity, and branch of military service. RESULTS Contraceptive knowledge was low among all participants, but black and Hispanic women had lower knowledge scores than whites in almost all knowledge domains. Compared to white women, black women were significantly less likely to answer correctly 15 of the 20 knowledge items, with the greatest adjusted difference observed in the item assessing knowledge about the reversibility of tubal sterilization (adjusted percentage point difference (PPD): -23.0; 95% CI: -27.8, -18.3). Compared to white women, Hispanic women were significantly less likely to answer correctly 11 of the 20 knowledge items, with the greatest adjusted difference also in the item assessing tubal sterilization reversibility (PPD: -13.1; 95% CI: -19.5, -6.6). CONCLUSION Contraceptive knowledge among women Veterans served by VA is suboptimal, especially among racial/ethnic minority women. Improving women's knowledge about important aspects of available contraceptive methods may help women better select and effectively use contraception. IMPLICATIONS Providers in the VA healthcare system should assess and address contraceptive knowledge gaps as part of high-quality, patient-centered reproductive health care.
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Affiliation(s)
- Elian Rosenfeld
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Pittsburgh, PA 15240
| | - Lisa S Callegari
- Health Services Research and Development, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108; Department of Obstetrics & Gynecology, University of Washington School of Medicine, Box 356460, Seattle, WA 98195-6460
| | - Florentina E Sileanu
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Pittsburgh, PA 15240
| | - Xinhua Zhao
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Pittsburgh, PA 15240
| | - E Bimla Schwarz
- Division of General Internal Medicine, University of California, Davis School of Medicine, 4150 V Street, Suite 3100, Sacramento, CA 95817
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Pittsburgh, PA 15240; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St., Pittsburgh, PA 15261
| | - Sonya Borrero
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Pittsburgh, PA 15240; Center for Research on Health Care, University of Pittsburgh School of Medicine, Suite 600, 230 McKee Place, Pittsburgh, PA 15213.
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Goldhammer DL, Fraser C, Wigginton B, Harris ML, Bateson D, Loxton D, Stewart M, Coombe J, Lucke JC. What do young Australian women want (when talking to doctors about contraception)? BMC FAMILY PRACTICE 2017; 18:35. [PMID: 28298197 PMCID: PMC5353872 DOI: 10.1186/s12875-017-0616-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 03/07/2017] [Indexed: 12/02/2022]
Abstract
Background Access to most contraceptives in Australia requires a prescription from a doctor, and it has been shown that doctors can influence women’s decision-making with respect to contraception. However, little research has documented how women experience their interactions with doctors within the context of a contraceptive consultation. Understanding such experiences may contribute to our knowledge of factors that may influence women’s contraceptive decisions more broadly. Methods We report on findings from the Contraceptive Use, Pregnancy Intentions and Decisions (CUPID) survey of young Australian women, a large-scale longitudinal study of 3,795 women aged 18–23 years. We performed a computer-assisted search for occurrences of words that indicated an interaction within the 1,038 responses to an open-ended question about contraception and pregnancy. We then applied a combination of conventional and summative content analysis techniques to the 158 comments where women mentioned an interaction about contraception with a doctor. Results Our analysis showed that women desire consistent and accurate contraception information from doctors, in addition to information about options other than the oral contraceptive pill. Some young women reported frustrations about the choice limitations imposed by doctors, perceived by these women to be due to their young age. Several women expressed disappointment that their doctor did not fully discuss the potential side-effects of contraceptives with them, and that doctors made assumptions about the woman’s reasons for seeking contraception. Some women described discomfort in having contraception-related discussions, and some perceived their doctor to be unsupportive or judgmental. Conclusions Both the content and the process of a contraceptive consultation are important to young Australian women, and may be relevant contributors to their choice and ongoing use of a contraceptive method. These findings provide useful insights into aspects of the patient-provider interaction that will enhance the efficacy of the contraceptive consultation. It is recommended that doctors adopt patient-centred, shared decision-making strategies to support women in making choices about contraception that suit their individual circumstances. We also acknowledge the need to involve other health care providers, other than doctors, in educating, informing, and assisting women to make the best contraceptive choice for themselves.
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Affiliation(s)
- Denisa L Goldhammer
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.
| | - Catriona Fraser
- Social Research Unit, WorkSafe Victoria, Melbourne, Victoria, Australia
| | - Britta Wigginton
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Melissa L Harris
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
| | - Deborah Bateson
- Family Planning NSW, Sydney, NSW, Australia.,The University of Sydney Discipline of Obstetrics, Gynaecology and Neonatology, Sydney, NSW, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
| | | | - Jacqueline Coombe
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
| | - Jayne C Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,School of Public Health, University of Queensland, Herston, QLD, Australia
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